乳腺癌患者的社会支持和应对方式对照研究

目的　探讨乳腺癌患者的社会支持和应对方式。方法　对32例乳腺癌患者和29名健康成人女性采用社会支持评定 量表和特质应对方式问卷,从不同婚姻状况、文化程度等方面对社会支持、应对方式进行评定分析。结果　已婚乳腺癌患者主 观支持分值低于已婚健康女性,差异有显著性(P<0.05);未婚乳腺癌患者消极应对分高于未婚健康女性,差异有显著性(P< 0.05);大学以上文化程度乳腺癌患者的客观支持分、主观支持分及社会总支持分均低于同文化程度健康女性,差异有显著性 (P<0.05)。结论　乳腺癌患者的主观支持较差,尤以已婚乳腺癌患者明显;大学以上文化程度的乳腺癌患者主、客观社会支 持均差;未婚乳腺癌患者常采用消极应对方式。     

Ambiguity and uncertainty: The ongoing concerns of male partners of women treated for breast cancer.

As the prevalence of breast cancer increases, survival improves and short stay or outpatient care become the norm, greater numbers of men will be involved in providing care and support for their partners at home. This qualitative study explored the experiences of 26 male partners of women who had completed treatment for breast cancer. A questionnaire was developed in order to collect background information and to provide a pool for further qualitative sampling. One hundred and five questionnaires were distributed, 79 returned and 26 one-to-one interviews were conducted. While negotiating a role in their wives' breast cancer experience the men attempted to find a balance between the ambiguity and uncertainty they experienced and their need to maintain normality. They described feeling 'in limbo' when expectations of being able to move on following their wives treatment were not fulfilled. An understanding of the 'liminal' experience of being a male partner of a woman with breast cancer may help health care professionals to address the ongoing difficulties men encounter. This is important as it is often the male partners who are called upon to provide continued care and support beyond the recognised treatment period.     

Associations between depression, pain behaviors, and partner responses to pain in metastatic breast cancer

Women with metastatic breast cancer (MBC) rely on their partners for emotional and practical support. They also experience significant pain and depression, which can trigger maladaptive pain behaviors (eg, distorted ambulation). The biopsychosocial model of pain posits that partner solicitous responses can reinforce pain behaviors, whereas punishing or distracting responses can minimize their occurrence. This study explored how psychosocial variables (ie, depression and partner responses) influence patient pain behaviors and partner responses in 191 couples coping with MBC. Because few studies have examined the biopsychosocial model in cancer, it also examined associations between partner responses and patient pain behaviors. Multilevel models showed that depression partially mediated: (1) associations between patients’ and partners’ reports of patient pain (MPI) and their ratings of patient pain behaviors (PBCL), accounting for 41% to 71% of the variance; and (2) associations between both partners’ reports of patient pain and the partner’s distracting and punishing responses (MPI), accounting for 66% to 75% of the variance. Partner punishing responses moderated associations between patient pain severity and pain behaviors. Specifically, punishing responses were associated with more pain behaviors for patients with low levels of pain and fewer pain behaviors for patients with higher levels of pain (effect size r = .18). These findings provide partial support for the biopsychosocial model of pain but also clarify and extend it in the cancer context. Future pain management programs in MBC may benefit from addressing both partners’ depression levels and teaching partners to engage in fewer punishing responses when the patient is experiencing low levels of pain.     

Couple distress after localised prostate cancer

Background

The experience of the diagnosis of prostate cancer is distressing for both men and their partners. The present study describes the prevalence of psychological distress in men with prostate cancer and their partners, and the predictors of adjustment outcomes.

Methods/design

A cross-sectional survey of 189 prostate cancer patients who were scheduled for or had undergone surgery for localised prostate cancer and their partners assessed socio-demographic variables, masculine self-esteem and social intimacy, psychological adjustment and quality of life.

Results

Overall, patients and partners reported low distress; however, female partners were more anxious with 36 % reporting mild to severe anxiety. For men, masculine self-esteem and time since diagnosis were most strongly related to mental health status; urinary bother most influenced physical quality of life. For female partners, the man’s psychological distress and his sexual bother were most strongly related to her mental health status; higher social intimacy was most strongly associated with physical quality of life.

Conclusion

The correlates of distress after the diagnosis of prostate cancer differ between patients and female partners. For men, masculine self-esteem may be most crucial, whereas for women, her partner’s level of distress may matter most. Research to better understand these interactions is needed.     

Individual and dyadic development of personal growth in couples coping with cancer

Rationale

Couples share distress as well as potential personal growth (PG) after a cancer diagnosis. It is essential for professionals to learn more about the ways couples cope together with adversity. Dyadic results may help to understand controversial results in the PG literature and inform clinicians in optimizing psychological support for couples.

Objective

We examine the temporal and dyadic development of PG among patients and their intimate partners. In addition, life threat is examined as a potential factor influencing PG after cancer diagnosis.

Methods

We assessed PG using the Personal Growth Inventory in a clinically representative, mixed-type and mixed-stage cancer cohort (N?=?154 couples) 6 and 12 months after cancer diagnosis. Medical data on cancer diagnoses and treatments were collected from physicians. Actor–partner interdependence models were applied.

Results

PG was reported by patients and their partners. Women (either as patients or partners) reported more PG than male patients or partners. PG remained relatively stable over 6 months and was related to whether the patient was receiving curative or palliative treatment. Female patients experienced less PG 6 months after the cancer diagnosis and if treatment was curative. Male patients experienced less PG if their partners experienced PG, and the treatment was curative.

Conclusions

Dyadic growth is a phenomenon not limited to breast cancer or female patient couples and may represent a form of dyadic coping. Patients and partners seem to develop individual and dyadic growth, depending on a combination of gender and life threat. Psycho-oncology services may want to promote both couple level coping and support in order to optimize cancer care.     

Relative contribution of intrapersonal and partner factors to contraceptive behavior among taiwanese female adolescents.

PURPOSE: To explore the relative contribution of intrapersonal factors (demographic data, sexual history, and self-efficacy for contraception) and partner factors (perceptions of support from sexual partners for contraception, and relationship power) to contraceptive behaviors among sexually active female adolescents in Taiwan. DESIGN: A cross-sectional design. Female adolescents who have had a steady male sexual partner in the past 3 months (N=375) were recruited as participants. METHODS: Questionnaires including demographic data, sexual history, contraceptive behavior, self-efficacy for contraception, perceptions of support from sexual partner for contraception, and perceptions of relationship power were submitted anonymously for this study. FINDINGS: Participants who had their first sexual experience at less than 14 years of age and were from one-parent families had the least comprehensive contraceptive behavior than did other participants. Number of steady sexual partners was significantly negatively correlated with contraceptive behavior. Self-efficacy, perceptions of support from sexual partner for contraception, and relationship power all were positively correlated with contraceptive behavior. The important explanatory variables of contraceptive behavior were self-efficacy, age of first sexual intercourse, intervals between sexual intercourse, and perceptions of support from sexual partner for contraception. These accounted for 39.1% of variance in contraceptive behavior. CONCLUSIONS: Intrapersonal factors (self-efficacy, age of first sexual intercourse, and intervals between sexual intercourse) were more important than were partner factors (perceptions of support from sexual partners for contraception and relationship power) in influencing contraceptive behavior among sexually active female adolescents in Taiwan. CLINICAL RELEVANCE: Intervention to increase contraceptive behavior among female adolescents should be focused more on intrapersonal factors than on partner factors.     

“The Body Gives Way, Things Happen”: Older women describe breast cancer with a non-supportive intimate partner

Purpose

Many women identify their intimate partner as important source of support during cancer diagnosis and recovery, but little is known about how women deal with breast cancer while in a relationship self-described as difficult. The purpose of this article is to describe the aging-related experiences of older women who were diagnosed with breast cancer while in a non-supportive, difficult intimate relationship.

Method

Semi-structured qualitative interviews were conducted with a convenience sample of 16 women aged 55-84 years (mean 68.1 years) in community settings in the mid-Atlantic United States. Data were analyzed using hermeneutic phenomenological analysis.

Results

Participants self-identified as being in a difficult intimate relationship (relationship length range: 1 year- 60 years, mean 35.6 years). Reasons for relationship difficulty ranged from intimate partner abuse to terminal illness. The findings included the themes: “At my Age”: participants reflect on aging and breast cancer; breast cancer, sexuality, and aging; and silence.

Conclusions

Issues related to aging such as changes in sexual relationships, comorbidities, and partner illness complicated the women’s breast cancer experience. Despite relationship difficulties, these women coped effectively with breast cancer in various ways. Study findings will increase awareness about the unique, complex needs of older women facing breast cancer with non-supportive intimate partners. Nurses should assess older breast cancer patients keeping in mind physical functioning, comorbidities, social support network, and quality of intimate partner support.     

The relationship of maternal attributes, resources, and perceptions of postpartum experiences to depression

The relationships of maternal attributes, resources, and perceptions of the postpartum experience to postpartum depression (PPD) were examined. One hundred and forty-three mothers completed measures of maternal attributes, resources, and perceptions of the postpartum experience, as well as depressed mood and clinical depression symptoms. Results from canonical correlation analysis revealed two patterns. Pattern 1: Women without history of depression, more emotional support from partners, higher parenting evaluation, lower centrality of the infant in the mother's thoughts and actions, and fewer life changes had lower depressed mood and fewer clinical depression symptoms than their counterparts. Pattern 2: Mothers without history of depression who were married, with higher financial stress, and lower parenting evaluation had higher depressed mood, but not more clinical depression symptoms. Maternal age, parity, time since delivery, income, and help from partner were unrelated to either depression indicator. These patterns suggest multiple paths to PPD, and the need for routine mental health assessment and exploration of women's perceptions of their postpartum experience.     

Men's experiences of their partner's primary and recurrent breast cancer.

The reaction and support from the partner of the woman with breast cancer is viewed by health professionals as an important factor in her adjustment to disease. However, there is little theory and research that focuses on the individual concerns and experiences of the man living with a woman who has breast cancer. Literature concerning the experience of breast cancer recurrence for both the partner and the patient is particularly sparse. The aim of this literature review is to explore the experiences of male partners of women with breast cancer. The role of the male partner supporting the woman with breast cancer, and the potential concerns he may have, will be explored. It will also focus on the partners' experience of living with a woman with primary breast cancer. Finally, the partners' experience of living with a woman with a recurrence of metastatic breast cancer will be considered. Relevant literature is reviewed and critiqued to place current knowledge in context, including identifying areas for further research.     

Living with heart failure: partner perspectives

To preserve the supportive capabilities of partners of heart failure (HF) patients, it is necessary to gain insight in the experiences and potential needs of these partners. Thirteen partners of HF patients participated in semistructured interviews specifically focused on their experiences as a partner. Patients had had HF for at least 18 months, and their partners were interviewed at home without the patient being present. Content analysis was used to organize the data and to identify categories and themes. Partners of HF patients experience several changes in life as reflected in the main themes: changes in life, changes in relationship, coping, and support. Partners support patients in their daily activities; they often change their own daily schedule and have to adjust joint activities. Regaining a new balance together is one of the challenges that couples face when confronted with HF. Anxiety is an important theme especially in the acute phase that can interfere with adequate coping strategies. Changes in relationship are related to difficulties in communication and sexuality. Although most partners seem to cope relatively well, the impact of HF on their lives is profound. Partners are vulnerable especially at the onset of the illness, and therefore, it is important to involve partners actively in the early process of rehabilitation and recognize their importance to the patient and their potential problems.     

Biased Partner Perceptions of Women's Pain Self-Efficacy in Postpartum Pain During Intercourse: A Dyadic Longitudinal Examination

Postpartum pain during intercourse is a prevalent and distressing problem that has substantial consequences for affected couples. Partner perceptions—such as how partners perceive women's pain self-efficacy—contribute to an individual's pain experience. This study examined whether partners under- or over-estimate women's intercourse pain self-efficacy at 3-months postpartum and the implications of this bias for women's pain and couples’ sexual functioning at 3- and 6-months postpartum. Women who reported pain during intercourse and their partners (N = 89 couples) completed online measures assessing pain self-efficacy (own or partner perceptions), pain intensity, and sexual functioning at 3- and 6-months postpartum. Analyses were based on the Truth and Bias Model of Judgement and Response Surface Analysis. Partners were accurate in their estimates of women's pain self-efficacy (ie, their estimates were positively correlated with women's), but they also underestimated it by perceiving women to be less efficacious than women themselves reported. When couples showed greater agreement for lower levels of pain self-efficacy at 3 months, women reported greater pain intensity and both partners reported poorer sexual functioning at 3- and 6-months postpartum. Findings may inform interventions that promote pain self-efficacy to improve partner support and couples’ sexual functioning.PerspectiveWhen women report—and their partners perceive—low levels of women's self-efficacy for managing painful intercourse, women report greater postpartum pain during intercourse and couples indicate poorer sexual functioning. These findings suggest that interventions aimed at promoting couples’ agreement at high pain self-efficacy may improve their adjustment to postpartum pain.     

The Use of Partners in Undergraduate Public Health Nursing

This study assessed undergraduate student perceptions regarding homevisitingwithpartnersdutingthepublkh ealthnursing clinical experience. Approximately 130 public health nursing students completed a self-administered questionnaire at the end of their clinical experience. Students identified positive aspects of visiting with partners as support, safety, and collaboration. On ranked items, they identified support as the most important benefit from visiting in pairs. Feedback, safety, and ventilation were next in importance, while expertise of the partner and economic considerations wererankedasleastimportant Visitingwith oneconsistent partner was first choice in making visits, fonOWed by visits with rotating partners, and finally, visits with staff nurses or alone. These findings suggest that making home visits with a parlner can be a beneficial experience, increasing the support perceived by undergraduate students and enhancing learning through feedback and collaboration.     

Determinants of shift-work adjustment for nursing staff: the critical experience of partners.

Levels of congruence between shift workers and their partners on experiences of shift work are rarely addressed. Partners, however, might be a potential source for validation of shift-work issues in terms of their understanding of these issues and might have an impact on the shift workers' experience of support or personal disruption. Participants consisted of 59 hospital shift-working nurses (55 women, 4 men) and their 59 partners. Two parallel versions of a previous questionnaire (Smith & Folkard, 1993a, 1993b) were used to obtain subjective data from workers and their partners on perceptions of the workers' experience of sleep flexibility and chronotype and lifestyle factors (sleep/fatigue, health/stress, and social/family) relating to tolerance across three shift types: day, evening, and night. All participants provided information on ideal shift choice and ratings of their own personal disruption and family, communication, and relationship issues. Results indicate that shift workers and their partners are congruent in their perceptions of the impact of shift work on the worker in all three lifestyle factors relating to tolerance across the three shift types. Shift workers experience more health/stress and social/family problems on the evening shift; this is related to their partners' increased sense of personal disruption. Similarly, when partners report the perceived impact of shift work on these same dimensions, it is associated with shift workers' heightened sense of personal disruption. Fewer sleep/fatigue and health/stress problems on the night shift are related to greater sleep flexibility, and evening types experience increased sleep/fatigue problems on the day shift. Social measures (particularly the personal disruption of the partner) rather than biological measures are the greatest predictors of shift workers' personal disruption. Findings are supported by qualitative data. It appears that the partner's understanding and own sense of disruption is critical to the experience of the shift worker regarding coping and predictability of tolerance.     

Life after cancer: couples’ and partners’ psychological adjustment and supportive care needs

Goals of work Partners of cancer patients may experience significant distress at the time of treatment and many may experience persistent difficulties, although little research has examined their longer term psychosocial outcomes or supportive care needs. Materials and methods One hundred and fifty-four cancer survivors who were 1–11 years post diagnosis and disease-free and their partners completed mailed questionnaires. Main results A positive relationship was found between psychological distress and supportive care needs both within and between partner and survivor samples. Partners reported high levels of anxiety and supportive care needs, most frequently concerning relationships and the impact of the cancer illness. Partners within couples reported both shared and unique needs, although agreement on ratings of shared needs was low. Needs did not diminish over time although partners demonstrated psychological resilience and reported positive outcomes. Predictors of distress and unmet needs were explored: physical QOL, relationship satisfaction, and total needs contributed to variability in partners’ distress; relationship satisfaction and total needs were associated with survivors’ distress. Distress and relationship satisfaction were associated with partners’ unmet needs; only distress was associated with survivors’ unmet needs. Conclusions Partners are not merely providers of support, but need support themselves many years after a cancer diagnosis and in the context of apparently cured disease. The quality of the dyadic relationship may be critical in determining both partner and survivor distress and needs, and may prove a useful target for psychosocial interventions.     

Awareness,concern, and communication between physicians and patients on bone health in cancer

Purpose

This study aims to explore physician–patient communications about bone metastases and cancer treatment-induced bone loss (CTIBL).

Methods

The study utilizes online survey of patients with breast cancer, prostate cancer, and multiple myeloma, and the physicians who treat them.

Results

Even though 69 and 48 % of patients with nonmetastatic breast and prostate cancer aware of treatment-induced bone loss, only 39 and 23 %, respectively, were concerned about bone loss. Yet, 62 and 71 % of oncologists treating breast and prostate cancer felt that their patients were concerned. Among patients with metastatic breast and prostate cancer, two thirds had not discussed treatment for bone metastases with their doctor; when discussed, 88 and 91 % of discussions were initiated by the doctor, usually prior to initiating treatment. Most myeloma patients (77 %) had discussed treatment options with their physicians; 99 % of hematologists reported discussing treatment of bone disease with patients.

Conclusions

Physicians are primary sources of information to patients regarding bone health. There is a gap between what physicians assume their patients know about bone health and the patients’ perceptions, presenting a need for systematic awareness and education.     

Testicular cancer: a longitudinal pilot study on stress response symptoms and quality of life in couples before and after chemotherapy

Goals of work The current study was designed to longitudinally examine stress response symptoms (SRS) and quality of life (QoL) in couples confronted with disseminated testicular cancer. The objectives were to examine couples’ patterns of adjustment over time and possible differences in adjustment between the patient and his partner. Materials and methods Couples completed the Impact of Event Scale and the QoL subscales physical functioning, social functioning, and mental health of the RAND-36 before chemotherapy (T1), after completion of chemotherapy (T2), and 1 year later (T3). Results Before chemotherapy 26% of the patients and 50% of partners reported clinically elevated levels of SRS. Patients reported lower physical and social functioning at T2 compared to T1 and T3. Partners reported an improvement in social functioning over the year and no changes in physical functioning or mental health. No relationships between patients and partners’ functioning were found. One year after diagnosis, QoL of patients and partners was similar to that of reference groups, and patients even reported better physical functioning than the reference group. SRS of patients and partners were negatively related at T1, and patients and partners’ social functioning were positively related at T2. Conclusions According to stress response levels, the period before the start of chemotherapy was most stressful for couples. Adjustment patterns differ between testicular cancer patients and their partners with patients reporting lowered QoL after completion of chemotherapy. QoL of couples returned to normal levels 1 year after diagnosis. The effect of disseminated testicular cancer on the QoL of patients and their partners seems to be temporary. A minority may need clinical attention for severe SRS.     

Couples surviving prostate cancer: Long-term intimacy needs and concerns following treatment

Couples surviving prostate cancer face long-term challenges in their relationships as they adapt to chronic illness. Ten couples surviving prostate cancer were brought together in a focus group to discuss their experiences and concerns regarding intimacy in their relationships. During three 30-minute segments, couples described their experiences (a) as couples, (b) as individual men and women in two concurrent break-out groups, and (c) regarding current intimacy and relationship needs. Questions asked of couples focused on (a) the process of being diagnosed and treated for prostate cancer, (b) what the experience was like for them as a couple, (c) what was helpful, harmful, and surprising throughout the experience, (d) what they currently needed most as a couple, and (e) what advice they had for other couples. Findings suggested that men and women think and respond differently to intimacy and relationship challenges that occur as a result of prostate cancer, diagnosis, and treatment. Consequently, healthcare providers in any clinical setting who may interact with prostate cancer survivors must consider the relationship and intimacy needs that are unique to men, women, and couples.     

Dyadic influence of hope and optimism on patient marital satisfaction among couples with advanced breast cancer

Purpose

An estimated 10–40 % of breast cancer (BC) patients report negative changes to their partnered relationships. Literature suggests that for these patients, marital satisfaction is related to depression and other quality of life factors which are associated with survivorship and treatment response. However, existing literature does not provide a clear explanation of the factors that strengthen vs. create strain in couples facing cancer. Given the benefits of a satisfying relationship to patient quality of life, it is important to better understand factors that put patients at greater risk for marital difficulties. This study examined the differential and combined roles of hope and optimism among BC patients and their partners on patient marital satisfaction.

Method

Fifty-six breast cancer patient-partner dyads completed study questionnaires as part of a larger study. Regression analyses were used to examine the main and interaction effects of patient and partner hope and optimism on patient marital satisfaction.

Results and conclusion

Higher patient and partner hope predicted greater patient marital satisfaction, whereas optimism did not. These results are divergent from the literature on optimism and well-being, which shows the importance of studying these two traits concurrently. Interaction effects suggest certain combinations of patient and partner hope and optimism are more beneficial than others for patient marital satisfaction and suggest a dyadic approach is important for investigation of well-being in breast cancer.