Men´s utilization of control strategies and spousal support after prostatectomy: Managing autonomy in the face of postoperative morbidities
Final Report Abstract
Disease-related and postsurgery functional limitations can pose substantial challenges to patients and their caregivers. The Motivational Theory of Life-span Development (MTLD) and the complementing Lines of Defense (LoD) Model predict that individuals encountering health-threats actively regulate their development by using control strategies and adjusting hierarchically organized health-related autonomy goals, or Lines of Defense. Within this theoretical framework, an individual experiencing progressive decline with a given illness would need to select the appropriate level of functioning to strive for, disengage from levels of functioning that are no longer maintainable, and engage with the next level. On the other hand, when health improves during convalescence and rehabilitation, individuals should readjust their health-related autonomy goals to higher levels of this hierarchy. This challenging process of goal adjustment in the face of changing disease-related functional impairment is usually supported by close others, most often spousal caregivers. Although this is likely to produce beneficial synergistic effects, it may also at times interfere with the recovering partners’ self-regulatory efforts. Using the framework of MTLD and the complementing LoD Model, we investigated how prostate cancer patients and their caregiving partners adapt to new functional limitations following tumor surgery. A further aim of this study was to test if a potentially better fit between patients’ health-related autonomy goals and caregiver support may also protect patients’ and caregivers’ well-being. We assessed data from N = 209 prostate cancer patients and their partners in a longitudinal study with a diary period and 5 measurement points spanning 8 months around patients’ tumor surgeries (i.e., radical prostatectomies). Among other variables, patients gave accounts of their experienced level of post-surgery functional limitations due to urinary incontinence, health-related autonomy goals or Lines of Defense, and utilization of control strategies. Both, patients and their partners repeatedly reported on their emotional wellbeing, extended activities of daily living, and received and provided caregiver support. Following surgery, almost all patients reported some level of functional limitation due to incontinence, but with progressing convalescence throughout the first months postsurgery, urinary incontinence was decreasing. Strikingly, patients were rapidly able to recover presurgery levels of activities of daily living even while incontinence was still prevalent. These improvements in postsurgical functional capacity, in turn, corresponded with changes in patients’ endorsement of hierarchically-organized autonomy goals as proposed by the LoD Model. We further found that patients received high levels of caregiver support and resorted to a variety of control strategies to maintain their functional capacity despite incontinence, including the intense investment of time and effort and the utilization of external resources (e.g., partners’ or other people’s help and/or use of technical aids). Use of these external resources, however, did not prospectively predict later performance of activities of daily living. Given patients’ relatively rapid recovery of presurgery levels of functional capacity, postsurgery measurement lags of 2 months in this study might have been too long to capture these prospective relations. Findings also supported the notion of challenges in calibrating caregiver support to patients’ changing autonomy goals. In patients with less ambitious autonomy goals (or lower-order Lines of Defense), higher levels of caregiver support were related with better well-being. When patients were striving for more autonomy or endorsed higher-order Lines of Defense, higher levels of received caregiver support were associated with worse well-being. For partners a similar trend emerged as they tended to report worse well-being when they provided much support to patients who were striving for more self-reliance (or endorsed higherorder Lines of Defense). However, these findings were somewhat inconsistent, as they could not be fully replicated with different indicators of well-being. In sum, studying patients’ and caregivers’ responses to patients’ postoperative functional limitations and their improvement during convalescence provided new insights into the interplay of patients’ self-regulatory efforts and caregiver support. Findings indicate that patients actively regulate their adaptation to functional limitations by adjusting health-related autonomy goals (or Lines of Defense), and by using control strategies and caregiver support. Also, a better fit between patients’ health-related autonomy goals and support from partners may have beneficial effects for patients’ and partners’ well-being.
Publications
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2010. Anpassung der Selbstregulation und Unterstützungsnutzung bei Patienten mit Harninkontinenz nach Prostatektomie [Adaptation of self-regulation and utilization of social support following prostatectomy]. Joint conference of the German Society for Medical Psychology/German Society for Medical Sociology, Giessen, Germany
Knoll, N.
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2011. Dyadische Bewältigung von Harninkontinenz: Soziale Unterstützung und selbstregulative Strategien fördern Gesundheitsverhalten bei Prostatektomie-Patienten [Dyadic coping with urinary incontinence: Social support and self-regulatory stategies promote health behaviour in patients after prostatectomy]. 10th Congress of the Division of Health Psychology of the German Psychological Society, Berlin, Germany
Wiedemann, A.U., Burkert, S. & Knoll, N.
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2011. Partnerschaftliche Unterstützung im Erkrankungskontext: Bedingungen, Verlauf und Hinweise auf Effektivität [Spousal Support in Illness Contexts: Predictors, Development, and Hints at Efficiency]. 27th Symposion on Methods in Social Psychology, University of Hamburg, Germany
Knoll, N.
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2011. Social exchange and self-regulation processes in health behaviour. Invited presentation at the workshop ‘Coping with stress and adversity: Implications and interventions from a mental and physical health perspective’ funded by the Sino-German Research Center, Beijing, China.
Wiedemann, A.U., Burkert, S., Knoll, N.
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2011. Utilization of social support and selfregulatory strategies: How couples manage prostatectomy patients’ urinary incontinence. 32nd International Conference of the Stress and Anxiety Research Society, Münster, Germany
Wiedemann, A.U., Burkert, S. & Knoll, N.
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2012. Akzeptanz partnerschaftlicher Unterstützung und Selbstregulation bei Prostatektomie-Patienten mit funktionellen postoperativen Einschränkungen [Acceptance of spousal support and self-regulation in prostatatectomy patients mit post-operative functional limitations]. Conference of Psychosomatic Medicine and Psychotherapy, Munich, Germany
Wiedemann, A.U., Knoll, N., Burkert, S., Felber, J. & Schrader, M.
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2012. Men’s Utilization of Spousal Support After Prostatectomy: Managing Autonomy in the Face of Postoperative Morbidities. 12th International Congress of Behavioral Medicine, Budapest, Hungary.
Knoll, N., Wiedemann, A.U., Heckhausen, J., Burkert, S., Felber, J. & Schrader, M.
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2012. Men’s Utilization of Spousal Support After Prostatectomy: Managing Autonomy in the Face of Postoperative Morbidities. Paper presented at the 12th International Congress of Behavioral Medicine, Budapest, Hungary.
Knoll, N., Wiedemann, A.U., Heckhausen, J., Burkert, S., Felber, J. & Schrader, M.
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2012. Nutzung partnerschaftlicher Unterstützung und Selbstregulation bei Krebspatienten mit funktionellen Einschränkungen [The utilization of partner support and self-regulation in cancer patients with functional limitations]. 48th Congress of the German Psychological Society, Bielefeld, Germany
Knoll, N. Wiedemann, A.U., Heckhausen, J., Burkert, S., Felber, J. & Schrader, M.
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2012. The interplay of autonomy goals and spousal support: A prospective study with couples facing cancer. 26th Conference of the European Health Psychology Society, Prague, Czech Republic
Knoll, N., Wiedemann, A.U., Heckhausen, J., Burkert, S., Felber, J. & Schrader, M.
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2013. Couples Managing the First Days of Sequelae Following Prostatectomy: Support Relations with Affect and Conflict. Paper presented at the 27th Conference of the European Health Psychology Society, Bordeaux, France.
Knoll, N., Wiedemann, A.U., Burkert, S., Felber, J. & Schrader, M.
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2014. Adjusting lines of defense during rehabilitation: Sequelae of radical prostatectomy in patients and their spouses. Paper presented at the 26th Annual APS Convention, San Francisco, USA.
Knoll, N., Wiedemann, A. U., Schultze, M., Schrader, M., & Heckhausen, J.
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2014. Prostate cancer patients gradually advance goals for rehabilitation after radical prostatectomy: Applying a Lines-of-Defense Model to rehabilitation. Psychology and Aging, Vol 29. 2014, Issue 4, pp. 787-792.
Knoll, N., Wiedemann, A. U., Schultze, M., Schrader, M., & Heckhausen, J.
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2015. Calibrating independence goals and partner support: Couples adjust to functional limitations after tumor surgery. Applied Psychology: Health and Well-Being, Vol. 7. 2015, Issue 2, pp. 167–187.
Knoll, N., Wiedemann, A. U., Schrader, M., Felber, J., Burkert, S., Daig, I., & Heckhausen, J.
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2015. Good for one, bad for the other: Cancer patients’ compensatory control strategies and partners’ well-being. Paper presented at the 29th Conference of the European Health Psychology Society, Limassol, Cyprus. European Health Psychologist, Vol. 17. 2015, Supp., pp. 373.
Knoll, N., Wiedemann, A., & Heckhausen, J.
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2015. Individual and dyadic planning predicting pelvic floor exercise among prostate cancer survivors. Rehabilitation Psychology, Vol. 60. 2015, Issue 3, pp. 222-231.
Keller, J., Burkert, S., Wiedmann, A. U., Luszczynska, A., Schrader, M., & Knoll, N.
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2016. Enabling or cultivating? The role of prostate cancer patients’ received partner support and self-efficacy in the maintenance of pelvic-floor exercise following tumor surgery.
Annals of Behavioral Medicine, Vol. 50. 2016, Issue 2, pp. 247–258.
Hohl, D. H., Knoll, N., Wiedemann, A. U., Keller, J., Scholz, U., Schrader, M., & Burkert, S.
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Predictors of dyadic planning: Perspectives of prostate cancer survivors and their partners. British Journal of Health Psychology
Early View (Online Version of Record published before inclusion in an issue).
Keller, J., Wiedemann, A. U., Hohl, D. H., Scholz, U. Burkert, S., Schrader, M., & Knoll, N.
