Family-Focused Oncology Nursing Research

Frances Marcus Lewis

ONF 2004, 31(2), 288-292. DOI: 10.1188/04.ONF.288-292

Purpose/Objectives: To analyze five common assumptions about a family's adjustment to breast cancer and to suggest needed future directions for family-focused research.

Data Sources: Published research in nursing, psychiatry, behavioral medicine, and psycho-oncology about families' functioning with breast cancer.

Data Synthesis: Evidence from published research is that family members do not modify their coping behavior in response to illness-related pressures, do not appear to learn over time how to manage illness-related concerns, are not responsive to each other's thoughts and feelings about cancer, experience tension in the marriage from cancer, and neither understand nor assist children affected by a mother's breast cancer.

Conclusions: Current assumptions about how families function with breast cancer need to be replaced with a more informed, data-based view that guides the development of better programs and services for assisting families.

Implications for Nursing: Future research and interventions need to address the impact of breast cancer on the primary relationships in a household, the impact of the illness on the family's core functions, and the family members' competencies to manage the illness.

Jump to a section


    Armsden, G.C., & Lewis, F.M. (1993). The child's adaptation to the mother's illness: Theory and clinical implications. Patient Education and Counseling, 22, 153-165.

    Baider, L., & De-Nour, A.K. (1984). Couples' reactions and adjustment to mastectomy: A preliminary report. International Journal of Psychiatry in Medicine, 14, 265-276.

    Bandura, A. (1997). Self-efficacy, the exercise of control. New York: W.H. Freeman and Co.

    Bandura, A. (2001). Social cognitive theory: An agentic perspective. Annual Review of Psychology, 52, 1-26.

    Baranowski, T., Perry, C.L., & Parcel, G.S. (2002). How individuals, environments, and health behavior interact: Social Cognitive Theory. In K. Glanz, B. Rimer, & F.M. Lewis (Eds.), Health behavior and health education: Theory, research and practice (3rd ed., pp. 165-184). San Francisco: Jossey-Bass.

    Casey, S.M. (2002). Metastatic recurrent breast cancer: The couple's experience with role changes. Unpublished doctoral dissertation. University of Washington, Seattle.

    Cochrane, B.B., & Lewis, F.M. (in press). The spouse's adjustment to breast cancer: A critical analysis of intervention studies. Health Psychology.

    Dougherty, C., Johnson-Crowley, N., Lewis, F.M., & Thompson, E.A. (2001). Theoretical development of nursing interventions for sudden cardiac survivors using social cognitive theory. Advances in Nursing Science, 24(1), 78-86.

    Feldman, D.J. (1974). Chronic disabling illness: A holistic view. Journal of Chronic Diseases, 27, 287-291.

    Fisher, L., & Weihs, K.L. (2000). Can addressing family relationships improve outcomes in chronic illness? Journal of Family Practice, 49, 561-566.

    Fitch, M.I., Bunston, T., & Elliot, M. (1999). When Mom's sick: Changes in a mother's role and in the family after her diagnosis of cancer. Cancer Nursing, 22, 58-63.

    Goeppinger, J., & Lorig, K. (1997). Interventions to reduce the impact of chronic disease: Community-based arthritis patient education. Annual Review of Nursing Research, 15, 101-122.

    Issel, L.J., Ersek, M., & Lewis, F.M. (1990). How children cope with mother's breast cancer. Oncology Nursing Forum, 17, 5-13.

    Kirsch, S.D., & Lewis, F.M. (2004). Using the World Wide Web in health-related intervention research. CIN: Computers, Informatics, and Nursing, 22(1), 8-18.

    Lazarus, R.S., & Folkman, S. (1984). Stress, appraisal, and coping. New York: Springer.

    Lewis, F.M. (1993). Psychosocial transitions and the family's work in adjusting to cancer. Seminars in Oncology Nursing, 9, 127-129.

    Lewis, F.M. (1997). Behavioral research to enhance adjustment and quality of life among adults with cancer. Preventive Medicine, 26(5, Pt. 2), S19-S29.

    Lewis, F.M. (1998). Family-level services in oncology nursing: Facts, fallacies, and realities revisited. Oncology Nursing Forum, 25, 1377-1388.

    Lewis, F.M. (2002). Family issues in cancer care. In C. Miaskowski & P. Buchsel (Eds.), Cancer across health care sites (pp. 319-331). St. Louis, MO: Mosby Year Book.

    Lewis, F.M., Behar, L.C., Anderson, K.H., Shands, M.E., Zahlis, E.H., Darby, E., et al. (2000). Blowing away the myths about the child's experience with the mother's breast cancer. In L. Baider & C.L. Cooper (Eds.), Cancer and the family (pp. 201-221). New York: John Wiley.

    Lewis, F.M., & Deal, L.W. (1995). Balancing our lives: A study of the couples' experience with breast cancer recurrence. Oncology Nursing Forum, 22, 943-953.

    Lewis, F.M., & Hammond, M.A. (1992). Psychosocial adjustment of the family to breast cancer: A longitudinal analysis. Journal of the American Medical Women's Association, 47, 194-200.

    Lewis, F.M., & Hammond, M.A. (1996). The father's, mother's and adolescent's functioning with breast cancer. Family Relations, 45, 456-465.

    Lewis, F.M., Hammond, M.A., & Woods, N.F. (1993). The family's functioning with newly diagnosed breast cancer in the mother: The development of an explanatory model. Journal of Behavioral Medicine, 16, 351-370.

    Lewis, F.M., Zahlis, E.H., Shands, M.E., Sinsheimer, J.A., & Hammond, M.A. (1996). The functioning of single women with breast cancer and their school-aged children. Cancer Practice, 4, 15-24.

    Longman, A.J., Braden, C.J., & Mishel, M.H. (1996). Side effects burden in women with breast cancer. Cancer Practice, 4, 274-280.

    Longman, A.J., Braden, C.J., & Mishel, M.H. (1997). Pattern of association over time of side-effects burden, self-help, and self-care in women with breast cancer. Oncology Nursing Forum, 24, 1555-1560.

    Lorig, K.R., Gonzalez, V.M., Laurent, D.D., Morgan, L., & Laris, B.A. (1998). Arthritis self-management program variations: Three studies. Arthritis Care and Research, 11, 448-454.

    Lorig, K.R., Sobel, D.S., Stewart, A.L., Brown, B.W., Jr., Bandura, A., Ritter P., et al. (1999). Evidence suggesting that a chronic disease self-management program can improve health status while reducing hospitalization: A randomized trial. Medical Care, 37(1), 5-14.

    Manne, S. (1994). Couples coping with cancer: Research issues and recent findings. Journal of Clinical Psychology in Medical Settings, 1, 317-330.

    Manne, S.L., Alfieri, T., Taylor, K.L., & Dougherty, J. (1999). Spousal negative responses to cancer patients: The role of social restriction, spouse mood, and relationship to satisfaction. Journal of Consulting and Clinical Psychology, 67, 352-361.

    Manne, S.L., Pape, S.J., Taylor, K.L., & Dougherty, J. (1999). Spouse support, coping, and mood among individuals with cancer. Annals of Behavioral Medicine, 21, 111-121.

    McCubbin, H., & Patterson, J. (1983). The family stress process: The double ABCX Model of Adjustment and Adaptation. In H.I. McCubbin, M.B. Sussman, & J.M. Patterson (Eds.), Social stress and the family. New York: Hawthorne.

    McCubbin, M.A., & McCubbin, H.I. (1993). Families coping with illness: The Resiliency Model of Family Stress, Adjustment, and Adaptation. In C.B. Danielson & B.P. Hamel-Bissell (Eds.), Families, health and illness: Perspectives on coping and intervention (pp. 21-65). St. Louis, MO: Mosby.

    Meyerowitz, B.E., Heinrich, R.L., & Schag, C.C. (1983). A competence-based approach to coping with cancer. In T.G. Burish & L.A. Bradley (Eds.), Coping with chronic research and application (pp. 137-158). New York: Academic Press.

    Miaskowski, C., Dodd, M.J., West, C., Paul, S.M., Tripathy, D., Koo, P., et al. (2001). Lack of adherence with the analgesic regimen: A significant barrier to effective cancer pain management. Journal of Clinical Oncology, 19, 4275-4279.

    Northouse, L.L., & Swain, M.A. (1987). Adjustment of patients and husbands to the initial impact of breast cancer. Nursing Research, 36, 221-225.

    Parcel, G.S., Swank, P.R., Mariotto, M.J., Bartholomew, L.K., Czyzewski, D.I., Sockrider, M.M., et al. (1994). Self-management of cystic fibrosis: A structural model for educational and behavioral variables. Social Science and Medicine, 38, 1307-1315.

    Quint, J.C. (1963). The impact of mastectomy. American Journal of Nursing, 63, 88-92.

    Roberts, J., Browne, G.B., Streiner, D., Gafni, A., Pallister, R., Hoxby, H., et al. (1995). Problem-solving counseling or phone-call support for outpatients with chronic illness: Effective for whom? Canadian Journal of Nursing Research, 27, 111-136.

    Sabo, D., Brown, J., & Smith, C. (1986). The male role in mastectomy: Support groups and men's adjustment. Journal of Psychosocial Oncology, 4(12), 19-31.

    Samms, M. (1999). The husband's untold account with his wife's breast cancer: A chronological analysis. Oncology Nursing Forum, 26, 1351-1358.

    Shands, M.E., Lewis, F.M., & Zahlis, E.H. (2000). Mother and child interactions about the mother's breast cancer: An interview study. Oncology Nursing Forum, 27, 77-85.

    Simpson, J.A., & Weiner, E.S. (Eds.) (1989). Oxford English dictionary (2nd ed., Vols. 1-20). New York: Oxford University.

    Weihs, K., Fisher, L., & Baird, M. (2002). Families, health and behavior. Families, Systems and Health, 20(1), 7-46.

    Wenzel, L., Glanz, K., & Lerman, C. (2002). Stress, coping and health behavior. In K. Glanz, F.M. Lewis, & B.R. Rimer (Eds.), Health behavior and health education: Theory, research and practice (3rd ed., pp. 210-239). San Francisco: Jossey-Bass.

    Woods, N.F., & Lewis, F.M. (1995). Living with chronic illness: Women's perspectives on their families' adaptation. Health Care for Women International, 16, 135-148.

    Yates, B.C., Bensley, L.S., Lalonde, B., Lewis, F.M., & Woods, N.F. (1995). The impact of marital status and quality on family functioning in maternal chronic illness. Health Care for Women International, 16, 437-449.

    Zahlis, E.H. (2001). The child's worries about the mother's breast cancer: Sources of distress in school-age children. Oncology Nursing Forum, 28, 1019-1025.

    Zahlis, E.H., & Lewis, F.M. (1998). The mother's story of the school age child's experience with the mother's breast cancer. Journal of Psychosocial Oncology, 16(2), 25-43.

    Zahlis, E.H., & Shands, M.E. (1991). Breast cancer: Demands of illness on the patient's partner. Journal of Psychosocial Oncology, 9(1), 75-93.

    Zunkel, G. (2002). Relational coping processes: Couples' response to a diagnosis of early stage breast cancer. Journal of Psychosocial Oncology, 20(4), 39-55.