Linda Goodfellow, PhD, RN, of Duquesne University, discussing the important role nurses play in supporting the spouses of patients with cancer, a critical, yet often unmet need.
Linda M. Goodfellow, PhD, RN
Associate Professor, Duquesne University School of Nursing,
Family systems theory emphasizes the interrelatedness of family members and their effects on one another1; from this perspective, the effects of cancer on one member of the family can also affect the health and well-being of other family members. Most spouses experience high levels of stress after their partner has been diagnosed with a potentially life-threatening disease like cancer, and this stress is evident during and after treatment.2
High levels of stress have been associated with profound psychological and physiological disturbances in the spouse of a patient with cancer,3 stemming from uncertainty about the future, fear and lack of knowledge about cancer, its treatment, and symptom management, as well as alterations in daily activities brought about by the patient’s disease and treatment.2 In addition, caregiver fatigue is viewed by spouses as a source of stress,4 as many worry about who would take care of their ill partner if they, too, should become ill.5
A high incidence of respiratory infections, hypertension, and reduction in immune function,3,6 as well as eating disorders, sleep disturbances, and poor health,4,7,8 have been found in spouses of patients with cancer. In addition, psychosocial disturbances, such as depression, negative mood, and perceived stress, have been reported as a result of caring for a partner with cancer9,10; depressive mood and perceived stress also have been shown to be significantly associated with poor natural killer cell activity.9 Natural killer cell activity is an excellent measure of overall health and well-being.11
Despite these findings, little attention has been given to helping spouses of patients with cancer reduce the effects of stress associated with their partner’s illness. In my recent study, I found that spouses were indeed willing to use a number of interventions to reduce their stress (Table).12 Interestingly, male spouses were less inclined to pray than female spouses, but more inclined to exercise when asked how many times per week they used an intervention to reduce stress.
1-2 times (%)
3-4 times (%)
5-7 times (%)
Talk to Friends
Listen to Music
Read a Book
Play with a Pet
Take a Walk
*Gender differences: P ≤ .01.
Often the spouse is too concerned with an ill partner to ask for help. It is up to the nurse to ascertain whether or not the spouse may need a referral to a support group or for counseling. A spouse who is highly anxious or depressed may need to see his or her own physician for medical treatment or a behavioral psychologist to learn stress management or relaxation techniques. Some seek spiritual-based resources, whereas others may just need encouragement to rely on what has helped them to cope with stressful events in the past.
Sometimes, spouses do not want to leave their partners for a long period of time to engage in an exercise class or to have a massage,5 so it is important to suggest activities that can be done at home, such as listening to music, reading a good novel, gardening, playing with a pet, or taking a walk around the block.12 It is also important for the nurse to remind the spouse to avoid poor health habits,7,8 including alcohol, smoking, drinking caffeinated beverages in excess, or eating foods high in sugar and fat. Levels of stress and ways of coping will differ from one spouse to another, so it is important for the nurse to help them identify the best options.
Here at Duquesne, undergraduate nursing students study cancer care during the fall semester of their junior year. They are encouraged to include the spouse and other family members in their patient’s plan of care and given opportunities to apply theory learned in the classroom to patients with cancer in both the hospital and community settings.
Too frequently we forget about the spouse’s vital role in caring for an ill partner. As nurses, we must include the spouse in our plan of care to help maintain their overall health and well-being, so that they remain healthy throughout the cancer experience and are able to provide the care and support their partner needs.