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. Author manuscript; available in PMC: 2022 May 19.
Published in final edited form as: Health Commun. 2020 Jan 8;36(6):714–721. doi: 10.1080/10410236.2020.1712039

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

Amy K Otto a, Dana Ketcher a, Richard E Heyman b, Susan T Vadaparampil a, Lee Ellington c, Maija Reblin a
PMCID: PMC9118123  NIHMSID: NIHMS1803351  PMID: 31910681

Abstract

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.

Introduction

Life-limiting cancer impacts both the patient and their spouse caregiver. Not only will the cancer become a stressor for both (e.g., both spouses will be taking on new roles and may be worried about the patient’s health), but patients and their spouse caregivers often engage in dyadic coping. This involves making sense of and negotiating how to manage the illness together. Various models and theories of dyadic coping exist (Traa, De Vries, Bodenmann, & Den Oudsten, 2015), but the Cognitive-Transactional Model of couples’ adaptation to chronic illness is a recent model that synthesizes and extends previous work (Badr & Acitelli, 2017). In this model, individual appraisal and coping becomes dyadic when the ownership of an illness is shared, or in response to the sharing of an individual coping process. Further, the effectiveness of coping on individual or relationship outcomes is dependent on self- and dyadic-efficacy.

Because individual coping processes often need to be shared to encourage dyadic coping, communication is a key component to the Cognitive-Transactional Model (Falconier & Kuhn, 2019). Several reviews on couples coping with cancer have suggested that better communication between couples is associated with more congruent beliefs and goals and higher levels of intimacy and relationship satisfaction (Li & Loke, 2014; Traa et al., 2015). Other work has found that communication is a specific unmet desire for caregivers, who recognize that communication can be difficult but want more of it (Fried, Bradley, O’Leary, & Byers, 2005). A systematic review of psychosocial interventions for cancer caregivers suggested that communication skills interventions might particularly improve caregiver quality of life (Waldron, Janke, Bechtel, Ramirez, & Cohen, 2013). Additionally, worse dyadic communication is associated with lower concordance between patient and caregiver preferences regarding end-of-life decisions (Shin et al., 2015), which may increase the risk of patients receiving medical care that is inconsistent with their preferences. Perceived or actual incongruence between a patient’s received care and preferences is also associated with greater patient physical distress and psychological distress (Mack, Weeks, Wright, Block, & Prigerson, 2010), lower quality of life (Mack et al., 2010), and greater health care utilization costs (Teno, Fisher, Hamel, Coppola, & Dawson, 2002). Interventions that improve communication, and thus quality of life (Waldron et al., 2013), then have the potential to improve well-being for both patient and caregiver. However, the evidence base is scant when it comes to determining what is normal or ideal for communication about cancer for patients and their spouse caregivers (Badr, 2017). Some research indicates that positive communication, such as self-disclosure, partner responsiveness, and engagement will facilitate positive psychological outcomes in couples coping with cancer, whereas more hostile communication behaviors, such as criticism, will compromise these outcomes (Manne & Badr, 2008).

Thus far, little attention has been paid to caregiver outcomes. A recent priority statement (Kent et al., 2016) identified informal cancer care burden as a key area for research. Although some research exists to determine factors that influence caregiver burden, much of this work focuses on populations with early-stage cancer (Manne et al., 2004; Scott, Halford, & Ward, 2004; Van Ryn et al., 2011). Notably, caregivers for patients at later disease stages are at increased risk for anxiety and depression (Kurtz, Kurtz, Given, & Given, 2005; Rhee et al., 2008; Rumpold et al., 2016). Some research suggests that communication between caregivers and patients is a determinant of caregiver burden, as would be expected from the Cognitive-Transactional Model (Falconier & Kuhn, 2019). Without effective communication, dyadic coping is impeded. Further, self-reported preparedness for caregiving is important. Caregiver preparedness in previous work has been shown to be a key factor for caregiver well-being and can predict aspects of role strain (Archbold, Stewart, Greenlick, & Harvath, 1990), quality of life (Rha, Park, Song, Lee, & Lee, 2015), and multiple dimensions of mood (Schumacher, Stewart, & Archbold, 2007).

More research is needed with a focus on communication in couples coping with advanced cancer (Given, Given, & Kozachik, 2001) and to determine how patient-caregiver communication impacts caregiver burden. Additionally, little research has been done to determine how communication impacts caregiver preparedness for caregiving.

Objectives

First, we sought to describe cancer-related communication between advanced cancer patients and their spouse caregivers. Second, we aimed to describe how dyadic communication patterns are related to caregivers’ reported burden and preparedness for caregiving. We hypothesized that more positive communication during stressful cancer-related discussions would be related to higher self-reported caregiver preparedness and lower self-reported caregiver burden, whereas more hostile communication would have the inverse effect.

Materials and methods

The present study is a secondary analysis of data gathered as part of a prospective observational study of couples coping with advanced cancer. A detailed description of study methods can be found elsewhere (Reblin et al., 2018). All procedures were conducted with Institutional Review Board approval.

Recruitment

Couples consisting of advanced cancer patients and their spouse caregivers were recruited from thoracic and gastrointestinal oncology clinics at a National Cancer Institute Designated Comprehensive Cancer Center. Inclusion criteria for patients were (a) a diagnosis of stage III or IV non-small cell lung cancer or pancreatic, esophageal, gastric, gallbladder, colorectal, hepatocellular, or bile duct cancer; (b) a Karnofsky Performance Status (KPS) score of 70+ at time of enrollment; (c) a physician-estimated prognosis of more than 6 months; and (d) undergoing active treatment at the cancer center. Patients had to be cohabiting with a spouse or partner who self-identified as providing some care and who also agreed to participate in this study. All participants were required to be over 18 years of age and able to communicate in English.

Procedure

Participants provided informed consent and were asked to complete a self-report questionnaire independently. Patients and caregivers reported on demographics. Caregivers also completed measures of caregiver burden and preparedness for caregiving:

Montgomery Caregiver Burden Scale (MCBS)

The MCBS is a 14-item, 3-subscale measure assessing the impact of caregiving on three dimensions of burden: Objective Burden, Demand Burden, and Stress Burden (Montgomery, Gonyea, & Hooyman, 1985; Montgomery, Stull, & Borgatta, 1985). Objective Burden is the perceived interruption of tangible aspects of a caregiver’s life. Demand Burden is the perceived demands of caregiving responsibilities. Stress Burden is the perceived emotional response to caregiving responsibilities (Ferrell & Mazanec, 2009; Montgomery et al., 1985). Responses are given on a five-point Likert-type scale ranging from 1 (a lot less) to 5 (a lot more).

Family Care Inventory (FCI) – Preparedness subscale

The 8-item Preparedness subscale of the FCI assesses the perceived level of preparation for various facets of caregiving such as dealing with physical needs and emotional problems, as well as previous caregiving experience (Archbold et al., 1990; Schumacher et al., 2007).

After completing the questionnaires, the couple was asked to interact with each other in two structured discussions used in previous research (Manne et al., 2004). First, couples engaged in a 10-minute neutral discussion in which they were instructed to talk as normally as possible about something they recently saw on television or read. Next, participants independently completed the Cancer Inventory of Problem Situations (Heinrich, Schag, & Ganz, 1984), in which a list of 20 common cancer concerns (e.g., lack of energy, finances, overprotection) are rated as being not a problem, somewhat of a problem, or a severe problem. After completing this measure, concerns that (a) at least one member of the couple rated as a severe problem, or (b) both members of the couple rated as at least somewhat of a problem were used as a prompt for a cancer-related problem discussion. Couples were asked to have a 10-minute conversation describing the concerns, how the concerns made them feel, and why they felt the concerns were a problem. Discussions were audio-recorded.

Trained coders coded and timestamped communication behaviors within discussion audio recordings using the Rapid Marital Interaction Coding System, 2nd Generation (RMICS2; Heyman, Wojda, Hopfield, & Salas, 2015). Although the problem discussion was of primary interest for the present study, both discussions were coded using RMICS2. The unit of analysis used in the present study was speaker turn, whereby each time an individual takes the floor to speak is a turn. For instance, an interaction where the patient speaks, the caregiver speaks, and the patient speaks again consists of three turns. Codes represent the emotional valence of the speaker’s behavior (verbal and paraverbal) during the turn and are organized into a continuum from negative (i.e., hostile) to positive: high hostility, low hostility, constructive problem discussion, low positivity, and high positivity. Constructive problem discussion represents a more emotionally neutral discussion of the problem or conversational topic. Two other communication codes exist outside of this hostility-positivity continuum: dysphoric affect and other. Each speaker turn is given a single communication code. If a speaker turn includes more than one type of communication behavior, it is coded based on the most salient behavior during that speaker turn. If multiple behaviors are equally salient during a speaker turn, the code is assigned using on a hierarchy based on intensity and valence: A high-intensity code supersedes a low-intensity code; a negative code supersedes a positive code, which supersedes the neutral code, which supersedes the “other” code.

Codes and examples are described in Table 1. Because high-intensity behaviors were relatively infrequent in the present study, high- and low-intensity hostility were collapsed into a single hostility variable for analysis; similarly, high- and low-intensity positivity were collapsed into a single positivity variable. The frequency of each code was calculated and divided by the total number of speaker turns in the discussion (including both patient and caregiver speaker turns); thus, participants were left with a total score for each of the five codes (i.e., hostility, constructive problem discussion, positivity, dysphoric affect, and other) that represented a percentage of the total speaker turns in the discussion.

Table 1.

Descriptions and examples of RMICS2 codes.

Code Definition Examples
Hostility, High-Intensity (HH) Intense negative affect. Includes contempt, belligerence, and character assassination.

  • Why are we still even in this relationship?

  • Of course – you always think about yourself. That’s just what you do.
Hostility, Low-Intensity (HL) Mild to medium intensity negative affect. Includes blame/criticism (focus on behavior instead of character) and demands.

  • I’m bothered by you not fixing anything around the house.

  • Shut up.

Constructive Problem Discussion (PD) Includes descriptions of the problem, solutions, and questions.

  • When I take that medication I feel groggy.

  • We could be better at scheduling.
Positivity, Low-Intensity (PL) Measured positive affect and low-level bonding within the couple. Includes (low-intensity) self-disclosure, humor.

  • This is my favorite time of day.

  • I appreciate that you cleaned the house the other day without me asking you to do so.
Positivity, High-Intensity (PH) Intense positive affect, and statements that focus on deep connection and character. Includes (high-intensity) self-disclosure, humor.

  • I love you.

  • You’re the funniest person I know.
Dysphoric Affect (DY) Sad or depressed expressed emotional states. Includes negative self-evaluations and helplessness.

  • I’m useless. I can’t even mow the lawn anymore.

  • I just don’t know what else I can do.

Other (OT) Talk about the experimental situation.

  • Do you think the recorder stopped?

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A random sample of 20% of problem discussions was coded by a second coder to calculate interrater reliability; interrater agreement was excellent, with kappa values on all codes collapsed by interaction ranging from .76 to .98.

Analysis

To address the first aim, descriptive statistics were calculated for the neutral and problem discussion communication variables. Paired-samples t-tests were conducted to evaluate differences in communication between caregivers and patients as well as between men and women.

For each participant, a difference score was calculated for each RMICS2 variable to account for any baseline individual differences in communication; for example, those who are more hostile during a neutral discussion would be expected to be more hostile during a cancer-related problem discussion. To address the second aim, these patient and caregiver difference scores (for hostility, positivity, constructive problem discussion, and dysphoric affect) were entered in a path analysis as predictors of caregiver burden and preparedness for caregiving.

Results

Table 2 provides demographic information on the sample, which comprised 84 patient-caregiver dyads.

Table 2.

Demographic characteristics (N = 84 dyads).

Patients
 Caregivers
Variable M SD M SD
Age 66.6 9.3 64.4 9.1
Years in relationship – – 34.2 15.6
n % n %
Female 24 28.6 60 71.4
Ethnicity
 Non-Hispanic/Latinx 81 96.4 77 91.7
 Hispanic/Latinx 3 3.6 5 6.0
 Missing 0 0.0 2 2.4
Race
 White/Caucasian 79 94.0 77 91.7
 Black/African American 4 4.8 3 3.6
 American Indian/Alaska Native 1 1.2 1 1.2
 Other 0 0.0 1 1.2
 Missing 0 0.0 2 2.4
Education
 7–11 years 3 3.6 2 2.4
 High school graduate or equivalent 13 15.5 13 15.5
 Some college, or vocational school 28 33.3 30 35.7
College graduate (4 years) 15 17.9 13 15.5
 Some graduate or professional school 6 7.1 6 7.1
 Graduate or professional degree 19 22.6 20 23.8
Employment
 Not currently employed 64 76.2 51 60.7
 Employed part-time 5 6.0 10 11.9
 Employed full-time 14 16.7 20 23.8
 Missing 1 1.2 3 3.6
Annual household income
 $10,000–$24,999 5 6.0 4 4.8
 $25,000–$39,999 12 14.3 13 15.5
 $40,000–$49,999 8 9.5 8 9.5
 $50,000–$74,999 25 29.8 23 27.4
 $75,000 or more 32 38.1 35 41.7
 Missing 2 2.4 1 1.2
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Descriptive statistics for communication and caregiver self-report variables are displayed in Table 3. On average, caregivers reported relatively high levels of Objective Burden (M = 22.23), only slightly below the cutoff score of 23 (Montgomery et al., 1985). Demand Burden was somewhat lower (M = 11.80), but the average Stress Burden was over the established cutoff of 13.5 for elevated levels (M = 14.02). Caregivers reported feeling moderately prepared for caregiving on average (M = 21.33, possible range = 0–32).

Table 3.

Descriptive statistics for communication and caregiver self-report variables (N = 84 dyads).

Patients
 Caregivers
Variable M SD Mdn Min Obs Max Obs M SD Mdn Min Obs Max Obs
Questionnaire
 MCBS Objective Burden – – – – – 22.23 3.71 22 14 30
 MCBS Demand Burden – – – – – 11.80 3.03 12 4 19
 MCBS Stress Burden – – – – – 14.02 2.48 14 8 20
 FCI Preparedness – – – – – 21.21 6.28 21 5 32
Communication Variables: Neutral Discussion
 Hostility (High & Low Intensity) 0.23 0.71 0 0 4 0.34 0.96 0 0 5
 Constructive Problem Discussion 45.39 4.98 46.78 28 52 45.86 5.77 47 25 67
 Positivity (High & Low Intensity) 2.99 3.43 2.26 0 16 2.78 3.38 2 0 16
 Dysphoric Affect 0.24 0.82 0 0 5 0.05 0.26 0 0 2
 Other 0.91 1.77 0 0 8 1.15 2.13 0 0 11
 Grand Total (All Speaker Turns) 49.81 4.1 50 31 69 50.18 4.10 50 31 69
Communication Variables: Problem Discussion
 Hostility (High & Low Intensity) 0.57 1.39 0 0 8 0.97 2.00 0 0 11
 Constructive Problem Discussion 39.29 6.64 40.79 23 54 40.33 6.04 41 20 49
 Positivity (High & Low Intensity) 7.19 5.38 5.88 0 29 6.45 4.79 6 0 24
 Dysphoric Affect 2.03 3.22 0.81 0 13 0.96 2.17 0 0 13
 Other 0.92 1.57 0 0 8 1.28 2.24 0 0 10
 Grand Total (All Speaker Turns) 50.01 3.9 50 33 60 49.99 3.90 50 40 67
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In both the neutral and problem discussions, patients and caregivers averaged 50 speaker turns each. The most common type of behavior in both discussions was constructive problem discussion. The problem discussion had comparatively more affective codes (i.e., hostility, positivity, and dysphoric affect), which is unsurprising given the discussion topic. In the problem discussion, patients and caregivers did not significantly differ in hostility (t = −1.83, df = 83, p = .072) or positivity (; t = 1.16, df = 83, p = .251), but patients expressed significantly more dysphoric affect than caregivers (t = 3.15, df = 83, p = .002). Analyses comparing males and females revealed no significant differences in any of these communication variables.

Analyses to determine communication factors associated with caregiver preparedness and burden (see Figure 1) found no significant relationships between patient or caregiver communication variables and Objective Burden. Patient communication variables also were not associated with Demand Burden or Stress Burden. However, greater caregiver hostility was associated with greater Demand Burden (B = 0.27, z = 3.16, p = .002) and greater Stress Burden (B = 0.16, z = 2.11, p = .035); that is, when caregivers exhibited more hostility, they perceived caregiving to be more demanding and felt more stressed about caregiving responsibilities. Greater caregiver dysphoric affect was associated with significantly lower Stress Burden (B = −0.18, z = −2.18, p = .029), meaning that when caregivers exhibited more sadness, they felt less stressed about their caregiving responsibilities.

Figure 1. Simplified diagram of path model with results.

Figure 1.

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Note. Predictors represent difference scores (neutral discussion score subtracted from problem discussion score). Bolded lines indicate significant relationships (p < .05); thin, dotted lines represent non-significant relationships (p > .05).

Patient hostility was significantly associated with caregiver preparedness (B = 0.62, z = 2.00, p = .046), such that when patients exhibited more hostility, their caregivers felt more prepared for caregiving. Patient constructive problem discussion was also associated with increased caregiver preparedness (B = 0.34, z = 1.97, p = .049). No caregiver communication variables were associated with caregiver preparedness.

As the Cognitive-Transactional Model suggests that preparedness for caregiving (conceptualized as a form of self-efficacy) may be a mediating factor in the relationship between dyadic communication and caregiver outcomes, preparedness was also explored as a potential mediator of relationships between communication variables and caregiver outcomes. Preparedness was removed from the model as an outcome, and considered as a mediator of the remaining significant effects between hostility and Stress Burden, hostility and Demand Burden, and dysphoric affect and Stress Burden. However, preparedness did not significantly mediate any of these effects.

Discussion

This is one of the first studies to outline how advanced cancer patients and their spouse caregivers communicate about cancer. Because communication is a critical process through which couples make sense of cancer and coordinate coping (Badr, 2017; Traa et al., 2015), it is important to establish a sense of what typical and beneficial communication patterns look like before developing interventions.

The majority of communication about cancer in our study was emotionally-neutral constructive problem discussion. However, about 20% of talk in the problem discussions was more affective; of this affective talk, positivity vastly outweighed both hostility and dysphoric affect. This suggests that most of couples’ discussion about cancer-related concerns may involve information exchange, deliberation, and logistics, rather than emotional expression. This is similar to patterns seen in other cancer-relevant interpersonal interactions between patients and caregivers and their providers (Ellington, Clayton, Reblin, Donaldson, & Latimer, 2018; Laidsaar-Powell et al., 2016). However, when couples do express emotion, it most often is positive and rarely hostile. These patterns are similar to findings in previous research on non-clinically distressed couples (Braun, Mura, Peter-Wight, Hornung, & Scholz, 2010; Heyman, Eddy, Weiss, & Vivian, 1995; Manne et al., 2004). Further, these are, on average, long-term relationships among older adults. Previous research has shown that this population tends to optimize positive experiences, often by avoiding conflict (Luong, Charles, & Fingerman, 2011); more hostile relationships may have ended prior to this point.

Patient-caregiver communication patterns were not related to Objective Burden, although they were significantly associated with more subjective types of burden (i.e., Demand Burden and Stress Burden). This is similar to other work that suggests that although the actual tasks caregivers take on are important, the appraisal of tasks as either demands or opportunities can shape the caregiving experience (Fletcher, Miaskowski, Given, & Schumacher, 2012; Kang et al., 2013). Communication specifically may be a fundamental mechanism by which couples mutually appraise caregiving and process stress associated with cancer (Li & Loke, 2014). For example, more effective interpersonal communication may ensure patients and caregivers have congruent and mutually-agreed-upon expectations for care. When both individuals have agreed to the same expectations, it is less likely for conflict to arise.

Although positivity was more common than hostility in our study, patient hostility was more strongly associated with greater caregiver burden and, interestingly, preparedness. This may be due to the greater weight that negative emotional communication may carry in impacting psychosocial outcomes (Gottman, 1994; Manne, Badr, Zaider, Nelson, & Kissane, 2010; Manne et al., 2004). In contrast, previous work on dementia patient-caregiver communication and caregiver depression indicates that patient positive communication is linked to lower levels of caregiver depression (Braun et al., 2010). Our finding that caregiver hostility is associated with more subjective types of burden may indicate that hostility disrupts this congruence of expectations, leading to higher perceived caregiver burden. Evidence from research on dyads coping with cancer indicates that communication that inhibits open communication, like hostility, can have an adverse effect on outcomes (Regan et al., 2015). Alternatively, when expectations differ such that caregivers take on more than they can cope with, they may deplete their emotion-regulation capacity and respond with hostility (Arndt et al., 2014; Trougakos, Beal, Cheng, Hideg, & Zweig, 2015).

Only caregiver communication was associated with perceived caregiver burden, whereas only patient communication was associated with preparedness for caregiving. Although subjective burden and caregiver preparedness have often been highly correlated in previous research (Fujinami et al., 2015; Grant et al., 2013), our findings may indicate how these two related measures are distinguished conceptually. Burden may be a more intrapersonal assessment of one’s own current capacity, whereas preparedness for caregiving may be a more interpersonal assessment of one’s future capacity, based on the status of another individual. For example, a caregiver at any given time may feel overwhelmed and thus indicate high levels of burden, but because the patient seems to be improving, the caregiver may also indicate a high level of preparedness for future care. Similarly, our finding that increased patient hostility and constructive problem discussion was associated with greater caregiver preparedness may indicate that when patients are able to better communicate about their issues and even express anger, the caregiver may have a better sense of what is needed and the caregiving task may seem less daunting. Previous research indicates that although avoidance and protective buffering – hiding negative information or emotions from one another – are common in couples coping with advanced cancer, these strategies are associated with worse mental health outcomes and quality of life (Langer, Rudd, & Syrjala, 2007; Manne et al., 2007).

Less caregiver dysphoric affect predicted more Stress Burden (the emotional response to burden). Although, on its face, the finding that more caregiver-expressed sadness is related to lower emotional burden may be counterintuitive, in the general population it has been shown that non-hostile negative emotional expression may benefit relationship function (Campbell, Renshaw, & Klein, 2017). This type of emotional expression can indicate a need for social support and may serve to elicit comfort and help from others (Clark, Fitness, & Brissette, 2001; Clark, Pataki, & Carver, 1996); if met with a positive response, this expression can also increase intimacy, which has been shown to improve relationship outcomes and specifically adjustment to cancer (Manne & Badr, 2008; Reis & Franks, 1994).

Limitations

Because of the cross-sectional nature of our data, we are unable to determine the directionality of our results. For example, it is possible that caregivers who naturally communicate with more hostility during stressful situations are more prone to perceived burden; alternatively, caregivers who are experiencing higher levels of burden may lack emotional regulation and thus express more hostility in their communication. Our sample was also relatively homogeneous.

Further, our findings represent a single audiotaped conversation in a structured environment. As noted earlier, the conversations contained a large proportion of more emotionally-neutral constructive problem discussion behavior. The lack of video may have limited identification of non-verbal cues. Couples may also tend to have more emotionally-charged conversations during more transitional times, such as cancer diagnosis, progression, or response to treatment. Unfortunately, we did not have data on the length of time since the patient’s diagnosis or the details of their treatment and we were not able to explore this possibility. Whereas analogue discussions are widely-used in research and communication patterns are often are representative (Foster, Caplan, & Howe, 1997; Heyman, 2001), using a single audiotaped discussion does ignore the larger context of couples’ communication. It is possible that the preponderance of constructive problem discussion was related to the prompted, somewhat artificial nature of the conversation; for instance, being prompted to discuss a specific problem may have discouraged couples from sharing their emotions as much as they might during a typical conversation. However, it is also possible that the preponderance of constructive problem discussion behaviors seen in the present study reflected a preexisting tendency to engage in avoidance of more emotionally-charged discussion (Floyd & Rogers, 2004). To address all of these issues, a larger, more naturalistic, longitudinal study would better inform the ongoing process of communication’s impact on caregiver preparedness and burden.

Implications

Researchers have agreed that communication between advanced cancer patients and their spouse caregivers is an important mechanism for coping and, as such, it has been included as a component to many interventions to improve quality of life for patients and caregivers. However, there is little consensus about what communication should look like (Badr, 2017). This research suggests patient and caregiver communication patterns that are predictive of lower burden and higher preparedness for caregivers are marked by lower levels of caregiver and patient hostility, respectively, but also include caregiver expression of dysphoric affect and patient constructive problem discussion. This study represents an important first step toward understanding the types of communication that are most beneficial for patients and spouse caregivers when discussing cancer-related concerns. Future interventions may benefit from specifically targeting expression of negativity (including dysphoria and hostility) in both patients and caregivers. However, additional research is needed to determine when these communication behaviors are most beneficial, as well as specific levels of communication that are most effective.

Acknowledgments

The authors would like to thank the patient and caregiver participants who contributed to this work.

Funding

This work was supported by the American Cancer Society under ACS MRSG 13-234-01-PCSM (PI: Reblin).

Footnotes

Disclosure of potential conflicts of interest

No potential conflict of interest was reported by the authors.

Data availability statement

The data that support the findings of this study are available from the corresponding author, MR, upon reasonable request.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author, MR, upon reasonable request.

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