Carla L. Fisher

Attitudes Toward Decision Making and Aging, and Preparation for Future Care Needs

Adult children are the primary source of informal eldercare in the United States. Unfortunately, however, families rarely prepare for an aging parents future care needs. This is problematic, as advance preparation may reduce depression and anxiety in older adults and be helpful for adult children. Given the importance of preparation prior to parental dependency, we examined factors associated with preparation for caregiving. Using survey methodology, we studied 2 groups of people: Functionally independent parents at least 60 years of age, and adult children at least 40 years of age. Several variables appeared to be associated with awareness of care needs, gathering information, and discussion of possible care arrangements. Most notably, attitudes regarding shared autonomy and aging anxiety were positively associated with each of these stages of preparation. Other findings suggest that being concerned about possible negative effects of caregiving and perceiving the future as limited may also be associated with preparation for caregiving. The results provide gerontologists, interventionists, and families with insight into attitudes that may inhibit or facilitate preparation for future caregiving needs.

Sources of uncertainty about daughters' breast cancer risk that emerge during genetic counseling consultations.

Uncertainty is central to the experience of genetic decision making and counseling about cancer risk. Women seeking genetic counseling about their breast cancer risk may experience a great deal of uncertainty about issues related to their daughters. We used a theory of Communication and Uncertainty Management to guide analysis of sources of uncertainty about daughters that emerged during 16 video-recorded and transcribed conversations between mothers at risk for a BRCA 1/2 mutation and their genetic healthcare practitioners. An interpretive design and constant comparative method revealed three dominant patterns or themes representing sources of uncertainty mothers have relating to their daughters: disease risk, future cancer screening, and communication of related information to daughters. Both practitioners and mothers discussed these aspects of uncertainty. The findings identify the significant role uncertainty and familial concerns play in mothers’ genetic testing decision making process. To assist genetic practitioners, we highlight daughter-related concerns that mothers are uncertain about and which are vital to their genetic counseling needs.

Coping with Breast Cancer across Adulthood: Emotional Support Communication in the Mother–Daughter Bond

Women diagnosed with breast cancer encounter traumatic changes and their ability to cope is tied to support they receive from their families. Women describe the mother–daughter relationship as a significant potential source of this support. Forty diagnosed women in young, middle, and later adulthood and 38 of their mothers/daughters were interviewed to capture how communication functioned both adaptively and maladaptively in their adjustment. Findings highlight differences in womens communication preferences related to development.

Talking About Familial Breast Cancer Risk Topics and Strategies to Enhance Mother–Daughter Interactions

A hereditary cancer predisposition can rattle families, creating dysfunctional interactions. Families need assistance navigating conversations about risk. Because mothers and daughters uniquely share breast cancer experiences and risk, there is a particular need for practitioners to assist them with communication. Three focus groups were conducted with 11 mothers with an elevated cancer risk (with adolescent daughters) receiving genetic counseling. We explored three inquiries to capture mother–daughter communication: emergent challenging topics (e.g., health-promotion behavior, daughter’s risk, mother’s risk of death), factors complicating discussions (e.g., balancing what to share and when, guilt and blaming, confusion about risk and prevention), and strategies enhancing conversations initiated by mothers (e.g., paying attention to daughter’s cues) or practitioners (e.g., inviting daughters to appointments). Findings suggested that mothers struggle to balance eliciting daughters’ concerns, providing them with support, and imparting knowledge without overwhelming them. We offer mothers and practitioners guidance to help facilitate these conversations.

Politeness Strategies in Imagined Conversation Openers About Eldercare

In the United States, many adult children and their aging parents reach the point when it is necessary to address future care needs of the parent. Given that the prevailing culture values independence over interdependence, discussing future care needs can be face threatening. Therefore, an examination of how adult children approach such conversations and manage face needs is an important first step toward understanding what makes these conversations effective and supportive. We use politeness theory to illuminate ways in which adult children incorporate facework in imagined messages (“openers”) to initiate a conversation with their aging parent about eldercare. Openers were thematically coded for politeness strategies and messages. Imagined openers featured complex “strings” of positive and negative politeness strategies. Implications are addressed.

Communication and Mental Health: A Conversation from the CM Café

The Communication Monographs Café is once again open for business. After stimulating conversations about social justice and public scholarship (Volume 78, Issue 2), about communication and materiality (Volume 78, Issue 4), and about theory and research in the age of new media (Volume 78, Issue 2), in the spring of 2012 I found myself casting about for another topic that would consider critical interests in society and the discipline, that would engage us in both theoretical and applied ways, and that would cut across subdisciplinary boundaries. I asked some key members of my editorial board for ideas, and one idea surfaced several times a consideration of the role of communication in processes of mental illness and mental health. Luckily, a number of scholars engaged with this topic agreed to stop by the CM Café in June, and the conversation commenced. Joining me in the Café for this round were Carla L. Fisher (George Mason University), Daena Goldsmith (Lewis & Clark College), Kristen Harrison (University of Michigan), Cynthia A. Hoffner (Georgia State University), Chris Segrin (University of Arizona), and Kevin Wright (St. Louis University). As before, the CM Café was facilitated through a private group on Facebook, and the setting of the Café allowed participants to drop in and out of the conversation, post their own questions as desired, and take each other down new paths as ideas diverged and converged. It was an early summer conversation, and participants who were celebrating the end of the school term engaged in high-spirited and interesting discussion. I opened the Café with a few questions the simplest of these being ‘‘How and why is communication associated with mental health?’’ Chris Segrin took the first shot at this question, and from there participants jumped in with thoughts of their own, discussions of relevant research programs, and movements down a variety of theoretical and methodological paths. So relax with your beverage of choice, and listen in to the conversation. Chris: Because human beings are inherently social animals, connections with other human beings are essential to well-being. When communication problems prevent or corrupt those connections our psychological systems react accordingly. For a parallel, consider how physiological systems react to a lack of nourishment.

Older Adults’ Evaluations of Middle-Aged Children’s Attempts to Initiate Discussion of Care Needs

We explored how older adults evaluated the strategies used by an adult child to initiate discussion of future care needs, and subsequently, whether these judgments affected older adults’ willingness to engage in discussions about eldercare if approached in a similar fashion by one of their own children. One hundred and thirty older adults were randomly assigned to read one of four scripts depicting efforts by a middle-aged daughter to raise the topic of future care needs with her mother by implementing a variety of facework behaviors. Scripts manipulated the degree to which the daughter conveyed respect for her mother’s desires for autonomy (negative face) and connection (positive face). The daughter’s facework significantly predicted older parents’ evaluation of her as supportive, which in turn predicted their willingness to discuss future care needs with one of their own children if they were to approach the conversation in a similar way.

Maximizing Wellness in Successful Aging and Cancer Coping: The Importance of Family Communication from a Socioemotional Selectivity Theoretical Perspective

Interpersonal communication is a fundamental part of being and key to health. Interactions within family are especially critical to wellness across time. Family communication is a central means of adaptation to stress, coping, and successful aging. Still, no theoretical argument in the discipline exists that prioritizes kin communication in health. Theoretical advances can enhance interventions and policies that improve family life. This article explores socioemotional selectivity theory (SST), which highlights communication in our survival. Communication partner choice is based on one’s time perspective, which affects our prioritization of goals to survive—goals sought socially. This is a first test of SST in a family communication study on women’s health and aging. More than 300 women of varying ages and health status participated. Two time factors, later adulthood and late-stage breast cancer, lead women to prioritize family communication. Findings provide a theoretical basis for prioritizing family communication issues in health reform.

Clinician barriers to initiating sexual health conversations with breast cancer survivors: The influence of assumptions and situational constraints.

Introduction: Sexual health (SH) is an important dimension of physical, emotional, and social functioning after breast cancer (BC). Research suggests that survivors’ SH concerns are not being adequately addressed in oncology or primary care settings. It is important to understand why these conversations are not taking place and what can be done to enhance care for women in this context. This research aims to identify when clinicians initiate SH conversations with survivors and to uncover factors that influence these decisions. Method: Thirty-six clinicians from family medicine, internal medicine, oncology, and gynecology participated in semistructured interviews. Analysis uncovered themes that influence clinicians’ decisions about initiating SH conversations with survivors. Attention was given to capturing the personal, professional, and system-level issues that inform clinicians’ communication choices. Results: Clinicians reported their decisions are based on (a) beliefs about patients, (b) inability to address survivors’ concerns, (c) time constraints that affect the delivery of care, and (d) views of professional function in survivor health care. Discussion: Clinician decisions are based on sometimes-erroneous assumptions and situational constraints. This suggests the need for medical education and support regarding SH care. Several practice points are outlined to facilitate clinicians’ efforts to improve SH care for female BC survivors.