Adaptive communicative behavior of mothers and their adult daughters after a breast cancer diagnosis.

摘要

A diagnosis of breast cancer is life altering. Diagnosed women do not cope with this transition alone. A patient's family interactions are critical to her well-being and adjustment. In particular, diagnosed women's mother-daughter bond is a significant part of their experience. Although kin communication can function both adaptively and maladaptively in women's adjustment to cancer, health professionals do not provide families guidance in how to communicatively adjust in a healthy manner. The research report in this dissertation had two purposes: (1) to investigate the significance of family communication in adjusting to breast cancer by using Carstensen's (1991, 1992) socioemotional selectivity theory (SST) and (2) to explore how diagnosed women communicatively adjust to the disease in their mother-adult daughter bond through openness, avoidance, and emotional support.The quantitative results extend the utility of SST. Using SST as a framework, Hypothesis 1 and Research Question 1 focused on whether a limited time perspective, due to being closer to the end of life because of age or a breast cancer diagnosis, leads women to prefer kin communication partners. The results revealed that both time factors led women to prioritize communication in family bonds. The qualitative findings showed how women communicatively adapted to breast cancer in their mother-daughter bond. Research Questions 2-5 related to what cancer-related topics diagnosed women openly share or avoid in this bond as well as their motives. Across ages, women openly disclosed physical aspects of the disease (e.g., treatment side effects) but often avoided talking about emotional or distressful topics (e.g., mortality). Diagnosed women often displayed openness and avoidance to protect the mother/daughter from distress. Developmental diversity influenced women's open and avoidant communication. Research Questions 6-7 asked how mothers and daughters of diagnosed women enact emotional support. Across age groups, women had similar experiences particularly in regard to support that always functioned adaptively (e.g., using humor and listening). Age appeared to influence women's conceptualization of emotional support, their communication preferences, and their evaluations of support. The context in which support was enacted affected whether women perceived other behaviors as helpful or unhelpful in their adjustment to cancer. The diary findings primarily matched the interview results. Those findings also furthered our understanding of openness, avoidance, and emotional support within the context of mothers and daughters coping with breast cancer treatment.The major implications of this dissertation extend theoretical and practical knowledge of family communication, cancer, aging, and health. First, the findings extend SST. Later life women appear to prefer kin communication partners more so than younger generations. In addition, when women are diagnosed with breast cancer in stages 3 or 4, regardless of age, they prefer kin communication partners more than women diagnosed in earlier stages. These findings enhance existing literature in health communication by expanding our theoretical understanding of the role of family communication in a cancer context. Second, the qualitative findings demonstrate that human development affects women's open, avoidant, and support communicative needs when adjusting to breast cancer. These findings also highlight the need for scholars to appreciate context to capture whether kin communication functions adaptively or not when adjusting to this health transition.The study incorporated a multiple methods design and involved the collection of both cross-sectional and longitudinal data. A single phase quantitative design served the first purpose, and a multimethods qualitative design the second purpose. For the first purpose, women in three age groups (young, middle, and later adulthood) representing the following two conditions were recruited to participate in a survey: (1) 301 healthy women and (2) 39 women diagnosed with breast cancer. Chi-Square tests of associations were run to examine associations between a limited time perspective (due to age or diagnosis of breast cancer) with social partner preference. Women in Condition 2 (representing each age group) also participated in the qualitative phase. A total of 40 diagnosed women participated and recruited their mothers or adult daughters. A total of 78 women (35 dyads) participated in an individual in-depth interview. Subsamples (N = 10) participated in longitudinal diaries and diary-interviews (N = 8). Women shared how they communicatively adjusted to cancer in their mother-daughter bond through open communication, avoidance, and enacted emotional support. Grounded theory was used to examine all transcripts and diaries. The diary-interview method was employed to permit triangulation with findings from the interviews. Findings from the diary-interview method were analyzed as illustrative and descriptive case studies (a case study representing the experiences of each age group of dyads) and compared with the analyses of the interviews. The case studies deepened the credibility of the findings from the interviews and illustrated each communicative phenomenon on a deeper level.