Everyday couples' communication research: Overcoming methodological barriers with technology

Exploring barriers to resilience among preoperative non-small cell lung cancer patients: a qualitative study in China

BACKGROUND

Resilience is crucial for lung cancer patients to navigate the challenges they face. However, current research on the barriers to resilience, particularly in relation to various levels of stressors, is limited. This study seeks to explore and analyze the barriers at various levels affecting resilience among preoperative lung cancer patients.

METHODS

A descriptive phenomenological qualitative research method was employed, conducting semi-structured interviews with 23 patients who had received a preliminary diagnosis of lung cancer and were preparing for surgical treatment. Data were analyzed using Colaizzi's seven-step method within the social-ecological framework.

RESULTS

Three categories and 11 themes were identified among lung cancer patients: (i) Micro-level system: Individual vulnerability (Fear of the unknown, Empathy for pain, Self-blame, Physical function decline, Waning interest). (ii) Meso-level system: Unstable family structure (Family enmeshment, Role conflicts, Communication barriers between couples). (iii) Macro-level system: Weak support systems (Lung cancer demonization, Workplace discrimination, Insufficient information support).

CONCLUSION

This study sheds light on barriers to resilience at the individual, family, and societal levels among preoperative lung cancer patients. Given the variability in patient experiences, there is a critical need for patient-centered psychological, informational, and self-management support. Particularly in China, enhancing public awareness of lung cancer stands as a vital measure. Exploring the intricate dynamics of the empathy for pain, familial enmeshment, and the demonization of lung cancer emerges as pivotal areas for future inquiry. These knowledge can inform enhanced pain management strategies, improved family support systems, and a more accurate and less stigmatizing perception of lung cancer.

TRIAL REGISTRATION

The registered No. from Chinese Clinical Trial Registry (CHICTR) was ChiCTR2300074853 and the registration date is August 17, 2023 (Archived by Webcite at https://www.chictr.org.cn/showproj.html?proj=205091 ).

Telehealth for the study of palliative care communication: opportunities, methodological challenges, and recommendations

BACKGROUND

While telehealth may offer promise for accessible, efficient palliative care delivery, leveraging telehealth technologies as an opportunity to better understand and advance the science of palliative care communication has been less well explored. Without identifying solutions to overcome challenges to conducting research in the virtual environment, we are unable to conduct the foundational work to offer evidence-based recommendations for high-quality telehealth, particularly in the context of palliative care. Our objective is to highlight methodological challenges in the use of telehealth for the study of palliative care communication and share lessons learned from using these methods.

METHODS

This paper is the result of a reflective process and experience across three ongoing observational communication research studies focused on the use of telehealth during serious illness. These research datasets have been collected from multiple sites and represent rural and urban telehealth palliative care consultations for patients receiving dialysis (n = 34), patients with cancer (n = 13), and seriously ill, home-bound patients (n = 9). We illustrate challenges, insights, and recommendations with case studies from these studies.

RESULTS

We identify key challenges, and offer recommendations to address them, in telehealth palliative care communication research. Key insights fall within three themes: 1) addressing accessibility barriers to enrollment in telehealth research; 2) technical considerations regarding how software and hardware choices have implications for data collection and analysis; and 3) ethical considerations regarding the nuances of consent and privacy in telehealth encounters.

CONCLUSIONS

Overall, our approach demonstrates possibilities for the use of telehealth to study palliative care communication and provides a "how-to" example for unique telehealth considerations from data collection through analysis. These strategies can facilitate success with large-scale health communication research studies in the telehealth context.

Effects of alcohol problem discrepancy on relationship adjustment: The moderating role of conflict negotiation among couples with alcohol use disorder and intimate partner violence

Alcohol use disorder (AUD) has well-known negative effects on romantic relationship functioning, including the occurrence of intimate partner violence (IPV). A separate literature focused on community couples indicates that relationship functioning is more likely to suffer when partners report greater discrepancies in alcohol consumption. It is important to expand this literature to couples with AUD and to examine the role of impactful AUD domains in dyadic functioning. Furthermore, few studies have examined adaptive, treatment-malleable factors that could potentially offset the negative impact of alcohol discrepancies on relationship functioning. This study examined the association between couples' alcohol problem discrepancies and relationship adjustment, as well as the moderating effect of self-reported adaptive conflict negotiation behaviors. Participants were 100 couples (N = 200 individual participants) with intimate partner violence wherein at least one partner met diagnostic criteria for AUD. Actor-Partner Interdependence Models indicated that greater alcohol problem discrepancy was associated with lower dyadic adjustment. Moderation analyses revealed that the highest level of relationship adjustment was observed among couples with lower alcohol problem discrepancy and greater negotiation behaviors, while relationship adjustment was similar for couples with larger alcohol problem discrepancy, regardless of negotiation behaviors. Although further study is needed to clarify under what specific conditions adaptive negotiation behaviors are most helpful, they appear to be beneficial for some couples in this sample. We found no evidence that negotiation behaviors may be harmful among these high-risk couples.

Spouse caregivers' identification of the patient as their primary support person is associated with better patient psychological well-being

Examine the impact of the primary-support person (PSP) role on advanced cancer patient and spouse caregiver psychological well-being, above and beyond the effects of relationship satisfaction.

Secondary analysis of cross-sectional questionnaire data.

88 advanced cancer patient/spouse-caregiver dyads.

Patients and caregivers independently completed measures assessing depression, anxiety, perceived stress, and relationship satisfaction, and identified their PSP. Patient and caregiver psychological well-being outcomes were regressed on patient and caregiver PSP variables in an actor-partner interdependence model.

Half of patients identified their caregiver as PSP; 9% of caregivers identified their patient as PSP. When caregivers identified their patient as PSP, the patient reported better outcomes. No associations were seen for patient identification of caregiver as PSP or caregiver well-being.

Clinicians can encourage patients to find ways to continue to focus on their relationship with the caregiver and help caregivers connect with other sources of support.

Social-Ecological Measurement of Daily Life: How Relationally Focused Ambulatory Assessment can Advance Clinical Intervention Science

Individuals’ daily behaviors and social interactions play a central role in the diagnosis and treatment of psychological disorders. Despite this, observational ambulatory assessment methods—research methods that allow for direct and passive assessment of individuals’ momentary activities and interactions—have a remarkably scant history in the clinical science field. Prior discussions of ambulatory assessment methods in clinical science have focused on subjective methods (e.g., ecological momentary assessment) and physiological methods (e.g., wearable heart rate monitoring). Comparatively less attention has been dedicated to ambulatory assessment methods that collect objective, relational data about individuals’ social behaviors and their interactions with their momentary environmental contexts. Drawing on extant social-ecological measurement frameworks, this article first provides a conceptual and psychometric rationale for the integration of daily relational data into clinical science research. Next, the nascent research applying such methods to clinical science is reviewed, and priorities for further research organized by the NIH Stage Model for Clinical Science Research are recommended. These data can provide unique information about the social contexts of diverse patient populations; identify social-ecological targets for transdiagnostic, precision, and culturally responsive interventions; and contribute novel data about the effectiveness of established interventions at creating behavioral and relational change.

Care provided by older adult caregivers to a spouse in active cancer treatment: a scoping review

PURPOSE

Due to population aging, the number of older adults with cancer will double in the next 20 years. There is a gap in research about older adults who are the caregiver of a spouse with cancer. Therefore, this review seeks to answer the overarching research question: What is known about the association of providing care on Health-Related Quality of Life (HRQOL), psychological distress, burden, and positive aspects of caregiving for an older adult caregiver to a spouse with cancer?

METHODS

This scoping review was guided by the framework of Arksey and O'Malley and refined by Levac et al. Comprehensive search strategies were conducted in Medline, Excerpta Medica Database (EMBASE), PsycINFO, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) from inception until April 15, 2021. Two independent reviewers screened abstracts, full text, and completed data abstraction. A gray literature search and two stakeholder consultations were conducted.

RESULTS

A total of 8132 abstracts were screened, and 17 articles were included. All studies outlined caregivers provided preventive, instrumental, and protective care to a spouse in active cancer treatment. However, the time spent on caregiving was rarely examined (n = 4). Providing care had a negative association on HRQOL, perceived burden, and psychological distress outcomes. Five studies examined positive experiences of caregivers.

CONCLUSION

The scoping review findings highlight the informal care provided by older adult caregivers to a spouse with cancer and how the care provided is associated with HRQOL, burden, psychological distress, and the positive aspects of caregiving.

The Psychosocial Impact of Spouse-Caregiver Chronic Health Conditions and Personal History of Cancer on Well-being in Patients With Advanced Cancer and Their Caregivers

CONTEXT

Caregiving during advanced cancer presents many physical and psychological challenges, especially for caregivers who are coping with their own history of cancer or their own chronic health conditions. There is growing recognition that caregiver health and patient health are interdependent.

OBJECTIVES

The objective of this study was to use quantitative and interview data to examine and explore the impact of a caregiver's personal cancer history and chronic health conditions on the psychosocial well-being of both the caregiver and patient.

METHODS

This was a secondary analysis of data from 88 patients with advanced lung/gastrointestinal cancer and their spouse-caregivers. Participants self-reported subjective health, chronic health conditions (including cancer), anxiety and depression symptoms, and social support and social stress. Caregivers self-reported caregiving burden and preparedness for caregiving. Caregivers also completed semistructured interviews.

RESULTS

Participants were mostly white, non-Hispanic, and in their mid-60s. Caregivers reported 1.40 (SD = 1.14) chronic conditions on average; 11 reported a personal history of cancer ("survivor-caregivers"). The number of caregiver chronic health conditions was positively associated with patient depression symptoms. Patients of survivor-caregivers also reported more depression symptoms than patients of caregivers without cancer (t(85) = -2.35, P = 0.021). Survivor-caregivers reported higher preparedness for caregiving than caregivers without cancer (t(85) = -2.48, P = 0.015). Interview data enriched quantitative findings and identified factors that may drive patient depression, including emotions such as resentment or guilt. Experiencing cancer personally may provide caregivers unique insight into the patient experience.

CONCLUSION

Providers should be aware of caregiver chronic conditions and cancer history, given the potential negative effects on patient psychosocial well-being.

Impact of Relationship and Communication Variables on Ambulatory Blood Pressure in Advanced Cancer Caregivers

BACKGROUND

Cancer impacts both patients and their family caregivers. Evidence suggests that caregiving stress, including the strain of taking on a new role, can elevate the risk of numerous health conditions, including high blood pressure (BP). However, the caregiver's psychosocial experiences, including their interpersonal relationship with the patient, may buffer some of the negative physiological consequences of caregiving.

PURPOSE

To examine the influence of psychosocial contextual variables on caregiver ambulatory BP.

METHODS

Participants were 81 spouse-caregivers of patients with advanced gastrointestinal or thoracic cancer. For an entire day at home with the patient, caregivers wore an ambulatory BP monitor that took readings at random intervals. Immediately after each BP reading, caregivers reported on physical circumstances (e.g., posture, activity) and psychosocial experiences since the last BP measurement, including affect, caregiver and patient disclosure, and role perceptions (i.e., feeling more like a spouse vs. caregiver). Multilevel modeling was used to examine concurrent and lagged effects of psychosocial variables on systolic and diastolic BP, controlling for momentary posture, activity, negative affect, and time.

RESULTS

Feeling more like a caregiver (vs. spouse) was associated with lower systolic BP at the same time point. Patient disclosure to the caregiver since the previous BP reading was associated with higher diastolic BP. No lagged effects were statistically significant.

CONCLUSIONS

Caregivers' psychosocial experiences can have immediate physiological effects. Future research should examine possible cognitive and behavioral mechanisms of these effects, as well as longer-term effects of caregiver role perceptions and patient disclosure on caregiver psychological and physical health.

The lump-versus-split dilemma in couple observational coding: A multisite analysis of rapid marital interaction coding system data

Historically, observational couple communication researchers have oscillated between splitting behaviors into narrowly defined discrete codes and grouping behaviors into broader codes-sometimes within the same study. We label this the "lump-versus-split dilemma." Coding across a decade and 11 investigators were used to recommend the most meaningful number of codes to use when observing couples' conflict. We combined data from 14 studies that used the Rapid Marital Interaction Coding System (RMICS) to score communication behavior during different-sex couples' conflict interactions. In each study, couples completed at least one 10-min, video-recorded conflict discussion. Communication during these interactions was coded by trained research staff using RMICS; all codes were compiled into a single data set for descriptive analysis and exploratory factor analyses (EFAs). The final sample comprised N = 2,011 couples. Several RMICS codes were extremely infrequent-specifically, distress-maintaining attributions, psychological abuse, withdrawal, dysphoric affect, and relationship-enhancing attributions. By far, the most frequent code was constructive problem discussion. EFAs yielded two factors for both women and men. Factor 1 (Negative) contained two items: distress-maintaining attributions and hostility. Factor 2 (Nonnegative) contained constructive problem discussion and humor (and, for women only, acceptance). Results side heavily with the "lump" camp in the lump-versus-split dilemma in couple observational coding. These RMICS factor analysis results converge with those from other systems and imply that the microanalytic "splitting" era in couples coding should draw to a close, with future studies instead focused on negative, neutral, and positive codes. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Communication between Advanced Cancer Patients and Their Family Caregivers: Relationship with Caregiver Burden and Preparedness for Caregiving

Cancer impacts spouse caregivers, especially when couples engage in dyadic coping around the cancer. Communication is a key factor in this process. Our goals were to describe cancer-related communication between advanced cancer patients and their spouse caregivers, and to describe how dyadic communication patterns are related to caregivers' reported burden and preparedness for caregiving. Caregivers completed measures of caregiver burden and preparedness for caregiving. Then, the patient and caregiver were asked to interact with each other in two structured discussions: a neutral discussion and a problem discussion focused on cancer. Discussions were coded using the Rapid Marital Interaction Coding System (RMICS2). Caregivers reported moderate levels of preparation and burden. Greater caregiver hostility communication predicted higher levels of caregiver burden, whereas greater caregiver dysphoric affect communication predicted lower levels of caregiver burden. Whereas positivity was more common than hostility in couples' communication, patient hostility was a significant predictor of caregiver preparedness. Patient neutral constructive problem discussion was also associated with increased caregiver preparedness. Caregiver outcomes are an understudied component to dyadic cancer research. Our paper describes observational data on cancer-related communication between caregivers and advanced cancer patients and communication's influence on caregiver outcomes. This work provides the foundation for future evidence-based communication interventions that may influence both patient and caregiver outcomes.

Listening to Family Life After Serious Pediatric Injury: A Study of Four Cases

Following a serious child injury, the entire family can be affected. Gaining an understanding of family support, interactions, and stress levels can help clinicians tailor treatment. Presently, these factors are assessed mainly via self-reports and structured observations. We aimed to explore the value of naturalistic observation of postinjury parent-child interactions, in order to highlight how clinicians might use these data in their practice. Our qualitative study involved an in-depth analysis of four cases from the Ear for Recovery project, against the backdrop of the larger sample's characteristics. Children who had been hospitalized with a serious injury wore the Electronically Activated Recorder (EAR). Over a two-day period postdischarge, the EAR recorded 30-second audio "snippets" every 5 minutes. Families also completed self-report measures on family functioning, child stress and social support, parent stress, optimism, and self-efficacy. For each case, two coders independently used an ethnographic method, integrating self-report measures, family and injury characteristics, audio recordings, and transcripts to mimic integration of information within clinical practice. The coders then reached consensus on the main themes for each case through discussion. Families showed substantial variation in their communication in terms of content, tone, and frequency, including moments of conflict, humor, and injury-related conversations. We explored how these recorded interactions converged with and diverged from the self-report data. The EAR provided an opportunity for rich descriptions of individual families' communication and activities, yielding potential clinical information that may be otherwise difficult or impractical to obtain.

In-home conversations of couples with advanced cancer: Support has its costs

OBJECTIVE

The goal of this study was to describe the quality of naturalistic communication between patients with advanced cancer and their spouse caregivers using observational methods. We also assessed the association between patient and caregiver communication behaviors and psychological and physical health using the actor-partner interdependence model.

METHODS

Data on 81 dyads were gathered as part of a prospective observational study. Patients with advanced cancer and their spouse caregivers completed demographic, physical health, and emotional well-being questionnaires. Cancer and relationship communication captured in "day-in-the-life" audio recordings were coded using Gottman's Turning System to assess the quality of bids for attention and responses.

RESULTS

Bids for attention were most often informational (Low Bids) and responses were mostly positive and effortful (Turn Towards); patients and caregivers did not significantly differ in communication behavior. More effortful bids for attention (High Bids) were associated with more positive and effortful responses. Patient communication behaviors were significantly associated with caregiver emotional well-being, whereas caregiver communication behaviors were significantly associated with their own emotional well-being and patient physical health.

CONCLUSIONS

While patients may benefit from caregivers' more positive and engaged communication at home, the emotional labor of focusing on and engaging the patient may take a toll on caregivers' own well-being. This work contributes to the understanding of what everyday communication looks like for patients with advanced cancer and their spouse caregivers and how this communication may impact physical and psychological health. Our findings provide a foundation to develop guidelines for psychosocial couple-based interventions.

Caring for a spouse with advanced cancer: similarities and differences for male and female caregivers

Most caregiving literature has focused on women, who have traditionally taken on caregiving roles. However, more research is needed to clarify the mixed evidence regarding the impact of gender on caregiver/patient psychological outcomes, especially in an advanced cancer context. In this paper, we examine gender differences in caregiver stress, burden, anxiety, depression, and coping styles, as well as how caregiver gender impacts patient outcomes in the context of advanced cancer. Eighty-eight patients with advanced cancer and their caregivers completed psychosocial surveys. All couples were heterosexual and most caregivers were women (71.6%). Female caregivers reported significantly higher levels of perceived stress, depression, anxiety, and social strain compared with male caregivers, and female patients of male caregivers were more likely to use social support as a coping style compared with male patients of female caregivers. These findings highlight the potential differences between male and female caregivers' needs and psychological health.

Dyadic effects of distress on sleep duration in advanced cancer patients and spouse caregivers

OBJECTIVE

Short sleep duration is a common problem for both advanced cancer patients and their spouse caregivers. Sleep and distress have been shown to be interdependent in patient-caregiver and spouse dyads, yet virtually, no work has explored the dyadic effects of psychological distress on sleep in advanced cancer patients and spouse caregivers. The goal of the present study was to examine the dyadic impact of anxiety and depression on sleep duration in a sample of advanced cancer patients and their spouse caregivers. It was hypothesized that, for both patients and caregivers, anxiety and depression in individuals would be associated with sleep duration in both themselves (actor effects) and in their spouses (partner effects).

METHOD

Advanced cancer patients and their spouse caregivers (N = 87 dyads) completed cross-sectional questionnaires assessing demographic variables, subjective health, subjective sleep duration, and anxiety and depression symptoms.

RESULTS

Controlling for sex, age, and subjective health, individuals' anxiety was negatively associated with their own and their partner's sleep duration. No significant actor or partner effects were found for depression.

CONCLUSIONS

Results provided partial support for hypotheses. Although past work has demonstrated links between subjective sleep disturbance and anxiety/psychological distress, this is one of the first studies to examine partner effects of distress on sleep disturbance in advanced cancer patients and spouse caregivers.

Behind closed doors: How advanced cancer couples communicate at home

OBJECTIVE

Describe communication between patients with advanced cancer and their spouse/partner caregivers.

DESIGN

Prospective observational study.

SAMPLE

83 advanced cancer patient-spouse caregiver couples.

METHODS

Couples completed surveys and recorded naturalistic communication for one day. Descriptive analysis was performed on self-report and observational communication data.

FINDINGS

Both patients and caregivers self-reported high likelihood of engaging in positive interactions. The majority of observed communication was logistical or social small-talk. Cancer and relationship talk was highly skewed; many couples had no talk in these domains.

CONCLUSION

This study is one of the first to assess continuous naturalistic observation of communication in the homes of couples coping with advanced cancer. We found that routine aspects of daily life continue even when couples are facing important challenges. Implications for Psychosocial Providers: There appear to be few naturalistic cues encouraging couples to discuss potentially difficult topics. More work is needed to determine appropriate levels of communication.