Dilemmas of talking about lifestyle changes among couples coping with a cardiac event

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.

Using Normative Rhetorical Theory to Identify Dilemmas and Responses in Internal Medicine Patient-Provider Communication

Drawing on normative rhetorical theory (NRT), we examined communication dilemmas that internal medicine residents (IMRs) experience when interacting with patients and responses they adopt to manage these dilemmas. We conducted semi-structured, intensive interviews with 15 IMRs and analyzed the data using the phronetic iterative approach. Findings suggested that IMRs experienced two interpersonal dilemmas: (a) asserting expertise while respecting patients and (b) discussing patient behaviors without indicating deviance. The two dilemmas were more salient for international IMRs who were less familiar with the local culture and embraced a different perspective of the IMR-patient relationship. The two interpersonal dilemmas were connected to a supra-level dilemma of practicing tasks required by evidence-based medicine while being patient-centered. IMRs reported engaging in an interpretive lens to view patients as "people" and communicative responses to manage the dilemmas. By applying NRT to a novel context, our findings demonstrate the impact of macro-level paradigms on IMRs' conflicting purposes in medical encounters and offer practical implications for communication interventions for IMRs.

Behavioral Mimicry as a Strategy to Increase Drinking Behaviors in Older Adults

Purpose Individuals with dysphagia, particularly in the presence of dementia, are at high risk for decreased nutrition and hydration. Unfortunately, current treatment options are not without limitations and often ignore the crucial social aspects of mealtimes. The aim of this exploratory, proof-of-concept study was to examine whether the social phenomenon of nonconscious behavioral mimicry can increase drinking behaviors in healthy older adults. Method Forty-two older adults (M _age = 68.26 years, SD = 6.49) participated. Participants and a member of the research team posing as another participant (a confederate) took turns describing two series of pictures, while, unbeknownst to the participants, the confederate either frequently drank from a cup of water or touched the cup. The primary outcome measures (number of drinks per minute, number of cup touches per minute, percentage of time spent drinking, and percentage of time spent touching the cup) were coded and analyzed across both the confederate drinking and cup-touching conditions. Results Participants drank more frequently and spent more task time drinking during the confederate drinking condition as compared to the cup-touching condition. There was significant variability in drinking patterns across participants, with some only drinking when they were not engaged in the picture description task. Conclusions Behavioral mimicry may increase drinking behaviors in healthy older adults, although the effect may not be as robust among certain subsets of individuals. Clinically, mimicry may hold potential as a powerful, noninvasive supplemental mealtime strategy for increasing intake in those who are most at risk for malnutrition.

Partner presence in the emergency department and adherence to daily cardiovascular medications in patients evaluated for acute coronary syndrome

Stressful health situations may compromise spouses'/partners' ability to provide patients with support. We tested whether partner status/partner presence in the emergency department (ED) were associated with patients' adherence to daily cardiovascular medications and whether effects differed by age/gender. Participants were 189 patients evaluated for acute coronary syndrome at an urban academic ED (M_Age = 62.18; 57.1% male; 58.7% Hispanic). Participants self-reported partner status/partner presence. Medication adherence was measured using an electronic pillcap. For male patients, having a partner was associated with increased adherence in the first month post-discharge, OR 1.94, p < .001, but having a partner present in the ED was associated with lower adherence, OR 0.33, p < .001. The opposite effect was evident for female patients. Partner status/partner presence in the ED are associated with medication adherence during the first month post discharge, with opposing effects for male and female patients.

Patients' Experiences of Cardiovascular Health Education and Risk Communication: A Qualitative Synthesis

Coronary heart disease (CHD) has no cure, and patients with myocardial infarction are at high risk for further cardiac events. Health education is a key driver for patients' understanding and motivation for lifestyle change, but little is known about patients' experience of such education. In this review, we aimed to explore how patients with CHD experience health education and in particular risk communication. A total of 2,221 articles were identified through a systematic search in five databases. 40 articles were included and synthesized using thematic analysis. Findings show that both "what" was communicated, and "the way" it was communicated, had the potential to influence patients' engagement with lifestyle changes. Communication about the potential of lifestyle change to reduce future risk was largely missing causing uncertainty, anxiety, and, for some, disengagement with lifestyle change. Recommendations for ways to improve health education and risk communication are discussed to inform international practice.

Experiences of informal caregivers after cardiac surgery: a systematic integrated review of qualitative and quantitative studies

OBJECTIVES

To provide a comprehensive synthesis of informal caregivers' experiences of caring for a significant other following discharge from cardiac surgery.

DESIGN

Systematic integrated review without meta-analysis.

DATA SOURCES

A bibliographic search for publications indexed in six databases (Cochrane Library, CINAHL, MEDLINE, EMBASE, AMED and PsycINFO), including a scan of grey literature sources (GreyNet International, Google Scholar, Web of Science, WorldCat and the Clinical Trials Registry) was conducted in October 2018.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Studies were included if they described views and perspectives of informal caregivers of cardiac surgery patients (non-intervention studies (qualitative and quantitative)), and the effectiveness of interventions to evaluate support programme for informal caregivers of cardiac surgery patients (intervention studies).

RESULTS

Of the 4912 articles identified in searches, 42 primary research studies were included in a narrative synthesis with 5292 participants, including 3231 (62%) caregivers of whom 2557 (79%) were women. The median sample size across studies was 96 (range 6-734). Three major themes emerged from the qualitative study data: (1) caregiver information needs; (2) caregiver work challenges and (3) caregivers adaption to recovery. Across the observational studies (n=22), similar themes were found. The trend across seven intervention studies focused on caregiver information needs related to patient disease management and symptom monitoring, and support for caregivers to reduce symptoms of emotional distress.

CONCLUSION

Informal caregivers want to assist in the care of their significant others after hospital discharge postcardiac surgery. However, caregivers feel insecure and overwhelmed and they lack clear/concise discharge information and follow-up support during the early at-home recovery period. The burden of caregiving has been recognised and reported since the early 1990s, but there remains a limited number of studies that assesses the effectiveness of caregiver interventions.

PROSPERO REGISTRATION NUMBER

CRD42018096590.

"It Changed Our Outlook on How We Want to Live": Cancer as a Transformative Health Experience for Young Adult Survivors and Their Family Members

Although young adult cancer survivors (YACSs) and their families face unique psychosocial and health-related challenges related to cancer, little is known about how the illness experience of cancer may positively transform their mental, physical, and social well-being following primary treatment. We conducted individual qualitative interviews with 30 YACSs and 21 of their family members. Participants described positive transformations as (a) perspective shifts on health and risk, (b) behavior changes toward more proactive healthy living, and (c) opportunities for more open communication about wellness. Few participants reported little to no transformation based on a fatalistic view of their diagnosis. Our findings illuminate important implications for health promotion and support in this population, including the role health care providers can play following primary treatment. We also discuss how YACSs can serve as important advocates for others and the need for more work exploring how and why positive illness transformations take place.

'Between a rock and a hard place': family members' experiences of supporting a relative with bipolar disorder

PURPOSE

Clinical guidelines emphasise the central role of family members in supporting people with bipolar disorder. However, there has been little focus on the challenges family members face in supporting their relative. This qualitative study explored the challenges of providing support to a relative with bipolar disorder, and how family members attempted to meet these challenges. Factors that helped or hindered their efforts were also explored, including experiences of professional support.

METHODS

Semi-structured interviews were conducted with 18 family members (partners, parents, adult children, and siblings). Transcripts were analysed using the Framework approach.

RESULTS

Participants faced numerous challenges pertaining to the nature of the disorder and specific illness phases, their relative's responses to their attempts to help, and the limitations of support from healthcare professionals. Although participants were resourceful in managing these challenges, they strongly valued professional input. Six themes were identified: 'Not knowing: like being in a minefield', 'It's out of my control: sitting waiting for the next thing to happen', 'Treading on eggshells', 'Picking up on signs', 'Times of crisis: between a rock and a hard place', and 'I have to make my voice heard'.

CONCLUSIONS

Family members supporting a relative with bipolar disorder face significant challenges but show considerable resourcefulness in managing them. The findings underline the importance of input from healthcare professionals to help family members effectively support their relative and manage the challenges they face. Professional support should be strengths-based, and tailored to family members' needs.

Goal-Directed Drinking Behaviors Can Be Modified Through Behavioral Mimicry

PURPOSE

This study tested whether behavioral mimicry can alter drinking behavior. It was hypothesized that participants would increase drinking behaviors given increased confederate drinking but not cup touching.

METHODS

Nineteen healthy adults (Mage = 20.32 years) completed 2 picture description tasks; during 1 task, a confederate frequently sipped water (complete drinking gesture), and during the other, the confederate touched her cup but did not drink (partial gesture). Outcome measures included number of drinks per minute, number of cup touches per minute, percentage of time spent drinking, and percentage of time spent touching the cup.

RESULTS

Participants spent more time drinking and had an increased drinking rate during the drinking condition versus the cup-touching condition. For a majority of participants, drinking rate increased during the drinking condition versus baseline. Drinking, but not cup touching, rate also increased given increased confederate cup touching for many.

CONCLUSIONS

Mimicry likely contributes to social modeling of drinking behaviors. This effect appears more robust given a complete target gesture (full drink); however, a partial goal-directed drinking gesture may also yield a mimicked response. Beyond the theoretical implications, these results provide directions for research investigating more naturalistic mechanisms for increasing dietary intake in various patient populations (e.g., individuals with dysphagia).

Normative Social Support in Young Adult Cancer Survivors

Following a cancer diagnosis, young adults (YAs; that is, 18-39) often experience altered social relationships with family, friends, romantic partners, and peers. In light of the social struggles YA patients and survivors report due to cancer's biographical disruption, we elicited narratives from 30 YA cancer survivors to examine how their normative perceptions of social support functioned to hinder and assist them in coping with the cancer experience. Through thematic narrative analysis of their individual accounts, YA survivors explained why and how they perceived various support attempts from peers and loved ones to be effective (i.e., being treated "normally"), ineffective (i.e., receiving pity, negative stories, rudeness, excessive self-monitoring, and returns from estrangement), and both effective and ineffective (e.g., instrumental and relational support) in integrating cancer into their biographies. Implications for the advancement of interpersonal communication theory and for the development of age-appropriate communication interventions, educational programs, and informational resources are discussed.

Meeting Weight Management Goals: The Role of Partner Confirmation

Social support research suggests romantic partners could play a vital role in the success of individuals' weight management (WM) efforts, but contradictory findings from previous research have impeded our understanding of how romantic partners influence weight management goal attainment. Employing a confirmation perspective, overweight participants (body mass index [BMI] greater than 25) who were actively trying to manage their weight (N = 53) were asked to respond to daily questionnaires for a period of 2 weeks regarding their interactions with their romantic partner. Diet, exercise, and general weight management goal accomplishment were assessed. HLM was employed to assess the independent and interactive effects of partner acceptance and challenge on each of these goals. Findings suggest that perceiving high levels of both acceptance and challenge from partners was associated with more general WM and diet goal accomplishment. However, greater attainment of exercise goals was associated with only challenge. Fluctuations in partner acceptance and challenge were also examined to determine whether consistency in confirmation behaviors was associated with WM goals. Hierarchical regressions revealed that fluctuations in acceptance, but not challenge, were linked with goal attainment. Specifically, fluctuations in acceptance were helpful for those whose partners were perceived to exhibit lower levels of acceptance, but fluctuations were detrimental for those whose partners exhibited greater acceptance. Implications for communication among couples in which one partner is attempting to lose weight are discussed.

"It has been a long journey from first knowing": narratives of unplanned pregnancy

Unplanned pregnancies come with risks of various health and financial consequences for women. Understanding such experiences is vital to aiding women in this health context; however, there is little research in this vein, particularly for college-aged young women. Narratives of unplanned pregnancy may help to shed light on the experiences of these women, leading to greater understanding and more congruent and helpful support communication, prevention, and education resources. The present study aimed to identify themes in unplanned pregnancy narratives. Stories for women who had continued their pregnancies differed from those of women who did not continue their pregnancies, and overall, narratives seemed to work toward positively reappraising and making sense of the experience, especially in terms of autonomy, as well as seeking affirmation and support for decisions made. Implications of these results will be discussed in terms of future narrative work in the unplanned pregnancy context.

Dilemmas families face in talking with returning U.S. military service members about seeking professional help for mental health issues

Drawing on Goldsmith's (2004) normative theory, this article maps dilemmas family members experience when talking with returning service members (SMs) about seeking mental health care. Eighty family members of United States SMs who served in Iraq or Afghanistan read a scenario where their SM was displaying posttraumatic stress disorder (PTSD) or depression symptoms. Participants described goals they would pursue, barriers they might encounter, and advice they would give others in the situation. Four dilemmas of talking about mental health emerged: (a) getting you to recognize the problem without implying you're not normal, (b) convincing you to seek help without implying you're weak, (c) being persistent but patient, and (d) wanting you to open up without implying I can understand. Family members reported using four groups of strategies to manage these dilemmas. Directions for expanding the concept of dilemmas as "paradoxes" and for supporting military families as well as rethinking policy assumptions are discussed.

Elderly patients' heart-related conditions: Disclosing health information differs by target

Americans are living longer, and many are managing at least one chronic illness. Having people with whom to disclose health information is a salient component of managing a chronic health condition, such as heart disease. The purpose of this study is to explore differences in elderly patients' health disclosures by target (i.e. disclosing to a partner vs. another person). Elderly patients (>age 60) with a diagnosed heart-related condition (n = 273) completed a survey regarding sharing information about their health condition. Results indicated significant differences between the two groups in perceived support; breadth, depth, and frequency of disclosures; and disclosure of psychological/emotional symptoms, physical symptoms, and talk about heart-healthy behaviors. No significant differences were found between the two groups for relationship quality and efficacy. Patients who reported sharing information with a partner reported significantly more health information disclosures compared to patients who reported sharing information with another person.

Communication dilemmas in the context of cancer: survivors' and partners' strategies for communicating throughout survivorship

More people are now living longer beyond cancer treatment and are facing the complexities associated with survivorship. Communicating amid a cancer experience, for example, can be difficult for couples, and survivors must face these challenges for extended periods of time. The current study employed a communication perspective to explore couples' conversations throughout cancer survivorship. In-depth interviews with 35 cancer survivors and 25 partners yielded insight into the specific communicative challenges couples face after completing cancer treatment. The data highlight cancer's lingering uncertainties and are discussed in terms of the dyadic challenges inherent in couples' communicative efforts.

A Dyadic Approach

The purpose of the present study was to apply Berg and Upchurch’s developmental-conceptual model toward a better understanding of how couples cope with chronic illness. Specifically, a model was hypothesized in which proximal factors (relational quality), dyadic appraisal (illness interference), and dyadic coping (partner support) influence adjustment (health condition management). The study was cross-sectional and included 308 dyads in which one partner has a chronic health condition. The actor partner interdependence model shows how congruence and noncongruence in relational quality, dyadic appraisal, and dyadic coping influence dyadic adjustment.

"I tell my partner everything . . . (or not)": patients' perceptions of sharing heart-related information with their partner

This study is grounded in theories of information management. Patients with a diagnosed heart-related condition (N=253) completed a survey regarding their perceptions of sharing/not sharing information with a partner about their health condition. Data were analyzed using descriptive and inferential statistics. Results indicated that although most patients reported sharing "everything" with their partner, others reported not sharing certain topics such as health issues and physical symptoms/ailments. In addition, patients who reported sharing everything with a partner reported significantly greater communication efficacy, and breadth, depth, and frequency of communication about a heart-related condition compared with those who reported not sharing certain topics. Finally, as hypothesized, there were no significant group differences in terms of sharing specific physical and psychological health information. We discuss the findings and implications of the study for nursing practice.

Re-birth after coronary bypass graft surgery: a hermeneutic-phenomenological study

Although coronary artery bypass graft surgery has significant effects on reducing the symptoms of coronary artery disease, there is not enough knowledge and understanding of lived experience of patients after surgery. Understanding lived experience of this group of patients would be helpful for healthcare staff to provide better services to the patients. The aim of this study was to describe with a deeper understanding, the lived experiences of patients after Coronary Artery Bypass Graft Surgery. Using a hermeneutic phenomenological approach and a Van-Manen analysis method, in-depth semi-structured interviews were conducted with eleven participants who had lived experienced of at least six months post - coronary artery bypass graft surgery. Re-birth was the main theme that emerged in the process of data analysis. This theme was derived from four sub-themes including "feels younger", ''vigorous heart'', ''intrepid life'' and ''oriented to be healthy''. Life after a coronary artery bypass graft surgery is often appreciated as a re-birth by persons with these experiences as surgery did not only provide a feeling of wellness, but also added a sensation of youthfulness and improvement in the quality of life for these participants. In addition, they would actively participate in health promotional activities such as; adherence to medication and diet regimes, changes in lifestyle to maintain their health.

Social support communication in unplanned pregnancy: support types, messages, sources, and timing

Pregnancy is a time of uncertainty and stress for many women, and these aspects are compounded for those facing unplanned pregnancies. Social support communication is considered a vital part of healthy outcomes in pregnancy but is largely unexplored in the unplanned pregnancy context, particularly for college-aged young women. The present study aimed to identify various dimensions of social support in unplanned pregnancy for this population, including support types desired and enacted, sources of support, support types helpful in various stages of this health experience, and message strategies used in helpful support communication. Results of an online semi-structured survey exploring message content and these other elements were analyzed through qualitative and quantitative content analysis as well as statistical analysis. Nurturing support, specifically network support, was found to be most desired in this health context, and the message strategies found in the most helpful support messages differed according to support type. Source and timing of support were also factors in the most helpful types of support in this context. Implications of these results will be discussed in terms of future research in social support in the unplanned pregnancy context.

The partners for life program: a couples approach to cardiac risk reduction

Morbidity and mortality are reliably lower for the married compared with the unmarried across a variety of illnesses. What is less well understood is how a couple uses their relationship for recommended lifestyle changes associated with decreased risk for illness. Partners for Life compared a patient and partner approach to behavior change with a patient only approach on such factors as exercise, nutrition, and medication adherence. Ninety-three patients and their spouses/partners consented to participate (26% of those eligible) and were randomized into either the individual or couples condition. However, only 80 couples, distributed across conditions, contributed data to the analyses, due to missing data and missing data points. For exercise, there was a significant effect of couples treatment on the increase in activity and a significant effect of couples treatment on the acceleration of treatment over time. In addition, there was an interaction between marital satisfaction and treatment condition such that patients who reported higher levels of marital distress in the individuals condition did not maintain their physical activity gains by the end of treatment, while both distressed and nondistressed patients in the couples treatment exhibited accelerating gains throughout treatment. In terms of medication adherence, patients in the couples treatment exhibited virtually no change in medication adherence over time, while patients in the individuals treatment showed a 9% relative decrease across time. There were no condition or time effects for nutritional outcomes. Finally, there was an interaction between baseline marital satisfaction and treatment condition such that patients in the individuals condition who reported lower levels of initial marital satisfaction showed deterioration in marital satisfaction, while non satisfied patients in the couples treatment showed improvement over time.

Do practitioners and friends support patients with coronary heart disease in lifestyle change? a qualitative study

Background

Healthy lifestyles help to prevent coronary heart disease (CHD) but outcomes from secondary prevention interventions which support lifestyle change have been disappointing. This study is a novel, in-depth exploration of patient factors affecting lifestyle behaviour change within an intervention designed to improve secondary prevention for patients with CHD in primary care using personalised tailored support. We aimed to explore patients’ perceptions of factors affecting lifestyle change within a trial of this intervention (the SPHERE Study), using semi-structured, one-to-one interviews, with patients in general practice.

Methods

Interviews (45) were conducted in purposively selected general practices (15) which had participated in the SPHERE Study. Individuals, with CHD, were selected to include those who succeeded in improving physical activity levels and dietary fibre intake and those who did not. We explored motivations, barriers to lifestyle change and information utilised by patients. Data collection and analysis, using a thematic framework and the constant comparative method, were iterative, continuing until data saturation was achieved.

Results

We identified novel barriers to lifestyle change: such disincentives included strong negative influences of social networks, linked to cultural norms which encouraged consumption of ‘delicious’ but unhealthy food and discouraged engagement in physical activity. Findings illustrated how personalised support within an ongoing trusted patient-professional relationship was valued. Previously known barriers and facilitators relating to support, beliefs and information were confirmed.

Conclusions

Intervention development in supporting lifestyle change in secondary prevention needs to more effectively address patients’ difficulties in overcoming negative social influences and maintaining interest in living healthily.

Communicating in complex situations: a normative approach to HIV-related talk among parents who are HIV+

Parents with HIV/AIDS are confronted with unique challenges when discussing HIV-related information with their children. Strategies for navigating these challenges effectively have not been systematically examined. In this study, we conducted in-depth interviews with 76 parents with HIV/AIDS who had children ages 10-18 years. Guided by O'Keefe and Delia's definition of a complex communication situation and Goldsmith's normative approach to interpersonal communication, we examined parents' goals for discussing HIV-related information, factors that made conversations challenging, and instances where these conversational purposes conflicted with one another. Our data reveal the following parent-adolescent communication predicaments: relaying safety information about HIV while minimizing child anxiety, modeling open family communication without damaging one's parental identity, and balancing parent-child relational needs amid living with an unpredictable health condition. Parents also described a variety of strategies for mitigating challenges when discussing HIV-related topics. Strategies parents perceived as effective included reframing HIV as a chronic, manageable illness; keeping talk educational; and embedding HIV-related topics within more general conversations. The theoretical and practical applications of these findings are discussed with regard to their relevance to health communication scholars and HIV care professionals.

Autonomy support, self-regulation, and weight loss

OBJECTIVE

Social support is believed to contribute to weight loss success, yet the type of support received is rarely assessed. To develop more effective weight loss interventions, examinations of the types of support that are associated with positive outcomes are needed. Self-Determination Theory suggests that support for an individual's autonomy is beneficial and facilitates internalization of autonomous self-regulation. We examined whether autonomy support and directive forms of support were associated with weight loss outcomes in a larger randomized controlled trial.

METHOD

Adults (N = 201; 48.9 ± 10.5 years; 78.1% women) participating in a weight loss trial were assessed at 0, 6, and 18 months. Autonomy support (AS), directive support, and autonomous self-regulation (ASR) were measured at 0 and 6 months and examined in relation to 18-month weight loss outcomes.

RESULTS

Baseline AS and ASR did not predict outcomes; however, AS and ASR at 6 months positively predicted 18-month weight losses (ps < .05), encouragement of healthy eating at 6 months was negatively related to 18-month weight losses (p < .01), and other forms of directive support were not associated with outcomes.

CONCLUSIONS

Autonomy support predicted better weight loss outcomes while some forms of directive support hindered progress. Weight loss trials are needed to determine whether family members and friends can be trained to provide autonomy support and whether this is more effective than programs targeting more general or directive forms of support.

Coping Experiences: A Pathway towards Different Coping Orientations Four and Twelve Months after Myocardial Infarction-A Grounded Theory Approach

Background. Patients recovering from a myocardial infarction (MI) are faced with a number of serious challenges. Aim. To create a substantive theory on myocardial infarction patients' coping as a continuum. Methods. Grounded theory method was used. Data were collected by using individual interviews. The informants were 28 MI patients. Results. The core category “coping experiences—a pathway towards different coping orientations” includes 2 main categories: “positive and negative coping experiences” (4 months after MI) and “different coping orientations” (12 months after MI). Conclusion. Coping with a myocardial infarction is a long-term dynamic process of dealing with varied emotions and adjustment needs. Coping is threatened, if the patient denies the seriousness of the situation, suffers from depression and emotional exhaustion, or if there are serious problems in the interaction with family members. This study stresses the importance of recognizing the patient's depressive state of mind and the psychological aspects which affect family dynamics. A more family-centered approach involving a posthospital counseling intervention is recommended. Relevance to Clinical Practice. The results of this study can be used in nursing care practice when organizing support interventions for myocardial infarction patients.

Beyond initial disclosure: the role of prognosis and symptom uncertainty in patterns of disclosure in relationships

This study is framed in Greene's (2009) health disclosure decision-making model (DD-MM) and explores the role of prognosis and symptom uncertainty in patterns of disclosure in a close relationship. Toward this end, an uncertainty and disclosure model is hypothesized in which prognosis and symptom uncertainty and relational quality are expected to predict perceived partner support, communication efficacy, and the depth, breadth, and frequency of disclosure to a partner about a chronic health condition. Patients with diagnosed heart-related conditions visiting a private medical office were recruited to complete anonymous surveys. Results indicated that (1) the key mechanisms identified in the DD-MM are associated with the depth, breadth, and frequency of disclosure to a partner about a health condition, and (2) uncertainty plays a prominent role in people's communication with their partner about the heart-related condition. The findings and implications of the study are discussed.

The nature of communication work during cancer: advancing the theory of illness trajectories

More theory development about interpersonal communication during cancer is needed so that scholarship can be advanced and practical applications of findings can be best disseminated and applied. We proposed an evidence-based extension to the theory of illness trajectories based on findings from a qualitative study of cancer survivors' (n = 40) experiences with communication. Grounding our analysis in respondents' descriptions of the demands, obligations, and preparatory activities involved in discussing their cancer, we theorized the construct of communication work, which focuses on the labor and resources devoted to managing talk during cancer and living with illness. Findings are discussed in terms of how this conceptualization presents new opportunities for research and practice.

Managing multiple goals in supportive interactions: using a normative theoretical approach to explain social support as uncertainty management for organ transplant patients

In this study, we used a normative theoretical perspective to examine the relationship between uncertainty management and support in the lives of organ transplant patients. We conducted in-depth interviews with 8 pretransplant and 30 posttransplant patients, including individuals who were waiting for or had received a kidney, liver, heart, or pancreas. Interview transcripts were analyzed using a grounded theory approach, which involved two levels of thematic analysis. Participants reported that others provide assistance in various ways, and that this social support entailed a number of challenges. Participants also described several strategies for handling these support dilemmas. These findings suggest that the effectiveness of support is related to how well multiple goals (including uncertainty-related goals) are managed in the supportive interaction.

Meanings and dilemmas of sexual safety and communication for transgender individuals

HIV prevention efforts stress interpersonal communication skills and their protective benefits; however, research on sexual communication has lagged behind interventions that emphasize communication. This project was undertaken to determine how sex talk unfolds in a specific relational and sociocultural context--the transgender community-as well as what constitutes effective or satisfying safer sex talk. Goldsmith's normative theory guided semistructured interviews with 41 transgender individuals. Transgender participants held multiple, often competing goals in safer sex conversations, which resulted in communicative dilemmas. Creative management strategies allowed participants to achieve desired outcomes, like safer sex, without threatening identities and relationships. Implications for communication and health behavior theory and practice are discussed in light of these findings.

"Nobody thinks twice about asking": women with a fertility problem and requests for information

For women with a fertility problem, responding to questions about childbearing, pregnancy, and the nature of infertility is a salient issue. In this study of talking about infertility, women described their experiences in handling such requests for information. Results suggest that requests come in a variety of forms, that women attribute multiple and potentially conflicting meanings to such requests, and that requests can elicit a variety of responses. From a communication standpoint, such inquiries suggest the varied ways that conversational partners can attempt to elicit disclosive information, thus enabling or constraining the emergent nature of the interaction.