HOW FAMILY COMMUNICATION PATTERNS AND CONFLICT …

HOW FAMILY COMMUNICATION PATTERNS AND CONFLICT MANAGEMENT

AFFECT CANCER PATIENTS’ SUPPORT SATISFACTION AND AVAILABILITY

by

TARA J. ABBOTT

(Under the Direction of Jennifer A. Samp)

ABSTRACT

This study examines the relationship between family communication patterns, conflict

management styles, and cancer patients’ perceptions of received social support. Fifty-three

cancer survivors recruited from online message boards completed an online survey which

assessed their level of family conformity and conversation orientations, their conflict

management styles, their perceptions of the amount and types of support they receive from their

primary support provider, and their perception of optimal matching of support. Results indicated

that although there were not significant relationships between level of conformity and perception

of received social support or optimal matching, there were significant relationships between a

patient’s level of family conversation orientation and his/her amount of communication with

family about the cancer and support needs, perception of received support and optimal matching.

There were also significant relationships between particular conflict management styles and

perceived optimal matching.

INDEX WORDS: Family communication patterns, Conflict styles, Social support, Optimal

Matching, Cancer



by

TARA J. ABBOTT

B.A., Boston College, 2006

A Thesis Submitted to the Graduate Faculty of the University of Georgia in Partial Fulfillment of

the Requirements for the Degree

MASTER OF ARTS

ATHENS, GEORGIA

2008

© 2008

TARA J. ABBOTT

All Rights Reserved



by

TARA J. ABBOTT

Major Professor: Jennifer A. Samp

Committee: Jerold Hale

Jennifer Monahan

Electronic Version Approved:

Maureen Grasso

Dean of the Graduate School

The University of Georgia

August 2008

iv

DEDICATION

This thesis is dedicated first and foremost to my parents. Their endless encouragement

and support are the foundation of all of my accomplishments. I am both so grateful for and so

inspired by their patience, love, and generosity.

I also dedicate this work to Betsy, Carolyn, and Katie for continuously standing by me

the last two years. I could not have asked for better friends and classmates to experience graduate

school with and to keep me laughing.

This work is also dedicated to Lauren and Danielle, my Georgia family, who have truly

made the South my home. I could not have made it through the last two years without their

humor and compassion. I feel so lucky and honored to call them my friends.

And finally, this thesis is dedicated to Dorothy, the inspiration for this project. She

exuded passion, love and positive energy each day of her life. She may have lost her fight with

cancer, but her amazing spirit and heart continue to live on in all the people whose life she

touched.

v

ACKNOWLEDGEMENTS

I would like extend my sincerest gratitude to Dr. Jennifer Samp for her endless

commitment to this project. Her input and encouragement from start to finish have been

irreplaceable. I am so lucky to have had the opportunity to have her as a teacher and as an

advisor these past two years. I am a stronger student and a more thoughtful individual as a result

of having learned from her.

I would also like to thank Dr. Jennifer Monahan and Dr. Jerold Hale for their insight and

support. I am extremely grateful for all the time and energy they devoted to this project.

vi

TABLE OF CONTENTS

PAGE

ACKNOWLEDGEMENTS.........................................................................................................v

LIST OF TABLES...................................................................................................................viii

CHAPTER

1 INTRODUCTION .....................................................................................................1

2 LITERATURE REVIEW AND PREDICTIONS .......................................................4

Social Support and Well-being ..............................................................................4

Conflict and its Hazardous Effects.......................................................................10

Family Communication Patterns and Conflict Management Styles ......................17

Hypotheses and Research Questions ....................................................................21

3 METHOD................................................................................................................30

Sample and Procedure .........................................................................................30

Measures .............................................................................................................32

4 ANALYSES AND RESULTS .................................................................................39

Preliminary Analyses...........................................................................................39

Tests of Hypotheses.............................................................................................48

6 DISCUSSION, LIMITATIONS AND CONCLUSION............................................60

Observations about Optimal Matching.................................................................60

Observations about Conversation Orientation ......................................................65

Observations about Conformity Orientation.........................................................69

vii

Limitations and Future Research..........................................................................75

Conclusion ..........................................................................................................78

REFERENCES .........................................................................................................................82

APPENDICES ..........................................................................................................................87

A SOLICITATION LETTER ......................................................................................87

B LETTER OF INFORMED CONSENT ....................................................................88

C QUESTIONNAIRE .................................................................................................90

viii

LIST OF TABLES

PAGE

Table 1: Correlations among Independent and Dependent Variables..........................................39

Table 2: Hierarchical Regression of the Family Conversation Orientation and the Family

Conformity Orientation on the Frequency of Family Discussion about the Cancer ......48


Conformity Orientation on the Perceived Amount of Emotional Support ....................50


Conformity Orientation on the Perceived Amount of Tangible Support ......................51


Conformity Orientation on the Perceived Amount of Informational Support ...............52


Conformity Orientation on the Amount of Patient Talk about Support Needs..............53


Conformity Orientation on External Support Optimal Matching .................................54


Conformity Orientation on Within-Family Optimal Matching.....................................55

Table 9: Hierarchical Regression of the Collaboration and Compromise, Avoidance,

Competition, and Accommodation Conflict Management Styles on External Support

Optimal Matching ......................................................................................................57

ix

Table 10: Hierarchical Regression of the Collaboration and Compromise, Avoidance,

Competition, and Accommodation Conflict Management Styles on Within-Family

Optimal Matching.......................................................................................................58

1

CHAPTER 1

INTRODUCTION

When an individual is diagnosed with cancer, the impact of the diagnosis extends far

beyond that individual who is diagnosed. The diagnosis not only marks a change in the physical

health and well-being of the individual, but consequently also marks the beginning of what is

sure to be a drastic change in the overall dynamic of the individual’s family unit. Only recently,

however, have researchers begun focusing their efforts on studying the effects of illness on the

family unit as a whole (Revenson, 1994). Martire, Lustig, Schulz, Miller, and Helgeson (2004)

explain that severity of a patient’s illness is related to strain in family relationships. The stress

experienced by a patient due to such things as physical discomfort, a more restricted lifestyle,

and fear of the future combined with the stress experienced by other family members resulting

from such things as fear of losing their loved one and increased responsibilities can breed a

negative environment that has the potential for much conflict. Glasdam, Jensen, Madsen, and

Rose (1996) explain, for example, that family stress resulting from a patient’s illness is often

accompanied by anger and greater difficulty coping with daily stress. Ell (1996, p. 174) suggests

that, “families are not merely static resource banks from which a seriously ill member withdraws

desirable social supports.” She emphasizes that families, particularly in these trying

circumstances, can be additional sources of stress and can unintentionally hamper both the

communication a support-receiving process (Ell, 1996). Unfortunately, it is during this extremely

stressful time when the potential for conflict, negative energy, and poor communication within

2

the family is so high, that it is also critical that the family unit pulls together and finds some way

to meet the staggering social support needs of the sick individual.

Because a supportive environment is so important to the physical and mental health of a

patient (Albrecht, Burleson, & Goldsmith, 1994), it is imperative that there is an examination of

how patients perceive the type and amount of social support provided by their primary support

providers within their family and what family communication characteristics post diagnosis

influence these perceptions. We must also examine how cancer patients perceive handling

conflict within their family following the diagnosis in order to determine how it could potentially

influence not only the overall family dynamic, but also the ability for the patients’ to feel

satisfied with the support efforts made by their family members.

This thesis proposes that family communication patterns can be used to understand and

predict the types and amount of support that cancer patients receive from their family members

after their diagnosis. It will also be argued that the conflict management used within the families

following the diagnoses will influence the patients’ perceived satisfaction with their support. In

order to carry out this study, 53 adult cancer survivors were asked to answer questions regarding

how their families communicate, the types of support they perceive themselves as receiving since

the diagnosis, their satisfaction with their support and also the way they believe they manage

conflict within their family. The hope is that this research can provide future insight into

protecting the well-being of the family unit during a particularly trying and uncertain time so that

the cancer patient can receive optimal support with minimal burden to the other already

overwhelmed family members. Allowing a cancer patient the best possible opportunity to live a

happy and satisfying life involves much more than just treating the physical symptoms of the

cancer. Hopefully medical staff and professionals will be able to apply the findings of this

3

research to their own professions to ensure that they can provide their patients not only with the

proper medical treatment, but also the proper communication tools and strategies to ensure that

their life and environment at home is positively contributing to the overall health and wellbeing

of the patient.

In the remainder of this paper I will review past literature related to the concepts

underlying this thesis project and explain my predictions that developed out of an analysis of this

past research (Chapter 2). I will then describe the methods (Chapter 3) and results of this study

(Chapter 4). I will conclude by offering an analysis of these findings and their potential

implications (Chapter 5).

4

CHAPTER 2

LITERATURE REVIEW AND PREDICTIONS

This chapter will provide a review of the existing literature on the concepts of social

support (particularly that relating to physical illness), optimal matching, conflict and family

communication patterns. There will also be an overview of the different literature exploring the

relationship and possible interaction between social support and conflict. This chapter will

conclude with a presentation and explanation of the hypotheses and research questions for this

study.

Social Support and Well-being

When an individual within a family unit is diagnosed with a potentially terminal illness,

social support becomes an essential component of the relationship between the family members.

The exchange of social support is a way of ensuring the physical and emotional wellbeing of the

sick family member. Albrecht, Burleson, and Goldsmith (1994) explain that receiving social

support is associated with reduced sorrow or distress, improved recovery from illness, increased

resistance to disease, and improved psychological adjustments. Blanchard, Albrecht,

Ruckdeschel, Grant, and Hemmick (1995) found that social support plays an important role in

reducing and/or buffering hopelessness, depression, and other negative psychological responses

to chronic and terminal illnesses. In an examination of the feelings of hopelessness felt by cancer

patients, it was found that patients who had less social support had more symptoms of

hopelessness. Also, those patients who reported less social support also indicated more

symptoms of depression, thereby suggesting that individuals receiving more social support have

5

a greater likelihood of better psychological adjustment than those with less available support (Gil

& Gilbar, 2001). Therefore, it could be determined from this study that social support is an

important external resource for coping with various stressors, particularly those stressors

resulting from serious illness (Gil & Gilbar, 2001). Ensuring that the support needs of the sick

family member are being met not only helps to improve the well-being of the sick individual but,

in doing so, also helps to prevent the stress and burnout of his/her family members that could

result from the frustration of not being able to adequately address the needs of their loved one.

With this in mind, it is important that we not only have a conceptual understanding of social

support but also an understanding of which types of support are optimal in particular

circumstances. To do this, the concept of social support must be explicated and its critical

components identified.

Since the 1970s, a great deal of research has been done relating to the concept of social

support (Cobb, 1976; Norbeck, Lindsey, & Carrieri, 1981). Even with all the attention paid to the

concept, however, a universal description of social support has yet to be developed. Norbeck,

Lindsey, and Carrieri (1981) explain, “at one extreme, simple contact or presence of another

during a stressful experience is described as social support, at the other extreme, elaborate

formulations about social network properties are suggested as essential properties to study” (p.

264). Cobb (1976) defined social support as information leading to one or more of three

categories: believing one is esteemed and valued, feeling cared for, and believing one belongs to

a reciprocal communication network. Since then, the term social support has been used as a

blanket term to describe many communication styles and networks that aid with coping in a

number of different contexts.

6

Sarason, Levine, Basham, and Sarason (1983) describe social support as “the existence or

availability on people whom we can rely, people who let us know that they care about, value, and

love us” (p. 127). Kahn (1979) developed a general, yet more descriptive and structured

definition that states that social support is an “interpersonal transaction that includes one or more

of the following: the expression of positive affect of one person towards another; the affirmation

or endorsement of another person’s behaviors, perceptions, or expressed views; the giving of

symbolic or material aid to another” (p. 85). Piko (1998) defines social support as an interactive

process in which certain behaviors can positively affect one’s social, physical, and/or

psychological well-being. While there are dozens of other conceptualizations of social support

that recognize its multi-dimensionality, with some emphasizing the structural component (the

actual social network) and others emphasizing the functional component (the perceived types and

amount of available resources), many researchers that examine social support and conflict

interdependently use definitions which align with those just described and, therefore, those are

the ones that will be used for the purposes of this paper.

Several studies have focused on what types of social support and which social support

networks best meet the needs of certain individuals in various contexts. Robinson and Turner

(2001) suggest that the source from which the social support comes can, in some instances, be

just as important as the social support itself. Intimate relationships such as those between family

members have been found to be suitable for providing multiple types of support simultaneously

to meet the changing needs of an individual (Eggert, 1987). Glasdam, Jensen, Madsen and Rose

(1996) specify that most married patients identify their spouses as their most important sources

of support.

7

Judging by past research it appears that, in most cases, the members of the family unit are

the critical support providers. This places a great deal of responsibility in the hands of these

individuals. Not only must the family members be willing and able to offer support, but in order

to be helpful and successful support providers, they must be able to recognize the types and

amount of support desired by those individuals in need. Of course, social support does not look

the same in every situation. Support comes in a variety of different forms and can be manifested

in a variety of ways. It is important to identify these common support types and to recognize that

certain coping situations require particular types of support.

While certain scholars will acknowledge different types of social support, usually

depending on the context of their research, there are three main types of socially supportive

interactions: emotional, tangible, and informational (Helgeson & Cohen, 1996). Emotional

support occurs when individuals interact with others to achieve feelings of comfort or a sense of

belonging in times of difficulty (Cutrona & Russel, 1990). This type of support, therefore,

involves providing love, empathy, and trust to a coping individual (Piko, 1998). Tangible support

involves the provision of goods and services, such as financial assistance or help with daily

chores/errands. Informational support is when information or guidance is provided to the coping

individual by the support provider in order to help solve a problem; for example, when an

individual provides a cancer patient with a list of top oncologists in his/her area.. In recognizing

that there are different types of support, we must also recognize that these support types serve

different purposes and meet different needs of a coping individual. It seems logical to believe

that individuals will perceive certain types of support as more important than others depending

on which needs they find most pressing and will, therefore, be more receptive to those support

8

types. To understand this idea more, we can turn to research by Cutrona and Russel (1990) on

the concept of optimal matching.

Optimal matching. It has been suggested that support that comes from the wrong person

or that is perceived as the wrong kind may, in fact, worsen one’s stress level (Taylor, Falke,

Shoptaw & Lichtman, 1986). Glasdam et al. (1996) identified that those patients satisfied with

the support from family members were significantly less depressed and anxious than those who

were not satisfied with their support. Cutrona and Russel (1990) developed the theoretical model

of optimal matching that suggests that social support is most effective when the type of support

needed is the type of support provided. Optimal matching theory (OMT) recognizes the

distinction between three different types of support: emotional, informational, and tangible.

OMT argues that the relative importance of these support types as social resources depends on

how controllable an individual’s stressors are. When it comes to uncontrollable stressors such as

death and illness, OMT suggests that emotional support will be most important. When it comes

to more controllable stressors, however, OMT argues that tangible and informational support will

be most important. Cutrona and Russel (1990) also explained, however, that an illness is an

uncontrollable event that can influence a variety of aspects of an individual’s life and, therefore,

support that addresses each of these aspects will be most effective. Ell (1996) suggests that

optimal support can only occur when there is clear, accurate communication of need by an

individual and sufficient ability on the part of the support providers to meet that expressed need.

Clearly, during time of serious illness within a family, many circumstances can hinder both the

patient’s communication and the family members’ support-giving abilities, thereby making

optimal matching an extremely challenging and potentially all too rare occurrence.

9

Hazards of not achieving optimal matching. Ensuring that a sick individual gets the type

and amount of support that he/she requires can be challenging for anyone, but it is particularly

challenging for that individual’s family members who are usually experiencing their own anxiety

and hurt over the sickness of their loved one. The sick individual’s family members are usually

trying to cope with their own feelings and challenges while also being a coping devise for their

loved one. A lack of optimal matching of social support, however, can not only be detrimental to

the well-being of the individual in need, but also to the well-being of the support providers and

the familial relationships.

Because it is so difficult for family members to recognize what level of support will be

sufficient for their sick loved ones, they often struggle with how much physical and emotional

assistance to offer. Revenson (1994) suggests that relational partners have difficulty balancing on

the line between being supportive of their sick spouses and being too controlling and smothering.

Ell (1996) argues that well-intentioned support that is misguided can often lead to a decrease in a

patient’s communication about distressful feelings which can, in turn, cause overprotectiveness

on the part of the caregivers and eventually have a negative effect on a patient’s perceived self-

efficacy and coping abilities. Some evidence also shows that the degree to which family

members are willing to engage in supportive behaviors may be influenced by the patient’s ability

to cope with the emotions pertaining to his/her illness. Revenson (1994) suggests that spouses of

seriously ill individuals who are seen as highly distressed and continuously poor at coping may

decrease their supportive efforts with the fear that any efforts will be ineffective.

The concerns that arise from being a primary support provider can have significant

effects on the provider’s lifestyle and well-being. Glasdam et al. (1996) report that spouses of

patients often report greater anxiety, a poor ability to cope with daily stresses, and physical

10

symptoms resulting from fatigue and stress in addition to having strong feelings of anger, guilt,

increased vulnerability. They also found that the spouses rarely talked about or addressed any of

these personal issues with family and/or friends and felt that they had little support provided to

them by others. Revenson (1994) explains that spouses are often reluctant to disclose emotions

or personal concerns to their partners for fear of placing further burden on their already sick

loved ones. As a result, however, it is possible that the emotional needs of both the patient and

the partner are not adequately met.

The stress that results from the obligation family members feel to provide adequate

support to their loved ones, added to the nervousness and fear that is present when there is a life-

threatening illness in the family, can cause an environment that has the potential for extreme

conflict. While conflict always has the potential to cause discomfort and hurt within a family, the

stakes are heightened in families that are dealing with illness. Conflict in families with a sick

family member has the potential not only to add further stress and anxiety to the home

environment, but also to hamper the flow of support within the family unit. To have a better

understanding of this potential, however, we must first conceptualize social conflict and its

recognized relationship to social support.

Conflict and its Hazardous Effects

Much like the conceptualization of social support, the conceptualization of social conflict

has varied significantly depending on the researcher examining it and the context in which it has

been examined. If social support represents the positive aspects of a support network, then social

conflict represents the negative aspects of a support network (MaloneBeach & Zarit, 1995).

Abbey, Abramis, and Caplan (1985) defined conflict using the concept of social support when

they explain, “If social support represents the potentially positive aspects of interpersonal

11

relations, such as expressions of positive affect and affirmation, then social conflict represents

the potentially negative aspects of these relations, such as expressions of negative affect and

disconfirmation” (p.114). Moos and Schaefer (1984) explain that social conflict has sometimes

been defined as the extent to which anger and aggression characterize a relationship.

MaloneBeach and Zarit (1985) further specified that interactions that lack overt aggression and

are, instead, made up more of frustration, hurt and irritation can also be identified as conflictual.

These various interpretations of social conflict suggest that conflictual situations must not always

arise from bad intentions or one individual’s lack of consideration for another; they can also arise

from misguided or poorly executed well-intentioned actions (MaloneBeach & Zarit, 1985).

Social conflict, like social support has been found to have significant ties to well-being.

MaloneBeach and Zarit (1985) explained that social conflict can lead to lower life satisfaction

and cognitive functioning problems. The relationship that social support and social conflict share

with an individual’s well-being is not the only connection these concepts have to one another. In

fact, social support and conflict are often co-existing concepts in the lives of loved ones,

particularly in times of heightened stress and uncertainty.

Relationship between conflict and social support. There are a few different ways in which

the concepts of social support and conflict can be linked to one another. Conflict and distress can

be the result of well-intentioned social support. Support providers can intend to be helpful by

providing various types of aid, but may do so in a way that is perceived as insensitive by the

recipient, thereby causing conflict between the two parties (Barrera, Chassin, & Rogosch, 1993).

This is in line with MaloneBeach and Zarit’s (1985) understanding of social conflict as distress

that results from both good and bad intentions. MaloneBeach and Zarit (1995) observed, for

example, that the pressure a caregiver feels when he/she perceives that the individual being cared

12

for is continuously requesting an alternative approach to the caregiving can lead to significant

conflict.

In addition to conflict being the result of a support providers’ well-intentioned aid, there

are also those situations in which conflict arises from the negative interactions an individual has

with the same people who provide him/her with support (Barrera, Chassin, & Rogosch, 1993).

Barrera (1981) described this as “conflicted support.” Manne and Schnoll (2001), when

examining cancer patients and their support providers, identified three types of unsupportive

responses from support providers that are considered common within this context: overtly critical

and insensitive responses, the avoidance of and withdrawal from the patient, and the

encouragement of the patient to distance him/herself from the cancer experience (i.e., refrain

from discussing it, trying to keep feelings to him/herself). These unsupportive responses may be

a result of burnout on the part of the support provider or perhaps an attempt at emotional

distancing. Carter and Carter (1994) studied marriages in which one partner suffered from cancer

and observed patient-spouse interactions that indicated an oscillation that entailed the partners

interacting up to a critical point of intimacy and then quickly disengaging with force through

interpersonal conflict, only to repeat the cycle.

Research has also been done examining the possible interaction effects between the

presence of social support and conflict on and individual’s wellbeing. Barrera et al. (1993)

examined the potential for “synergistic effects” of interactions between social support and

conflict by looking at effects of social support and conflict on adolescents of alcoholic and

nonalcoholic parents. They argued that synergistic effects occur when high conflict neutralizes

the effectiveness of social support or when low conflict provides situations suitable for

individuals to better reap the benefits of social support. Barrera et al. (1993) found no evidence

13

that conflict in a relationship neutralizes the effectiveness of the social support provided in that

relationship, suggesting that adolescent children have separate appraisals of parental support and

conflict. Their findings reinforce the possibility that increasing the supportiveness of family and

friend relationships is entirely unrelated to decreasing conflict within these relationships and vice

versa.

Research in a number of different contexts has been done to examine the simultaneous

effects of social support and social conflict on individual well-being. Major, Zubek, Cooper,

Cozzarelli, and Richards (1997), for example, looked at the implications of social conflict and

social support within close relationships for post-abortion adjustment. The main goals of the

study were to compare the impacts of perceived support and perceived conflict on adjustment to

stressful life events and to explore the potential for interactive effects of support and conflict on

adjustment. Major et al. (1997) used two pre-established hypotheses to interpret the results: the

social negativity hypothesis and the affect-matching hypothesis. The social negativity hypothesis

assumes that conflict in social relationships is a greater predictor of mental health than is social

support in those relationships, given that a substantial amount of evidence supports the idea that

negative events are weighed more heavily in one’s judgment and, therefore, result in stronger

effects on mental health and well-being than do positive events. The affect-matching hypothesis

assumes that perceptions of social support are stronger predictors of positive indexes of mental

health, whereas perceptions of social conflict are stronger predictors of negative indexes of

mental health. Though neither hypothesis obtained complete support, there was stronger support

for the affect matching hypothesis than the social negativity hypothesis. Pre-abortion conflict

was found to uniquely predict post-abortion distress, whereas pre-abortion support was a unique

predictor of post-abortion wellbeing (Major et al., 1997). Although there was no evidence of an

14

interaction between partner conflict and partner support in terms of mental health, social conflict

from either the mother or the friend interacted with social support from that same individual to

predict psychological distress. For example, women who perceived their mothers as non-

supportive were just as likely to be as distressed if their mothers were a source of high conflict as

if their mothers were a source of no conflict, whereas women who perceived their mothers to be

very supportive were significantly more distressed if they also perceived them as being sources

of high conflict than if they perceived them as sources of no conflict (Major et al., 1997).

Although post-abortion coping is very different than coping with cancer, considering that the act

of abortion is an individual’s choice and not a threat to his/her life, this finding still helps to

illustrate the importance of considering family conflict when examining the satisfaction with

family support and the effect of that support on the cancer patients well-being. It suggests that

during times of heightened sensitivity and stress, the presence of conflict between a patient and

his/her primary support provider could effect the satisfaction with and usefulness of his/her

available support.

Abbey, Abramis, and Caplan (1985) researched the effects of different sources of social

support and social conflict on an individual’s emotional wellbeing. They sought to determine

whether or not the significance of an interaction between social support and social conflict was

related to the type of source an individual was referring to. Each respondent was asked to explain

how much social support and how much conflict he/she experienced with respect to either the

person closest to them, some one person, or people in their personal life (Abbey et al., 1985).

They hypothesized that social conflict and social support would only be negatively and

moderately correlated in those situations where the source was people in their personal life or

some one person, given that individuals can receive both social support and social conflict at the

15

same time from different sources or from the same source (i.e. if someone gives useful

information in an argumentative way). They also hypothesized, however, that the negative

relationship between social support and conflict would be stronger when the source was the

person closest to them. They suggested that this would be because they are less likely to feel

closest to individuals who provide significant conflict along with support. Their hypotheses

regarding the correlation between social support and social conflict were supported (Abbey et al.,

1985). Results of their research also suggested a buffering effect, but only in some conditions.

For respondents who reported receiving low support from some one person, there was a strong,

positive relationship between social conflict and feelings of anxiety, depression, and

interpersonal sensitivity, while there was a strong, negative relationship between social conflict

and quality of life. As for respondents who reported high levels of social support, however, the

relationship between conflict and well-being was not exhibited (Abbey et al., 1985).

All of these findings highlight the importance of continued research on the relationship

between conflict and social support, particularly in situations of high-anxiety. There is strong

evidence suggesting that both social support and conflict are critical factors influencing the well-

being of coping individuals and that supportive relationships have the potential to be breeding

grounds for conflict in situations of high stress and uncertainty. The fact, however, that some

research has found a relationship between conflict and social support, while other results would

imply that there is no direct relationship suggests that further exploration and explanation is

needed. Rather than solely considering the amount of conflict in families in which significant

social support is required, what is needed is an examination of the way in which conflict is

managed when it does arise. A family situation where one individual has been diagnosed with a

life-threatening illness is a particularly important context in which to explore conflict

16

management and social support. This is because the potential for conflict is heightened more so

than in other situations, partly because of fear of the suffering and potential death of the cancer

patient and partly because of the constant support that the diagnosed individual may expect of

family members. Because the individuals in this situation have very little control over the factors

that could easily spark conflict, it is an extremely important context in which to focus on the

effects of conflict management strategies rather than just the amount of conflict. The conflict

management styles the various families in this situation use could have an important connection

to the social support that the sick individuals perceive as being available to them. When conflict

is not managed in a constructive way it could influence the ability for the family members to

provide adequate amounts or types of support. It could also influence the ability the individual in

need has to perceive or be open to the support being offered. Conflict management could also be

a useful predictor of which supportive relationships have the greatest potential to breed conflict.

In a situation where a life-threatening illness is involved and, therefore, where social support is

of the utmost importance, it is important to consider how a variety of the factors influencing the

family dynamic could work together to influence the satisfaction the patient feels with his/her

support.

Given the fact that not all families operate or communicate in the same way, we can not

expect all families to handle a life-threatening diagnosis in a similar manner. The ways in which

families deal with providing support and manage conflict are partially a reflection of their overall

family dynamic and interaction patterns. Therefore, one must have an understanding of the

different communication patterns that characterize families in order to gain insight into their

supportive capabilities.

17

Family Communication Patterns and Conflict Management Styles

Koerner and Fitzpatrick (2002, p. 71) define the term family as, “a group of intimates

who generate a sense of home and group identity and who experience a shared history and a

shared future.” Fitzpatrick and Ritchie (1994) conceptualized two sets of beliefs, known as

conversation orientation and conformity orientation, as beliefs that will determine how family

members will go about communicating and interacting with each other.

Conversation orientation is the degree to which families create an environment in which

all of the members feel unrestrained when it comes to communicating about a wide range of

topics. Members of families that fall on the high end of the conversation orientation encourage

one another to participate in communication frequently and openly. Individuals in these types of

families spend lots of time with one another and discuss a number of different topics regarding

their thoughts, emotions, and individual activities without feeling as though there are restrictions

as to what they are permitted to discuss or how much time they should spend interacting with

one another (Koerner & Fitzpatrick, 2002). Families high in conversation orientation use open

and frequent communication in family decision making and stress that this open communication

is the key to a successful and rewarding family life. Those families on the low end of the

conversation orientation dimension usually don’t spend as much time interacting with one

another and only have a few topics that all the members feel comfortable discussing openly with

one another. The exchange of personal thoughts and feelings does not occur frequently in these

low conversation orientation families because they do not see openness as essential for the

functioning of a family unit.

In addition to conversation orientation, dimension influencing communication within the

family is conformity orientation (Koerner & Fitzpatrick, 2002). The conformity orientation

18

dimension deals with the degree to which family communication stresses every member sharing

similar values, attitudes, and beliefs. Families that are on the high end of this dimension focus on

emphasizing the uniformity and harmony of the family unit through their interactions. As a

result, families high in conformity orientation value the interdependence of family members and

try to avoid conflict as much as possible. High conformity orientation families value the family

relationship over any and all other relationships outside of the family unit and, therefore, try to

maximize the time they spend together. Families high in conformity orientation are also those

families that value a hierarchy and, therefore, often do not involve children (if there are any) in

the decision making process. When it comes to specific speech acts, individuals in families high

in conformity orientation frequently engage in advice giving and evaluating of others’ behaviors

based on their own attitudes and perspectives (Koerner & Cvancara, 2002). Families that are on

the low end of the conformity orientation dimension, on the other hand, emphasize the

individuality of family members and each member’s independence from the family. As a result,

low conformity orientation families do not follow the traditional, hierarchical family structure

but rather believe that it is important to foster individual growth and personal relationships

outside of the family even if it is at the expense of the cohesiveness of the family unit (Koerner

& Fitzpatrick, 2002). When it comes to specific speech acts, individuals in low conformity

families deliver more confirming statements and value-free reflections of others’

communication. Communication within these low conformity families is freer and more

spontaneous (Koerner & Cvancara, 2002).

Family communication patterns also influence how people manage conflict within their

families. I argue that a focus on how families manage conflict, rather than just focusing on the

amount of conflict within the family, may provide insight into the conflicting research regarding

19

the relationship between social support and conflict. As previously mentioned, some research has

found a relationship between conflict and social support, while other results would imply that

there is no direct relationship. A reason for this discrepancy between findings could be that these

past studies explored the amount of conflict within families when, perhaps, the relationship

between conflict and the presence of and satisfaction with social support is actually a result of

how conflict is managed rather than whether or not it is significantly present. In the context of

cancer, where numerous uncontrollable stressors make conflictual situations nearly unavoidable,

conflict management is important to explore in order to determine whether or not satisfactory

support can still be offered and under what circumstances.

Conflict can either be managed constructively or destructively. Noller, Feeney, Sheehan,

and Peterson (2000) explain that constructive conflict management involves openly sharing

differences and supporting one another in joint problem solving so that there can be some sort of

mutually acceptable solution. There have been found to be five important conflict behaviors that

vary along two dimensions- concern for self and concern for the relationship (Rahim, 1983).

Which conflict behaviors individuals typically choose to use within the family unit will

determine whether or not conflict is resolved constructively or destructively (Noller et al., 2000).

Competition involves a high concern for self and a low concern for the relationship. Individuals

that engage in this conflict behavior are concerned with being the “winner” of the conflict rather

than with ensuring that the needs and concerns of all parties involved are being addressed.

Competitive individuals may use their power or expertise to persuade others that they are right

and deserve to have their needs met. Collaboration involves a high concern for both the self and

the relationship. Both parties work together to come up with a solution in which everyone

involved gets what they want and are completely satisfied with the outcome. This style involves

20

high levels of disclosure on the part of the individuals and much discussion regarding the issues.

The accommodating conflict behavior involves a low concern for self but a high concern for the

relationship. Individuals with this conflict behavior give in to others’ wishes and opinions at the

onsite of conflict so as to not have to deal with the issues and so as not to disturb their

relationships. The compromise behavior involves a moderate concern for both the self and the

relationship and entails each person getting part of what they want. As a result, the compromise

style requires moderate to low levels of self disclosure. And lastly, avoidance involves a low

concern for self and the relationship. The avoidant style often involves little self-disclosure and

retreating physically and or emotionally in order to get away from conflict.

Koerner and Fitzpatrick (1997) explored the relationship between family communication

patterns and conflict behaviors. They observed that families high in the conformity orientation

were more likely to practice conflict avoidance while those high in conversation orientation were

less likely to practice avoidance. Koerner and Fitzpatrick (1997) also observed that when conflict

avoidance did occur, it had negative effects on the relationship. This avoidance led to negative

feelings about the family and caused tension among the family members. Botta and Dumlao

(2002) supported these findings when they argued that living in a high conformity family could

cause children to have unresolved conflict with their parents (as a result of being forced to

conform and refrain from communication) and that could then result in unhealthy mindsets and

dangerous behaviors.

From past research we can begin to see that both communication patterns and conflict

management styles are important predictors of how members of different family types are going

to interact with one another on a daily basis. While these concepts have been applied to some

challenging family situations such as a child’s adjustment to college or eating disorders within

21

the family, there is little research on the effects of these communication patterns and conflict

styles on family behaviors in times of serious stress and uncertainty, such as during the presence

of a life-threatening illness. This research will, therefore, explore the relationship between

communication patterns, conflict styles and the amount and type of support that cancer patients

receive following their diagnoses, when social support is necessary and unavoidable. The context

of cancer within the family is a particularly important context in which to study these concepts

because it is in these times of such enormous stress and anxiety that communication and support

are critical, but also that conflict has the greatest potential of occurring. With this in mind, a

number of hypotheses and research questions are proposed.

Hypotheses and Research Questions

Families that are high in conversation orientation spend significant amounts of time

communicating with one another and, therefore, should take comfort in using open and frequent

communication as a coping strategy in the uncertain time following a cancer diagnosis. Once an

individual is diagnosed with cancer, managing the disease becomes an important part of not only

the patient’s life, but his/her family’s life as well. To avoid discussion of the cancer would be to

stop communicating about a significant portion of the family members’ lives. Given that high

conversation orientation families believe communication to be an important contributor to the

success of the family unit, this significant decrease in conversation would not be something that

these families high in conversation would be comfortable with, especially during a time when

they need to feel especially close to one another. Families low in conversation, on the other hand,

are not used to significant amounts of self-disclosure and, therefore, engaging in frequent

communication about feelings and concerns relating to the cancer might be uncomfortable and/or

anxiety producing. It is difficult, however, to predict the relationship between a family’s level of

22

conformity and its frequency of discussion about the cancer. While the heads of a high

conformity household will probably refrain from involving the entire family in the process of

making medical decisions, they wont necessarily refrain from encouraging family members to

discuss facts related to the cancer, feelings associated with the cancer, and other related

information that is not a threat to the hierarchy, particularly since they value interdependence and

are used to focusing on relationships within the family. Therefore, the level of conformity within

a family may not have a significant impact on the amount of disclosure about the illness. With

this rationale, the following prediction and research question are posed:

H1: There will be a positive association between a cancer patient’s level of family

conversation orientation and the patient’s perceived frequency of family discussion about the

cancer.

RQ1: What is the relationship between family conformity orientation and the frequency

of family discussion about the cancer?

In addition to the belief that there is a relationship between a family’s communication

patterns and the amount of communication its members engage in about the cancer, it is also

believed that there is a relationship between family communication patterns and the type and

amount of support that a cancer patient perceives as being available within the family.

Individuals in high conversation orientation families expect high levels of self-disclosure with

one another given that they depend on and encourage frequent communication as well as the

expression of feelings. Individuals in these high conversation orientation families, therefore,

should be best equipped to offer emotional support to the family member in need. The significant

amount of time spent together supportively sharing their thoughts and feelings should make it

easier and more natural for individuals in high conversation families than for individuals in low

23

conversation families to be empathetic towards one another as well as a source of trust and

comfort. As a result, cancer patients in families that are higher in conversation orientation should

perceive more emotional support from their primary support providers than cancer patients in

families that are lower in conversation orientation. It is more difficult to predict the relationship

between family conformity orientation and the amount of emotional support that is perceived by

the cancer patient as being provided. The high conformity orientation family stresses family

interdependence and loyalty and, therefore, individuals in these families, more so than

individuals in low conformity families, should be used to being the primary support providers for

their family members. It may be, however, that the vulnerability that often comes along with

giving and/or receiving emotional support could be perceived by the family as threatening the

power balance within the established family hierarchy. Also, the higher the conformity

orientation, the greater difficulty family members may have being empathetic if they feel a

cancer-related decision made by the patient does not go along with family values or beliefs and,

therefore, the less emotional support that patient will perceive. It is also important, then, to

question if level of family conformity orientation influences family members’ tendencies to

provide other, less vulnerable types of support. Perhaps individuals in high conformity

orientation families use tangible and information support as a way to make sure they are

protecting and being loyal to their family unit even when they do not feel comfortable providing

emotional support. With this rationale, the following hypothesis and research question are

presented:

H2: There will be a positive association between a cancer patient’s family conversation

orientation and his/her perception of the amount of emotional support provided by their primary

support provider.

24

RQ2: What is the relationship between a cancer patient’s family conformity orientation

and the amount of emotional, informational and tangible support he/she perceives him/herself as

receiving from the primary support provider?

Individuals in families that frequently discuss their wants, desires and concerns are more

likely to feel comfortable talking openly with their family about what kind of assistance they

need in coping with cancer. Individuals in families that emphasize open communication are less

likely to feel guilt or hesitation when it comes to being open about the specific ways in which

they want to be supported because they are used to turning to their family members to talk about

their needs and feelings. Individuals in high conversation orientation families should not

consider their disclosure an additional burden for their family members because they recognize

that this method of open and honest communication is what their families rely on and are

comfortable with. In fact, these patients in high conversation orientation families would probably

recognize that not openly communicating their support needs would cause more stress and

concern amongst their family members. Patients in families that are low in conversation, on the

other hand, would probably see their communication of support needs as a heavy burden to their

family members because they are not as used to going to these members to talk about their wants

and needs. Also, because families low in conversation orientation do not engage in as much self-

disclosure, patients within these families might feel embarrassed about or uncomfortable with

being so direct in their expression of need. It is harder to predict the relationship between a

patient’s family conformity orientation and his/her disclosure about support needs. Because

families high in conformity emphasize putting family relationships and the good of the family

unit over all else, one might suspect that the members of these families would encourage their

sick loved ones to express their support needs so that they may be taken care of in the best way

25

possible, consequently preserving the well-being of the family units. However, families high in

conformity orientation also have well-established family roles as well as a strong desire to

maintain harmony. Cancer patients in families that are high in conformity may refrain from

expressing their support needs because they feel as though it will threaten the power structure

established within the family unit or because they feel their support wishes/needs do not align

with the attitudes and values of the family. Given these assumptions, the following hypothesis

and research question are proposed:


orientation and the amount of time that patient spends talking about his/her social support needs

with the other family members.


and the amount of time that patient spends talking about his/her social support needs with the

other family members?

Because families that are high in conversation orientation engage in so much dialogue

and disclosure, cancer patients in these families can work through figuring out their specific

support needs and concerns through communication with their family members. Also, the more

communication going on, the more up to date the family is on the patient’s challenges, concerns,

etc., and the greater the understanding between the family members about what needs to be done

in order to best cope with the situation. Also, because families that are high in conversation

orientation are used to being honest with and trusting of one another, cancer patients in these

families should feel comfortable expressing when they are not satisfied with the type and/or

amount of support they are receiving and what kind of change they would like to see. With all of

this in mind, it seems that the cancer patients in families that are high in conversation orientation

26

are going to be the most satisfied with the support they are receiving from their family members.

Family members in low conversation orientation families are probably not engaging in as much

communication with their sick loved ones and, therefore, should have a lesser understanding of

what they are going through and what they are in need of. It is more difficult to predict the

relationship between conformity orientation and optimal matching. If the reasons previously

mentioned prevent individuals in these families from expressing their support needs, it may be

that they will not receive the type or amount of support that they are looking for. Also,

individuals in high conformity orientation families are not used to expressing disapproval of or

disagreement with family behaviors and, therefore, may also refrain from expressing

dissatisfaction with support family members have provided because it goes against the family

norms of maintaining harmony. If they do not express this disapproval, it could prevent optimal

matching. Also, during a time of such heightened stress, when the future of the family unit is

threatened, the high conformity family’s emphasis on the importance of family togetherness and

dependence will only be strengthened. Therefore, individuals in these high conformity

orientation families who are dissatisfied with their support will be heavily discouraged to look

outside the family to have their support needs met. With this rationale the following hypothesis

and research question are proposed:


orientation and the degree to which he/she reports optimal matching.


and the degree to which he/she reports optimal matching?

Based on past research, it is believed that the way conflict is managed within the

household can be a strong predictor of whether or not a cancer patient will feel satisfied with the

27

type of support he/she is receiving within the family. The reason conflict management style is

expected to be an important predictor of optimal matching within this particular context is that

the significant number of uncontrollable stressors resulting from a cancer diagnosis leaves the

family environment prone to conflict-inducing situations. Those cancer patients that practice an

avoidant management style with their family members are going to frequently distance

themselves from those family members. The reason for this is that avoidant individuals are so

concerned with not having to address or deal with conflict that they avoid most situations or

interactions that they fear could potentially result in conflict. This also means that avoidant

individuals will be more cautious when it comes to choosing what to approach their family

members about. As a result, those avoidant individuals with cancer will be less likely to voice

their support needs or to bring up the issue of their support needs not being adequately met for

fear of upsetting or insulting their family members. Individuals with an accommodating

management style should behave similarly to those who practice conflict avoidance when it

comes to dealing with their social support concerns. Almost equally uncomfortable with conflict,

accommodating individuals are so used to appeasing others that they will accept the support

behaviors of their loved ones with little input or suggestions for improvement when they are

unsatisfied. Also, when a specific conflict situation does arise, these individuals with either an

avoidant or accommodating conflict style will usually keep their feelings and wants inside so as

to not perpetuate the conflict. As a result, the individuals with avoidant or accommodating

conflict styles may build up feelings of hurt, frustration and anger that prevent them from being

open to support from their loved ones or from having a realistic perception of the amount or

quality of support they are receiving. Individuals with collaborative or compromising conflict

management styles, on the other hand, should not have these issues. Individuals with

28

collaborative and compromising conflict styles should be use to talking through concerns with

their family members and should not be overly anxious about discussing sensitive issues. As a

result, collaborating and compromising individuals should be more comfortable talking about

their support needs and sharing concerns they have about the support they are receiving with

their loved ones, thereby allowing them a greater opportunity for optimal matching. Also, if a

conflict does arise in the family, it is usually addressed in such a quick and communicative

manner that there are fewer hostile or hurt feelings that could get in the way of the offering

and/or receiving of support. With this information in mind, the following prediction can be

made:

H5: There will be a relationship between cancer patients’ conflict management styles and

optimal matching such that:

(a) Avoidant or accommodative styles will be negatively associated with


(b) Collaborative or compromising styles will be positively associated with


Given what we know about the competitive conflict style, it is more challenging to

predict how satisfied cancer patients with this conflict style will be with the social support they

receive from their family members. Individuals with a competitive conflict style have a win-lose

attitude about conflict, meaning that they continue to battle out issues until one individual has

conquered the other and, therefore, gotten his/her way. Therefore, on the one hand we can expect

competitive individuals to be comfortable bringing up issues relating to their social support,

because they are not intimidated by the potential for conflict. On the other hand, however, if

significant conflict does arise (either about social support concerns or another issue), competitive

29

individuals’ intense, often hurtful attempts to get their way and win the battle could cause

negative feelings that would deter their loved ones from providing adequate support. With this in

mind, the following research question is posed:

RQ5: What is the association between competitive conflict management style and

optimal matching?

30

CHAPTER 3

METHOD

Sample and Procedure

Individuals who had been diagnosed with some form of cancer were recruited from

several internet-based cancer discussion forums and message boards. A general explanation of

the research goals were made available for forum and message board visitors with a link to a

questionnaire for those individuals who decided that they would like to participate. The

explanation provided described that I was interested in looking at how those fighting cancer

generally communicate with their family and discuss their support needs for the future goal of

improving the quality of support offered to cancer patients by their loved ones. The solicitation

letter is provided in Appendix A. The online forums that the were used for participant

recruitment were Breast Cancer Support (http://bcsupport.org/), American Cancer Society’s

Cancer Survivor Network (http://www.acscsn.org/), the Lung Cancer Support Community

(http://lchelp.org/), Cancer Compass (http://www.cancercompass.com), Susan G. Komen For the

Cure Message Boards (http://apps.komen.org/Forums/), and the MSN Cancer Message Board

(http://health.msn.com/message-boards.aspx). Before posting the explanation and questionnaire

link on these websites, I contacted the administrators of each forum and message board and gave

them a brief explanation of my intent. Six of ten message board administrators granted

permission to solicit participants for this study. Only those on-line communities that agreed to

post the survey solicitation were used to solicit participants. The solicitation of participants

occurred during the period of February through June 2008.

31

Each individual who decided to participate completed an anonymous questionnaire

hosted by www.surveymonkey.com, after reading a letter of informed consent, and responses

were encrypted and sent over a secure 256-bit secure SSL- socket server. The letter of informed

consent may be found in Appendix B and a copy of the full questionnaire may be found in

Appendix C. Participants did not receive any tangible credit for their participation.

Seventy-eight individuals completed a portion of the survey. Twenty-five of those

people, however, did not complete significant portions of the survey related to the tests of

hypotheses and were, therefore, not used for analysis. Thus, the final sample was comprised of

53 individuals who have, at one time, been diagnosed with cancer and who have at least one

other person in their immediate family. Respondents ranged in age from 32 to 72 with a mean

age of 48.90 (SD = 9.75). Forty-nine respondents (92.5%) were female and 3 (5.7%) were male.

The sample was 94.3% white (n = 50) and 1.9% Asian (n = 1). The majority of the sample

identified themselves as both a wife and a mother in their immediate family (n = 30). Of the

remaining sample, 2 respondents identified themselves as both a husband and a father, 2

identified themselves daughters, and 4 identified themselves as sisters. Participant cancer status

ranged from newly diagnosed (less than 1 month ago) to diagnosed 10 years ago (M = 14.76

months). When asked to indicate on a Likert scale how differently they now manage family

conflict when it arises as compared to before the diagnosis (1 = very differently; 5 = exactly the

same) most participants reported that they managed it fairly similarly (M = 3.58). However, in

response to a three-option question regarding the amount of conflict experienced in the family

since the diagnosis, over half (n = 30, 56.6%) of the participants reported that they engaged in

less conflict. Twenty respondents (37.7%) indicated that they engaged in the same amount of

conflict and 3 respondents (5.7%) indicated they engaged in more conflict.

32

Participants were asked to think about their primary support provider while answering a

series of items. The average age of the respondents’ primary support providers was 47.75 years

old (SD = 12.93, range: 16-70). Of these primary support providers, 38 were male (71.1%) and

14 were female (26.4%). Forty-one (77.4%) of the primary care givers were the spouses of the

cancer patients, whereas 8 (15.1%) were children of the patients, 2 (3.8%) were parents of the

patients, and 2 (3.8%) were siblings of the patients. The average length of time the respondents

had known these support providers was 26.62 years (SD =12.72, range: 5-54).

Measures

Family communication patterns. Family communication patterns were measured using

the Revised Family Communication Pattern Instrument (RFCP; Ritchie & Fitzpatrick, 1990).

The RFCP is 26-item measure designed to assess two dimensions of family communication

patterns: conversation and conformity. For this study, a modified version of the RFCP was

utilized to assess the two dimensions in order to prevent participant burnout. Further, because

participants were not required to have children to complete the questionnaire, those items that

focused exclusively on children were not included. Also, some of the items included in the

questionnaire were reworded so that instead of referring specifically to parents and children they

referred to “heads of the household” and “other family members.” Thus, the following eight

items measuring conversation orientation were used to assess conversation orientation: (i) ‘We

often talk as a family about things we have done during the day’; (ii) ‘My family encourages me

to express my feelings’; (iii) ‘I can tell my family members almost anything’; (iv) ‘I really enjoy

talking to my family members, even when we disagree’; (v) ‘In our family, we often talk about

our plans and hopes for the future’; (vi) ‘I usually tell the people in my family what I am

thinking about things’; (vii) ‘In our family we often talk about our feelings and emotions’; and

33

(viii) ‘The people in my family like to hear my opinion, even when they don’t agree with me’.

Responses were averaged (M = 3.98, SD = .84, range: 1.88-5.00, α = .90). Eight items measured

conformity orientation: (i) ‘My family has established rules that everyone is expected to obey’;

(ii) ‘If the head(s) of the house don’t approve of it, they don’t want to know about it’; (iii) ‘In our

home, the head(s) of the household usually have the last word’; (iv) ‘The head(s) of the house

often say something like, “My ideas are right and you should not question them”’; (v) ‘The

head(s) of my household say something like “You should give in on arguments rather than risk

making people mad”’; (vi) ‘My family members become irritated with my views if they are

different from theirs’; (vii) ‘The head(s) of my household say something like, “There are some

things that just shouldn’t be talked about”’; (viii) ‘The head(s) of the household feel that it is

important to be the boss’. Individuals completing the scale were asked to respond to these items

on a scale ranging from 1 (never) to 5 (frequently). Responses were averaged (M = 2.17, SD =

.91, range = 1.00 – 5.00, α = .89). Although in some past studies (Orrego & Rodriquez, 2001;

Zhang, 2007) four family communication styles have been derived using the mean splits on both

dimensions, I chose to focus solely on the 2 dimensions given the rather limited sample size of

this study.

Frequency of Family Discussion of the Cancer. The cancer patients’ perceived frequency

of family discussion about the cancer was measured with a single item: ‘How often would you

say your family spends talking about the illness and issues surrounding the illness?’ Participants

responded to this item using a scale from 1 (never) to 5 (frequently). Responses were averaged

(M = 3.32, SD = 1.03, range: 1.00-5.00).

Social Support. A portion of the Revised Inventory of Socially Supportive Behaviors

(ISSB; Krause, 1987) was used to measure the type and amount of support patients believed they

34

received from their primary support providers. The ISSB is 41-item measure which measures

four dimensions of support: tangible support, informational support, emotional support, and

support provided to others. Since this study was not focused on support provided to others, the

13 items on the measure that address this type of support were not included in the questionnaire.

Before completing the support items, participants were asked to think of the one family

member that currently provides them with the most support, to write down that person’s

relationship to them, and to keep that person in mind while answering the remaining

questionnaire items. Participants were asked to answer the support questions thinking back as far

as their last diagnosis. Also, some of the items were slightly modified from the original measure

to make them more applicable to the context of coping with cancer.

All 11 of the revised ISSB items measuring emotional support were included in the

questionnaire. Participants were, therefore, asked to respond to the following items on a scale

ranging from 1(never) to 5 (frequently): Since the diagnosis, how often has this person, (i) ‘Been

right there with you (physically) during this stressful situation’; (ii) ‘Told you you were okay just

the way you are, (iii) Comforted you by showing you physical affection’; (iv) ‘Listened to you

talk about your private feelings’; (v) ‘Told you they felt very close to you’; (vi) ‘Joked and

kidded to try to cheer you up’; (vii) ‘Expressed interest in and concern for your well-being’;

(viii) ‘Went with you to see someone who helped you with a problem that you were having

related to the illness/coping with the illness’; (ix) ‘Told you that they would keep the things you

talked about privately just between the two of you’; (x) ‘Did some activity together with you to

help you get your mind off things’; (xi) ‘Told you how they felt in a situation that was similar to

yours’. Responses were averaged (M = 3.92, SD = .87, range = 1.55 to 5.00, α = .90).

35

Out of the original 9 tangible support items, only 3 were selected for the questionnaire,

given that most of the items (i.e. ‘Provided you with a place to stay overnight’) were not

particularly applicable to relationships within the immediate family. Like with the emotional

support items, participants were asked to respond on a scale from 1 (never) to 5 (frequently).

Factor analysis suggested that one item be dropped. Principle components analyses using

varimax rotation indicated the following 2 item measure for the emotional support factor: Since

the diagnosis, how often has this person, (i) ‘pitched in to help you do something that needed to

get done, like household chores or yardwork?’; (ii) ‘helped you with shopping?’ Responses were

averaged (M = 4.42, SD = 1.02, range: 1.00-5.00, α = .75).

All 7 of the informational support items were included in the questionnaire. Like with all

of the other items, participants were asked to respond on a scale from 1 (never) to 5 (frequently).

Factor analysis suggested that one item be dropped. Principle components analyses using

varimax rotation indicated the following 6 item measure for the informational support factor:

Since the diagnosis, how often has this person (i) ‘suggested some action that you should take in

dealing with a problem you were having related to the illness/coping with the illness?’; (ii)

‘given you information that made a difficult situation clearer and easier to understand?’; (iii)

‘helped you understand why you didn't do something well?’; (iv) ‘told you who you should see

for assistance with a problem that you were having relating to the illness/coping with the

illness?’; (v) ‘commented on how you were dealing with a problem related to the illness/coping

with the illness without saying it was good or bad?’; (vi) ‘checked back with you to see if you

followed advice you were given on how to deal with a problem related to the illness/coping with

the illness?’ Responses were averaged (M = 3.48, SD = .91, range = 1.85 – 5.00, α = .82).

36

Amount of Patient Talk about Support Needs. The cancer patients’ perceived amount of

time spent talking about their support needs with their family was measured with the following

item: ‘How often would you say you talk to your family about your support needs?’ Participants

responded to this item using a scale from 1 (never) to 5 (very often). Responses were averaged

(M = 3.24, SD = 1.30, range: 1.00-5.00).

Optimal Matching. Six Likert-type items were created for this study to measure the

degree to which the cancer patients report experiencing optimal matching. Principle components

analyses using varimax rotation suggested a 2 factor measure of optimal matching. One factor

reflected optimal matching that occurs from within-family support (i.e., from the primary support

provider the respondents were asked to think about before answering the revised ISSB items)

which was defined by 4 items: (i) ‘How satisfied are you with the support you are currently

receiving from this individual?’ (answered using a Likert scale ranging from 1 “not at all

satisfied” to 5 “very satisfied”); (ii) ‘I feel like I am getting the support that I need from this

individual’ (answered using a Likert scale ranging from 1 “not at all true” to 5 “very true”); (iii)

‘When it comes to the amount of support I am receiving I am…’ (answered using a Likert scale

ranging from 1 “not at all satisfied” to 5 “very satisfied”); (iv) ‘Sometimes I wish that my family

offered me more support’ (answered using a Likert scale ranging from 1 “not at all true” to 5

“very true”). The final item listed was reverse coded for analyses. Responses were averaged (M

= 3.91, SD = 1.14, α = .91). The second factor reflected optimal matching that occurs from

external support (i.e., support from individuals outside the immediate family) which was defined

by 2 items: (i) ‘I turn to people outside of my immediate family to provide me with support’

(answered using a Likert scale ranging from 1 “never” to 5 “frequently”); (ii) ‘If I can’t get the

support that I need from within my family, I have people outside my family who can provide me

37

with the support I need’ (answered using a Likert scale ranging from 1 “not at all true” to 5 “very

true”). Responses were averaged (M = 2.36, SD = 1.14, range = 1.00 - 5.00, α = .78).

Conflict styles. Conflict styles were measured with the Rahim Organizational Conflict

Inventory- II (ROCI-II; Rahim, 1983). This measure consists of 28 Likert-type items that assess

the five conflict styles: competition, collaboration, compromise, accommodation, and avoidance.

All 28 items were included in the questionnaire along with 4 additional items that had once been

developed by Rahim (1983) to measure conflict styles. Participants responded to these items

using a scale ranging from 1 (never) to 5 (frequently) and were reminded to continue to think of

their primary support providers while responding.

Principle components analyses using varimax rotation suggested a 4 factor measure of

conflict orientation. One factor reflected collaboration and compromise which was defined by 10

items: (i) ‘I try to investigate an issue with ____________ to find a solution acceptable to us’;

(ii) ‘I try to integrate my ideas with those of ____________’s to come up with a decision

jointly’; (iii) ‘I try to work with ___________ to find solutions to a problem which satisfy our

expectations’; (iv) ‘I propose a middle ground for breaking deadlocks’; (v) ‘I exchange accurate

information with ____________ to solve a problem together’; (vi) ‘I negotiate with

____________ so that a compromise can be reached’; (vii) ‘I try to bring all our concerns out in

the open so that the issues can be resolved in the best possible way’; (viii) ‘I use "give and take"

so that a compromise can be made’; (ix) ‘I collaborate with ___________ to come up with

decisions acceptable to us’; (x) ‘I try to work with ____________ for a proper understanding of a

problem’. Responses were averaged (M = 3.82, SD = .85, range = 1.70 – 5.00, α = .93). The

second factor reflected competition and was defined by 5 items: (i) ‘I use my power to win a

competitive situation’; (ii) ‘I use my influence to get my ideas accepted’; (iii) ‘I use my authority

38

to make a decision in my favor’; (iv) ‘I use my expertise to make a decision in my favor’; (v) ‘I

am generally firm in pursuing my side of the issue’. Responses were averaged (M = 2.38, SD =

.80, range = 1.00 – 5.00, α = .86). The third factor reflected accommodation and was defined by

3 items: (i) ‘I generally try to satisfy the needs of ___________’; (ii) ‘I accommodate the wishes

of __________’; (iii) ‘I go along with the suggestions of __________’. Responses were averaged

(M = 3.60, SD = .87, range = 1.33 – 5.00, α = .74). And the final factor reflected avoidance and

was defined by 6 items: (i) ‘I try to keep my disagreement with ___________to myself in order

to avoid hard feelings’; (ii) ‘I try to avoid unpleasant exchanges with ____________’; (iii) ‘I

generally avoid an argument with _____________’; (iv) ‘I attempt to avoid being "put on the

spot" and try to keep my conflict with __________ to myself’; (v) ‘I avoid open discussion of

my differences with _________’; (vi) ‘I try to stay away from disagreement with

____________’. Reponses were averaged (M = 2.80, SD = 1.18, range 1.00 – 5.00, α = .92).

39

CHAPTER 4

ANALYSES AND RESULTS

Preliminary Analyses

Zero-order correlations. Zero-order correlations were computed between all measures of

the dependent and independent variables. These are reported in Table 1.

Table 1

Correlations among Independent and Dependent Variables

Conversation

Orientation

Conformity

Orientation

Family

Discussion

About

Cancer

Talk About

Support

Needs

Conversation Orientation

___

Conformity Orientation

-.46** ___

Family Discussion About

Cancer

.65** -.35** ___

Talk About Support Needs

.53** -.41** .54** ___

Emotional Support

.72** -.35** .66** .44**

Tangible Support

.65** -.32* .54** .45**

Informational Support

.51** -.13 .54** .33*

Collaboration & Compromise

.53** -.36** .47** .46**

Avoidance

-.42** .39** -.40** -.50**

Competition

-.25 .38** -.29* -.13

40

Conversation

Orientation

Conformity

Orientation

Family

Discussion

About

Cancer

Talk About

Support

Needs

Accommodation

.13 .07 .17 -.01

Within-Family Optimal

Matching

.58** -.24 .53** .30*

External Support Optimal

Matching .08 .17 .06 .09

Table 1

Correlations among Independent and Dependent Variables (Con’t)

Emotional

Support

Tangible

Support

Informational

Support

Collaboration

&

Compromise

Avoidance

Emotional Support

___

Tangible Support

.67** ___

Informational Support

.75** .46** ___

Collaboration &

Compromise

.59** .47** .64** ___

Avoidance

-.46** -.62** -.36** -.26 ___

Competition

-.37** -.08 -.12 -.38** .11

Accommodation

.02 -.17 .09 .34* .39**

Within-Family

Optimal Matching

.70** .48** .66** .57** -.26

External Support

Optimal Matching .17 .17 .04 -.06 -.14

41

Table 1

Correlations among Independent and Dependent Variables (Con’t)

Competition Accommodation Within-Family

Optimal

Matching

External Support

Optimal

Matching

Competition

___

Accommodation

-.20 ___

Within-Family

Optimal Matching

-.18 .11 ___

External Support

Optimal Matching .05 -.03 .07 ___

*. p < .05, two-tailed. **. p < .01, two-tailed. N = 53

Correlations within construct dimensions. Within the social support variables, there was

a significant positive correlation between perceived amount of emotional support and perceived

amount of tangible support, r = .67, p < .01, perceived amount of informational support and

perceived amount of tangible support r = .46, p < .01, and perceived amount of informational

support and perceived amount of emotional support, r = .75, p < .01. The positive correlations

between each type of support are important because they suggest that the primary support

providers may be viewed by the patient as generally more or less supportive.

Both expected and unexpected significant correlations were found when looking at the

relationships between the different dimensions of conflict management. It was expected, given

that engaging in collaboration and compromise requires a desire to meet the wishes of all parties,

that those individuals high in the competitive conflict style would be low in the collaborative and

compromising conflict styles. Indeed, there was a significant negative correlation between a

patient’s degree of competition and his/her degree of collaboration and compromise, r = -.38, p <

42

.01. The unexpected significant relationships that were found were between the avoidance and

accommodation conflict styles and between the accommodation and collaboration conflict styles.

A significant positive correlation was found between a patient’s degree of avoidance and his/her

degree of accommodation, r = .39, p < .01. This indicates that many of those individuals that are

practicing avoidant conflict tactics are also practicing accommodation tactics. There was also a

significant positive correlation between a patient’s degree of accommodation and his/her degree

of collaboration, r = .34, p < .05.

Looking at the associations between family communication patterns, it appears that there

was a significant negative correlation between a patient’s level of family conversation orientation

and his/her reported level of family conformity orientation, r = -.46, p < .01. This negative

association between conversation and conformity provides insight into the finding that nearly all

of the conformity orientation’s relationships to the support-related variables are opposite that of

conversation orientation.

Correlations regarding communication about cancer and social support. One expectation

throughout this research was that those families that practice and encourage open communication

regularly were going to use this skill to cope with and manage their one member’s diagnosis and

fight with cancer. Because these high conversation orientation families value talking through

emotions, concerns and ideas, it was suspected that individuals in these families were going to

feel comfortable frequently discussing the cancer and the physical and psychological needs

associated with the cancer. Preliminary analyses indicated that, in fact, the level of family

conversation orientation was significantly and positively associated with both a patient’s

perceived frequency of family discussion about the cancer, r = .66, p < .01, and a patient’s

amount of talk about his/her support needs, r = .53, p < .01. A significant negative correlation, on

43

the other hand, was found between the level of family conformity orientation and both a patient’s

perceived frequency of family discussion about the cancer, r = -.35, p < .01, and a patient’s

amount of talk about his/her support needs, r = -.41, p < .01.

Because families high in conversation orientation have members that are comfortable

with expressing and responding to emotions, it was suspected that there would be a positive

relationship between a patient’s family conversation orientation and his/her perception of

emotional support provided by his/her primary support provider. A significant positive

association between the level of family conversation orientation and the perceived amount of

emotional support was, in fact, found in preliminary analyses, r = .72, p < .01. In addition, there

was a significant positive relationship found between family conversation orientation and

perceived amount of tangible support, r = .65, p < .01, and between family conversation

orientation and perceived amount of informational support, r = .51, p < .01. Perhaps the more a

family emphasizes open communication, the more information that is exchanged regarding

support needs and, therefore, the more support that is provided (emotional or other). Indeed,

there was also a significant positive relationship between a patient’s amount of discussion about

his/her support needs and his/her perceived amount of emotional support, r = .44, p < .01,

tangible support, r = .45, p < .01, and informational support, r = .33, p < .01.

There was also a positive association between the frequency of family discussion about

the patient’s cancer and the patient’s perceived amounts of all three types of social support. The

zero-order correlations showed a significant positive correlation between the frequency of family

discussion about the patient’s cancer and his/her perceived amount of emotional support, r = .66,

p < .01, tangible support, r = .54, p < .01, and informational support, r = .54, p < .01. In other

44

words, those families that were engaging in more frequent communication about the patient’s

cancer had cancer patient’s that perceived themselves as having more support.

Because families that are high in conformity orientation are less comfortable expressing

emotions and concerns and are particularly careful to maintain the established power hierarchy

(which evidence of vulnerability could threaten), it was also suspected that there would be a

negative relationship between a patient’s family conformity orientation and his/her perception of

the amount of emotional support provided by his/her primary support. The primary analysis

confirmed this suspicion, showing a significant negative association between a patient’s level of

family conformity orientation and his/her perceived amount of emotional support, r = -.35, p <

.01. It also indicated a significant negative association between a patient’s level of family

conformity orientation and his/her perceived amount of tangible support, r = -.32, p < .05.

Zero-order correlations showed that there was a significant positive association between

the level of family conversation orientation and within-family optimal matching, r = .58, p < .01.

In other words, the more open communication seems to allow for what the patients perceive as a

better understanding of their support needs on the part of their primary support providers.

It was previously suspected that the more cancer patients were able to communicate their

support needs to their support providers, the more optimal matching would occur. This belief

stemmed from the idea that the more cancer patients discussed their support needs, the clearer

understanding both the support providers and the patients would have about the amount and

types of support that the patients were finding most helpful and what, if any, changes needed to

be made. The suspected association was indicated in the zero-order correlations. While there

were no significant correlations found between external support optimal matching and any of the

45

other variables, there was a significant positive correlation between the patient’s amount of talk

about his/her support needs and his/her within-family optimal matching, r = .30, p < .05.

A significant positive correlation was identified between the frequency of family

discussion about the cancer and a patient’s amount of talk about his/her support needs to the

family, r = .54, p < .01. This relationship may stem from the fact that the more a cancer patient

discusses the experience of the illness, the more likely his or her support needs will emerge in

discussion. There was also a significant positive association between the frequency of family

discussion about the cancer and the collaborative and compromising conflict style, r = .47, p <

.01 and significant negative associations between the frequency of family discussion about the

cancer and the degree of both avoidant conflict management, r = -.40, p < .01, and competitive

conflict management, r = .29, p < .05. Given the positive relationship between the frequency of

family discussion about the cancer and the patient’s amount of communication about his/her

support needs, it is not surprising that the zero-order correlations also identified a positive

relationship between the patient’s amount of communication about his/her support needs and the

degree of collaborative and compromising conflict management, r = .46, p < .01, and a negative

relationship between the patient’s amount of communication about his/her support needs and the

degree of avoidant conflict management, r = -.50, p < .01.

There was a positive association found between the frequency of family discussion about

the cancer and within-family optimal matching, r = .53, p < .01. This positive association

indicates that the patients who perceive their families as being open to discussing the issues,

concerns, and decisions surrounding their cancer are often the same individuals who are most

satisfied with their within-family support. There were also significant correlations between

within-family optimal matching and the perceived amount emotional support, r = .70, p < .01,

46

tangible support, r = .48, p < .01, and informational support, r = .66, p < .01. Thus, it appears

that the more support received from the primary caregiver (regardless of which type), the more

the patient experienced optimal matching.

Correlations regarding conflict. In regard to the relationship between conversation

orientation and conflict management, because individuals in a family high in conversation

orientation are used to talking through issues and both hearing and expressing different ideas, it

was suspected that these same individuals would be the ones engaging in constructive conflict

management Therefore, there was a suspected positive relationship between family conversation

and the collaborative and compromising conflict style. There was also a suspected negative

relationship between the level of family conversation orientation and the patient’s degree of

conflict avoidance. The suspected associations were indicated in the zero-order correlations, as

there was a significant positive correlation between a patient’s level of family conversation

orientation and the degree of collaborative and compromising conflict management, r = .53, p <

.01, and a significant negative correlation between a patient’s family conversation orientation

and the degree of avoidant conflict management, r = -.42, p < .01.

With regard to family conformity orientation, because individuals in families high in

conformity are discouraged from expressing differing viewpoints and from challenging both

established roles and ideas, it was believed that these individuals actively seek to avoid conflict.

It was also suspected that when conflict is brought into the open, it is solved mainly by those

who have the power in the household in the way they see fit, with little input from the rest of the

family. Therefore, it was believed that there would be a positive relationship between family

conformity and the avoidant conflict style and a negative relationship between family conformity

and the collaboration and compromise conflict style. Indeed, the zero-order correlations

47

indicated a significant positive association between a patient’s level of family conformity

orientation and his/her degree of avoidance, r = .39, p < .01, thus mirroring the relationship

Koerner and Fitzpatrick (1997) identified between these two variables. A significant negative

correlation was also found between a patient’s level of family conformity and his/her degree of

collaboration and compromise, r = -.36, p < .01. In addition, a significant positive correlation

was found between a patient’s level of family conformity orientation and his/her degree of

competition, r = .38, p < .01.

Considering the relationship between social support and conflict styles, the degree of

collaborative and compromising conflict management was positively associated with a patient’s

perceived amount of emotional support, , r = .59, p < .01, tangible support, r = .47, p < .01, and

informational support, r = .64, p < .01. This pattern of significant associations suggests that the

more patients engaged in constructive conflict management styles with their family members, the

more social support they perceived themselves as receiving from those members. The degree of

avoidant conflict management, on the other hand, was negatively associated with a patient’s

perceived amount of emotional support, r = -.45, p < .01, tangible support, r = -.62, p < .01, and

informational support, r = -.36, p < .01. This negative association suggests that the more patients

try to prevent conflict from occurring and/or avoid managing conflict situations with their family

members, the less social support they perceive themselves as receiving from those members.

Finally, a significant negative relationship was found between the degree of competitive conflict

management and the perceived amount of emotional support, r = -.37, p < .01. Perhaps when

competitive tactics are used to handle conflict between the patients and their family members, at

least one (if not both) of the individuals could become hurt or frustrated and, therefore, not open

to giving or receiving emotional support.

48

Tests of Hypotheses

Hypothesis 1 and Research Question 1. H1 stated that there will be a positive association

between a cancer patient’s family conversation orientation and his/her perceived frequency of

family discussion about the cancer. RQ1 asked about the relationship between the level of family

conformity orientation and the frequency of family discussion about the cancer. H1 and RQ1

were examined together via hierarchical regression in order to evaluate both the main and

potential interaction effects of the family conversation orientation and family conformity

orientation (the two dimensions of the family communication pattern construct). In step-one of

the regression, the measure of family conversation orientation and the measure of family

conformity orientation were entered to look for main effects. Step two of the regression required

entering the two-way combination of the above measures to look for an interaction effect. The

results for the regression analyzing the association between family communication patterns and

the frequency of family discussion about the cancer are presented in Table 2.

Table 2

Hierarchical Regression of the Family Conversation Orientation and the Family Conformity

Orientation on the Frequency of Family Discussion about the Cancer

B SE B β R R²∆ F∆

Step 1: Main Effects



Step 2: Two – Way Interaction

.77

-.07

-.04

.15

.14

.14

.63**

-.06

-.12

.66

.66

.43

.00

.00

.77

**p < .01, two-tailed. N = 53.

49

Analyses indicated that there was a significant main effect for the association between family

conversation orientation and frequency of family discussion about the cancer, β = .63, p < .01.

Therefore, as the preliminary analysis suggested, H1 received support. In regards to RQ1,

however, no significant main effect was found for the association between family conformity

orientation and frequency of family discussion about the cancer. The analyses indicated no

significant two-way interaction effect for the family orientations on frequency of family

discussion about the cancer.

Hypothesis 2. H2 stated that there will be a positive association between a cancer

patient’s family conversation orientation and that patient’s perception of the amount of emotional

support provided by the primary support provider. This hypothesis was examined via multiple

regression with the measure of perceived amount of emotional support as the dependent variable.

Specifically, in step-one of the regression, the measure of family conversation orientation and

the measure of family conformity orientation were entered to look for main effects. Step two of

the regression required entering the two-way combination of the above measures to look for an

interaction effect. The results for the regression analyzing the association between a cancer

patient’s family conversation orientation and his/her perception of the amount of emotional

support provided are presented in Table 3.

50

Table 3


Orientation on the Perceived Amount of Emotional Support






.73

-.02

.06

.11

.10

.14

.71**

-.03

.21

.72

.72

.52

.00

.00

.58

**p < .01, two-tailed. N = 53.

Analyses indicated that there was a significant main effect for the association between family

conversation orientation and perceived amount of emotional support, β = .71, p < .01. Therefore,

H2 received support. The analyses indicated no significant two-way interaction effect for the

family orientations on perceived amount of emotional support.

Research Question 2. RQ2 asked about the relationship between a cancer patient’s level

of family conformity orientation and the amount of emotional, tangible and informational

support he/she perceives him/herself as receiving from their primary support provider. The

results shown in Table 3 for the regression described above indicate no significant main effect

for the association between family conformity orientation and perceived emotional support.

Another hierarchical regression was run with the perceived amount of tangible support as the

dependent variable. In step-one of the regression, the measure of family conversation orientation

and the measure of family conformity orientation were entered to look for main effects. Step two

51

of the regression required entering the two-way combination of the above measures to look for

an interaction effect. The results for this regression are provided in Table 4.

Table 4


Orientation on the Perceived Amount of Tangible Support






.77

-.03

-.01

.15

.14

.14

.64**

-.03

-.03

.65

.65

.42

.00

.00

.94

**p < .01, two-tailed. N = 53

Analyses showed no significant main effects for the association between the level of conformity

orientation and the perceived amount of tangible support. There was, however, a significant main

effect for the association between conversation orientation and the perceived amount of tangible

support, β = .64, p = .01. The analysis indicated no significant two-way interaction effect for the

family orientations on perceived amount of tangible support.

An additional hierarchical regression with the same regression analysis steps was run

with the perceived amount of informational support as the dependent variable. The results for

this regression are provided in Table 5.

52

Table 5


Orientation on the Perceived Amount of Informational Support






.62

.13

.03

.15

.14

.14

.57**

.13

.10

.53

.53

.28

.00

.00

.84

**p < .01, two-tailed. N = 53.

Analyses showed no significant main effects for the association between the level of conformity

orientation and the perceived amounts of informational support. There was, however, a

significant main effect for the association between conversation orientation and the perceived

amount of informational support, β = .57, p = .01. The analyses indicated no significant two-way

interaction effect for the family orientations on perceived amount of informational.

Hypothesis 3 and RQ3: H3 stated that there will be a positive association between a

cancer patient’s family conversation orientation and the amount of time that patient spends

talking about his/her social support needs with the other family members. RQ3 asked about the

relationship between a cancer patient’s family conformity orientation and the amount of time that

patient spends talking about his/her social support needs with the other family members. H3 and

RQ3 were examined together via hierarchical regression with the dependent variable being the

amount of time a patient spends talking about his/her social support needs with the other family

members. In step-one of the regression, the measure of family conversation orientation and the

53

measure of family conformity orientation were entered to look for main effects. Step two of the

regression required entering the two-way combination of the above measures to look for an

interaction effect. The results for this regression are provided in Table 6.

Table 6


Orientation on the Amount of Patient Talk about Support Needs






.67

-.30

-.20

.23

.18

.20

.43**

-.21

-.47

.56

.58

.32

.02

.00

.31

**p < .01, two-tailed. N = 53.

Analyses indicated that there was a significant main effect for the association between level of

family conversation orientation and the amount of time a patient spends talking about his/her

social support needs with the family, β = .43, p < .01. Therefore, as the preliminary analysis

suggested, H3 received support. With regard to RQ3, no significant main effect was found for the

association between family conformity orientation and the amount of time a patient spends

talking about his/her social support needs. Also the analysis indicated no significant two-way

interaction effect for the family orientations on the amount of time a patient talks about his/her

support needs.

54

Hypothesis 4 and Research Question 4. H4 stated that there will be a positive association

between a cancer patient’s family conversation orientation and the degree to which he/she

reports optimal matching. RQ 4 asked about the relationship between a cancer patient’s family

conformity orientation and the degree to which he/she reports optimal matching. Both H4 and

RQ4 were examined with two hierarchal regression analyses. The first regression utilized the

measure of within-family optimal matching as the dependent variable and the second regression

used the measure of external support optimal matching as the dependent variable. For both

regression analyses, the measure of family conversation orientation and the measure of family

conformity orientation were entered in step one to look for main effects. Step two required

entering the two-way combination of the above measures to look for an interaction effect. The

results of the regression analysis with the within-family optimal matching as the dependent

variable are found in Table 7.

Table 7


Orientation on External Support Optimal Matching






.27

.33

.04

.21

.19

.20

.20

.26

.11

.25

.25

.06

.00

.21

.84

N = 53

55

As with the preliminary analysis, the regression analyses examining the relationship between

family communication patterns and external support optimal matching identified no significant

correlations. Also the analyses indicated no significant two-way interaction effect for the family

orientations on the amount of external support optimal matching.

The results of the regression analyses with the within-family optimal matching as the

dependent variable are found in Table 8.

Table 8


Orientation on Within-Family Optimal Matching






.81

.04

-.04

.18

.16

.17

.60**

.04

-.11

.58

.59

.34

.00

.00

.81

**p < .01, two-tailed. N = 53.

Analyses examining the relationship between family communication patterns and within-family

optimal matching identified a significant main effect for the relationship between the level of

family conversation orientation and within-family optimal matching, β = .60, p < .01. Therefore,

as indicated in the primary analysis, H4 received support. In regards to RQ4, however, no

significant main effects were found between the level of family conformity orientation and

56

within-family optimal matching. Also the analysis indicated no significant two-way interaction

effect for the family orientations on the amount of within-family optimal matching.

Hypothesis 5 and Research Question 5. H5 stated that there will be a relationship

between cancer patients’ conflict management style and optimal matching such that: (a) Avoidant

or accommodative orientations will be negatively associated with perceived optimal matching

and (b) Collaborative or compromising orientations will be positively associated with perceived

optimal matching. RQ5 asked about the association between the competitive conflict

management style and optimal matching. An examination of the mean scores on the conflict

management styles indicated that several participants could not be categorized into only one

style so regressions based on the dimensional measures of conflict orientation were conducted.

Further, since optimal matching was defined by two factors, two separate regression analyses

were run. For both analyses, the same two steps were followed. In step-one, the measure of the

collaborative and compromising management style, the measure of the avoidant management

style, the measure of the competitive management style, and the measure of the accommodating

management style were all entered to look for main effects. Step two of both regression analyses

required entering all possible two-way combinations of the above measures (collaborative and

compromising and avoidant; collaborative and compromising and competitive; collaborative and

compromising and accommodating; avoidant and competitive; avoidant management style and

accommodating; competitive and avoidant). The results for the regression analyses examining

the relationship between conflict management style and external support optimal matching are

presented in Table 9.

57

Table 9

Hierarchical Regression of the Collaboration and Compromise, Avoidance, Competition, and

Accommodation Conflict Management Styles on External Support Optimal Matching



Collaboration and Compromise

Avoidance

Competition

Accommodation

Step 2: Two – Way Interactions

Collaboration and Compromise x

Avoidance


Competition


Accommodation

Avoidance x Accommodation

Competition x Avoidance

-.17

-.21

.07

.15

-.23

-.22

.24

.03

.01

.23

.17

.22

.23

.23

.23

.29

.17

.22

-.13

-.22

.05

.11

-.88

-.59

1.02

.15

.04

.19

.40

.04

.12

.77

.44

N = 53

Analyses identified no significant effects for the relationship between conflict management style

and external support optimal matching. Also, analyses indicated no significant interaction effects

for the conflict management styles on the amount of external support optimal matching.

58

The results for the regression examining the relationship between conflict management

style and within-family optimal matching are presented in Table 10.

Table 10

Hierarchical Regression of the Collaboration and Compromise, Avoidance, Competition, and

Accommodation Conflict Management Styles on Within-Family Optimal Matching



Collaboration and Compromise

Avoidance

Competition

Accommodation

Step 2: Two – Way Interactions


Avoidance


Competition


Accommodation

Avoidance x Accommodation

Competition x Avoidance

.75

-.10

.05

-.04

.21

.04

.19

-.02

-.23

.19

.14

.18

.19

.18

.18

.22

.13

.17

.56**

-.11

.03

-.03

.83

.10

.82

-.12

-.75

.58

.70

.34

.15

.00

.08

**p < .01, two-tailed. N = 53.

59

Analyses examining the relationship between conflict management styles and within-family

optimal matching identified a significant main effect for the relationship between the

collaborative and compromising management style and within-family optimal matching, β = .56,

p < .01. No other significant main or interaction effects were identified. Therefore, H5 was

partially supported, with evidence being found for H5b but not H5a.

60

CHAPTER 5

DISCUSSION, LIMITATIONS AND CONCLUSION

The purpose of this thesis was to examine the effects of family communication patterns

and conflict management styles on cancer patients’ support satisfaction and availability. Support

was found for the hypotheses predicting positive relationships between the level of family

conversation orientation and each of the following dependent variables: frequency of family

discussion of cancer, the amount of patient communication about support needs, the perception

of the amount of available types of support, and the degree of optimal matching. Preliminary

analyses suggested potential negative relationships between conformity orientation and most of

these same dependent variables. The prediction of a positive relationship between the

collaboration and compromising conflict management styles and a patient’s reported degree of

optimal matching was also supported. Examining all of these results together, some significant

observations can be made regarding the importance of successful, open communication and

constructive conflict management when it comes to the exchanging of social support within the

family. The remainder of this chapter will highlight the significant observations that arose from

this study, discuss potential limitations of the study, and offer a conclusion that addresses the

potential implications of this work.

Observations about Optimal Matching

The theory of optimal matching has been relatively under explored up until this point

and, therefore, it is important to call attention to this study’s significant findings pertaining to the

theory. One of the most insightful findings regarding OMT was the positive association found

61

between the collaboration and compromise conflict style and the degree of optimal matching that

was predicted in H5b. What this finding suggests is that engaging in constructive conflict

management may actually be a tool for families to both become closer as a result of overcoming

challenges and to learn how to be comfortable with open and encouraging communication,

thereby making the members more in tune with one another and, thus, more satisfactory support

providers. Using collaborative and compromising conflict management techniques requires a

heightened level of trust, patience, and self-disclosure amongst the family members and the

presence of these characteristics within the household make for a safer and more effective

environment for support. Therefore, by engaging in collaboration and/or compromise, family

members may be developing the skills needed to grow closer to one another and to make them

more aware of each other’s support needs. Relationships identified in the preliminary analyses

that provided additional support for this idea were the positive relationship between the

collaboration and compromise conflict style and the frequency of family discussion of the cancer

as well as the positive relationship between the collaboration and compromise conflict style and

the cancer patient’s amount of talk about his/her support needs. The findings regarding the

relationship between constructive conflict management and support are particularly important

because they suggest that rather than avoiding conflict, families should be embracing it as tool to

become more successful communicators and social support providers. Thompson and Pitts

(1992) suggest that the nature of the well-established relationship and shared history that

characterize a family influences a sick individuals’ supportive experience. Therefore, individuals

in families that develop a history of handling conflict constructively could have more positive

feelings, feelings of closeness and feelings of trust towards one another, thereby contributing to

satisfactory communication and support. This explanation is also in line with Smetana, Yau, and

62

Hanson’s (1991) belief that collaboration and compromise are associated with healthier family

functioning than unilateral approaches to conflict management (i.e. use of power). The

understanding of the relationship between conflict and social support gained in this study is

particularly important for contexts such as cancer, because it suggests that in situations of

potentially high conflict, there is still the potential for extremely effective support exchange;

therefore, rather than trying to minimize conflict following a cancer diagnosis, families should

confront their issues, as long as they are willing and able to do it in a constructive way.

The suggestion that constructive conflict management provides the tools needed for

successful support exchange is also supported by the positive relationship found between level of

family conversation orientation and the degree of optimal matching observed in tests of H4. The

positive relationship between conversation orientation and optimal matching of within-family

social support suggests that, as expected, family members in high conversation orientation

families are more up to speed on their cancer patients’ challenges, concerns, needs, etc. due to

the more frequent and open communication all the members engage in with one another. These

family members are, therefore, better able to discern the specific types and amounts of support

that their sick loved ones need. Ell (1996) explains that optimal support requires clear

communication of need by the individual in need. The significant relationships found in both the

zero-order correlations and the regression model for the relationship between family

conversation orientation and a patient’s perceived amount of support as well as the significant

positive correlation found between a patient’s amount of talk about support needs and within-

family optimal matching of social support further support Ell’s (1996) argument. Knowing that

collaboration and compromise require significant amounts of clear, encouraging, and free

communication and that, in this study, a positive relationship was found in the preliminary

63

analyses between collaboration and compromise and level of family conversation orientation, it

is evident that constructive conflict management tools can be important to keeping

communication open and free within the family unit, thereby providing a greater opportunity for

successful support exchange.

It should also be mentioned here that zero-order correlations indicated that there were

significant positive relationships between within-family optimal matching and each of the 3

support types. This is an interesting and important finding because it suggests that with this

particular sample, the more social support a cancer patient received, the more satisfied that

patient was with his/her support. This may be because participants were asked to think about

their primary support providers when answering questions about their social support and these

are the people from whom they expect and need to receive a significant amount of assistance.

While significant relationships found in this study offer a great deal of insight into the

important contributing factors to optimal matching, further knowledge can also be gained by

trying to understand and explain the nonsignficant relationships pertaining to conflict and

optimal matching. Contrary to H5a, no significant associations were found between the avoidant

and accommodating conflict styles and within-family optimal matching in either the preliminary

analyses or the regression models. This prediction was developed partially with the belief that

cancer patients who were avoidant or accommodating would be hesitant to express

dissatisfaction with support or to request an adjustment of the support being provided to them for

fear of bringing about conflict. It could be, however, that there was not this initial dissatisfaction

with support that was being assumed and, therefore, a patient’s fear of causing conflict did not

significantly affect the degree of optimal matching. This prediction was also developed with the

belief that individuals with avoidant and accommodating conflict styles bottle up feelings of hurt

64

and frustration from unresolved issues with their family members so as to avoid engaging in

expressed conflict. This belief was in line with Koerner and Fitzpatrick’s (1997) argument that

conflict avoidance leads to negative feelings about the family which, in turn, causes tension

among family members that could result in resentment. It was thought that bottled up feelings of

tension and hurt would make it more difficult for these individuals to be open to support from

their loved ones or to have a realistic perception of the amount and quality of support they are

receiving. Because over half of the sample reported engaging in less conflict since the cancer

diagnosis, the effect of residual feelings of hurt on the perception of social support satisfaction

would not be as strong as predicted, thus potentially helping to explain the lack of significant

results for the relationship between the avoidant and accommodating conflict styles and optimal

matching.

There were also no significant associations between competitive conflict management

and within-family optimal matching, as inquired about in RQ5, in either the preliminary analyses

or the regression model. There was, therefore, no evidence supporting the suspicion that one’s

degree of competition is a strong predictor of how comfortable he/she feels expressing

satisfaction or dissatisfaction and, thus also a strong indicator of optimal matching. In fact, there

was a significant negative relationship found, between competition and frequency of family

discussion about the cancer, suggesting that competitive individuals may actually be less

comfortable engaging in open communication about sensitive topics. There was also no evidence

found lending support to the opposing explanation that competitive conflict management creates

tension and negative feelings between family members that negatively influences a patient’s

perceived reception of support and, thus, his/her degree of optimal matching. This explanation

was in line with Smetana, Yau, and Hanson’s (1991) belief that collaboration and compromise

65

are associated with healthier family functioning than unilateral approaches to conflict

management (i.e. use of power). Lack of significant support for this explanation, however, may

have to do with over half of the sample reporting that their family engaged in less conflict since

the cancer diagnosis.

Observations about Conversation Orientation

It is no surprise that, as mentioned above, the level of conversation orientation was found

to be positively related to optimal matching of support when considering the positive

relationships found between conversation orientation and each of the support-related variables.

One of the most important realizations that can be taken from this study is that open and frequent

communication is crucial within a family if that family environment is going to be one that is

conducive to the exchanging of social support. The emphasis placed on unrestrained

communication and the expression of feelings and ideas, even during times of conflict, in

families that are high in conversation orientation allows for more comfortable discussion about

the cancer and about support needs while also helping to breed trust and closeness amongst the

family members. These positive effects experienced by families high in conversation orientation

allow for optimal support exchange with as few feelings of burden or frustration as can be

expected given the circumstances. In order to offer more detailed evidence for this argument

regarding the positive effects of conversation orientation on the exchange of social support, the

hypotheses not yet discussed regarding family conversation orientation will now be examined

more closely.

As predicted in H1, a significant main effect was found for this relationship between

family conversation orientation and family discussion of cancer. This finding is not surprising

given Koerner and Fitzpatricks’s (2002) argument that the greater the level of family

66

conversation orientation, the more frequent the communication between family members and the

fewer topics family members are uncomfortable discussing with one another. Further, Elwood

and Schrader (1998) observed that conversation orientation was negatively correlated with

communication apprehension in both public and private contexts. Understanding this

observation, one could suspect that because individuals in families higher in conversation

orientation interact and communicate with one another more on a day-to-day basis than

individuals in families lower in conversation orientation, it is natural that they have more

opportunity for the topic of the patients’ cancer to arise. Also, individuals in families high in

conversation orientation feel less restricted when it comes to discussing sensitive topics such as

treatment options and concerns and fears that come along with the cancer than individuals in

families low in conversation orientation because high conversation orientation families

continuously emphasize the importance of each family member expressing his/her feelings and

ideas. Koerner and Fitzpatrick (2002) also argued that families high in conversation orientation

view open and frequent communication as a key to family success; whereas families low in

conversation do not. Therefore, it is reasonable to suspect that coming together to engage in open

family discussion about the cancer is being used as a source of comfort and a type of coping

strategy for the families. This discussion of the cancer may be a way to hold the family together

and ensure their strength during a time of heightened fear and uncertainty. Avoiding discussion

of the cancer might be just as much a coping strategy for individuals in families that are low in

conversation orientation. Because individuals in low conversation orientation families are not as

comfortable discussing ideas and feelings as openly, frequent discussion of issues and feelings

pertaining to the cancer might be too much of an additional emotional burden to take on

following a cancer diagnosis.

67

Not only was there a significant main effect found for the relationship between the level

of conversation orientation and a patient’s perceived amount of emotional support, as was

predicted in H2, but there were also significant main effects found for the relationship between

family conversation orientation and perceived amounts of tangible and information support as

well. The significant positive relationship found between family conversation orientation and

perceived emotional support falls in line with Koerner and Fitzpatrick’s (2002) argument that the

higher the level of family conversation orientation, the more encouraging and supportive

individuals are going to be of their family members’ expression of feelings and attitudes.

Individuals in high conversation orientation families are probably better equipped to be

empathetic towards one another than individuals in low conversation orientation families

because they spend more time together, supportively exchanging thoughts and feelings. For

example, Koesten (2004) found that teenage women from high conversation orientation families

were more likely to be able to offer emotional support to friends and relational partners than

teenage women from low conversation families. It is quite possible that the greater ease with

which individuals in high conversation orientation families can provide emotional support causes

them to be more emotionally supportive than those individuals in low conversation orientation

families. Therefore, patients in high conversation orientation families perceive they are getting

more emotional support from their primary support provider than individuals in low conversation

orientation families. The relationship between level of family conversation orientation and

perceived amount of emotional support could also have to do with the positive relationship

between level of family conversation orientation and frequency of family discussion about the

cancer. It may be that because families high in conversation orientation engage in more

discussion about the cancer than families low in conversation orientation, cancer patients in high

68

conversation families spend more time expressing concerns, challenges, and fears related to the

cancer than those in low conversation families and, therefore, perceive themselves as receiving

more emotional support in response to that communication.

The positive relationships that were found between conversation orientation and tangible

and emotional support might suggest that those primary support providers in high conversation

orientation families are being perceived as generally more willing and able to provide social

support than those support providers in low conversation families. Recognizing the relationship

that was found between family conversation orientation and frequency of family discussion

about the cancer, one could suspect that patients whose families spend more time talking about

their cancer view their primary support providers as generally more in-tune with their needs and

their struggles and, therefore, more supportive. Positive relationships between frequency of

family discussion about cancer and all three support types found in the preliminary analyses offer

further support for this argument.

A significant main effect was also found for the relationship between family conversation

orientation and a patient’s amount of time spent talking about support needs that was predicted in

H3. The support found for this hypothesis is in line with Koerner and Fitzpatrick’s (2002)

argument that individuals in high conversation orientation families are encouraged to freely

express their thought and feelings, whereas individuals in low conversation orientation families

are not as concerned with the thoughts and feelings of their other family members. Therefore,

individuals in families low in conversation orientation probably feel less comfortable being open

and honest with their family members about what support they feel they need than individuals in

high conversation orientation families. Individuals in low conversation orientation families might

also be feeling that directly communicating their support needs would be equally uncomfortable

69

for their family members and an additional burden for them seeing as how they are not used to

going to each other with their wants and needs. Those individuals in high conversation families,

however, probably recognize their families’ dependence on open communication and, therefore,

feel that not directly expressing their support needs would make their family members more

anxious. Further explanation may also lie in the positive correlations identified in the preliminary

analyses between the level of family conversation orientation and the frequency of family

discussion about cancer and between the level of family conversation orientation and a patient’s

amount of talk about his/her support needs. Although speculative, these significant positive

correlations may suggest that because high conversation orientation families spend more time

discussing the cancer in general, there is greater opportunity for a patient’s support needs to be

brought up and expressed in these families than in families with a low conversation orientation.

Observations about Conformity Orientation

The results found in this study regarding the effects of conformity orientation are

particularly intriguing. Looking at the preliminary analyses, it appears that nearly all of the

relationships between conformity orientation and the support-related variables are directly

opposite those relationships between conversation orientation and the support-related variables.

This makes great sense when considering the significant negative relationship found in the

preliminary relationship between the conversation orientation and the conformity orientation.

When run in regressions with conversation orientation, however, significant main effects were

always found for conversation orientation only. There are a few possible explanations for this

observation. One explanation, which will be brought up again in the Limitations and Future

Research section of this paper may be the sample size. There may not have been enough power,

as a result of the small, relatively homogeneous sample, to find significant main effects of

70

conformity orientation. Had there been a larger and more diverse sample, the pattern that

appeared in the zero-order correlations may have carried through to the results of the regressions.

The lack of a larger, more diverse sample would also potentially explain the fact that no

significant relationship was found in either the preliminary analyses or the regressions between

conformity orientation and the degree of optimal matching of support, when the other significant

correlations would suggest there possibly should be. The majority of the participants in this

sample were both parents and spouses and thus probably one of the heads (if not the head) of

his/her household. Therefore, while a shared desire with their other family members to maintain

family harmony and hierarchy may have prevented the cancer patients from frequently

discussing their support needs, having the role of a leader in their family may have made the

degree of family conformity a less significant factor in determining optimal matching. This is

because these individuals have the power within the family to express dissatisfaction with

support or alternative approaches to support, even if they do not enjoy doing so, when they feel

like their needs are not being adequately met. A larger, more diverse sample including cancer

patients that were not heads of their households may have revealed a significant negative

correlation between conformity and optimal matching that would be in line with those negative

relationships found in the preliminary analyses between conformity orientation and the other

support-related variables.

The other possible explanation for the significant negative relationships between

conformity orientation and support-related variables not carrying over into the regression results

is that, perhaps, conversation orientation is the real driving force behind the effects of family

communication patterns on family behaviors. It may be, therefore, that the theoretical

conceptualization of the family communication pattern variables needs some refining in order to

71

most accurately reflect the presence and role of each orientation within the family. In the future,

theorists should spend some time examining the potential theoretical issue with the family

communication patterns.

If we consider the small sample size to be a reason for the lack of significant main effects

of conformity, then significant relationships found in the preliminary analyses are important to

look at because they offer insight into the relationships that may truly exist between conformity

and support-related variables that were inquired about in RQ1-RQ3. In the remained of this

section, therefore, results of the preliminary analyses will be looked at in order to begin to

understand the possible relationships that were found with this particular sample between

conformity orientation and support-related variables. Preliminary analyses showed a significant

negative correlation between conformity orientation and frequency of family discussion about

cancer. This negative relationship is surprising to some degree, given Koerner and Fitzpatrick’s

(2002) research suggesting that families higher in conformity emphasize family togetherness and

cohesiveness whereas families lower in conformity emphasize the strengthening of relationships

outside of the family. One would not suspect that individuals in families that focus their efforts

on relationships outside of the family unit would discuss the cancer with their family members

more than individuals in families that place familial relationships above all other relationships.

However, the negative relationship between level of family conformity orientation and frequency

of family discussion about cancer may be better understood by considering past research by

Koerner and Cvancara (2002) regarding the type of communication that occurs within low and

high family conformity orientations. Koerner and Cvancara (2002) found that communication in

families that are low in conformity is freer and more spontaneous than communication in

families that are high in conformity because individuals in low conformity orientation families

72

use more confirming statements and value-free reflections of others’ communication than

individuals in high conformity orientation families. Thus, the low conformity orientation families

may offer a more supportive, encouraging environment for individuals to freely discuss their

feelings and ideas concerning the cancer than the high conformity orientation families. The

negative relationship between family conformity orientation and family discussion of illness

found in the preliminary analyses could also be because of the value placed on the family

hierarchy. Koerner and Fitzpatrick (2002) explain that high conformity families value the idea

that children should be seen and not heard and, therefore, the head(s) of the household make(s)

the decisions regarding the well-being of the family. Since the majority of the sample identified

themselves as a parent and a spouse, perhaps those participants in the high conformity families

believe that their children need not be kept informed of all the details pertaining to their parents’

cancer, nor involved in making decisions regarding the cancer.

Preliminary analyses indicated significant negative relationships between conformity

orientation and emotional support and between conformity orientation and tangible support.

Preliminary analyses did not, however, indicate a relationship between conformity orientation

and informational support. These negative relationships between family conformity orientation

and emotional support and between family conformity orientation and tangible support are, to

some extent, surprising given Koerner and Fitzpatrick’s (2002) argument that high conformity

families value the family unit and family relationships above all else. Because of Koerner and

Fitzpatrick’s (2002) argument, one could suspect that individuals in these high conformity

families who are used to relying more on family members than on individuals outside the family

would perceive more support from their loved ones than individuals in low conformity families

that do not emphasize familial interdependence. The negative relationship between conversation

73

orientation and emotional support is better understood, however, if one considers the high

conformity family’s goals of maintaining homogeneity of attitudes and beliefs as well as the

established family hierarchy. Again considering Koerner and Cvancara’s (2002) finding that

communication in families that are low in conformity is freer and more spontaneous than

communication in families that are high in conformity, it is possible that the more a family

values conformity, the more taboo topics there are within the family and, therefore, the less

comfortable its members are being honest and free with their communication of feelings. A lack

of comfort with honest and free communication of feelings in families high in conformity could

make it more challenging for members of these families to be empathetic and/or emotionally

supportive towards one another, thus causing patients in these families to perceive less emotional

support. The negative correlation between conformity and emotional support could also be a

result of the sample. Almost all of the participants were women and the majority of these women

indicated that their primary support providers were their husbands. Koerner and Fitzpatrick

(2002) explain that high conformity families value a traditional, hierarchical family structure.

Perhaps, therefore, families that are higher in conformity adhere more to traditional family roles

where the husband and father figure is the “rock” of the family and, thus, less likely to show

vulnerability by showing emotion and providing emotional support.

The negative relationship between conformity orientation and tangible support found in

the primary analyses is more difficult to understand, especially given the negative relationship

between conformity and emotional support. It was thought that if emotional support was difficult

for individuals in high conformity families, perhaps they would compensate for this lack of

emotional support by engaging in less vulnerable types of support. Perhaps as mentioned above,

however, the more a family emphasizes conformity, the more emphasis it places on maintaining

74

the established family roles and, thus, the less comfortable and/or capable the primary support

provider is assisting in or taking over responsibilities that fall in the cancer patient’s domain.

The lack of a significant positive relationship between conformity orientation and

informational support is somewhat surprising seeing that Koerner and Cvancara (2002) found

that individuals in high conformity families engage in advice giving more than individuals in low

conformity families. Perhaps their predisposition to engage in advice giving is tempered in the

context of cancer because the family members do not feel knowledgeable enough about the

disease and what the patient is going through.

Finally, preliminary analyses indicated a significant negative correlation between

conformity orientation and a patient’s amount of talk about his/her support needs. Perhaps,

therefore, cancer patients in high conformity families are more hesitant to discuss their support

needs with their family members because they fear the requesting of certain types of support

(i.e., emotional support) would threaten the power structure and/or family roles that are already

established in the family. It could also be that cancer patients in high conformity families are less

likely to talk about their support needs than patients in low conformity families because they feel

that their family members are more likely to judge their perception of need if it is not in line with

the traditional attitudes and beliefs of the family unit. This explanation is in line with Koerner

and Cvancara’s (2002) finding that families high in conformity orientation engage in more

advice giving and evaluating of others’ behaviors based on their own attitudes and perspectives,

whereas families low in conformity engage in more confirming statements and value-free

reflections of others’ communication.

The above interpretation of the zero-order correlations suggest that being high in

conformity orientation may prevent a family from creating an environment that is conducive to

75

the type of communication and trust amongst family members that is required for successful

support exchange. Further research is needed with a larger, more diverse sample is needed to

confirm if this suspicion is correct or if the conceptualization of the family communication

patterns requires further theorizing.

Limitations and Future Research

One of the chief limitations of this study concerns the sample. Although 78 individuals

completed a portion of the survey, 25 of those people did not complete significant portions of the

survey related to the tests of hypotheses and, therefore, were not used in the analyses. As a result,

there was a relatively small sample size (N = 53). As previously mentioned, a lack of power as a

result of the smaller sample may account for the lack of significant main effects for the

conformity orientation on the dependent variables. It is important to note here that recruitment

was particularly challenging given that the limited available funds for the project prevented there

from being a monetary reward for participants and that local hospitals would not permit

recruitment at their social support group meetings given the number of research projects they

already had underway. Future research with a larger number of participants should be done to see

if similar significant results are found. Also, with a larger sample it may be possible to use the

four categories of family communication patterns that past studies (Orrego & Rodriquez, 2001;

Zhang, 2007) have derived using the mean splits on both the conformity and conversation

dimensions. Using the four category system would allow for a comparison between family types

to determine which combinations of conversation and conformity orientation allow for optimal

support. It would also allow for a more nuanced understanding of the connection between the

conversation and conformity orientations that was not possible in this particular study.

76

Another limitation of the sample is its lack of diversity. Nearly all of the participants

were women who identified themselves as both a wife and a mother in their immediate families.

This may be a result of two of the message boards used for recruiting being solely about breast

cancer. The results of this research, therefore, may not be as applicable for families that have

male cancer patients or whose cancer patients are not one of the heads of the household. Also, as

mentioned earlier, the fact that the majority of participants are heads of their household may have

played a role in the lack of significant main effects of conformity found in the study. Also, the

sample was significantly lacking in racial diversity with 94.3% of the respondents identifying

themselves as white. This is probably a result of the recruitment medium. Im, Chee, Tsai, Lin,

and Cheng (2005) explained that online help and support for cancer is used primarily by white,

highly educated individuals. Results of this research, therefore, may not be applicable for

families of different ethnic backgrounds. Future research should be done on a more diverse

sample so that results can extend to these other groups.

Because individuals that use online message boards are clearly getting some other

support outside of their family unit, their perception of within-family support and optimal

matching might be impacted by this external support. Also, individuals who use online support

tools may share certain individual or familial characteristics that influence the perceived amount

and quality of support available in their households. Future research should be done using

participants who do not have this additional external support so that results can be applied to a

larger population.

Another potential limitation is that, in order to increase sample size, individuals who

were in remission were also asked to complete the survey. For some participants, it has been

over 10 years since they have needed the sort of support that was required following their last

77

diagnosis and, therefore, they may not accurately recall the amount or type of support they felt

they were receiving at the time or how much they felt they discussed cancer and support with

their family members. As a result, retrospection error may have impacted some of the results.

Future research should try to examine individuals who are not yet in remission, and thus still in

great need of social support. It may be extremely beneficial to do a longitudinal study of cancer

patients directly following their cancer diagnoses to see how their support needs change and also

how their support providers’ abilities to provide support change with the passing of time.

How participants conceptualized the term conflict may be an additional limitation to the

study. When asked to identify whether the amount of conflict within their families had changed

since the diagnosis, they may have only been considering competitive conflict, or conflict that

was managed poorly or resulted in a fight, thus causing the majority of the participants to

unexpectedly report engaging in less conflict during a time of such stress and uncertainty. If it

was made evident to the participants that conflict referred to any situation involving misaligning

goals or a struggle over scarce resources, regardless of how the situation was handled

(constructively or not), it may be that they would have reported engaging in more conflict.

A final limitation to this study is that results were mostly based off of the participants’

views of their primary support providers in their family. In families larger than 2 people,

however, it is likely that important support is also coming from those other family members. For

a more thorough understanding of the kind of supportive atmosphere perceived by the patients as

being provided by their families, future research should examine all of the support providers in

the household. Future research might also survey the family members of the cancer patients so

that one can better examine how family communication patterns and conflict management styles

78

may cause discrepancies between the support that is being provided by the family members and

the support that the cancer patient perceives as being provided by the family members.

Despite these limitations, the significant findings of this study provide valuable insight

into the relationship between communication patterns, conflict styles, and social support in the

context of coping with cancer within the family. The remainder this thesis offers a summary of

this work and its greater importance for improving the well-being of cancer patients and their

loved ones.

Conclusion

This thesis sought to gain further insight into the capability of a family to be a positive,

supportive environment for a cancer patient while members try to cope with the cancer diagnosis

of their loved one. The relationships between family communication patterns, conflict

management styles, perceived social support and optimal matching of support were discovered

by having cancer survivors complete a self-report questionnaire in which they reported how their

family communicates, how they handle conflict within their family, and their perception of and

satisfaction with the social support they receive from their primary support provider.

Hierarchical regression modeling was used to analyze the data.

A cancer diagnosis is not only a life-altering event for the individual diagnosed, but

rather a life-altering event for that individual’s entire family unit. When an individual is

diagnosed with cancer, social support becomes a critical component of the relationship between

the family members. It is unreasonable to suspect, however, that all families are equally

equipped to provide what the cancer patients perceive as adequate support, especially while they

themselves are trying to cope with the fear and sadness that result from having a sick loved one.

Several factors relating to how individuals within a family unit inherently communicate with and

79

relate to one another can influence their ability to exchange support. A cancer patient’s

dissatisfaction with family support is not only a physical and psychological threat to his/her well-

being, but also an additional stressor in the family environment and another disappointment for

their already anxious family members. Ensuring that the support needs of the sick family

member are being met thus helps to both improve the well-being of the sick individual and

prevent stress and burnout on the part of the family members. When an individual is fighting

cancer, the presence of so many uncontrollable stressors related to illness in the family

environment makes this environment a breeding ground for conflict. It is important, therefore, to

try to ensure that the management of conflict within the family does not prevent the successful

exchange of support and that any inadequate offering of support does not become an additional

source of tension and potential conflict within the family during this stressful time.

Because both family communication patterns and conflict management styles are

significant influences on familial behavior and relationships, both were suggested to be

significant predictors of available support and optimal matching. As expected, significant results

were found for both of these constructs, suggesting that they were, in fact, useful constructs to

explore within this context. Preliminary analyses showed evidence of negative relationships

between level of family conformity orientation and the frequency of family discussion of cancer,

the amount of patient communication about his/her support needs, and the patient’s perceived

amount of emotional and tangible support. Further research should be done with a larger sample

size to gain further insight into the actual influence of conformity orientation on these variables.

Support was found for the hypotheses predicting positive relationships between the level of

family conversation orientation and each of the following dependent variables: frequency of

family discussion of cancer, the amount of patient communication about support needs, the

80

perception of the amount of available types of support, and the degree of optimal matching. The

prediction of a positive relationship between the collaboration and compromising conflict

management styles and a patient’s reported degree of optimal matching was also supported.

The support found for the hypotheses is important evidence that family environments

conducive to frequent open and clear communication are most suitable for providing substantial

support that a cancer patient deems satisfying. In other words, during this time of heightened

uncertainty and fear, constructive and consistent family communication is critical to meet the

demanding needs of the cancer patient and, consequently, decrease the potential for additional

strain within the family thus preserving the well-being of the all of the family members. The

findings regarding conflict management is also particularly important because they emphasize

that engaging in constructive conflict is an important tool for gaining experience and skill at

communicating in a way that will allow for optimal support exchange.

The findings of this research highlight the importance of making sure that medical staff

and professionals are doing more than just treating the physical symptoms of cancer. It can not

be assumed that families of cancer patients inherently have the communication tools needed to

be successful support providers during such a vulnerable time. Also, the potential threat to the

patient and his/her family members’ well-being that can result from inadequate supportive

exchange can not be overlooked. Medical staff and professionals must, therefore, not only

concern themselves with providing patients with the best possible medical treatment, but also

with making sure patients’ families get educated about the communication and conflict

management strategies that can be used to provide the most supportive and constructive home

environment possible. An individual’s cancer diagnosis puts the well-being of every family

81

member at risk and, therefore, every step must be taken to ensure that the environment at home is

both positive and supportive.

82

REFERENCES

Abbey, A., Abramis, D. J., & Caplan, R. D. (1985). Effects of different sources of social support

and social conflict on emotional well-being. Basic and Applied Social Psychology, 6(2),

111-129.

Albrecht, T.L., Burleson, B.R., & Goldsmith, D. (1994). Supportive communication. In M. L.

Knapp, & G. R. Miller (Eds.), Handbook of interpersonal communication (rev. ed., p.

419-449). Newbury Park, CA: Sage.

Barrera, M., Chassin, L. & Rogosch, F. (1993). Effects of social support and conflict on

adolescent children of alcoholic and nonalcoholic fathers. Journal of Personality and

Social Psychology, 64(4), 602-612.

Barrera, M., Sandler, I.N. & Ramsey, T.B. (1981). Preliminary development of a scale of social

support: Studies on college students. American Journal of Community Psychology, 9,

435-447.

Blanchard, C.G., Albrecht, T.L., Ruckdeschel, J.C., Grant, C.H., & Hemmick, R.M. (1995). The

role of social support in adaptation to cancer and to survival. Journal of Psychosocial

Oncology, 13(1-2), 75-95.

Chaffee, S.H., McLeod, J.M., & Atkin, C.K. (1971). Parental influences on adolescent media

use. American Behavioral Scientist, 14, 323-340.

Cobb, S. (1976). Social support as a moderator of life stress. Psychosomatic Medicine, 38, 300-

314

83

Cutrona, C. & Russell, D. (1990). Social Support: An Interactional View. In B. Sarason & G.

Pierce (Eds.), Type of social support and specific stress: Toward a theory of optimal

matching (p. 319-366). New York: Wiley.

Dumlao, R. & Botta, R.A. (2000). Family communication patterns and the conflict young adults

use with their fathers. Communication Quarterly, 48(2), 174-189.

Eggert, L.L. (1987). Support in the family. In T. Albrecht & M. Adelman (Eds.), Communicating

social support (p. 240-254). Newbury Park, CA: SAGE Publications.

Ell, K. (1996). Social networks, social support and coping with serious illness: The family

connection. Social Science and Medicine, 42(2), 173-183.

Elwood, T. & Schrader, D. (1998). Family communication patterns and communication

apprehension. Journal of Social Behavior and Personality, 13(3), 493-502.

Gil, S., & Gilbar, O. (2001). Hopelessness among cancer patients. Journal of Psychosocial

Oncology, 19(1), 21-33.

Glasdam, S., Jensen, A.B., Madsen, E.L., & Rose, C. (1996). Anxiety and depression in cancer

patients’ spouses. Psycho-oncology, 5, 23-29.

Hagerty, B. M. & Williams, A. R. (1999). Sense of belonging, social support, conflict, and

loneliness on depression. Nursing Research, 48(4), 215-219.

Im, E., Chee, W., Tsai, H., Lin, L., Cheng, C. (2005). Internet cancer support groups. Cancer

Nursing, 28(1), 1-7

Kahn, R. L. (1979). Aging and social support. In M. W. Riley (Ed.), Aging from Birth to Death:

Interdisciplinary Perspectives (p. 77-91). Boulder, CA: Westview Press.

84

Kenen, R., Ardern-Jones, A., & Eeles, R. (2004). We are talking, but are they listening?

Communication patterns in families with a history of breast/ovarian cancer (HBOC).

Psycho-Oncology, 13, 335-345.

Krause, N. (1987). Chronic financial strain, social support, and depressive symptoms among

older adults. Psychology and Aging, 2(2), 185-192.

Koerner, A.F. & Cvancara, K.E. (2002). The influence of conformity orientation on

communication patterns in family conversations. Journal of Family Communication,

2(3), 133-152.

Koerner, A.F. & Fitzpatrick, M. (1997). Family type and conflict: The impact of conversation

orientation and conformity orientation on conflict in the family. Communication Studies,

48, 59.

Koerner, A.F. & Fitzpatrick, M. (2002). Toward a theory of family communication.

Communication Theory, 12(1), 70-91.

Koesten, J. (2004). Family communication patterns, sex of subject and communication

competence. Communication Monographs, 71(2), 226-244.

Major, B., Cooper, M. L., Zubek, J. M., Cozzarelli, C., & Richards, C. (1997). Mixed Messages:

Implications of social conflict and social support within close relationships for

adjustment to a stressful life event. Journal of Personality and Social Psychology, 72(6),

1349-1363.

MaloneBeach, E. E. & Zarit, S. H. (1995). Dimensions of social support and social conflict as

predictors of caregiver depression. International Psychogeriatrics, 7(1), 25-38.

85

Manne, S. & Schnoll, R. (2001). Measuring supportive and unsupportive responses during

cancer treatment: A factor analytical assessment of the partner responses to cancer

inventory. Journal of Behavioral Medicine, 24(4), 297-321.

Martire, L. M., Lustig, A.P., Schulz, R., Miller, G.E., & Helgeson, V.S. (2004). Is it beneficial to

involve a family member? A meta-analysis of psychosocial interventions for chronic

illness. Health Psychology, 23(6), 599-611.

Moos, R. H., & Schaefer, J. A. (1984). The crisis of physical illness: An overview and

conceptual approach (Vol. 2, pp. 3-23). New York: Plenum.

Noller, P., Feeney, J.A., Sheehan, G., & Peterson, C. (2000). Marital conflict patterns: Links

with family conflict and family members’ perceptions of one another. Personal

Relationships, 7(1), 71-94.

Norbeck, J. S., Lindsey, A. M., & Carrieri, V. L. (1987). Further development of the Norbeck

Social Support Questionnaire: Normative data and validity testing. Nursing Research,

32(1), 4-10.

Orrego, V.O. & Rodriguez, J. (2001). Family communication patterns and college adjustment:

The effects of communication and conflictual independence on college students. Journal

of Family Communication, 1(3), 175-189.

Piko, B. (1998). Social support and health in adolescence: A factor analytical study. British

Journal of Health Psychology, 3, 333-344.

Rahim, M. A. (1983). A measure of styles of handling interpersonal conflict. Academy of

Management Journal, 26, 368-376.

Revenson, T. A. (2004). Social support and marital coping with chronic illness. Annals of

Behavioral Medicine, 16(2), 122-130.

86

Ritchie, L. D. & Fitzpatrick, M. (1990). Family communication patterns. Communication

Research, 17(4), 523-544.

Robinson, J. D. & Turner, J. (2003). Impersonal, interpersonal, and hyperpersonal social support:

Cancer and older adults. Health Communication, 15(2), 227-234.

Sarason, I. G., Levine, H. M., Basham, R. B., & Sarason, B. R. (1983). Assessing social support:

The Social Support Questionnaire. Journal of Personality and Social Psychology, 44(1),

127-139.

Smetana, J. G., Yau, J. & Hanson, S. (1991). Conflict resolution in families with adolescents.

Journal of Research on Adolescents, 1(2), 189-206.

Taylor, S. E., Falke, R. L., Shoptaw, S. J., & Lichtman, R. R. (1986). Social support, support

groups, and the cancer patient. Journal of Consulting and Clinical Psychology, 54(5),

608-615.

Thompson, S. & Pitts, J.S. (1992). In sickness and in health: Chronic illness, marriage, and

spousal caregiving. In S. Spacapan & S. Oskamp (Eds.), Helping and Being Helped (pp

115-151). Newbury Park, CA: Sage

Turner, J. W., Grube, J. A., & Meyers, J. (2001). Developing an optimal match within online

communities: An exploration of CMC support communities and traditional support.

Journal of Communication, 51(2), 231-251.

Zang, Q. (2007). Family communication patterns and conflict styles in Chinese parent-child

relationships. Communication Quarterly, 55(1), 113-128.

87

APPENDIX A

SOLICITATION LETTER

Hello,

I am a graduate student at the University of Georgia studying Speech Communication. I

am particularly interested in communication related to health and families. I am in my second

year of my Master’s program and, therefore, working on my thesis. My project is entitled, “How

Family Communication Patterns and Conflict Management Affect Cancer Patients’ Support

Satisfaction and Availability.” I am examining the communication styles and strategies in

families in which one individual is fighting cancer. More specifically, I am looking at how those

fighting cancer communicate/discuss their support needs with their loved ones. The future goal

of this research is to obtain the information necessary to improve the type and quality of support

that is offered to cancer patients, and to ensure that the type of support that they want/need is the

type that their family and loved ones are able to provide.

In order to carry out my research, I need individuals who are currently fighting cancer to

fill out a questionnaire about how they communicate with their families, particularly in regards

to the illness. Therefore, I am asking for your assistance. Any individuals over the age of 18

who have, at one time, been diagnosed with cancer and who have at least one other individual

in their immediate families are welcome and encouraged to click on the link below, read the

consent form explaining the study and questionnaire in more detail, and then fill out and submit

the anonymous questionnaire online. You are free to contact me if you have any

questions/concerns regarding your decision to participate. Further contact information is

available on the informational letter at the beginning of the survey (you will have the opportunity

to read through the letter and make your decision before you are asked to look at/answer any of

the questions).

Many of my loved ones have fought and continue to fight cancer and for this reason I am

extremely passionate about my project. I believe that my work could potentially make a

significant difference and, therefore, I would love the opportunity to get a decent number of

individuals involved. Thank you so much in advance for your time and consideration.

Link to the questionnaire:

http://www.surveymonkey.com/s.aspx?sm=3eydO24u5OJ6qDwA_2bR_2bmOg_3d_3d

88

APPENDIX B

LETTER OF INFORMED CONSENT

To Whom It May Concern,

I am a graduate student in the department of Speech Communication at the University of Georgia

working under the direction of Dr. Jennifer Samp (706-542-4893, [email protected]). I invite you

to participate in a research study titled "HOW FAMILY COMMUNICATION PATTERNS

AND CONFLICT MANAGEMENT AFFECT CANCER PATIENTS’ SUPPORT

SATISFACTION AND AVAILABILITY." Your participation is entirely voluntary. You can

refuse to participate or stop taking part without giving any reason, and without penalty. You can

ask to have all of the information about you returned to you, removed from the research records,

or destroyed.

The reason for this study is to see if the different ways family members communicate with one

another and handle conflict influence the giving and receiving of support when one family

member has cancer. If you volunteer to take part in this study, you will be asked to do the

following things:

1) Answer questions about how your family communicates, how your family handles conflict,

and the amount and type of support available within your family which will take 20-40 minutes

While there are no direct benefits for participating in this study, you may gain a better

understanding of your support needs as a result of participating in this research. As the

researcher, I also hope to learn more about the impact of family communication and conflict

styles on cancer patient support.

No risk is expected but there is a slim chance that you may experience some psychological stress

when completing the questionnaire as a result of having to think about situations of conflict in

your family. These risks will be reduced in the following way: by the questionnaire refraining

from asking for detailed information about specific conflicts or instances of poor support-giving

within the family.

Please note that Internet communications are insecure and there is a limit to the confidentiality

that can be guaranteed due to the technology itself. However, once we receive the completed

surveys, the surveys will be anonymous, meaning that no one will be able to trace your responses

back to me. If you are not comfortable with the level of confidentiality provided by the Internet,

please feel free to print out a copy of the survey, fill it out by hand, and mail it to me at the

address given below, with no return address on the envelope.

Thank you for your consideration! If you have any questions about this research project, please

feel free to call me at (706) 542-4893 or send an e-mail to [email protected]. Questions or

89

concerns about your rights as a research participant should be directed to The Chairperson,

University of Georgia Institutional Review Board, 612 Boyd GSRC, Athens, Georgia 30602-

7411; telephone (706) 542-3199; email address [email protected].

90

APPENDIX C

QUESTIONNAIRE

Please think about your immediate family and how you typically go about talking to one

another and then answer the following questions.

1.) My family has established rules that everyone is expected to obey.

1 2 3 4 5

Never

2.) If the head(s) of the house don’t approve of it, they don’t want to know about it.

1 2 3 4 5

Never Frequently

3.) We often talk as a family about things we have done during the day.

1 2 3 4 5

Never Frequently

4.) My family encourages me to express my feelings.

1 2 3 4 5

Never Frequently

5.) In our home, the head(s) of the household usually have the last word.

1 2 3 4 5

Never Frequently

6.) I can tell my family members almost anything.

1 2 3 4 5

Never Frequently

91

7.) The head(s) of the house often say something like “My ideas are right and you should not

question them.”

1 2 3 4 5

Never Frequently

8.) The head(s) of my household say something like “You should give in on arguments rather

than risk making people mad.”

1 2 3 4 5

Never Frequently

9.) I really enjoy talking to my family members, even when we disagree.

1 2 3 4 5

Never Frequently

10.) My family members become irritated with my views if they are different from theirs.

1 2 3 4 5

Never Frequently

11.) The head(s) of my household say something like “There are some things that just shouldn’t

be talked about.”

1 2 3 4 5

Never Frequently

12.) In our family, we often talk about our plans and hopes for the future.

1 2 3 4 5

Never Frequently

13.) I usually tell the people in my family what I am thinking about things.

1 2 3 4 5

Never Frequently

14.) In our family we often talk about our feelings and emotions.

1 2 3 4 5

Never Frequently

92

15.) The people in my family like to hear my opinion, even when they don’t agree with me.

1 2 3 4 5

Never Frequently

16.) The head(s) of the household feel that it is important to be the boss.

1 2 3 4 5

Never Frequently

17.) How often would you say your family spends talking about the illness and issues

surrounding the illness?

1 2 3 4 5

Never Frequently

18.) How often would you say your family spends talking about each other’s support needs?

1 2 3 4 5

Never Frequently

Now, please think of the most important person in your immediate family as you are

dealing with your illness.

19.) How is this person related to you? ____________________________

Please continue to think of this person as you answer the following questions:

Since the diagnosis, how often has this person. . .

20.) Told you what they did in a stressful situation that was similar to

one you were experiencing?

1 2 3 4 5

Never Frequently

21.) Been right there with you (physically) during this stressful situation?

1 2 3 4 5

Never Frequently

22.) Suggested some action that you should take in dealing with a problem you were having

related to the illness/coping with the illness?

1 2 3 4 5

Never Frequently

93

23.) Told you you were okay just the way you are?

1 2 3 4 5

Never Frequently

24.) Given you information that made a difficult situation clearer and easier to understand?

1 2 3 4 5

Never Frequently

25.) Comforted you by showing you physical affection?

1 2 3 4 5

Never Frequently

26.) Helped you understand why you didn't do something well?

1 2 3 4 5

Never Frequently

27.) Provided you with some transportation?

1 2 3 4 5

Never Frequently

28.) Listened to you talk about your private feelings?

1 2 3 4 5

Never Frequently

29.) Told you who you should see for assistance with a problem that you were having relating to

the illness/coping with the illness?

1 2 3 4 5

Never Frequently

30.) Told you they felt very close to you?

1 2 3 4 5

Never Frequently

94

31.) Commented on how you were dealing with a problem related to the illness/coping with the

illness without saying it was good or bad?

1 2 3 4 5

Never Frequently

32.) Joked and kidded to try to cheer you up?

1 2 3 4 5

Never Frequently

33.) Checked back with you to see if you followed advice you were given on how to deal with a

problem related to the illness/coping with the illness?

1 2 3 4 5

Never Frequently

34.) Pitched in to help you do something that needed to get done, like household chores or

yardwork?

1 2 3 4 5

Never Frequently

35.) Expressed interest in and concern for your well-being?

1 2 3 4 5

Never Frequently

36.) Went with you to see someone who helped you with a problem that you were having related

to the illness/coping with the illness?

1 2 3 4 5

Never Frequently

37.) Helped you with shopping?

1 2 3 4 5

Never Frequently

38.) Told you that they would keep the things you talked about privately just between the two of

you?

1 2 3 4 5

Never Frequently

95

39.) Did some activity together with you to help you get your mind off things?

1 2 3 4 5

Never Frequently

40.) Told you how they felt in a situation that was similar to yours?

1 2 3 4 5

Never Frequently

41.) How often would you say you talk to your family about your support needs?

1 2 3 4 5

Never Very Often

42.) How satisfied are you with the support you are currently receiving from this individual:

1 2 3 4 5

Not at all Very satisfied

Satisfied

43.) I feel like I am getting the support that I need from this individual:

1 2 3 4 5

Not at all Very True

True

44.) When it comes to the amount of support I am receiving I am:

1 2 3 4 5

Not at all Very Satisfied

Satisfied

45.) Sometimes I wish that my family offered me more support:

1 2 3 4 5


True

46.) I turn to people outside of my immediate family to provide me with support

1 2 3 4 5

Never Frequently

96

47.) If I can’t get the support that I need from within my family, I have people outside my family

who can provide me with the support I need.

1 2 3 4 5


True

Continue to think of that same family member you mentioned above as you answer the

following questions:

Since the diagnosis…

48.) I try to investigate an issue with ____________ to find a solution acceptable to us

1 2 3 4 5

Never Frequently

49.) I avoid an encounter with ________________

1 2 3 4 5

Never Frequently

50.) I sometimes use my power to win a competitive situation

1 2 3 4 5

Never Frequently

51.) I win some and I lose some

1 2 3 4 5

Never Frequently

52.) I try to integrate my ideas with those of ____________’s to come up with a decision jointly

1 2 3 4 5

Never Frequently

53.) I try to keep my disagreement with ________________ to myself in order to avoid hard

feelings

1 2 3 4 5

Never Frequently

97

54.) I generally try to satisfy the needs of __________________

1 2 3 4 5

Never Frequently

55.) I try to play down our differences to reach a compromise

1 2 3 4 5

Never Frequently

56.) I try to work with _________________ to find solutions to a problem which satisfy our

expectations

1 2 3 4 5

Never Frequently

57.) I try to avoid unpleasant exchanges with ________________

1 2 3 4 5

Never Frequently

58.) I usually accommodate the wishes of __________________

1 2 3 4 5

Never Frequently

59.) I usually propose a middle ground for breaking deadlocks

1 2 3 4 5

Never Frequently

60.) I exchange accurate information with ______________ to solve a problem together

1 2 3 4 5

Never Frequently

61.) I generally avoid an argument with ____________________

1 2 3 4 5

Never Frequently

98

62.) I give in to the wishes of _________________

1 2 3 4 5

Never Frequently

63.) I negotiate with _______________ so that a compromise can be reached

1 2 3 4 5

Never Frequently

64.) I try to bring all our concerns out in the open so that the issues can be resolved in the best

possible way

1 2 3 4 5

Never Frequently

65.) I usually hold on to my solution to a problem

1 2 3 4 5

Never Frequently

66.) I use "give and take" so that a compromise can be made

1 2 3 4 5

Never Frequently

67.) I collaborate with _____________ to come up with decisions acceptable to us

1 2 3 4 5

Never Frequently

68.) I use my influence to get my ideas accepted

1 2 3 4 5

Never Frequently

69.) I try to work with _______________for a proper understanding of a problem

1 2 3 4 5

Never Frequently

70.) I use my authority to make a decision in my favor

1 2 3 4 5

Never Frequently

99

71.) I often go along with the suggestions of ____________________

1 2 3 4 5

Never Frequently

71.) I attempt to avoid being "put on the spot" and try to keep my conflict with _____________

to myself

1 2 3 4 5

Never Frequently

72.) I try to satisfy the expectations of _________________

1 2 3 4 5

Never Frequently

73.) I usually avoid open discussion of my differences with ______________

1 2 3 4 5

Never Frequently

74.) I use my expertise to make a decision in my favor

1 2 3 4 5

Never Frequently

75.) I give some to get some

1 2 3 4 5

Never Frequently

76.) I try to stay away from disagreement with _______________

1 2 3 4 5

Never Frequently

77.) I am generally firm in pursuing my side of the issue

1 2 3 4 5

Never Frequently

78.) I try to find a middle course to resolve an impasse

1 2 3 4 5

Never Frequently

100

79.) Before the diagnosis, I handled conflict:

1 2 3 4 5

Very differently Exactly the Same

80.) Since the diagnosis I engage in:

______________ Less Conflict __________ The same amount ___________ More Conflict

Of Conflict

Please tell us about yourself:

Your gender (circle): Male or Female

Your age:________

The age of your primary support provider _________.

The sex of your primary support provider: Male or Female

How long have you know your primary support provider: __________________.

The racial/ethnic identification that best describes you is:_________________________

How would you define the role you play in your immediate family (please circle all that apply):

Husband Father Daughter Sister Other_____________

Wife Mother Son Brother

When were you last diagnosed with cancer? ____________________________.

THANK YOU FOR YOUR PARTICIPATION

Documents

HOW FAMILY COMMUNICATION PATTERNS AND CONFLICT …