Links Between Communication and Relationship Satisfaction Among Patients With Cancer and Their Spouses: Results of a Fourteen-Day Smartphone-Based Ecological Momentary Assessment Study.

Abstract

Cancer treatment poses significant challenges not just for those diagnosed with the disease but also for their intimate partners. Evidence suggests that couples' communication plays a major role in the adjustment of both individuals and in the quality of their relationship. Most descriptive studies linking communication to adjustment have relied on traditional questionnaire methodologies and cross-sectional designs, limiting external validity and discernment of temporal patterns. Using the systemic-transactional model of dyadic coping as a framework, we examined intra- and inter-personal associations between communication (both enacted and perceived) and relationship satisfaction (RS) among patients with stage II-IV breast or colorectal cancer and their spouses (N = 107 couples). Participants (mean age = 51, 64.5% female patients, and 37.4% female spouses) independently completed twice-daily ecological momentary assessments (EMA) via smartphone for 14 consecutive days. Items assessed RS and communication (expression of feelings, holding back from expression, support and criticism of partner, and parallel ratings of partner behavior). Linear mixed models employing an Actor Partner Interdependence Model were used to examine concurrent, time-lagged, and cross-lagged associations between communication and RS. Expressing one's feelings was unassociated with RS. Holding back from doing so, in contrast, was associated with lower RS for both patients and spouses in concurrent models. These effects were both intrapersonal and interpersonal, meaning that when individuals held back from expressing their feelings, they reported lower RS and so too did their partner. Giving and receiving support were associated with one's own higher RS for both patients and spouses in concurrent models, and for patients in lagged models. Conversely, criticizing one's partner and feeling criticized were maladaptive, associated with lower RS (own and in some cases, partner's). Cross-lagged analyses (evening RS to next-day afternoon communication) yielded virtually no effects, suggesting that communication may have a stronger influence on short-term RS than the reverse. Findings underscore the importance of responsive communication, more so than expression per se, in explaining both concurrent and later relationship adjustment. In addition, a focus on holding back from expressing feelings may enhance the understanding of RS for couples coping with cancer.

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Citation

Published Version (Please cite this version)

10.3389/fpsyg.2018.01843

Publication Info

Langer, Shelby L, Joan M Romano, Michael Todd, Timothy J Strauman, Francis J Keefe, Karen L Syrjala, Jonathan B Bricker, Neeta Ghosh, et al. (2018). Links Between Communication and Relationship Satisfaction Among Patients With Cancer and Their Spouses: Results of a Fourteen-Day Smartphone-Based Ecological Momentary Assessment Study. Frontiers in psychology, 9(OCT). p. 1843. 10.3389/fpsyg.2018.01843 Retrieved from https://hdl.handle.net/10161/21883.

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Scholars@Duke

Strauman

Timothy J. Strauman

Professor of Psychology and Neuroscience

Professor Strauman's research focuses on the psychological and neurobiological processes that enable self-regulation, conceptualized in terms of a cognitive/motivational perspective, as well as the relation between self-regulation and affect. Particular areas of emphasis include: (1) conceptualizing self-regulation in terms of brain/behavior motivational systems; (2) the role of self-regulatory cognitive processes in vulnerability to depression and other disorders; (3) the impact of treatments for depression, such as psychotherapy and medication, on self-regulatory function and dysfunction in depression; (4) how normative and non-normative socialization patterns influence the development of self-regulatory systems; (5) the contributory roles of self-regulation, affect, and psychopathology in determining immunologically-mediated susceptibility to illness; (6) development of novel multi-component treatments for depression targeting self-regulatory dysfunction; (7) utilization of brain imaging techniques to test hypotheses concerning self-regulation, including the nature and function of hypothetical regulatory systems and characterizing the breakdowns in self-regulation that lead to and accompany depression.

Keefe

Francis Joseph Keefe

Professor in Psychiatry and Behavioral Sciences

I am Director of the Duke Pain Prevention and Treatment Research Program, an active NIH funded clinical research program focused on developing new and more effective ways of assessing and treating patients having acute and persistent pain.  I have been active in nationally and internationally in shaping the pain research agenda.  For the past 10 years I served as Editor in Chief of PAIN the premier journal in pain research.  I also have served as the Chair of a number of NIH Study Sections.   Finally, I was a member of the Institute of Medicine committee that published a report in 2011 (Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research) that has played a key role in shaping national policies in pain research and pain care.

Over my career, I have played a key role in the development of clinical pain services and pain research programs at Duke Medical Center.  For over 20 years, I directed the Duke Pain Management Program and was a leader in the development of Duke Medical Center's multidisciplinary pain programs (both out-patient and in-patient.)  I collaborate actively with investigators in other countries (e.g. United Kingdom, South Africa, China, and Australia). 

Over the course of my career, I have collaborated closely with investigators both in and outside my lab.  Together we have developed and refined a number of treatment protocols for persistent pain conditions (e.g. pain in patients with advanced cancer; sickle cell disease, and persistent joint pain due to osteo- and rheumatoid arthritis) including partner and caregiver-assisted pain coping skills training interventions.  We have conducted a number of NIH- and foundation- funded randomized clinical trials testing the efficacy of these and other behavioral interventions (e.g. aerobic exercise protocols, yoga based interventions, mindfulness-based interventions, forgiveness-based interventions, loving kindness meditation, and emotional disclosure). 

I currently serve as a Co-Investigator on a number of NIH grants, a number of which are funded by the HEAL Initiative.  Many of these grants are testing novel strategies for delivering training in pain coping skills (e.g. video over internet, web-based training, virtual reality interventions, and apps for mobile devices).  Along these lines, I collaborated with Dr. Chris Rini to develop an internet-based program for training in pain coping skills called painTRAINER (available at mypaintrainer.org). This program is free to any individuals or health professionals who wish to use it.  I have a keen interest in exploring the efficacy of these and other strategies (e.g. training physical therapists, social workers, and nurses) promise to increase access to behavioral pain management interventions making them more widely available to the large population of patients and caregivers who might benefit from them.

I have published over 490 papers on topics ranging from pain coping strategies used during mammography to behavioral approaches to managing acute pain and pain at end of life.  I have a longstanding interest in mentoring students and early career professionals interested in developing, testing, and disseminating novel protocols for managing pain, stress, and medical symptoms.

 

Zafar

Syed Yousuf Zafar

Adjunct Professor in the Department of Medicine

Dr. Zafar is a gastrointestinal medical oncologist and Associate Professor of Medicine, Public Policy, and Population Health Science at the Duke Cancer Institute and Duke-Margolis Center for Health Policy. He serves as Director of Healthcare Innovation at the Duke Cancer Institute. Dr. Zafar also serves as Clinical Associate Director of Duke Forge (Health Data Science Center). Dr. Zafar is considered an international expert in identifying and intervening upon the financial burden of cancer care. His research explores ways to improve cancer care delivery with a primary focus on improving the value of cancer treatment from both patient-focused and policy perspectives.

Dr. Zafar speaks internationally on his research and cancer care delivery. He has over 100 publications in top peer-reviewed journals including the New England Journal of Medicine, the Journal of Clinical Oncology, and JAMA Oncology. His research has been funded by the National Institutes of Health and the American Cancer Society, among others. His work has been covered by national media outlets including New York Times, Forbes, Wall Street Journal, NPR, and Washington Post. He is a Fellow of the American Society of Clinical Oncology.


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