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PubMed2003

Experiences of the onset of coronary artery disease in a spouse.

The purpose of this study was to describe the experiences of persons whose spouses have newly diagnosed coronary artery disease (CAD). The purpose was to obtain knowledge that would help us to understand better the life of persons with a chronically ill spouse and to develop the education and rehabilitation of both the patients and their spouses. Data were collected from healthy spouses by an open-ended question. There were 146 informants. They were asked to write about their experiences of everyday life after their spouse had been diagnosed for CAD. The data were analyzed by methods of content analysis. The following categories were formulated to describe the healthy spouses' experiences: slow pace of life, limited life and unsure life. Slow pace of life meant that the disease had been adopted as a normal part of life. Life was organized in a new way, and the earlier busy and work-oriented lifestyle had been given up. The informants whose spouses had medication considered their personal freedom to be limited, because they had to assume responsibility for the care of their spouses. The spouses of the patients who had undergone bypass surgery (CABS) or angioplasty (PTCA) had a new role in the family. They had to monitor for symptoms, treat symptoms, take care, understand and support. They had to assume responsibility for everyday life. They felt themselves to be alone in that situation. They did not receive support from health care providers. All informants felt uncertainty due to financial problems, poorly planned care and unexpected changes in the course of the disease. As a conclusion, it can be said that life was limited by the sick spouse's needs. The disease caused changes in emotional balance, a need for continuous control of life, fears about a new myocardial infarction and worries about many issues of everyday life.

Adaptation, Psychological↗

PubMed2001

Hepatitis C virus infection in spouses: sexual transmission or common exposure to the same risk factors?

OBJECTIVES: The aim of this study was to evaluate whether the transmission of hepatitis C virus (HCV) between spouses occurs through sexual contact or through other types of exposure. METHODS: We consecutively enrolled 311 chronic HCV carriers and their spouses. The spouses underwent HCV blood testing. Exposure to parenteral risk factors was compared between couples of which both partners were HCV positive and couples with one positive partner. In couples with both partners positive, qualitative detection of serum HCV RNA and genotyping were performed. RESULTS: The prevalence among spouses was 10.3% (32/311). The mean age was higher for HCV-positive spouses (57.7 vs 49.6 yr for HCV-negative spouses; p < 0.01). The prevalence among spouses increased with the duration of marriage, whereas no difference was found in relation to the clinical status of the index case. The 32 HCV-positive spouses reported parenteral exposure (blood transfusion, drug use, and use of multiple-use glass syringes inside or outside the family) more often than the 279 HCV-negative spouses (84.4% vs 26.2%; odds ratio [OR], adjusted for age by multiple logistic regression analysis, 12.4; 95% CI = 4.5-34.0). The percentage of couples sharing glass syringes was significantly higher among those with both partners infected (65.6% vs 12.9%; OR = 12.9; 95% CI = 5.4-31.4). Qualitative serum HCV RNA was determined in 22 couples with both partners infected; in 13 of them, both partners were HCV RNA positive, whereas in the remaining nine, only one partner was positive. In eight of the 13 couples with both partners HCV RNA positive, the same genotype was found for both partners. CONCLUSIONS: The findings that the same genotype was detected for both partners in relatively few couples, and that a history of parenteral exposure was an independent predictor of HCV positivity, suggest that the risk of sexual transmission is low. The sharing of glass syringes may have played an important role in transmission between spouses.

Adult↗

PubMed2002

Mental health insurance claims among spouses of frequent business travellers.

OBJECTIVES: Following up on two earlier publications showing increased psychological stress and psychosocial effects of travel on the business travellers this study investigated the health of spouses of business travellers. METHODS: Medical claims of spouses of Washington DC World Bank staff participating in the medical insurance programme in 1997-8 were reviewed. Only the first of each diagnosis with the ninth revision of the international classification of diseases (ICD-9) recorded for each person was included in this analysis. The claims were grouped into 28 diagnostic categories and subcategories. RESULTS: There were almost twice as many women as men among the 4630 identified spouses. Overall, male and female spouses of travellers filed claims for medical treatment at about a 16% higher rate than spouses of non-travellers. As hypothesised, a higher rate for psychological treatment was found in the spouses of international business travellers compared with non-travellers (men standardised rate ratios (RR)=1.55; women RR=1.37). For stress related psychological disorders the rates tripled for both female and male spouses of frequent travellers (>or= four missions/year) compared with those of non-travelling employees. An increased rate of claims among spouses of travellers versus non-travellers was also found for treatment for certain other diagnostic groups. Of these, diseases of the skin (men RR=2.93; women RR=1.41) and intestinal diseases (men RR=1.31; women RR=1.47) may have some association with the spouses' travel, whereas others, such as malignant neoplasms (men RR=1.97; women RR=0.79) are less likely to have such a relation. CONCLUSION: The previously identified pattern of increased psychological disorders among business travellers is mirrored among their spouses. This finding underscores the permeable boundary between family relations and working life which earlier studies suggested, and it emphasises the need for concern within institutions and strategies for prevention.

Adult↗

PubMedDate not supplied

Quality of life and coping in patients with gynecologic cancer and their spouses.

PURPOSE/OBJECTIVES: To examine differences in and relationships between quality of life (QOL) and coping of patients with gynecologic (GYN) cancer and their spouses. SETTING: An oncology ambulatory care center in the midwestern United States. DESIGN: Cross-sectional. SAMPLE: 40 patients with GYN cancer and their spouses. METHODS: Patients and spouses completed the Quality of Life-Cancer Version scale and the Coping Scale. FINDINGS: Patients with GYN cancer and their spouses recorded similar responses. They were fairly satisfied with their QOL especially regarding family. Similarities and differences existed in the use of coping strategies between the two groups. Patients were more inclined to do something about their situation, whereas spouses tended to hope that problems would go away. For spouses, finding positive aspects of the illness experience correlated with three QOL indicators; correlations also were found between health/functioning and three coping strategies. CONCLUSIONS: In this study, no significant differences were found between patients with GYN cancer and their spouses in overall QOL or QOL domains. Family was the highest QOL domain for both groups. Patients reported significantly more use of cognitive restructuring and threat minimization than spouses. For both groups, especially patients, different strategies correlated with different QOL areas. IMPLICATIONS FOR NURSING PRACTICE: Nurses working in GYN oncology ambulatory care centers are in a key position to assess areas of QOL with which patients and spouses are most and least satisfied and the types of coping strategies they are using. Differences in coping strategies used suggest that patients and spouses might benefit by being assessed separately.

Adaptation, Psychological↗

PubMed2002

Effect of support programme to reduce stress in spouses whose partners 'fall off' clinical pathways post cardiac surgery.

Cardiac surgery is flourishing in today's health care industry and looks to prosper well into the future. More than ever, improved technology, surgical skill and the worldwide trend of increasing longevity means that surgical intervention is offered to patients rarely seen in cardiac units in previous years. Patients are now much older, with multiple co-morbidity including repeat cardiac surgery. In line with advances in cardiac surgery, critical pathways to map the expected recovery route for the patient have been introduced. These maps are used extensively as guides for treatment and care. It is not only health professionals who use the pathways; patients and their relatives also refer to them as indicators of a 'normal' post-operative route. As a result, the critical pathway provides an avenue for expectations of predicted progress through to discharge. These predictors appear to give spouses hope, access to earliest possible visitation and confidence in a positive outcome. Nevertheless, it has recently become increasingly clear that for partners of patients who fail to proceed as expected, who apparently 'fall off' the predicted road to recovery, the critical pathway is problematic. Partners of such patients tend to demonstrate greatly heightened anxiety and nurses often have to deal with them at the point of crisis. In the cardio-thoracic unit at which this study was undertaken, the significant number of spouses who ended up in crisis drew attention to the need for additional support to be built into the post open-heart surgery critical recovery pathway. This study sought therefore to examine how nurses might assist spouses to adapt in the event of a complicated recovery following bypass surgery. A convenience sample of 39 spouses of cardiac surgical patients admitted to the cardio-thoracic recovery unit was obtained to assess stress responses at a critical post-operative data point, 5 days post-surgery. A symptoms of stress inventory was used to measure 94 items of physiological stress in 10 specific subscale categories. As a result of this study, it was found that incorporating a spousal support programme into the critical pathway of open-heart surgical patients significantly reduced stress suffered by spouses of patients who deviated from pre-determined recovery goals. The findings suggest that nurses need to understand the implications of the critical pathway and provide families with information concerning issues associated with complicated recovery. An unexpected finding of the study pointed to an apparent difference in the stress experienced by male spouses to that of female spouses. Recommendations from this study are to further explore the qualitative component of the stress felt by spouses and the negative association of stress with morbidity and mortality for women and patients without spouses. Nurses need to consider developing and implementing a stress management programme for spouses, establishing spousal support groups and exploring the possibility of incorporating spousal support strategies into the critical pathways of patients across hospital settings.

Adult↗

PubMedDate not supplied

Spouses' psychosocial problems, resources, and marital functioning postmyocardial infarction.

The psychosocial problems and adjustments of 40 myocardial infarction (MI) patients and their spouses were examined 3 months after hospitalization. The following relationships were explored: spouse anxiety and coping methods with marital functioning; and couple-shared responsibility and the patient's perception of spouse's beliefs about patient compliance in regard to actual patient compliance. Results indicate that spouses received minimal information about expected roles and responsibilities, and no information about the patients' symptoms or the spouses' personal needs after discharge. Approximately 50% of the spouses received information on the medical regimen and cardiac condition. Patient compliance was high for all regimen prescriptions, and patient's perception of spouse's beliefs was significantly related to patient compliance. There was almost no agreement between patient and spouse on shared responsibility for regimen compliance. Marital functioning was negatively related to state/trait anxiety with trait anxiety predictive of marital functioning. Problem solving was the coping method most frequently used by spouses, with emotive (affective) coping methods negatively related to marital functioning. These findings lend support for future studies to examine the most effective method of couple inclusion in rehabilitation programs. In addition, program content should reflect the information spouses perceive as necessary for them to receive in such programs.

Adaptation, Psychological↗

PubMedDate not supplied

Decisive situations influencing spouses' support of patients with heart failure: a critical incident technique analysis.

OBJECTIVE: The aim of this study was to describe decisive situations experienced by spouses of patients with heart failure that could potentially affect their ability to provide social support to the patient. METHODS: A qualitative descriptive design with a critical incident technique was used. Twenty-three informants, 15 women and 8 men, who were spouses of patients with severe heart failure were strategically chosen to ensure maximal variation in sociodemographic data and experiences as a spouse. RESULTS: Decisive situations influenced the experience of spouses of patients with heart failure in a manner that was either positive (involvement with others) or negative (feeling like an outsider). When spouses were given attention and treated like persons of value, they experienced involvement with others. In these cases, spouses had someone to turn to and were included in the physical care. In contrast, when spouses were kept at a distance by the patient, were socially isolated, and received insufficient support from children, friends, and health care professionals, they experienced feeling like an outsider. CONCLUSIONS: By identifying spouses' experiences, health care professionals can assess which kind of specific interventions should be used to improve the life situation of the patient with heart failure and his or her spouse.

Aged↗

PubMed2006

The effect of hypnotherapeutic ego strengthening with female spouses of South African coronary artery bypass surgery patients.

In addition to exacerbating morbidity in male coronary artery bypass surgery (CABS) patients, their plight can also impose considerable strain on their female spouses' mood states, resulting in compromised quality of life. The current study was aimed at determining the impact of pre postoperative hypnotherapeutic ego strengthening (HES) on anxiety and depression in female spouses. It was conducted simultaneously with a recently published study of their CABS husbands' response to HES. Spouses whose husbands had been randomly assigned to an experimental group, were designated the experimental spouse group (n = 25) and spouses whose husbands constituted the control group, likewise comprised the control spouse group (n = 25). Assessment occurred preoperatively, on the day of discharge and at six week follow-up. Spouses in the experimental group (n = 25) were introduced to hypnotherapeutic ego strengthening (HES), pre and postoperatively. In the postoperative assessment experimental female spouses showed significantly reduced morbidity levels, which were maintained at follow-up. In contrast, females in the control group (n = 25) showed no change. The results supported the value of brief hypnotherapy as a means of psychologically empowering spouses whose husbands' were undergoing CABS.

Adult↗

PubMed1998

Spouses' view during their partners' illness and treatment.

Nine spouses of people who had suffered from acute leukemia or highly malignant lymphoma were interviewed about their everyday life experiences throughout their partner's illness and treatment, and concerning their view of the professional care provided. The transcribed texts were subjected to phenomenological-hermeneutic analysis. The spouses felt they were in a situation of overall severe crisis (i.e., experiencing feelings of distress, restrictions, and limited or lack of support). The analysis revealed three family types: the couple acting as a unit, the couple acting independently on equal terms, and the couple acting separately with the spouse in a subordinate position. The spouses' evaluation of the entire experience varied according to the family type and the spouses' personal resources, which influenced the availability and utilization of their social network as well as the support of health-care staff. Contentment was related to the couple acting as a unit or the couple acting independently on equal terms and taking control over the situation, actively asking for support and requiring the staff to meet their needs. Discontentment was related to subordination of the spouse to the partner or to health-care staff, and failure of the couple to obtain support between them or from others. Empowering the spouses may mean helping them develop their skills, providing them with opportunities and authority, and assisting them in gaining access to resources based on knowledge of the family type, the consent of the partner, and the spouse's freedom to make choices. This may well lead to increased efficiency and have positive effects for the patient, for the spouse, and for them both as a couple.

Acute Disease↗

PubMed1996

Quality of life of the spouses of stroke patients: a preliminary study.

To study the global quality of life (QOL) of spouses of chronic stroke patients, and to determine its most pertinent factors, we assessed nine stroke patients and their spouses, using the Barthel index, the Functional Independence Measure (FIM), the Montgomery and Asberg Depression Rating Scale (MADRS), the Reintegration to Normal Living Index (RNLI), and a 10-cm visual analogue scale (VAS) to evaluate spouses' QOL. Correlation analysis was performed with the Spearman rank correlation analysis. Mean age of spouses was 53.6 +/- 11.3 years (male:female ratio, 8:1). The mean interval from stroke was 17.6 +/- 10.6 months. The spouses' median QOL score was 4.9, with a significant correlation between spouses' QOL scores and patients Barthel index scores, FIM global scores, and FIM locomotion scores. Spouses complained of the physical burden, but psychological, social, economic and marital consequences of the stroke were also reported. This study confirms the constant impact of stroke on the QOL of the spouses, and demonstrates the role of patients' physical disability. However, the VAS allows only a global approach. A self-administered composite index, exploring the consequences of the stroke on the spouses' daily life, would be a useful complement.

Activities of Daily Living↗

PubMed1994

Psychologic distress of patients and their spouses after coronary artery bypass surgery.

The first 6 weeks of recovery from coronary artery bypass graft surgery is a source of stress for both patients and their spouses. Attempts by patients and spouses to manage the stress associated with this post-hospitalization recovery are associated with alterations in psychologic functioning. This study consisted of a secondary analysis of a larger study evaluating the effects of a homegoing family information intervention. The authors identify and compare the psychologic distress of patients and spouses 6 weeks after coronary artery bypass graft surgery. Patients and spouses were individually interviewed in their homes 6 weeks after surgery. They were asked about their psychologic functioning by using the Profile of Moods States. Results indicated that spouses experienced more psychologic distress than patients at 6 weeks after surgery. Younger spouses reported more anger than older spouses. These results support the need for discharge and home interventions to reduce the psychologic distress of spouses as well as patients. Younger spouses, in particular, may need targeted interventions. Additionally, the effect of gender on measures of psychologic distress needs further exploration.

Adult↗

PubMed2005

Spouses' satisfaction with caregiver support in stroke rehabilitation.

OBJECTIVE: To examine the satisfaction of spouses of stroke patients with the support given to them during clinical rehabilitation and to explore the relationships between satisfaction and characteristics of the support received. METHODS: Spouses of patients with a first-ever supratentorial stroke were included (n = 194). Satisfaction was measured on a 0-10 scale. Bivariate and multivariate relationships were studied between overall satisfaction score and characteristics of the support provided (number of full days of attendance, participation in caregiver group, discipline providing most support), the spouses (age, gender, family situation, education and employment) and the patients (activity of daily living (ADL) dependency (Functional Independence Measure), length of stay). RESULTS: The median satisfaction score was 7, and 44% of all spouses scored >or=8 (very satisfied) but 23% were dissatisfied. Spouses' and patients' characteristics and satisfaction scores were not associated. Of the support characteristics the number of full days of attendance (p = 0.02), participation in a caregiver group (p = 0.006) and support received from a team member (p = 0.000) were related to satisfaction. No differences in spouses' satisfaction scores were found between the participating rehabilitation centres. Only 39% of the spouses participated in a caregiver group. The most important reason for not participating in such a group was not being aware of the opportunity to take part in a group (49%). Spouses participating in a group showed more depressive symptoms and had a more severely disabled partner. Caregiver support was primarily given by the nurse and the social worker. One in five spouses indicated not to have been supported at all by the rehabilitation team. CONCLUSION: A large proportion of the caregivers were satisfied with the care they had received, although one in four was dissatisfied. Satisfaction was related to support characteristics.

Consumer Behavior↗

PubMed2006

Spouse abuse and alcohol problems among white, African American, and Hispanic U.S. Army soldiers.

BACKGROUND: Prior studies suggest racial/ethnic differences in the associations between alcohol misuse and spouse abuse. Some studies indicate that drinking patterns are a stronger predictor of spouse abuse for African Americans but not whites or Hispanics, while others report that drinking patterns are a stronger predictor for whites than African Americans or Hispanics. This study extends prior work by exploring associations between heavy drinking, alcohol-related problems, and risk for spouse abuse within racial/ethnic groups as well as variations associated with whether the perpetrator is drinking during the spouse abuse incident. METHODS: Cases (N=7,996) were all active-duty male, enlisted Army spouse abusers identified in the Army's Central Registry (ACR) who had also completed an Army Health Risk Appraisal (HRA) Survey between 1991 and 1998. Controls (N=17,821) were matched on gender, rank, and marital and HRA status. RESULTS: We found 3 different patterns of association between alcohol use and domestic violence depending upon both the race/ethnicity of the perpetrator and whether or not alcohol was involved in the spouse abuse event. First, after adjusting for demographic and psychosocial factors, weekly heavy drinking (>14 drinks per week) and alcohol-related problems (yes to 2 or more of 6 alcohol-related problem questions, including the CAGE) were significant predictors of domestic violence among whites and Hispanics only. Also for the white soldiers, the presence of family problems mediated the effect of alcohol-related problems on spouse abuse. Second, alcohol-related problems predicted drinking during a spouse abuse incident for all 3 race groups, but this relation was moderated by typical alcohol consumption patterns in Hispanics and whites only. Finally, alcohol-related problems predicted drinking during a spouse abuse incident, but this was a complex association moderated by different psychosocial or behavioral variables within each race/ethnic group. CONCLUSION: These findings suggest important cultural/social influences that interact with drinking patterns.

Black or African American↗

PubMed1998

Cardiac spouses' help-seeking experiences.

The purpose of this study was to investigate the phenomenon of help seeking by spouses of cardiac rehabilitation patients by eliciting their verbal description of the experience. A phenomenological approach was used to collect data that consisted of individual interviews and focus group interviews. The exhaustive description of the phenomenon of help seeking described how the spouses' views of the illness affected initiation of help seeking. Spouses' stories revealed three time periods when spouses needed help: diagnosis, a time of uncertainty and loss of control; hospitalization, a time of information seeking and vigilance; and homecoming, a time of active help seeking because control is regained. To manage the uncertainty, spouses sought meaningful information to contend with difficulties. Spouses told of the individuals who assisted most, of barriers to seeking help, and availability of resources for support. This study increases health care providers' understanding of spouses' experiences, which may facilitate design of interviews that maximize supports for spouses. Assisting spouses will subsequently improve patients' recovery and facilitate lifestyle changes.

Adult↗

PubMed2001

Psychosocial impact of heart transplantation on spouses.

The purpose of this study was to evaluate the psychosocial impact of heart transplantation on spouses and compare the adjustment of spouses and their partners. Data were collected from 51 couples prior to transplant and 12 months posttransplant. The Psychosocial Adjustment to Illness Scale (PAIS) was used to measure adjustment in seven domains. Prior to the transplant, spouses experienced profound psychosocial distress related to their partner's illness. From pretransplant to posttransplant, PAIS total score decreased (lower scores indicate better adjustment) for spouses (M = 42, SD = 16, vs. M = 26, SD = 13). Spouses showed improvement in all domains. Posttransplant, patients' and spouses' PAIS total scores (overall adjustment) were not significantly different. Spouses reported more psychological distress than patients; patients reported more problems than spouses in vocational and domestic function. Study findings highlight the importance of sensitivity in the clinical setting to the distinct psychosocial needs of spouses.

Adaptation, Psychological↗

PubMed2006

Identifying problems faced by spouses and partners of patients with prostate cancer.

PURPOSE/OBJECTIVES: To describe problems chosen as targets of problem-solving therapy by spouses and partners of patients with prostate cancer. DESIGN: Descriptive, cross-sectional. SETTING: Spouses' and partners' homes. SAMPLE: Spouses and partners (N = 66) aged 32-79 years (mean = 60 years). The sample was predominantly Caucasian (82%) and African American (8%). METHODS: As part of a randomized clinical trial, women received problem-solving therapy to help manage issues related to their husbands' or partners' prostate cancer. The issues they chose to address during therapy and the categorization of the issues fell into four groups: treatment and side-effect issues, patient issues, family issues, and spouse issues. Scores on the Social Problem-Solving Inventory-Revised, which measures everyday problem-solving skills, and the Profile of Mood States, which measures mood disturbance, were contrasted with the problems women chose to address. MAIN RESEARCH VARIABLES: Problems faced by spouses and partners of patients with prostate cancer. FINDINGS: The most frequently reported categories were spouse issues (e.g., women's emotional wellness, balancing their medical concerns with their husbands' condition) and patient issues (e.g., men's lack of communication, fear, or depression). CONCLUSIONS: Findings of this study alert nurses to a variety of key problem areas for spouses and partners of patients with prostate cancer. IMPLICATIONS FOR NURSING: Spouses and partners play a critical role when their loved ones have cancer. Understanding the problems spouses and partners face can help nurses design optimal supportive care interventions.

Adult↗

PubMed1997

The psychosocial impact of severe hypoglycemic episodes on spouses of patients with IDDM.

OBJECTIVE: No previous studies have examined the psychosocial impact of severe hypoglycemic episodes in IDDM patients on their spouses. This study compared spouses of IDDM patients with and without a history of recent severe hypoglycemia (SH) using traditional measures of psychosocial status and marital conflict, as well as diabetes-specific measures. RESEARCH DESIGN AND METHODS: A total of 61 nondiabetic spouses (23 wives and 38 husbands) of IDDM patients participated in the study. Spouses completed a battery of traditional psychometric measures (depression, anxiety, marital conflict) and diabetes-specific measures (fear of hypoglycemia, marital conflict over diabetes, sleep disturbance caused by hypoglycemia). Scores of spouses of IDDM patients with and without a recent history of SH were compared with t tests. RESULTS: Spouses of IDDM patients with and without a recent history of SH showed no differences on traditional psychometric measures of depression, anxiety, and marital conflict. However, spouses of patients with a recent history of SH showed significantly more fear of hypoglycemia, marital conflict about diabetes management, and sleep disturbances caused by hypoglycemia. Exploratory analyses of variance (ANOVAs) found no differences on psychometric measures between wives and husbands, with the exception that husbands of SH patients reported more sleep disturbance. Nondiabetic spouses, on average, showed greater fear of hypoglycemia than their diabetic partners. CONCLUSIONS: Although SH in IDDM patients can have a significant impact on the psychosocial status of their spouses, in this study the negative impact was restricted to areas of life that are directly related to diabetes and its management. Thus, SH per se is not necessarily associated with significant increases in spousal anxiety, depression, or marital conflict, but may be associated with types of diabetes-specific psychosocial distress that are not easily identified by traditional psychometric measures.

Adult↗

PubMed2000

Spouse quality of life before and 1 year after heart transplantation.

These results indicate that overall perceived quality of life in spouses of heart transplant patients did not change significantly from the pretransplant period to 1 year posttransplantation. Conversely, specific factors influencing quality of life such as health, socioeconomic satisfaction, family satisfaction, coping styles, and the impact of the transplant experience on the spouses' life did change after transplantation. One year after heart transplantation, spouses reported less satisfaction with their health and socioeconomic status but more satisfaction with their family than they experienced before the transplant. In addition, spouses used less fatalistic, emotive, optimistic, and self-reliant coping styles after transplant than before. Lastly, spouses perceived the transplant experience more positively after the transplant than they did before the transplant. An ideal analysis would encompass data collected at more frequent periods pretransplantation and posttransplantation. The significant negative change found in the spouses' perceived health 1 year after transplant when compared with the spouses' perceived health before the transplant was based on a single-item question. A more comprehensive measure is needed to assess the health changes in the spouse that take place over time. This investigation highlights the importance of studying the impact that a catastrophic illness has on family members and the patient. As health care systems cut costs and streamline production, the needs of spouses and family members are more likely to be ignored. As a result, at some point in the future they could enter the health care arena as patients themselves. Early interventions are thus necessary to support family members of patients during the illness and throughout the recovery trajectory.

Adaptation, Psychological↗