RESUMO
BACKGROUND: For patients and intimate partners, the challenge of advanced cancer is often compounded by difficulties in effectively communicating about disease treatment. Relevant evidence-based data are limited, in part because of limitations in understanding the dynamics of dyad-based communication. OBJECTIVES: This pilot study targeted development/feasibility testing of a practical model for assessment of these dynamics in a small group of cancer patients and their intimate partners, with a focus on communication before/after cancer diagnoses, including end-of-life discussions. METHODS: A descriptive phenomenological design was based on the Bodenmann systemic-transactional model of dyadic coping and on semistructured interviews with 7 dyads. Qualitative data analysis used the Colaizzi 7-step method for narrated text interpretation and identification of emergent themes. RESULTS: Patients (median age, 59 years; median intimate partner age, 52 years) had been given a diagnosis of cancer 0 to 6 months before enrollment and were receiving active therapy during participation. Of 534 significant statements analyzed, 2 emergent themes were identified: (1) vulnerable communication during advanced cancer is influenced by preexisting dynamics and complicated by balancing hope/positivity and uncertainty/fear, and (2) communications about end-of-life issues are emotional and influenced by dyad member perceptions about death. A study with a broader racial/demographic representation is planned. CONCLUSION: It is feasible to study dyad communication in the advanced cancer setting, and preliminary data suggest the importance of these dynamics in expression of clinical preferences. IMPLICATIONS FOR PRACTICE: Structured interviews with dyads during advanced cancer care can be used to identify specific challenges and inform improved support approaches.
