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University of Southern California Dissertations and Theses

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Social support, constraints, and protective buffering in prostate cancer patients and their partners

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Social support, constraints, and protective buffering in prostate cancer patients and their partners

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SOCIAL SUPPORT, CONSTRAINTS, AND PROTECTIVE BUFFERING IN
PROSTATE CANCER PATIENTS AND THEIR PARTNERS

by
Sindy Oh
________________________________________________________________________

A Dissertation Presented to the
FACULTY OF THE GRADUATE SCHOOL
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
DOCTOR OF PHILOSOPHY
(PSYCHOLOGY)

May 2009

Copyright 2009 Sindy Oh

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Table of Contents
List of Tables iii
Abstract vi
Chapter 1: Introduction 1
Chapter 2: Specific Aims 14
Chapter 3: Methods 18
Chapter 4: Results 28
Chapter 5: Discussion 67
References 83
Appendix A 89
Appendix B 96
Appendix C 105
Appendix D 118
Appendix E 126
Appendix F 139

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List of Tables
Table 1: Spouses' Demographic and Medical Characteristics 30
Table 2: Patients' Demographic and Medical Characteristics 31
Table 3: Spouse and Patient Variables 33
Table 4: Descriptives and Paired T-tests for Spouse Variables 34
Table 5: Descriptives and Paired T-tests for Patient Variables 35
Table 6: Pearson Correlations for Spouse Variables at T1 and T2 39
Table 7: Pearson Correlations of Spouse Variables between T1 and T2 41
Table 8: Pearson Correlations for Patient Variables at T1 and T2 42
Table 9: Pearson Correlations of Patient Variables between T1 and T2 44
Table 10: Multiple Regression Analyses Examining the Role of 45
T1 Spousal Perception of Social Constraints from Patients
on T1 Spousal Affect

Table 11: Multiple Regression Analyses Examining the Role of 45
T2 Spousal Perception of Social Constraints from Patients
on T2 Spousal Affect

Table 12: Multiple Regression Analyses Examining the Role of 46
T1 Spouse Perception of Social Constraints from
Family/Friends on T1 Spousal Affect

Table 13: Multiple Regression Analyses Examining the Role of 46
T2 Spousal Perception of Social Constraints from
Family/Friends on T2 Spousal Affect

Table 14: Multiple Regression Analyses Examining the Role of 47
T1 Spousal Protective Buffering of Patients on T1 Spousal Affect

Table 15: Multiple Regression Analyses Examining the Role of 47
T2 Spousal Protective Buffering of Patients on T2 Spousal Affect

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Table 16: Multiple Regression Analyses Examining the Role of 49
T2 Spousal Perception of Protective Buffering by Patients on
T2 Spousal Affect

Table 17: Multiple Regression Analyses Examining the Role of 49
T1 Spousal Perception of Social Constraints from Patients on
Change in Spousal Affect

Table 18: Multiple Regression Analyses Examining the Role of 50
T1 Spousal Perception of Social Constraints from Family/Friends
on Change in Spousal Affect

Table 19: Multiple Regression Analyses Examining the Role of 51
T1 Spousal Protective Buffering of Patients on Change
in Spousal Affect

Table 20: Multiple Regression Analyses Examining the Role of 52
T1 Spousal Perception of Protective Buffering by Patients on
Change in Spousal Affect

Table 21: Multiple Regression Analyses Examining the Moderating 56
Role of T1 Spousal Protective Buffering of Patients on the
Relation between T1 Spousal Perception of Social Constraints
from Family/Friends and Change in Spousal Affect

Table 22: Multiple Regression Analyses Examining the Role of 57
T1 Spousal Negative Affect on T1 Spousal Support Provision
to Patients

Table 23: Multiple Regression Analyses Examining the Role of 58
T1 Spousal Negative Affect on T2 Spousal Support Provision
to Patients

Table 24: Multiple Regression Analyses Examining the Role of 59
T1 Spousal Positive Affect on T1 Patient Perceptions of
External and Internal Limitations on Communication

Table 25: Multiple Regression Analyses Examining the Role of 60
T1 Spousal Negative Affect on T1 Patient Perceptions of
External and Internal Limitations on Communication

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Table 26: Multiple Regression Analyses Examining the Role of 61
T1 Spousal Protective Buffering of Patients on Change
in Patient Affect

Table 27: Multiple Regression Analyses Examining the Moderating 62
Role of T1 Patient Perception of Social Constraints from
Spouses on the Relation between T1 Spousal Protective Buffering
of Patients and Change in Patient Affect

Table 28: Multiple Regression Analyses Examining the Moderating 63
Role of T1 Patient Perception of Protective Buffering by
Spouses on the Relation between T1 Spousal Protective Buffering
of Patients and Change in Patient Affect

Table 29: Multiple Regression Analyses Examining the Mediational 64
Role of T1 Spousal Perception of Social Constraints from
Patients on the Relation between T1 Spousal Perception of
Protective Buffering by Patients and Change in Spousal
Negative Affect

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Abstract

The social-cognitive processing model proposes that open communication within
a supportive environment facilitates processing and emotional adjustment following a
traumatic event. The study examined 2 types of limitations on communication- social
constraints and protective buffering- among prostate cancer patients and their spouses.
The purpose of the study was to investigate the relation of social constraints and
protective buffering on affect, as well as to explore potential mediators and moderators of
these relations. The study was a subset of a larger study that assessed the health-related
quality of life of prostate cancer patients who underwent laparoscopic radical
prostatectomy. Questionnaire data were obtained from 50 couples at two time-points:
prior to surgery and three months following surgery. The results indicated that greater
spousal perceived social constraint from patients significantly predicted less of a
reduction in spousal negative affect over time. Contrary to the study’s hypotheses,
spousal perceived social constraint from family/friends and spousal protective buffering
of patients were not significantly associated with changes in spousal affect over time.
Mediational relations from a social-cognitive perspective, specifically the role of
communication on the above relations, also were not supported. Greater spousal negative
affect was associated with greater provision of support to patients from both the spouses’
and patients’ perspectives. Spousal affect, however, was not associated with patients’
perceived social constraint from spouses or perceived protective buffering by spouses.
Exploratory findings revealed that greater spousal perceived protective buffering by

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patients significantly predicted less of a reduction in spousal negative affect, in part due
to greater spousal perceived social constraints. For patients, however, perceptions of
being buffered by spouses were not predictive of change in patients’ affect over time.
The results of the study suggest that it will be important for physicians and behavioral
medicine specialists to assess not only patients’ adjustment to cancer, but spouses’
adjustment and relationship factors as well. Additionally, couple’s interventions focusing
on dyadic interactions, specifically perceived social constraints and protective buffering,
could assist couples in coping with the challenges faced during illness.

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CHAPTER 1: INTRODUCTION
Prostate cancer is the most common cancer in men in the United States, with a 5
year survival rate of 99.9% for all stages (localized, regional, and distant) and a 100%
survival rate for local disease (American Cancer Society, 2007). Due to the high
prevalence of prostate cancer, coupled with its excellent prognosis, it is important to
understand the psychosocial impact of prostate cancer and its treatments. Although the
health-related quality of life of prostate cancer patients has received considerable
attention in the literature (see Eton & Lepore, 2002 for a review), research on the quality
of life and adjustment of their partners is limited (Kornblith, Herr, Ofman, Scher, &
Holland, 1994; Perez, Skinner, & Meyerowitz, 2002; Thornton, Perez, & Meyerowitz,
2004). Research on partners of other cancer patients has indicated that partners
experience similar levels of psychological and emotional distress as patients (Baider &
Kaplan De-Nour, 1984; Keitel, Zevon, Rounds, Petrelli, & Karakousis, 1990; Northouse
& Swain, 1987; Northouse, 1990; Northouse, Mood, Templin, Mellon, & George, 2000;
Oberst & James, 1985). Cancer diagnosis and treatment can be a traumatic experience
for partners, and some partners may experience emotional distress months after treatment
has ended. The present study examined emotional adjustment following prostate cancer
diagnosis and treatment from a social-cognitive processing perspective.
Cognitive Processing Theory
Before discussing the social context in which cognitive processing occurs,
cognitive processing theory will be addressed. According to cognitive processing

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theories, when an individual faces a traumatic event, one’s pre-existing mental schema,
consisting of basic assumptions and core beliefs about oneself and the world, may be
challenged, resulting in psychological distress (Janoff-Bulman, 1989). In order for
recovery to occur, one must successfully process and integrate the experience into
preexisting schematic representations (Creamer, Burgess, & Pattison, 1992; Horowitz,
1986). Confronting, contemplating, and re-assessing the experience is thought to
facilitate integration.
When confronted by a stressful life event, intrusive thoughts are believed to be a
normative response, and may initially be adaptive in processing (Creamer et al., 1992).
Although intrusive thoughts may be adaptive overtime, they are associated with
emotional discomfort, thus are thought to alternate with self-protective avoidance. This
process of alternating between intrusive thoughts and avoidance is believed to facilitate
cognitive processing by gradual repeated exposure and integration. Until the traumatic
event is processed, it remains in active memory and continues to produce intrusive
thoughts (Horowitz, 1986). Therefore, prolonged intrusion long past the event is thought
to be maladaptive, and indicative of incomplete cognitive processing, whereas a
reduction in intrusive thoughts is suggestive of successful cognitive processing.
Social Cognitive Processing Model
The Social Cognitive Processing Model, proposed by Lepore and colleagues
(1996), suggests that cognitive processing of a traumatic event occurs within a social
context. Talking about one’s experience in a supportive and positive environment is
believed to facilitate cognitive processing. On the other hand, individuals who are faced

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with constraining environments may have difficulty, or avoid sharing thoughts about their
trauma. If efforts to disclose thoughts and feelings are thwarted by an unsupportive,
unreceptive, and critical social environment, then cognitive processing may be inhibited.
Such a social environment may impede processing by limiting opportunities for
disclosure (Lepore, 2001; Lepore & Helgeson, 1998), validation, positive reappraisal,
coping assistance, benefit finding, and arousal reduction (Lepore, 1995; Silver &
Wortman, 1980; Silver, Boon, & Stones, 1983).
External and Internal Limitations on Communication
The present study examined two types of limitations on communication that may
inhibit cognitive processing- external limitations, which are limitations imposed by the
social environment, and internal limitations, that is, limitations that are self-imposed.
External limitations on communication previously have been examined to understand
adjustment to cancer from a social-cognitive processing model, however, internal
limitations on communication have not been considered a type of limitation within this
model in prior studies. There are two constructs that have been examined in the field of
chronic illness that are relevant to the study of external and internal limitations on
communication in partners, social constraints and protective buffering, respectively.
Social constraint is a type of external limitation on communication that occurs in
the form of negative social responses. This term refers to “any social condition that
causes trauma survivors to feel unsupported, misunderstood, or otherwise alienated from
their social network when they are seeking support and attempting to discuss their
trauma” (Lepore & Ituarte, 1999, p.168). These include behaviors such as minimization

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of problems, forced cheerfulness, avoidance, withdrawal, and criticism, regardless of the
provider’s intentions, all of which may inhibit open communication and result in negative
emotional adjustment.
Cancer patients have reported a variety of unsupportive and unhelpful behaviors
in response to their cancer by their partners, as well as other family and friends (Dakof &
Taylor, 1990; Dunkel-Schetter & Wortman, 1982; Peters-Golden, 1982). The cancer
patient literature recently has focused on these negative social interactions (Manne, 1999;
Manne, Alfieri, Taylor, & Dougherty, 1999; Manne & Glassman, 2000; Manne, Ostroff,
Winkel, Grana, Miller, et al., 2005; Manne, Ostroff, Winkel, Grana, & Fox, 2005;
Manne, Pape, Taylor, & Dougherty, 1999; Manne, Taylor, Dougherty, & Kemeny, 1997),
including social constraints (Cordova, Cunningham, Carlson, & Andrykowski, 2001;
Lepore & Helgeson, 1998; Lepore & Ituarte, 1999; Schimdt & Andrykowski, 2004;
Zadowski et al., 2003; Zakowski, Ramati, Morton, Johnson, & Flanigan, 2004), as they
have been shown to be better predictors of distress than positive social interactions
(Manne et al., 1997; Rook, 1984; Schuster, Kessler, & Aseltine, 1990). Research has
shown that positive and negative social interactions are independent domains (Rook,
1984), especially for male patients (Manne et al., 1997). Negative responses from one’s
environment are thought to be more salient, evoking stronger reactions, thus are more
influential in adjustment (Taylor, 1991).
Research on various cancer populations has indicated that social constraints
imposed by one’s partner or family/friends are associated with poor emotional adjustment
for the patient. For example, in a study of 178 prostate cancer survivors, Lepore and

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Helgeson (1998) reported that perceived social constraints from partners and
family/friends were negatively associated with psychological well-being. In a study of
97 women who were being treated for primary breast or colon cancer, Lepore and Ituarte
(1999) reported that greater perceived social constraint from partners and family/friends
was associated with more negative affect. Furthermore, Schmidt and Andrykowski’s
(2004) study of 210 breast cancer survivors who were members of an internet support
group indicated that social constraints were associated with greater depression and
anxiety. Other studies have focused more specifically on spousal criticism and
avoidance, and have also reported an association with negative emotional outcomes in
cancer patients (Manne, 1999; Manne & Glassman, 2000; Manne, Ostroff, Winkel,
Grana, et al., 2005). For example, Manne and colleagues (1997) reported that greater
negative spousal behaviors were associated with greater distress and lower well-being in
158 patients receiving treatment for primarily gastrointestinal and breast cancer.
However, the negative aspect of social interactions has not been explored in the
partners of cancer patients. Social constraints experienced by partners may be
particularly important to study because partners are a step removed from the cancer, and
their distress and support needs may be less apparent to individuals in their environment.
In fact, partners of breast cancer (Northouse, 1988) and colon cancer (Northouse et al.,
2000) patients have reported fewer support resources than patients. Thus, partners of
patients may need to play a more active role in seeking out the support they need if
support is not readily available to them. The seeking of social support, although
considered an adaptive coping mechanism, may be an additional source of distress if

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one’s social environment is unreceptive. Similar to the experiences of some patients,
partners may experience negative reactions from others. Partners’ social networks may
also be more likely to minimize their concerns and distress because they are the healthy
member of the couple. In addition, healthy partners may be more likely to be criticized
by others for expressing support needs themselves. The present study examined relations
between social constraints and partners’ emotional adjustment within and across time-
points, and examined disease-specific communication as a potential mediator.
In addition to external limitations on communication, such as social constraints,
protective buffering is a type of internal limitation on communication and refers to
behaviors such as “hiding concerns, denying worries, and yielding to the partner to avoid
disagreements” (Coyne & Smith, 1991, p. 405). When a member of a couple is
diagnosed with cancer, the partner’s support network is naturally reduced, as the partner
can no longer expect support from the patient, particularly during the early phase of
diagnosis and treatment. Not only may partners withdraw their support expectations,
they may also engage in protective behaviors to shield patients from additional burden
and stress. As a result, partners who engage in protective buffering are less likely to
openly communicate their own concerns and distress to patients, which may result in
negative emotional adjustment for the partner.
Studies that have examined partners’ protective buffering and emotional
adjustment concurrently have indicated negative associations (Coyne & Smith, 1991;
Suls, Green, Rose, Lounsbury, & Gordon, 1997). However, prospective examinations of
this relation are limited. For example, in a cross-sectional study of 56 men who had

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suffered a myocardial infarction and their wives six months following hospital discharge,
Coyne and Smith (1991) reported that wives’ protective buffering was positively
associated with their own psychological distress. This relationship remained significant
even after controlling for various demographic variables, patients’ symptoms, and marital
quality. Suls and colleagues (1997) conducted a longitudinal study of 43 couples
following husbands’ myocardial infarction. When examined cross-sectionally, the
authors reported that wives who engaged in more protective buffering were more
psychologically distressed four weeks and six months posthospital discharge, even after
controlling for age, patients’ distress, and marital quality. However in the same study, a
prospective look indicated that wives’ protective buffering at four months was not
significantly associated with their subsequent distress at six months. The authors
suggested that the lack of negative outcomes over time may be due to wives’
opportunities to express their concerns with other relatives and friends during the months
following hospital discharge. The present study examined relations between protective
buffering and emotional adjustment within and across time-points, and examined disease-
specific communication as a potential mediator. Additionally, sources of social
constraints were examined as potential moderators of the prospective relation between
protective buffering and emotional adjustment in partners. Specifically, partners may not
experience the negative effects of protective buffering if they are not constrained in other
relationships, as hypothesized by Suls et al.
In sum, there are two types of limitations on communication that may inhibit
cognitive processing in partners, social constraints and protective buffering. Social

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constraints represent limitations imposed on an individual by others, and protective
buffering represents a self-imposed limitation. Both types of limitations on
communication are associated with the perception that one’s social network is
unreceptive, which may inhibit the sharing and processing of cancer-related concerns and
result in negative emotional adjustment. Although they may be conceptually similar, the
source and cause of the constraints clearly differ. These constructs have received
separate attention in the literature; however, they have not yet been studied together.
Furthermore, in the social-cognitive processing literature, the focus has been solely on
external limitations on communication. It is unclear whether internal limitations on
communication, such as protective buffering, would yield similar relations; that is, inhibit
cognitive processing. Therefore, the present study explored the potential role of
protective buffering on cognitive processing in partners.
Mediating Role of Communication
Although the literature has clearly indicated that social constraints interfere with
the adaptive processing of intrusive thoughts over time for patients, the mediating
mechanisms are yet to be sufficiently supported (Manne & Zautra, 1989). As mentioned
earlier, social constraints are thought to inhibit opportunities for disclosure. However,
sharing thoughts and concerns about a traumatic event with others has not been shown to
mediate the relation between social constraints and negative outcomes in patients
(Cordova et al., 2001; Lepore, Silver, Wortman, & Wayment, 1996; Manne, 1999).
Although this may pose a theoretical conflict with the social-cognitive processing model,
as disease-specific communication is believed to facilitate processing and integration, it is

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important to note that in previous studies, a single item or 2-item scale was used to
measure the amount of trauma-related communication. Therefore, the present study
utilized a more comprehensive measure of cancer-specific communication with patients
and other family/friends.
To summarize, the social-cognitive processing model has been well supported in
the cancer patient literature. However, it is yet to be studied in partners of cancer
patients. Due to distress previously reported by partners and the potential for greater
constraints in one’s environment, which may disrupt cognitive processing, the present
study examined the social-cognitive processing model in partners of prostate cancer
patients. In addition, the mediators of the social constraints-adjustment relation were
examined with a more comprehensive measure of cancer-specific communication from
multiple sources. Lastly, the study explored the role of protective buffering as a type of
constraint that may inhibit cognitive processing and adjustment. Protective buffering,
although shown to be associated with negative outcomes, has yet to be examined in
relation to cognitive processing.
Relation of Partners’ Adjustment on Patients’ Adjustment
Thus far, we have discussed the importance of social contextual variables in the
adjustment of partners partly because studies report that partners too experience distress
during the cancer experience. The adjustment of partners is also crucial to study because
their responses may influence patients’ adjustment. Partners are the primary source of
support for cancer patients (Neuling & Winefield, 1988; Pistrang & Barker, 1995),
particularly for married male patients (Harrison, Maguire, & Pitceathly, 1995). Thus, it is

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critical to understand the factors associated with partners’ provision of support, how their
support is perceived by the patients, and how this influences patients’ own adjustment.
Studies have typically examined patient characteristics, such as physical
impairment, psychological distress, and optimism (Bolger, Foster, Vinokur, & Ng, 1996;
Lepore & Ituarte, 1999; Trunzo & Pinto, 2003) as determinants of supportive and
unsupportive behaviors from partners. The limited research on partners’ influence on
their provision of support to patients has suggested that partners’ adjustment to disease is
important to patient-partner relations. Specifically, research has indicated that partners’
negative affect is positively associated with cancer patients’ perceptions of spousal
critical remarks, and partners’ marital satisfaction is negatively associated with spousal
critical remarks to patients (Manne, Alfieri, et al., 1999). The present study examined the
relations between partners’ emotional adjustment, and their provision of support to
patients and protective buffering of patients. Since couples’ perceptions of their
interactions may not be highly correlated, the study also explored the relations between
partners’ emotional adjustment and patients’ perceptions of their own social constraints
and protective buffering by partners.
In addition to partners’ adjustment, the interaction between patients and partners
may influence patients’ perceptions of their social environment, which may be associated
with their own adjustment. Although studies on protective buffering by partners have
consistently shown negative effects on partners’ adjustment, the results regarding
patients’ adjustment when being protected by others have been inconsistent. Some
studies (Coyne & Smith, 1994) have found that protective buffering by partners is

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associated with greater patient self-efficacy, whereas other studies have reported greater
depression and less sense of control (Kuijer et al., 2000). Due to inconsistencies in the
literature, potential moderators of the relation between protective buffering by partners
and adjustment outcomes in patients need to be examined.
There are several moderators worth exploring to explain the inconsistent
relationship between protective buffering by partners and adjustment in patients. Well-
intended efforts to protect patients from additional stress may be perceived by patients as
socially constraining. Protective buffering includes behaviors that may be perceived as
ignoring or avoiding patients’ concerns. Patients who wish to discuss illness-related
issues may feel they have limited opportunities to do so because of partners’ efforts to
shield them from negative thoughts and feelings. Thus, protective buffering by partners
may have negative outcomes for patients if the patient also views the relationship as
socially constraining. The present study examined social constraints as a possible
moderator of the relation between protective buffering by partners and emotional
adjustment among patients.
Another possible moderator may be patients’ awareness of partners’ attempts to
protect them. Perhaps protective buffering is associated with positive outcomes only if
partners are effective in their delivery of these behaviors; that is, buffering the patients
without their knowledge. Recent literature on social support indicates a similar process
in regard to support transactions. In a study of 68 couples in which one member was
preparing to take the bar exam, Bolger and colleagues (2000) reported that the best type
of support, in terms of reducing depression, was invisible support, support transactions

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that were delivered without the recipient’s knowledge. In other words, individuals under
stress who did not recognize that their partners had indeed provided them support
reported lower psychological distress. It was suggested that perhaps there is a cost to
self-esteem in receiving support because it highlights that one is experiencing difficulties.
Similar to the research on social support, it may also be distressing if a patient was aware
that he was being shielded by his partner. It seems as though it would be more
distressing if patients were aware that their partners were concealing concerns and giving
in, rather than just providing support. Not only does this highlight the patients’
difficulties, but it may reveal that their perceived inability to cope is so apparent that
others feel the need to protect them. Therefore, patients’ perceptions of being protected
were explored as a potential moderator of the relation between protective buffering by
partners and emotional adjustment among patients.
To conclude, partners’ adjustment to the disease may influence their interactions
with patients, whether it is associated with supportive, constraining, or protective
behaviors. The present study examined partners’ emotional adjustment and its
association with patients’ and partners’ perceptions of their relationships. In addition, the
present study explored how patients’ and partners’ perspectives interact with one another
to predict patient outcomes.
Summary
The present study provided a comprehensive assessment of social contextual
variables and emotional adjustment in prostate cancer patients and their partners. Given
that partners have been understudied in the cancer literature, the present study focused on

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partners’ adjustment while also assessing patients’ adjustment. In contrast, previous
studies have included limited partner information in the primary study of patients. Unlike
partner studies that have typically been cross-sectional in design, this study offered a
longitudinal examination through assessment at two time-points. In addition, two
important constructs in the study of disease adjustment, social constraints and protective
buffering, were examined together for the first time. Not only did the study assess both
patients’ and partners’ perspectives, but the study examined partners’ social environment
from two interpersonal domains, patients and other family/friends.

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CHAPTER 2: SPECIFIC AIMS
The social context in which patients experience cancer has been shown to be an
important predictor of adjustment and distress in cancer patients. However, whether the
same social contextual principles apply to partners of cancer patients is unknown.
Moreover, partners’ emotional adjustment may be associated with their provision of
support and how their support is perceived by patients. The interaction between patients
and partners may ultimately influence patients’ own emotional adjustment. The present
study examined the factors associated with social support, social constraints, and
protective buffering among prostate cancer patients and partners at two time-points, prior
to laparoscopic radical prostatectomy (T1) and 3 months postsurgery (T2). Relations that
have been demonstrated in other samples, or have a strong theoretical foundation are
investigated as hypotheses, whereas relations that are newly proposed, or lack substantial
background are explored as questions.
Specific Aim 1
To identify the relation of internal and external limitations on communication to
partners’ affect, controlling for partners’ demographic variables and time since diagnosis.
Hypothesis 1a
Social constraints on partners from patients and protective buffering of patients by
partners will be positively associated with negative affect and negatively associated with
positive affect in partners within and across time-points.

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Hypothesis 1b
Partners’ T1 cancer-specific communication with patients will mediate the
relation between T1 limitation on communication variables- social constraints and
protective buffering- and change in partners’ positive and negative affect. Specifically,
lower social constraints on partners by patients and lower protective buffering of patients
by partners will be associated with an increase in positive affect and a reduction in
negative affect for partners, in part due to greater communication with patients.
Hypothesis 1c
A reduction in intrusive thoughts among partners will mediate the relation
between T1 cancer-specific communication with patients and change in partners’ positive
and negative affect. Specifically, greater communication with patients will be associated
with an increase in positive affect and a reduction in negative affect, in part due to a
reduction in intrusive thoughts.
Hypothesis 1d
The relation between T1 protective buffering by partners and change in partners’
positive and negative affect will be moderated by T1 social constraints on partners by
family/friends. Specifically, a positive relation between protective buffering by partners
and change in their negative affect will be stronger among partners who are socially
constrained by family/friends. A negative relation between protective buffering and
change in partners’ positive affect will be stronger among partners who are not socially
constrained by family/friends.

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Specific Aim 2
To examine the relation of partners’ affect to their provision of support to patients
and partners’ perception of internal and external limitations on communication,
controlling for partners’ demographic variables and time since diagnosis.
Hypothesis 2a
Within each time-point, partners’ negative affect will be negatively associated
with their provision of support to patients, whereas partners’ positive affect will be
positively associated with their provision of support to patients.
Question 2a
What are the relations between partners’ positive and negative affect and patients’
perceptions of their own social constraints from partners and protective buffering by their
partners?
Specific Aim 3
To explore the relation of partners’ protective buffering of patients to patients’
affect, as well as the moderating role of patients’ perceptions of their internal and
external limitations on communication on this relation, controlling for patients’
demographics and time since diagnosis.
Question 3a
What is the relation between T1 protective buffering of patients by partners and
change in patients’ positive and negative affect?

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Question 3b
Is the relation between T1 protective buffering of patients by partners and
patients’ change in positive and negative affect moderated by patients’ T1 perceptions of
their own social constraints? Specifically, is the negative relation between protective
buffering by partners and patients’ positive affect, and the positive relation between
protective buffering by partners and patients’ negative affect only significant among
patients who perceive it as constraining?
Question 3c
Is the relation between T1 protective buffering of patients by partners and
patients’ change in positive and negative affect moderated by patients’ T1 perceptions of
protective buffering by partners? Specifically, is the negative relation between protective
buffering by partners and patients’ positive affect, and the positive relation between
protective buffering by partners and patients’ negative affect only significant among
patients who perceive they are being protected?

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CHAPTER 3: METHODS
The present study was a subset of a larger study that assessed the health-related
quality of life of men with carcinoma of the prostate who underwent laparoscopic radical
prostatectomy (LRP) at City of Hope National Medical Center (COH). This study
examined the subset of patients who were married or partnered and their partners.
Questionnaire data were obtained at two time-points: prior to surgery (T1) and three
months following surgery (T2). This project was approved by the Institutional Review
Board at COH and underwent an expedited review process at the University of Southern
California.
Participants
Participants in this study were men who had consented to undergo a LRP at COH
for the treatment of prostate cancer, and their partners. Eligibility criteria included: 1)
both patient and partner attendance at the initial LRP consultation, 2) both patient and
partner participation in the present study, 3) fluency in English, 4) completion of
questionnaires at both time-points, and 5) no active patient cancers other than prostate
during the course of the study.
Procedures
Time I: Presurgery
The Department of Urology contacted our support staff on a weekly basis as
patients scheduled an initial LRP consultation at COH. At that point, patients had not yet
consented to undergo a LRP, but attended the consultation because they were considering
LRP as a treatment option. Our support staff received computerized patient records,

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including general demographic and basic medical information. New patient consultations
were held twice a week, and I was present at the clinic on these days to invite patients
and partners to participate in the study.
Immediately prior to the consultation with the urologist, patients and partners
attended a brief meeting with a research assistant from the Department of Urology. I was
present at this meeting and was introduced as a research associate from the Department of
Urology. If the patient was not partnered, or if the patient was partnered but attended the
consultation alone, he was invited to participate in the larger study assessing patient
quality of life that did not require partner participation. If the patient was partnered, and
the partner was present at the consultation, the couple was invited to participate together
in the patient and partner studies. If neither member of the couple was interested in
participating, their reasons for declining were assessed, and they were not contacted
further. If the patient was interested in participating, but the partner was not interested,
the patient was invited to participate in the larger study. If the patient was not interested
in participating, but the partner was interested, the partner was invited to participate in the
study. However, the partner’s responses were not included in the final analysis.
After obtaining separate patient and partner informed consent, separate patient
and partner versions of the materials were handed to them that included: 1) a cover letter,
2) a letter from the urologist stating the study’s rationale, 3) a copy of the IRB-approved
consent form (see Appendix A and B), 4) a presurgical questionnaire (see Appendices C
and D), and 5) a stamped envelope addressed to the central data collection point (at COH)
for each member of the couple. The cover letter instructed patients and partners to

20

complete the questionnaire independently at home, and to mail back the completed
questionnaire prior to the patient’s surgery date.
If the completed questionnaires were not returned at least two weeks prior to the
patient’s surgery date, the couple was contacted by telephone to remind them to return
the completed questionnaires prior to the patient’s surgery date. If any of the
questionnaire packets were returned incomplete, the participants were telephoned to
retrieve any missing items that were inadvertently omitted. Lastly, each participant
received a thank you letter, which also included a reminder that they would be re-
contacted approximately three months following the patient’s surgery.
Time II: Three months postsurgery
Couples who completed and returned presurgical questionnaires were mailed a
follow-up questionnaire (see Appendices E and F) three months following the date of the
patient’s surgery. Following the mailing, I contacted the participants by telephone to
confirm the receipt of the materials and answer any questions. If the follow-up
questionnaires were not received within two weeks, the participants received a reminder
call. If the follow-up questionnaires were returned incomplete, the participants were
telephoned to retrieve any missing items that were inadvertently omitted. Each
participant was mailed a thank you letter indicating the completion of their participation.
Instruments
For the larger study, patients were assessed for health-related quality of life,
sexual functioning, psychological adjustment, coping, and expectations. Patient and
spousal measures for the present study only are described below. For the majority of T1

21

questionnaires, participants were asked to respond based on their experience since the
patient’s diagnosis. For the majority of T2 questionnaires, participants were asked to
respond based on their experience since the patient’s surgery. Patients completed a T2
questionnaire for only one variable for the present study. Participants were instructed
that there are no right or wrong answers and were asked to respond to the questions to the
best of their ability. Participants could leave blank any questions they preferred not to
answer. They were asked to cross out any questions they had intentionally omitted.
Patient and Partner Questionnaires
Demographic Information
A Background Information form was used to assess demographics, such as age,
length of relationship, education, occupation, and ethnic background.
Mood
The Positive and Negative Affect Schedule (PANAS) (Watson, Clark, &
Tellegen, 1988) was used to measure mood. This scale is an adjective checklist in which
20 mood states assess positive affect (PA) and negative affect (NA). Participants were
asked to rate the extent to which they experienced these emotions on 5-point Likert-type
scales, ranging from 1 (“Very slightly or Not at all”) to 5 (“Extremely”). The total scores
can range from 10 to 50 for each scale, with higher scores indicative of higher levels of
the type of affect. Both scales have good internal consistency and convergent and
discriminant validity. Cronbach’s alphas range from .86 to .90 for Positive Affect, and
.84 to .87 for Negative Affect (Watson et al., 1988).

22

Contextual Variables
Dyadic adjustment. The Revised Dyadic Adjustment Scale (RDAS) (Busby,
Christensen, Crane, & Larson, 1995) was used to measure the perceived quality of the
patient-partner relationship. It is a shortened version of the Dyadic Adjustment Scale
(Spainer, 1976). It is a 14-item self-report scale that measures the level of agreement on
various relationship issues, and the frequency with which the couple engages in specific
behaviors. Participants were asked to rate items on a variety of Likert-type scales,
providing a total dyadic adjustment score, ranging from 0 to 69. A higher score indicates
a less distressed relationship. This scale demonstrates good internal consistency and
validity. Cronbach’s alpha for this instrument is .90 (Busby et al., 1995).
Social support. A social support measure developed by Bolger and colleagues
(1996) was used to measure support provision and receipt within dyads. Participants
were asked to rate how much they provided and received various types of support. The
8-item self-report scale is rated on 5-point Likert-type scales, ranging from 1 (“Not at
all”) to 5 (“A great deal”). Total scores range from 8 to 40, with higher scores indicative
of both greater provision and greater receipt of support. Sample item: “How much has
your partner provided you with encouragement and reassurance when you needed it?”
For both patient and partner, two separate scales were given to assess their provision of
support to one another (Support Provision), and their receipt of support from one another
(Support Receipt). Cronbach’s alpha for support provision is .87 (Bolger et al., 1996).

23

Limitation on Communication Variables
Social constraints. The Social Constraints Scale (Lepore & Ituarte, 1999) was
used to assess social constraints on disclosure about cancer. It is a 15-item self-report
instrument that measures social responses that inhibit expressions of cancer-related
thoughts and feelings. Participants were asked to rate how often others had responded in
this manner on 4-point Likert-type scales, ranging from 1 (“Never”) to 4 (“Often”). Total
scores range from 15 to 60, with higher scores indicative of a more socially constraining
environment. Sample item: “How often has your partner changed the subject when you
tried to discuss his illness?” For partners, two separate scales were given to assess
constraints by the patient (Social Constraints-Pt) and by family/friends (Social
Constraints-F/F). For patients, one social constraints scale was given to assess
constraints by their partner (Social Constraints-Sp). The scale has good internal
consistency. Cronbach’s alphas range from .88 to .92 (Lepore & Ituarte, 1999).
Protective buffering. The Protective Buffering subscale of the revised
Relationship-focused Coping Scale (J. Coyne, personal communication) was used to
assess behaviors intended to shield partners from additional stress. The 7-item self-report
subscale is rated on 5-point Likert-type scales, ranging from 1 (“Never”) to 5 (“Very
often”). Total scores range from 7 to 35, with higher scores indicative of greater use of
protective buffering. Sample item: “I try to hide my worries about my partner.” For
partners, two separate scales were given to assess their own degree of engaging in
protective buffering (Protective Buffering-By Sp) and also their perceptions of the

24

patients’ level of engaging in protective buffering (Protective Buffering-By Pt). Both
scales were given to patients as well. Previous versions of the protective buffering scale
indicate good internal consistency, with Cronbach’s alphas equal to .92 for patient’s own
protective buffering and .91 for partner’s own protective buffering (Coyne & Smith,
1991).
Partner Questionnaires Only
Processing Variable- Intrusive Thoughts
The Impact of Events Scale-Revised (IES-R) (Weiss & Marmar, 1997) was used
to assess intrusive thoughts in response to patient’s cancer. It is a 22-item self-report
scale that consists of a list of comments made by people after stressful life events. It can
be anchored to any specific life event, in this case, “partner’s cancer diagnosis”. This
measure taps the three most commonly reported responses to stressful events, and
provides three subscales: intrusive thoughts, avoidance, and hyperarousal. The present
study will utilize the intrusive thoughts subscale only. Participants were asked to rate
these items on 5-point Likert-type scales, ranging from 0 (“Not at all”) to 4
(“Extremely”). Subscales are calculated by taking the average rating of the items. Scores
range from 0-4, with a higher score indicating more frequent intrusive thoughts.
Cronbach’s alpha for this scale ranges from .87 to .92 for intrusive thoughts (Weiss &
Marmar, 1997).
Contextual Variable- Cancer-specific Communication
An adapted version of The Primary Communication Inventory (Locke, Sabaght,
Thomas, authors; as cited in Perez et al., 2002) was used to assess the amount and type of

25

communication specific to cancer. The content of the 12-item self-report scale is not
changed, but rather the items are reworded to address communication specific to cancer.
Participants were asked to rate items on 5-point Likert-type scales, ranging from 1
(“Never”) to 5 (“Very Frequently”). The total score can range from 12 to 60, with higher
scores indicative of greater communication. Sample item: “How often do you and your
partner talk over negative or unpleasant things regarding prostate cancer and its
treatment?” Partners were given two separate versions of the measure to assess
communication with patients (Communication-Pt) and communication with
family/friends (Communication-F/F).
Statistical Analyses
All data were first examined for missing values, outliers, nonlinearity,
heteroscedasticity, and deviations from normality. Cronbach’s alphas were calculated to
determine internal consistency for all the study’s instruments. For all analyses, p-values
≤ .05 were considered statistically significant.
Descriptive statistics were used to describe the characteristics of the study’s
sample of patients and partners. Mean comparisons were conducted to compare
participants and non-participants (for patients only) and completers and non-completers
on demographic variables. Independent t-tests were used for continuous variables, and
Chi-square tests were be used for categorical variables. Pearson correlations were
conducted to examine the relations between the key variables and to assess for
multicollinearity.

26

Multiple regression analyses were conducted to test all hypotheses. Covariates
for equations examining partner outcomes included partners’ age and education, and
patients’ time since diagnosis. Covariates for equations examining patient outcomes
included patients’ age, education, and time since diagnosis. Regression equations
examining change over time included the T1 assessment of that particular dependent
variable as a covariate so that the dependent variable was a residualized score. All
covariates were entered in the first block, followed by the independent variable(s) in the
second block.
In order to test for mediation, two approaches were utilized. First, Baron and
Kenny’s (1986) preliminary mediational criteria were assessed prior to testing for
mediation. Specifically, significant associations need to be established between: a) the
predictor and the dependent variable, b) the predictor and potential mediator, and c) the
potential mediator and the dependent variable. If these relations were supported, then all
covariates were entered as the first block in the regression equation, the potential
mediator was entered as the second block, which was followed by the predictor as the
third block. A mediator effect was supported if the association between the predictor and
the dependent variable was no longer significant or was substantially reduced in
significance, after controlling for the potential mediator. In addition to Baron and
Kenny’s approach, Sobel’s test (Sobel, 1982) of mediation was utilized to test whether
the indirect effect of the predictor on the dependent variable via the mediator was
significantly different from zero.

27

In order to test for moderation, the independent and interaction terms were
centered around zero before calculating the cross-product term (Aiken & West, 1991).
All covariates were entered in the regression equation as the first block. The independent
variable and moderator were entered as the second block, followed by the interaction
term as the third block. If the interaction term significantly predicted the dependent
variable, it indicated that the slope of the relation between the independent and dependent
variable was significantly different for varying levels of the moderator, supporting a
moderator effect. Simple regression lines were then plotted for high and low values of
the moderator (Aiken & West, 1991).

28

CHAPTER 4: RESULTS
Sample Characteristics
Participants
During the period of October 2005 to August 2006, 264 diagnosed prostate cancer
patients underwent LRP (Figure 1). Eighty-four percent of the patients were partnered
(n=221). Eighty-one percent of the partnered patients attended the consultation with their
partners, yielding 179 eligible couples. Ninety percent of the couples agreed to
participate in the study (n=161). Fifty-eight percent returned completed T1
questionnaires (n=94) and 53% returned completed T2 questionnaires (n=50). This
yields a total participation rate of 28%. Reasons for not participating included the
following: “too busy”, “not interested”, and “not relevant” to their situation.
Of the 50 couples who participated at both time points, all comprised of male-
female married dyads
1
. Table 1 presents the demographic and medical characteristics for
spouses. Spouses’ mean age was 59.5 years. Couples were typically in long
relationships. Sixty-two percent had a college degree or advanced degree, and 54% were
currently employed at least part-time. The majority of the spouses were non-Hispanic
Whites. Table 2 presents the demographic and medical characteristics for patients.
Patients’ mean age was similar to other prostate cancer patients (Eton & Lepore, 2002).
Sixty percent had a college degree or advanced degree, and 62% were currently
employed at least part-time. The majority of the patients were non-Hispanic Whites.

1
All patients in the present study were married to female partners. Thus, partners will be referred to as
“spouses” for the remainder of the study.

29

264 diagnosed patients
underwent LRP
221 patients were married 43 patients were not married
179 patients
attended LRP consultation with spouse
42 patients
attended LRP consultation without spouse
161 couples
agreed to participate in the study
94 couples
completed T1 Qxs
67 couples
did not complete T1 Qxs
50 couples
completed T2 Qxs
44 couples
did not complete T2 Qxs
18 couples
declined to participate in the study
Final n-size
Figure 1. Flowchart of study participation
# of eligible couples

30

Table 1. Spouses' Demographic and Medical Characteristics

Mean or Percent SD Range
Age (years) 59.5 7.1 47 to 77
Length of Relationship (years) 35.6 9.5 3 to 55
Education
high school graduate or GED 2%
some college 28%
associate degree 8%
college graduate 20%
some college or professional
school after college 12%
completed masters degree 24%
completed doctoral degree 6%
Employment
employed full-time 28%
employed part-time 26%
full-time homemaker 4%
full-time or part-time volunteer 2%
retired 40%
Ethnicity
non-Hispanic White 90%
African-American 0%
Hispanic 2%
Asian-American 8%
Medical Conditions*
allergies 44%
arthritis 42%
migraines 10%
high blood pressure 24%
osteoporosis 10%
thyroid problem 22%
cancer 8%
* Can total >100%

31

Table 2. Patients' Demographic and Medical Characteristics

Mean or Percent SD Range
Age (years) 61.3 7.2 48 to 76
Education
some high school 2%
high school graduate or GED 4%
some college 30%
associate degree 4%
college graduate 16%
some college or professional
school after college 10%
completed masters degree 12%
completed doctoral degree 22%
Employment
employed full-time 54%
employed part-time 8%
retired 34%
unemployed 2%
permanently disabled 2%
Ethnicity
non-Hispanic White 86%
African-American 0%
Hispanic 4%
Asian-American 10%
Time from diagnosis to
consultation (months) 1.68 1.09
.47 to
4.9

Patients were diagnosed on average 1.68 months prior to the surgical consultation and
received their surgery on average 1.27 months following their consultation.
Participants Versus Non-participants
T-test and chi-square analyses indicated that there were no significant differences
between patient participants (n=50) and patient non-participants (n=129) with respect to
age and ethnicity. This information was gathered from computerized patient information
and was the only information that was available. As a result, demographic information
for spouse non-participants was not available.

32

Completers versus Non-completers
T-test and chi-square analyses indicated that there were no significant differences
between completers (n=50, patient and spouse participation at both time points) versus
non-completers (n=44, patient and spouse participation at time 1 only) on demographic
characteristics or any of the study’s key variables for either patients or spouses.
Description of Key Variables
As defined in the Methods section and listed in Table 3, variables for spouses and
patients were categorized as mood, processing, contextual, or limitation on
communication variables. Cronbach’s alphas to test internal reliability of the study’s key
variables for spouses and patients are listed in Tables 4 and 5. Cronbach’s alphas
indicated acceptable reliabilities for spouse variables (.70 to .96) and for the majority of
patient variables (.64 to .95). Table 4 also presents the descriptive data for spouses at
both time points. Overall, spouses of patients appeared to be adjusting well to the
patient’s cancer. Relative to the average of the scales’ ranges and reports from other
studies, spouses reported moderate levels of positive affect, low levels of negative affect,
and low levels of intrusive thoughts, suggesting that spouses were not highly distressed
prior to and following surgery. The level of spousal intrusive thoughts in the present
study (x=1.07) is similar to another study of spouses of prostate cancer patients (x=0.98)
(Banthia et al., 2003). With respect to contextual variables, spouses appeared to be in
positive social environments. Spouses reported good marital quality, providing and
receiving good levels of support within their marriage, and engaging in a moderate
amount of cancer-specific communication with patients and family/friends. Additionally,

33
Table 3. Spouse and Patient Variables
Spouse Variables Patient Variables
I. Mood Variables I. Mood Variables
PANAS-positive affect PANAS-positive affect
PANAS-negative affect PANAS-negative affect

II. Processing Variable -
IESR-Intrusive Thoughts subscale -

III. Contextual Variables II. Contextual Variables
RDAS RDAS
Social Support Social Support
Support Provision (Provision of support to patient) Support Provision (Provision of support to spouse)
Support Receipt (Receipt of support from patient) Support Receipt (Receipt of support from spouse)
Cancer-specific communication -
Communication-Pt (Communication with patient) -
Communication-F/F (Communication with family/friends) -

IV. Limitation on Communication Variables III. Limitation on Communication Variables
Social Constraints Social Constraints
Social Constraints-Pt (Spousal perception of constraints from
patient)
Social Constraints-Sp (Patient perception of constraints
from spouse)
Social Constraints-F/F (Spousal perception of constraints from
family/friends) -
Protective Buffering Protective Buffering
Protective Buffering-By Sp (Spousal protective buffering of patient)
Protective Buffering-By Pt (Patient protective buffering
of spouse)
Protective Buffering-By Pt (Spousal perception of protective
buffering by patient)
Protective Buffering-By Sp (Patient perception of
protective buffering by spouse)
Note. PANAS=Positive and Negative Affect Schedule; IESR=Impact of
Events Scale-Revised; RDAS=Revised Dyadic Adjustment Scale

34
Table 4. Descriptives and Paired T-tests for Spouse Variables

Variable
Scale
Range
Range at
T1
Range at
T2
Cronbach's
alphas
T1 Mean
(SD)
T2 Mean
(SD) t-value
p-
value
PANAS
Positive Affect 10 to 50 20 to 45 16 to 44 0.70 31.42(4.90) 32.26(6.18) -1.30 0.198
Negative Affect 10 to 50 13 to 39 13 to 31 0.87 22.02(7.04) 19.24(4.71) 2.94 0.005
IESR-Intrusive Thoughts 0 to 4 0 to 3.88 0 to 3 0.92 1.07(0.82) 0.77(0.66) 4.18 <0.001
RDAS 0 to 69 32 to 63 32 to 64 0.78 52.08(6.40) 51.46(6.49) 0.95 0.348
Social Support
Support Provision 8 to 40 23 to 40 20 to 40 0.88 33.78(4.57) 32.34(5.52) 2.87 0.006
Support Receipt 8 to 40 11 to 40 12 to 40 0.96 28.92(8.59) 27.18(7.64) 2.64 0.011
Cancer-specific Communication
Communication-Pt 12 to 60 26 to 59 26 to 56 0.81 45.54(6.89) 43.08(6.96) 3.58 0.001
Communication-F/F 12 to 60 24 to 58 20 to 53 0.81 35.55(6.66) 33.76(6.76) 1.82 0.075
Social Constraints
Social Constraints-Pt 15 to 60 15 to 49 15 to 49 0.90 26.16(8.29) 27.08(8.59) -1.05 0.300
Social Constraints-F/F 15 to 60 15 to 50 15 to 55 0.93 24.10(8.60) 25.39(9.19) -1.03 0.307
Protective Buffering
Protective Buffering-By Sp 7 to 35 7 to 24 7 to 23 0.72 15(4.19) 14.88(3.86) 0.25 0.803
Protective Buffering-By Pt 7 to 35 7 to 24 7 to 30 0.73 14.9(4.37) 15.04(4.96) -0.27 0.786
Note. PANAS=Positive and Negative Affect Schedule; IESR=Impact of Events Scale-Revised; RDAS=Revised Dyadic Adjustment
Scale

35

Table 5. Descriptives and Paired T-tests for Patient Variables

Variable
Scale
Range
Range at
T1
Range at
T2
Cronbach's
alphas
T1 Mean
(SD)
T2 Mean
(SD) t-value p-value
PANAS
Positive Affect 10 to 50 16 to 46 12 to 43 0.79 30.78(6.48) 31.88(6.86) -1.04 0.304
Negative Affect 10 to 50 10 to 42 10 to 37 0.87 21.54(7.27) 18.24(5.82) 4.08 <0.001
RDAS 0 to 69 37 to 64 - 0.80 52.20(5.60) - - -
Social Support
Support Provision 8 to 40 10 to 40 - 0.94 30.66(6.10) - - -
Support Receipt 8 to 40 12 to 40 - 0.95 34.68(6.26) - - -
Social Constraints
Social Constraints-Sp 15 to 60 15 to 36 - 0.83 20.38(5.06) - - -
Protective Buffering
Protective Buffering-By Pt 7 to 35 7 to 27 - 0.76 15.14(4.72) - - -
Protective Buffering-By Sp 7 to 35 7 to 19 - 0.64 11.90(3.31) - - -
Note. PANAS=Positive and Negative Affect Schedule; RDAS=Revised Dyadic Adjustment Scale

36

spouses reported perceiving few constraints in their environment, as well as engaging in
and receiving moderate amounts of buffering behaviors within their marriage.
Table 4 also presents the change over time for spouses on the study’s key
variables. Paired t-tests indicated a significant decline in spouses’ PANAS-negative
affect and IESR-intrusive thoughts, suggesting improved affect and cognitive processing
over time. There was also a significant decline in spouses’ Support Provision and
Support Receipt. Spouses reported not only providing less support to patients, but
receiving less support from patients over time. Additionally, there were significant
declines in spouses’ Communication-Pt. Over time spouses reported engaging in less
cancer-specific communication with patients.
Table 5 presents the descriptive data for patients at both time points. Overall,
patients too appeared to be adjusting well to cancer. Relative to the average of the scales’
ranges and reports from other studies, patients reported moderate levels of positive affect
and low levels of negative affect at both time points, with a reduction in negative affect
over time. With respect to contextual variables, patients appeared to be in positive social
environments, as they reported good marital quality, and providing and receiving good
levels of support within the dyad. Additionally, patients reported perceiving few
constraints, as well as engaging in and receiving moderate amounts of buffering
behaviors within their marriage.
Paired t-tests also were conducted to examine potential differences in contextual
and limitation on communication variables within time. With respect to spouse-patient
relations, analyses indicated that spouses reported more Support Provision (x=33.78) than

37

Support Receipt [(x=28.92) (t=-5.56, p<.001)] at T1, but reported similar levels of
Protective Buffering-By Sp and Protective Buffering-By Pt (t=.16, p=.87). Although
spouses reported providing more support to than receiving support from patients, spouses
felt they buffered patients as much as patients said they buffered them. With respect to
spousal relations with patients and family/friends, spouses reported significantly greater
Communication-Pt (x=45.54) than Communication-F/F [(x=35.50) (t=9.56, p<.001)] at
T1, but reported similar levels of Social Constraints-Pt and Social Constraints-F/F
(t=1.65, p=.11). It appears that although spouses reported communicating more about
cancer with patients than family/friends, they experienced similar levels of social
constraints from both sources.
In addition, paired t-tests were conducted to investigate potential differences
between spouses’ and patients’ variables. Analyses revealed significant spouse-patient
differences in Support Provision, Support Receipt, Social Constraints, and Protective
Buffering. Spouses reported receiving less support from patients than patients reported
receiving from spouses (t=4.48, p<.001), and providing more support to patients than
patients reported providing to spouses (t=.31.49, p=.001). Spouses also reported greater
perceptions of social constraints from patients than patients reported perceiving from
spouses (t=-4.49, p<.001), and greater perceptions of being buffered by patients than
patients reported perceiving from spouses (t=-3.64, p=.001). There were no significant
differences between spouses and patients on PANAS, RDAS, or engaging in Protective
Buffering.

38

Correlations
Spouses
In order to examine the associations between the study’s key variables among
spouses, Pearson correlations were conducted within each time point (Table 6). Social
Constraints-F/F was significantly associated with PANAS at T1 only, with greater
perceived constraints from family/friends being associated with less positive affect and
greater negative affect. Social Constraints-Pt was significantly positively associated with
PANAS-negative affect at T2 only. It appears that perceived constraint from
family/friends has a greater association with spousal affect during the initial phase of
diagnosis and treatment, whereas constraint from patients was more influential during
subsequent months. However, Protective Buffering-By Sp was significantly associated
with spousal affect at both time-points. Specifically, greater spousal buffering of patients
was associated with greater spousal negative affect.
Table 6 also presents the correlations between limitation on communication and
contextual variables among spouses. Social Constraints-Pt was significantly associated
with spouse-patient relations. Greater spousal perceived constraint from patients was
associated with lower RDAS, Support Provision (T2 only), Support Receipt, and
Communication-Pt among spouses. Social Constraints-F/F was significantly associated
with spouse-family/friends relations. Greater spousal constraint from family/friends was
associated with lower Communication-F/F at both time points. Additionally, Protective
Buffering-By Sp was significantly negatively associated with Communication-Pt at T2
only. Overall, it appears as though both internal and external types of limitations on

39
Table 6. Pearson Correlations for Spouse Variables
at T1 and T2

1 2 3 4 5 6 7 8 9 10 11 12
1. PANAS-Positive Affect - -0.26 -0.36 -0.01 0.11 0.14 -0.28 -0.19 -0.26 -0.30 0.22 0.11
2. PANAS-Negative Affect -0.28 - 0.79 0.11 0.42 0.35 0.35 0.25 0.26 0.35 -0.09 -0.18
3. IESR-Intrusive Thoughts -0.16 0.66 - 0.20 0.26 0.28 0.28 0.16 0.20 0.24 -0.17 -0.22
4. RDAS 0.13 -0.04 0.15 - 0.47 0.62 -0.09 -0.38 -0.49 -0.05 0.51 0.24
5. Support Provision 0.20 0.04 0.21 0.62 - 0.72 -0.06 -0.11 -0.23 0.04 0.30 0.15
6. Support Receipt 0.23 -0.09 0.16 0.59 0.78 - -0.13 -0.16 -0.40 0.07 0.38 0.17
7. Protective Buffering-By Sp -0.17 0.39 0.33 -0.19 -0.31 -0.45 - 0.51 0.55 0.52 -0.19 -0.19
8. Protective Buffering-By Pt -0.47 0.20 0.20 -0.31 -0.46 -0.50 0.65 - 0.62 0.54 -0.32 -0.36
9. Social Constraints-Pt -0.28 0.30 0.20 -0.39 -0.49 -0.53 0.56 0.66 - 0.46 -0.47 -0.26
10. Social Constraints-F/F -0.12 0.14 0.15 -0.11 0.03 0.01 0.30 0.20 0.41 - 0.02 -0.30
11. Communication-Pt 0.41 -0.02 0.10 0.38 0.60 0.65 -0.41 -0.61 -0.51 0.03 - 0.39
12. Communication-F/F 0.33 -0.05 -0.18 0.05 0.11 0.13 -0.12 -0.33 -0.17 -0.35 0.33 -
Note. Top half presents T1 correlations and bottom half presents T2
correlations
Bold=p≤.05
PANAS=Positive and Negative Affect Schedule; IESR=Impact of Events Scale-Revised; RDAS=Revised Dyadic Adjustment
Scale

40

communication were associated with cancer-specific communication, with more
constraints being associated with less communication from respective sources.
The correlations between the different limitation on communication variables for
spouses also are presented (Table 6). Social Constraints-Pt, Social Constraints-F/F,
Protective Buffering-By Sp, and Protective Buffering-By Pt were significantly positively
associated with one another within each time point. The only exception was that Social
Constraints-F/F was not associated with Protective Buffering-By Pt at T1.
In order to examine the associations over time, specifically, between limitation on
communication variables at T1 and affect at T2, Pearson correlations were conducted for
spouses between time points (Table 7). Both Social Constraints-Pt and Social
Constraints-F/F at T1 were significantly associated with affect at T2. Greater external
limitations on communication from both sources prior to treatment were associated with
lower spousal positive affect and greater spousal negative affect three months after
treatment. Greater Protective Buffering-By Sp was significantly associated with only
greater spousal negative affect.
Patients
In order to examine the associations between the study’s key variables among
patients, Pearson correlations for all variables were conducted for patients at T1 (Table
8). PANAS was the only patient variable given at T2, thus correlations at T2 are
provided only for PANAS. Analyses within T1 indicated that none of the limitation on
communication variables was significantly associated with PANAS-positive or negative
affect. There were significant associations, however, between limitation on

41
Table 7. Pearson Correlations of Spouse Variables
between T1 and T2

1 2 3 4 5 6 7 8 9 10 11 12
1. PANAS-Positive Affect 0.69 -0.23 -0.27 0.01 0.15 0.06 -0.07 -0.12 -0.11 -0.04 0.27 0.11
2. PANAS-Negative Affect -0.12 0.41 0.67 0.32 0.33 0.27 0.31 0.10 0.11 0.24 0.07 -0.13
3. IESR-Intrusive Thoughts -0.06 0.42 0.78 0.33 0.26 0.19 0.36 0.09 0.13 0.10 -0.03 -0.07
4. RDAS 0.15 -0.05 0.05 0.74 0.58 0.63 -0.31 -0.41 -0.46 0.00 0.47 0.10
5. Support Provision 0.03 0.12 0.20 0.55 0.77 0.68 -0.22 -0.23 -0.31 0.08 0.39 -0.05
6. Support Receipt 0.25 0.08 0.25 0.56 0.73 0.84 -0.24 -0.36 -0.37 0.04 0.52 0.16
7. Protective Buffering-By Sp -0.27 0.30 0.17 0.03 -0.05 -0.22 0.65 0.36 0.24 0.21 -0.27 -0.19
8. Protective Buffering-By Pt -0.40 0.38 0.19 -0.18 -0.26 -0.29 0.59 0.71 0.52 0.12 -0.43 -0.11
9. Social Constraints-Pt -0.37 0.34 0.17 -0.35 -0.35 -0.47 0.55 0.53 0.73 0.32 -0.49 -0.14
10. Social Constraints-F/F -0.34 0.29 0.26 0.01 -0.07 -0.02 0.35 0.37 0.34 0.52 -0.20 -0.25
11. Communication-Pt 0.32 -0.14 -0.12 0.41 0.49 0.51 -0.40 -0.45 -0.49 0.04 0.75 0.26
12. Communication-F/F 0.31 -0.16 -0.26 0.16 0.24 0.22 -0.26 -0.39 -0.28 -0.12 0.48 0.47
Note. T1 on left column and T2
on top row
Bold=p≤.05
PANAS=Positive and Negative Affect Schedule; IESR=Impact of Events Scale-Revised; RDAS=Revised Dyadic Adjustment
Scale

42
Table 8. Pearson Correlations for Patient Variables at T1 and T2

1 2 3 4 5 6 7 8
1. PANAS-Positive Affect - 0.04 -0.04 0.01 -0.16 -0.02 -0.10 0.18
2. PANAS-Negative Affect -0.23 - -0.39 -0.44 -0.24 0.18 0.10 0.03
3. RDAS - - - 0.46 0.52 -0.17 -0.17 -0.35
4. Support Provision - - - - 0.69 -0.29 -0.25 -0.45
5. Support Receipt - - - - - -0.32 -0.23 -0.66
6. Protective Buffering-By Sp - - - - - - 0.57 0.60
7. Protective Buffering-By Pt - - - - - - - 0.47
8. Social Constraints-Sp - - - - - - - -
Note. Top half presents T1 correlations and bottom half presents T2 correlations
Bold=p≤.05
PANAS=Positive and Negative Affect Schedule; RDAS=Revised Dyadic Adjustment Scale
PANAS was only patient variable given at T2

43

communication and contextual variables. Social Constraints-Sp was significantly
associated with RDAS, Support Provision, and Support Receipt, with greater perceived
constraint from spouses being associated with lower marital quality, and lower provision
and receipt of support within the marriage. Protective Buffering-By Pt was significantly
associated with contextual variables. With respect to the relations between limitation on
communication variables, analyses indicated that Social Constraints-Sp and Protective
Buffering-By Pt were significantly associated, with greater perceived constraint by
spouses being associated with greater patient buffering of spouses.
Table 9 presents the Pearson correlations for patients across time. None of the
study’s variables at T1 were significantly associated with PANAS-positive affect at T2,
with the exception of T1 PANAS-positive affect. RDAS and Support Provision at T1
were both significantly associated with PANAS-negative affect at T2, with greater
marital quality and greater provision of support to spouses prior to surgery being
associated with less patient negative affect following surgery.
Specific Aim 1: Relation of Limitation on Communication Variables to Spouses’
Affect
Within Time Analyses
In order to investigate the relation of spousal perceived social constraints and
protective buffering on spousal affect within time, multiple regression analyses were
conducted separately for each limitation on communication variable. Although Pearson
correlations between limitation on communication variables and affect were examined
earlier, the regression analyses control for spousal demographic and patients’ medical

44

Table 9. Pearson Correlations of Patient Variables between T1 and T2

PANAS-
Positive Affect
PANAS- Negative
Affect
1. PANAS-Positive Affect 0.37 -0.18
2. PANAS-Negative Affect -0.06 0.64
3. RDAS 0.11 -0.30
4. Support Provision 0.27 -0.29
5. Support Receipt 0.03 -0.13
6. Protective Buffering-By Sp 0.01 0.14
7. Protective Buffering-By Pt -0.23 -0.09
8. Social Constraints-Sp -0.10 0.05
Note. T1 on left column and T2 on top row
Bold=p≤.05
PANAS=Positive and Negative Affect Schedule; RDAS=Revised Dyadic Adjustment Scale
PANAS was only patient variable given at T2

variables as covariates in the regression equations. Multiple regression analyses
including these covariates revealed fewer significant relations than the bivariate
correlations demonstrated earlier. The hypothesis that social constraints and protective
buffering would be associated with spousal affect within time was partially supported.
Although Social Constraints-Pt was not significantly associated with PANAS at either
time point (Tables 10 and 11), Social Constraints-F/F and Protective Buffering-By Sp
were significantly associated with PANAS-negative affect among spouses. At T1, Social
Constraints-F/F was significantly positively associated with PANAS-negative affect
(Table 12), but was not significant at T2 (Table 13). Protective Buffering-By Sp, on the
other hand, was significantly positively associated with PANAS-negative affect at both
time points (Tables 14 and 15).

45

Table 10. Multiple Regression Analyses Examining the Role of T1 Spousal Perception of
Social Constraints from Patients on T1 Spousal Affect

T1 Spouse PANAS-
positive
T1 Spouse PANAS-
negative
R
2
0.127 0.058

β β
Block 1
Spouse age -0.017 -0.155
Spouse education -0.258 -0.028
Patient time since diagnosis 0.086 0.004

Block 2
T1 Spouse Social Constraints-Pt -0.239 0.185
Note. For PANAS-positive R
2
= .073 (p=.367) for Block 1; ΔR
2
= .054 (p=.125) for Block 2
For PANAS-negative R
2
= .025 (p=.784) for Block 1; ΔR
2
= .032 (p=.248) for Block 2
No significant results

Table 11. Multiple Regression Analyses Examining the Role of T2 Spousal Perception of
Social Constraints from Patients on T2 Spousal Affect

T2 Spouse PANAS-
positive
T2 Spouse PANAS-
negative
R
2
0.087 0.106

β β
Block 1
Spouse age -0.096 -0.130
Spouse education 0.070 -0.130
Patient time since diagnosis 0.069 -0.141

Block 2
T2 Spouse Social Constraints-Pt -0.279 0.219
Note. For PANAS-positive R
2
= .087 (p=.875) for Block 1; ΔR
2
= .070 (p=.087) for Block 2
For PANAS-negative R
2
= .106 (p=.445) for Block 1; ΔR
2
= .043 (p=.172) for Block 2
No significant results

46

Table 12. Multiple Regression Analyses Examining the Role of T1 Spouse Perception of
Social Constraints from Family/Friends on T1 Spousal Affect

T1 Spouse PANAS-
positive
T1 Spouse PANAS-
negative
R
2
0.114 0.141*

β β
Block 1
Spouse age -0.017 -0.155
Spouse education -0.258 -0.028
Patient time since diagnosis 0.086 -0.004

Block 2
T1 Spouse Social Constraints-F/F -0.205 0.345*
Note. For PANAS-positive R
2
= .073 (p=.367) for Block 1; ΔR
2
= .041 (p=.183) for Block 2
For PANAS-negative R
2
= .025 (p=.784) for Block 1; ΔR
2
= .115* (p=.026) for Block 2
***p≤.001, **p≤.01, *p≤.05

Table 13. Multiple Regression Analyses Examining the Role of T2 Spousal Perception of
Social Constraints from Family/Friends on T2 Spousal Affect

T2 Spouse PANAS-
positive
T2 Spouse PANAS-
negative
R
2
0.018 0.083

β β
Block 1
Spouse age -0.096 -0.130
Spouse education 0.070 -0.130
Patient time since diagnosis 0.069 -0.141

Block 2
T2 Spouse Social Constraints-F/F -0.041 0.146
Note. For PANAS-positive R
2
= ..017 (p=.875) for Block 1; ΔR
2
= .002 (p=.795) for Block 2
For PANAS-negative R
2
= .062 (p=.445) for Block 1; ΔR
2
= .021 (p=.345) for Block 2
No significant results

47

Table 14. Multiple Regression Analyses Examining the Role of T1 Spousal Protective Buffering
of Patients on T1 Spousal Affect

T1 Spouse PANAS-
positive
T1 Spouse PANAS-
negative
R
2
0.129 0.115*

β β
Block 1
Spouse age -0.017 -0.155
Spouse education -0.258 -0.028
Patient time since diagnosis 0.086 -0.004

Block 2
T1 Spouse Protective Buffering-By Sp -0.248 0.315*
Note. For PANAS-positive R
2
= .073 (p=.367) for Block 1; ΔR
2
= .056 (p=.117) for Block 2
For PANAS-negative R
2
= .025 (p=.784) for Block 1; ΔR
2
= .090* (p=.051) for Block 2
***p≤.001, **p≤.01, *p≤.05

Table 15. Multiple Regression Analyses Examining the Role of T2 Spousal Protective Buffering
of Patients on T2 Spousal Affect

T2 Spouse PANAS-
positive
T2 Spouse PANAS-
negative
R
2
0.035 0.205**

β β
Block 1
Spouse age -0.096 -0.130
Spouse education 0.070 -0.130
Patient time since diagnosis 0.069 -0.141

Block 2
T2 Spouse Protective Buffering-By Sp -0.142 0.391**
Note. For PANAS-positive R
2
= .017 (p=.875) for Block 1; ΔR
2
= .019 (p=.385) for Block 2
For PANAS-negative R
2
= .062 (p=.445) for Block 1; ΔR
2
= .143* (p=.011) for Block 2
***p≤.001, **p≤.01, *p≤.05

48

Spousal perceived constraint from family/friends and protective buffering of
patients were associated with spousal negative affect, however, limitation on
communication variables were not associated with spousal positive affect at either time
point. In order to further examine the role of limitations on communication on positive
affect, exploratory analyses were conducted. Although the study introduced spousal
protective buffering of patients as an internal limitation on communication, spousal
perception of being buffered by patients was not hypothesized to be a limitation on
communication for spouses. Exploratory regression analyses indicated that Protective
Buffering-By Pt, rather than By Sp, was significantly associated with PANAS-positive
affect only at T2 (Table 16). Specifically, greater spousal perception that she was being
buffered by the patient was associated with lower spousal positive affect at T2. These
results suggest that although spousal buffering of patients may be an internal limitation
on communication for spouses, spousal perception of being buffered by patients may be a
type of external limitation on communication.
Across Time Analyses
The relation of perceived social constraints and protective buffering to spousal
affect also was hypothesized to be significant over time. In order to predict change in
affect over time, multiple regression analyses were conducted by entering the dependent
variable at T1 along with other covariates. Analyses indicated that T1 Social Constraints-
Pt was significantly associated with change in PANAS-negative affect (Table 17).
Greater initial spousal perceptions of constraint from patients predicted less of a
reduction in spousal negative affect over time than lower perceptions of constraint.

49

Table 16. Multiple Regression Analyses Examining the Role of T2 Spousal Perception of
Protective Buffering by Patients on T2 Spousal Affect

T2 Spouse PANAS-
positive
R
2
0.247***

β
Block 1
Spouse age -0.096
Spouse education 0.070
Patient time since diagnosis 0.069

Block 2
T2 Spouse Protective Buffering-By Pt -0.523***
Note. For PANAS-positive R
2
= .017 (p=.875) for Block 1; ΔR
2
= .230*** (p=.001) for Block 2
***p≤.001, **p≤.01, *p≤.05

Table 17. Multiple Regression Analyses Examining the Role of T1 Spousal Perception of
Social Constraints from Patients on Change in Spousal Affect

T2 Spouse PANAS-
positive
T2 Spouse PANAS-
negative
R
2
0.575*** 0.381**

β β
Block 1
Spouse age -0.083 -0.059
Spouse education 0.267* -0.117
Patient time since diagnosis 0.004 -0.143
T1 Spouse PANAS-positive 0.762*** -
T1 Spouse PANAS-negative - 0.461**

Block 2
T1 Spouse Social Constraints-Pt -0.155 0.349*
Note. For PANAS-positive R
2
= .554*** (p≤.001) for Block 1; ΔR
2
= .021 (p=.169) for Block 2
For PANAS-negative R
2
= .270** (p=.012) for Block 1; ΔR
2
= .111** (p=.012) for Block 2
***p≤.001, **p≤.01, *p≤.05

50

Although spousal perceived social constraint from patients was not associated with
spousal affect within time, as described in the within time analyses, it appears to be
associated with change in spousal negative affect, specifically less of a reduction in
negative affect over time. Across time analysis investigating the role of Social
Constraints-F/F and Protective Buffering-By Sp on change in PANAS, however, were
not significant among spouses, unlike as seen in within time analyses (Tables 18 and 19).

Table 18. Multiple Regression Analyses Examining the Role of T1 Spousal Perception of
Social Constraints from Family/Friends on Change in Spousal Affect

T2 Spouse
PANAS-positive
T2 Spouse
PANAS-negative
R
2
0.589*** 0.320**

β β
Block 1
Spouse age -0.083 -0.059
Spouse education 0.267* -0.117
Patient time since diagnosis 0.004 -0.143
T1 Spouse PANAS-positive 0.762*** -
T1 Spouse PANAS-negative - 0.461**

Block 2
T1 Spouse Social Constraints-F/F -0.194 0.243
Note. For PANAS-positive R
2
= .554*** (p≤.001) for Block 1; ΔR
2
= .035 (p=.076) for Block 2
For PANAS-negative R
2
= .270** (p=.012) for Block 1; ΔR
2
= .050 (p=.097) for Block 2
***p≤.001, **p≤.01, *p≤.05

51

Table 19. Multiple Regression Analyses Examining the Role of T1 Spousal Protective Buffering
of Patients on Change in Spousal Affect

T2 Spouse PANAS-
positive
T2 Spouse PANAS-
negative
R
2
0.561*** 0.331**

β β
Block 1
Spouse age -0.083 -0.059
Spouse education 0.267* -0.117
Patient time since diagnosis 0.004 -0.143
T1 Spouse PANAS-positive 0.762*** -
T1 Spouse PANAS-negative - 0.461**

Block 2
T1 Spouse Protective Buffering-By Sp -0.092 0.274
Note. For PANAS-positive R
2
= .554*** (p≤.001) for Block 1; ΔR
2
= .007 (p=.427) for Block 2
For PANAS-negative R
2
= .270** (p=.012) for Block 1; ΔR
2
= .062 (p=.065) for Block 2
***p≤.001, **p≤.01, *p≤.05

Given that exploratory regression analyses earlier indicated that spousal
perceptions of being buffered by patients were significantly associated with spousal
positive affect, exploratory regression analyses again were conducted to examine spousal
perceptions of being buffered by patients as a predictor of change in spousal affect.
Multiple regression analyses indicated that Protective Buffering-By Pt significantly
predicted a change in PANAS among spouses. Specifically, greater spousal perceptions
of being buffered by patients were associated with less of an increase in positive affect
and less of a reduction in negative affect over time (Table 20).

52

Table 20. Multiple Regression Analyses Examining the Role of T1 Spousal Perception of
Protective Buffering by Patients on Change in Spousal Affect

T2 Spouse PANAS-
positive
T2 Spouse PANAS-
negative

R
2
0.691*** 0.341**

β β
Block 1
Spouse age -0.083 -0.059
Spouse education 0.267* -0.117
Patient time since diagnosis 0.004 -0.143
T1 Spouse PANAS-positive 0.762*** -
T1 Spouse PANAS-negative - 0.461**

Block 2
T1 Spouse Protective Buffering-By Pt -0.264** 0.277*
Note. For PANAS-positive R
2
= .554*** (p≤.001) for Block 1; ΔR
2
= .065** (p=.014) for Block 2
For PANAS-negative R² = .270** (p=.012) fo r Block 1; ΔR² = .072* (p=.046) for Block 2
***p≤.001, **p≤.01, *p≤.05

Mediational Analyses: Cancer-specific Communication
Next, it was hypothesized that the relation between T1 limitation on
communication variables and change in affect over time would be mediated by T1
cancer-specific communication among spouses. As described in the across time analyses,
T1 Social Constraints-Pt was a significant predictor of change in PANAS-negative affect.
Prior to testing mediation, Baron and Kenny’s (1986) preliminary mediational criteria
were assessed. Although T1 Social Constraints-Pt and T1 Communication-Pt were
significantly associated (β=-.441, p=.004), the relation between T1 Communication-Pt
and change in PANAS-negative affect was not significant (β=-.111, p=.429).
Preliminary criteria were not met for mediation, and as a result, spousal cancer-specific

53

communication with patients was not tested as a mediator of the relation between spousal
perceived social constraint and change in spousal negative affect.
Across time analyses for the other limitation on communication variables- relation
between Social Constraints-F/F and Protective Buffering-By Sp to change in PANAS-
did not yield significant results, thus were not considered for mediational analyses.
However, exploratory analyses described earlier indicated that spousal perceptions of
being buffered by patients significantly predicted change in spousal affect over time.
Thus, exploratory analyses were conducted to examine the possible mediating role of
cancer-specific communication of this relation. Although T1 Protective Buffering-By Pt
and T1 Communication-Pt were significantly associated (β=-.301, p=.049), the relation
between T1 Communication-Pt and change in PANAS-positive affect (β=.030, p=.794)
and negative affect (β=-.111, p=.429) affect were not significant. Since preliminary
mediational criteria were not significant, Communication-Pt was not tested as a mediator.
Exploratory Mediational Analyses: Other Contextual Variables
Given that T1 cancer-specific communication did not meet preliminary
mediational criteria for either of the relations described above, exploratory analyses were
conducted. The study’s other social contextual variables, such as dyadic adjustment,
change in support from patients, and change in cancer-specific communication over time
were examined as potential mediators for the relation between T1 Social Constraints-Pt
and change in PANAS-negative affect among spouses. Although T1 Social Constraints-
Pt and T1 RDAS were significantly associated (β=-.516, p=.001), the relation between

54

T1 RDAS and change in PANAS-negative affect was not significant (β=-.071, p=.610).
Additionally, T1 Social Constraints-Pt and change in Support Receipt were significantly
associated (β=-.180, p=.035), however, the relation between change in Support Receipt
and change in PANAS-negative affect was not significant (β=-.425, p=.130). Change in
Communication-Pt was not associated with either T1 Social Constraints-Pt (β=-.151,
p=.215) or change in PANAS-negative affect (β=.009, p=.968). As a result, neither
dyadic adjustment, change in support from patients, nor change in cancer-specific
communication could be tested as mediators of the relation between spousal perceived
social constraint and change in spousal negative affect. Lastly, preliminary mediational
criteria were assessed for the relation between Protective Buffering-By Pt and change in
PANAS-positive and negative affect, which yielded similar non-significant findings.
Mediational Analyses: Cognitive Processing
The study also aimed to investigate the possible mediating role of cognitive
processing on the relation between cancer-specific communication and affect among
spouses. It was hypothesized that greater communication would be associated with better
affect over time, in part due to an increase in cognitive processing. A reduction in
intrusive thoughts was used as an indicator of cognitive processing. Contrary to the
study’s hypothesis, T1 Communication-Pt was not a significant predictor of change in
PANAS-positive affect (β=.030, p=.794) or negative affect (β=-.111, p=.429) among
spouses. Given these non-significant relations, mediational analyses were not conducted.
There was not a significant association between communication and change in affect,

55

however, multiple regression analyses indicated that a change in intrusive thoughts was
significantly associated with change in positive (β=-.033, p=.05) and negative affect
(β=.745, p=.001). Specifically, spouses who had a reduction in intrusive thoughts had an
increase in positive affect and a reduction in negative affect. The results suggest that
cognitive processing was associated with better affect over time, as supported by
cognitive processing theories.
Moderational Analyses: Social Constraints x Protective Buffering
The study also hypothesized an interaction effect for limitation on communication
variables from different sources. Specifically, it was hypothesized that spousal buffering
of patients would be associated with change in affect over time, more so for spouses who
also were constrained by family/friends. Contrary to the study’s prediction, an
interaction effect was not supported. Multiple regression analyses indicated that Social
Constraints-F/F was not a significant moderator of the relation between Protective
Buffering-By Sp and change in PANAS-negative affect among spouses (Table 21).
Specific Aim 2- Relation of Spouses’ Affect to Support Provision and Patients’
Limitations on Communication
Spouses’ Support Provision
The negative relation between limitation on communication variables and spousal
affect was illustrated above. The following section focuses on the relation of spousal
affect and their provision of support to patients. The hypothesis that greater spousal
positive affect and lower spousal negative affect would be associated with greater spousal
provision of support to patients was not supported. Contrary to the study’s prediction,

56

Table 21. Multiple Regression Analyses Examining the Moderating Role of T1 Spousal
Protective Buffering of Patients on the Relation between T1 Spousal Perception of
Social Constraints from Family/Friends and Change in Spousal Affect

T2 Spouse PANAS-
positive
T2 Spouse PANAS-
negative
R
2
0.591*** 0.362**

β Β
Block 1
Spouse age -0.083 -0.059
Spouse education 0.267* -0.117
Patient time since diagnosis 0.004 -0.143
T1 Spouse PANAS-positive 0.762*** -
T1 Spouse PANAS-negative - 0.461**

Block 2
T1 Spouse Protective Buffering-By Sp
(centered) 0.021 0.200
T1 Spouse Social Constraints-F/F (centered) -0.205 0.145

Block 3
T1 Spouse Protective Buffering-By Sp
x Spouse Social Constraints-F/F -0.049 -0.165
Note. For PANAS-positive R
2
= .554*** (p<.001) for Block 1; ΔR
2
= .035 (p=.209) for Block 2;
ΔR2 = .001 (p=.716) for Block 3
For PANAS-negative R² = .270** (p=.012) fo r Block 1; ΔR² = .075 (p=.127) for Block 2;
ΔR² = .017 (p=.328) for Block 3
***p≤.001, **p≤.01, *p≤.05

multiple regression analyses indicated that T1 PANAS-negative affect was significantly
positively associated with T1 Support Provision, rather than negatively associated (Table
22). Greater spousal negative affect was associated with greater spousal provision of
support to patients. Given that this relation is from the spouse’s perspective, exploratory

57

Table 22. Multiple Regression Analyses Examining the Role of T1 Spousal Negative Affect on
T1 Spousal Support Provision to Patients

T1 Spouse
Support Provision
R
2
0.168

β
Block 1
Spouse age -0.019
Spouse education -0.084
Patient time since diagnosis 0.036

Block 2
T1 Spouse PANAS-negative 0.404**
Note. R
2
= .009 (p=.947) for Block 1; ΔR
2
= .159** (p=.009) for Block 2
***p≤.001, **p≤.01, *p≤.05

analyses were conducted to determine if patients too perceived this relation. Multiple
regression analyses indicated that T1 PANAS-negative affect among spouses also was
significantly positively associated with T1 patients’ perceptions of Support Receipt
(β=.31, p=.04), suggesting that patients too report a positive relation between spousal
negative affect and patients’ receipt of support from spouses. Multiple regression
analyses indicated non-significant relations between spousal PANAS-positive affect and
spousal Support Provision at T1 (β=.121, p=.461) and at T2 (β=.219, p=161), as well as
spousal PANAS-negative affect and spousal Support Provision at T2 (β=.171, p=.266).
Given that these relations are examined within time, it is possible that greater
spousal provision of support to patients was contributing to greater spousal negative
affect, rather than greater negative affect contributing to greater support provision. In
order to elucidate the direction of this relation, multiple regression analyses were

58

performed across time. T1 PANAS-negative affect was significantly positively
associated with T2 Support Provision, indicating that the relation between spousal
negative affect and spousal provision of support to patients remained significant over
time (Table 23). However, this relation was not significant when Support Provision was
residualized (β=.063, p=.561), suggesting that negative affect does not account for the
change in provision of support over time. Additionally, when examining the reverse
relation, analyses indicated that T1 Support Provision and T2 PANAS-negative affect
were not significantly associated (β=.232, p=.128), indicating that spousal provision of
support to patients did not contribute to spousal negative affect over time.

Table 23. Multiple Regression Analyses Examining the Role of T1 Spousal Negative Affect on
T2 Spousal Support Provision to Patients

T2 Spouse
Support Provision
R
2
0.142

β
Block 1
Spouse age 0.019
Spouse education 0.073
Patient time since diagnosis -0.019
Block 2
T1 Spouse PANAS-negative 0.373*
Note. R
2
= .006 (p=.969) for Block 1; ΔR
2
= .142* (p=.016) for Block 2
***p≤.001, **p≤.01, *p≤.05

59

Patients’ Limitations on Communication
Analyses were conducted to explore the relation between spousal affect and
patients’ perceptions of their own limitations on communication. None of the analyses,
however, yielded significant results. PANAS-positive affect (Table 24) and negative
affect (Table 25) were not significantly associated with patients’ perceptions of Social
Constraints-Sp and Protective Buffering-By Sp.

Table 24. Multiple Regression Analyses Examining the Role of T1 Spousal Positive Affect on
T1 Patient Perceptions of External and Internal Limitations on Communication

T1 Patient Social
Constraints-Sp
T1 Patient Protective
Buffering-By Sp
R
2
0.108 0.065

β β
Block 1
Spouse age -0.036 -0.128
Spouse education 0.041 0.137
Patient time since diagnosis 0.323 0.178
Block 2
T1 Spouse PANAS-positive -0.041 -0.071
Note. For Social Constraints: R
2
= .106 (p=.200) for Block 1; ΔR
2
= .002 (p=.792) for Block 2
For Protective Buffering: R
2
= .060 (p=.461) for Block 1; ΔR
2
= .005 (p=.658) for Block 2
No significant results

60

Table 25. Multiple Regression Analyses Examining the Role of T1 Spousal Negative Affect on
T1 Patient Perceptions of External and Internal Limitations on Communication

T1 Patient Social
Constraints-Sp
T1 Patient Protective
Buffering-By Sp
R
2
0.143 0.071

β β
Block 1
Spouse age -0.036 -0.128
Spouse education 0.041 0.137
Patient time since diagnosis 0.323 0.178
Block 2
T1 Spouse PANAS-negative -0.196 -0.104
Note. For Social Constraints: R
2
= .106 (p=.200) for Block 1; ΔR
2
= .037 (p=.197) for Block 2
For Protective Buffering: R
2
= .060 (p=.461) for Block 1; ΔR
2
= .011 (p=.505) for Block 2
No significant results

Specific Aim 3: Relation of Spouses’ Protective Buffering of Patients to Patients’
Affect
The last section focuses on the relation between spousal protective buffering of
patients and patients’ affect. Multiple regression analyses indicated that T1 spousal
Protective Buffering-By Sp was not significantly associated with a change in PANAS-
positive affect or negative affect among patients (Table 26). Furthermore, neither
patients’ perceptions of Social Constraints-Sp (Table 27) nor patients’ perceptions of
Protective Buffering-By Sp (Table 28) were significant moderators of this relation,
indicating that patients’ perceptions of limitations on communication did not interact to
predict to patients’ affect.

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Table 26. Multiple Regression Analyses Examining the Role of T1 Spousal Protective Buffering
of Patients on Change in Patient Affect

T2 Patient PANAS-
positive
T2 Patient PANAS-
negative
R
2
0.334** 0.466***

β β
Block 1
Patient age -0.165 -0.298*
Patient education 0.486*** 0.031
Patient time since diagnosis -0.020 -0.066
T1 Patient PANAS-positive 0.339* -
T1 Patient PANAS-negative - 0.482***

Block 2
T1 Spouse Protective Buffering-By Sp 0.090 0.174
Note. For PANAS-positive R
2
= .327 (p=.003) for Block 1; ΔR
2
= .007 (p=.532) for Block 2
For PANAS-negative R² = .438*** (p ≤.001) for Block 1; ΔR² = .028 (p=.159) for Block 2
***p≤.001, **p≤.01, *p≤.05

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Table 27. Multiple Regression Analyses Examining the Moderating Role of T1 Patient
Perception of Social Constraints from Spouses on the Relation between T1 Spousal
Protective Buffering of Patients and Change in Patient Affect

T2 Patient PANAS-
positive
T2 Patient PANAS-
negative
R
2
0.371** 0.485***

β β
Block 1
Patient age -0.165 -0.298*
Patient education 0.486*** 0.031
Patient time since diagnosis -0.020 -0.066
T1 Patient PANAS-positive 0.339* -
T1 Patient PANAS-negative - 0.482***

Block 2
T1 Spouse Protective Buffering-By Sp
(centered) 0.111 0.170
T1 Patient Social Constraints-Sp (centered) -0.203 0.100

Block 3
T1 Spouse Protective Buffering-By Sp x
Patients Social Constraints-Sp -0.026 -0.099
Note. For PANAS-positive R
2
= .327** (p=.003) for Block 1; ΔR
2
= .043 (p=.283) for Block 2;
ΔR2 = .001 (p=.845) for Block 3
For PANAS-negative R² = .438*** (p ≤.001) for Block 1; ΔR² = .037 (p=.270) for Block 2;
ΔR² = .009 (p=.420) for Block 3
***p≤.001, **p≤.01, *p≤.05

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Table 28. Multiple Regression Analyses Examining the Moderating Role of T1 Patient
Perception of Protective Buffering by Spouses on the Relation between T1 Spousal
Protective Buffering of Patients and Change in Patient Affect

T2 Patient PANAS-
positive
T2 Patient PANAS-
negative
R
2
0.339* 0.492***

β β
Block 1
Patient age -0.165 -0.298*
Patient education 0.486*** 0.031
Patient time since diagnosis -0.020 -0.066
T1 Patient PANAS-positive 0.339* -
T1 Patient PANAS-negative - 0.482***

Block 2
T1 Spouse Protective Buffering-By Sp
(centered) 0.088 0.186
T1 Patient Protective Buffering-By Sp
(centered) 0.011 -0.061

Block 3
T1 Spouse Protective Buffering-By Sp x
Patients of Protective Buffering-By Sp 0.078 -0.163
Note. For PANAS-positive R
2
= .327** (p=.003) for Block 1; ΔR
2
= .007 (p=.822) for Block 2;
ΔR2 = .005 (p=.589) for Block 3
For PANAS-negative R² = .438*** (p ≤.001) for Block 1; ΔR² = .032 (p=.334) for Block 2;
ΔR² = .022 (p=.214) for Block 3
***p≤.001, **p≤.01, *p≤.05

Exploratory Analyses: Protective Buffering
The study’s findings revealed that spousal perceptions of being buffered by
patients were a significant predictor of change in spousal negative affect. However,
patients’ perceptions of being buffered by spouses were not a predictor of change in
patient negative affect (β=-.023, p=.853). Exploratory regression analyses were

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conducted to further understand this spouse-patient difference. Whether being buffered
was viewed as socially constraining, and if it was this perception that mediated the
relation between protective buffering and change in affect were explored. For spouses,
T1 Social Constraints-Pt partially mediated the relation between T1 Protective Buffering-
By Pt and change in PANAS-negative affect among spouses (Table 29). Specifically,
greater spousal perceptions of protective buffering by patients were associated with less
of a reduction in spousal negative affect over time, in part due to greater perceptions of
social constraint. Sobel’s test of mediation also indicated a significant mediation effect
(z=1.57, p=.05). In other words, spouses experienced buffering by patients as socially
constraining, which predicted less of a reduction in negative affect over time.
Table 29. Multiple Regression Analyses Examining the Mediational Role of T1 Spousal
Perception of Social Constraints from Patients on the Relation between T1 Spousal
Perception of Protective Buffering by Patients and Change in Spousal Negative Affect

T2 Spouse
PANAS-negative
R
2
0.385**

β
Block 1
Spouse age -0.059
Spouse education -0.117
Patient time since diagnosis -0.143
T1 Spouse PANAS-negative 0.461**

Block 2
T1 Spouse Protective Buffering-By Pt 0.277*

Block 3
T1 Spouse Protective Buffering-By Pt 0.094
T1 Spouse Social Constraints-Pt 0.288
Note. R² = .270** (p=.012) for Block 1; ΔR² = .072* (p=.046) for Block 2; ΔR² = .044 (p=.107)
***p≤.001, **p≤.01, *p≤.05

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The above mediational relation was examined from the spouse’s perspective. To
further explore this finding, analyses were conducted utilizing the patient’s perspective of
buffering his spouse. In other words, the study explored whether the patient’s report of
buffering his spouse would yield similar results as the spouse’s perception of being
buffered by the patient. Patients’ reports of T1 Protective Buffering-By Pt was
significantly associated with a change in spousal negative affect (β=.403, p=.004),
specifically less of a reduction in negative affect over time. However, preliminary
mediational criteria were not met. T1 patient’s Protective Buffering-By Pt was not
significantly associated with T1 spouse’s Social Constraints-Pt (β=.058, p=.724). As a
result, mediational analyses could not be conducted. Although spousal perceptions of
being buffered by patients were viewed as socially constraining, it appears that patients’
reports of buffering spouses were not perceived as constraining. This leads to the
question of whether spouses’ and patients’ perceptions of these behaviors were
associated. Analyses indicated that T1 spouse’s Protective Buffering-By Pt was not
significantly associated with T1 patient’s Protective Buffering-By Pt (β=.173, p=.296).
Multiple regression analyses were also conducted to explore the above relations
among patients. T1 patient’s Protective Buffering-By Sp and T1 patient’s Social
Constraints-Sp were significantly associated (β=.604, p<.001). However, whether the
perception that being buffered is socially constraining is predictive of change in negative
affect could not be tested due to the non-significant relation between buffering and
change in negative affect.

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In sum, spousal perceptions that being buffered by patients was socially
constraining partly contributed to less of a reduction in negative affect over time.
Exploratory analyses not only revealed that this mediational relation was not significant
from the patient’s perspective, but that spouses’ perceptions of being buffered by patients
were not associated with patients’ reports of buffering their spouses. Lastly, for patients,
the perception that being buffered was socially constraining was not associated with a
change in negative affect over time.

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CHAPTER 5: DISCUSSION
The purpose of the study was to investigate the role of external and internal
limitations on communication on affect, from spouses’ and patients’ perspectives, as well
as to explore contextual variables as potential mediators and moderators of these
relations. The aim of the study was to examine the relation between 1) spousal
limitations on communication and their own affect, 2) spousal affect and their support
provisions and limitations on communication toward patients, and 3) limitations on
communication and patients’ affect. Overall, the results indicated that environments with
greater perceived constraints and buffering were associated with worse spousal affect.
However, the relation between the type and source of limitation on communication and
spousal affect differed over time, and mediational relations from a social-cognitive
perspective were not supported. Additionally, spousal negative affect predicted greater
provision of support to patients, but did not predict patients’ perceptions of limitations on
communication. Furthermore, patients’ perceptions of limitations on communication did
not predict their own affect. Perhaps the study’s most interesting finding was the
exploratory finding that revealed greater spousal perceptions of being buffered by
patients predicted less of a decrease in negative affect over time than lower spousal
perceptions of being buffered by patients, in part because spouses experienced buffering
as socially constraining. Similar mediational relations were not demonstrated among
patients. Although patients’ perceptions of being buffered by spouses were viewed as
socially constraining, these perceptions were not predictive of change in patients’ affect
over time.

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Relation between Spousal Perceived Social Constraints and Spousal Affect
With respect to the relation between social constraints and affect among spouses,
spousal perceived social constraint from patients was not associated with spousal affect
prior to or following surgery. This is contrary to other studies that have demonstrated an
association between social constraints and various adjustment outcomes, including
depression, anxiety, psychological well-being, and affect (Lepore & Helgeson, 1998;
Lepore & Ituarte, 1999; Schmidt & Andrykowski, 2004). However, previous studies
investigated social constraints among patients, not spouses of patients. The lack of
association between spousal perceived social constraint from patients and spousal affect
may be because spouses reduce their expectations for support, and are more
understanding of negative responses and behaviors from patients since they are the
healthier member of the dyad. Additionally, spouses may seek out support in other social
relationships.
If spouses rely more on family and friends, then it is likely that social constraints
perceived in this environment would play a larger role on spousal affect. Although the
study did not measure social support from family and friends, the study’s results
indicated that constraining relations with family and friends were associated with greater
spousal negative affect prior to surgery. This relation did not remain significant
following surgery. Perhaps spouses feel a stronger need to seek support from family and
friends during the initial phase of cancer. One explanation could be that during the
period between diagnosis and surgery, spouses may not feel comfortable sharing their
cancer-related thoughts and fears with patients, as they may feel it is inappropriate, or

69

insensitive, thus relying more on family and friends. Concerns prior to surgery, such as
fear about cancer, patient’s mood and coping, also may be viewed as more appropriate to
discuss with family and friends, than concerns that might arise following surgery, such as
urinary incontinence and erectile dysfunction. However, our study indicated that prior to
surgery spouses engaged in more cancer-specific communication with patients than with
family and friends. Additionally, spouses did not report engaging in more protective
buffering of patients prior to surgery than following surgery. Another explanation for the
lack of association between spousal perceived social constraints from family and friends
and spousal affect following surgery may be because spouses withdraw, or reduce their
seeking of support from others over time. Spouses reported improved affect over time,
thus a socially constraining environment no longer may be critical toward their
adjustment.
Relation between Spousal Protective Buffering of Patients and Spousal Affect
The study’s results indicated that spouses’ external limitations on communication
from patients were not associated with spousal affect at either time point, however,
spouses’ own internal limitation on communication, protective buffering, was associated
with spousal affect both prior to and following surgery. Consistent with cross-sectional
studies of wives of myocardial infarction patients (Coyne & Smith, 1991; Suls et al.,
1997), spouses reported an association between engaging in protective buffering and
greater negative affect. Thus, as expected, hiding feelings in order to shield patients from
additional distress appeared to be disruptive to spouses’ affect.

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Given that this relation was examined within time, the reverse association also is
possible. Specifically, spouses with greater negative affect may engage in more
protective buffering because they have more to hide from patients. In other words,
spouses with worse affect may be the spouses with greater concerns and worries, thus
likely having more to hide from and deny to patients. When examined across time, the
relation between spousal protective buffering of patients and spousal affect no longer was
significant, similar to Suls et al.’s (1997) prospective study. Spousal protective buffering
of patients was not a predictor of change in spousal affect. Suls et al. hypothesized that
perhaps protective buffering by spouses no longer was detrimental to adjustment because
spouses learned to express their feelings and concerns in other relationships. However,
the study’s results indicated that perceived social constraint from family and friends was
not a moderator, suggesting that constraints in other relationships did not influence this
relation. The study did not measure positive support from family and friends, which may
have been a more relevant construct to assess than the lack of negative responses and
behaviors in other relationships. Although results within time indicated that internal
limitations on communication were associated with spousal affect, results across time
indicated that external limitations on communication were predictive of a change in
spousal affect. Greater spousal perceived social constraints from patients predicted less
of a decrease in spousal negative affect over time than lower spousal perceived social
constraints from patients.

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Relation between Spousal Perceived Protective Buffering by Patients and Spousal
Affect
A limitation on communication variable that was not hypothesized in the study,
spousal perceived protective buffering by patients, may be viewed as another type of
external limitation on communication. Feeling as though the patient is hiding his worries
and denying his concerns may be considered an external limitation on communication for
spouses because similar to social constraint, it is imposed by the environment and may
inhibit open communication. Additionally, feeling buffered by the patient may be
perceived by the spouse as a failure in her role as a caregiver. Results indicated that
feeling buffered by the patient also was predictive of a change in spousal affect.
Although protective buffering, in theory, is intended to be helpful, spouses experienced
buffering behaviors by patients negatively, as greater perceptions of buffering were
associated with less of a reduction in negative affect and less of an increase in positive
affect over time than lower perceptions of buffering.
An alternative explanation for the relation between spousal perceived protective
buffering by patients and negative spousal outcomes may be due to the measurement of
protective buffering. As mentioned above, protective buffering, in theory, refers to
behaviors that are well intended and in the service of the recipient. However, the
instrument utilized in the study does not specify the intent of the individual who is
engaging in these behaviors. In other words, elevated endorsements of the behaviors
described in the instrument may not accurately capture buffering behaviors intended to
protect the recipient. Instead, the instrument may measure behaviors intended to avoid

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and withdraw from the recipient due to one’s difficulty in coping, discomfort in cancer-
specific communication, and desire to exclude the spouse. For example, endorsing that
the patient “tries to hide his worries,” “tried to act as if nothing is the matter,” and “just
waves my worries aside” may be interpreted and perceived negatively, rather than as well
intended efforts to protect one’s spouse. As a result, caution should be used in
interpreting these results, as the construct of protective buffering may not be accurately
measured in this study.
Protective buffering of spouses from both the spouse’s and patient’s perspective
was associated with worse spousal affect, however, the mechanism for these relations
appears to be different. From the spouse’s perspective, feeling buffered by the patient
was viewed as socially constraining, which is consistent with the measurement issues
discussed above. On the other hand, from the patient’s perspective, engaging in buffering
behaviors toward the spouse was not viewed as socially constraining by the spouse.
Additionally, spouses’ and patients’ reports of protective buffering of spouses are not
associated. Perhaps when the patient engages in these behaviors without the spouse’s
awareness, these behaviors may not be viewed as blatantly constraining. However, the
spouse may feel subtle changes in the patient’s behavior that she perceives as emotionally
distant or lacking in intimacy that is in turn associated with worse spousal affect.
Overall, it appears that spouses’ external limitations on communication, such as
constraining marital relationships and feeling buffered by patients, were associated with
less improvement in spousal affect over time, whereas spouses’ internal limitations on
communication, such as buffering of patients, were not associated with affect over time.

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Perhaps because internal limitations on communication are self-imposed, they were
viewed as something that could be altered or changed by the individual, thus associated
with a greater sense of control. On the other hand, external limitations on communication
may be associated with a lack of control and experienced more negatively, thus predictive
of worse consequences over time.
Cancer-specific Communication: Measurement Issues
In order to elucidate the relations between spouses’ external limitations on
communication and change in spousal affect, various contextual variables were examined
as potential mediators. However, spousal measures of cancer-specific communication,
martial quality, support receipt, nor change in these contextual variables mediated the
above relations. An explanation to these null findings, particularly with respect to
communication, again may be due to the instruments used in the study. Although the
study included a measure of communication that was specific to cancer, the instrument
measures the amount of communication, not the quality or depth of discussion, or
satisfaction with communication.
Additionally, the communication instrument utilized in the study does not
measure basic communication skills that are believed to facilitate meaningful discussions
and intimacy. Supportive communication skills, such as empathy, active positive
listening, validation, and self-disclosure/expression of feelings are essential in order for
couples to engage in effective communication (Jacobson & Margolin, 1979). A study
that investigated couples’ communication from an interpersonal process model of
intimacy indicated that disclosure among breast cancer patients and their spouses

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predicted intimacy due to greater feelings of acceptance, understanding, and caring
among spouses (Manne et al., 2004). Lack of emotional intimacy may be what is
inhibited in a relationship that includes social constraints and protective buffering. The
measurement of these additional constructs may have yielded more interesting and
meaningful results with respect to the role of communication on cognitive processing and
emotional adjustment.
Furthermore, the communication skills described above may be particularly
important for couples coping with stressful life events. There may be increased meaning,
value, and expectations placed on communication during emotionally difficult times, as
compared to communication during neutral or more benign situations. Halford and
colleagues (2000) have suggested that during times of stress that evoke strong emotions,
couples’ communication skills may be disrupted. Even for couples with good
communication skills, cancer may be a difficult topic to discuss. It is likely to be a
difficult topic to initiate, but an even greater challenge to carry out a meaningful and
satisfying discussion about one’s feelings about cancer. Although communication may
be disrupted for couples during times of stress, couples who enter stressful situations
equipped with good communication skills may experience a lower degree of difficulty
coping with the challenges of discussing cancer than couples who are not familiar with
good communication skills. Couples’ pre-cancer communication patterns, however, were
not assessed in the study.

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Relation between Spousal Cognitive Processing and Spousal Affect
The relation between spousal perceived social constraints and protective buffering
and spousal affect was hypothesized to be explained by cancer-specific communication,
as the social-cognitive processing model would suggest. However, as explained above, a
mediational mechanism consistent with this model was not supported. Additionally,
cognitive processing was hypothesized to be a possible mediator of the relation between
spousal perceived communication and change in spousal affect, but due to a non-
significant association, mediational analyses could not be completed. Cognitive
processing was explored further, and results indicated that cognitive processing indeed
was associated with a change in affect over time. Specifically, greater spousal cognitive
processing, as indicated by a reduction in intrusive thoughts, predicted an increase in
positive affect and a decrease in negative affect among spouses. As cognitive processing
theories have suggested, prolonged intrusion long past a traumatic event is considered to
be maladaptive and associated with distress. On the other hand, a reduction in intrusive
thoughts is believed to be indicative of successful processing and integration, which is
associated with better psychological outcomes.
Relation between Spousal Affect and Support Provision and Patients’ Limitations
on Communication
With respect to the study’s second aim, the relation between spousal affect and
support to and limitations on communication toward patients, the results revealed an
interesting finding, in that worse spousal affect was associated with more provision of
support to patients prior to surgery. Additionally, results indicated that this relation was

76

significant even from patients’ perspectives, such that greater spousal negative affect was
associated with greater patients’ reports of receiving support from spouses. However,
neither of these relations remained significant following surgery.
Across time analyses revealed that negative affect also was a predictor of support
provision over time, specifically greater spousal negative affect prior to surgery predicted
greater provision of support to patients following surgery. It appears that if spouses
experience worse affect prior to surgery, then they are likely to continue to provide more
support to patients even following surgery. The reverse relation was not found, such that
spousal provision of support to patients prior to surgery did not predict spousal affect
following surgery. These results suggest that it was not the provision of support to
patients that contributed to poor affect among spouses, but that spouses who experienced
worse affect were providing more support to patients. Perhaps spouses with worse affect
believed patients were struggling with adjustment as well, thus providing more support to
alleviate the perceived poor emotional status of patients. In fact, the study indicated that
affect among couples was significantly associated. If a spouse who experiences worse
affect is coupled with a patient who experiences worse affect, she may provide more
support to her husband because she perceives that he needs it. Thus, the relation between
affect and provision of support may be explained by spousal perceptions of patients’
affect, coping, physical health, etc. However, spousal perceptions of patients’ adjustment
were not measured.
Although greater spousal negative affect was associated with greater spousal
provision of support to patients, the study revealed no association between spousal affect

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and patients’ perceptions of social constraints or protective buffering. As previously
mentioned, a spouse with poor affect also may perceive her husband to be experiencing
poor affect, thus providing him increased support. If the perception of worse affect
contributes to attempts to provide increased support, than why are there not attempts to
reduce constraining behaviors? Perhaps supportive behaviors, rather than unsupportive
behaviors, are more easily modified during emotionally difficult times. Spouses may be
more familiar with the benefits of providing positive support, such as giving
encouragement and reassurance, than the negative consequences of engaging in
unsupportive behaviors, such as changing the subject and hiding worries. As a result,
spouses may be able to increase supportive behaviors if they perceive the patient is in
distress, but experience difficulty engaging in less unsupportive behaviors. Whether
patients’ perceptions of spousal affect and patients’ limitations on communication would
be associated is unknown, as spousal affect as perceived by patients was not measured.
Interaction between Spouses’ and Patients’ Perceived Limitations on
Communication
With respect to the study’s third aim, the relation between spousal protective
buffering of patients and patients’ own affect, the results indicated that spousal buffering
of patients did not predict a change in patients’ affect. The moderators explored, in order
to explain this lack of association, yielded non-significant results. It appeared that even
when patients viewed their relationship as constraining, their affect was not predicted by
being buffering by spouses. Additionally, even when patients were aware that their
spouses were buffering them, their affect was not associated with being buffered,

78

contrary to previous findings regarding the effectiveness of invisible support (Bolger et
al., 2000).
So why did protective buffering predict a change in negative affect among
spouses, but not patients? The study revealed that spousal perception of being buffered
by patients was experienced as socially constraining, which in turn predicted less of a
reduction in negative affect over time. For patients, however, the perception that
buffering was socially constraining did not predict a change in affect, although protective
buffering and social constraints were associated. Perhaps spouses, who are the healthier
members of the dyad, desired to know and understand how the patient truly felt, thus
feeling as though the patient was hiding concerns was perceived negatively and as
constraining. Additionally, this difference may be a result of gender, as all patients were
male, and all spouses were female. Gender differences in the cancer patient and spouse
literature have indicated that women, whether they are the healthy or ill member of the
dyad, report more distress than men (Hagedoorn, Sanderman, Bolks, Tuinstra, & Coyne,
2008). Spouse and patient differences with respect to the deleterious effects of
constraints and buffering in part may be due to gender, rather than health status.
Although in the present study there were no differences in affect between female spouses
and male patients, gender may have moderated the relation between protective buffering
and affect. Given that gender and health status are confounded in this study, gender
comparisons could not be conducted.

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Limitations
Lastly, there are some study limitations that need to be addressed. The sample of
couples is relatively homogeneous, as the majority of the participants were well-
educated, non-Hispanic Whites. All couples were in heterosexual relationships, and all
patients were receiving the same type of surgery for their prostate cancer. As a result,
caution should be used when generalizing results to other more heterogeneous samples.
The next limitation of the study is the issue of attrition, which can be seen at both
time points. Forty-two percent of couples did not return completed T1 questionnaires,
although they initially had consented to participate in the study. Additionally, forty-
seven percent of couples did not complete T2 questionnaires, although they participated
at T1. The large amount of attrition may be explained by the period when couples were
recruited to participate in the study, which was during their LRP consultation
appointment. At this time, patients had not decided or consented to received LRP, but
were recruited to participate in a study that they would be eligible for if they
subsequently underwent a LRP at COH. Thus, failing to return completed T1
questionnaires may be because patients had not yet decided on receiving LRP at COH.
Couples may have forgotten or lost interest in participating in the study once they made a
decision to undergo the surgery. Additionally, couples who were experiencing more
distress during this period may have decided to withdraw their participation.
A limitation that is affected by attrition is the issue of power. The study only
consisted of 50 couples. Eighty-five couples were needed to achieve a power of .80 to
detect medium (.15) effect size with a one-tailed test of 4 predictors (Cohen, 1988). The

80

majority of the regression analyses in the study included 4 predictors. The moderation
analyses consisted of 7 predictors, which would require n=103. It appears that the study
only had enough power to detect a larger (.35) effect size, as that would require n=40.
Power may have contributed to the lack of significant findings for the several of the
regression analyses. The regression analyses, which included 3 covariates, yielded fewer
significant findings than demonstrated by the bivariate correlations. Given that the
significant bivariate relations were consistent with the study’s hypotheses and previous
studies, but were no longer significant after controlling for covariates, it is possible that
the inclusion of more variables may have affected the study’s power to detect significant
effects. Perhaps if the study’s sample size was larger, hypothesized relations may have
remained significant despite controlling for multiple covariates. Our analyses, however,
indicated that we did not have any borderline significant results or trends, suggesting that
the issue of power may not have influenced our inability to detect medium effect sizes,
but smaller effect sizes.
Another limitation was the eligibility criteria for participants. In order for couples
to be eligible for the study, the partner had to have accompanied the patient to the surgery
consultation, which, as mentioned above, was when the couple was recruited for the
study. As a result, the study examined constraints and communication among a subset of
couples who may have had good supportive relationships. Attending the consultation
together already suggests that those couples were communicating about some aspects of
the cancer experience. Additionally, couples in this study appeared to be adjusting well,
as they reported good mood, non-distressed marital relationships, good levels of support

81

and communication, and low levels of constraints in their relationship. It is unknown
whether the study would have revealed different findings if participation in the study was
offered to all couples, including couples whose partners did not attend the consultation.
Lastly, the study measured perception of social constraints, protective buffering, and
cancer-specific communication, rather than having an objective measure of these
constructs.
Future Directions and Clinical Implications
Future studies may benefit from ameliorating the limitations addressed above.
Additionally, in order to clarify and further investigate the relation of internal and
external limitations on communication to spouses’ and patients’ adjustment, other
contextual variables should be measured. Most importantly, measures of validation of
one’s concerns and fears, reciprocity of expression and communication, and feeling
understood by one’s spouse, all which may contribute to a sense of emotional intimacy
would provide further information to the study of couples coping with cancer. Although
the study measured limitations on communication from spouses’ and patients’
perspectives, it also may be helpful to examine spouses’ perceptions of patients’
emotional adjustment, concerns, and health, as spouses’ perceptions of how the patient is
coping may influence their supportive and constraining behaviors toward patients.
Despite the limitations, the study suggested that spouses and patients experience a
different process while coping with cancer, which is influenced by various contextual and
constraining factors. Spouses had worse affect if they believed that patients were
shielding them from their concerns because this was experienced as constraining.

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Patients, however, did not have worse mood if they believed spouses were hiding their
worries and concerns, even though they perceived it as constraining. The study also
revealed that different relationships may play an important role in spouses’ adjustment at
different periods throughout the cancer experience, with constraints from family and
friends being associated with worse affect prior to surgery, and constraints from patients
predicting less improvement in affect following surgery.
Given the study’s results, it will be important for physicians and behavioral
medicine specialists to assess not only patients’ adjustment, but spouses’ adjustment as
well. Various constraining and contextual aspects of a couple’s relationship, and not
merely support, will be relevant psychosocial areas to assess, in order to adequately
address couples’ needs during the period of diagnosis and recovery from treatment.
Physicians’ awareness of the various factors that influence a couple’s coping with cancer
also may lead to better and more appropriate referrals to mental health providers. Lastly,
the literature on cancer patients and spouses has highlighted the importance of the
relationship on adjustment to cancer. Research has demonstrated the psychological
benefits of couple-focused interventions (Manne, Ostroff, Winkel, Fox, et al., 2005). The
results of the present study suggest that couple’s interventions focusing on dyadic
interactions, specifically perceived social constraints and protective buffering could assist
couples in coping with the challenges faced during illness.

83

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APPENDIX A

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Principal Investigator: Andrea A. Thornton, Ph.D.
Department/Division: Psychology/Supportive Care, Pain, and Palliative Medicine
Telephone number: 626-256-HOPE (4673) ext. 65399
Co-Investigator: Martin A. Perez, Ph.D.
Department/Division: Psychology/Supportive Care, Pain, and Palliative Medicine
Telephone number: 626-256-HOPE (4673) ext. 65399

INFORMED CONSENT FOR PARTICIPATION IN RESEARCH ACTIVITIES
(PARTNER VERSION)
Quality of Life and Psychological Adjustment in Prostate Cancer Patients and their
Partners

I. PURPOSE OF THIS RESEARCH STUDY: You have been asked to participate
in this research study because you are married or partnered to a patient at City of
Hope who is interested in undergoing a laparoscopic radical prostatectomy to treat
prostate cancer. The purpose of the study is to learn more about the impact of
prostate cancer and its treatment on patient and partner quality of life and
psychosocial adjustment. Your participation in this study is expected to include
completion of a questionnaire at two separate time-points (before surgery and 3
months following surgery), each taking approximately 30 minutes to fill out.

II. BACKGROUND: Laparoscopic radical prostatectomy is a fairly new procedure
used in the treatment of prostate cancer. Very little information is available about
the quality of life and psychosocial adjustment of patients receiving this treatment
or the impact on close members of the patient’s family. This questionnaire study is
designed to address these concerns by asking patients and partners directly about
their experiences regarding prostate cancer and its treatment.

III. WHAT WILL BE DONE: The questionnaire covers a variety of topics about
your quality of life before and after your partner’s surgery. The questionnaire asks
you to share with us information about your current physical, psychological, and
social well-being. You are to complete the questionnaire independently. You may
leave blank any question that you prefer not to answer. The completed
questionnaire and the signed informed consent are to be mailed back to the
Principal Investigator at City of Hope in the envelope provided.

Approximately three months following your partner’s surgery, a follow-up
questionnaire will be mailed to you. Again, you will be asked to complete the
questionnaire by yourself, and mail it back to the Principal Investigator at City of
Hope.

In the event that we do not receive the necessary materials, or if we receive
materials that are incomplete, you may receive a telephone call from one of our

91

researchers in order to confirm your participation and answer any questions. You
will be asked about missing items so that you can provide missing answers or verify
that you left them blank on purpose.

The answers to the questionnaires will be kept in secure, locked filing cabinets
accessible only to key research personnel. Your responses will be identified only
with a code number. This code number will be known only to the researchers and
will not be shared with any physician or nurse who has provided care to your
partner. Your individual answers will be analyzed only as part of the total study
group.

IV. POSSIBLE BENEFITS: There is not likely to be any direct benefit to you for
participating in this study. Some participants may find it helpful to answer and think
about questions related to their experience with their partner’s cancer. Potential
benefits to others may result from the knowledge gained from your participation in
this research study.

V. POSSIBLE RISKS AND DISCOMFORTS: The possible risks and discomforts
of this study include emotional distress and embarrassment answering some
questions that are personal or are about your partner’s illness. You may leave blank
any question that you prefer not to answer. If you need to talk about your concerns,
you may call Andrea A. Thornton, Ph.D., who is a licensed clinical psychologists
with experience in prostate cancer and quality of life, at (626) 256-HOPE (4673)
ext. 65399.

VI. ALTERNATIVES TO PARTICIPATION: The alternative to participation in this
study is to choose not to participate. This choice will not affect any current or future
care you or your partner may receive at City of Hope.

VII. CONFIDENTIALITY OF RECORDS: “Any information learned from this
study in which you might be identified will be confidential and disclosed only with
your permission. By signing this form, however, you allow the researchers to make
your/your child’s records available to the City of Hope Institutional Review Board
(IRB) Office and regulatory agencies as required by law. If information learned
from this study is published, you will not be identified by name.”

VIII. OFFER TO ANSWER QUESTIONS: The Principal Investigator, Andrea
Thornton, Ph.D., or the research associate, Sindy Oh, M.A., has offered to and has
answered any and all questions regarding your participation in this research study.
If you have any further questions, you can contact the Principal Investigator, Dr.
Thornton at (626) 256-HOPE (4673) ext. 64290.

92

IX. SPONSOR OF THIS RESEARCH: The Departments of Urology and
Supportive Care, Pain and Palliative Medicine at City of Hope are the sponsors of
this research study.

X. COST TO THE SUBJECT FOR PARTICIPATION: There will be no cost to
you or your insurance carrier for participation in this study.

XI. VOLUNTARY PARTICIPATION WITH RIGHT OF REFUSAL: You have
been informed that your participation in this research study is voluntary. You are
free to withdraw your consent for participation in this study without any loss of
benefits, penalty, or interference with any future treatment for you or your partner
at City of Hope.

XII. IRB REVIEW AND IMPARTIAL THIRD PARTY: This study has been
reviewed and approved by the Institutional Review Board (IRB). A representative
of that Board, from the Research Subjects Protection Office, is available to discuss
the review process or your rights as a research subject. The telephone number of the
Research Subjects Protection Department is (626) 256-HOPE (4673) ext. 62700.

XIII. FINDINGS RELATING TO WILLINGNESS TO CONTINUE
PARTICIPATION: The research team has explained to you that you will be
informed of any significant new findings related to this study which might affect
your willingness to continue to participate.

XIV. EXPERIMENTAL SUBJECT'S BILL OF RIGHTS AND CONSENT FORM:
You have been given a signed copy of this consent form and the "Experimental
Subject's Bill of Rights for Psychosocial Studies" and have read them.

93

XV. SIGNATURE FOR CONSENT: The above-named investigators have answered
your questions and you agree to be a research subject in this study.

Print Subject's Name: ________________________________

Subject's Signature: ___________________________Date: _________________
(date must be in subject’s
handwriting)

Witness's Signature: ___________________________Date: _________________

Investigator's Signature: ________________________Date: _________________

94

EXPERIMENTAL SUBJECT'S BILL OF RIGHTS FOR PSYCHOSOCIAL STUDIES

You have been asked to participate as a subject in a research study. Before you decide
whether you want to participate in the experimental procedure, you have a right to:

1. Be informed of the nature and purpose of the study;

2. Be given an explanation of the procedures to be followed in the study;

3. Be given a description of any attendant discomforts and risks reasonably to be
expected from your participation in the study;

4. Be given an explanation of any benefits reasonably to be expected from your
participation in the study;

5. Be given a disclosure of any appropriate alternative to the study that might be
advantageous to you, and their relative risks and benefits;

6. Be informed of the avenues for referral should you experience any problems
during or after the study;

7. Be given an opportunity to ask any questions concerning the study or the
procedures involved;

8. Be instructed that consent to participate in the study may be withdrawn at any
time and that you may discontinue participation in the study without prejudice;

9. Be given a copy of this form and the signed and dated consent form; and

10. Be given the opportunity to decide to consent or not to consent to the study
without the intervention of any element of force, fraud, deceit, duress, coercion,
or undue influence on your decision.

95

You have carefully read the information contained above in the "Experimental Subject's
Bill of Rights for Psychosocial Studies" and you understand fully your rights as a
potential subject in this study.

__________________ _______________________________________________
Date Subject

__________________ _______________________________________________
Date * Subject’s Legally Authorized Representative
(if subject unable to sign)

_________________ __________________________________
Date Witness

96

APPENDIX B

97

Principal Investigator: Andrea A. Thornton, Ph.D.
Department/Division: Psychology/Supportive Care, Pain, and Palliative Medicine
Telephone number: 626-256-HOPE (4673) ext. 65399
Co-Investigator: Martin A. Perez, Ph.D.
Department/Division: Psychology/Supportive Care, Pain, and Palliative Medicine
Telephone number: 626-256-HOPE (4673) ext. 65399

INFORMED CONSENT FOR PARTICIPATION IN RESEARCH ACTIVITIES
(PATIENT VERSION)
Quality of Life and Psychological Adjustment in Prostate Cancer Patients and their
Partners

I. PURPOSE OF THIS RESEARCH STUDY: You have been asked to participate
in this research study because you are a patient at City of Hope who is interested in
undergoing a laparoscopic radical prostatectomy to treat prostate cancer. The
purpose of this study is to learn more about the impact of prostate cancer and its
treatment on the quality of life and psychosocial adjustment of both the patient and
his partner. Your participation in this study is expected to include completion of a
questionnaire at three separate time-points (before surgery, 3 months following
surgery, and 1 year following surgery), each taking approximately 30 minutes to fill
out.

II. BACKGROUND: Laparoscopic radical prostatectomy is a fairly new procedure
used in the treatment of prostate cancer. Very little information is available about
the quality of life and psychosocial adjustment of patients receiving this treatment
or the impact on close members of the patient’s family. This questionnaire study is
designed to address these concerns by asking patients and partners directly about
their experiences regarding prostate cancer and its treatment.

III. WHAT WILL BE DONE: The questionnaire covers a variety of topics about
your quality of life before and after your surgery. The questionnaire asks you to
share with us information about your current physical, psychological, and social
well-being. You are to complete the questionnaire by yourself. You may leave
blank any question that you prefer not to answer. The completed questionnaire and
the signed informed consent are to be mailed back to the Principal Investigator at
City of Hope in the envelope provided.

If you have a partner, that person will also be asked to participate in this study and
sign a separate consent form. Participation of a partner is not required for you to
participate in this study.

Approximately three months following your surgery and one year following you
surgery, a follow-up questionnaire will be mailed to you. Again, you will be asked

98

to complete the questionnaire independently, and mail it back to the Principal
Investigator at City of Hope.

In the event that we do not receive the necessary materials, or if we receive
materials that are incomplete, you may receive a telephone call from one of our
researchers in order to confirm your participation and answer any questions. You
will be asked about missing items so that you can provide missing answers or verify
that you left them blank on purpose.

Besides analyzing your completed questionnaires, we will review your medical
records to gather information about the cancer diagnosis, date of diagnosis,
treatment(s) received, and so on.

The answers to the questionnaires will be kept in secure, locked filing cabinets
accessible only to key research personnel. Your responses will be identified only
with a code number. This code number will be known only to the researchers and
will not be shared with any physician or nurse who has provided care to you. Your
individual answers will be analyzed only as part of the total study group.

IV. POSSIBLE BENEFITS: There is not likely to be any direct benefit to you for
participating in this study. Some participants may find it helpful to answer and think
about questions about their experience with cancer. Potential benefits to others may
result from the knowledge gained from your participation in this research study.

V. POSSIBLE RISKS AND DISCOMFORTS: The possible risks and discomforts
of this study include emotional distress and embarrassment answering some
questions that are personal or are about your illness. You may leave blank any
question that you prefer not to answer. If you need to talk about your concerns, you
may call Andrea A. Thornton, Ph.D., who is a licensed clinical psychologists with
experience in prostate cancer and quality of life, at (626) 256-HOPE (4673) ext.
65399.

VI. ALTERNATIVES TO PARTICIPATION: The alternative to participation in this
study is to choose not to participate. This choice will not affect any current or future
care you may receive at City of Hope.

99

VII. CONFIDENTIALITY OF RECORDS AND AUTHORIZATION TO USE
AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION FOR
PURPOSES OF THIS STUDY: As part of this research, you are agreeing to
allow City of Hope National Medical Center (City of Hope) to use and disclose
(share with others) your protected health information (PHI) in connection with
this study. PHI refers to your demographic information (your name, where you
live, your phone number, your age, etc.), and your medical record. This
includes, for example, your medical history, the results of physical exams, blood
tests, x-rays and other diagnostic and medical procedures.

Your PHI will be used and disclosed for the purpose of conducting this study as
indicated on the first page of this consent. Your PHI will also be used to keep the
research sponsor informed about this research and reporting to
oversight/regulatory agencies.

The people authorized to use and share your PHI for purposes of this study
include the principal investigators and the research team (the investigators listed
on this consent form); the staff supporting the research team; your City of Hope
physicians and treatment team; and the Health Information Management Services
Department (Medical Records).

Your PHI will be shared, as necessary with the City of Hope Institutional Review
Board (IRB), other City of Hope research regulatory committees, and the City of
Hope Cancer Protocol Review and Monitoring Committee (CPRMC). Your
information will also be shared, as necessary/appropriate with employees of the
research sponsor who are involved in the administration of this study. You are
also allowing the research team to share your PHI with the Office for Human
Research Protections (OHRP) and with any person or agency as required by law.

All uses and disclosures of your PHI for this study will be made as a result of this
authorization. Any additional uses and disclosures will be in accordance with City
of Hope’s Notice of Privacy Practices or will occur only after separate permission
is obtained from you. Use and disclosure of your PHI will continue until the
research study has been completed and the study file closed.

By signing this consent form, you also authorize disclosure of your PHI by other
health care providers outside the City of Hope to be given to the City of Hope
investigator and/or the City of Hope research team for follow-up purposes. This
follow-up information may include results of laboratory tests, physical
examination, radiological tests, and other information about you.

100

Once your PHI has been given to a third party (for example, an individual or
agency outside of the City of Hope), it may be subject to further disclosure and is
not protected by City of Hope from further use or disclosure.

The information from this study may be published in scientific journals or
presented at scientific meetings but your identity will be kept confidential.

You may revoke this authorization to use and disclose your PHI at any time by
contacting City of Hope’s Privacy Officer at (626) 256-HOPE (4673) ext. 64025
and asking for the Revocation of Authorization for Use of Protected Health
Information for Research. Fill this form out and return it as the form instructs.
If you revoke this authorization to use and disclose your PHI, you will no longer
be able to participate in this study. The researchers and others involved in
conducting this study will no longer be able to use or disclose your PHI for this
research, except to the extent they have already relied on this authorization such
as for purposes of maintaining the integrity of this study and for regulatory
purposes. This means that any uses and disclosures made by City of Hope prior to
receiving your Revocation form cannot be taken back. While no further PHI will
be shared for this study, your PHI already shared and used will continue to be
used in the overall study. Your decision to revoke this authorization to use and
disclose your PHI as part of this study will not affect your ability to obtain routine
care at City of Hope.

VIII. OFFER TO ANSWER QUESTIONS: The principal investigator, Andrea
Thornton, Ph.D., or the research associate, Sindy Oh, M.A., has offered to and has
answered any and all questions regarding your participation in this research study.
If you have any further questions, you can contact Dr. Thornton, at (626) 256-
HOPE (4673) ext. 64290.

IX. SPONSOR OF THIS RESEARCH: The Departments of Urology and
Supportive Care, Pain and Palliative Medicine at City of Hope are the sponsors of
this research study.

X. COST TO THE SUBJECT FOR PARTICIPATION: There will be no cost to
you or your insurance carrier for participation in this study.

XI. VOLUNTARY PARTICIPATION WITH RIGHT OF REFUSAL: You have
been informed that your participation in this research study is voluntary. You are
free to withdraw your consent for participation in this study without any loss of
benefits, penalty, or interference with any future treatment at City of Hope.

101

XII. IRB REVIEW AND IMPARTIAL THIRD PARTY: This study has been
reviewed and approved by the Institutional Review Board (IRB). A representative
of that Board, from the Research Subjects Protection Office, is available to discuss
the review process or your rights as a research subject. The telephone number of the
Research Subjects Protection Department is (626) 256-HOPE (4673) ext. 62700.

XIII. FINDINGS RELATING TO WILLINGNESS TO CONTINUE
PARTICIPATION: The research team has explained to you that you will be
informed of any significant new findings related to this study which might affect
your willingness to continue to participate.

XIV. EXPERIMENTAL SUBJECT'S BILL OF RIGHTS AND CONSENT FORM:
You have been given a signed copy of this consent form and the "Experimental
Subject's Bill of Rights for Psychosocial Studies" and have read them.

102

XV. SIGNATURE FOR CONSENT: The above-named investigators have answered
your questions and you agree to be a research subject in this study.

Print Subject's Name: ________________________

Subject's Signature: ________________________Date: ____________________
(date must be in subject’s
handwriting)
* Subject’s Legally
Authorized Representative ___________________Date: ____________________
(if subject unable to sign) (date must be in
representative’s handwriting)

Witness's Signature: ________________________Date: ____________________

Investigator's Signature: _____________________Date: ____________________

(If applicable) I have translated this form into the __________________language.

Translator's Signature: ______________________ Date: ____________________

* If signed by other than subject, indicate relationship (e.g., mother, father,
husband, wife, daughter, son, etc.): _____________________________________

103

EXPERIMENTAL SUBJECT'S BILL OF RIGHTS FOR PSYCHOSOCIAL STUDIES

You have been asked to participate as a subject in a research study. Before you decide
whether you want to participate in the study, you have a right to:

1. Be informed of the nature and purpose of the study;

2. Be given an explanation of the procedures to be followed in the study;

3. Be given a description of any attendant discomforts and risks reasonably to be
expected from your participation in the study;

4. Be given an explanation of any benefits reasonably to be expected from your
participation in the study;

5. Be given a disclosure of any appropriate alternative to the study that might be
advantageous to you, and their relative risks and benefits;

6. Be informed of the avenues for referral should you experience any problems
during or after the study;

7. Be given an opportunity to ask any questions concerning the study or the
procedures involved;

8. Be instructed that consent to participate in the study may be withdrawn at any
time and that you may discontinue participation in the study without prejudice;

9. Be given a copy of this form and the signed and dated consent form; and

10. Be given the opportunity to decide to consent or not to consent to the study
without the intervention of any element of force, fraud, deceit, duress, coercion,
or undue influence on your decision.

104

You have carefully read the information contained above in the "Experimental Subject's
Bill of Rights for Psychosocial Studies" and you understand fully your rights as a
potential subject in this study.

__________________ _______________________________________________
Date Subject

__________________ _______________________________________________
Date * Subject’s Legally Authorized
Representative
(if subject unable to sign)

_________________ __________________________________
Date Witness

(If applicable) I have translated this form into the ________________________
language.

_________________ __________________________________
Date Translator

* If signed by other than subject, indicate relationship (e.g., mother, father, Legally
Authorized Representative): _________________________________

105

APPENDIX C

106

GENERAL INFORMATION Today’s Date:______________

We are interested in your experience as the wife or partner of a prostate cancer patient. Please note that
time frames may apply to some sections of the questionnaire. Answer each question to the best of your
ability. Remember, there are no right or wrong answers. If you prefer not to answer a question, please
cross out the item and leave it blank.

I. BACKGROUND INFORMATION

1. What is your current employment status? (mark only one)

_____1 Employed full-time (including self-employed)
_____2 Employed part-time (including self-employed)
_____3 Full-time homemaker
_____4 Full-time or part-time volunteer
_____5 Full-time or part-time student
_____6 On temporary medical leave
_____7 Retired
_____8 Unemployed
_____9 Permanently disabled
2. Do you currently have any of the following conditions? (check all that apply)

_____1 Allergies
_____2 Arthritis
_____3 Asthma
_____4 Chronic Obstructive Pulmonary Disorder (COPD)
_____5 Diabetes
_____6 Glaucoma
_____7 Frequent headaches/migraines
_____8 Heart disease (heart attack, angina, heart failure)
_____9 High blood pressure
_____10 Osteoporosis (hip fractures, compression fractures)
_____11 Thyroid problems
_____12 Moderate to major psychological difficulties (depression, anxiety, recent suicide attempts, or
recent mental health hospitalization)
_____13 Problems with alcohol
_____14 Problems with drug use of dependence (either prescription or street drugs)
_____15 Other medical conditions (please specify)____________________________________________
_____16 I do not have any of these conditions

3. Have you been diagnosed with cancer in the past three months?

_____1 No
_____2 Yes (please specify type of cancer, treatments, and approximate date of diagnosis)____________

______________________________________________________________________________________

107

II. YOUR FEELINGS AND ATTITUDES

This scale consists of a number of words that describe different feelings and emotions. Read each item and
then mark the appropriate answer in the space next to that word. Indicate to what extent you have felt this
way SINCE YOUR PARTNER’S PROSTATE CANCER DIAGNOSIS.
(circle one number on each line)
Since your partner’s diagnosis, how much
have you felt:
Very
slightly
or not at
all

A
little

Moderately

Quite
a bit

Extremely

1. Interested……………………………………

1

2

3

4

5

2. Distressed……………………………………

1

2

3

4

5

3. Excited……………………………………….

1

2

3

4

5

4. Upset………………………………………

1

2

3

4

5

5. Strong………………………………………

1

2

3

4

5

6. Guilty………………………………………

1

2

3

4

5

7. Scared………………………………………

1

2

3

4

5

8. Hostile………………………………………

1

2

3

4

5

9. Enthusiastic…………………………………

1

2

3

4

5

10. Proud………………………………………

1

2

3

4

5

11. Irritable……………………………………

1

2

3

4

5

12. Alert………………………………………

1

2

3

4

5

13. Ashamed……………………………………

1

2

3

4

5

14. Inspired……………………………………

1

2

3

4

5

15. Nervous……………………………………

1

2

3

4

5

16. Determined…………………………………

1

2

3

4

5

17. Attentive……………………………………

1

2

3

4

5

18. Jittery………………………………………

1

2

3

4

5

19. Active………………………………………

1

2

3

4

5

20. Afraid………………………………………

1

2

3

4

5

108

III. REACTIONS TO PROSTATE CANCER

The following is a list of difficulties people sometimes have after stressful life events. Please read each
item, and then indicate how distressing each difficulty has been for you with respect to your partner’s
prostate cancer.

(circle one number on each line)
Since your partner’s diagnosis, how much
were you distressed or bothered by these
difficulties?

Not at
all
A
little
bit

Moderately

Quite a
bit

Extremely

1. Any reminder brought back feelings about it..

0

1

2

3

4
2. I had trouble staying asleep…………………. 0 1 2 3 4
3. Other things kept making me think about it… 0 1 2 3 4
4. I felt irritable and angry…………………… 0 1 2 3 4
5. I avoided letting myself get upset when I
thought about it or was reminded of it…………

0

1

2

3

4
6. I thought about it when I didn’t mean to……. 0 1 2 3 4
7. I felt as if it hadn’t happened or wasn’t real… 0 1 2 3 4
8. I stayed away from reminders about it……… 0 1 2 3 4
9. Pictures about it popped into my mind……… 0 1 2 3 4
10. I was jumpy and easily startled……………. 0 1 2 3 4
11. I tried not to think about it…………………. 0 1 2 3 4
12. I was aware that I still had a lot of feelings
about it, but I didn’t deal with them…………….

0

1

2

3

4
13. My feelings about it were kind of numb… 0 1 2 3 4
14. I found myself acting or feeling like I was
back at that time………………………………

0

1

2

3

4
15. I had trouble falling asleep………………… 0 1 2 3 4
16. I had waves of strong feelings about it…… 0 1 2 3 4
17. I tried to remove it from my memory……… 0 1 2 3 4
18. I had trouble concentrating………………… 0 1 2 3 4
19. Reminders of it caused me to have physical
reactions, such as sweating, trouble breathing,
nausea, or a pounding heart……………………

0

1

2

3

4
20. I had dreams about it………………………. 0 1 2 3 4
21. I felt watchful and on guard……………… 0 1 2 3 4
22. I tried not to talk about it………………… 0 1 2 3 4

109

IV. RELATIONSHIP WITH PARTNER

Please answer the following questions regarding your relationship with your partner.

(circle one number on each line)
Since your partner’s prostate cancer diagnosis,
how much has your partner:
Not at
all
A
little
Moderate
amount
Very
much
A great
deal

1. Provided you with encouragement and
reassurance when you needed it?.............................

1

2

3

4

5

2. Showed that he cares about you as a person?.....

1

2

3

4

5
3. Helped you understand and sort things out
when you were troubled by something?..................

1

2

3

4

5
4. Listened to you when you needed to talk about
things that were important to you?...........................

1

2

3

4

5
5. Understood the way you were thinking and
feeling about things?................................................

1

2

3

4

5

6. Said things that raised your self-confidence?.....

1

2

3

4

5

7. Given you useful advice when you needed it?....

1

2

3

4

5
8. Provided you with direct help, that is, did
things for you or gave you things you needed?.......

1

2

3

4

5

(circle one number on each line)
Since your partner’s prostate cancer diagnosis,
how much have you:
Not at
all
A
little
Moderate
amount
Very
much
A great
deal

1. Provided him with encouragement and
reassurance when he needed it?...............................

1

2

3

4

5

2. Showed that you care about him as a person?....

1

2

3

4

5
3. Helped him understand and sort things out
when he was troubled by something?......................

1

2

3

4

5
4. Listened to him when he needed to talk about
things that were important to him?..........................

1

2

3

4

5
5. Understood the way he was thinking and
feeling about things?................................................

1

2

3

4

5

6. Said things that raised his self-confidence?........

1

2

3

4

5

7. Given him useful advice when he needed it?......

1

2

3

4

5
8. Provided him with direct help, that is, did
things for him or gave him things he needed?.........

1

2

3

4

5

110

IV. RELATIONSHIP WITH PARTNER (CONT.)

Sometimes, even when your partner has good intentions, he may say or do things that upset you. Think
about the TIME SINCE YOUR PARTNER’S PROSTATE CANCER DIAGNOSIS and indicate how
often your partner did the following things.

(circle one number on each line)
Never Rarely Sometimes Often

1. How often has your partner changed the subject when
you tried to discuss his illness?................................................

1

2

3

4
2. How often did it seem that your partner did not
understand your situation?.......................................................

1

2

3

4
3. How often did your partner avoid you?.............................. 1 2 3 4
4. How often did your partner minimize your problems?....... 1 2 3 4
5. How often did your partner seem to be hiding his
feelings?...................................................................................

1

2

3

4
6. How often did your partner act uncomfortable when you
talked about his illness?...........................................................

1

2

3

4
7. How often has your partner trivialized your problems?..... 1 2 3 4
8. How often did your partner complain about his own
problems when you wanted to share yours?............................

1

2

3

4
9. How often did your partner act cheerful around you to
hide his true feelings and concerns?........................................

1

2

3

4
10. How often did your partner tell you not to worry so
much about his health?............................................................

1

2

3

4
11. How often did your partner tell you to try not to think
about the cancer?.....................................................................

1

2

3

4
12. How often did you get the idea that your partner didn't
want to hear about his cancer?.................................................

1

2

3

4
13. How often did your partner make you feel as though you
had to keep your feelings about his cancer to yourself,
because they made him feel uncomfortable?...........................

1

2

3

4
14. How often did your partner make you feel as though you
had to keep your feelings about his cancer to yourself,
because they made him upset?.................................................

1

2

3

4
15. How often did your partner let you down by not
showing you as much love and concern as you would have
liked?........................................................................................

1

2

3

4

111

IV. RELATIONSHIP WITH PARTNER (CONT.)

The following statements focus on the way you deal with the fact that your partner has prostate cancer.
Please indicate to what extent you do or do not act in the ways described.

(circle one number on each line)
Since my partner’s diagnosis…..
Never

Seldom
Now and
Then
Quite
often
Very
often

1. I try to hide my worries about my partner...

1

2

3

4

5

2. I try to act as if nothing is the matter……...

1

2

3

4

5

3. I give in when my partner makes an issue
of something..…...............................................

1

2

3

4

5

4. I just wave my partner’s worries aside..…..

1

2

3

4

5

5. I do everything to prevent my partner from
thinking about his disease…………………….

1

2

3

4

5

6. I can’t endure my partner being concerned
and act as if I don’t notice his worries………..

1

2

3

4

5

7. I take over as much of my partner’s work
as possible…..…...............................................

1

2

3

4

5

Now, the following statements focus on the way your partner deals with the fact that he has prostate cancer.
Please indicate to what extent your partner does or does not act in the ways described.

Since my partner’s diagnosis…..
Never

Seldom
Now and
Then
Quite
often
Very
often

1. My partner tries to hide his worries.............

1

2

3

4

5

2. My partner tries to act as if nothing is the
matter..………………………………………..

1

2

3

4

5

3. My partner gives in when I make an issue
of something..…..……………………………..

1

2

3

4

5

4. My partner just waves my worries aside…..

1

2

3

4

5

5. My partner does everything to prevent me
from thinking about his disease………………

1

2

3

4

5

6. My partner can’t endure me being
concerned and acts as if he doesn’t notice my
worries...………………………………………

1

2

3

4

5

7. My partner takes over as much of my work
as possible..…..….............................................

1

2

3

4

5

112

IV. RELATIONSHIP WITH PARTNER (CONT.)

Below is a list of items on communication between you and your partner. Please circle the number which
best represents the extent to which you and your partner behave in the specified way.

(circle one number on each line)
Since your partner’s diagnosis….. Never Seldom Occasionally Frequently Very
frequently
1. How often do you and your partner
talk over positive or pleasant things
regarding prostate cancer and its
treatment?.............................................

1

2

3

4

5
2. How often do you and your partner
talk over negative or unpleasant things
regarding prostate cancer and its
treatment?.............................................

1

2

3

4

5
3. Do you and your partner talk over
things regarding cancer you disagree
about or have difficulties over?............

1

2

3

4

5
4. Do you and your partner talk over
things regarding cancer in which you
are both interested?...............................

1

2

3

4

5
5. Does your partner adjust what he
says about cancer and how he says it
to the way you seem to feel at the
moment?...............................................

1

2

3

4

5
6. Do you and your partner avoid
certain subjects related to the cancer in
conversations?......................................

1

2

3

4

5
7. Do you and your partner discuss
things together regarding the cancer
and its treatment before making an
important decision?..............................

1

2

3

4

5
8. Does your partner discuss matters
of sex with you?....................................

1

2

3

4

5
9. Can you and your partner discuss
and share your feelings without
feelings of restraint or embarrassment?

1

2

3

4

5
10. How often do you and your partner
talk with each other about personal
problems related to the cancer
experience?...........................................

1

2

3

4

5
11. Would you rather talk about
intimate matters related to the cancer
with your partner than with some other
person?..................................................

1

2

3

4

5

113

IV. RELATIONSHIP WITH PARTNER (CONT.)

(circle one number on each line)

Most people have disagreements in their relationships. Please indicate below the approximate extent of
agreement or disagreement between you and your partner for each item on the following list.

All of the
time

Most of
the time
More
often than
not

Occasionally

Rarely

Never
7. How often do you discuss
or have you considered
divorce, separation, or
terminating your
relationship?...........................

0

1

2

3

4

5
8. Do you ever regret that
you married or lived
together?................................

0

1

2

3

4

5
9. How often do you and
your partner quarrel?..............

0

1

2

3

4

5
10. How often do you and
your partner “get on each
other’s nerves”?.....................

0

1

2

3

4

5

Since your partner’s diagnosis….. Never Seldom Occasionally Frequently Very
frequently
12. During your relationship, have you
and your partner, in general, talked
most things over together?....................

1

2

3

4

5

Always
agree
Almost
always
agree

Occasionally
disagree

Frequently
disagree
Almost
always
disagree

Always
disagree

1. Religious matters………..

1

2

3

4

5

6
2. Demonstrations of
affection…………………….
1 2 3 4 5 6
3. Sex relations……………. 1 2 3 4 5 6
4. Conventionality (correct
or proper behavior)…………

1

2

3

4

5

6
5. Making major decisions... 1 2 3 4 5 6
6. Career decisions………... 1 2 3 4 5 6

114

IV. RELATIONSHIP WITH PARTNER (CONT.)

11. Do you and your partner engage in outside interests together?

_____1 Never
_____2 Rarely
_____3 Occasionally
_____4 Almost everyday
_____5 Everyday

How often would you say the following events occur between you and your partner?

(circle one number on each line)

Never
Less than
once a
month
Once or
twice a
month
Once or
twice a
week

Once
a day

More
often

12. Have a stimulating exchange of
ideas……………………………………...

0

1

2

3

4

5
13. Calmly discuss something………….. 0 1 2 3 4 5
14. Work together on a project…………. 0 1 2 3 4 5

115

V. RELATIONSHIP WITH OTHERS

Earlier we asked about things that your partner may say or do that upset you. Now we would like to ask
you the same questions, but in regard to your family and friends, excluding your partner.

Sometimes, even when your family and friends have good intentions, they may say or do things that upset
you. Think about the TIME SINCE YOUR PARTNER’S PROSTATE CANCER DIAGNOSIS and
indicate how often your family and friends did the following things.

(circle one number on each line)
Never Rarely Sometimes Often

1. How often have they changed the subject when you tried
to discuss your partner’s illness?...............................................

1

2

3

4
2. How often did it seem that they did not understand your
situation?...................................................................................
1 2 3 4
3. How often did they avoid you?............................................ 1 2 3 4
4. How often did they minimize your problems?..................... 1 2 3 4
5. How often did they seem to be hiding their feelings?.......... 1 2 3 4
6. How often did they act uncomfortable when you talked
about your partner’s illness?.....................................................

1

2

3

4
7. How often have they trivialized your problems?................. 1 2 3 4
8. How often did they complain about their own problems
when you wanted to share yours?.............................................

1

2

3

4
9. How often did they act cheerful around you to hide their
true feelings and concerns?.......................................................

1

2

3

4
10. How often did they tell you not to worry so much about
your partner’s health?................................................................

1

2

3

4
11. How often did they tell you to try not to think about the
cancer?.......................................................................................
1 2 3 4
12. How often did you get the idea that they didn't want to
hear about your partner’s cancer?.............................................

1

2

3

4
13. How often did they make you feel as though you had to
keep your feelings about your partner’s cancer to yourself,
because they made them feel uncomfortable?...........................

1

2

3

4
14. How often did they make you feel as though you had to
keep your feelings about your partner’s cancer to yourself,
because they made them upset?................................................

1

2

3

4
15. How often did they let you down by not showing you as
much love and concern as you would have liked?....................

1

2

3

4

116

V. RELATIONSHIP WITH OTHERS (CONT.)

Earlier we asked about things that your partner may say or do that upset you. Now we would like to ask
you the same questions, but in regard to your family and friends, excluding your partner.

Below is a list of items on communication between you and your family and friends. Please circle the
number which best represents the extent to which you and your family and friends behave in the specified
way.
(circle one number one each line)
Since your partner’s diagnosis….. Never Seldom Occasionally Frequently Very
frequently
1. How often do you and your family
and friends talk over positive or
pleasant things regarding prostate
cancer and its treatment?....................

1

2

3

4

5
2. How often do you and your family
and friends talk over negative or
unpleasant things regarding prostate
cancer and its treatment?....................

1

2

3

4

5
3. Do you and your family and friends
talk over things regarding cancer you
disagree about or have difficulties
over?...................................................

1

2

3

4

5
4. Do you and your family and friends
talk over things regarding cancer in
which you are both interested?...........

1

2

3

4

5
5. Do your family and friends adjust
what they say about cancer and how
they say it to the way you seem to feel
at the moment?............................

1

2

3

4

5
6. Do you and your family and friends
avoid certain subjects related to the
cancer in conversations?.....................

1

2

3

4

5
7. Do you and your family and friends
discuss things together regarding the
cancer and its treatment before making
an important decision?...........

1

2

3

4

5
8. Do your family and friends discuss
matters of sex with you?.....................

1

2

3

4

5
9. Can you and your family and friends
discuss and share your feelings without
feelings of restraint or
embarrassment?..................................

1

2

3

4

5

117

V. RELATIONSHIP WITH OTHERS (CONT.)

(circle one number on each line)

Since your partner’s diagnosis….. Never Seldom Occasionally Frequently Very
frequently
10. How often do you and your family
and friends talk with each other about
personal problems related to the
cancer experience?........................

1

2

3

4

5
11. Would you rather talk about
intimate matters related to the cancer
with your family and friends than with
some other person?.............................

1

2

3

4

5
12. During your relationships, have
you and your family and friends, in
general, talked most things over
together?...............................................

1

2

3

4

5

118

APPENDIX D

119

GENERAL INFORMATION Today’s Date:____________________

We are interested in your experience as a prostate cancer patient. Please note that time frames may apply
to some sections of the questionnaire. Answer each question to the best of your ability. Remember, there
are no right or wrong answers. If you prefer not to answer a question, please cross out the item and leave it
blank.

I. YOUR FEELINGS AND ATTITUDES

This scale consists of a number of words that describe different feelings and emotions. Read each item and
then mark the appropriate answer in the space next to that word. Indicate to what extent you have felt this
way SINCE YOUR PROSTATE CANCER DIAGNOSIS.
(circle one number on each line)
Since your diagnosis, how much have you felt: Very
slightly
or not at
all

A
little

Moderately

Quite
a bit

Extremely

1. Interested……………………………………

1

2

3

4

5

2. Distressed……………………………………

1

2

3

4

5

3. Excited……………………………………….

1

2

3

4

5

4. Upset………………………………………

1

2

3

4

5

5. Strong………………………………………

1

2

3

4

5

6. Guilty………………………………………

1

2

3

4

5

7. Scared………………………………………

1

2

3

4

5

8. Hostile………………………………………

1

2

3

4

5

9. Enthusiastic…………………………………

1

2

3

4

5

10. Proud………………………………………

1

2

3

4

5

11. Irritable……………………………………

1

2

3

4

5

12. Alert………………………………………

1

2

3

4

5

13. Ashamed……………………………………

1

2

3

4

5

14. Inspired……………………………………

1

2

3

4

5

15. Nervous……………………………………

1

2

3

4

5

120

I. YOUR FEELINGS AND ATTITUDES (CONT.)
(circle one number on each line)
Since your diagnosis, how much have you felt: Very
slightly
or not at
all

A
little

Moderately

Quite
a bit

Extremely

16. Determined…………………………………

1

2

3

4

5

17. Attentive……………………………………

1

2

3

4

5

18. Jittery………………………………………

1

2

3

4

5

19. Active………………………………………

1

2

3

4

5

20. Afraid………………………………………

1

2

3

4

5

121

II. RELATIONSHIP WITH PARTNER

Please answer the following questions regarding your relationship with your partner.

(circle one number on each line)
Since your prostate cancer diagnosis, how much
has your partner:
Not at
all
A
little
Moderate
amount
Very
much
A great
deal

1. Provided you with encouragement and
reassurance when you needed it?.............................

1

2

3

4

5
2. Showed that s/he cares about you as a person?... 1 2 3 4 5
3. Helped you understand and sort things out
when you were troubled by something?..................

1

2

3

4

5
4. Listened to you when you needed to talk about
things that were important to you?...........................

1

2

3

4

5
5. Understood the way you were thinking and
feeling about things?................................................

1

2

3

4

5

6. Said things that raised your self-confidence?.....

1

2

3

4

5

7. Given you useful advice when you needed it?....

1

2

3

4

5
8. Provided you with direct help, that is, did
things for you or gave you things you needed?.......

1

2

3

4

5

(circle one number on each line)
Since your prostate cancer diagnosis, how much
have you:
Not at
all
A
little
Moderate
amount
Very
much
A great
deal

1. Provided her/him with encouragement and
reassurance when s/he needed it?............................

1

2

3

4

5
2. Showed that you care about her/him as a
person?.....................................................................

1

2

3

4

5
3. Helped her/him understand and sort things out
when s/he was troubled by something?...................

1

2

3

4

5
4. Listened to her/him when s/he needed to talk
about things that were important to her/him?..........

1

2

3

4

5
5. Understood the way s/he was thinking and
feeling about things?................................................

1

2

3

4

5

6. Said things that raised her/his self-confidence?..

1

2

3

4

5
7. Given her/him useful advice when s/he needed
it?..............................................................................

1

2

3

4

5
8. Provided her/him with direct help, that is, did
things for her/him or gave her/him things s/he
needed?....................................................................

1

2

3

4

5

122

II. RELATIONSHIP WITH PARTNER (CONT.)

Sometimes, even when your partner has good intentions, s/he may say or do things that upset you. Think
about the TIME SINCE YOUR PROSTATE CANCER DIAGNOSIS and indicate how often your
partner did the following things.

(circle one number on each line)
Never Rarely Sometimes Often

1. How often has your partner changed the subject when
you tried to discuss your illness?.............................................

1

2

3

4
2. How often did it seem that your partner did not
understand your situation?.......................................................

1

2

3

4
3. How often did your partner avoid you?.............................. 1 2 3 4
4. How often did your partner minimize your problems?....... 1 2 3 4
5. How often did your partner seem to be hiding her/his
feelings?...................................................................................

1

2

3

4
6. How often did your partner act uncomfortable when you
talked about your illness?........................................................

1

2

3

4
7. How often has your partner trivialized your problems?..... 1 2 3 4
8. How often did your partner complain about her/his own
problems when you wanted to share yours?............................

1

2

3

4
9. How often did your partner act cheerful around you to
hide her/his true feelings and concerns?..................................

1

2

3

4
10. How often did your partner tell you not to worry so
much about your health?..........................................................

1

2

3

4
11. How often did your partner tell you to try not to think
about the cancer?.....................................................................

1

2

3

4
12. How often did you get the idea that your partner didn't
want to hear about your cancer?..............................................

1

2

3

4
13. How often did your partner make you feel as though you
had to keep your feelings about your cancer to yourself,
because they made her/him feel uncomfortable?.....................

1

2

3

4
14. How often did your partner make you feel as though you
had to keep your feelings about your cancer to yourself,
because they made her/him upset?...........................................

1

2

3

4
15. How often did your partner let you down by not
showing you as much love and concern as you would have
liked?........................................................................................

1

2

3

4

123

II. RELATIONSHIP WITH PARTNER (CONT.)

The following statements focus on the way your partner deals with the fact that you have prostate cancer.
Please indicate to what extent your partner does or does not act in the ways described.

Since my prostate cancer diagnosis…..
Never

Seldom
Now and
Then
Quite
often
Very
often

1. My partner tries to hide her/his worries.......

1

2

3

4

5

2. My partner tries to act as if nothing is the
matter..………………………………………..

1

2

3

4

5

3. My partner gives in when I make an issue
of something..…..……………………………..

1

2

3

4

5

4. My partner just waves my worries aside…..

1

2

3

4

5

5. My partner does everything to prevent me
from thinking about his disease………………

1

2

3

4

5

6. My partner can’t endure me being
concerned and acts as if s/he doesn’t notice
my worries...………………………………….

1

2

3

4

5

7. My partner takes over as much of my work
as possible..…..….............................................

1

2

3

4

5

Now, the following statements focus on the way you deal with the fact that you have prostate cancer.
Please indicate to what extent you do or do not act in the ways described.

(circle one number on each line)
Since my prostate cancer diagnosis…..
Never

Seldom
Now and
Then
Quite
often
Very
often

1. I try to hide my worries...............................

1

2

3

4

5

2. I try to act as if nothing is the matter……...

1

2

3

4

5

3. I give in when my partner makes an issue
of something..…...............................................

1

2

3

4

5

4. I just wave my partner’s worries aside..…..

1

2

3

4

5

5. I do everything to prevent my partner from
thinking about my disease……………………

1

2

3

4

5

6. I can’t endure my partner being concerned
and act as if I don’t notice her/his worries……

1

2

3

4

5

7. I take over as much of my partner’s work
as possible…..…...............................................

1

2

3

4

5

124

II. RELATIONSHIP WITH PARTNER (CONT.)

Most people have disagreements in their relationships. Please indicate below the approximate extent of
agreement or disagreement between you and your partner for each item on the following list.

(circle one number on each line)

All of the
time

Most of
the time
More
often than
not

Occasionally

Rarely

Never
7. How often do you discuss
or have you considered
divorce, separation, or
terminating your
relationship?...........................

0

1

2

3

4

5
8. Do you ever regret that
you married or lived
together?................................

0

1

2

3

4

5
9. How often do you and
your partner quarrel?..............

0

1

2

3

4

5
10. How often do you and
your partner “get on each
other’s nerves”?.....................

0

1

2

3

4

5

11. Do you and your partner engage in outside interests together?

_____1 Never
_____2 Rarely
_____3 Occasionally
_____4 Almost everyday
_____5 Everyday

Always
agree
Almost
always
agree

Occasionally
disagree

Frequently
disagree
Almost
always
disagree

Always
disagree

1. Religious matters………..

1

2

3

4

5

6
2. Demonstrations of
affection…………………….
1 2 3 4 5 6
3. Sex relations……………. 1 2 3 4 5 6
4. Conventionality (correct
or proper behavior)…………

1

2

3

4

5

6
5. Making major decisions... 1 2 3 4 5 6
6. Career decisions………... 1 2 3 4 5 6

125

II. RELATIONSHIP WITH PARTNER (CONT.)

How often would you say the following events occur between you and your partner?

(circle one number on each line)

Never
Less than
once a
month
Once or
twice a
month
Once or
twice a
week

Once
a day

More
often

12. Have a stimulating exchange of
ideas……………………………………...

0

1

2

3

4

5
13. Calmly discuss something………….. 0 1 2 3 4 5
14. Work together on a project…………. 0 1 2 3 4 5

126

APPENDIX E

127

GENERAL INFORMATION Today’s Date:______________

We are interested in your experience as the wife or partner of a prostate cancer patient. Please note that
time frames may apply to some sections of the questionnaire. Answer each question to the best of your
ability. Remember, there are no right or wrong answers. If you prefer not to answer a question, please
cross out the item and leave it blank.

I. BACKGROUND INFORMATION

1. What is your current employment status? (mark only one)

_____1 Employed full-time (including self-employed)
_____2 Employed part-time (including self-employed)
_____3 Full-time homemaker
_____4 Full-time or part-time volunteer
_____5 Full-time or part-time student
_____6 On temporary medical leave
_____7 Retired
_____8 Unemployed
_____9 Permanently disabled
2. Do you currently have any of the following conditions? (check all that apply)

_____1 Allergies
_____2 Arthritis
_____3 Asthma
_____4 Chronic Obstructive Pulmonary Disorder (COPD)
_____5 Diabetes
_____6 Glaucoma
_____7 Frequent headaches/migraines
_____8 Heart disease (heart attack, angina, heart failure)
_____9 High blood pressure
_____10 Osteoporosis (hip fractures, compression fractures)
_____11 Thyroid problems
_____12 Moderate to major psychological difficulties (depression, anxiety, recent suicide attempts, or
recent mental health hospitalization)
_____13 Problems with alcohol
_____14 Problems with drug use of dependence (either prescription or street drugs)
_____15 Other medical conditions (please specify)____________________________________________
_____16 I do not have any of these conditions

3. Have you been diagnosed with cancer in the past three months?

_____1 No
_____2 Yes (please specify type of cancer, treatments, and approximate date of diagnosis)____________

______________________________________________________________________________________

128

II. YOUR FEELINGS AND ATTITUDES

This scale consists of a number of words that describe different feelings and emotions. Read each item and
then mark the appropriate answer in the space next to that word. Indicate to what extent you have felt this
way SINCE YOUR PARTNER’S PROSTATE CANCER SURGERY.
(circle one number on each line)
Since your partner’s surgery, how much have
you felt:
Very
slightly
or not at
all

A
little

Moderately

Quite
a bit

Extremely

1. Interested……………………………………

1

2

3

4

5

2. Distressed……………………………………

1

2

3

4

5

3. Excited……………………………………….

1

2

3

4

5

4. Upset………………………………………

1

2

3

4

5

5. Strong………………………………………

1

2

3

4

5

6. Guilty………………………………………

1

2

3

4

5

7. Scared………………………………………

1

2

3

4

5

8. Hostile………………………………………

1

2

3

4

5

9. Enthusiastic…………………………………

1

2

3

4

5

10. Proud………………………………………

1

2

3

4

5

11. Irritable……………………………………

1

2

3

4

5

12. Alert………………………………………

1

2

3

4

5

13. Ashamed……………………………………

1

2

3

4

5

14. Inspired……………………………………

1

2

3

4

5

15. Nervous……………………………………

1

2

3

4

5

16. Determined…………………………………

1

2

3

4

5

17. Attentive……………………………………

1

2

3

4

5

18. Jittery………………………………………

1

2

3

4

5

19. Active………………………………………

1

2

3

4

5

20. Afraid………………………………………

1

2

3

4

5

129

III. REACTIONS TO PROSTATE CANCER

The following is a list of difficulties people sometimes have after stressful life events. Please read each
item, and then indicate how distressing each difficulty has been for you with respect to your partner’s
prostate cancer.

(circle one number on each line)
Since your partner’s surgery, how much were
you distressed or bothered by these
difficulties?

Not at
all
A
little
bit

Moderately

Quite a
bit

Extremely

1. Any reminder brought back feelings about it

0

1

2

3

4
2. I had trouble staying asleep…………………. 0 1 2 3 4
3. Other things kept making me think about it… 0 1 2 3 4
4. I felt irritable and angry…………………… 0 1 2 3 4
5. I avoided letting myself get upset when I
thought about it or was reminded of it…………

0

1

2

3

4
6. I thought about it when I didn’t mean to……. 0 1 2 3 4
7. I felt as if it hadn’t happened or wasn’t real… 0 1 2 3 4
8. I stayed away from reminders about it……… 0 1 2 3 4
9. Pictures about it popped into my mind……… 0 1 2 3 4
10. I was jumpy and easily startled……………. 0 1 2 3 4
11. I tried not to think about it…………………. 0 1 2 3 4
12. I was aware that I still had a lot of feelings
about it, but I didn’t deal with them…………….

0

1

2

3

4
13. My feelings about it were kind of numb… 0 1 2 3 4
14. I found myself acting or feeling like I was
back at that time………………………………

0

1

2

3

4
15. I had trouble falling asleep………………… 0 1 2 3 4
16. I had waves of strong feelings about it…… 0 1 2 3 4
17. I tried to remove it from my memory……… 0 1 2 3 4
18. I had trouble concentrating………………… 0 1 2 3 4
19. Reminders of it caused me to have physical
reactions, such as sweating, trouble breathing,
nausea, or a pounding heart……………………

0

1

2

3

4
20. I had dreams about it………………………. 0 1 2 3 4
21. I felt watchful and on guard……………… 0 1 2 3 4
22. I tried not to talk about it………………… 0 1 2 3 4

130

IV. RELATIONSHIP WITH PARTNER

Please answer the following questions regarding your relationship with your partner.

(circle one number on each line)
Since your partner’s prostate cancer surgery,
how much has your partner:
Not at
all
A
little
Moderate
amount
Very
much
A great
deal

1. Provided you with encouragement and
reassurance when you needed it?.............................

1

2

3

4

5

2. Showed that he cares about you as a person?.....

1

2

3

4

5
3. Helped you understand and sort things out
when you were troubled by something?..................

1

2

3

4

5
4. Listened to you when you needed to talk about
things that were important to you?...........................

1

2

3

4

5
5. Understood the way you were thinking and
feeling about things?................................................

1

2

3

4

5

6. Said things that raised your self-confidence?.....

1

2

3

4

5

7. Given you useful advice when you needed it?....

1

2

3

4

5
8. Provided you with direct help, that is, did
things for you or gave you things you needed?.......

1

2

3

4

5

(circle one number on each line)

Since your partner’s prostate cancer surgery,
how much have you:
Not at
all
A
little
Moderate
amount
Very
much
A great
deal

1. Provided him with encouragement and
reassurance when he needed it?...............................

1

2

3

4

5

2. Showed that you care about him as a person?....

1

2

3

4

5
3. Helped him understand and sort things out
when he was troubled by something?......................

1

2

3

4

5
4. Listened to him when he needed to talk about
things that were important to him?..........................

1

2

3

4

5
5. Understood the way he was thinking and
feeling about things?................................................

1

2

3

4

5

6. Said things that raised his self-confidence?........

1

2

3

4

5

7. Given him useful advice when he needed it?......

1

2

3

4

5
8. Provided him with direct help, that is, did
things for him or gave him things he needed?.........

1

2

3

4

5

131

IV. RELATIONSHIP WITH PARTNER (CONT.)

Sometimes, even when your partner has good intentions, he may say or do things that upset you. Think
about the TIME SINCE YOUR PARTNER’S PROSTATE CANCER SURGERY and indicate how
often your partner did the following things.

(circle one number on each line)
Never Rarely Sometimes Often

1. How often has your partner changed the subject when
you tried to discuss his illness?..............................................

1

2

3

4
2. How often did it seem that your partner did not
understand your situation?.....................................................

1

2

3

4
3. How often did your partner avoid you?............................ 1 2 3 4
4. How often did your partner minimize your problems?.... 1 2 3 4
5. How often did your partner seem to be hiding his
feelings?.................................................................................
1 2 3 4
6. How often did your partner act uncomfortable when you
talked about his illness?.........................................................

1

2

3

4
7. How often has your partner trivialized your problems?... 1 2 3 4
8. How often did your partner complain about his own
problems when you wanted to share yours?..........................

1

2

3

4
9. How often did your partner act cheerful around you to
hide his true feelings and concerns?......................................

1

2

3

4
10. How often did your partner tell you not to worry so
much about his health?..........................................................

1

2

3

4
11. How often did your partner tell you to try not to think
about the cancer?...................................................................

1

2

3

4
12. How often did you get the idea that your partner didn't
want to hear about his cancer?...............................................

1

2

3

4
13. How often did your partner make you feel as though
you had to keep your feelings about his cancer to yourself,
because they made him feel uncomfortable?.........................

1

2

3

4
14. How often did your partner make you feel as though
you had to keep your feelings about his cancer to yourself,
because they made him upset?...............................................

1

2

3

4
15. How often did your partner let you down by not
showing you as much love and concern as you would have
liked?......................................................................................

1

2

3

4

132

IV. RELATIONSHIP WITH PARTNER (CONT.)

The following statements focus on the way you deal with the fact that your partner has prostate cancer.
Please indicate to what extent you do or do not act in the ways described.

(circle one number on each line)
Since my partner’s surgery…..
Never

Seldom
Now and
Then
Quite
often
Very
often

1. I try to hide my worries about my partner...

1

2

3

4

5

2. I try to act as if nothing is the matter……...

1

2

3

4

5

3. I give in when my partner makes an issue
of something..…...............................................

1

2

3

4

5

4. I just wave my partner’s worries aside..…..

1

2

3

4

5

5. I do everything to prevent my partner from
thinking about his disease…………………….

1

2

3

4

5

6. I can’t endure my partner being concerned
and act as if I don’t notice his worries………..

1

2

3

4

5

7. I take over as much of my partner’s work
as possible…..…...............................................

1

2

3

4

5

Now, the following statements focus on the way your partner deals with the fact that he has prostate cancer.
Please indicate to what extent your partner does or does not act in the ways described.

Since my partner’s surgery…..
Never

Seldom
Now and
Then
Quite
often
Very
often

1. My partner tries to hide his worries.............

1

2

3

4

5

2. My partner tries to act as if nothing is the
matter..………………………………………..

1

2

3

4

5

3. My partner gives in when I make an issue
of something..…..……………………………..

1

2

3

4

5

4. My partner just waves my worries aside…..

1

2

3

4

5

5. My partner does everything to prevent me
from thinking about his disease………………

1

2

3

4

5

6. My partner can’t endure me being
concerned and acts as if he doesn’t notice my
worries...………………………………………

1

2

3

4

5

7. My partner takes over as much of my work
as possible..…..….............................................

1

2

3

4

5

133

IV. RELATIONSHIP WITH PARTNER (CONT.)

Below is a list of items on communication between you and your partner. Please circle the number which
best represents the extent to which you and your partner behave in the specified way.

(circle one number on each line)
Since your partner’s surgery….. Never Seldom Occasionally Frequently Very
frequently
1. How often do you and your partner
talk over positive or pleasant things
regarding prostate cancer and its
treatment?.............................................

1

2

3

4

5
2. How often do you and your partner
talk over negative or unpleasant things
regarding prostate cancer and its
treatment?.............................................

1

2

3

4

5
3. Do you and your partner talk over
things regarding cancer you disagree
about or have difficulties over?............

1

2

3

4

5
4. Do you and your partner talk over
things regarding cancer in which you
are both interested?...............................

1

2

3

4

5
5. Does your partner adjust what he
says about cancer and how he says it
to the way you seem to feel at the
moment?...............................................

1

2

3

4

5
6. Do you and your partner avoid
certain subjects related to the cancer in
conversations?......................................

1

2

3

4

5
7. Do you and your partner discuss
things together regarding the cancer
and its treatment before making an
important decision?..............................

1

2

3

4

5
8. Does your partner discuss matters
of sex with you?....................................

1

2

3

4

5
9. Can you and your partner discuss
and share your feelings without
feelings of restraint or embarrassment?

1

2

3

4

5
10. How often do you and your partner
talk with each other about personal
problems related to the cancer
experience?...........................................

1

2

3

4

5
11. Would you rather talk about
intimate matters related to the cancer
with your partner than with some other
person?..................................................

1

2

3

4

5

134

IV. RELATIONSHIP WITH PARTNER (CONT.)

(circle one number on each line)

Most people have disagreements in their relationships. Please indicate below the approximate extent of
agreement or disagreement between you and your partner for each item on the following list.

All of the
time

Most of
the time
More
often than
not

Occasionally

Rarely

Never
7. How often do you discuss
or have you considered
divorce, separation, or
terminating your
relationship?...........................

0

1

2

3

4

5
8. Do you ever regret that
you married or lived
together?................................

0

1

2

3

4

5
9. How often do you and
your partner quarrel?..............

0

1

2

3

4

5
10. How often do you and
your partner “get on each
other’s nerves”?.....................

0

1

2

3

4

5

Since your partner’s surgery….. Never Seldom Occasionally Frequently Very
frequently
12. During your relationship, have you
and your partner, in general, talked
most things over together?....................

1

2

3

4

5

Always
agree
Almost
always
agree

Occasionally
disagree

Frequently
disagree
Almost
always
disagree

Always
disagree

1. Religious matters………..

1

2

3

4

5

6
2. Demonstrations of
affection…………………….
1 2 3 4 5 6
3. Sex relations……………. 1 2 3 4 5 6
4. Conventionality (correct
or proper behavior)…………

1

2

3

4

5

6
5. Making major decisions... 1 2 3 4 5 6
6. Career decisions………... 1 2 3 4 5 6

135

IV. RELATIONSHIP WITH PARTNER (CONT.)

11. Do you and your partner engage in outside interests together?

_____1 Never
_____2 Rarely
_____3 Occasionally
_____4 Almost everyday
_____5 Everyday

How often would you say the following events occur between you and your partner?

(circle one number on each line)

Never
Less than
once a
month
Once or
twice a
month
Once or
twice a
week

Once
a day

More
often

12. Have a stimulating exchange of
ideas……………………………………...

0

1

2

3

4

5
13. Calmly discuss something………….. 0 1 2 3 4 5
14. Work together on a project…………. 0 1 2 3 4 5

136

V. RELATIONSHIP WITH OTHERS

Earlier we asked about things that your partner may say or do that upset you. Now we would like to ask
you the same questions, but in regard to your family and friends, excluding your partner.

Sometimes, even when your family and friends have good intentions, they may say or do things that upset
you. Think about the TIME SINCE YOUR PARTNER’S PROSTATE CANCER SURGERY and
indicate how often your family and friends did the following things.

(circle one number on each line)
Never Rarely Sometimes Often

1. How often have they changed the subject when you tried
to discuss your partner’s illness?...............................................

1

2

3

4
2. How often did it seem that they did not understand your
situation?...................................................................................
1 2 3 4
3. How often did they avoid you?............................................ 1 2 3 4
4. How often did they minimize your problems?..................... 1 2 3 4
5. How often did they seem to be hiding their feelings?.......... 1 2 3 4
6. How often did they act uncomfortable when you talked
about your partner’s illness?.....................................................

1

2

3

4
7. How often have they trivialized your problems?................. 1 2 3 4
8. How often did they complain about their own problems
when you wanted to share yours?.............................................

1

2

3

4
9. How often did they act cheerful around you to hide their
true feelings and concerns?.......................................................

1

2

3

4
10. How often did they tell you not to worry so much about
your partner’s health?................................................................

1

2

3

4
11. How often did they tell you to try not to think about the
cancer?.......................................................................................
1 2 3 4
12. How often did you get the idea that they didn't want to
hear about your partner’s cancer?.............................................

1

2

3

4
13. How often did they make you feel as though you had to
keep your feelings about your partner’s cancer to yourself,
because they made them feel uncomfortable?...........................

1

2

3

4
14. How often did they make you feel as though you had to
keep your feelings about your partner’s cancer to yourself,
because they made them upset?................................................

1

2

3

4
15. How often did they let you down by not showing you as
much love and concern as you would have liked?....................

1

2

3

4

137

V. RELATIONSHIP WITH OTHERS (CONT.)

Earlier we asked about things that your partner may say or do that upset you. Now we would like to ask
you the same questions, but in regard to your family and friends, excluding your partner.

Below is a list of items on communication between you and your family and friends. Please circle the
number which best represents the extent to which you and your family and friends behave in the specified
way.
(circle one number one each line)
Since your partner’s surgery….. Never Seldom Occasionally Frequently Very
frequently
1. How often do you and your family
and friends talk over positive or
pleasant things regarding prostate
cancer and its treatment?....................

1

2

3

4

5
2. How often do you and your family
and friends talk over negative or
unpleasant things regarding prostate
cancer and its treatment?....................

1

2

3

4

5
3. Do you and your family and friends
talk over things regarding cancer you
disagree about or have difficulties
over?...................................................

1

2

3

4

5
4. Do you and your family and friends
talk over things regarding cancer in
which you are both interested?...........

1

2

3

4

5
5. Do your family and friends adjust
what they say about cancer and how
they say it to the way you seem to feel
at the moment?............................

1

2

3

4

5
6. Do you and your family and friends
avoid certain subjects related to the
cancer in conversations?.....................

1

2

3

4

5
7. Do you and your family and friends
discuss things together regarding the
cancer and its treatment before making
an important decision?...........

1

2

3

4

5
8. Do your family and friends discuss
matters of sex with you?.....................

1

2

3

4

5
9. Can you and your family and friends
discuss and share your feelings without
feelings of restraint or
embarrassment?..................................

1

2

3

4

5

138

V. RELATIONSHIP WITH OTHERS (CONT.)

(circle one number on each line)

Since your partner’s surgery….. Never Seldom Occasionally Frequently Very
frequently
10. How often do you and your family
and friends talk with each other about
personal problems related to the
cancer experience?........................

1

2

3

4

5
11. Would you rather talk about
intimate matters related to the cancer
with your family and friends than with
some other person?.............................

1

2

3

4

5
12. During your relationships, have
you and your family and friends, in
general, talked most things over
together?...............................................

1

2

3

4

5

139

APPENDIX F

140

GENERAL INFORMATION Today’s Date:____________________

We are interested in your experience as a prostate cancer patient. Answer each question to the best of your
ability. Remember, there are no right or wrong answers. If you prefer not to answer a question, please
cross out the item and leave it blank.

I. YOUR FEELINGS AND ATTITUDES

This scale consists of a number of words that describe different feelings and emotions. Read each item and
then mark the appropriate answer in the space next to that word. Indicate to what extent you have felt this
way SINCE YOUR PROSTATE CANCER SURGERY.
(circle one number on each line)
Since your surgery, how much have you felt: Very
slightly
or not at
all

A
little

Moderately

Quite
a bit

Extremely

1. Interested……………………………………

1

2

3

4

5

2. Distressed……………………………………

1

2

3

4

5

3. Excited……………………………………….

1

2

3

4

5

4. Upset………………………………………

1

2

3

4

5

5. Strong………………………………………

1

2

3

4

5

6. Guilty………………………………………

1

2

3

4

5

7. Scared………………………………………

1

2

3

4

5

8. Hostile………………………………………

1

2

3

4

5

9. Enthusiastic…………………………………

1

2

3

4

5

10. Proud………………………………………

1

2

3

4

5

11. Irritable……………………………………

1

2

3

4

5

12. Alert………………………………………

1

2

3

4

5

13. Ashamed……………………………………

1

2

3

4

5

14. Inspired……………………………………

1

2

3

4

5

15. Nervous……………………………………

1

2

3

4

5

141

I. YOUR FEELINGS AND ATTITUDES (CONT.)
(circle one number on each line)
Since your surgery, how much have you felt: Very
slightly
or not at
all

A
little

Moderately

Quite
a bit

Extremely

16. Determined…………………………………

1

2

3

4

5

17. Attentive……………………………………

1

2

3

4

5

18. Jittery………………………………………

1

2

3

4

5

19. Active………………………………………

1

2

3

4

5

20. Afraid………………………………………

1

2

3

4

5

Abstract (if available)

Abstract The social-cognitive processing model proposes that open communication within a supportive environment facilitates processing and emotional adjustment following a traumatic event. The study examined 2 types of limitations on communication -- social constraints and protective buffering -- among prostate cancer patients and their spouses. The purpose of the study was to investigate the relation of social constraints and protective buffering on affect, as well as to explore potential mediators and moderators of these relations. The study was a subset of a larger study that assessed the health-related quality of life of prostate cancer patients who underwent laparoscopic radical prostatectomy. Questionnaire data were obtained from 50 couples at two time-points: prior to surgery and three months following surgery. The results indicated that greater spousal perceived social constraint from patients significantly predicted less of a reduction in spousal negative affect over time. Contrary to the study's hypotheses, spousal perceived social constraint from family/friends and spousal protective buffering of patients were not significantly associated with changes in spousal affect over time. Mediational relations from a social-cognitive perspective, specifically the role of communication on the above relations, also were not supported. Greater spousal negative affect was associated with greater provision of support to patients from both the spouses' and patients' perspectives. Spousal affect, however, was not associated with patients' perceived social constraint from spouses or perceived protective buffering by spouses. Exploratory findings revealed that greater spousal perceived protective buffering by patients significantly predicted less of a reduction in spousal negative affect, in part due to greater spousal perceived social constraints. For patients, however, perceptions of being buffered by spouses were not predictive of change in patients' affect over

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