Abstract and Introduction
Background: Husbands of patients with breast cancer (HBCs) experience as much as or even more distress than patients. Husbands' coping strategies may predict their level of distress.
Objective: The present study examined the coping strategies of HBCs compared with husbands of women without cancer (HWCs) and the relationship between coping and various psychosocial variables.
Methods: Psychosocial and physical health correlates of coping in both groups were assessed. Husbands of women with breast cancer (n = 83) and without breast cancer (n = 79) completed self-report questionnaires including the Ways of Coping Questionnaire, the Center for Epidemiological Studies Depression Scale, the Subjective Stress Scale, the Satisfaction With Life Scale, and the Locke-Wallace Marital Adjustment Test, in addition to measures of burden.
Results: The HBC and HWC groups were significantly different for 6 of the 8 coping styles assessed, with HBC using these strategies less than HWCs. Among HBCs, higher use of distancing, accepting responsibility, and escape-avoidance was associated with higher stress and symptoms of depression, and distancing and accepting responsibility were associated with lower marital satisfaction.
Conclusions: Results suggest that coping strategies may be different when dealing with cancer in a wife than at other times and that coping relates to well-being and is therefore worthy of focus.
Implications for Practice: Simple assessments of primary coping strategies may help clinicians identify HBCs in need of interventions. Husbands of women with breast cancer can be given problems to solve that will help them cope and help the patient and clinic staff as well. Interventions aimed at the couple, and not exclusively the HBC, may be particularly helpful.
In the cancer care arena, increasing emphasis is being directed at attending to the psychosocial needs of patients and their families. Family members are sometimes considered "second-order patients," as high stress levels in caregivers can interfere with their ability to provide support to the cancer patient. In this environment, husbands of breast cancer patients (HBCs) are receiving more and more attention from researchers as the negative impact of the cancer on their well-being is recognized. Distress among HBCs is as high as the patient's or higher, because of the cancer. Compared with husbands of women without illness, HBCs report worse physical and mental health regardless of the severity of the cancer. Wagner et al found among HBCs that the coping style they used was related to overall quality of life.
Coping is an important variable to examine because it traditionally has been conceptualized as a mediator between a stressor (in this case, breast cancer in a wife) and outcome (physical or mental deterioration). As such, it exercises quite a bit of influence over whether the stressor will result in negative outcomes for any one individual.
Coping has been defined as "…constantly changing cognitive and behavioral efforts to manage specific external and/or internal demands that are appraised as taxing or exceeding the resources of the person." It can serve several functions. Coping may prevent a stressful situation, help manage the situation, manage the meaning of the situation, or manage the stress symptoms associated with the situation. Husbands of women with breast cancer will need to use their repertoire of coping skills to manage their involvement in the cancer patients' illness and care, manage the meaning of the chronic illness for their families, and manage the stress symptoms associated with it.
To help manage the situation in the breast cancer context, HBCs may use problem-solving strategies to reduce the burden associated with the illness. Lazarus and Folkman characterized such strategies as problem-focused coping. For example, an HBC may actively participate in discussions with health care providers to ensure that effective medications are prescribed for the patient. Husbands of women with breast cancer also may use other forms of problem-focused coping to help manage their own stress associated with the patients' chronic illness, resulting in less negative outcomes. These strategies tend to be directed at internal processes. Common strategies include finding time to take care of one's own needs and the use of stress management techniques.
Another style of coping used by HBCs can be characterized as emotion focused. The meaning HBCs attribute to their wives' illness and to their own role in helping the patient cope with it will determine how stressful it becomes for them. Husbands of women with breast cancer who use coping strategies that make the situation seem less threatening, such as cognitive reappraisal, avoidance, or denial, may feel less stress/burden than those who view the patients' illness as unbearable. Emotion-focused coping may be used "…to maintain hope and optimism, to deny both fact and implication, to refuse to acknowledge the worst, to act as if what happened did not matter…." Examples of such coping strategies are the use of humor and remembering the relationship before the onset of the breast cancer, rather than focusing on the possibility that increased deterioration of the patient will continue to occur.
Lazarus and Folkman identify 3 possible ways in which coping can mediate the relationship between stress and poor health. First, coping influences neurochemical stress reactions. For example, research has shown that at different levels of perceived stress, coping is associated with different immune function responses. Second, when coping efforts used to deal with stress are noxious to the individual, such as using drugs or alcohol, individuals' health may suffer. Finally, sometimes the use of emotion-focused coping, which may involve denial or avoidance, prevents the individual from searching for solutions to a solvable problem and, as a result, becomes a counterproductive style.
A small but important literature examines coping strategies among HBCs-typically within the context of the dyadic relationship. The usual approach is to compare HBCs coping with patient coping and examine the effects of one on the other. This literature suggests that HBCs use fewer coping strategies than their wives and that their coping is mostly problem focused, although to a lesser degree than the patient's/wife's. Findings from this literature support general coping research in that coping style is associated with psychological functioning. For example, Kershaw et al found that avoidance coping in caregivers of breast cancer patients was associated with lower mental quality of life to a larger degree than any other strategy examined. Ptacek et al found problem-focused coping to be associated with higher marital satisfaction and emotion-focused coping to be associated with lower marital satisfaction.
These findings are significant because HBC coping styles have been associated with outcomes in the wives/patients. Problem-focused coping in the HBCs has been associated with higher marital satisfaction in the wife/patient, whereas emotion-focused coping in the HBCs is associated with distress in the patient.
No reports have yet been published, however, that describe in detail the coping strategies of HBCs, especially when compared with husbands of women without illness. Such data would allow us to further understand to what extent HBCs draw on their coping resources in the context of their wives' breast cancer, whether such coping strategies are effective, and, if so, which work best. Comparing the coping of HBCs with that of husbands of women who are not ill will allow us to identify differences in coping strategies between the groups. The findings may also shed light on the significance of the research that explains the impact of HBC coping on patient outcomes, as it would provide us with a snapshot of whether their coping in this situation is similar to their general coping style or whether coping gets blunted or changed in some way that is unique to this stressor. Finally, a clear understanding of how coping in these men is different from coping in men without this stressor may suggest avenues for interventions aimed at maximizing coping resources for this population.
The purpose of the present study was to examine in detail the coping strategies used by HBCs and to compare their strategies with those of husbands whose wives are not ill. Psychosocial and physical health correlates of coping in both groups were also examined, as was the relation between HBC coping and wife/patient illness variables.
Cancer Nurs. 2011;34(3):193-201. © 2011 Lippincott Williams & Wilkins