Exploring a Diffusion of Benefit: Does a Woman With Breast Cancer Derive Benefit From an Intervention Delivered to Her Partner?

Barbara B. Cochrane

Frances Marcus Lewis

Kristin A. Griffith

psychosocial aspects, breast neoplasms, education
ONF 2011, 38(2), 207-214. DOI: 10.1188/11.ONF.207-214

Purpose/Objectives: To provide preliminary data on a diffusion of psychosocial benefit to women diagnosed with breast cancer when only their partners receive a psychoeducational intervention focused on the breast cancer experience.

Design: Single-group, pretest/post-test pilot study; participants served as their own controls.

Setting: Communities in the Pacific Northwest region of the United States.

Sample: 9 women with a first diagnosis of breast cancer within the previous six months whose partners received the Helping Her Heal intervention.

Methods: Data were collected from women pre- and postintervention via standardized questionnaires with established reliability and validity. Confidential exit interviews were conducted after postintervention data were returned.

Main Research Variables: State anxiety (State-Trait Anxiety Inventory Form Y [STAI-Y]), depression (Center for Epidemiologic Studies-Depression scale [CES-D]), and marital quality (Dyadic Adjustment Scale [DAS]; Mutuality and Interpersonal Sensitivity scale).

Findings: Wilcoxon signed-rank tests showed significant improvements on the CES-D (p = 0.01), STAI-Y (p = 0.01), and DAS affectional expression subscale (p = 0.03) in women from pre- to postintervention. Review of exit interview transcripts indicated that women generally were positive about the impact of the program and viewed their partners' gains in communication skills as the greatest benefit of participating.

Conclusions: This study offers preliminary support for a diffusion of psychosocial benefit to women with breast cancer when a psychoeducational intervention is delivered to their partners.

Implications for Nursing: Diffusion of benefit should be examined in a large, randomized, clinical trial to provide evidence for focusing some clinical efforts on partners alone, rather than adding to diagnosed women's burden of multiple clinical encounters.

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    Badger, T. A., Braden, C. J., & Mishel, M. H. (2001). Depression burden, self-help interventions, and side effect experience in women receiving treatment for breast cancer. Oncology Nursing Forum, 28, 567-574.
    Baider, L., & Kaplan De-Nour, A. (1999). Psychological distress of cancer couples: A leveling effect. New Trends in Experimental and Clinical Psychiatry, 15(4), 197-203.
    Bandura, A. (1997). Self-efficacy, the exercise of control. New York, NY: W. H. Freeman.
    Baucom, D. H., Porter, L. S., Kirby, J. S., Gremore, T. M., Wiesenthal, N., Aldridge, W., … Keefe, F. J. (2009). A couple-based intervention for female breast cancer. Psycho-Oncology, 18, 276-283.
    Ben-Zur, H., Gilbar, O., & Lev, S. (2001). Coping with breast cancer: Patient, spouse, and dyad models. Psychosomatic Medicine, 63(1), 32-39.
    Blanchard, C. G., Toseland, R. W., & McCallion, P. (1996). The effects of a problem-solving intervention with spouses of cancer patients. Journal of Psychosocial Oncology, 14(2), 1-21.
    Bloom, J. R., Cook, M., Fotopoulis, S., Flamer, D., Gates, C., Holland, J. C., … Ross, R. D. (1987). Psychological response to mastectomy: A prospective comparison study. Cancer, 59, 189-196.
    Brusilovskiy, E., Mitstifer, M., & Salzer, M. S. (2009). Perceived partner adaption and psychosocial outcomes for newly diagnosed stage I and stage II breast cancer patients. Journal of Psychosocial Oncology, 27, 42-58. doi: 10.1080/07347330802614774
    Bultz, B. D., Speca, M., Brasher, P. M., Geggie, P. H., & Page, S. A. (2000). A randomized controlled trial of a brief psychoeducational support group for partners of early stage breast cancer patients. Psycho-Oncology, 9, 303-313. doi: 10.1002/1099-1611(200007/08)9:4303::AID-PON462>3.0.CO;2-M
    Cochrane, B. B., & Lewis, F. M. (2005). Partner's adjustment to breast cancer: A critical analysis of intervention studies. Health Psychology, 24, 327-332. doi: 10.1037/0278-6133.24.3.327
    Fergus, K. D., & Gray, R. E. (2009). Relationship vulnerabilities during breast cancer: Patient and partner perspectives. Psycho-Oncology, 18, 1311-1322. doi: 10.1002/pon.1555
    Frasure-Smith, N., Lespérance, F., & Talajic, M. (1995). The impact of negative emotions on prognosis following myocardial infarction: Is it more than depression? Health Psychology, 14, 388-398.
    Giese-Davis, J., Hermanson, K., Koopman, C., Weibel, D., & Spiegel, D. (2000). Quality of couples' relationship and adjustment to metastatic breast cancer. Journal of Family Psychology, 14, 251-266.
    Hewitt, M., Herdman, R., & Holland, J. (Eds.). (2004). Meeting psycho-social needs of women with breast cancer. Washington, DC: National Academies Press.
    Hinnen, C., Hagedoorn, M., Ranchor, A. V., & Sanderman, R. (2008). Relationship satisfaction in women: A longitudinal case-control study about the role of breast cancer, personal assertiveness, and partners' relationship-focused coping. British Journal of Health Psychology, 13, 737-754. doi: 10.1348/135910707X252431
    Jemal, A., Siegel, R., Xu, J., & Ward, E. (2010). Cancer statistics, 2010. CA: A Cancer Journal for Clinicians, 60, 277-300.
    Landmark, B. T., Strandmark, M., & Wahl, A. K. (2001). Living with newly diagnosed breast cancer—The meaning of existential issues. A qualitative study of 10 women with newly diagnosed breast cancer, based on grounded theory. Cancer Nursing, 24, 220-226.
    Lewis, F. M. (1996). Final report of the Family Home Visitation Program. [National Institutes of Health, R01-CA-55347]. Bethesda, MD: National Cancer Institute.
    Lewis, F. M. (2004). Family-focused oncology nursing research. Oncology Nursing Forum, 31, 288-292. doi: 10.1188/04.ONF.288-292
    Lewis, F. M., Cochrane, B. B., Fletcher, K. A., Zahlis, E. H., Shands, M. E., Gralow, J. R., … Schmitz, K. (2008). Helping Her Heal: A pilot study of an educational counseling intervention for spouses of women with breast cancer. Psycho-Oncology, 17, 131-137. doi: 10.1002/pon.1203
    Lewis, F. M., Cochrane, B. B., Zahlis, E., & Shands, M. E. (2005). Domains of spousal breast cancer-related concerns: A meta-synthesis of qualitative research [Abstract]. Oncology Nursing Forum, 32, 192.
    Lewis, F. M., Fletcher, K. A., Cochrane, B., & Fann, J. R. (2008). Predictors of depressed mood in spouses of women with breast cancer. Journal of Clinical Oncology, 26, 1289-1295. doi: 10.1200/JCO.2007.12.7159
    Lewis, F. M., Hammond, M. A., & Woods, N. F. (1993). The family's functioning with newly diagnosed breast cancer in the mother: The development of an explanatory model. Journal of Behavioral Medicine, 16, 351-370. doi: 10.1007/BF00844777
    Longman, A. J., Braden, C. J., & Mishel, M. H. (1996). Side effects burden in women with breast cancer. Cancer Practice, 4, 274-280.
    Loveys, B. J., & Klaich, K. (1991). Breast cancer: Demands of illness. Oncology Nursing Forum, 18, 75-80.
    Manne, S. L., Ostroff, J., Winkel, G., Grana, G., & Fox, K. (2005). Partner unsupportive responses, avoidant coping, and distress among women with early stage breast cancer: Patient and partner perspectives. Health Psychology, 24, 635-641. doi: 10.1037/0278-6133.24.6.635
    Motzer, S. A., Moseley, J. R., & Lewis, F. M. (1997). Recruitment and retention of families in clinical trials with longitudinal designs. Western Journal of Nursing Research, 19, 314-333.
    Naaman, S., & Pappas, J. (2004). The clinical efficacy of psychological interventions in breast cancer patients: A report of three meta-analyses. Retrieved from
    Northouse, L. L. (1992). Psychological impact of the diagnosis of breast cancer on the patient and her family. Journal of the American Medical Women's Association, 47, 161-164.
    Northouse, L. L., Templin, T., & Mood, D. (2001). Couples' adjustment to breast disease during the first year following diagnosis. Journal of Behavioral Medicine, 24, 115-136. doi: 10.1023/A:1010772913717
    Nosarti, C., Roberts, J. V., Crayford, T., McKenzie, K., & David, A. S. (2002). Early psychological adjustment in breast cancer patients: A prospective study. Journal of Psychosomatic Research, 53, 1123-1130.
    Radloff, L. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385-401. doi: 10.1177/014662167700100306
    Rodrigue, J. R., & Park, T. L. (1996). General and illness-specific adjustment to cancer: Relationship to marital status and marital quality. Journal of Psychosomatic Research, 40, 29-36.
    Rothrock, N. E., Matthews, A. K., Sellergren, S. A., Fleming, G., & List, M. (2004). State anxiety and cancer-specific anxiety in survivors of breast cancer. Journal of Psychosocial Oncology, 22, 93-109.
    Rowland, J. H., Meyerowitz, B. E., Crespi, C. M., Leedham, B., Desmond, K., Belin, T. R., & Ganz, P. A. (2009). Addressing intimacy and partner communication after breast cancer: A randomized controlled group intervention. Breast Cancer Research and Treatment, 118, 99-111.
    Samms, M. C. (1999). The husband's untold account of his wife's breast cancer: A chronologic analysis. Oncology Nursing Forum, 26, 1351-1358.
    Spanier, G. B. (1976). Measuring dyadic adjustment: New scales for assessing the quality of marriage and similar dyads. Journal of Marriage and the Family, 38(1), 15-28. doi: 10.2307/350547
    Spielberger, C. D. (1983). Manual for the State-Trait Anxiety Inventory (Form Y). Palo Alto, CA: Consulting Psychologists Press.
    Toseland, R. W., Blanchard, C. G., & McCallion, P. (1995). A problem solving intervention for caregivers of cancer patients. Social Science and Medicine, 40, 517-528. doi: 10.1016/0277-9536(94)E0093-8
    Weihs, K., Enright, T., Howe, G., & Simmens, S. J. (1999). Marital satisfaction and emotional adjustment after breast cancer. Journal of Psychosocial Oncology, 17, 33-49. doi: 10.1300/J077v17n01_03
    Zahlis, E. H., & Shands, M. E. (1991). Breast cancer: Demands of the illness on the patient's partner. Journal of Psychosocial Oncology, 9(1), 75-93. doi: 10.1300/J077v09n01_04