I looked at the communication tensions experienced by men who were on a prostate biopsy waiting list and how they managed these tensions using their networks. As background, the worldwide incidence of prostate cancer is increasing significantly and will continue to do so for the foreseeable future; a trend also reflected in New Zealand. The rise of prostate cancer is due in part to the increasing age of the population, but also more cancers are detected with improved diagnostic testing especially with the PSA test for prostate cancer. Men with prostate issues and at the pre-diagnosis stage are at a unique time in their medical journey because it can be fraught with difficulties and tensions due to uncertainty of the diagnosis.
Managing communication tensions
Communication tensions are opposing forces existing in a struggle, at once pushing and pulling against each other, like two ends or poles of a continuum. For example, despite prostate cancer being perceived as a disease of couples, husbands and wives have different expectations of how to manage communication about information gathering and decision making around the benefits of screening versus side-effects of treatment. Wives prefer their husbands to be screened but men prefer not to be screened leading to possible tensions in the relationship. Further, there are several ways for individuals to manage these tensions, such as selecting one pole over the other, vacillating between the poles or reframing the tension.
I was interested in how men communicate at this time and so my two research questions were:
- What are the communication tensions experienced by men on a prostate biopsy waiting list?
- How are the tensions managed by the men within their communication networks?
After receiving ethics approval, a urologist contacted men on a prostate biopsy waiting list and 36 men agreed to be interviewed. I analysed the interviews and found that men experienced four tensions. First, obligation to disclose/autonomy not to disclose. Many men felt an obligation to disclose about their health issues to friends and family, but also wanted the freedom not to have to talk. The second tension was confident to help others/vulnerable and needing help from others. At times, the men chose to disclose for the benefit of others. For example, to encourage men to attend their physician for a routine prostate examination; however, by disclosing they made themselves vulnerable. The third tension of accept support/not accept support was shown by most men. For example, accepting emotional and information support but not wanting tangible support such as transport to hospital. Finally, the desire for normality/need to tolerate uncertainty tension arose because many men desired a normal lifestyle-one in which they retained their independence, kept their regular routine and were not focused on medical issues-but they also needed to tolerate the uncertainty associated with the biopsy, which was not being normal.
These tensions were predominantly managed by vacillation. Specifically, the men used their networks to select one pole with some people and the other pole with others to maintain balance between the poles of these tensions. Some men demonstrated selection by favouring one pole over another. For instance, they had a dominant tendency to help others and be an advocate for prostate issues considering it was worth being vulnerable to do so.
Tensions start early
Three interesting findings from this research are, first, it has highlighted that tensions exist earlier than is traditionally studied in health care; i.e. at the point of diagnosis. While much focus is rightfully placed post-diagnosis, the pre-diagnosis period is also a challenging one for the psychological health of men. Also, men use networks to manage tensions that allow them to facilitate both poles. In the early stages of the medical process, the men used their networks in a passive way by only utilising vacillation or selection to manage the tensions requiring little effort. Third, men most at risk (i.e. those with small networks) may have difficulty navigating the tensions since they only have their wives and being bereft of friends means they have no one left to be normal or independent with other than family.
In conclusion, health care professionals can help men in this situation by having a conversation about disclosure and support prior to them being diagnosed, educating men to reframe or connect as a more effective form of tension management, and linking men who have small or ineffective networks to other resources such as social support networks to facilitate managing tensions.
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 European Journal of Oncology Nursing.