Although cancer presents a crisis for both patients and spouses, previous research has not clearly identified what factors place certain couples at higher risk than others for developing adjustment problems to cancer. The purpose of the proposed program of research is to test a model that can be used to predict cancer patients and spouses who are at higher risk of poorer adjustment to cancer. The proposed program of research, that builds on the principal investigator's initial research with mastectomy patients and their husbands, consists of three phases that extend over a five-year time period. In Phase I a preliminary model that was developed to predict cancer patients and spouses at risk will be tested in a four-part longitudinal study. The sample will consist of 80 breast cancer patients and their husbands (n=160 subjects) and a comparison group of 80 couples (n=160 subjects) in which the woman received a breast biopsy but was diagnosed with benign breast disease. All subjects will be interviewed prior to biopsy, prior to surgery (post-biopsy), 60 days post-surgery, and one year post-surgery. The preliminary model is based on House's paradigm of stress research and consists of five independent variables: social support, uncertainty, marital satisfaction, family function, and optimism. Psychosocial adjustment, the dependent variable, is conceptualized as a multidimensional construct that assesses level of distress, and ability to function in work, family, and social roles. Variables will be measured with standardized instruments and data will be analyzed using repeated measures analysis of variance and multiple regression. In Phase II of the proposed program of research the preliminary model will be refined using causal modeling and path analysis. In Phase III the refined model will be tested in a two--part prospective study with couples who are adjusting to a different type of cancer, colon cancer (n=80 couples). Subjects will be interviewed prior to surgery and 60 days post-surgery. Overall, the three- phase program of research will provide a theoretically-based and empirically-tested model that can be used by nurses to identify patients and spouses at higher risk of poorer adjustment to cancer.
