Couples' communication in the breast cancer context

Breast cancer is one of the most frequently diagnosed cancers among women in Australia. Whereas the past two decades have seen significant medical advancements and substantially improved diagnostic and intervention practices, the flipside of this progress is that an increasing number of women must contend with the myriad physical and psychological challenges of breast cancer and its treatment. Not surprisingly, a substantial proportion of women diagnosed with breast cancer experience elevated psychological distress in the form of anxiety, depression and post-traumatic stress many years after diagnosis and treatment. Explanatory research focused on interpersonal dynamics points to the importance of effective communication between spouses in facilitating psychological and relationship outcomes,such as,reduced psychological distress, and the maintenance or enhancement of couple relationship satisfaction. Few studies to date, however, have focused on couples' communication in cancer as a primary outcome, frequently using brief (typically single-item) and imprecise global indices of communication. Many questions, therefore,remain regarding how couples communicate about cancer, how they negotiate and co-ordinate coping, and the associations of specific dimensions of communication behaviours with psychological and relationship outcomes, and the underlying processes of these associations. Another limitation of the existing literature is that many of the studies have focused on positive dimensions of interpersonal and communication variables, such as social support dynamics and open disclosure of feelings, as compared to negative dimensions of interpersonal and communication behaviours. This is problematic as positive and negative social interactions are distinct constructs and relate to psychosocial adaptation outcomes in different ways, with some research even suggesting a more detrimental effect of negative social interaction, as compared to the beneficial effects of positive social interactions. An initial literature review was conducted to conceptualise the associations between major adaptive and non-adaptive communication strategies, and couples' psychological distress and marital satisfaction and to identify areas of knowledge gaps. Major theoretical and methodological frameworks that have guided this research, and directions for future research are the nconsidered.The two empirical studies in this thesis examine negative dimensions of couple communication behaviours and their linkages with key psychological and relationship outcomes in women with breast cancer and underlying processes of these associations. Specifically, the first empirical study examines the associations of patient-reported avoidance of specific cancer-related topics, reports of partner avoidance of these topics, and coping and psychological distress among breast cancer survivors. The results of this study indicated that greater women's and perceived-partner's communication avoidance about cancer topics were associated with poorer mental health outcomes (anxiety, depression, and stress) in the women with breast cancer. This study also provided support for the view that avoiding talk about cancer may influence the woman's emotional distress by impeding her coping ability, consistent with the transactional stress and coping paradigm. The second empirical study examines the association between perceived partner social constraints, as well as patient's report of their own social constraints, with patient relationship satisfaction.Previous research has only assessed perceived partner constraints, without consideration of the potential adverse effects of the patient's own constraints on partner disclosure and relationship satisfaction. The results of this study indicated that greater women's and perceived-partner social constraints were associated with poorer patient-reported relationship satisfaction. This study also provided support for the view that social constraint signals may be detrimental to relationship satisfaction by impeding individuals' social processing about cancer, consistent with the social cognitive processing model. Overall, the literature review and results of the two empirical studies contribute to the understanding of the role of couples' communication in breast cancer adaptation. The results of the two empirical studies indicate that the way in which couples communicate and relate with one another, the frequency of unsupportive responses, and topical focus of their conversations, are all important considerations for whether or not couple talk contributes to couples' psychosocial adaptation to cancer. The results hold important implications for clinical practice and care of women with breast cancer, as they suggest that helping couples navigate and overcome unsupportive partner constraint behaviours, and minimise communication avoidance about specific cancer-related topics between spouses may be important targets for psychosocial interventions.