Clinical Implications

Although the overwhelming majority of cancer survivors endorse good relationship adaptation, a subgroup of patients, their partners, or family members may experience impairments in relationship quality or interaction patterns deserving of clinical attention. One of the major lessons that we take after reviewing the literature in this area is the importance of asking about specific components of relationship functioning versus focusing solely on perceptions or ratings of global relationship quality. Thus, we suggest that clinicians working with cancer survivors or members of their social network inquire specifically about communication and support patterns between the survivor and their significant others [see also ref. 60]. In addition, couple-focused interventions may be indicated when cancer-related communication problems are identified,43,94 particularly given the relationships between partner responses and patient coping and distress outcomes, and the protective effect of dyadic adjustment on psychological distress.94

Clinically, reducing negative interpersonal interactions may have a more profound impact on psychological adjustment than increasing supportive interactions.67,68 However, interventions that improve the couple's ability to appropriately give and receive support after cancer also appear to improve relationship quality and distress.14,102 Survivors themselves may benefit from learning how to express their worries and concerns in a manner that increases rather than decreases supportive partner responses.

Finally, intervention efforts also should be targeted toward those at increased risk for distress. Although our conclusions can only be described as tentative, we suggest that female survivors and family members who are dealing with more invasive treatment regimens, are younger or in newer relationships, have fewer support resources, and are in relationships that are troubled prior to the cancer diagnosis may be at the highest risk for maladjustment. Given that relationship distress measured early on in diagnosis and treatment is a particularly potent predictor of later relationship dysfunction, efforts should be focused on early identification and treatment of relationship problems.

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