Restricted accessResearch articleFirst published online 2023-11
Protective Buffering: Nurses Facilitating Communication Between Adults With Cancer and Their Adult Family Caregivers Who Overprotect One Another—An Integrative Review
The aim of this study was to explore how nurses can alleviate protective buffering between adult patients with cancer and their adult family caregivers (PROSPERO No. CRD42020207072). An integrative review was conducted. PubMed, CINAHL, Embase, and Cochrane Library were searched for primary research articles published between January 2010 and April 2022. Only research conducted in oncology, hematology, or multiple settings and investigating communication between adult patients with cancer and their adult family caregivers and/or the communication between patients, family caregivers, and nurses was included. The constant comparison method outlined the approach to the analysis and synthesis of the included studies. Titles and abstracts of 7,073 references were screened; 22 articles (19 qualitative and three quantitative studies) were included in the review. Three themes emerged during data analysis: (a) family coping, (b) an isolating journey, and (c) the nurse’s role. A study limitation was that “protective buffering” is not a common term in the nursing literature. There is a need for further research on protective buffering in families with cancer, particularly on psychosocial interventions that focus on the whole family across various cancer types.
AaronsonN. K.AhmedzaiS.BergmanB.BullingerM.CullA.DuezN. J.FilibertiA.FlechtnerH.FleishmanS. B.de HaesJ. C. J. M.KaasaS.KleeM.OsobaD.RazaviD.RofeP. B.SchraubS.SneeuwK.SullivanM.TakedaF. (1993). The European organization for research and treatment of cancer QLQ-C30: A quality-of-life instrument for use in international clinical trials in oncology. Journal of the National Cancer Institute, 85(5), 365–376. https://doi.org/10.1093/jnci/85.5.365
2.
BachnerY. G.Gesis-ZaE. D.CarmelS. (2008). Caregivers’ communication with patients about illness and death: Initial validation of a scale. Omega-Journal of Death and Dying, 57(4), 381–397. https://doi.org/10.2190/OM.57.4.d
3.
BadrH.KrebsP. (2013). A systematic review and meta-analysis of psychosocial interventions for couples coping with cancer. Psycho-Oncology, 22(8), 1688–1704. https://doi.org/10.1002/pon.3200
4.
BamideleO.LaganB. M.McGarveyH.WittmannD.McCaughanE. (2019). “. . . It might not have occurred to my husband that this woman, his wife who is taking care of him has some emotional needs as well. . .”: The unheard voices of partners of Black African and Black Caribbean men with prostate cancer. Supportive Care in Cancer, 27(3), 1089–1097. https://doi.org/10.1007/s00520-018-4398-4
BellJ. M.WrightL. M. (2015). The illness beliefs model: Advancing practice knowledge about illness beliefs, family healing, and family interventions. Journal of Family Nursing, 21(2), 179–185. https://doi.org/10.1177/1074840715586889
7.
BergC. A.UpchurchR. (2007). A developmental-contextual model of couples coping with chronic illness across the adult life span. Psychological Bulletin, 133(6), 920–954. https://doi.org/10.1037/0033-2909.133.6.920
BramerW. M.de JongeG. B.RethlefsenM. L.MastF.KleijnenJ. (2018). A systematic approach to searching: An efficient and complete method to develop literature searches. Journal of the Medical Library Association, 106(4), 531–541. https://doi.org/10.5195/jmla.2018.283
CaughlinJ. P.Mikucki-EnyartS. L.MiddletonA. V.StoneA. M.BrownL. E. (2011). Being open without talking about it: A rhetorical/normative approach to understanding topic avoidance in families after a lung cancer diagnosis. Communication Monographs, 78(4), 409–436. https://doi.org/10.1080/03637751.2011.618141
12.
CimprichB.JanzN. K.NorthouseL.WrenP. A.GivenB.GivenC. W. (2005). Taking CHARGE: A self-management program for women following breast cancer treatment. Psycho-Oncology, 14(9), 704–717. https://doi.org/10.1002/pon.891
CoyneE.DieperinkK. B. (2017). A qualitative exploration of oncology nurses’ family assessment practices in Denmark and Australia. Supportive Care in Cancer, 25(2), 559–566. https://doi.org/10.1007/s00520-016-3438-1
17.
CoyneE.HeynsberghN.DieperinkK. B. (2020). Acknowledging cancer as a family disease: A systematic review of family care in the cancer setting. European Journal of Oncology Nursing, 49, 1–14. https://doi.org/10.1016/j.ejon.2020.101841
18.
DalgaardK. M. (2010). Uhelbredeligt syge har brug for sundhedsprofessionelle som følgeskab [The terminally ill need healthcare professionals as companions]. Klinisk Sygepleje, 24(3), 47–57. https://doi.org/10.18261/ISSN1903-2285-2010-03-06
19.
DieperinkK. B.CoyneE.CreedyD. K.ØstergaardB. (2018). Family functioning and perceived support from nurses during cancer treatment among Danish and Australian patients and their families. Journal of Clinical Nursing, 27(1–2), e154–e161. https://doi.org/10.1111/jocn.13894
20.
DohertyW. J.CampbellT. L. (1988). Families and health. SAGE.
21.
Donovan-KickenE.TollisonA. C.GoinsE. S. (2012). The nature of communication work during cancer: Advancing the theory of illness trajectories. Health Communication, 27(7), 641–652. https://doi.org/10.1080/10410236.2011.629405
FjoseM.EilertsenG.KirkevoldM.GrovE. K. (2016). A valuable but demanding time family life during advanced cancer in an elderly family member. Advances in Nursing Science, 39(4), 358–373. https://doi.org/10.1097/ANS.0000000000000145
24.
FoxwellK. R.ScottS. E. (2011). Coping together and apart: Exploring how patients and their caregivers manage terminal head and neck cancer. Journal of Psychosocial Oncology, 29(3), 308–326. https://doi.org/10.1080/07347332.2011.563343
GoldsmithJ.WittenbergE.PlattC. S.IannarinoN. T.RenoJ. (2016). Family caregiver communication in oncology: Advancing a typology. Psycho-Oncology, 25(4), 463–470. https://doi.org/10.1002/pon.3862
27.
GoudreauJ.DuhamelF.RicardN. (2006). The impact of a Family Systems Nursing educational program on the practice of psychiatric nurses: A pilot study. Journal of Family Nursing, 12(3), 292–306. https://doi.org/10.1177/1074840706291694
28.
HagedoornM.KuijerR. G.BuunkB. P.DeJongG. M.WobbesT.SandermanR. (2000). Marital satisfaction in patients with cancer: Does support from intimate partners benefit those who need it the most?Health Psychology, 19(3), 274–282. https://doi.org/10.1037/0278-6133.19.3.274
29.
HamanoJ.MoritaT.MoriM.IgarashiN.ShimaY.MiyashitaM. (2018). Prevalence and predictors of conflict in the families of patients with advanced cancer: A nationwide survey of bereaved family members. Psycho-Oncology, 27(1), 302–308. https://doi.org/10.1002/pon.4508
30.
HarrisJ.BowenD. J.BadrH.HannonP.HayJ.SterbaK. R. (2009). Family communication during the cancer experience. Journal of Health Communication, 14(Suppl.1), 76–84. https://doi.org/10.1080/10810730902806844
31.
HaukenM. A.LarsenT. M. B. (2019). Young adult cancer patients’ experiences of private social network support during cancer treatment. Journal of Clinical Nursing, 28(15–16), 2953–2965. https://doi.org/10.1111/jocn.14899
32.
HuY.LiuT.LiF. (2019). Association between dyadic interventions and outcomes in cancer patients: A meta-analysis. Supportive Care in Cancer, 27(3), 745–761. https://doi.org/10.1007/s00520-018-4556-8
33.
HudsonJ.ReblinM.ClaytonM. F.EllingtonL. (2019). Addressing cancer patient and caregiver role transitions during home hospice nursing care. Palliative & Supportive Care, 17(5), 523–530. https://doi.org/10.1017/S1478951518000214
34.
IkanderT.RaunkiærM.HansenO.DieperinkK. B. (2022). Nurses’ involvement in end-of-life discussions with incurable cancer patients and family caregivers: An integrative review. Palliative & Supportive Care, 20(4), 570–581. https://doi.org/10.1017/S1478951521000596
KornblithA. B.ReganM. M.KimY.GreerG.ParkerB.BennettS.WinerE. (2006). Cancer-related communication between female patients and male partners scale: A pilot study. Psycho-Oncology, 15(9), 780–794. https://doi.org/10.1002/pon.1004
37.
KuijerR. G.YbemaJ. F.BuunkB. P.De JongM.Thijs-BoerF.SandermanR. (2000). Active engagement, protective buffering, and overprotection: Three ways of giving support by intimate partners of patients with cancer. Journal of Social and Clinical Psychology, 19(2), 256–275. https://doi.org/10.1521/jscp.200.19.2.256
38.
LangerS. L.BrownJ. D.SyrjalaK. L. (2009). Intrapersonal and interpersonal consequences of protective buffering among cancer patients and caregivers. Cancer, 115(Suppl.18), 4311–4325. https://doi.org/10.1002/cncr.24586
39.
LazarusR. (1966). Psychological stress and the coping process. McGraw-Hill.
40.
LazarusR.FolkmanS. (1984). Stress, appraisal, and coping. Springer.
41.
LeskeJ. S. (1991). Internal psychometric properties of the Critical Care Family Needs Inventory. Heart & Lung, 20(3), 236–244.
42.
LewisF. M. (1996). Family home visitation study final report. National Cancer Institute, National Institutes of Health.
43.
LewisF. M. (2010). The family’s “stuck points” in adjusting to cancer. In HollandJ. C.BreitbartW. S.JacobsenP. B.LederbergM. S.LoscalzoM. J.McCorkleR. (Eds.), Psycho-oncology (2nd ed., pp. 511–515). Oxford University Press. https://doi.org/10.1093/med/9780195367430.003.0071
44.
LiJ.LuoX.CaoQ.LinY.XuY.LiQ. (2020). Communication needs of cancer patients and/or caregivers: A critical literature review. Journal of Oncology, 2020, Article 7432849. https://doi.org/10.1155/2020/7432849
45.
LiQ.ChiangV. C.XuX.XuY.LokeA. Y. (2015). The experiences of Chinese couples living with cancer: A focus group study. Cancer Nursing, 38(5), 383–394. https://doi.org/10.1097/NCC.0000000000000196
46.
ManneS. L.NortonT. R.OstroffJ. S.WinkelG.FoxK.GranaG. (2007). Protective buffering and psychological distress among couples coping with breast cancer: The moderating role of relationship satisfaction. Journal of Family Psychology, 21(3), 380–388. https://doi.org/10.1037/0893-3200.21.3.380
47.
MazanecP.DalyB. J.FerrellB. R.Prince-PaulM. (2011). Lack of communication and control: Experiences of distance caregivers of parents with advanced cancer. Oncology Nursing Forum, 38(3), 307–313. https://doi.org/10.1188/11.ONF.307-313
48.
McCaughanE.McKennaS.McSorleyO.ParahooK. (2015). The experience and perceptions of men with prostate cancer and their partners of the CONNECT psychosocial intervention: A qualitative exploration. Journal of Advanced Nursing, 71(8), 1871–1882. https://doi.org/10.1111/jan.12648
MishelM.EpsteinD. (1990). Uncertainty in illness scales: Manual. University of Arizona.
51.
MoodD.SongL.KershawT.NorthouseL. (2007). Assessing risk for distress in cancer patients and family caregivers. Oncology Nursing Forum, 34(1), 233.
52.
NorthouseL. L.MoodD.TemplinT.MellonS.GeorgeT. (2000). Couples’ patterns of adjustment to colon cancer. Social Science & Medicine, 50(2), 271–284. https://doi.org/10.1016/S0277-9536(99)00281-6
53.
NorthouseL. L.MoodD. W.SchafenackerA.MontieJ. E.SandlerH. M.FormanJ. D.HussainM.PientaK. J.SmithD. C.KershawT. (2007). Randomized clinical trial of a family intervention for prostate cancer patients and their spouses. Cancer, 110(12), 2809–2818. https://doi.org/10.1002/cncr.23114
54.
OguchiM.JansenJ.ButowP.ColagiuriB.DivineR.DhillonH. (2011). Measuring the impact of nurse cue-response behaviour on cancer patients’ emotional cues. Patient Education and Counseling, 82(2), 163–168. https://doi.org/10.1016/j.pec.2010.04.006
55.
ØstergaardB.ClausenA. M.AgerskovH.BrødsgaardA.DieperinkK. B.FunderskovK. F.NielsenD.SorknaesA. D.VoltelenB.KonradsenH. (2020). Nurses’ attitudes regarding the importance of families in nursing care: A cross-sectional study. Journal of Clinical Nursing, 29(7–8), 1290–1301. https://doi.org/10.1111/jocn.15196
56.
PinkertC.HoltgräweM.RemmersH. (2013). Needs of relatives of breast cancer patients: The perspectives of families and nurses. European Journal of Oncology Nursing, 17(1), 81–87. https://doi.org/10.1016/j.ejon.2011.10.006
ReganT. W.LambertS. D.KellyB.FalconierM.KissaneD.LevesqueJ. V. (2015). Couples coping with cancer: Exploration of theoretical frameworks from dyadic studies. Psycho-Oncology, 24(12), 1605–1617. https://doi.org/10.1002/pon.3854
59.
RollandJ. S. (2018). Helping couples and families navigate illness and disability: An integrated approach. Guilford Press.
60.
SelmanL. E.BeynonT.RadcliffeE.WhittakerS.OrlowskaD.ChildF.HardingR. (2015). “We’re all carrying a burden that we’re not sharing”: A qualitative study of the impact of cutaneous T-cell lymphoma on the family. British Journal of Dermatology, 172(6), 1581–1592. https://doi.org/10.1111/bjd.13583
61.
SendenC.VandecasteeleT.VandenbergheE.VersluysK.PiersR.GrypdonckM.Van Den NoortgateN. (2015). The interaction between lived experiences of older patients and their family caregivers confronted with a cancer diagnosis and treatment: A qualitative study. International Journal of Nursing Studies, 52(1), 197–206. https://doi.org/10.1111/bjd.13583
62.
SerçeÖ.GünüşenN. P. (2021). The interaction between hematological cancer patients and family caregivers and their life changes: A qualitative dyadic approach. Cancer Nursing, 44(4), E201–E208. https://doi.org/10.1097/NCC.0000000000000800
63.
SercekusP.BesenD. B.GunusenN. P.EdeerA. D. (2014). Experiences of family caregivers of cancer patients receiving chemotherapy. Asian Pacific Journal of Cancer Prevention, 15(12), 5063–5069. https://doi.org/10.7314/APJCP.2014.15.12.5063
64.
ShamaliM.ØstergaardB.KonradsenH. (2020). Living with heart failure: Perspectives of ethnic minority families. Open Heart, 7(1), Article e001289. https://doi.org/10.1136/openhrt-2020-001289
65.
SongL.NorthouseL. L.ZhangL.BraunT. M.CimprichB.RonisD. L.MoodD. W. (2012). Study of dyadic communication in couples managing prostate cancer: A longitudinal perspective. Psycho-Oncology, 21(1), 72–81. https://doi.org/10.1002/pon.1861
66.
TraaM. J.De VriesJ.BodenmannG.Den OudstenB. L. (2015). Dyadic coping and relationship functioning in couples coping with cancer: A systematic review. British Journal of Health Psychology, 20(1), 85–114. https://doi.org/10.1111/bjhp.12094
67.
TreanorC. J.SantinO.PrueG.ColemanH.CardwellC. R.O’HalloranP.DonnellyM. (2019). Psychosocial interventions for informal caregivers of people living with cancer. Cochrane Database of Systematic Reviews, 2019(6), Article CD009912. https://doi.org/10.1002/14651858.CD009912.pub2
68.
Trudeau-HernS.DaneshpourM. (2012). Cancer’s impact on spousal caregiver health: A qualitative analysis in grounded theory. Contemporary Family Therapy, 34(4), 534–554. https://doi.org/10.1007/s10591-012-9211-9
69.
UssherJ. M.Tim WongW. K.PerzJ. (2011). A qualitative analysis of changes in relationship dynamics and roles between people with cancer and their primary informal carer. Health (London, United Kingdom), 15(6), 650–667. https://doi.org/10.1177/1363459310367440
70.
ValenteS. (2011). Nurses’ perspectives of challenges in end of life care. JOCEPS: The Journal of Chi Eta Phi Sorority, 55(1), 28–31.
71.
Van HumbeeckL.DillenL.PiersR.DeveugeleM.GrypdonckM.VerhaegheS.Van Den NoortgateN. (2015). Tightrope walkers suffering in silence: A qualitative study into the experiences of older parents who have an adult child with cancer. International Journal of Nursing Studies, 52(9), 1445–1453. https://doi.org/10.1016/j.ijnurstu.2015.05.010
72.
Van HumbeeckL.DillenL.PiersR.GrypdonckM.VerhaegheS.Van Den NoortgateN. (2019). Cancer patients’ experiences of communicating and dealing with their older parents: A qualitative study. European Journal of Oncology Nursing, 38, 98–103. https://doi.org/10.1016/j.ejon.2018.12.005
73.
VoltelenB.BjerreJ. (2018). Familiedialog og refleksion ved alvorlig sygdom: En guide for sundhedsprofessionelle [Family dialogue and reflection on serious illness: A guide for health professionals]. Samfundslitteratur.
74.
VoltelenB.KonradsenH.ØstergaardB. (2016). Family nursing therapeutic conversations in heart failure outpatient clinics in Denmark: Nurses’ experiences. Journal of Family Nursing, 22(2), 172–198. https://doi.org/10.1177/1074840716643879
75.
WachithaP. S.DeviL. U. (2015). Family interactions/communications through out life span. IOSR Journal of Humanities and Social Science, 20(3), 29–32. https://doi.org/10.9790/0837-20312932
WeiJ. T.DunnR. L.LitwinM. S.SandlerH. M.SandaM. G. (2000). Development and validation of the expanded prostate cancer index composite (EPIC) for comprehensive assessment of health-related quality of life in men with prostate cancer. Urology, 56(6), 899–905. https://doi.org/10.1016/S0090-4295(00)00858-X
WittenbergE.BullerH.FerrellB.KoczywasM.BornemanT. (2017). Understanding family caregiver communication to provide family-centered cancer care. Seminars in Oncology Nursing, 33(5), 507–516. https://doi.org/10.1016/j.soncn.2017.09.001
80.
WittenbergE.FerrellB.GoldsmithJ.RuelN. H. (2017). Family caregiver communication tool: A new measure for tailoring communication with cancer caregivers. Psycho-Oncology, 26(8), 1222–1224. https://doi.org/10.1002/pon.4251
81.
WoottenA. C.AbbottJ. M.OsborneD.AustinD. W.KleinB.CostelloA. J.MurphyD. G. (2014). The impact of prostate cancer on partners: A qualitative exploration. Psycho-Oncology, 23(11), 1252–1258. https://doi.org/10.1002/pon.3552
WrightL. M.LeaheyM. (2013). Nurses and families: A guide to family assessment and intervention (6th ed.). F.A. Davis.
85.
ZhangA. Y.SiminoffL. A. (2003). Silence and cancer: Why do families and patients fail to communicate?Health Communication, 15(4), 415–429. https://doi.org/10.1207/S15327027HC1504_03
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
