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Couples Coping with a Biopsy

Character-Growth

A cancer diagnosis is a profound and often very stressful experience for both patients and their partners. Spouses and partners are by far the most common informal cancer caregivers, helping patients manage disease symptoms, treatment side effects, and emotional distress. Despite these significant challenges, research over the past two decades demonstrates that cancer patients and caregivers commonly report positive changes, including greater appreciation of life and improved relationships with close others, following a diagnosis of cancer. However, most prior studies that have examined positive changes in cancer patients and their caregivers have solely relied on an individual’s ability to retrospectively report whether or not he or she perceives these positive changes, which can be a biased method that does not capture true changes. More research is needed in order to study whether cancer patients and caregivers show actual changes in character strengths, such as gratitude, empathy, and humility, by measuring these characteristics both before and after a cancer diagnosis.

It is also important to consider the shared experience between the cancer patient and caregiver as well as identify how aspects of their relationship, including communication, empathy, and support, influence positive changes in both individuals and their relationship. Several theories posit that receiving empathy and support from close others helps individuals cope with adversity more adaptively and can promote positive changes in an individual by shifting schemas, or how the individual thinks about his/her experience. However, these mechanisms have not been tested. Furthermore, whether the experience of a cancer diagnosis leads to actual, positive changes in relationship strengths, including trust, commitment, and intimacy between a cancer patient and caregiver, has not been previously studied.

To address the current limitations in this area of research, our study will recruit both individuals who are undergoing a cancer biopsy (women undergoing a breast biopsy and men undergoing a prostate biopsy) and their partners. In order to assess actual, positive changes over time, repeated assessments of character strengths and relationship strengths will be administered both before biopsy results (malignant biopsy = cancer diagnosis, benign biopsy = no cancer diagnosis) as well as every three months over the course of nine months. This method will also allow for the comparison of couples in which a partner was diagnosed with cancer to couples with no cancer diagnosis. Dyadic processes, including communication, empathy, and support, will also be measured to test whether these processes underlie positive changes in the patient, caregiver, and their relationship. This study will meaningfully advance our understanding of how patients and caregivers cope with the challenges of a cancer diagnosis and whether or not this experience can lead to actual, positive changes in the patient, caregiver, and their relationship.

The overarching aim of this project is to determine whether the challenges associated with a new cancer diagnosis engender character and couple growth in both the patient and caregiver, as defined by actual change in character and relationship strengths across time. Using a prospective design with quantitative approaches that model actor-partner effects, we will determine predictors, mechanisms, and outcomes of character and couple growth in patients and caregivers as well as test the intrapersonal and shared dyadic processes that underlie character and couple growth in our expanded dyadic theoretical model. Furthermore, we will compare trajectories of character and couple growth in cancer patient-caregiver couples with a comparison group of couples who undergo a cancer biopsy but receive a benign result (i.e., no cancer diagnosis). Importantly, we will use multimodal measurement, including daily-diary sampling to test dyadic processes as mechanisms of positive changes, traditional self-reports of perceived growth to differentiate perceived growth from actual measured changes in character strengths (i.e., character growth), and partner reports of character strengths to examine the observability of character growth.

This study has been developed to meet the goals of the Templeton Foundation Pathways to Character Project. A prospective, multimodal, longitudinal design that includes repeated measurement of character and relationship strengths and daily-diary sampling of dyadic mechanisms is a crucial and needed next step to address gaps in the literature and improve our conceptualization and understanding of positive psychological changes following adversity.