Online Exclusive Article

Differences in Physical, Emotional, and Social Adjustment of Intimate, Family, and Nonfamily Patient-Partner Dyads Based on a Breast Cancer Intervention Study

Deborah Witt Sherman

Judith Haber

Carol Noll Hoskins

Wendy Budin

Greg Maislin

Jacqui Cater

Frances Cartwright

Christina Beyer McSherry

Renee Feurbach

Mildred Ortu Kowalski

Mary Rosedale

family and caregivers, breast neoplasms
ONF 2009, 36(4), E185-E197. DOI: 10.1188/09.ONF.E185-E197

Purpose/Objectives: To assess the degree to which postsurgical adjustment in patients with breast cancer and their partners depends on the nature of the patient-partner dyad relationship.

Design: Secondary data analysis from a randomized controlled trial.

Setting: Three cancer centers and one suburban community hospital in New York.

Sample: 205 patient-partner dyads (112 intimate-partner, 58 family-member, and 35 nonfamily-member dyads).

Methods: Mann-Whitney nonparametric comparisons and chi-square tests were used to assess dyad types on continuous and categorical variables, and a mixed model for repeated measures compared postsurgical adjustment among dyad types.

Main Research Variables: Type of patient-partner dyads and physical, emotional, and social adjustment.

Findings: Patients in intimate-partner dyads were younger, had greater incomes, and discovered the lump by routine mammogram as compared to family- or nonfamily-member dyads. No significant differences were observed in patients' physical or emotional adjustment. Patients with intimate partners had greater difficulty in their social and domestic environments. Partners in intimate-partner dyads had lower scores on psychological well-being, more problems in social and domestic adjustment, and less social support to promote social adjustment.

Conclusions: Women with breast cancer experience successful physical and emotional adjustment whether they have intimate-partner, family-member, or nonfamily-member partners. Intimate partners are at greater risk for emotional and social adjustment issues.

Implications for Nursing: When designing interventions, consideration must be given to the type of patient-partner dyad involved.

Jump to a section

    References

    Allen, S.M., Goldscheider, F., & Ciambrone, D.A. (1999). Gender roles, marital intimacy, and nomination of spouse as primary caregiver. Gerontologist, 39(2), 150-158.
    Baider, L., & Kaplan-DeNour, A.K. (1984). Couples' reactions and adjustment to mastectomy: A preliminary report. International Journal of Psychiatry and Medicine, 14(3), 265-276.
    Ben-Zur, H., Gilbar, O., & Lev, S. (2001). Coping with breast cancer: Patient, spouse, and dyad models. Psychosomatic Medicine, 63(1), 32-39.
    Budin, W., Cartwright, F., & Hoskins, C. (2008). The Breast Cancer Treatment Response Inventory: Development, psychometric testing, and refinement for use in practice. Oncology Nursing Forum, 35(2), 209-215.
    Budin, W.C. (1998). Psychosocial adjustment to breast cancer in unmarried women. Research in Nursing and Health, 21(2), 155-166.
    Budin, W.C., Hoskin, C.N., Haber, J., Sherman, D.W., Mailsin, G., Cater, J.R., et al. (2008). Breast cancer: Education, counseling, and adjustment among patients and partners: A randomized controlled trial. Journal of Nursing Research, 57(3), 199-213.
    Cantor, M.H. (1979). Neighbors and friends: An overlooked resource in the informal support system. Research on Aging, 1(4), 434-463.
    Derogatis, L.R. (1983). The Psychosocial Adjustment to Illness Scale. Baltimore, MD: Clinical Psychometric Research.
    Douglass, L.G. (1997). Reciprocal support in the context of cancer: Perspectives of the patient and spouse. Oncology Nursing Forum, 24(9), 1529-1536.
    Ellsworth, R. (1981). Profile of Adaptation to Life Clinical Scale. Palo Alto, CA: Consulting Psychologists Press.
    Fang, C., Manne, S., & Pape, S. (2001). Functional impairment, marital quality, and patient psychological distress as predictors of psychological distress among cancer patients' spouses. Health Psychology, 20(6), 452-457.
    Flaherty, J.A., Gaviria, F.M., & Pathak, D.S. (1983). The measurement of social support: The Social Support Network Inventory. Comprehensive Psychiatry, 24(6), 521-529.
    Gilbar, O., Steiner, M., & Atad, J. (1995). Adjustment of married couples and unmarried women to gynecological cancer. Psycho-Oncology, 4(3), 203-211.
    Given, B., & Given, C.W. (1992). Patient and family caregiver reaction to new and recurrent breast cancer. Journal of the American Medical Women's Association, 47(5), 201-207.
    Hasida, B., Gilbar, O., & Lev, S. (2001). Coping with breast cancer: Patient, spouse, and dyad models. Psychomatic Medicine, 63(1), 32-39.
    Hearn, J., & Higginson, I. (1998). Do specialists palliative care teams improve outcomes for cancer patients? A systematic literature review. Palliative Medicine, 12(5), 317-332.
    Hodgson, J., Shields, C., & Rousseau, S. (2003). Disengaging communication in later-life couples coping with breast cancer. Families, Systems, and Health, 21(2), 145-163.
    Holmberg, S.K., Scott, L.L., Alexy, W., & Fife, B.L. (2001). Relationship issues of women with breast cancer. Cancer Nursing, 24(1), 53-60.
    Hoskins, C.N., Baker, S., Budin, W., Ekstrom, D., Maislin, G., Sherman, D., et al. (1996). Adjustment among husbands of women with breast cancer. Journal of Psychosocial Oncology, 14(1), 41-69.
    Hoskins, C.N., Baker, S., Sherman, D., Bohlander, J., Bookbinder, M., Budin, W., et al. (1996). Social support and patterns of adjustment to breast cancer. Journal of Scholarly Inquiry for Nursing Practice, 10(2), 99-123.
    Hoskins, C.N., Haber, J., Budin, W.C., Cartwright-Alcarese, F., Kowalski, M.O., Panke, J., et al. (2001). Breast cancer: Education, counseling, and adjustment—A pilot study. Psychological Reports, 89(3), 677-704.
    Kadmon, L., Ganz, F.D., Rom, M., & Woloski-Wruble, A.C. (2008). Social, marital, and sexual adjustment of Israeli men whose wives were diagnosed with breast cancer. Oncology Nursing Forum, 35(1), 131-135.
    Lawton, M.P., Moss, M., Fulcomer, M., & Kleban, M.H. (1982). A research and service oriented multilevel assessment instrument. Journal of Gerontology, 37(1), 91-99.
    Lazarus, R., & Folkman, S. (1984). Stress, appraisal, and coping. New York: Springer.
    Lewis, F.M., Woods, N.F., Hough, E.E., & Bensley, L.S. (1989). The family's functioning with chronic illness in the mother: The spouse's perspective. Social Science and Medicine, 29(11), 1261-1269.
    Litwak, E. (1985). Helping the elderly: The complementary roles of informal networks and formal systems. New York: Gilford Press.
    Mallinger, J.B., Griggs, J.J., & Shields, C.G. (2006). Family communication and mental health after breast cancer. European Journal of Cancer Care, 15(4), 355-361.
    Manne, S. (1998). Cancer in the marital context: A review of the literature. Cancer Investigation, 16(3), 188-202.
    Morely, W.E., Messick, J.M., & Aguilera, D.C. (1967). Crisis: Paradigms of intervention. Journal of Psychiatric Nursing, 5(6), 537-544.
    Northouse, L.L. (1990). A longitudinal study of the adjustment of patients and husbands to breast cancer. Oncology Nursing Forum, 17(3), 39-45.
    Northouse, L.L. (1994). Breast cancer in younger women: Effects on interpersonal and family relations. Journal of the National Cancer Institute Monographs, 16, 183-190.
    Northouse, L.L., Dorris, G., & Charron-Moore, C. (1995). Factors affecting couples' adjustment to recurrent breast cancer. Social Science and Medicine, 41(1), 69-76.
    Northouse, L.L., Templin, T., & Mood, D. (2001). Couples' adjustment to breast disease during the first year following diagnosis. Journal of Behavioral Medicine, 24(2), 115-136.
    Northouse, L.L., Templin, T., Mood, D., & Oberst, M. (1998). Couples' adjustment to breast cancer and benign breast disease: A longitudinal analysis. Psycho-Oncology, 7(1), 37-48.
    Samms, M.C. (1999). The husband's untold account of his wife's breast cancer: A chronologic analysis. Oncology Nursing Forum, 26(8), 1351-1358.
    Scott, J.L., Halford, W.K., & Ward, B.G. (2004). United we stand? The effects of a couple-coping intervention on adjustment to early stage breast or gynecological cancer. Journal of Consulting and Clinical Psychology, 72(6), 1122-1135.
    Segrin, C., Badger, T.A., Meek, P., Lopez, A.M., Bonham, E., & Sieger, A. (2003). Dyadic interdependence on affect and quality-of-life trajectories among women with breast cancer and their partners. Journal of Social and Personal Relationships, 22(5), 673-689.
    Spencer, S., Carver, C., & Price, A. (1998). Psychological and social factors in adaptation. In J. Holland (Ed.), Psycho-oncology (pp. 211-222). New York: Oxford University Press.
    Verbeke, E., & Molenberghs, G. (2000). Linear mixed models for longitudinal data. New York: Springer.
    Wai Ming, V.M. (2002). Psychological predictors of marital adjustment in breast patients with cancer. Psychology, Health, and Medicine, 7(1), 37-51.
    Wellisch, D., Fawzy, F., Landsverk, J., Pasnau, R., & Wolcott, D. (1988). Evaluation of psychosocial problems of the homebound cancer patient: The relationship of disease and the sociodemographic variables of patients to family problems. Journal of Psychosocial Oncology, 1(3), 1-15.
    Wimberly, S.R. Carver, C.S., Laurenceau, J., Harris, S.D., & Antonia, M.H. (2005). Perceived partner reactions to diagnosis and treatment of breast cancer: Impact on psychosocial and psychosexual adjustment. Journal of Counseling and Clinical Psychology, 73(2), 300-311.
    Wingate, A.L., & Lackey, N.R. (1989). A description of the needs of noninstitutionalized cancer patients and their primary caregivers. Cancer Nursing, 12(4), 216-225.
    Zahlis, E.H., & Shands, M.E. (1991). Breast cancer: Demands of illness on the patients' partner. Journal of Psychosocial Oncology, 9(1), 75-93.