Natural language use and couples' adjustment to head and neck cancer

Cancer caregivers at the end-of-life: How much me vs. how much we?

OBJECTIVE

This study explored cancer caregivers' individual and communal coping through their use of personal and communal pronouns during naturally occurring conversations.

METHODS

Nurse-home hospice visits involving cancer patients and their partner caregivers were audio recorded and then transcribed. Pronoun use was analyzed using Linguistic Inquiry Word Count (LIWC) software and descriptive statistics compared patient and partner caregivers' pronoun use. Personal and communal pronoun use was examined within six identified topics of caregiver speech: patient medical care, daily life, emotion, criticism/disagreement, relationships with family/friends, and asserting needs.

RESULTS

Dyads (N = 76) had an average of 35.8 years in their relationship. Caregivers used proportionately more first-person singular (I-talk) than first-person plural (we-talk). However, they used significantly less I-talk than patients and less I-talk than LIWC measures in naturally occurring speech. Caregivers were most likely to discuss patient medical care (41.9%) and least likely to discuss their own needs (3.8%).

CONCLUSION

Partner caregivers may find it easier to express emotions related to communal stressors, rather than their individual ability to cope with end-of-life caregiving.

INNOVATION

Examining personal and communal pronoun use by partner caregivers during nurse-home hospice visits may provide a more objective measure of caregiver coping than standard self-report measures.

Hematopoietic Cell Transplantation Patient-Caregiver Dyad Perspectives on Participation in a Digital Storytelling Intervention: A Qualitative Approach

Storytelling has long been considered an effective means of communication, allowing the teller to process their emotions in light of particular life challenges. Effects on the listener also have been demonstrated to be beneficial, especially if the listener is faced with a similar life challenge. Less is known regarding the potential effects of storytelling on listening dyads and opportunities for joint processing following exposure to relevant stories. We sought to study these phenomena in the context of hematopoietic cell transplantation (HCT), a demanding medical procedure requiring intensive informal caregiving and thus great patient-caregiver entwinement. The purpose of this qualitative descriptive study was to explore participants' perceptions of a 4-week web-based digital storytelling (DST) intervention using both quantitative ratings of acceptability and qualitative coding of interviews conducted after intervention completion. A total of 202 participants (101 HCT patient-caregiver dyads) were recruited from the Mayo Clinic Arizona and randomized into either a DST arm or an Information Control (IC) arm. Participants in the DST arm rated the acceptability of the intervention and were asked to participate in a 30-minute phone interview to discuss their experience with the DST intervention. All interviews were recorded and transcribed verbatim and imported into NVivo 12 for coding and analysis, using a combination of deductive and inductive approaches to organize the data, create categories, and develop themes and subthemes. A total of 38 participants (19 HCT patient-caregiver dyads) completed the post-intervention interviews. Patients were 63% male and 82% White, 68% received allogeneic HCT, and their mean age was 55 years. The median time from HCT was 25 days (range, 6 to 56 days). Caregivers were mostly patients' spouses (73%) and female (69%), with a mean age of 56 years. In general, the 4-week web-based DST intervention was well accepted and liked by both patients and caregivers regarding the duration, dyadic participation, and convenience of participating in the intervention at home. Patients and caregivers who completed the DST intervention indicated that they were satisfied with the intervention (mean score, 4.5 of 5), were likely to recommend it to others (mean score, 4.4), would watch more stories (mean score, 4.1), and that the experience was worth their time (mean score, 4.6). Major themes that emerged from the qualitative analysis included (1) building communal connection through engaging with the stories; (2) positive emotional growth after HCT; (3) value of gaining the other's perspective; and (4) impact of open communication on the patient-caregiver relationship. A web-based DST intervention provides an attractive format through which to deliver a nonpharmacologic psychosocial intervention to HCT patient-caregiver dyads. Watching the emotional content in digital stories may help patients and caregivers cope with psychoemotional challenges together and provide an opportunity for emotional disclosure. Further work on determining optimal paths to disclosure is warranted.

Shared Responsibility and Network Collaboration in Caregiving

Communal coping may benefit caregivers, but most communal coping research focuses on dyads. Using an egocentric network design, we examine caregivers' we-talk-a linguistic marker of shared responsibility-and caregiver reports of 1) network member involvement in collaborative care roles and 2) met/unmet expectations across typically developing and rare disease contexts. We-talk was linked to involvement in direct care and support, but links of we-talk to decision-making varied based on network member closeness; we-talk was linked to meeting expectations for decision-making only. There were no differences across context, suggesting shared responsibility is linked to collaborative roles across caregiving contexts.

Couple-Based Communication Interventions for Cancer Patient-Spousal Caregiver Dyads' Psychosocial Adaptation to Cancer: A Systematic Review

(1) Background: Effective communication among couples in which one has been diagnosed with cancer is critical to improve their psychosocial adaptation to cancer. The objective of this review was to explore the characteristics and measurement outcomes of existing couple-based communication interventions in the cancer context. (2) Methods: Eight electronic databases were searched from database initiation to August 2022 to identify eligible articles. Hand searching was also performed on the included articles' reference lists and authors. (3) Results: A total of 14 intervention studies were eligible to be included in this review. Cancer couples with distress or communication problems before intervention were more likely to benefit from the couple-based communication interventions. Positive outcomes were reported, including an improvement in relationship functioning (including mutual communication, intimacy, and relationship satisfaction) and individual functioning (including a decline of anxiety, depression and cancer-related concerns, and an increase in psychological adjustment and quality of life). (4) Conclusions: These findings supported the importance of improving mutual communication behaviors to promote cancer patient-spousal caregiver dyads' psychosocial adaptation to cancer. While most included studies were conducted in western countries and the sample size was relatively small, more research is warranted to develop more efficacious couple-based communication interventions.

Links of we-talk to caregiver social network systems and health

Caring for a child, particularly one with a rare disease, presents a challenging set of stressors that can impact entire family networks. Given this shared impact, caregivers can engage in communal coping to address the caregiving process, defined as the perception of caregiving as shared and collaborative behaviors to address it. In this study, we examined one common measure of communal coping-first person plural pronouns or "we-talk"-in caregivers of either (a) children with rare or undiagnosed diseases or (b) typically developing children. We sought to examine how we-talk is linked to (a) caregiver health and well-being and (b) social network involvement in caregiving. Caregivers (n = 311) participated in (a) survey questionnaires (b) a network enumeration interview and (c) a semistructured interview of caregiving. Results indicated we-talk was unrelated to stress or self-rated health, but was linked to more benefit-finding; greater individual-focused language (I-talk) was also linked to worse self-rated health. Additionally, we-talk was unrelated to malfeasant behavior (e.g., overly critical), but was linked to less nonfeasant behavior (e.g., underinvolvement), more uplift behavior (e.g., helping with caregiving), and more health-related communication with network members. Further, these findings did not differ across caregiving context. This work highlights the role of communal coping for caregivers managing general parenting stress as well as the stress associated with caring for a child with complex medical needs. Future research should continue to examine how interpersonal coping processes operate within social networks to impact health and well-being for all involved. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Evaluating a couple communication skills training (CCST) intervention for advanced cancer: study protocol for a randomized controlled trial

BACKGROUND

For patients and their intimate partners, advanced cancer poses significant challenges that can negatively impact both individuals and their relationship. Prior studies have found evidence that couple-based communication skills interventions can to be beneficial for patients and partners. However, these studies have been limited by reliance on in-person treatment delivery and have not targeted couples at high risk for poor outcomes. This study tests the efficacy of a Couples Communication Skills Training (CCST) intervention delivered via videoconference for couples reporting high levels of holding back from discussing cancer-related concerns, a variable associated with poorer psychological and relationship functioning.

METHODS

This RCT is designed to evaluate the efficacy of CCST in improving patient and partner relationship functioning (primary outcome). Secondary outcomes include patient and partner psychological functioning and patient symptoms and health care use. We also examine the role of objective and self-reported communication behaviors as mediators of treatment effects. Two hundred thirty patients with advanced lung, gastrointestinal, genitourinary, and breast cancer and their partners will be randomized to CCST or an education control intervention. Participants in both conditions complete self-reported outcome measures at baseline, mid-treatment, post-treatment, and 3 months post-treatment. Objective measures of communication are derived from video-recorded couple conversations collected at baseline and post-treatment. An implementation-related process evaluation (assessing implementation outcomes and potential barriers to/facilitators of implementation) will be conducted to inform future efforts to implement CCST in real-world settings.

DISCUSSION

This trial can yield important new knowledge about effective ways to improve patient and partner adjustment to advanced cancer.

TRIAL REGISTRATION

This study trial is registered at clinicaltrials.gov (Trial # NCT04590885); registration date: October 19, 2020.

Natural language markers of social phenotype in girls with autism

BACKGROUND

Girls with autism spectrum condition (ASC) are chronically underdiagnosed compared to boys, which may be due to poorly understood sex differences in a variety of domains, including social interest and motivation. In this study, we use natural language processing to identify objective markers of social phenotype that are easily obtained from a brief conversation with a nonexpert.

METHODS

87 school-aged children and adolescents with ASC (17 girls, 33 boys) or typical development (TD; 15 girls, 22 boys) were matched on age (mean = 11.35 years), IQ estimates (mean = 107), and - for ASC participants - level of social impairment. Participants engaged in an informal 5-min 'get to know you' conversation with a nonexpert conversation partner. To measure attention to social groups, we analyzed first-person plural pronoun variants (e.g., 'we' and 'us') and third-person plural pronoun variants (e.g., 'they' and 'them').

RESULTS

Consistent with prior research suggesting greater social motivation in autistic girls, autistic girls talked more about social groups than did ASC boys. Compared to TD girls, autistic girls demonstrated atypically heightened discussion of groups they were not a part of ('they', 'them'), indicating potential awareness of social exclusion. Pronoun use predicted individual differences in the social phenotypes of autistic girls.

CONCLUSIONS

Relatively heightened but atypical social group focus is evident in autistic girls during spontaneous conversation, which contrasts with patterns observed in autistic boys and TD girls. Quantifying subtle linguistic differences in verbally fluent autistic girls is an important step toward improved identification and support for this understudied sector of the autism spectrum.

Factors associated with psychological distress for couples facing head and neck cancer: A systematic literature review

OBJECTIVES

Cancer patients in supportive relationships display improved health and survival outcomes. Identifying factors that might respond to intervention for Head and Neck Cancer (HNC) dyads is important as HNC patients and their partners experience heightened distress. This article systematically reviewed and evaluated the research findings and methodological quality of studies which identified factors influencing psychological distress for couples facing HNC.

METHODS

PsycINFO, Medline, and CINAHL were searched. Studies were included if they used validated psychological distress measures and quantitative data collection methods. Eleven studies satisfied inclusion criteria.

RESULTS

Studies identified factors associated with the psychological distress experienced by couples facing HNC, with substantial effect size variation. These factors included clinical, sociodemographic, relational, and psychological variables. Factors associated with increased psychological distress included disease burden, reduced social contact, perception of reduced relationship quality, and less adaptive/assimilative coping although the effect sizes displayed considerable heterogeneity. Overall, studies possessed good methodological quality but generally could have been improved by minimising the risk of non-response bias and fully reporting relational characteristics.

CONCLUSIONS

The implications of these results for clinical practice and future research are discussed. Further research is recommended to report effect sizes more consistently for both dyad members to gain greater insight into couple-level distress and to perform moderator analyses to identify which variables influence the magnitude of psychological distress.

Couple-based communication intervention for head and neck cancer: a randomized pilot trial

OBJECTIVE

To test feasibility and preliminary efficacy of a couple-based supportive communication (CSC) intervention for head and neck cancer (HNC) delivered during patients' oncology treatment.

METHODS

Twenty couples were randomly assigned to either a four-session CSC or a treatment-as-usual (TAU) condition. The CSC intervention primarily focused on increasing couple emotional disclosure, supportive listening, and social support. Patients and partners completed measures of individual and relationship functioning at baseline, post-intervention, and 6-month follow-up.

RESULTS

Ninety-eight percent of CSC sessions were completed and couples reported high levels of satisfaction with the intervention. Between-group effect sizes indicated that patients and partners in CSC reported improvements in individual and relationship functioning, relative to those in the TAU condition.

CONCLUSIONS

A couple-based communication intervention delivered during oncology treatment is feasible and acceptable in the context of HNC and may lead to improvements in individual and relationship functioning. Preliminary efficacy results are interpreted in the context of social-cognitive processing and intimacy theories.

TRIAL REGISTRATION

The trial was registered on www.clinicaltrials.gov (NCT01785576) first posted on February 7, 2013.

Couple identity and well-being in Chinese HIV serodiscordant couples: resilience under the risk of stigma

Resilience literature has suggested the context-specific nature of resilience while such framework has yet to be expanded to health psychology research among HIV serodiscordant couples. Conceptualizing a couple affected by chronic diseases using a "we-ness" framework rather than two separate individuals is important for stress coping of the couple. Considering this social-cognitive context of couple coping would be helpful to facilitate resilience of both the patient and the spouse. It is not clear whether couple identity serves as a protective factor for HIV serodiscordant couples and whether stigma, a prevalent contextual risk in this population, will alter the strength of such a protective effect on well-being. This longitudinal study examined the protective effect of couple identity in predicting the psychological and physical well-being of HIV discordant couples and the moderating role of stigma in such associations. A total of 160 Chinese HIV serodiscordant couples completed the baseline survey and follow-up one year later. Results showed that couple identity predicted fewer depressive symptoms at both the within- and between-couple level and better self-rated physical health at the between-couple level one year later. These protective effects were diminished when HIV stigma was high. This study highlights the importance of examining resources with consideration of contextual factors. It also calls for the sensitivity of stigma in developing a couple-based intervention for HIV serodiscordant couples.

New frontiers in couple-based interventions in cancer care: refining the prescription for spousal communication

BACKGROUND

The diagnosis and treatment of cancer is a life-altering experience that signals profound changes in a person's life. However, most people do not experience cancer in isolation or cope alone. Despite the fact that partners (i.e. spouses, significant others) provide emotional support and play a critical role in caregiving, cancer exacts a heavy toll on them and challenges their relationship with the patient by altering established communication patterns and roles. In recognition of this, a burgeoning literature involving couple-based interventions to improve patient and partner quality of life and adaptation has emerged. However, questions remain regarding how we can improve these interventions to exact greater impact on patient and partner outcomes.

MATERIAL AND METHODS

A narrative review of the literature on couples' communication processes in cancer was conducted in order to describe knowledge gaps and directions for future research.

RESULTS

Most couple-based interventions have included a communication skills training component because communication is an important process through which couples make sense of cancer, engage in social support, negotiate role changes and coordinate coping responses. However, scholars still know very little about what they should instruct couples to talk about, how often they should talk and when talking (or not talking) is beneficial (and for whom - the patient, partner, or both).

CONCLUSION

In order push this field forward, we need to develop a more nuanced view of couples' communication that acknowledges that there are multiple ways to talk, different aspects of the cancer experience to talk about, and preexisting communication patterns and preferences for different couples that may influence the utility of talk. Interventions that replace the unilateral and generic prescription to talk openly about cancer with targeted questions that prompt reflection on couples' unique strengths, preexisting communication patterns and support resources may thus help bolster the impact of couple-based interventions on patient and partner quality of life.

The decision-making process for breast reconstruction after cancer surgery: Representations of heterosexual couples in long-standing relationships

OBJECTIVES

Most people deal with intrusive life events such as cancer and the care trajectory together with their intimate partners. To our knowledge, no research has studied the involvement of the partner in the decision-making process regarding breast reconstruction (BR) after cancer. This study aimed to gain a better understanding of the couples' decision-making process for BR in the cancer context and particularly to investigate the partners' involvement in this process.

METHOD

Eighteen participants (nine women who underwent a mastectomy following a first breast cancer and their intimate partners) took part in this study. We conducted semidirective interviews, and a general inductive approach was chosen to capture the representations of the couples.

RESULTS

The women in the sample were aged between 33 and 66 years (M = 54, SD = 7.5) and their partner between 40 and 76 years (M = 59, SD = 11.6). The duration of their intimate relationship was on average 18 years (SD = 10.4; minimum = 4; maximum = 33). The analysis revealed 11 major themes. The two most salient ones were 'external influence' and 'implication of the partner'. The exploration of the subthemes revealed that the decision-making process is often reported as an interrelated experience by the couples and as a dyadic stressor. The partner's role is depicted as consultative and mostly supportive.

CONCLUSION

These results provide new insights on the involvement of the partner in decision-making. Thus, it now seems crucial to develop a prospective study, which will help understand the progression of the decision-making process over time. Statement of contribution What is already known on this subject? Most people deal with intrusive life events such as cancer and the care trajectory together with their intimate partners. Shared decision-making between patients and physicians is now the 'gold standard' in Western Europe and the United States. However, in the context of breast reconstruction (BR) after cancer, factors guiding the decision-making process for BR, especially the potential involvement of the partner, are not very well understood. What does this study add? Provides a qualitative insight on the specific nature of heterosexual couples' representations regarding the decision-making process for breast reconstruction after cancer. Reveals that the decision-making process is often reported as an interrelated experience by the couples and as a dyadic stressor. Underlines the consultative function of partners with women engaged in breast reconstruction.