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Are Your Metastatic Cancer Patients and their Family Members using Protective Buffering?

May 15, 2012 | AONN+ Blog
Featuring:
Lillie D. Shockney, RN, BS, MAS, HON-ONN-CG
Lillie D. Shockney, RN, BS, MAS, HON-ONN-CG
Editor-in-Chief, JONS; Co-Founder, AONN+; University Distinguished Service Professor of Breast Cancer, Administrative Director, The Johns Hopkins Breast Center; Director, Johns Hopkins Cancer Survivorship Programs; Professor of Surgery and Oncology, JHU School of Medicine; Co-Creator, Work Stride-Managing Cancer at Work

Protective buffering refers to hiding cancer-related thoughts and concerns from one’s partner. As a navigator, it is important for you to assess your patient and spouse/caregiver to determine if this is happening among them. Those using buffering as a coping mechanism can develop adverse psychosocial outcomes as well as cause added stress for the person they are trying to protect.

When we think about ways that individuals deal with bad news, they commonly will use coping strategies  is commonly used. There is such a thing as relationship –focused coping strategies which are ways of coping designed to maintain, preserve, and protect social relationships during times of stress.[i] One strategy that individuals use is referred to as protective buffering.  In regard to cancer, it is a way of withholding or denying cancer related thoughts and concerns from one’s partner, hiding dispiriting information and acquiescing to avoid conflict. [ii] Buffering that has been carried out by patients has been associated with negative outcomes including increased distress. [iii] It can also increase the stress of the partner too. [iv]

The nature of buffering can also result in self-protection in that it enables the patient to avoid arguments, stressful discussions, and showing emotions when the news being withheld is in essence bad news. By withholding information the patient can minimize negative emotions, avoid conflicts, and avoid personal negative feelings of having upset their partner.  When treatment options are coming to an end, buffering may be applied more often than at other times perhaps as a way to avoid discussion about what lies ahead next or the simple fact that the treatment being received or considered is the “last resort.”

Studies have demonstrated that the psychological sequelae among caregivers include decreased mental health, decreased relationship satisfaction, sexual difficulties, decreased social support, increased negative affect, increased loneliness, and decreased spiritual well being. [v]

As the nurse navigator working with a specific family dealing with metastatic cancer or some type, it will be important to spend time with the patient and his/her partner to learn how they usually communicate with one another about issues of serious concern. It is also of value to explain that there can be a need to consider withholding information from one another, however this doesn’t result in the unfavorable information “going away” or changing later, and can increase stress and psychological well being for both of them.

Some ways to help this family would be:

  1. Discuss the specific appointments when decisions are being made regarding next treatment steps as well as when results of tests, biopsies and other procedures will be discussed so that both patient and partner can be present to hear and participate in the discussion.
  2. Offer to be a sounding board for the patient, when he/she is fearful of what lies ahead and is worried for their loved one not coping well with an unknown future or the knowledge that the patient will die of cancer.
  3. Encourage couples to talk about making end of life plans together so that each other’s wishes are known. Present this as a useful exercise to do, totally unrelated to one of them having cancer. (ie, car accident could result in death before cancer does.)
  4. Offer psychological counseling services for patients and make the referral early on.
  5. Discuss with the patient when appropriate their knowledge of Hospice services and engage the partner in a discussion about this as well. All too often, treatment is given for treatments sake and without considering its purpose and the patient’s need to preserve quality of life.

There are situations in which a patient is hanging on to life, no matter how poor the quality is, as a way to please their partner who keeps asking them to “hold on a while longer” or if the partner says that he “can’t live without her, can’t raise the children alone……”  This can place a huge burden on the patient who is ready to discontinue treatment but doesn’t to fulfill the request of the patient. The patient uses buffering to hide her feelings and even the degree of pain she may be experiencing. Serving in your role to promote candid discussions and respecting the patient’s wishes by enabling her to make them known to her family is a wonderful way to support your patients at end of life.

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