Betsy L. Fife

The conceptualization of meaning in illness

The focus of this paper is the development of a conceptualization of meaning within the context of serious illness. It is based on a symbolic interactionist perspective, with the significance of the concept of meaning for the process of adaptation being a primary point of discussion. Meaning, as it is defined here, refers to the perceived nature of the relationship between the individual and his/her world that is developed within the context of specific events. It is comprised of two inextricably linked dimensions: meaning that pertains to ones identity and how that is affected by the event of the illness, and meaning which pertains to perceived characteristics of the event and to the social circumstances that surround it. Interviews with 38 persons living with the stress of cancer provide qualitative data that illustrate the concept as it is set forth in this paper. Four specific domains relevant to symbolic interactionism were explored in these interviews: (1) the individuals response to the illness; (2) changes that occurred relative to identify as a consequence of the illness; (3) the impact of cancer on the individuals relationship to the social world; (4) anticipated effects of the illness on the individuals future. Clinical implications of specific aspects of meaning are discussed.

Relationship Issues of Women With Breast Cancer

This in-depth, qualitative pilot study explored the impact of breast cancer on specific dimensions of the relationships and roles of women. It included interaction within the partner relationship as well as with family, friends, and colleagues. Data were obtained by individual and group interviews from 10 women with a diagnosis of breast cancer and 5 male partners. Both partnered and single women participated. There were four major findings seldom discussed in the literature, which have important implications for preventive intervention. First, partner relationships troubled before the diagnosis as well as those characterized by mutual caring faced challenges and negative changes. Second, in an effort to protect each other, communication within the partner dyad became less open, and there were changes in the usual manner of conflict resolution. Third, unpartnered women appeared to be more vulnerable to problems of negative adjustment, largely because of relationship issues. Fourth, participants confirmed the need for a comprehensive intervention to facilitate coping with issues relative to relationships, intimacy, and sexuality. Although the sample was small, in-depth data were obtained that provide a basis for specific areas in which further empirical investigation is needed, and they indicate that preventive intervention may well be warranted.

The family's adaptation to childhood leukemia.

This baseline study obtained data measuring the specific effects of the stress of childhood leukemia on family life and on the lives of individual family members. Mothers, fathers, siblings, and patients were included in the data collection. Specific variables measured were marital adjustment, anxiety level, dynamics of family interaction, and the school behavior of patients and siblings. The data were collected at designated intervals over a one year period beginning at the time of diagnosis. In addition, the data were utilized to speculate on those families that appeared to be at risk for the development of long-term psychosocial problems secondary to, or aggravated by the illness. Results indicated that patterns of coping for families, as well as for individual family members, were relatively constant over time. Families with predominantly stable relationships and adequate support within the family unit were able to maintain their usual quality of life over an extended period of time despite the onset of acute stress. However, families with pre-existing problems prior to diagnosis for the most part experienced increased deterioration in family life and had difficulty coping. Results of the Spielberger State-Trait Anxiety Scale, the Locke-Wallace Marital Adjustment Test, the Moos Family Environment Scale, the MMPI, and school data supporting these conclusions are given.

The measurement of meaning in illness

A scale is presented that operationalizes the concept of meaning as it is constructed within the context of life-threatening illness. Development of the scale is based on a symbolic interactionist perspective. The reliability and validity of the scale are examined using a sample of 422 persons with a variety of types of cancer at specified points in the illness trajectory. The scale was found to have item-total correlations ranging from 0.50 to 0.73, all significant at P < 0.01, and a Cronbachs alpha of 0.81. A factor analysis indicated the total scale explained 57.3% of the variance. Evidence of the scales validity was found in its ability to differentiate persons who were newly diagnosed as having non-metastatic cancer from those individuals experiencing the first recurrence of cancer and those with metastatic disease, as well as individuals experiencing a first remission from those experiencing a first recurrence or those with metastatic disease. In addition, using regression analysis meaning was found to be predicted by social support and specific coping strategies, and to be predictive of personal control, body image and psychological adjustment. A bi-directional relationship was demonstrated between the construction of meaning (primarily a cognitive phenomenon) and emotional response, which is congruent with the bi-directional relationship between cognition and emotion as proposed in the theory of Lazarus and Folkman.

Cancer and the partner relationship: What is its meaning?*

When cancer occurs, it is an illness that has meaning for the lives of all members of the family. This article focuses on the meaning and significance of the illness for the partner relationship, both the individuals within the relationship and the dyad. Results of two studies are presented: one study is based on in-depth interviews with 50 individuals who were newly diagnosed with cancer and their partners, and the other study used questionnaires from 412 patients and 175 partners to obtain statistical data. Findings pointed to the importance of meaning in the adjustment of individuals, as well as the dyad. Interview data indicated that patients and their partners searched for meaning in the illness that would decrease its threat, and statistical analyses showed the significance of meaning as it applies to specific aspects of adjustment. The importance of considering meaning in care that is directed toward the prevention of problems within the dyad, which can occur as a result of coping with the stress of cancer are emphasized, and some specific recommendations are made.

Gender and Adjustment to Cancer: Clinical Implications

The assumption that women are more vulnerable than men to developing stress in response to negative life events is common in Westem cultures. This research focused on gender differences in psychosocial adjustment to cancer. The sample included 125 men and 206 women. The influence of social support, coping strategies, cognitive response, and emotional response on adjustment were studied. No significant differences by gender were found in the level of distress experienced; however, women made a more positive adjustment, and social support and coping strategies appeared to affect these differences. Clinical implications relative to differences in the impact of social support by gender, as well as implications of differences in coping, are discussed in detail.

A Comparative Study of the Attitudes of Physicians and Nurses Toward the Management of Cancer Pain

Although the effective management of cancer pain depends on adequate collaboration and cooperation of the physician and the nurse, little research has been done comparing the attitudes of the two groups. This study investigated the attitudes of physicians and nurses toward cancer pain and its treatment with respect to three domains: (a) the management of cancer pain as a health-care issue; (b) the potential problems of addiction and drug misuse; and (c) the involvement of patients in the management of their own pain. A questionnaire was mailed to a randomly selected sample of individuals registered with the Health Professions Bureau of Indiana. It was completed by 500 physicians and 471 nurses. Specific differences that were found are discussed, along with the implications of these differences for the management of cancer pain and the education of professionals.

Promoting Adaptive Coping by Persons With HIV Disease: Evaluation of a Patient/Partner Intervention Model

This study evaluated an intervention to facilitate adaptive coping by persons living with HIV (PLWH), with the participation of their cohabiting partners as a dimension of the intervention. An experimental design with randomization was used, and 84 PLWH and their partners were recruited. The intervention was based on a psychosocial educational model that incorporated four 2-hour sessions focused on communication, stress appraisal, adaptive coping strategies, and building social support. Both members of the dyad were included in each session. The comparison control included four supportive phone calls to the PLWH alone. Data were collected from both the PLWH and their partner in each of the two groups at baseline, immediately following the intervention, and 3 months and 6 months posttreatment. Data were analyzed using repeated measures analysis of variance, with change scores from the partner data being covariates. Results indicated that the design was a feasible model, which demonstrated potential for the management of stress and possibly problems such as adherence in PLWH. A manual was developed as a part of this intervention and is currently available.

Women and the Prevention of HIV Infection: An Integrative Review of the Literature

In the United States, recent epidemiological evidence suggests that the epidemic of AIDS is growing rapidly among women. However, the theories used to guide research in the area of prevention of HIV infection often do not account for gender. As a result, research with women has been limited and the development of interventions to reduce risk behaviors impeded. This review examines research with women and HIV related to prevention and identifies the gaps and strengths in this body of work. Content analysis was used to evaluate 40 published papers meeting the following criteria: title or abstract indicating a report of research with women and HIV/AIDS, refereed journal as source, English language, and implications for prevention of HIV among women. Findings suggest a growing awareness of womens risk of HIV, but basic research pertaining to the behavior of women related to their vulnerability to HIV infection is scant. Prevention research and evaluation of interventions are also in their infancy. This review calls attention to the need for continued research that specifically addresses womens needs in the prevention of HIV.

Partner interdependence and coping with life-threatening illness: the impact on dyadic adjustment.

General systems theory and Bodenmanns theory of dyadic coping (Bodenmann, 1997) provided the framework for exploring the impact of life-threatening illness on the dyadic relationship. The sample included 193 dyads experiencing the stress of treatment by bone-marrow transplantation (BMT) for cancer which had not responded to first-line therapies. A prospective design over 12 months included four measurements at designated periods in the treatment process. Except for the symptom checklist, which was completed only by the recipient, data were obtained on each measure from both partners at each time point. The primary outcome was dyadic adjustment measured by the Dyadic Adjustment Scale (DAS; Spanier, 1976). A general linear mixed model indicated that dyadic adjustment was stable over time for BMT recipients and family caregivers; however, caregivers had lower mean values on dyadic adjustment than recipients, and higher mean values on negative affect. Bayesian path analysis was used to test actor-partner interdependence models reflecting the theory of dyadic coping. Models exhibited adequate fit to the data and indicated that apart from baseline dyadic adjustment, partner-related coping had the greatest positive impact on dyadic adjustment over the trajectory for both recipients and their caregivers. Limitations in resources for health care occurring on a national level have increased the extent of in-home care for acutely ill family members, including BMT recipients. This has serious implications for the mental health of the caregiver and for the integrity of the family system. Mental health assessment and integration of supportive interventions would be important in the prevention of secondary psychosocial morbidity.