This study looks at how communication contributes to health-related quality of life (HRQOL) for men living with prostate cancer. The rise of prostate-specific antigen (PSA) testing in the 1990s has resulted in more accurate testing and, as a consequence, many men are now symptom-free at diagnosis. But more men are faced with the prospect of living with and managing prostate cancer now than at any time in the past. However, the side-effects of treatment mean that men may have physical, social and psychological issues to contend with, and the personal nature of these issues may have anti-social consequences.
What are communication networks?
Communication networks often provide opportunities for support and resources for people diagnosed with a chronic illness, and a positive set of social relations has long been recognised as beneficial to health. Older people may have diminished communication networks due to bereavement following the death of a spouse or friends, and may experience complications associated with increasing loss of mobility. But increasing emotional closeness and positive relationships with a few people can provide effective support, better health outcomes, and increased quality of life.
Many scholars have explored the relationship between networks and HRQOL and the purpose of this study is to consider how network opportunities, relational communication characteristics (social support, social undermining, and disclosure) and an individual communication characteristic (communication efficacy) shape HRQOL. Network opportunities are the type of network an individual is in. Proximity of kin, proportions of family and others in networks, and involvement in the community can be used to show different types of networks. Relational communication characteristics are social support, social undermining, and disclosure. The provision and receipt of social support is closely related to the level of integration into networks, so a high level of connection with others provides more support and leads to improved health. Social undermining refers to actions that cause someone to experience an adverse reaction as well as reservations about the relationship itself and can be quite destructive. For men to access their networks for support, they need to disclose their health status, which is why disclosure is an important factor. Finally, individual communication efficacy is an individuals’ perception that they possess the skills to complete successfully the communication tasks involved. The ability to communicate effectively with medical staff, partners and others in networks is especially important in health issues.
The links between networks and health-related quality of life
Men with prostate cancer were recruited mainly through short-write ups in community papers, which included a brief synopsis of the study and invitation to participate. This resulted in 214 men completing an online or hard copy questionnaire describing aspects of their networks including opportunities for connection, social support/undermining, disclosure, communication efficacy, and HRQOL. Three models were analysed and tested and the most preferred one surprisingly showed that the five types of networks did not have a significant effect on HRQOL. This may be because of the increased use of communication technologies in this study, whereas the original network types in the 1980s were based on geographic proximity. Many of the men in this study lived in rural areas and/or were located away from families. However, they have access to technology, which enables them to connect with family and friends.
The present study also found that social support was not significantly related to HRQOL, which was surprising; however, the difference between social support and undermining may not be clear cut because the same person can be both supportive and undermining. Of interest is that absence of social undermining has a greater impact on health and well-being than the presence of social support, showing that high levels of social undermining will counteract the value of social support. This study also found that disclosure did not impact HRQOL. Men with prostate cancer face the dilemma of revealing some potentially embarrassing symptoms and challenges and the risk to disclose may be too great or unnecessary. Finally, communication efficacy was found to be partly related to HRQOL. In summary, this study showed that while social undermining and communication efficacy played a part in HROQL, network type, disclosure, and social support did not. Communication is an important factor in men’s quality of life.
The author is grateful for the support of the Prostate Cancer Foundation of New Zealand to conduct this research. This article has been published in the journal Health Communication.