Table Of ContentHelping Couples Cope with Women’s Cancers
·
Karen Kayser Jennifer L. Scott
Helping Couples Cope
with Women’s Cancers
An Evidence-Based Approach
for Practitioners
123
KarenKayser JenniferL.Scott
GraduateSchoolofSocialWork SchoolofPsychology
BostonCollege UniversityofTasmania
ChestnutHill,MA02467,USA Hobart,Tasmania7001,Australia
[email protected] [email protected]
ISBN:978-0-387-74802-3 e-ISBN:978-0-387-74803-0
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(cid:2)c 2008SpringerScience+BusinessMedia,LLC
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Inmemoryofourmothers,Verna
B.E.Kayser,andAudreyB.Scott,whofirst
taughtustheimportanceofrelationshipsin
copingwithillness.
Preface
Our work with cancer patients has been an interweaving of both our professional
andpersonallives.Eachofusbeganourcareersinthisareaaround20yearsago.In
this preface, we individually describe the journeys that led us to our collaboration
onthisbook,beginningwithProfessorKayser.
Iwasworkingasapost-doctoralfellowontheChildhoodCancerProjectatthe
University of Michigan. This was a clinical research program that offered home-
basedpsychosocialservicestofamilieswhohadachildwithcancer.AlthoughIhad
workedasacouplesandfamilytherapistforyearsbeforethepost-doc,thiswasmy
firstexperiencewithseeinghowcancerdiagnosisandtreatmentcanaffectanentire
family system. Spending time with families in their own homes gave me a more
in-depth look into not only the inner workings of the family but also the context
of their coping. What intrigued me was how some families who lived in affluent
suburbancommunitieswithseeminglyendlessresourceswerenotadjustingtotheir
child’sillnessaswellassomeofthefamilieswevisitedinthepoorestpartsofthe
city of Detroit. Numerous questions about what constitutes good coping and what
contributes to a good adjustment arose. In addition, I wondered what was the best
way for a family, as a whole, to cope. Should family members take on designated
rolesaroundmanagingthedemandsoftheillness?Orshouldeveryonebeusingthe
samestrategiestocope?
When I left Michigan for a university position in Boston, I continued my work
onthepsychosocialaspectsofcancer.Thedirectorsofthesocialworkdepartments
atBrigham&Women’sHospitalandDana-FarberCancerInstituteencouragedmy
researchinterests.Withpractitionersattheseinstitutions,Istudiedtheexperiences
ofmotherswithcancerandhowcloserelationshipseitherhelpedorhinderedtheir
adjustment. What became clear from this research was the importance of a mutu-
ally supportive relationship for coping with the diagnosis and treatment of cancer.
Motherswhohadsupportiverelationshipsreportedhigherlevelsofwell-beingand
lower levels of depression. They also engaged more frequently in positive health
carebehaviors.Basedonthesefindings,Istartedtodevelopapsychosocialinterven-
tionthatwouldenhancethecopingofthecancerpatientandherspouseorpartner.
Although there were numerous support groups available for patients with cancer,
thereseldomwereanyprogramsforpartnersofpatients.Morestrikingly,therewere
no programs available for both patients and partners to work on facing the cancer
vii
viii Preface
together,eventhoughthefindingswerequitedefinitivethatsupportivepartnersare
crucialtothewell-beingofcancerpatients.Insteadofattemptingtocreatesupport
amongagroupofstrangers,itmadesensetometoworkwiththepatient’snatural
supportsystem—thepeoplewithwhomshelives.
CollaboratingwithDana-FarberCancerInstitute,Brigham&Women’sHospital,
andMassachusettsGeneralHospital,IdevelopedthePartnersinCopingProgram.It
wasevaluatedthrougharandomizedcontroltrialand,soonafter,Ibeganreporting
myfindings.IthendecidedtodisseminatetheProgramtopractitionerswhoworked
with patients on a daily basis. Around the same time, I met Professor Scott and
we began to learn about each other’s work—the similarities in our perspectives,
our interventions, and our research findings. Based on the similarities of studies
conductedindifferentcountries,wedecidedtocollaborateandputourinterventions
togetherinabook.
Justaswestartedourworktogether,Imyselfwasdiagnosedwithbreastcancer.
Fortunately,itwasdetectedearlyandsuccessfullytreatedwithsurgeryandradiation
treatments.However,itgavemeanewlensthroughwhichIviewthecancerexpe-
rience.Onequicklylearnsthatthereisnorightorwrongwaytocope.The“best”
coping method depends on one’s personality and life circumstances. Also, cancer
isnotasimpledisease—itappearsinvariousforms,intensities,andistreatedbya
range of modalities. Similarly, approaches to coping with it will vary from person
topersonandcoupletocouple.Oneofthegoalsofourbookistohelppractitioners
learntoassistpartnersinacceptingeachother’sindividualwayofhandlingthestress
of an illness. It is evident to me that it is not the differences between the partners
thatcreatedistressbutratherthewaytheyhandlethesedifferences.
KarenKayser
AfterearningmyBachelorsDegreesome22yearsago,Itookmyfirstjobasa
welfare officer at a cancer treatment center in the city of Brisbane, in the State of
Queensland,Australia.Thepeoplediagnosedwithcancer,theirfamilies,andclosest
support persons who came to the center often had traveled long distances, many
arrivingfromruralandremoteregionsofQueensland.Partofmyrolewastohelp
peoplecompletethenecessarypaperworktoclaimgovernment reimbursementfor
travel,accommodation,andassociatedmedicalcosts.Aswefilledinthepaperwork
together, I observed that the couple and families who seemed to be adjusting well
wereveryintouchwitheachothers’thoughtsandfeelingsabouttheircancerexpe-
riences.Theyseemedtobecopingasateam.Thoughtheirindividualcopingstyles
wereoftendifferent,theirwaysofcopingseemedcomplementary.Thisseemedto
givefamilymembersgreaterstrengththaniftheystoodalone.
The things I learned from these families, and the wonderful medical and allied
health colleagues I worked with, have stayed with me for life. These experiences
alsoinspiredmetogobacktouniversityandseekfurthertrainingtogaintheclinical
skills I felt I needed to help families cope with cancer. I completed my Masters
Degree in Clinical Psychology, and then pursued my doctoral research. I did not
knowitatthetime,butonoppositesidesandindifferenthemispheresoftheworld,
Preface ix
Karen and I were designing and testing similar programs to harness the power of
couples’copingwithcancer.
IdevelopedCanCOPE,acouple-based,cognitive-behavioralcopingtrainingand
support-enhancement intervention. CanCOPE was evaluated empirically through
randomized control trials. It was found to be effective for improving adjustment
for both the women and their partners, across a range of quality of life outcomes,
includingmood,copingbehaviors,supportivecommunication,sexualintimacy,and
female body image. I have since modified some components of CanCOPE to suit
differenttypesofcloserelationships,wherethewoman’snominatedsupportperson
isanotherfamilymemberorclosefriend.
While I was writing up the results of my trial of CanCOPE for my doctoral
dissertation, my dear mother was diagnosed with advanced stage cancer. I moved
backtothefamilyhometogivesupporttomyparents.Iwillbeforevergratefulfor
this time with them. With dignity, love, and a great sense of fun, they got on with
livingandgettingthemostoutofeachday.Theyshowedmefirsthandhowcoping
asacouplecansustainpeopleintheirdarkesthours,evenwhenthismeanstheloss
ofanintimatebondthat,intheircase,lasted50years.
JennScott
Acknowledgments
My development of the Partners in Coping intervention would not have been pos-
sible without the support and generosity of the staff at Dana-Farber Cancer Insti-
tute(DFCI),BrighamandWomen’sHospital,andMassachusettsGeneralHospital
(MGH).Inparticular,IwanttothankDr.LawrenceShulman,Dr.UrsulaMatulonis,
and Dr. Eric Winer for their commitment and dedication to psychosocial care for
patients and families as part of best practices in medicine. I am grateful to Nancy
Borstelmann, Ann Daniels, Martha Burke, Barry Feldman, and the clinical social
workersfromDFCIandMGHwhohelpedwiththedailyworkofrecruitingcouples
andimplementingthePartnersinCopinginterventions.Iespeciallyappreciatethe
time, commitment, and fortitude of the couples who participated in my research
duringadifficulttimeintheirlives.IamgratefulforagrantfromtheMassachusetts
DepartmentofPublicHealthBreastCancerProgramthatfacilitatedmyresearch.
IalsothankOscarBarbarinwhofirsttaughtmeaboutfamily-basedinterventions
with cancer patients and Tracey Revenson and Guy Bodenmann who continue to
inspire me in my research on dyadic coping. I deeply appreciate the support of
colleague and friend, Jane O’Rourke, who read early drafts of the manuscript and
providedanexperiencedclinicalperspectivetomyresearch.
I am grateful to my husband, Fred Groskind, whose enduring support helped
me in my own journey with cancer and whose tenacious editing helped transform
our academic writing into a more readable manuscript. I would like to thank my
daughter, Emma, for her patience while I worked on this project. Finally, I thank
Jenn Scott for joining me in this book project. Her collaboration and good humor
wereinvaluable.
KarenKayser
I would like to thank my colleagues and friends working in couples and health
who share my passion and have inspired me over the years. In particular, I thank
KarenKayser,DonBaucom,NinaHeinrichs,andTanjaZimmerman.Iverymuch
appreciatethewarmthandsupportshowntomebymyworkmatesandpostgraduate
students in the School of Psychology at the University of Tasmania. I respect the
courageofthefamiliesinvolvedinthe“CanCOPE”projects,whoworkedwithme
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xii Acknowledgments
at such challenging times in their lives, and who generously shared their cancer
experiences so that others may benefit. I am grateful for research grants from the
National Health and Medical Research Council (NHRMC Id 9937170; Australian
ClinicalTrialsRegistryNo.12607000061437)andtheCancerCouncilQueensland.
Iamdeeplyappreciativeoftheencouragementandunderstandingthatmyfather,
brother,extendedfamily,andfriendsofferme,forthehappinessandsenseofpur-
posetheserelationshipsbringtomylife.IamgratefultoBenforremindingmethat
sharingmakesthings‘Shiny’andtoDavidbecausehealwaystoldmeitwasso.
Finally,thankyoutomycousinJoy,whowithgraceandlovegenerouslyshared
her artistic vision of the interwoven strength and beauty that flows from “couple
living in harrnony”; the theme of her woven tapestry that is the cover art for this
book.
JenniferL.Scott
We would like to thank the editorial staff of Springer Publishers for their help
intheproductionofthisbook.Inparticular,wewouldrecognizeAnnaTobiasand
JenniferHadleyfortheirextremepatienceandencouragement.
KarenKayser
JenniferL.Scott
