Adaptation of wives to prostate cancer following diagnosis and 3 months after treatment: A test of family adaptation theory

https://doi.org/10.1016/j.ijnurstu.2006.05.004Get rights and content

Abstract

Background

Prostate cancer challenges not only the men with the disease, but also their partners. Existing studies have focused on the relationship between type of treatment and sexual and urinary function in men, with recent qualitative work suggesting that men and their spouses have differing responses to the illness. Factors predicting women's adaptation to prostate cancer have not been examined.

Objectives

Using a model derived from family stress and adaptation theory, this study examined (1) the contribution of urinary and sexual symptoms, sense of coherence, marital resources and situational appraisal to wives’ global adaptation (PAIS) and emotional adaptation (POMS), and (2) the role of situational appraisal as a mediator between the set of independent variables and PAIS and POMS.

Design

In a prospective, correlational design, data were collected from 70 women following their partners’ diagnosis and again 3 months later.

Methods and results

Using a path analysis approach, between 30% and 62.7% of the variance in global adjustment and mood disturbance was explained across model tests. Sense of coherence was a strong and consistent predictor. Appraisal acted as a mediator only at time 2, mediating the effect of symptom distress on global adaptation. Change in sense of coherence and change in family resources predicted global adaptation and emotional adaptation at time 2, and predicted the change between time 1 and 2 in those variables.

Conclusions

The findings suggest nursing interventions that mobilize and build wives’ sense of the manageability, meaningfulness and comprehensibility of life events, and that foster cohesion and flexibility within the marital relationship. Interventions that mitigate the impact of urinary symptoms and the appraisal of threat in the illness event are also indicated. Additional model-testing studies based on family adaptation theory with patients and family members in other types of cancer would help build nursing knowledge for interventions in cancer.

Section snippets

What is already known about the topic?

  • Prostate cancer studies focus primarily on urinary and sexual functioning in men, with little study of the experience of their spouses. There are no theoretically driven studies in this population.

  • Wives make their own personal adjustments in the face of the illness and set the stage for the adaptation of other family members.

  • There are differences in husbands’ and wives’ perceptions of stress and in their coping patterns in the first year following diagnosis of prostate cancer.

What this paper adds

  • Theory-based knowledge about the factors that explain global and emotional adaptation of wives in the early stages of the prostate cancer experience.

  • Support for the critical role of the personal resource of “sense of coherence” for wives of cancer patients in the initial phase of the illness experience. Support for nursing interventions that enhance the components of SOC—meaning, manageability and comprehensibility of life events.

  • Data that supports the use of family stress and adaptation theory

Methods

The study passed through the scientific and ethical review procedures of the hospital institutional review boards prior to recruitment. Subjects were recruited through referrals from urologists and radiation oncologists at three large urban centers in Montreal, Canada. Men and their wives received a written explanation of the study during an office visit and returned a response card indicating their willingness to participate. Questionnaires were administered separately to each partner at the

Results

The contributions of the variables in explaining variance in PAIS and POMS at T1 and T2 for the four sets of model test are summarized in Table 2. The table shows that the retained models explained between 30% and 50% of variance in global adaptation and between 47% and 63% of the variance in emotional adaptation. The variables were moderate to strong predictors for PAIS, and consistently strong predictors for POMS. The variables retained in the models were the same for PAIS and POMS at T1, but

Discussion

The wives’ scores on global adaptation as well as on the dimension of psychological adaptation suggested that they were doing well at the time of diagnosis and also 3 months later. The high level of adaptation seen in the wives in this study has not been a consistent observation in spouses of cancer patients in the initial phase of illness, with some studies reporting lower levels of general adaptation and more psychological distress (Baider et al., 1998; Gray et al., 2000a; Morse and Fife, 1998

Considerations and directions for future study

Less than half of the women who were eligible actually participated, and the estimated accrual rate may have resulted in a non-response bias. Most non-participants stated that they were not interested or indicated that they were too overwhelmed to participate, suggesting that the sample was not representative of all wives. In addition, the requirement that both husbands and wives had to agree to participate may also have skewed the original sample to reflect couples that were more cohesive and

Acknowledgements

This study was supported by grants received from the Montreal General Hospital Research Foundation and Social Science Health Research Council grants to McGill University. The contributions of Marie Durand, RN, B.Sc. N., Julie Gross RN M.Sc.(A) and Cindy Dalton, RN M.Sc.(A) are gratefully acknowledged.

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