Pathways to psychological wellbeing for patients with bladder cancer and their partners-in-care.

PURPOSE: The goal of the current analyses was to describe pathways through which Psychological Wellbeing might be better understood for clinical participants with bladder cancer and their partners. This was achieved by applying Roy's Adaptation Model that provides a framework with which to understand responses to challenging circumstances that has proved useful in the study of a range of chronic conditions. METHODS: The sample comprised 119 patients with a diagnosis of bladder cancer, and 103 supportive partners. Participants completed a self-report questionnaire comprising the Bladder Cancer Index, Mini-Mental Adjustment to Cancer Scale, Psychosocial Adjustment to Illness Scale, and sociodemographic details. For each sample, structural equation modelling was used to determine goodness of fit, guided by Roy's Adaptation Model. RESULTS: For patients, increasing age and disease duration, the negative appraisal of health care, perceived poor functioning and elevated burden of disease provided pathways to Psychological Wellbeing. For partners, increasing age, being male, a negative health care experience, and perceived burden of disease were significant. However, for both groups a positive evaluation of family and social support was the key indicator of lower Psychological Wellbeing. CONCLUSIONS: The models presented describe a suite of issues that could inform a nursing model of care to enhance the experience of living with bladder cancer for both patients and their supportive partners.

Toward an Understanding of Patients' and Their Partners' Experiences of Bladder Cancer.

BACKGROUND: Bladder cancer is characterized by recurrence and progression, ongoing surveillance and treatment, adverse effects, and complications and is associated with chronic ill health that may compromise relationships, social activities, and employment. OBJECTIVE: The aim of this study was to gain an understanding of quality of life disruptions among both those diagnosed with bladder cancer and their supportive partners (spouses or other family members). INTERVENTIONS/METHODS: Couples were recruited from a tertiary care public hospital database. Nine heterosexual couples (married/de facto) and another comprising a clinical participant and her daughter-in-law were interviewed for approximately 60 minutes. Interviews were audio recorded and transcribed, with qualitative description used to gain an in-depth understanding of participants' experiences without previous agenda or knowledge, allowing their viewpoints to be summarized in everyday terms. RESULTS: Thematic analysis highlighted 4 themes: psychical responses, cognitive and emotional reactions, survival techniques and the importance of partner support and its assistance for clinical participants acceptance of, and adaptation to their bladder cancer, surveillance, and treatment protocols. CONCLUSION: A key finding was the value of a supportive partner in dealing with the effects of bladder cancer daily. From a health service perspective, the need for clear information provision and counseling/support to assist patient management was also evident. IMPLICATIONS FOR FUTURE PRACTICE: Health professionals need to appreciate the quality of life implications for patients and partners, thus understanding the needs of couples. Greater collaboration with and by health professionals who assist in care may allow couples to move more confidently toward adaptation to bladder cancer.

The relative contributions of function, perceived psychological burden and partner support to cognitive distress in bladder cancer.

OBJECTIVE: Bladder cancer is a genitourinary disease of increasing incidence. Despite improvements in treatment, outcomes remain equivocal with high recurrence rates. It is associated with poor psychosocial outcomes due to reduced functioning of the genitourinary system. The objective of these analyses was to query whether reported loss of function or the perception of psychological burden caused by this functional impedance was the key to understanding psychosocial outcomes. METHODS: The sample comprised 119 participants with a confirmed diagnosis of bladder cancer. They completed a self-report questionnaire comprising the Bladder Cancer Index, Mini-mental Adjustment to Cancer Scale, Psychosocial Adjustment to Illness Scale and standard sociodemographic details. Simple mediation and serial mediation were used to explore the potential for psychological burden to mediate associations between loss of function and cognitive distress, and the potential additional contribution of positive partner support on these relationships. Age and duration of cancer were considered as covariates. RESULTS: Simple mediation demonstrated that the association between function and cognitive distress was fully mediated by perceived psychological burden. Serial mediation, which allowed for the addition of partner support, again demonstrated full mediation, with partner support being the key predictive variable. CONCLUSIONS: These analyses emphasise the importance of an appreciation of individuals' interpretation of the burden occasioned by bladder cancer and the role of a supportive partner. The implications for management discussions and support services in alleviating negative psychological outcomes in bladder cancer are highlighted. Copyright © 2015 John Wiley & Sons, Ltd.