Supporting the support person: Oncologists' roles in reducing support people's uncertainty and facilitating psychological adjustment.

OBJECTIVE: Support people of cancer patients are at significant risk for psychological distress. Additionally, cancer patients' well-being is reciprocally associated with support peoples' psychological well-being. Informed by Uncertainty in Illness Theory, this study tests whether support person psychological well-being is influenced by provider communication and uncertainty reduction. METHODS: We tested a multiple mediation model to investigate how empathic communication facilitates psychological adjustment in support people of cancer patients and how this process is mediated by support peoples' illness uncertainty and caregiver burden. Support people of cancer patients (N = 121; including spouses, adult children, etc.) completed an online questionnaire about their perceptions of oncologists' empathy, uncertainty about the cancer patients' illness, perceived caregiving burden, and their psychological adjustment to diagnoses. RESULTS: Path analysis revealed that (1) more perceived oncologist empathy was associated with less illness uncertainty, (2) more illness uncertainty was associated with worse psychological adjustment and more perceived caregiver burden, and (3) more burden was associated with worse adjustment (χ2 (2) = 1.19, p = 0.55; RMSEA < 0.01; CFI = 1.00; SRMR = 0.02). CONCLUSIONS: Given the reciprocal nature of well-being between cancer patients and their support people, it is critical to understand and bolster support people's psychological well-being. Results demonstrated how empathic provider communication can support psychological well-being for support people of cancer patients. Additionally, this study offers theoretical contributions to understandings of illness uncertainty in caregiver populations.

Healthcare provider assessments of caregiver communication behaviors during gynecologic Cancer treatment appointments.

Objective: Caregivers often accompany patients to cancer-related medical appointments. Limited research exists on healthcare providers' (HCPs) evaluation of how caregiver communication influences interactions between healthcare providers and patients, particularly during gynecologic treatment visits. HCPs may perceive caregiver communication as helpful or challenging, and these triadic interactions may influence patient outcomes. Methods: Interviews with ten cancer specialist HCPs (medical assistants/technicians, nurse practitioners/registered nurses, oncologists) addressed experiences interacting with patients and caregivers. Results: Analyses revealed two themes concerning helpful communication: caregivers managing information and managing patient emotions. Three challenging themes include caregiver communication unsettling healthcare interactions, caregiver presence limiting patient communication, and caregiver engagement challenges. Conclusion: HCPs evaluate caregiver communication as helpful and challenging. Findings suggest benefits of communication training for gynecologic cancer patients such as requesting privacy when interacting with HCPs, for caregivers to promote awareness of effects of their behavior, and for HCPs to help manage triadic interactions while supporting patient needs. Innovation: HCP assessment of caregiver communication during gynecologic treatment visits offers unique insights regarding helpful and challenging behaviors contributing to implications for patient care and well-being. Applications may extend to other triadic interactions and cancer settings.

Dilemmas and Strategy When Companion Participation During Appointments Differs from Patient and Companion Expectations.

Cancer patients often attend medical interactions with at least one companion. The degree to which companions participate varies, ranging from passive observer to active advocate. However, the structure of the medical interaction often promotes dyadic rather than triadic communication, creating ambiguity about to the degree to which companions can and should participate. Participants (N = 34, 16 dyads) included gynecologic cancer patients who were undergoing chemotherapy treatment (n = 18) and their companions (n = 16); all participants were separately interviewed. Interviews included discussion of dyadic communication patterns within medical interactions. The normative rhetorical theory (Goldsmith, 2019) was applied as a guiding framework. Patients discussed the dilemma they experience when companions are expected but absent. Patients and companions provided positive reports of companion communication when behavior aligned with expectations. Alternatively, patients and companions experience dilemmas when companions participate more than or differently from how patients and/or companions had expected. Companions provided one strategy for managing the dilemma of how to participate in medical interactions. Implications and limitations are discussed.

The Influence of Perceived Provider Empathic Communication on Disclosure Decision-Making.

Provider empathy is a crucial component in establishing therapeutic provider-patient relationships. The benefits of increased perceptions of empathy can support patient psychological adjustment to their cancer as well as patients' comfort and confidence in disclosing to providers, ultimately promoting patient engagement. Guided by the disclosure decision-making model, this manuscript explores how perceptions of empathy influence patient psychological adjustment and how those variables influence patient disclosure efficacy. The model ultimately predicts patient sharing and withholding of information during the medical interaction. This study tested a mediation model to investigate how current (n = 111) and former (n = 174) breast cancer patients' psychological adjustment mediates the relationship between patient perceptions of oncologist empathic communication and efficacy to disclose health information to their oncologist and their disclosure enactment in sharing and withholding. Overall, former patients compared to current patients had more positive perceptions of their oncologist's empathic communication, had better psychological adjustment, felt more self-efficacy to disclose to their oncologist, and shared more and withheld less information from their oncologist (p < .05 in all cases). Structural equation modeling revealed good fit to the data for both current and former patients such that more perceived empathic communication was associated with more efficacy for disclosure, which was associated with more sharing and less withholding. Additionally, there was an indirect relationship from perceptions of empathic communication to disclosure efficacy through patients' psychological adjustment to the diagnosis. Results reinforce the importance of providers' empathic communication for cancer patients' psychological adjustment because patient sharing and withholding of information remain crucially important to achieving holistic care across the cancer trajectory.

Facilitating psychological adjustment for breast cancer patients through empathic communication and uncertainty reduction.

OBJECTIVES: This study examined the degree to which breast cancer patients' psychological well-being is facilitated through empathic provider communication. We explored symptom/prognostic uncertainty reduction as a mechanism through which provider communication influences patient psychological adjustment. Additionally, we tested if treatment status moderates this relationship. METHODS: Informed by uncertainty in illness theory, current (n = 121) and former (n = 187) breast cancer patients completed questionnaires about perceptions of their oncologists' empathy and their symptom burden, uncertainty, and adjustment to their diagnosis. Structural equation modeling (SEM) was conducted to test hypothesized relationships between perceived provider empathic communication, uncertainty, symptom burden, and psychological adjustment. RESULTS: SEM supported the following: (1) higher symptom burden was associated with increased uncertainty and reduced psychological adjustment, (2) lower uncertainty was associated with increased adjustment, and (3) increased empathic communication was associated with lower symptom burden and uncertainty for all patients (χ2(139) = 307.33, p < .001; RMSEA = .063 (CI .053, .072); CFI = .966; SRMR = .057). Treatment status moderated these relationships (Δχ2 = 264.07, Δdf = 138, p < .001) such that the strength of the relationship between uncertainty and psychological adjustment was stronger for former patients than for current patients. CONCLUSIONS: Results of this study reinforce the importance of perceptions of provider empathic communication as well as the potential benefits of eliciting and addressing patient uncertainty about treatment and prognosis throughout the cancer care continuum. PRACTICE IMPLICATIONS: Patient uncertainty should be a priority for cancer-care providers both throughout and post-treatment for breast cancer patients.

Communicative Pathways Predicting Adherence in Type II Diabetic Patients: A Mediation Analysis.

Type II diabetes is a chronic health condition and its successful management requires effective patient-provider communication. Responding to a call to model pathways between provider communication and patient health outcomes, this study tested four models of type II diabetic patient adherence with four mediators. Given the complex nature of type II diabetic care, patient adherence was conceptualized as wellness, screening, medication, and treatment adherence. Mediators included patient understanding, agreement, trust, and motivation. A sample of U.S. patients with type II diabetes patients who were both under the care of a medical provider and taking medication for their type II diabetes completed online surveys (n = 793). Findings indicated that the relationships between patient-centered communication and adherence outcomes were mediated by proximal outcomes. The results contribute to the understanding of patient-centered communication, adherence behaviors, and proximal outcomes of patient understanding, agreement, trust, and motivation. Findings indicate that relationships between patient-centered communication and wellness adherence is mediated by patient motivation, patient-centered communication and screening adherence is mediated by patient agreement, trust, and motivation, and patient-centered communication and treatment adherence is mediated by patient agreement, trust, and motivation. The discussion addresses theoretical and practical implications and directions for future research.

Women's Agentic Role in Enabling and Dismantling Menstrual Health Taboos in Northern India: A Culture-Centered Approach.

Communication about menstrual health continues to be influenced by institutional and social practices which deem it to be unclean and impure. In a country such as India, several customs and traditions reinforce secrecy and shame about menstruation. As such, scholars advocate the need to generate knowledge that can open opportunities to converse on the topic of menstruation and understand issues related to bodily changes. Using a culture-centered approach, this study examined how college-going adult women from two cities in Northern India made sense of menstrual health. Data collection included 20 focus groups with 180 college-going women and interviews with 16 female family members. Participants discussed communication patterns surrounding menstrual health and how they uphold, challenge, and change social practices. Specifically, participants reflected on how they were communicated to about their menstrual health with underpinnings of secrecy and shame and how the influence of current opportunities for openness encourage them to anticipate positive change. Theoretical and practical implications for studying communication around menstruation in diverse cultural contexts are discussed.

Resilience Communication Mitigates the Negative Relational Effects of Topic Avoidance: Evidence from Parental Caregiving and COVID-19 Pandemic Contexts.

Communicating about hardships with close others can be challenging, leading to avoidance of hardship-related topics. Although typically considered relationally damaging, topic avoidance could serve as a beneficial or neutral strategy when paired with relationally affirming communication. The current research investigates if the resilience communication processes outlined in the communication theory of resilience mitigate the negative relational effects of topic avoidance. Hypotheses are tested in two different contexts: sibling communication during parental caregiving (N=207) and spousal communication in the first months of the COVID-19 pandemic (N=598). The processes of crafting normalcy, communication networks, and productive action were beneficial across contexts. When participants reported higher engagement in these processes, topic avoidance was not significantly related to relationship satisfaction. At lower engagement levels, topic avoidance was negatively related to relationship satisfaction. Nuance between contexts existed. For example, humor moderated the effect of sibling caregiving topic avoidance but not spousal COVID-19 topic avoidance.

Conflicting views during gynecologic cancer care: a comparison of patients' and caregivers' perceptions of burden.

This study describes the experiences of cancer caregivers and compares these experiences with patients' assessment of cancer's toll on their caregiver. Participants (16 patient-caregiver dyads) were recruited from a NCI cancer center of excellence in the northeastern United States. Patients were in treatment for ovarian (n = 7), uterine (n = 2), or endometrial (n = 7) cancers. Caregivers included 7 women and 9 men who described themselves as spouse/partner (n = 7), adult child (n = 4), sister (n = 2), parent (n = 1), nephew (n = 1), and friend (n = 1). Participants completed semi-structured individual interviews that focused on perceptions of caregiver burden or the impact of the patient's diagnosis on the caregiver specifically. Data were coded inductively to identify themes present within participants' responses. This process included open and axial coding. Two overarching themes emerged: (1) patient-caregiver agreement and (2) patient-caregiver disagreement. Patient-caregiver agreement included two subthemes: (1) weight gain and (2) weight loss. Patient-caregiver disagreement consisted of two subthemes: (1) differing perspectives of quantity and quality of caregiving provided and (2) withholding of caregiver concerns. Overall, there was 56% agreement between patient and caregiver responses. The results may inform intervention development to address patient-caregiver communication, cancer caregiver needs, and ultimately improve caregiver quality of life.

Aligned and Divergent Perceptions of Support Persons' Role in Triadic Gynecologic Cancer Communication.

Health care providers routinely advise cancer patients to involve support persons in oncology care to fulfill critical support roles. This qualitative descriptive study explored alignment of triadic perceptions of support person involvement in oncology treatment visits and cancer-related care from the perspectives of patients with gynecologic cancer (n = 18), regular visit-attending support people (n = 16), and health care providers (n = 10), including oncologists, nurses, and medical assistants. Semi-structured interviews (N = 44) captured perceptions of facilitation and interference of support persons' roles within and outside appointments with oncology providers. Thematic analyses revealed alignment and divergence regarding support persons' instrumental, informational, and emotional support behaviors. Perspectives aligned regarding what support functions companions provide. However, patients and support persons emphasized the significance of instrumental followed by informational and emotional support, whereas oncology providers highlighted informational, followed by emotional and instrumental support. Discussion provides insight into each role's perspective in the triad.

"We Cannot Have any Negativity": A secondary analysis of expectancies for the experience of emotion among women with gynecologic cancer.

This study aimed to elucidate whether gynecologic cancer patients and their support persons have certain expectancies for emotion and whether these expectancies, if they exist, affect cancer-related communication. Semi-structured interviews (N = 34) were conducted separately with 18 patients and one of their support persons (n = 16). Thematic analysis revealed a subset of patients and support persons expected patients to not have any negative emotions, which patients also reported they perceived from support persons, and that these expectancies could affect cancer-related communication. These results have implications and can facilitate appropriate recommendations for how cancer patients and support persons co-manage patients' emotions.

Decision-Making Criteria When Contemplating Disclosure of Transgender Identity to Medical Providers.

As identified in HealthyPeople 2020, the transgender population faces various barriers in accessing quality health care. One barrier includes the fear of negative response or refusal of treatment after disclosing one's transgender identity. In an effort to address this concern, it is essential to understand the criteria that transgender patients consider when determining if they will disclose their gender identity. The disclosure decision-making model (DD-MM) describes how individuals make decisions to share non-visible, health-relevant information with others. Applying the information assessment component of the DD-MM, the present study investigated the salient information assessment themes that contribute to transgender patients' decisions to disclose or withhold their gender identity from medical providers. The sample (N = 26) included transgender individuals who participated in in-depth interviews and described instances and criteria of disclosure decisions. Results revealed that when gauging stigma, participants consider cultural attitudes, how providers may attribute health concerns to their transgender identity, and if providers will perceive them as "trans enough" to provide access to transition-related care. When transition-related care is not necessary, participants' disclosure decision criteria include thoughts on how providers will perceive their gender expression and whether their transgender identity is salient to the medical interaction. Findings also highlighted opportunities for extending prior theoretical conceptualizations and practical implications for transgender care.

Revealing Mental Health Information in Friendships: The Role of Disclosure Strategy and Perceived Recipient Response on Disclosure Outcomes.

Processes of revealing, or disclosures, take various forms, and are sometimes referred to as disclosure strategies. How individuals share information influences how recipients respond, which may have important consequences that shape perceptions of the overall interaction and relationship satisfaction. This research explores mental health disclosures among friends to understand how (a) one's disclosure strategy predicts their perceptions of the recipient response, (b) perceived recipient response predicts perceptions of disclosure outcomes, and (c) perceived recipient response potentially mediates the relationships between disclosure strategies and disclosure outcomes (e.g., interaction success, relationship satisfaction). Participants were 144 individuals who had disclosed their mental health condition to a friend. Analyses revealed that when disclosing mental health information to a friend, strategy use was, in part, predictive of perceived recipient response which, in turn, predicted discloser's ratings of disclosure outcomes. This manuscript discusses implications of findings and suggests directions for future research.

Reports of Sharing and Withholding Cancer-Related Information by Patients With Gynecologic Cancer and Their Supporters.

PURPOSE: To examine patients' with gynecologic cancer and supporters' reports of sharing and withholding cancer-related information during oncology visits, with a focus on navigating communication encounters more effectively. PARTICIPANTS & SETTING: 18 women who were recently diagnosed with gynecologic cancer and their supporters (N = 16) were recruited from the Rutgers Cancer Institute of New Jersey in New Brunswick. METHODOLOGIC APPROACH: Data were collected via audio-recorded semistructured interviews and analyzed to determine the types of information that patients and supporters share or withhold during oncology visits. FINDINGS: Thematic analyses revealed two major themes. IMPLICATIONS FOR NURSING: Probing patients and supporters separately on topics that they may not feel comfortable discussing can help nurses to identify unaddressed concerns and better assist patients and their supporters during oncology visits.

The Dyadic Communicative Resilience Scale (DCRS): scale development, reliability, and validity.

PURPOSE: There has yet to be a quantitative measurement of communicative resilience processes as outlined in the Communicative Theory of Resilience (CTR). This study aims to determine the structure, reliability, and validity of the Dyadic Communicative Resilience Scale (DCRS) in cancer patients and partners. METHOD: The DCRS was administered to 584 participants, including 312 cancer patients and 272 partners of cancer patients along with the common coping subscale of the dyadic coping inventory, the cancer-related communication problems with couples scale, and the resilience promoting scale. RESULTS: Exploratory and confirmatory factor analyses revealed nine dimensions of dyadic communicative resilience within the five resilience processes outlined in the CTR. Structure reliability was shown with Cronbach's alphas between .77 and .88 and good to excellent model fit for the nine factors. Convergent and discriminant validities were demonstrated by significant Pearson correlations with relevant, established coping/resilience measures. CONCLUSIONS: The DCRS has a clear nine factor structure and demonstrates good reliability. The measure has good convergent and discriminate validity indicating its utility in future research examining resilience in cancer populations.

The Role of Response Perceptions in Couples' Ongoing Cancer-Related Disclosure.

In efforts to better understand the intricate nature of response, we tested a four-dimension structure of response patterns (measured as support, reciprocity, emotional reaction, and avoidance) as well as four single dimension models within the context of couples managing cancer. All models incorporate dyadic data, including both patient and partner perceptions that relational quality influences response patterns, and response patterns influence ongoing disclosure (measured as breadth and depth). Participants were 95 dyads in which one partner had been diagnosed with cancer. We conducted multilevel analyses using an actor-partner interdependence model. Results supported the four-dimension model as well as individual dimension models. All response types predict within person disclosure. However, only reciprocity predicts the other person's disclosure, and only patient's reports of partner reciprocity predict partner disclosure.

Provider Information Provision and Breast Cancer Patient Well-Being.

Research continues to delineate and clarify specific communication behaviors associated with improved patient outcomes. In the context of breast cancer surgery, this exploratory study examined the effect of breast surgeon information provision on the immediate post-visit outcomes of patients' anxious preoccupation, intention to adhere to treatment recommendations, and treatment plan satisfaction. Participants included 51 newly diagnosed breast cancer patients receiving care from one breast surgeon at a National Cancer Institute-designated cancer center in the northeastern United States. Participants completed pre- and post-visit questionnaires. Medical interactions were recorded, transcribed, and analyzed via multidimensional analysis, a method of linguistic analysis that uses exploratory factor analysis to identify how specific types of words are patterned and work to accomplish communicative goals (Biber, 1988). The multidimensional analysis identified constellations of language used by providers and patients. Although five linguistic dimensions emerged, one dimension, impersonal information provision, is of unique interest in understanding how providers communicate with patients. Impersonal information provision encompasses the ways in which the provider, using an impersonal tone, discussed the logistics, details, and implications of treatment options. Increased impersonal information provision was associated with patients' decreased anxious preoccupation (ß = -.22, t = -2.82, p = .007), increased treatment plan satisfaction (ß = .36, t = 2.54, p = .012), and increased intention to adhere to treatment recommendations (ß = .34, t = 2.45, p = .018). Findings suggest that specific provider behavior and types of information provided have unique and important effects on patients' health outcomes.

Social Network, Surgeon, and Media Influence on the Decision to Undergo Contralateral Prophylactic Mastectomy.

OBJECTIVES: The rate of contralateral prophylactic mastectomy (CPM) has risen sharply in the past decade. The current study was designed to examine social network, surgeon, and media influence on patients' CPM decision-making, examining not only who influenced the decision, and to what extent, but also the type of influence exerted. METHODS: Patients (N=113) who underwent CPM at 4 Indiana University-affiliated hospitals between 2008 and 2012 completed structured telephone interviews in 2013. Questions addressed the involvement and influence of the social network (family, friends, and nonsurgeon health professionals), surgeon, and media on the CPM decision. RESULTS: Spouses, children, family, friends, and health professionals were reported as exerting a meaningful degree of influence on patients' decisions, largely in ways that were positive or neutral toward CPM. Most surgeons were regarded as providing options rather than encouraging or discouraging CPM. Media influence was present, but limited. CONCLUSIONS: Patients who choose CPM do so with influence and support from members of their social networks. Reversing the increasing choice of CPM will require educating these influential others, which can be accomplished by encouraging patients to include them in clinical consultations, and by providing patients with educational materials that can be shared with their social networks. Surgeons need to be perceived as having an opinion, specifically that CPM should be reserved for those patients for whom it is medically indicated.

"He would never let me just give up": Communicatively Constructing Dyadic Resilience in the Experience of Breast Cancer.

A breast cancer diagnosis is a significant stressor that impacts both survivors' and their partners' psychological adjustment and well-being. Communication patterns and strategies utilized by survivors and partners are the key determinants of how some couples adjust to a cancer diagnosis. This study employs the Communicative theory of resilience (CTR)(Buzzanell, 2010) to examine the dyadic communicative processes couples enact that contribute to their resilience. Researchers conducted semi-structured interviews with 27 breast cancer survivors concerning communication with their partners. All interviews were transcribed and independently coded using thematic analysis. Findings support and extend the presence of the five communicative processes of resilience outlined by Buzzanell (2010), demonstrating how these processes interact with one another. Results also suggest that couples' communication both promotes and interferes with resilience. Practical and theoretical implications are discussed.

Disclosing Mental Illness Information to a Friend: Exploring How the Disclosure Decision-Making Model Informs Strategy Selection.

Within the context of mental illness disclosure between friends, this study tested the disclosure decision-making model (DD-MM; Greene, 2009) to comprehensively investigate factors that predict disclosure enactment strategies. The DD-MM describes how individuals determine whether they will reveal or conceal non-visible health information. Processes of revealing, called disclosures, take various forms including preparation and rehearsal, directness, third-party disclosure, incremental disclosures, entrapment, and indirect mediums (Afifi & Steuber, 2009). We explore the disclosure decision-making process to understand how college students select to disclose their mental illness information with a friend. Participants were 144 students at a Midwestern university who had disclosed their mental illness information to a friend. Structural equation modeling analyses revealed that college students choose strategies based on their evaluation of information assessment and closeness, and that for some strategies, efficacy mediates the relationship between information assessment and strategy. This manuscript discusses implications of findings and suggests direction for future research.