Decision making in cancer-related topic avoidance

Unveiling the silent suffering: Examining the complexities of disclosure and concealment strategies in women living with obstetric fistula

Obstetric Fistula (OF), one of the tragic birth injuries in developing countries, overwhelms women living with this condition with multifaceted effects. Although concealing has been justified in some studies, revealing is also encouraged. Such uncertainty leaves women in a loop of tension in managing the disclosure or non-disclosure of their diagnosis. They resort to several strategies to manage their private information. Using Communication Privacy Management (CPM) Theory, this study documents the disclosure or non-disclosure strategies that women living with OF adopt to manage their diagnosis information. Data was derived from semi-structured interviews conducted with 19 women either living with OF presently or have lived with it before. The thematic analysis yielded categories of who, when, what, and how. These categories were further subdivided into nine specific practices or strategies for revealing. However, the categories under the non-disclosure focused on only who and how, where four themes emerged. This study has both practical and theoretical significance by identifying disclosure and non-disclosure intervention strategies useful for providing relief for women diagnosed with OF.

Navigating the Decision to Disclose Mental Illness in the Workplace: The Role of Leader Motivating Language and Perceived Organizational Support

Mental health disclosure in the workplace has drawn much attention as it comes with multiple benefits such as reducing financial burden, facilitating relationships, and counteracting related stress. Drawing on insights from the disclosure decision-making model, motivating language theory, and organizational support theory, the study presents a model that pictures the underlying mechanisms of the disclosure decision-making process. The findings from a survey of 416 participants suggested that the direction-giving and empathic language strategy can lead to employees' perceived organizational support. Such perception can help them reduce anticipated negative outcomes when considering disclosure and increase their disclosure efficacy, which in turn increases their disclosure intention.

Examining the role of pre-visit anxiety on patient uncertainty and breast cancer patient-provider communication

OBJECTIVE

Effective communication between cancer patients and providers is critical for addressing psychological distress, reducing uncertainty, and promoting patient well-being. This is particularly relevant during medical appointments that may elicit uncertainty, such as surgical consultations for newly diagnosed women with breast cancer. This study aimed to evaluate how pre-appointment anxiety and illness uncertainty affect patient-provider communication in breast cancer surgical consultations and subsequent post-appointment well-being. Breast cancer patient anxiety has been studied as an outcome of provider communication, though less is known about the extent to which preexisting anxiety or uncertainty act as antecedents to effective patient-provider communication.

METHODS

This study analyzed videorecorded breast cancer surgical consultations (N = 51) and corresponding patient surveys to understand how pre-appointment anxiety influences pre-appointment patient uncertainty, patient-provider communication during the appointment, and subsequent post-appointment uncertainty.

RESULTS

The proposed model achieved good fit to the data such that more pre-appointment anxiety was associated with more pre-appointment uncertainty, more pre-appointment anxiety was associated with more empathic opportunities per minute, and more empathic opportunities were associated with less post-appointment uncertainty.

CONCLUSIONS

Results indicate breast cancer patients with anxiety pre-appointment are at-risk for more illness uncertainty and are more likely to explicitly provide empathic opportunities. This supports the need for added attention to empathic opportunities to not only address patients emotionally but to also assess whether a patient may be at higher risk of having preexisting anxiety.

Linking patient-centered communication with cancer information avoidance: The mediating roles of patient trust and literacy

OBJECTIVES

This study, drawing on the pathway mediation model developed by Street and his colleagues (2009) that links communication to health outcomes, explores how patient-centered communication affects cancer information avoidance.

METHODS

Data was gathered through online access panel surveys, utilizing stratified sampling across Germany, Switzerland, the Netherlands, and Austria. The final sample included 4910 non-cancer and 414 cancer patients, all receiving healthcare from clinicians within the past year.

RESULTS

The results demonstrated that patient-centered communication is directly associated with reduced cancer information avoidance, especially among cancer patients. Additionally, this association is indirectly mediated through patient trust and healthcare literacy.

CONCLUSION

The findings provide empirical evidence that reveals the underlying mechanism linking clinician-patient communication to patient health information behavior.

PRACTICE IMPLICATIONS

The potential of clinician-patient communication in addressing health information avoidance is highlighted by these findings. Future interventions in healthcare settings should consider adopting patient-centered communication strategies. Additionally, improving patient trust and literacy levels could be effective in reducing cancer information avoidance.

Making Sense of Gynecologic Cancer: A Relational Dialectics Approach

This study used the relational dialectics theory (RDT) as a theoretical lens to examine how the interplay of competing discourses shaped meaning making about gynecologic cancer. A reflexive thematic analysis of the narratives of 12 survivors of cervical cancer, ovarian cancer, and uterine cancer in Arkansas showed two discursive struggles at play, including continuity of care versus change, and voicing versus repressing of feelings. The findings showed that long history of care with physicians contributed to how participants privileged the discourse of continuity of care when faced with a decision to travel for care or receive care locally. We also found that cultural discourses about concealing women's cancer-afflicted bodies, lack of supportive spaces for women to discuss side effects of cancer treatments, and appropriate communication behavior between patients and physicians shaped the interplay of the discursive struggle of voicing versus repressing. The findings extend the RDT by showing that geographic location, disease characteristics, history of care between patients and physicians, and prevailing cultural discourses can contribute to the interplay of discursive struggles in the gynecologic cancer context. Further, the findings suggest to healthcare professionals to address harmful discourses about gynecologic cancer to help create support avenues for survivors.

Understanding the role of parents' information sharing and withholding on emerging and young adults' caregiving and coping during their parents' advanced cancer

Emerging and young adult caregivers (EYACs) who provide care to their parents are a hidden, unsupported population of caregivers. Research identifies information sharing or withholding as a key aspect of caregivers' ability to cope and adjust, which may be especially critical when a parent is diagnosed with advanced cancer. The goal of this study was to examine the impact of parent information sharing/withholding on EYACs' caregiving and coping experiences. We conducted in-depth, semi-structured interviews with 33 EYACs between the ages of 18-35 who cared for a parent that died of advanced cancer. Interview transcripts were thematically analyzed. Three factors played a role in how parents' information sharing/withholding affected EYACs' caregiving/coping: 1) topic, 2) timing, and 3) who is included. Findings highlight the adaptive functioning of parents' information sharing and negative outcomes associated with information withholding, illustrating how parents' disclosure decisions function to promote or inhibit EYACs' care involvement and coping.

Adult-Child Caregivers' Family Communication Experiences after an Older Parent's Blood Cancer Diagnosis: A Survey Exploring Their Openness, Avoidance, and Social Support

Adult-child caregivers of an aging parent living with a blood cancer describe struggling to communicate with one another and within the family system. They may avoid critical care conversations, which may impede care and their ability to receive social support. We examined what approaches adult-child caregivers of a parent diagnosed with a blood cancer use to enhance their family communication, the topics they find most challenging to discuss, and the roles of openness and support. We used qualitative and quantitative approaches to analyze data from a larger online survey study. In partnership with the Leukemia & Lymphoma Society, we recruited 121 adult-child caregivers. Responses to one open-ended item were analyzed to capture strategies used to enhance communication with their parent and family. They reported utilizing digital communication modalities, prioritizing frequent communication, engaging in openness, establishing boundaries, kinkeeping, and enacting support. Within the quantitative data, we further explored two of these themes (openness and support) and their relationships to other variables using t-tests and regression analysis. Adult-child caregivers and diagnosed parents avoid talking about mortality and negative feelings. Openness in the family about cancer was linked to caregivers' perceptions of receiving social support. Findings demonstrate that cultivating openness between midlife adult children and diagnosed parents may enhance opportunities to receive support.

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.

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.

Openness and topic avoidance in interpersonal communication about ovarian cancer: An uncertainty management perspective

This study examined openness and topic avoidance in interpersonal communication about ovarian cancer. Guided by the uncertainty management theory, the researchers analyzed qualitative data from 28 ovarian cancer patients/survivors and found openness and topic avoidance to be complex communication behaviors which are connected to patients/survivors’ uncertainty. Participants appraised uncertainty about disease prognosis and effectiveness of treatments as a threat; thus, they avoided topics such as treatment side effects and fears about death and disease recurrence to manage such uncertainty. Furthermore, findings showed that communication about ovarian cancer is layered with degrees of openness and avoidance relative to respective audiences and changing illness trajectories. Overall, the findings indicate connections between interpersonal communication about ovarian cancer and uncertainty management practices, suggesting that intervention efforts should help cancer patients/survivors and relational others practice sensitivity when discussing topics such as death and dying.

Misconception on oxygen administration among patients and their caregivers in Ado Ekiti, Nigeria

Introduction:

Appropriate oxygen administration is a life-saving therapy; however, patients and their caregivers could decline such therapy for several reasons. Poor perceptions may delay consent to oxygen therapy. There is a lack of data on the perception of oxygen use among patients and caregivers in our setting. Hence, this study was aimed at evaluating the perception of patients and their caregivers toward emergency oxygen use in a tertiary hospital in Nigeria.

Materials and Methods:

This survey was a descriptive cross-sectional study conducted between December 2017 and May 2018 at a tertiary hospital in southwestern Nigeria. We administered a structured questionnaire to 334 eligible patients and their 539 caregivers while on admission.

Results:

A significant proportion of the patients compared to their caregivers have had oxygen therapy in the past 40.6% versus. 6.9% P < 0.0001. The majority of the participants (patients vs. caregivers 84.7% vs. 81.1% P = 0.511) believed oxygen therapy to be beneficial and safe for use (patients vs. caregivers 79.4% vs. 78.6%; P = 0.8949). However, 21.1% of patients and 19.5% of caregivers believed it is solely for terminally ill patients. More than 50% of patients and caregivers thought oxygen can cause adverse effects and fire outbreaks. Most of the respondents considered oxygen therapy as expensive (patients vs. caregivers; 78.2% vs. 87.2%; P = 0.0176) which was regarded as a possible barrier to treatment (patients vs. caregivers 81.9% vs. 85.0% P = 0.3893). <1% of both patients and their caregivers have had any form of training in basic life support.

Conclusion:

The misconceptions about oxygen use require urgent attention by raising community awareness and knowledge toward improving the acceptability of this life-saving intervention.

Efficacy of a dyadic intervention to improve communication between patients with cancer and their caregivers: A randomized pilot trial

OBJECTIVE

Cancer-related communication is critical for patients' and caregivers' adaptation to illness. This randomized pilot study was conducted to test the feasibility, acceptability, and efficacy of a specific dyadic intervention to improve communication.

METHODS

A four weekly-session intervention was developed to reinforce cancer-related patient-caregiver communication. Patients receiving treatment for any diagnosed cancer, and their caregivers, were recruited from two oncology clinics in Belgium. Sixty-four patient-caregiver dyads were assigned randomly to intervention and waitlist groups. Cancer-related dyadic communication, dyadic coping and emotional distress were assessed at baseline and post-intervention.

RESULTS

The intervention attrition rate was 6 %. Linear mixed models were performed on 60 dyads. Significant two-way group × time interaction indicated improvement in participants' cancer-related dyadic communication frequency (β = -1.30; SE = 0.31; p =  .004), self-efficacy (β = -10.03; SE = 3.90; p =  .011) and dyadic coping (β = -5.93; SE = 2.73; p =  .046) after the intervention.

CONCLUSION

These results indicate that the brief dyadic communication intervention is feasible and acceptable, and show preliminary evidence of efficacy.

PRACTICE IMPLICATIONS

Encouraging patients and caregivers to discuss personal cancer-related concerns may improve their ability to cope with the illness together.

"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.

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.

"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.

Men's and Women's Approaches to Disclosure About BRCA-Related Cancer Risks and Family Planning Decision-Making

Little is known about how men and women who test positive for a BRCA gene mutation or have a strong family history of carrying a BRCA mutation manage disclosures about their BRCA-related cancer risks and family planning decision-making. By conducting interviews with 25 men and 20 women, this study investigated men's and women's approaches to disclosing their BRCA-related cancer risks and family planning decision-making. Guided by the Disclosure Decision-Making Model (DD-MM), this study demonstrates that men and women assess both information and the recipients of disclosures when making disclosure decisions. Theoretical implications for the DD-MM are discussed along with practical implications for hereditary cancer risk and family planning.

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.

Dyadic Perceptions of the Decision Process in Families Living With Lung Cancer

PURPOSE/OBJECTIVES

To use dyadic analyses to identify determinants of patients' and family members' perceptions of the positive and negative aspects of the decision-making process in families living with lung cancer. 
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DESIGN

Cross-sectional study. 
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SETTING

Community setting in Greater Portland, Oregon.
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SAMPLE

109 family care dyads (patient and family member) recruited from a statewide cancer registry. 
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METHODS

Surveys were completed in-person, separately, and privately by each member of the family care dyad. Secondary analysis was completed using multilevel modeling. 
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MAIN RESEARCH VARIABLES

Negative and positive aspects of the decision process. 
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FINDINGS

Level 1 data revealed significant variability across care dyads' positive or negative perceptions of the decision-making process. Level 2 results for negative perceptions of decision making indicated that patient and family member perceptions were significantly associated with their own depressive symptoms and feelings of not being listened to by others. Level 2 results for positive perceptions of decision making indicated that patient and family member perceptions were significantly inversely associated with their own feelings of not being listened to and being in nonspousal relationships. In addition, family members' perceptions were more positive when the patients were older. 
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CONCLUSIONS

This study highlighted the complexity of the decision-making process in families with lung cancer, and underscored the importance of the care dyad feeling listened to by family members in the context of life-threatening illnesses. 
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IMPLICATIONS FOR NURSING

Nurses assisting families with decisions about lung cancer should be aware of the dynamics of the care dyad and how the decision process is perceived by patients and their family members.

Planning a Stigmatized Nonvisible Illness Disclosure: Applying the Disclosure Decision-Making Model

This study applied the disclosure decision-making model (DD-MM) to explore how individuals plan to disclose nonvisible illness (Study 1), compared to planning to disclose personal information (Study 2). Study 1 showed that perceived stigma from the illness negatively predicted disclosure efficacy; closeness predicted anticipated response (i.e., provision of support) although it did not influence disclosure efficacy; disclosure efficacy led to reduced planning, with planning leading to scheduling. Study 2 demonstrated that when information was considered to be intimate, it negatively influenced disclosure efficacy. Unlike the model with stigma (Study 1), closeness positively predicted both anticipated response and disclosure efficacy. The rest of the hypothesized relationships showed a similar pattern to Study 1: disclosure efficacy reduced planning, which then positively influenced scheduling. Implications of understanding stages of planning for stigmatized information are discussed.