Need for cognition and psychological adjustment in patients and partners of prostate cancer

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Content NEED FOR COGNTION AND PSYCHOSOCIAL ADJUSTMENT IN PATIENTS
AND PARTNERS OF PROSTATE CANCER
Copyright 2003
by
Sindy Oh
A Thesis Presented to the
FACULTY OF THE GRADUATE SCHOOL
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
MASTERS OF ARTS
(PSYCHOLOGY)
August 2003
Sindy Oh
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UMI Number: 1420391
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UNIVERSITY OF SOUTHERN CALIFORNIA
THE GRADUATE SCHOOL
UNIVERSITY PARK
LOS ANGELES, CALIFORNIA 90089-1695
This thesis, written by
S i n d y Oh
under the direction o f h e r thesis committee, and
approved by all its members, has been presented to and
accepted by the Director o f Graduate and Professional
Programs, in partial fulfillment of the requirements fo r the
degree o f
A . i n P s y c h o l o g y
. Director
Date A ugust 1 2 . 2003
Thesis Committee
Chair
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Table of Contents
List of Tables ................................ iii
Abstract................................................................................................. iv
Introduction......................................................................................................................... 1
Communication with the Medical Team...................................... 3
Communication and Support within the Dyad............................... 4
Need for Cognition.......................................................................................................5
Methods............................................................................................................................ 10
Participants...................................................................................................................11
Procedures....................................................................................................................11
Instruments..................................................................................................................12
Demographics...................................................................................................... 13
Stress.....................................................................................................................13
Mood.................. 14
Dyadic Adjustment..............................................................................................15
Communication.................................................................................................... 15
Need for Cognition..............................................................................................16
Statistical Analyses..................................................................................................... 17
Results................................................................................................................................18
Participants..................................................................................................................18
Need for Cognition, and Stress and Mood................... 21
Exploratory Analyses: Patient’s Stress and Mood ................... 23
Need for Cognition and Communication with the Medical Team..........................23
Exploratory Mediational Analyses: Need for Cognition and Perceived Stress
Scale in Partners................... 24
Exploratory Mediational Analyses: Communication with the Medical Team and
Perceived Stress Scale in Patients..............................................................................25
Need for Cognition Match/Mismatch Dyads.................................................... 26
Discussion........................................... .29
Limitations...................................................................................... 35
Implications/Future Directions...................................................................................37
Footnotes.................... 39
References......................................................... 40
Appendixes.................................................................. 47
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List of Tables
Table 1. Demographic and Medical Characteristics of Participants and Non-
participants............................................................. 19
Table 2. Variable Means for Patients and Partners ....... 22
Table 3. Intercorrelations between Key Study Variables for Patients and Partners...22
Table 4. Identifying the Impact of Events Scale as a Mediator of the Need for
Cognition Scale and the Perceived Stress Scale............................................................24
Table 5. Identifying the Impact of Events Scale as a Mediator of the Communication
w/the Medical Team Scale and the Perceived Stress Scale in Patients...................... 25
Table 6. Mean Dyadic Adjustment and Communication Scores by Need for
Cognition Dyads for Patients and Partners....................................................................27
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iv
Abstract
The diagnostic/pre-surgical period is one of the most stressful times of the
cancer experience. An essential aspect during this period is communication with the
medical team, and within the patient-paitner dyad. Individual differences in
cognitive style, specifically, need for cognition (NFC), may play a crucial role in
communication. This study addresses NFC and adjustment in 106 prostate cancer
patients and partners within 2 weeks prior to radical prostatectomy. High (NFC) was
significantly associated with less stress and greater mood in partners. Analyses
indicate that the relationship between NFC and general stress in partners is partially
mediated by disease-specific stress. A similar pattern of relationships was found for
patients, but with communication with the medical team as the independent variable.
Dyadic congruency in NFC and adjustment are also discussed. This study illustrates
the importance of identifying the factors that aid in adjustment in individuals who are
differentially affected by the disease.
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Introduction
Prostate cancer is the most common cancer in men in the United States, with
a 5 year survival rate of 96% for all stages (localized, regional, and distant) and a
100% survival rate for local and regional disease (American Cancer Society, 2002).
The high prevalence of prostate cancer, coupled with its excellent prognosis,
suggests that many individuals are living with the disease and dealing with its
consequences.
The most common form of treatment for clinically localized disease is radical
prostatectomy, a surgical procedure that removes the prostate gland. This treatment
facilitates long-term survival, but can have lasting side effects, such as urinary
incontinence and erectile dysfunction (Fowler et al, 1993; Perez et al., 1997;
Shrader-Bogen, Kjellberg, McPherson, & Murray, 1997; Talcott et al., 1996).
Despite its side effects, the majority of prostate cancer patients report good quality of
life and emotional well-being several years following surgery (Braslis, Santa-Cruz,
Brickman, & Soloway, 1995; Litwin et al., 1995; Perez et al., 1997). However, the
quality of life of prostate cancer patients in the early stages of the disease process has
not been extensively studied. Research with other cancer patients suggests that
disruptions in quality of life do occur in the early stages of disease (Oberst & James,
1985).
In addition to impacting the health-related quality of life of the cancer patient,
the diagnosis of cancer can have a significant impact on members of the family,
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particularly the partner of the patient. Research indicates that the partner of the
cancer patient is not immune to the effects of the patient’s illness, but instead may
experience equal amounts of psychological distress (Oberst & James, 1985). The
psychosocial difficulties experienced by the partner of the patient is important not
only to understand the impact of the disease on members of the family, but also to
examine the potential influence of the partner’s support on the patient’s adjustment.
Unfortunately, the quality of life of the partner of the prostate cancer patient has
received little attention in the literature (Perez, Skinner, & Meyerowitz, 2002).
This study addresses the patient’s and partner’s psychosocial adjustment
during a critical period of the disease process, the diagnostic/pre-surgical period.
This period has been found to be one of the most stressful times for cancer patients
(Maliski, Heilemann, & McCorkle, 2002; Northouse, 1989; Stanton & Snider, 1993).
In a study of 131 prostate cancer patients, anxiety was more prominent during the 2-
3 weeks prior to radical prostatectomy, than at 3, 6, 12, or 18 months following
surgery (Pedersen, Carlsson, Rahmquist, & Varenhorst, 1993). In another study of
79 prostate cancer patients, tension was significantly higher in patients awaiting
radical prostatectomy than in post-surgery patients (Brasiis et al., 1995). Thus,
understanding psychosocial adjustment during this period marked by anxiety and
tension is of particular importance.
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Communication with the Medical Team
An essential aspect of this diagnostic/pre-surgical period that both the patient
and partner confront, is communicating with the medical team about the disease,
treatment options, and the physical and psychosocial implications for the couple.
Research indicates that most cancer patients desire detailed illness-related
information (Cassileth, Zupkis, Sutton-Smith, & March, 1980; Fallowfield, Ford, &
Lewis, 1995; Harden et al., 2002; Northouse, 1989; Sutherland, Llewellyn-Thomas,
Lockwood, Tritchler, & Till, 1989). Information seeking was particularly high for
recently diagnosed patients (Cassileth et al., 1980) and for early stage disease groups
(Gotay, 1984). Similar information needs are also expressed by the partner of the
cancer patient (Derdiarian, 1989; Kilpatrick, Kristjanson, Tataryn, & Fraser, 1998;
Northouse & Northouse, 1987).
Although there may be a high need for information, exposure to detailed
information may also be potentially threatening and distressing, particularly when
the information provided is overwhelming or poorly understood (Fallowfield, 1993;
Maliski et al., 2002; Harden et al., 2002; Schag & Heinrich, 1989; Vess, Moreland,
Schwebel, & Kraut, 1988). During the period between diagnosis and surgery, a time
of shock, confusion, and distress, the patient and partner are presented with a vast
amount of typically unfamiliar information. Thus, effective communication with the
medical team, the primary source of information during this period, is essential. Yet
in a study with 63 prostate cancer patients, Moore and Estey (1999) found that
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patients’ comprehension of the treatment options were severely limited, and reported
that patients could not remember the details of the conversation following diagnosis.
Additional research indicates that cancer patients’ comprehension and recall of
medical information are often poor (Cassileth et al., 1980; Dunn et al, 1993;
Mackillop, Stewart, Ginsberg, & Stewart, 1988).
This lack of effective communication with the medical team has been
associated with poor disease adjustment. In a study with 97 breast cancer patients,
individuals who experienced communication problems with their health care
providers reported more anxiety, depression, anger, and confusion than patients who
did not report communication problems (Lerman et al., 1993). Similarly, patient
perception of good physician communication in 100 newly diagnosed breast cancer
patients was associated with psychological adjustment (Roberts, Cox, Reintgen,
Baile, & Gibertini, 1994). Factual understanding is believed to aid in coping with
the stress resulting from the diagnosis, perhaps reducing uncertainty, anxiety, and
fears associated with the disease (Blanchard, Albrecht, & Ruckdeschel, 2000; Stark
& House, 2000; Derdiarian, 1989).
Communication and Support within the Dyad
In addition to communication with the medical team, effective
communication and feelings of support within the patient-partner dyad also aid in
disease adjustment. Research indicates that open communication within couples is
associated with positive adjustment and low levels of distress for both the patient and
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partner (Hilton, 1994; Northouse & Northouse, 1987). In a study of 102 cancer
patients, 42 of whom were prostate cancer patients, communication with a significant
other in an emotionally supportive environment was conducive to effective
adjustment (Gotcher, 1992). Feelings of support from the partner are also found to
be associated with better adjustment (Hoskins et al., 1996; Manne, Taylor,
Dougherty, & Kemeny, 1997; Northouse, 1988). In addition, Vess, Moreland, and
Schwebel (1985) found that open communication allowed couples to negotiate more
effectively the reallocation of roles following cancer, resulting in a less conflicted
and more cohesive family environment.
It is evident that open communication aids couples in adjusting to cancer, but
many cancer patients report difficulties communicating about their illness with their
partners (Boehmer & Clark, 2001; Chekryn, 1984; Cooper, 1984; Lichtman, Taylor,
& Wood, 1987; Meyerowitz, Watkins, & Sparks, 1983; Harden et al., 2002).
Research indicates that improved communication is associated with better
relationship quality in couples with dyadic dissatisfaction (Jacobson & Addis, 1993;
Markman, Renick, Floyd, Stanley, & Clements, 1993). Thus, effective
communication and support within the patient-partner dyad may also lead to better
dyadic adjustment within the context of cancer.
Need fo r Cognition
As described above, effective communication with the medical team, and
open communication and support within the patient-partner dyad, aid in the
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adjustment to cancer. It has also been reported that a number of cancer patients and
their partners have notable difficulties in achieving the communication gains that are
associated with psychosocial adjustment. This study addresses potential individual
differences in personality that may be associated with optimal communication.
Individual differences in cognitive style and information processing may play
a crucial role in obtaining and sharing medical information and needs. Specifically,
individual differences in the tendency to engage in and enjoy effortful cognitive
endeavors may be relevant to the study of disease adjustment, particularly during the
diagnostic/pre-surgical period. This individual difference is referred to as the need
for cognition, as defined by Cacioppo and Petty (1982). It is believed to be a highly
stable individual difference variable (Cacioppo & Petty, 1982; Sadowski & Gulgoz,
1992) with no gender differences (Cacioppo & Petty, 1982; Sadowski, 1993; Tanaka,
Panter, & Winbome, 1988; Tolentino, Curry, & Leak, 1990).
According to Cacioppo and Petty’s (Cacioppo & Petty, 1982)
conceptualization, individuals both high and low in need for cognition, need to make
sense of their world. However, the mechanisms by which they derive meaning,
adopt positions, and solve problems are thought to be quite different. High need for
cognition individuals are believed to seek out, acquire, think about, and reflect back
on information in order to make sense of the events in their world (Cacioppo, Petty,
Feinstein, & Jarvis, 1996). This tendency to apply cognitive effort to process
information in all situations may result in lower levels of stress when applying
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cognitive effort in response to a challenging life event. In contrast, it is believed that
low need for cognition individuals do not regularly rely on cognitive effort to make
sense of the events in their world. As a result, when low need for cognition
individuals attempt to apply cognitive effort in more self-relevant and critical
situations, they may experience difficulties in doing so, in addition to experiencing
stress. Thus, if the manner in which high and low need for cognition individuals
approach and process information differs, and the level of stress experienced when
faced with a challenging event differs, then need for cognition may play an important
role in the way disease-related information is processed during the stressful period
between diagnosis and surgery.
As highlighted above, communication with the medical team is essential
during the diagnostic period before surgery, yet many patients report difficulties in
comprehending the information provided. If high need for cognition in low stress
conditions is associated with better recall (Reid et al., 1995), attention to ongoing
cognitive tasks (Osberg, 1987), low communication apprehension (Wycoff, 1992), and
the active seeking of relevant information (Berzonsky & Sullivan, 1992), as found in
previous research, then it may also be that high need for cognition individuals are
better able to communicate under more stressful conditions, specifically,
communicating with the medical team regarding cancer diagnosis and treatment.
Hence, previous experience and/or skills utilized in low stress conditions may aid in
communication in more stressful conditions. Greater communication with the
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medical team may lead to a better understanding of complex information, which may
then relieve the anxiety and stress often experienced by cancer patients and their
partners. Thus, effective communication may influence the processing and
integration of disease-related information, which in turn affects psychosocial
adjustment. In contrast, low need for cognition individuals may be less able to
communicate with the medical team, which may then influence the level of
understanding of the information provided. Thus, low need for cognition individuals
may experience more anxiety and stress during this critical period due to poor
processing and integration of disease-related information.
Although high need for cognition may be beneficial to individual adjustment,
it may not necessarily have positive outcomes in the adjustment experienced as a
couple. The manner in which one approaches and deals with challenging cognitive
experiences may differ between members of the couple, which may have an impact
on dyadic communication, support, and quality. If both members of a dyad are high
need for cognition individuals, they may be better able to communicate with one
another regarding the disease and its consequences. As mentioned above, open
communication and support have been linked to better adjustment and dyadic
satisfaction. In contrast, if both members of a dyad are low need for cognition
individuals, or if members of a dyad differ in need for cognition, they may be less
able to communicate with one another regarding the disease and its consequences.
The inability to communicate effectively within the dyad during this critical period
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may then influence the quality of the dyadic relationship. Thus, it is important to
examine the congruency in need for cognition within a couple and its relation to
dyadic adjustment.
The study addresses the relation between individual differences in the need
for cognition, and psychological, emotional, and interpersonal adjustment for
prostate cancer patients and their partners during the diagnostic/pre-surgical period.
The specific aims of the study include the following:
1) To examine the relation between need for cognition and psychological and
emotional adjustment in patients and partners-
Hypothesis la: Need for cognition will be negatively associated with general
stress, disease-specific stress, and negative affect, and positively associated with
positive affect in patients and partners.
2) To examine the relation between need for cognition and communication
with the medical team, and to examine its possible mediational role in patients’
and partners’ stress-
Hypothesis 2a: Need for cognition will be positively associated with
communication with the medical team, which will mediate the relation between need
for cognition and stress in patients and partners.
3) To examine need for cognition match/mismatch within the patient-partner
dyad and its relation to the dyadic relationship, as reported by patients and
partners. Need for cognition match refers to a dyad in which the patient and partner
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are both high In need for cognition (High Patient-High Partner), or both low In need
for cognition (Low Patient-Low Partner). Need for cognition mismatch refers to a
dyad in which one member is high in need for cognition and the other member is low
in need for cognition (High Patient-Low Partner; Low Patient-High Partner).
Hypothesis 3 a: High need for cognition match (High Patient-High Partner) dyads
will report greater dyadic disease-specific communication and support, and greater
dyadic adjustment than in the other groups, as reported by patients and partners.
Hypothesis 3b: Dyadic disease-specific communication will mediate the relation
between high need for cognition match (High Patient-High Partner) and dyadic
adjustment, as reported by patients and partners.
Question 3c: What are the relations between low need for cognition match (Low
Patient-Low Partner) and need for cognition mismatch (High Patient-Low Partner;
Low Patient-High Partner), and dyadic disease-specific communication and support,
and dyadic adjustment, as reported by patients and partners?
Methods
The present study is based on a preexisting data set. The original study was a
longitudinal study assessing the long-term quality of life of radical prostatectomy
patients and their partners. The present study is cross-sectional in design and
assesses patients and their partners at the first time point, within 2 weeks prior to
surgery.
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Participants
Participants are men with carcinoma of the prostate who were awaiting and
scheduled to receive a radical prostatectomy at the Norris Comprehensive Cancer
Center (NCCC) between 01/01/97 and 05/31/99, and their partners. Eligibility
criteria consisted of men who (1) were partnered, (2) had partners who were aware of
their diagnosis and were planning to attend the pre-surgical appointment with the
patient, (3) did not have other active cancers and were not undergoing salvage
radical prostatectomies, (4) did not have comorbid psychiatric disorders, and (5)
were English speaking.
Procedures
Participants were identified following the first consultation appointment, in
which the patient consented to undergo a radical prostatectomy. On a weekly basis,
researchers were provided computer-generated hospital records of patients who were
scheduled for a radical prostatectomy. These records provided general
demographics, including the patient’s marital status, date of pre-surgical appointment
and surgery, and information on where to contact the patient by telephone. If the
patient was married or partnered, they were contacted by a researcher and invited to
participate in the study. Patients identified as ‘single’ or ‘widowed’ on their records
were also contacted to determine whether they were currently partnered, and if
applicable, were invited to participate.
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Patients were given verbal information regarding the study, its procedures,
and eligibility criteria. Verbal consent was obtained prior to mailing patient and
partner versions of the materials to their residence. Both patient and partner
materials consisted of (1) a cover letter from the research associate, (2) a letter from
the surgeon stating the purpose of the study, (3) a pre-surgical questionnaire packet,
and (4) an informed consent form. Couples were instructed to review the materials
and sign the informed consent form, if interested in participating. Participants were
asked to complete the questionnaire packets independently and to bring them to the
pre-surgical appointment, the day prior to surgery. Following the mailing, the couple
was telephoned to confirm the receipt of the packet, to establish participation status,
and to answer any questions. Couples who declined to participate were not
contacted again. Participants were reminded to bring their completed questionnaire
packets and signed consent forms with them to the pre-surgical appointment. If they
did not bring their completed questionnaires with them to the appointment, they were
asked to complete the packet on site prior to the appointment.
Instruments
Nine questionnaires were selected from the original study, providing data
from both the patient and partner. They addressed basic demographics, stress, mood,
dyadic adjustment, communication with the medical team, communication within the
patient-partner dyad, and need for cognition. Participants were asked to respond to
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the questions based on their current situation, taking into account the past 3 weeks.
Copies of patient and partner measures appear in Appendix A and B, respectively.
Demographics
General Information. A General Information form was used to assess the
patients’ and partners’ basic demographics, such as age, education, ethnic
background, current relationship status, date of prostate cancer diagnosis, and other
major health problems.
Stress
General Stress. The Perceived Stress Scale (Cohen, Kamarck, &
Mermelstein, 1983) was used to measure the frequency of participants’ stressful
thoughts and feelings in general. It is a 14-item scale which consists of items that
ask participants how often they experienced stress or thought about stressful events.
Participants are asked to rate their experiences on a 5-point Likert-type scale, ranging
from 0 (“Never”) to 4 (Very Often”). Cronbach’s alpha for this scale averages .85
across 3 samples (Cohen et al, 1983). Test-retest reliability over a two-day time span
is .85, but .55 over a six-week time span. This scale also has good predictive
validity. Cronbach’s alphas for our sample of patients and partners are .82 and .83,
respectively.
Cancer-Specific Stress. The Impact of Events Scale (Horowitz, Wilner, &
Alvarez, 1979) was used to measure the participants’ responses to cancer. It is a 15-
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item scale which 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 the participants are
asked to respond in regard to the “cancer diagnosis”. This measure taps the two
most commonly reported responses to stressful events: intrusion and avoidance.
Participants are asked to rate these items on a 4-point Likert-type scale, ranging from
1 (“Not At All”) to 4 (“Often”). Cronbach’s alpha for this scale is .78 for the
intrusion subscale and .82 for the avoidance subscale (Horowitz et al., 1979).
Cronbach’s alphas for our sample of patients and partners for the intrusion subscale
are .83 and .81, respectively. Cronbach’s alphas for our sample o f patients and
partners for the avoidance subscale are .75 and .83, respectively.
Mood
The Positive and Negative Affect Schedule (Watson, Clark, & Tellegen, 1988) was
used to measure the participants’ mood. This scale is an adjective checklist in which
20 mood states are assessed. The measure provides ratings of Positive Affect and
Negative Affect. Participants are asked to rate the extent to which they had
experienced these emotions on a 5-point Likert-type scale, ranging from 1 (“Very
Slightly or Not At All”) to 5 (“Extremely”). Cronbach’s alpha for both Positive
Affect and Negative Affect (time instructions- past few weeks) are .87 (Watson et al.,
1988). This scale also has good external validity. Cronbach’s alphas for our sample
of patients and partners for Positive Affect are .86 and .81, respectively. Cronbach’s
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alphas for our sample of patients and partners for Negative Affect are .89 and .88,
respectively.
Dyadic Adjustment
The Dyadic Adjustment Scale (Spainer, 1976) was used to measure the perceived
quality of the participants’ relationship. Participants are asked to indicate the level
of agreement on various relationship issues, and the frequency with which they
engage in specific behaviors with their partner. This scale is a 32-item scale which
covers four independent areas: dyadic satisfaction, dyadic consensus, dyadic
cohesion, and affectional expression. Scores can range from 0 to 151, with lower
scores indicative of distress in marriage. A score above 100 is considered a high
quality relationship. Cronbach’s alpha for this scale is .96 (Spainer, 1976). It also
has established good content, criterion-related, and construct validity. Cronbach’s
alphas for our sample of patients and partners are .93 and .91, respectively.
Communication
Communication with the Medical Team. The Communication with the
Medical Team Scale, developed for the original study, is a 16-item measure used to
assess the participants’ level of general and disease-specific communication with the
medical team, satisfaction with the information provided, and sense of control over
the information process. Participants are asked to rate these various items on a 7-
point Likert-type scale. Cronbach’s alphas for our sample of patients and partners
are .83 and .86, respectively.
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Communication within the Patient-Partner Dyad. An adapted version of
The Primary Communication Inventory (Locke, Sabaght, Thomas, authors; as cited
in Navran, 1967) was used to measure the frequency and type of relationship
communication specific to cancer. The content of the items is not changed, but
rather the items are reworded to address communication specific to cancer. The
adapted version, a 10-item scale, asks participants to rate the extent to which they
behave in specified ways with their partner, on a 5-point Likert-type scale, ranging
from 1 (“Never”) to 5 (“Very Frequently”). Cronbach’s alphas for our sample of
patients and partners are .70 and .72, respectively.
Support Needs. The Support Needs Scale, developed for the original study,
was used to measure the participants’ perception that their needs were being met by
their partner and that they were meeting the needs of their partner. This scale is an
8-item scale which asks the participants to rate the strength of their feeling or
opinion, on a 7-point Likert-type scale. Cronbach’s alphas for our sample of patients
and partners are .85 and .91, respectively.
Need for Cognition
The short form of the Need for Cognition Scale (Cacioppo, Petty, & Kao, 1984)
was used to measure the participants’ tendency to engage in and enjoy effortful
cognitive endeavors. It is an 18-item scale which consists of statements in which
participants’ are asked to rate the extent to which each statement is characteristic of
them, on a 5-point Likert-type scale, ranging from 1 (“Extremely Uncharacteristic”)
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to 5 (“Extremely Characteristic”). Cronbach’s alpha for this scale is .90 (Cacioppo
et al, 1984). Test-retest reliability over a seven-week time span is .88 (Sadowski &
Gulgoz, 1992). It has also established good convergent and discriminant validity.
Cronbach’s alphas for our sample of patients and partners are .91 and .90,
respectively.
Statistical Analyses
Descriptive statistics are conducted to describe the characteristics of the
sample and the remaining 8 measures. T-tests, Pearson Chi-squares, and Fisher’s
Exact Tests are conducted to compare demographic variables between participants
and non-participants, and patients and partners. T-tests are also conducted to
compare patients and partners on the key variables1 . Pearson correlations are
conducted in order to examine the relationship between need for cognition and
psychological and emotional adjustment in patients and partners1. In order to test for
mediation, Baron and Kenny’s (1986) mediational model is used. First, the predicted
mediator is regressed on the independent variable, the dependent variable is
regressed on the independent variable, and the dependent variable is regressed on the
predicted mediator. If all three associations are significant, then the predicted
mediator is tested via multiple regression analysis. After controlling for the
predicted mediator, a non-significant relationship between the independent and
dependent variable would indicate a mediational effect.
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In order to examine need for cognition match/mismatch within the patient-
partner dyad and its relation to the dyadic relationship, as reported by the patient and
partner, the Need for Cognition Scale is dichotomized via median split2. Based on
this split, couples are categorized into a need for cognition match/mismatch dyad
group. As previously mentioned, need for cognition match refers to a dyad in which
patient and partner are both high in need for cognition, or both low in need for
cognition. Need for cognition mismatch refers to a dyad in which one member is
high in need for cognition and the other member is low in need for cognition. Thus,
there are four need for cognition dyad groups: high need for cognition match (High
Patient-High Partner), low need for cognition match (Low Patient-Low Partner),
need for cognition mismatch (High Patient-Low Partner), and need for cognition
mismatch (Low Patient-High Partner). One-way ANOVAs are conducted for each
dyadic relationship variable1 . If the ANOVAs indicate a significant difference
between groups, then Tukey HSD post hoc tests are conducted to determine the
location of the significance.
P-values less than .05 are considered to be statistically significant. Effect
sizes are also reported (Cohen, 1988).
Results
Participants
Of the 210 eligible couples, 106 (50.5%) couples participated in the study.
Of the 104 couples who declined to participate, 47% reported that they were either
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Table 1. Demographic and Medical Characteristics of Participants and Non-participants
Non-
Participants Participants
Patients Partners Patients
Age (mean yrs.) 61.3 56.3 63.0
Education
< High school degree 1% 3% n/ab
High school degree 5 13 n/ab
Some college 17 25 n/ab
Jr. college degree 8 19 n/ab
College degree 37 19 n/ab
Advanced degree 32 21 n/ab
Ethnicity
Non-Hispanic White 86% 83% 89%
African-American 5 5 3
Hispanic 6 5 6
Asian-Americam 1 4 2
Other 2 3 0
Employment Status
Employed 68% n/aa 63%
Retired 32 n/aa 37
Relationship Status
Married 97% n/aa 94%
Partnered 3 n/aa 6
Length of Relationship (mean yrs.) 28 n/aa n/aa
Stage A orB prostatic neoplasm 74.5% n/aa 78%
Data was either not collected or irrelevant. Data was obtained from the patient non-participants’
medical charts, and only indicated general levels of education (-90% had > a high school degree).
However, when compared to patient participants’ level of education obtained from medical charts,
chi-square analysis indicate no significant difference.
“too busy” or had “too much going on”. Table 1 presents the demographic and
medical characteristics of the participants and non-participants. There were no
significant differences between patient participants and patient non-participants on
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20
the following demographic and medical characteristics: ethnicity, employment
status, relationship status, and disease stage. However, our analyses indicate that
patient non-participants were significantly older than patient participants (t(206) =
2.14, p = .03). Characteristics of partner non-participants are unknown due the
nature of the recruitment process.
Table 1 also presents the demographic characteristics of the partner
participants. There were significant differences in age and level o f education
between patient and partner participants3. Patient participants were significantly
older than partner participants (t(198) = 4.25, p < .001) and had significantly higher
levels of education than partner participants (x2 (6) = 21.55, p < .001).
Table 2 presents the mean values of the key variables for patients and
partners. Patient and partner mean Perceived Stress scores indicate low-moderate
general stress, comparable to the scale’s norms on college student samples and
community samples enrolled in a smoking cessation program (Cohen et al., 1983).
Patient and partner mean Impact of Event scores also indicate low-moderate disease-
specific stress, comparable to samples who were not seeking psychological services
and have recently experienced parental bereavement (Zilberg, Weiss, & Horowitz,
1982). In addition, patient and partner mean Positive Affect scores indicate
moderate-high levels of positive affect, comparable to the scale’s norms on college
student samples (Watson et al., 1998). T-tests indicate that patients and partners
were similar on all variables, with the exception of Negative Affect, t(201) = -2.53,
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21
p = .01 (Table 2). Partners reported significantly greater levels o f negative affect
than patients. Although patients reported mean Negative Affect scores
similar to the scale’s norms, partners reported mean Negative Affect scores higher
than the scale’s norms, indicating higher levels of negative affect (Watson et a!.,
1988). In addition, patient and partner mean total Dyadic Adjustment scores were
greater than the scale’s norms on community married couples, indicating overall
high quality relationships (Spainer, 1976). Patient and partner mean total Dyadic
Adjustment scores are also comparable to other prostate and breast cancer patients
and partners (Northouse, Templin, Mood, & Oberst, 1998; Ptacek, Pierce, Ptacek, &
Nogel, 1999). Both patient and partner mean scores on Communication with the
Medical Team, Primary Communication, and Support Needs were above the scales’
midpoint of 64, 30, and 32, respectively, indicating that the couples perceived good
communication with the medical team, good communication within the dyad, and
felt as though they were meeting their partners’ needs and that their needs were
being met as well. Lastly, patient and partner mean Need for Cognition scores were
above the scale’s midpoint of 54, indicating moderate-high levels o f need for
cognition in this sample.
Need for Cognition, and Stress and Mood
Table 3 presents the Pearson correlations for patients and partners on all of
the study’s key variables. Need for Cognition was not significantly associated with
stress or mood in patients. However, Need for Cognition was significantly
associated with all stress and mood measures in partners: Perceived Stress, Impact of
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Table 2. Variable Means for Patients and Partners
Variable N
Patients
Mean SD N
Paftoers
Mean SD
p-value,
t-test
Stress
Perceived Stress Scale 105 19.8 6.6 104 21.4 6.6 0.08
Impact of Events Scale 102 22.7 13.3 104 24.3 14.4 0.4
Mood
PANAS (Positive Affect) 102 34.0 7.4 102 34.2 6.2 0.82
PANAS (Negative Affect) 101 19.8 7.2 102 22.3 6.9 0.01
Dyadic Adjustment
Dyadic Adjustment Scale 99 120.6 13.9 97 119.1 16.3 0.49
Communication
Communication w/the Medical Team Scale 104 84.3 13.8 91 81.3 16.2 0.16
Primary Communication Inventory 104 37.9 6.0 105 38.7 6.4 0,32
Support Needs Scale 102 41.0 8.3 102 39.2 10.4 0.18
Need for Cognition
Need for Cognition Scale 102 64.7 14.1 102 61.9 13.4 0.15
Table 3. Intercolletations between Key Study Variables for Patients and Partners
Scale 1 2 3 4 5 6 7 8 9
1. Need for Cognition Scale
. . .
.10 -.06 -.05 .09 -.04 .03 .04 -.02
2. Communication w/the Medical Team Scale -.002 — -.21* -.23* .36*** -.29** .12 .19* .19*
3. Impact of Events Scale -.19* -.12 — .46*** -.41*** .63*** -.10 -.13 -.22*
4. Perceived Stress Scale -.24** -.14 .45*** — -.50*** .60*** -.31** -.13 -.22*
5. PANAS (Positive Affect) .35*** .06 -.08 -.43*** — -.54*** .26** .11 .20*
6. PANAS (Negative Affect) -.21* -.15 .69*** .61*** -.09 — -.20* -.09 -.23*
7. Dyadic Adjustment Scale -.02 .22* -.01 -.47*** .45*** -.22*
. . .
.33** .54***
S. Primary Communication Inventory .17* .39*** .02 .,24** .39*** .05 .58*** — .58***
9. Support Needs Scale -.005 .29** -.003 -.25** .32** -.13 .62*** .64*** —
Note. Patient correlations are presented in the upper right-hand comer of the matrix. Partner correlations are presented in the lower
left-hand corner of the matrix.
*p < .05. **p< .01. ***p < .001.
23
Events, Positive Affect, and Negative Affect. For partners, high need for cognition
was significantly associated with lower general stress, lower disease-specific stress,
greater positive affect, and lower negative affect. Thus, the study’s hypotheses were
only partially confirmed.
Exploratory Analyses: Patient’s Stress and Mood
Although Need for Cognition was significantly associated with stress and
mood in partners only, a similar pattern of relationships appeared for patients, but
with one of the study’s other key measures, Communication with the Medical Team.
Communication with the Medical Team was significantly associated with all stress
and mood measures: Perceived Stress, Impact of Events, Positive Affect, and
Negative Affect (Table 3). For patients, higher quality of communication with the
medical team was significantly associated with lower general stress, lower disease-
specific stress, greater positive mood, and lower negative mood.
Need for Cognition and Communication with the Medical Team
Contrary to the study’s hypotheses, Need for Cognition was not significantly
associated with Communication with the Medical Team in patients or partners (Table
3). Since Need for Cognition was not significantly associated with Communication
with the Medical Team and Perceived Stress, mediational relationships between
Need for Cognition, Communication with the Medical Team, and Perceived Stress in
patients and partners could not be tested.
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Exploratory Mediational Analyses: Need for Cognition and Perceived Stress in
Partners
Exploratory analyses were conducted to examine the possible mediators of
the relationship between Need for Cognition and Perceived Stress in partners. Each
of the key variables that were associated with Need for Cognition and Perceived
Stress were entered into separate regression equations in order to examine its
mediational role. Multiple regression analyses indicate that only after controlling for
Impact of Events is the relationship between Need for Cognition and Perceived
Stress no longer significant. Table 4 presents the beta coefficients for the
mediational relationship. It appears that in partners the relationship between need for
cognition and general stress is partially mediated by disease-specific stress.
Table 4. Identifying the Impact of Events Scale as a Mediator of the Need for Cognition Scale
And the Perceived Stress Scale in Partners
Perceived Stress Scale
Partners
R2 .22***
B
Block 1 :
Impact of Events Scale (Total Score)
Block 2:
Need for Cognition Scale -.16
Note. For the Perceived Stress Scale R2 = .20*** for Block 1; □R2 = .03 for Block 2.
***p < .001.
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25
Exploratory Mediational Analyses: Communication with the Medical Team and
Perceived Stress in Patients
Since Communication with the Medical Team was significantly associated
with stress and mood in patients, further exploratory analyses were conducted to
examine the possible mediators of this relationship. Each of the key variables that
were associated with Communication with the Medical Team and Perceived Stress
were entered into separate regression equations in order to examine its mediational
role. Multiple regression analyses indicate that only after controlling for Impact of
Events is the relationship between Communication with the Medical Team and
Perceived Stress no longer significant. Table 5 presents the beta coefficients for the
mediational relationship. The data suggest that in patients the relationship between
communication with the medical team and general stress is partially mediated by
disease-specific stress, similar to the mediational relationship seen in partners with
need for cognition.
Table 5. Identifying the Impact of Events Scale as a Mediator of the Communication w/the
Medical Team Scale and the Perceived Stress Scale in Patients
Perceived Stress Scale
R2 .22***
B
Block 1:
Impact of Events Scale (Total Score) .46***
Block 2:
Communication w/the Medical Team
Scale -.13
Note. For the Perceived Stress Scale R2 = .21*** for Block 1; DR2 = .02 for Block 2.
***p < .001.
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26
Need for Cognition Match/Mismatch Dyads
In order to investigate Need for Cognition match/mismatch within the dyad.
Need for Cognition was dichotomized via median split. Need for Cognition cut-off
values were 67.76 and 64.59 for patients and partners, respectively. Scores greater
than or equal to these values were categorized as high need for cognition, and scores
below these values were categorized as low need for cognition. Table 6 presents the
means of the dyadic adjustment and communication variables for the four Need for
Cognition dyad groups, as reported by the patient.
One-way ANOVAs were conducted in order to compare aspects of the dyadic
adjustment and communication in need for cognition match/mismatch dyads, from
the patients’ perspective. There was a significant difference in Primary
Communication between groups, F(3,92) = 3.85, p = .01 (f = .35) (Cohen, 1988).
Consistent with the study’s hypotheses, Tukey post-hoc comparisons indicated that
Primary Communication was significantly higher for patients in a high Need for
Cognition match dyad (High Patient-High Partner), compared to patients in a Need
for Cognition mismatch dyad (High Patient-Low Partner) [p < .05], However,
contrary to the study’s hypotheses, Need for Cognition match/mismatch dyads did
not significantly differ on patient reports of Support Needs or Dyadic Adjustment.
Since there were no significant differences between Need for Cognition
match/mismatch dyads on Dyadic Adjustment, mediational relations between Need
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Table 6. Mean Dyadic Adjustment and Communication Scores by Need for Cognition Dyads for Patients and Partners
Patients _______ ________________________
Dyadic Adjustment Scale Primary Communication Inventory Support Needs Scale
Need for Cognition Dyad N Mean SD N Mean SD______ N Mean SD
High Patient-High Partner 29 121.97 15.16 30 39.77 5.73 29 43.25 8.37
Low Patient-Low Partner 21 123.95 14.04 23 36.35 5.58 24 41.42 8.35
High Patient-Low Partner 22 117.36 14.83 22 35.65 6.38 22 37.77 8.99
Low Patient-High Partner 21 119.12 11.62 21 40.01 4,45 21 39.95 7.80
Partners _________
Dyadic Adjustment Scale Primary Communication Inventory Support Needs Scale
Need for Cognition Dyad N Mean SD ______ N Mean______ SD N Mean SD
High Patient-High Partner 27 120.24 14.17 30 39.77 5.30 30 38.96 10.05
Low Patient-Low Partner 23 120.49 17.56 25 38.11 5.11 24 39.18 10.32
High Patient-Low Partner 20 119.29 17,60 21 39.10 6,32 21 39.29 9.61
Low Patient-High Partner 21 118.26 12.68 21 40.07 5.66 20 39.81 10.56
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for Cognition match/mismatch, Primary Communication, and Dyadic Adjustment in
patients could not be tested.
Table 6 also presents the means of the dyadic adjustment and communication
variables for the four Need for Cognition dyad groups, as reported by the partner.
One-way ANOVAs were conducted to compare aspects of the dyadic adjustment and
communication in Need for Cognition match/mismatch dyads, from the partners’
perspective. Need for Cognition match/mismatch dyads did not significantly differ
on Primary Communication, Support Needs, or Dyadic Adjustment. Thus,
exploratory analyses were conducted examining the partner’s individual
psychosocial adjustment in Need for Cognition match/mismatch dyads. One-way
ANOVAs indicated a significant group difference on Positive Affect only, F(3,92) =
3.70, p = .02 ( f = .35) (Cohen, 1988). Tukey post-hoc comparisons indicated that
Positive Affect was significantly greater for partners in a high Need for Cognition
match dyad (High Patient-High Partner) (M = 36.21; SD = 5.69), compared to
partners in a low Need for Cognition match dyad (Low Patient-Low Partner) (M =
31.92; SD = 5.59) [p = .04], In addition, post hoc comparisons indicated that
Positive Affect was significantly greater for partners in a Need for Cognition
mismatch dyad (Low Patient-High Partner) (M = 36.67; SD = 5.85), compared to
partners in a low Need for Cognition match dyad (Low Patient-Low Partner) (M =
31.92; SD = 5.59) [p = .03], Exploratory analyses were also conducted examining
the patient’s individual psychosocial adjustment in Need for Cognition
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29
match/mismatch dyads. However, there were no significant differences between
groups on any of the patient psychosocial variables.
Discussion
The primary purpose of the study was to examine the psychosocial benefits
of being high in need for cognition during a particularly stressful phase of the cancer
experience, the diagnostic/pre-surgical period. We found limited support for our
hypotheses regarding need for cognition and psychological and emotional
adjustment. Although need for cognition appears to be beneficial to partners of
patients, the hypothesized mechanism through which need for cognition and stress
are associated were not supported. We also found limited support for our hypotheses
regarding need for cognition congruency within the dyad and aspects of the dyadic
relationship. Although a high match in need for cognition appears to be beneficial to
the patient’s perception of dyadic communication, its hypothesized mediational role
was not supported. Due to null results regarding several of the study’s hypotheses,
the majority of the reported findings are a result of exploratory analyses.
Patients and partners in this sample reported similar levels of general and
disease-specific stress, and positive affect. However, the partners reported greater
levels of negative affect than patients. Although the majority of studies indicate that
cancer patients and partners experience equal amounts of psychological distress,
some studies have suggested that partners experience more distress than patients
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30
(Cliff & MacDonagh, 2000; Keitel, Zevon, Rounds, Petrelli, & Karakousis, 1990;
Komblith, Herr, Ofman, Scher, & Holland, 1994).
Our results indicate that high need for cognition is associated with better
psychological and emotional adjustment in partners only. Thus, partners who
typically engage in and enjoy the process of cognitive tasks adjusted better during
this challenging and stressful period. However, our results indicate that need for
cognition is not associated with communication with the medical team. Research
suggests that although the need for information is high in partners of patients, they
often report great difficulties in obtaining information from the medical team
(Hilton, 1993; Meissner, Anderson, & Odenkirchen, 1990; Northouse & Northouse,
1987; Oberst & James, 1985; Rees, Bath, Lloyd-Williams, 1998; Zahlis & Shands,
1991). Furthermore, they typically report being unsatisfied due to their lack of
contact with the medical team. Perhaps high need for cognition does not aid in
communicating with the medical team because partners have limited access to the
medical team to begin with. One’s tendency to seek out and acquire relevant
information may have little, if not any influence over the medical team’s standard
procedures.
If partners cannot turn to who is typically considered the primary source of
valuable information during this critical period, they may seek out information from
other sources. Previous research suggests that the partners’ primary source of
information becomes the patient (Northouse & Northouse, 1987; Rees et al., 1998).
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31
The partner must now rely on secondhand information from the medical team via the
patient, provided that he is willing to share. As mentioned earlier, studies have
shown that patients and partners experience great difficulty in communicating openly
with one another regarding the disease (Boehmer & Clark, 2001; Chekryn, 1984;
Cooper, 1984; Lichtman et al., 1987; Meyerowitz et al., 1983; Harden et al., 2002).
Hence, relying on the patient for accurate valuable information may be yet another
source of distress. Provided that the medical team is not a highly available resource
to partners, and open disease-related communication with patients is difficult, the
partner must now become an active seeker of information. Thus, in order to obtain
information in these circumstances, the partner’s level of need for cognition becomes
especially important. Rather than receive information directly from the medical
team or indirectly through the patient, the partner must now exert more effort, such
as seeking out reading materials and/or others who have had similar experiences.
Individuals high in need for cognition may not only prefer this type of information
gathering, but may also be better able to actively obtain pertinent information due to
previous experience and/or skills.
The results of our exploratory analyses indicate that high need for cognition
partners experience less general stress during this difficult period in part due to low
disease-specific stress. If high need for cognition individuals tend to seek out and
acquire information, they may be less likely to avoid thoughts about the cancer, and
less likely to perceive the thoughts about cancer as intrusive. In addition, if high
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32
need for cognition individuals tend to think about and reflect back on information in
order to make sense of their world, they may be more likely to process and integrate
these challenging new experiences. Previous research suggests a similar link
between cognitive processing and integration, and post-traumatic stress in various
trauma victims (Janoff-Bulman, 1989). It is suggested that cognitive integration of
previous beliefs and new stressful experiences is imperative in the coping of a
threatening event. Thus, the tendencies that characterize high need for cognition
individuals may aid partners in managing disease-specific stress. The ability to cope
with disease-specific stress may in turn influence the ability to manage one’s general
stress response. Hence, high need for cognition partners who experience low
disease-specific stress may then also experience low stress in other more general
areas of life.
Although need for cognition is associated with adjustment outcomes in
partners, it is not for patients. However, in patients, good communication with the
medical team is associated with better psychological and emotional adjustment.
Patients reporting high quality disease-specific communication with the medical
team, rather than high need for cognition, adjust better during this difficult period.
Perhaps need for cognition does not apply to situations in which information is
directly provided. Unlike partners, patients are the primary recipients of medical
care, and are not given the option to bypass pertinent disease-related information, nor
can they avoid diagnostic and surgical information from the medical team.
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33
Furthermore, patients in this study were receiving treatment from the NCCC, whose
standard care procedures involve discussing treatment options and medical
outcomes, in addition to providing a comprehensive information packet during the
consultation appointment approximately 2 weeks prior to the surgery. Thus, the
patient may not necessarily have to be an active seeker of information in order to
obtain pertinent information regarding the disease. So rather than benefiting from
need for cognition, patients’ adjustment may depend on the direct primary source of
information, the medical team. If so, the patient’s perception o f the quality of his
communication with the medical team would be crucial to his adjustment.
The results of our exploratory analyses indicate that patients with high quality
communication with the medical team experience less general stress during this
difficult period in part due to low disease-specific stress. Perhaps good
communication with the medical team fosters trust in the medical team, providing a
sense of security. Patients with good communication with the medical team may
also feel well-equipped with information, and thus feel less vulnerability during this
time. This sense of security instilled by the exchange with the medical team may
lead one to not view the situation as completely dangerous or threatening, thus
experiencing less disease-specific stress. The positive beliefs and feelings that good
communication with the medical team can foster may aid patients in managing
disease-specific stress. The ability to cope with disease-specific stress may in turn
influence the ability to manage one’s general stress response. Hence, patients who
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34
have good communication with the medical team may experience low disease-
specific stress, and then may also experience low stress in other more general areas
of life.
The last aim of the study was to examine the need for cognition match vs.
mismatch in couples, and its association to the dyadic relationship, as reported by
patients and partners. Our results indicate that in couples who were both high in
need for cognition, the patient reported better dyadic communication regarding the
disease than in couples in which the patient was high in need for cognition, but his
partner was low in need for cognition. When both members of a dyad approach this
stressful time with an active cognitive style, the patient may feel that he can relate to
and discuss disease-specific issues with his partner to a greater degree. If a patient
who wishes to reflect upon the disease and its consequences is met by a partner who
has no desire to reflect upon their situation, the patient is likely to perceive his
communication with his partner as poor. As mentioned above, high need for
cognition is associated with better mood and less stress in partners, but not in
patients. Although patient’s high need for cognition does not provide any direct
benefits to patients, perhaps need for cognition provides an indirect benefit to
patients via the partners. Thus, need for cognition may provide dyadic
communication benefits only to high need for cognition patients who are coupled
with a high need for cognition partner.
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In partners, need for cognition match vs. mismatch in couples is not
associated with his/her perceptions of the dyadic relationship. Partners in different
need for cognition match/mismatch dyads reported similar levels of dyadic
communication and support regarding the disease, and similar levels of dyadic
adjustment. However, the results of our exploratory analyses indicate that the type
of need for cognition match is associated with the partner’s own mood. Partners who
were in relationships in which both members were high in need for cognition
reported greater positive affect than partners who were in relationships in which both
members were low in need for cognition. In addition, partners who were in
relationships in which they were high in need for cognition, but the patient was low
in need for cognition, reported greater positive affect than partners who were in
relationships in which both members were low in need for cognition. Thus, it seems
as though for partners, the patient’s need for cognition is irrelevant to his/her own
emotional adjustment. Regardless of the patient’s need for cognition, the partner
experiences greater positive affect if s/he is high in need for cognition. This may be
attributed to the great benefits that high need for cognition partners experience, as
previously described.
Limitations
There are a few limitations to the study that should be considered when
interpreting the generalizability of the results. First, half the eligible patients and
partners refused to participate in the study. Although patient participants and patient
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36
non-participants did not significantly differ on the majority of relevant demographic
and medical characteristics, they may have significantly differed on the variables of
interest. Also, due to the nature of the recruitment process, relevant demographic
characteristics of the partners were not obtained. Thus, comparisons between partner
participants and partner non-participants could not be conducted. In addition, our
sample consisted primarily of non-Hispanic White, well-educated patients and
partners. Hence, we cannot conclude that our results are generalizable to other
patients and partners of different ethnic and educational backgrounds.
We also did not correct for Type I error, which may be a potential limitation
with regards to the statistical accuracy of our analyses. Given the number of
exploratory analyses conducted, our results may have been influenced by chance.
However, effect size indices were reported for r statistics and significant F statistics,
which indicate “medium” effects. In addition, post-hoc power analyses indicate that
our power to detect a “medium” effect for r and f were .94 and .50, respectively.
Thus, when comparing the four NFC dyad groups (ANOVAs), our sample size in
each group may not have been sufficient to reject a false null hypothesis.
In regards to the variables assessed, our study relied entirely on self-reported
data. In addition, we did not include a direct measure of the amount of information
obtained from sources other than the medical team. Thus, our interpretation
regarding the tendency for high need for cognition individuals to actively seek out
and obtain information from other sources could not be verified. Also, partners did
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37
not have to be present at the consultation appointment In order to be eligible to
participate in the study. Data regarding whether or not partners attended this highly
Information laden consultation appointment with the patient is thus unknown.
Furthermore, due to the high quality of standard care regarding information provided
at NCCC as discussed above, the study’s key variable of interest, need for cognition,
may have been irrelevant for patients. However, patients treated in other medical
centers that do not have strict policies regarding the quality of standard care may not
find null results regarding the psychological and emotional benefits o f need for
cognition in patients.
Implications/Future Directions
Cancer can have a significant impact on psychological, emotional, and
interpersonal adjustment in patients and partners, both as individuals and as a couple.
When facing a challenging and distressing event, research has shown that some
individuals adjust and cope better than others. The results of our study suggest that
although individual differences in need for cognition may aid in psychological and
emotional adjustment in partners, communication with the medical team is
imperative to adjustment in patients. Thus, this study emphasizes the importance in
determining the factors that influence and aid adjustment to adverse conditions, such
as cancer, in individuals who are differentially affected by the disease. There is a
need for differential assessment for patients and partners in order to identify the
individuals who are at greatest risk of adjustment difficulties. Furthermore,
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38
psychosocial services need to address these differential factors, so that interventions
are more tailored to the individual and their role throughout the cancer experience.
Lastly, future research on need for cognition in medically ill patients and
partners should include a more comprehensive examination of information. Multiple
aspects of information, such as the desire and need for information, information
seeking behaviors, the ability to obtain information, and one’s self-efficacy specific
to obtaining information all need to be addressed in order to understand the
mechanisms and benefits of high need for cognition during a particularly stressful
time. In addition, other mediators of need for cognition and stress should be
addressed, such as mastery and control. Moderators of this relationship also need to
be further examined, such as the gender of the patient and partner. Perhaps this
study could be replicated in a female cancer population with predominantly male
partners, such as breast cancer.
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39
Footnotes
*Non-parametric tests are conducted when making comparisons between
groups involving variables that are not normally distributed. In addition to t-tests,
Pearson correlations, and one-way ANOVAs, non-parametric tests, such as Mann-
Whitney U tests, Spearman correlations, and Kruskal Wallis H tests are also
conducted. However, our analyses indicate that the parametric and non-parametric
tests provide similar results. Thus, results from parametric tests are reported.
2
In order to examine need for cognition as a continuous variable, regression
analyses were conducted to explore the possible moderating effects of patient
(partner) need for cognition on partner (patient) need for cognition, and dyadic
adjustment and communication, as reported by the partner (patient). In order to test
for moderation, the predictor and moderator variables were entered into the
regression equation first, followed by the interaction of the predictor and moderator
variables (Holmbeck, 1997). Our analyses indicate that neither patient nor partner
need for cognition moderated the relationships examined.
3
Since age and education may serve as potential confounding variables,
additional analyses were conducted controlling for these demographic variables.
However, similar results were obtained even after controlling for age and education.
Thus, neither age nor education confounded our results.
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41
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45
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46
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Appendix A
Patient version of questionnaires
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48
m #:_
Date:
1. How old are you? yrs.
2. What is your highest level of education?
O 1-8 grades
□ 9-11 grades
O High school graduate
□ Some college
□ Junior college (2 year degree)
□ College degree (B.A./B.S.)
O Advanced degree (M.A., Ph.D., M.D., etc.)
3. What is your ethnic background?
□ White, Non-hispanic
□ African-American
□ Asian/Asian-American
□ Latino
□ Other (specify)__________
4. What is your current marital status or relationship status?
O Mamed
O Partnered
5. How long have you been in your current marriage/relationship?
6. On what date were you diagnosed with prostate cancer?_____
7. Please list any other major health problems:
8. Do any of these other major health problems interfere with your daily activities?
□ Always
O Often
O Occasionally
□ Rarely
□ Not at all
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49
The questions in this scale ask you about your feelings and thoughts DURING THE
PAST 3 WEEKS. In each case, you will be asked to indicate how often you felt or
thought a certain way. Although some of the questions are similar, there are differences
between them and you should treat each one as a separate question. The best approach is
to answer each question fairly quickly. That is, don't try to count up the number of times
you felt a particular way, but rather indicate the alternative that seems like a reasonable
estimate.
For each question choose from the following alternatives:
0 = Never
1 = Almost Never
2 - Sometimes
3 = Fairly Often
4 = Very Often
1. How often have you been upset because of something that
happened unexpectedly?
2. How often have you felt that you were unable to control the
important things in your life?
3. How often have you felt nervous and "stressed"?
4. How often have you dealt successfully with irritating life
hassles?
5. How often have you felt that you were effectively coping with
important changes that were occurring in your life?
6. How often have you felt confident about your ability to handle
your personal problems?
7. How often have you felt that things were going your way?
8. How often have you found that you could not cope with all
the things that you had to do?
9. How often have you been able to control irritations in your
life?
10. How often have you felt that you were on top of things?
11. How often have you been angered because of things that
happened that were outside of your control?
12. How often have you found yourself thinking about things that
you have to accomplish?
13. How often have you been able to control the way you spend
your time?
14. How often have you felt difficulties were piling up so high that
you could not overcome them?
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Recently you were faced with a cancer diagnosis. Below is a list o f comments made by
people after stressful life events, such as cancer. Please check each item indicating how
frequently these comments were true for you DURING THE PAST .3 WEEKS. Using
the scale described here, fill in the blank space next to each item with the number which
best represents your experience. If the comment did not apply to your situation in the past
3 weeks, please mark ”1" , "Not at all”.
1= Not At All
2= Rarely
3= Sometimes
4= Often
1. I thought about it when I didn't mean to.
2. I avoided letting myself get upset when I thought about it or was reminded of it.
3. I tried to remove it from memory.
4. I had trouble falling asleep or staying asleep.
5. I had waves of strong feelings about it.
6. I had dreams about it.
7. I stayed away from reminders of h.
8. I felt as if it hadn't happened or it wasn't real.
9. I tried not to talk about it.
10. Pictures about it popped into my mind.
11. Other things kept making me think about it.
12. I was aware that I still had a lot of feelings about it, but I didn't deal with them.
13. I tried not to think about it.
14. Any reminder brought back feelings about it.
15. My feelings about it were kind of numb.
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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 DURING THE PAST 3 WEEKS. Use
the following scale to record your answers.
1 2 3 4 5
Very Slightly A Little Moderately Quite A Bit Extremely
or Not At All
interested_________________ _____ irritable
distressed _____ alert
excited__________________ _____ ashamed
upset _____ inspired
strong__________________ _____ nervous
guilty . _____ determined
scared attentive
hostile _____ jittery
enthusiastic _____ active
proud _____ afraid
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Most persons have disagreements in their relationships. Please indicate below the approximate
extent of aggreement or disagreement between you and your partner for each item below.
PLEASE ANSW ER TAKING INTO ACCOUNT THE PAST 3 WEEKS.
Always
Agree
1. Handling family finances ____
2. Matters of recreation ____
3. Religious matters ____
4. Demonstration of affection _____
5. Friends________________ _____
6. Sex relations___________ ____
7. Conventionality (correct _____
or proper behavior)
8. Philosophy of life ____
9. Ways of dealing with _____
parents or in-laws
10. Aims, goals, and things _____
believed important
11. Amount of time spent _____
together
12. Making major decisions _____
13. Household tasks _____
14. Leisure time interests _____
and activities
15. Career decisions
Almost Occa- Fre- Almost
Always sionally quently Always
Agree Disagree Disagree Disagree
Always
Disagree
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53
More
All the Most of Often Occa-
Time the Time than not sionally Rarely Never
16. How often do you discuss
or have considered divorce,
separation, or terminating your
relationship? _____ _____ _____
17. How often do you or your
mate leave the house after
a fight?______________________ _____ _____ _____ _____ _____ _____
18. In general, how often do
you think that things between
you and your partner are
going well? _____ _____ _____ _____ _____ _____
19. Do you confide in your
20. Do you ever regret that
you married? (or lived
together)
21. How often do you and your
partner quarrel?
22. How often do you and your
mate "get on each other's
nerves?"
Almost
Every Every
Day Day
Occa
sionally Rarely Never
23. Do you kiss your mate?
24. Do you and your mate
engage in outside interests
together?
All of Most of Some of
Them Them Them
Very few None of
of Them Them
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How often would you say the following events occur between you and your mate?
Less than Once or Once or
Once a Twice a Twice a Once a More
Never Month M onth Week Day ■ Often
25. Have a stimulating
exchange of ideas._______________ _____ _____ ____ _____ _____
26. Laugh together.________ _____ _____ _____ _____ _____ _____
27. Calmly discuss some
thing._____________________ _____ _____ _____ _____ _____ _____
28. Work together on a
project.__________________ _____ _____ _____ _____ _____ _____
The following are some items on which couples sometimes agree and sometimes disagree.
Indicate if either item below caused differences of opinions or were problems in your relationship
during the past 3 weeks. (Check yes or no)
YES NO
29. □ o Being too tired for sex.
30. □ □ Not showing love.
31. The dots on the following line represent different degrees of happiness in your relationship.
The middle point "Happy," represents the degree o f happiness of most relationships. Please circle
the dot which best describes the degree of happiness, all things considered, of your relationship.
• • • • • • •
Extremely Fairly A little Happy Very Extremely Perfect
Unhappy Unhappy Unhappy Happy Happy
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32. Which of the following statements best describes how you feel about the future of your
relationship?
I want desperately for my relationship to succeed, and would .go to almost and.length to
see that it does.
I want very much for my relationship to succeed, and will do all Lean to see that it does.
I want very much for my relationship to succeed, and will do my fair share to see that it
does.
It would be very nice if my relationship succeeded, but I can't da much more than I am
doing now to help it succeed.
It would be nice if it succeeded, but I refuse to do any more than i am doing now to keep
the relationship going.
My relationship can never succeed, and there is no more that I can do to keep the
relationship going.
Continue on Next Page
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fOM Ml im ita tio n WITIIM EB M ^L-IEA M ^C A LE.
, „ j le-fnmo about your interaction w i t i the medical team.
In this questionnaire, we are interested in learning aoous. juu
For each question, please circle the number that best represents your current experience,
TAKING INTO ACCOUNT THE PAST 3 WEEKS. Remember that you m ay circle any one
of the numbers (from 1-7) on each scale, to represent the strength of your °r °PlG I ® n* 1
question does not apply to you, please skip it and go to the next question, ea^e
honest when answering the questions and answer all the questions at app y o you. y u.
1. Overall, How satisfied are you with the information you received from the m edical team during.
a. the consultation appointment
1 2 3
Totally
Satisfied
7
Totally
Unsatisfied
2. Do you feel prepared to ask the questions you want to ask of the medical r -S3.m ?
1 ■ * A ^ f t
1 2
1 Feel Completely
Prepared
3. How much information have you received from the medical team?
1 2 3 4 . 5
I received too much I received the right
information amount of information
4. How much have you communicated with the medical team about,
a. cancer
1 2 3 4 5
Very Little
I Feel Completely
Unprepared
I did not receive
enough information
Very Much
b. sexuality
1
Very Little Very Much
c. urinary incontinence
1 2
Very Little Very Much
d. radical prostatectomy
I 2 3 4 5
Very Little
5. When communicating with the medical team about cancer
opposed to just receiving information that the team shared)?
1 2 3 4 5
1 always asked
questions
Very Much
how often did you ask questions {as
6 7
I never asked
questions
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6. How confident are you that in the future you will be able to obtain desired information from th^
medical team?
1 2 3 4 5 6 7
Not at all Completely
Confident Confident
7. Were there issues that you wouid have wanted to discuss with the medical team but did not?
1 2 3 4 5 6 7
I discussed all the I did not discuss
issues i ranted any issue I wanted
8. Overall, how satisfied are you with the amount of information you have received from the
medical team?
1 2 3 4 5 6 7
Totally Totally
Satisfied
9. Overall, how satisfied are you with the rnotent of the information you received from the
medical team?
1 2 3 4 5 6 7
Totally . Totally
Satisfied Unsatisfied
10. How much desired information did you receive from the medical team?
1 2 3 4 5 6 7
Very Little Very Much
11. How much undpsireri information (information that you would have preferred aot to receive)
did you receive from the medical team?
1 2 3 4 5 6 7
Very 1 Ittig Very Much
12. Overall, how satisfied are you with the information you have received from the medical team?
I 2 3 4 5 6 7
Totally Totally
Satisfied Unsatisfied
13. How much control do you feel you have over fire Mldllill of information you receive from th®
medical team?
1 2 3 4 5 6 7
Very Little Very Much
14. How much control do you feel you have over the type of information you receive from the
medical team?
1 2 3 4 5 6 7
Very Little Very Much
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15. Overall. How much control do you feel you have over the information process (gathering and
receiving information from relevant sources)?
I 2 3 4 5 6 7
Very Little Very Much
Continue on Next Page
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PRIMARY COMMUNICATION INVENTORY
Below is a list of items on communication between you and your spouse/partner. Using
the scale described here, fill in the blank space next to each item with the number which
best represents the extent to which you and your spouse/partner behave in the specified
way, TAKING INTO ACCOUNT THE PAST 3 WEEKS.
1= Never
2= Seldom
3= Occasionally
4= Frequently
5= Very Frequently
1 . How often do you and your spouse/partner talk over positive or pleasant things
regarding prostate cancer and its treatment?
2. How often do you and your spouse/partner talk over negative or unpleasant
things regarding prostate cancer and its treatment?
3. Do you and your spouse/partner talk over things regarding cancer you disagree
about or have difficulties over?
4. Do you and your spouse/partner talk over things regarding cancer in which you
are both interested?
5. Does your spouse/partner adjust what he/she says about cancer and how he/she
says it to the way you seem to feel at the moment?
6. Do you and your spouse/partner avoid certain subjects related to the cancer in
conversation?
? ■ Do you and your spouse/partner discuss things together regarding the cancer and
its treatment before making an important decision?
8. Does your spouse/partner discuss matters of sex with you?
9. Can you and your spouse/partner discuss and share your feelings without feelings
of restraint or embarrassment?
10. How often do you and your spouse/partner talk with each other about personal
problems related to the cancer experience?
11 ■ Would you rather talk about intimate matters related to the cancer with your
spouse/partner than with some other person?
12. During your relationship, have you and your spouse/partner, in general, talked
most things over together?
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For the following questions, please circle the number that best represents your experience
DURING THE PAST 3 WEEKS. Remember that you may circle any one of the
numbers (1-7) on each scale, to best represent the strength of your feeling or opinion.
1 • Do you share your needs (what you need from your spouse/partner) regarding the
cancer experience with your spouse/partner?
1 2 3 4 5 6 7
Share All My Share None of
Needs Needs
2. Does your spouse/partner share his/her needs (what they need from you) regarding the
cancer experience with you?
1 - 2 3 4 5 6 7
Shares A ll Share None of
His/Her Needs His/Her Needs
3. Do you communicate to your spouse/partner when your needs have changed?
1 2 3 4 5 6 7
Never Always
4. Does your spouse/partner communicate to you when his/her needs have changed?
1 2 3 4 5 6 7
Never Always
5. Do you communicate to your spouse/partner when he/she is not meeting your needs?
I 2 3 4 5 6 7
Never Always
6. Does your spouse/partner communicate to you when his/her needs are not being met?
1 2 3 4 5 6 7
Never Always
7. Overall, do you feel you are meeting your spouse's/partner's needs?
1 2 3 4 5 6 7
Completely Not at All
8. Overall, do you feel your needs are being met by your spouse/partner?
1 2 3 4 5 6 7
Completely Not at All
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Instructions: For each of the statements below, please indicate to what extent the statement is
characteristic of you. If the statement is extremely uncharacteristic of you (not at all like you)
please write a " 1" to the left of the question; if the statement is extremely characteristic of you
(very much like you) please write a "5" next to the question . Of course, a statement may be
neither extremely uncharacteristic nor extremely characteristic of you; if so, please use the number
in the middle of the scale that describes the best fit. Please keep the following scale in mind as
you rate each of the statements below:
1 = Extremely Uncharacteristic
2 = Somewhat Uncharacteristic
3 = Uncertain
4 = Somewhat characteristic
5 = Extremely Characteristic
1 • I would prefer complex to simple problems.
2. I like to have the responsibility of handling a situation that requires a lot of thinking.
3. Thinking is not my idea of fun. 1
4. I would rather do something that requires little thought than something that is sure to
challenge my thinking abilities.
5. I try to anticipate and avoid situations where there is a likely chance I will have to think
in depth about something.
6. I find satisfaction in deliberating hard and for long hours.
7. I only think as hard as 1 have to.
8. I prefer to think about small, daily projects to long-term ones.
9- I like tasks that require little thought once I've learned them.
10. The idea of relying on thought to make my way to the top appeals to me.
11 ■ I really enjoy a task that involves coming up with new solutions to problems.
12. Learning new ways to think doesn't excite me very much.
13. I prefer my life to be filled with puzzles that I must solve.
14. The notion of thinking abstractly is appealing to me.
15. I would prefer a task that is intellectual, difficult, and important to one that is somewhat
important but does not require much thought.
16.1 feel relief rather than satisfaction after completing a task that required a lot of mental
effort.
17. It's enough for me that something gets the job done; I don't care how or why it works.
18. I usually end up deliberating about issues even when they do not affect me personally.
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Appendix B
Partner version of questionnaires
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63
ED#:_
Date:
1. How old are you? yrs.
2. What is your highest level of education?
O 1-8 grades
O 9-11 grades
O High school graduate
O Some college
□ Junior college (2 year degree)
□ College degree (B.A./B.S.)
O Advanced degree (M.A., Ph.D., M.D., etc.)
3. What is your ethnic background?
D White, Non-hispanic
O African-American
□ Asian/Asian-American
O Latino
O Other (specify)__________
4. What is your current marital status or relationship status?
□ Married
O Partnered
5. How long have you been in your current marriage/relationship?______
6. On what date was your spouse/partner diagnosed with prostate cancer?
7. Please list any major health problems:
8. Do any of these major health problems interfere with your daily activities?
O Always
O Often
□ Occasionally
□ Rarely
□ Net at all
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PFRGFTVED STRESS SCAJLfc
The questions in this scale ask you about your feelings and thoughts DURING THE
PAST 3 WEEKS. In each case, you will be asked to indicate how often you felt or
thought a certain way. Although some of the questions are similar, there are differences
between them and you should treat each one as a separate question. The best approach is
to answer each question fairly quickly. That is, don't try to count up the number of times
you felt a particular way, but rather indicate the alternative that seems like a reasonable
estimate.
For each question choose from the following alternatives:
0 = Never
1 = Almost Never
2 = Sometimes
3 = Fairly Often
4 = Very Often
1. How often have you been upset because of something that
happened unexpectedly?
2. How often have you felt that you were unable to control the
important things in your life?
3. How often have you felt nervous and "stressed"?
4. How often have you dealt successfully with irritating life
hassles? ---- ...
5. How often have you felt that you were effectively coping with
important changes that were occurring in your life?
6. How often have you felt confident about your ability to handle
your personal problems?
7. How often have you felt that things were going your way?
8. How often have you found that you could not cope with all
the things that you had to do?
9. How often have you been able to control irritations in your
life?
10. How often have you felt that you were on top of things?
11- How often have you been angered because of things that
happened that were outside o f your control?
12. How often have you found yourself thinking about things that
you have to accomplish?
13. How often have you been able to control the way you spend
your time?
14. How often have you felt difficulties were piling up so high that
you could not overcome them?
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IMPACT OF EVEM LSCALE.
Recently your spouse/partner was faced with a cancer diagnosis. Below is a list of
comments made by people after stressful life events, such as cancer. Please check each
item indicating how frequently these comments were true for you DURING THE PAST
3 WEEKS. Using the scale described here, fill in the blank space next to each item with
the number which best represents your experience. If the comment did not apply to your
situation in the past 3 weeks, please mark “1", "Not at all".
1= Not At All
2= Rarely
3= Sometimes
4= Often
1. I thought about it when I didn't mean to.
2. I avoided letting myself get upset when I thought about it or was reminded of it.
3. I tried to remove it from memory.
_ _ _ 4. I had trouble falling asleep or staying asleep.
5. I had waves of strong feelings about it.
6. I had dreams about it.
7. I stayed away from reminders of it.
8. I felt as if it hadn't happened or it wasn't real.
9- I tried not to talk about it.
10. Pictures about it popped into my mind.
11 • Other things kept making me think about it.
12. I was aware that I still had a lot of feelings about it, but I didn't deal with them.
13. I tried not to think about it.
14. Any reminder brought back feelings about it.
15. My feelings about it were kind of numb.
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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 DURING THE PAST 3 WEEKS. Use
the following scale to record your answers.
1
Very Slightly
or Not At All
2
A Little
interested
distressed
excited
upset
strong
guilty
scared
hostile
enthusiastic
proud
Moderately Quite A Bit
irritable
alert
ashamed
inspired
nervous
determined
attentive
jittery
active
afraid
Extremely
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M ost persons have disagreements in their relationships. Please indicate below the approximate
extent of aggreement or disagreement between you and your partner for each item below,
PLEASE ANSW ER TAKING INTO ACCOUNT THE PAST 3 WEEKS.
.Almost Occa- Fre- Almost
.Always Always sionaily quently Always
Agree Agree Disagree Disagree Disagree
1. Handling family finances ____ _____ _ _____ . ______
2. Matters of recreation ____ ______________________ ______
3. Religious matters _____ ______________________ ______
4. Demonstration of affection ____ ______________________ _ ______
5. Friends ____ ______________________ ______
6. Sex relations ._______ ______
7. Conventionality (correct
or proper behavior)
8. Philosophy of life
9. Ways of dealing with
parents or in-laws
10. Aims, goals, and things
believed important
11. Amount of time spent
together
' 12. Making major decisions
13. Household tasks
14. Leisure time interests
and activities
15. Career decisions
Always
Disagree
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More
.A il the Most of Often Gcca-
Time the Time than not sionaily Rarely Never
16. How often do you discuss
or have considered divorce,
separation, or terminating your
relationship?
17. How often do you or your
mate leave the house after
a fight?
18. In general, how often do
you think that things between
you and your partner are
going well?
19. Do you confide in your
20. Do you ever regret that
you married? (or lived
together)
21. How often do you and your
partner quarrel?
22. How often do you and your
mate "get on each other's
nerves?"
23. Do you kiss your mate?
24. Do you and your mate
engage in outside interests
together?
Almost
Every Every Occa-
Day Day sionaily
All of Most of Some of
Them Them Them
Rarely Never
Very few N one of
of Them The®
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How often would you say the following events occur between you and your mate?
Less than Once or Once or
Once a Twice a Twice a Once a More
Never Month Month Week Day Often
25. Have a stimulating
exchange of ideas. _____ _____ _____ _____ _____ _____
26. Laugh together.
27. Calmly discuss some
thing.
28. Work together on a
project.
The following are some items on which couples sometimes agree and sometimes disagree.
Indicate if either item below caused differences of opinions or were problems in your relationship
during the past 3 weeks. (Check yes or no)
□ Not showing love.
The middle point "Happy," represents the degree of happiness of most relationships. Please circle
the dot which best describes the degree of happiness, all things considered, o f your relationship.
Extremely Fairly A little Happy Very Extremely Perfect
Unhappy Unhappy Unhappy Happy Happy
YES NO
29. □ □
30. O □
31. The dots on tl
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32. Which of the following statements best describes how you feel about the future of your
relationship?
___ I want desperately for my relationship to succeed, and am ld-go to . alfflQ S Laad length to
see that it does.
____ I want very much for my relationship to succeed, and wjH H o all I can to see that it does.
_ ____ I want very much for my relationship to succeed, and will do my fair_sfaai£ to see that it
does.
____ It would be very nice if my relationship succeeded, but f can't do much mats, than I am
doing now to help it succeed.
____ It would be nice if it succeeded, but I refuse to do any more .thauJLaniilfililg now to keep
the relationship going.
____ My relationship can never succeed, and there is no more that I can .do to keep the ■
relationship going.
j —
Continue on Next Page
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COMMUNICATION WITH MEDICAL TEAM S£AIE.
in this questionnaire, we are interested in learning about your interaction with, the medical team.
For each question, please circle the number that best represents your gaugnt ei p en en ce,
TAKING INTO ACCOUNT THE PAST 3 WEEKS. Remember that you may circle any one
of the numbers (from 1-7) on each scale, to represent the strength o f your feeling or opinion. If the
question does not apply to you, please skip it and go to the next question. Please be completely
honest when answering the questions and answer all the questions that apply to you. Thank you.
1 . Overall, How satisfied are you with the information you received from the medical team during:
a. the consultation appointment
1 2 3
Totally
Satisfied
7
Totally
Unsatisfied
2. Do you feel prepared to ask the questions you want to ask of the medical team?
1 2
I Feel Completely
Prepared
I Feel Completely
Unprepared
3:S How much information have you received from the medical team?
1 2 3 4 5
I received too much I received the right
information amount of information
I did not receive
enough information
4. How much have you communicated with the medical team about:
a. cancer
1
Very Little Very Much
b. sexuality
1
Very Little Very Much
c. urinary incontinence
1 2
Very Little Very Much
d. radical prostatectomy
I 2
Very Little Very Much
’ 5., W hen communicating with the medical team about cancer how often did you ask questions (as
opposed to just receiving information that the team shared)?
1 2 3 4 5 6 7
I always asked I never asked
questions questions
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6. How confident are you that in the future you will be able to obtain desired information from the
medical team?
I 2 3 4 5 6 7
Not at all Completely
Confident Confident
-7 ./W ere there issues that vou would have wanted to discuss with the medical team but did not?
I 2 ' 3 4 5 6 7
I discussed all the I did not discuss
issues I wanted any issue I wanted
8. Overall, how satisfied are you with the a m o u n t o f information you have received from the
medical team?
1 2 3 4 5 6 7
Totally Totally
Satisfied Unsatisfied
9. Overall, how satisfied are you with the m n t e n t of the information you received from the
medical team?
1 2 3 4 5 6 7
Totally . Totally
Satisfied Unsatisfied
10. How much d e s ir e d information did you receive from the medical team?
1 - 2 3 4 5 6 7
Very Little Very Much
11. How much tindesirrd information (information that you would have preferred m i to receive)
did you receive from the medical team?
1 2 3 4 5 6 7
Very Little Very Much
12. Overall, how satisfied are you with the information you have received from the medical team?
1 2 3 4 * 5 6 7
Totally Totally
Satisfied Unsatisfied
13. How much control do you feel you have over the amount o f information you receive from the
medical team?
1 2 3 4 5 6 7
Very Little Very Much
14. How much control do you feel you have over the type o f information you receive from the
medical team?
1 2 3 4 5 6 7
Very Little Very Much
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'15. Overall, How much control do you fee! you have over the information process (gathering and
receiving information from relevant sources)?
1 2 3 4 5 6 7
Very Little Very Much
Continue on Next Page
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Beiow is a list of items on communication between you and your spouse/partner. Using
the scale described here, fill in the blank space next to each item with the number which
i best represents the extent to which you and your spouse/partner behave in the specified
way, TAKING INTO ACCOUNT THE PAST 3 WEEKS.
1= Never
2= Seldom
3= Occasionally
4= Frequently
5= Very Frequently
1. How often do you and your spouse/partner talk over positive or pleasant things
regarding prostate cancer and its treatment?
2. How often do you and your spouse/partner talk over negative or unpleasant
things regarding prostate cancer and its treatment?
3. Do you and your spouse/partner talk over things regarding cancer you disagree
about or have difficulties over?
4. Do you and your spouse/banner talk over things regarding cancer in which you
are both interested?
5. Does your spouse/partner adjust what he/she says about cancer and how he/she
says it to the way you seem to feel at the moment?
6. Do you and your spouse/partner avoid certain subjects related to the cancer in
conversation?
7. Do you and your spouse/partner discuss things together regarding the cancer and
its treatment before making an important decision?
8. Does your spouse/partner discuss matters of sex with you?
9. Can you and your spouse/partner discuss and share your feelings without feelings
of restraint or embarrassment?
10. How often do you and your spouse/partner talk with each other about personal
problems related to the cancer experience?
11. Would you rather talk about intimate matters related to the cancer with your
spouse/partner than with some other person?
32. During your relationship, have you and your spouse/partner, in general, talked
most things over together?
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For the following questions, please circle the number that best represents youf -xperienc
DURING THE PAST 3 WEEKS. Remember that you may circle any one ol the
numbers (1-7) on each scale, to best represent the strength o f your ee ng or opinion.
1 . Do you share your needs (what you need from your spouse/partner) regarding the
cancer experience with your spouse/partner? ^
* . . . ^ J ^ Share None o f
Share AU My Needs
Needs
2. Does your spouse/partner share his/her needs (what they need from you) regarding th
cancer experience with you? ,
1 7 3 4 5 6 /
' Share None of
snares Ait His/Her Needs
His/Her Needs
3. Do you communicate to your spouse/partner when your needs have changed.
Never 2 ' 4 5
4. Does your spouse/partner communicate to you when his/her needs have changed.
Never 2 ^ 4 5 Always
5. Do you communicate to your spouse/partner when he/she is not meeting your needs.
Never * ’
6. Does your spouse/partner communicate to you when his/her needs are not being met -
1 2 3 4 5
Never ******
7. Overall, do you feel you are meeting your spouses/partner's needs?
1 7 3 4 5 6 /
Completely NotatAB
8. Overall, do you feel vour needs are beina met by your spouse/partner.
1 2 ’ 3 4 5 6 1
Completely NotatM
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Instructions: For each of the statements below, please indicate to what extent the statement is
characteristic of you. If the statement is extremely uncharacteristic of you (not at all like you)
please wnte a " 1" to the left of the question; if the statement is extremely characteristic of you
(very much like you) please write a "5” next to the question . Of course, a statement may be
neither extremely uncharacteristic nor extremely characteristic of you; if so, please use the number
in the middle of the scale that describes the best fit. Please keep the following scale in mind as
you rate each of the statements below:
1 = Extremely Uncharacteristic
2 = Somewhat Uncharacteristic
3 = Uncertain
4 = Somewhat characteristic
5 = Extremely Characteristic
__1 ■ I would prefer complex to simple problems.
2. I like to have the responsibility of handling a situation that requires a lot of thinking.
3. Thinking is not my idea of fun. ■
4- I would rather do something that requires little thought than something that is sure to
challenge my thinking abilities.
5. I try to anticipate and avoid situations where theie is a likely chance I will have to think
in depth about something.
6- I find satisfaction in deliberating hard and for long hours.
2- I only think as hard as I have to.
8. I prefer to think about small, daily projects to long-term ones.
9. I like tasks that require little thought once I've learned them.
10. The idea of relying on thought to make my way to the top appeals to me.
11. I really enjoy a task that involves coming up with new solutions to problems.
12. Learning new ways to think doesn’ t excite me very much.
13.1 prefer my life to be filled with puzzles that I must solve.
14- 'fbe notion of thinking abstractly is appealing to me.
15.1 would prefer a task that is intellectual, difficult, and important to one that is somewhat
important but does not require much thought.
16.1 feel relief rather than satisfaction after completing a task that required a lot o f mental
effort.
12- It's enough for me that something gets the job done; I don't care how or why it works.
18. 1 usually end up deliberating about issues even when they do not affect me personally.
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Asset Metadata

Creator Oh, Sindy (author)

Core Title Need for cognition and psychological adjustment in patients and partners of prostate cancer

Contributor Digitized by ProQuest (provenance)

Degree Master of Arts

Degree Program Psychology

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag health sciences, oncology,health sciences, public health,OAI-PMH Harvest,Psychology, clinical

Language English

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c16-312857

Unique identifier UC11337491

Identifier 1420391.pdf (filename),usctheses-c16-312857 (legacy record id)

Legacy Identifier 1420391.pdf

Dmrecord 312857

Document Type Thesis

Rights Oh, Sindy

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the au...

Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus, Los Angeles, California 90089, USA