Understanding the patient-spouse communication experience during chemotherapy for gastric cancer based on the couple's adaptation to cancer intimacy model: a directed content analysis

Abstract

Purpose: This study analyzes the communication experience between gastric cancer patients and their spouses regarding the disease. It also evaluates the impact of positive or negative communication on Psychological Adaptation and couples' Relationship Intimacy. The ultimate objective was to help nurses develop effective patient-spouse communication strategies that promote the psychological well-being of patients and their spouses.

Method: Based on The Relationship Intimacy Model of Couple Adaptation to Cancer, the study used purposive sampling to select participants, guided by the principle of maximum variation. Sixteen pairs of patients with gastric cancer and their spouse caregivers, hospitalized in the oncology department of a tertiary hospital in Jingjiang City, Jiangsu Province, between March and July 2023, were chosen for semi-structured face-to-face interviews. Within 24 h after each interview, the recorded data were transcribed and supplemented with field notes. Directed content analysis was used for qualitative content analysis.

Results: The interview data revealed five themes and 12 subthemes: (1) Negative Spousal Communication, which includes (i) lack of awareness of proactive communication, (ii) lack of emotional interaction and patience in exchange, and (iii) substituting conflict for communication; (2) Positive Spousal Communication, which includes (i) appropriate communication topics, (ii) appropriate timing and approach, and (iii) integration with emotional support; (3) Protective Concealment, which includes (i) suppressing emotions and making compromises and (ii) avoiding taboo topics; (4) Negative Spousal Disease Communication, which may lead to reduced psychological adaptation and a decline in couples' relationship intimacy; and (5) Positive Spousal Disease Communication, which may enhance psychological adaptation and strengthen couples' relationship intimacy. During chemotherapy, gastric cancer patients and their spouses experienced positive, negative, and Protective Concealment communication patterns. Both psychological adaptation and relationship intimacy are significantly influenced by spousal disease communication.

Conclusions: For patients with gastric cancer and their spouses, nurses should focus on the importance of spousal disease communication during chemotherapy, take positive measures to mitigate one-side, conflictual communication and avoidance behaviors, and adopt appropriate communication cut-in content and timing to promote couple communication deeply, with the need to focus on physical and psychological stress of the protective concealment in couple.

Keywords: Chemotherapy; Communication (MESH); Couples therapy (MESH); Qualitative research (MESH); Spouses (MESH); Stomach neoplasms (MESH).