Open Communication about Health Conditions

I have long been interested in how and why we decide to share information about ourselves, our feelings, and our experiences, as well as the reasons we have for withholding that information and the strategies we employ to manage information.  I went to University of Washington for graduate work in large part because Mac Parks and Gerry Philipsen were writing about the ideologies, meanings, and practices of openness in US American culture.  My masters thesis examined reasons for disclosing (or not disclosing) in dating couples and my dissertation examined variability in belief and behavior about openness in romantic relationships.

I’ve returned to these issues recently in a series of studies that examine open communication in the context of couples (married or committed partners) in which one person had been treated for cancer or for heart disease.

Goldsmith, D. J., & Miller, G. (2015).  Should I tell you how I feel? A mixed method analysis of couples’ talk about cancer.  Journal of Applied Communication Research, 43, 273-293.

Couples coping with cancer are often told to talk about feelings, yet there is limited theoretical, empirical, or intervention research to justify this advice. We interviewed 19 patients and 16 partners about their communication. In a mixed methods analysis, we found talk about feelings was associated with distress and functioning, even after controlling for marital satisfaction, perceived constraint from discussing cancer, or physical functioning; however, patients and partners who focused on feelings and personal issues had worse outcomes than those who focused on facts and medical issues. Through qualitative analysis, we found multiple ways to cope that did not require talking about feelings as well as ways that higher levels of distress affected talk about feelings. Our findings suggest we should reconsider advice to couples, encouraging multiple ways of communicating, and considering contextual factors that influence the timing and desirability of talk about feelings.

Goldsmith, D. J., & Miller, G. (2014).  Conceptualizing how couples talk about cancer.  Health Communication, 29, 51-63.

Scholarship on couple communication about cancer employs variable conceptualizations of communication, and common measurement strategies make questionable assumptions about communication. This study provides a descriptive foundation for a multiple-topic, multidimensional approach to studying couple talk about cancer. Based on interviews with persons treated for cancer in the last 5 years and partners, we identified 16 topics and 5 dimensions of talk. “Talk about cancer” covers a broad range of issues. The frequency, openness, difficulty, and focus of talk vary considerably for different topics and can change over time or differ between partners. Disagreements were rare but highly salient, and satisfaction with talk tended to be high. These findings suggest we move away from abstract, general measures of couple communication and that we develop descriptive advice for couples, rather than simply prescribing “be open.”

Goldsmith, D. J., & Domann-Scholz, K. (2013). The meanings of “open communication” among couples coping with a cardiac event. Journal of Communication, 63, 266-286.

The value placed on open communication is an ideology in U.S. American discourse. It has particular urgency among couples coping with a cardiac event, who are often advised that open communication can enhance recovery, bolster individual coping, and sustain relational satisfaction. Our interpretive analysis of 41 interviews with cardiac patients and partners explored the connection between a widespread ideology of openness and varied ways of enacting it that included apparently contradictory practices. Our findings raise questions about interventions designed to change couples’ communication, expand concepts and theories of open communication, and suggest developments in the ideology of openness.

Goldsmith, D. J., Miller L. E., & Caughlin, J. P. (2008).  Openness and avoidance in couples communicating about cancer. In C. Beck (Ed.), Communication Yearbook 31 (pp.62-115)Malden, MA: Blackwell.

Open communication and avoidance are fundamental communication processes that have been studied across a range of communication contexts. Couples in which one person has cancer is a theoretically and practically important context in which to study openness and avoidance.  We examine the cancer-related topics couples find challenging, couples’ reasons for communicating openly or avoiding talk about cancer-related topics, outcomes of communication, features and strategies of communication, and individual, relational, and illness-related factors that may influence communication. The application of theories of open and avoidant communication suggests new directions for cancer research and has practical implications for interventions designed to assist couples. Studying openness and avoidance in this context also provides opportunities to refine and extend existing theory and method.

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