Communication Currents

“Cancer” may be the most dreaded word a patient ever hears a doctor speak. When plunged into the world of uncertainty and fear that a diagnosis of breast cancer conjures, many women turn to others for support. Communication with health care providers, friends, and even loved ones may be less satisfying, however, than engaging in interaction with women who have “been there” and “done that.” This is why many patients and survivors have joined at least one of the hundreds of breast cancer support groups meeting across the United States. A study by Michael Dennis, Adrianne Kunkel, and Joann Keyton examines how the messages created in breast cancer support group(BCSG) meetings promote members' well being and emotional health.  

An overwhelming amount of research has shown that sufferers of various diseases are positively affected physically, emotionally, and mentally when they receive the social support of caring others. As support groups employ different formats, and are composed of different participants, the extent to which each group helps its members is likely to vary. Still, both research and anecdotal information indicate that such groups can be of incredible benefit to women's feelings of well being.

Since group meetings feature women talking about their common experiences, what exactly are they saying to each other? How much emotion do they display? What sort of information do they share? What kinds of messages are offered?

These questions were addressed by observing and coding the regular weekly meetings of the Bosom Buddies BCSG (see their picture below). These women gather once a week to share news about their cancer experiences and personal lives. Ranging in age from late 30s to early 70s, some women were newly diagnosed while others were long-ago pronounced as in remission. Though some veteran members have attended for many years out of a sense of commitment and gratitude, new members are not only welcome, but encouraged to attend.

As the Bosom Buddies BCSG is considered supportive and worthwhile by every individual member, the nature of its talk demonstrates how effective support groups function. The content of Bosom Buddies' messages was quite consistent with concepts made popular in problematic integration theory and appraisal theory.

Women in Bosom Buddies most often employed positive evaluation within their messages, as they stated favorable reactions or opinions of people, objects, or events. Members frequently complemented each other, reported or responded to happy medical outcomes (e.g., “you're better off!”), and provided encouragement. To do so, they used phrases such as “no problems,” “getting better,” “good,” “fine,” “best,” “lucky,” and “wonderful.”

Negative evaluations were also used by group members, and these phrases (“itch so bad,” “shook her up,” “would be the worst,” and “double-whammy”) were often directed toward the physical manifestation of the disease. Members warned others of treatment side effects (e.g., “nauseated and just felt pretty rough”) and expressed disapproval of discouraged practices such as putting on false appearances of strength.

Though many think of emotion management and transformation as the primary elements of support, the exchange of information and ideas comprised a large portion of the BCSG dialogue. In fact, after evaluation comments the next most common type of talk was suggesting courses of action. Veteran members gave advice to newer members about health care providers (e.g., “take a list of questions”), post-treatment activity (e.g., “wear Jodee bras”), and even unrelated ailments (e.g., “get your flu shot”).

Besides making explicit suggestions, one strategy often employed was to imply a course of action by relating one's own experiences as a guide for others' behaviors (e.g., “I do all the things they tell me to do,” and “I stay hydrated”). However, members were very mindful of reminding each other that “everyone is different.” It appears that their group culture discouraged the idea that strict adoption of another's behavior would secure the same outcomes.

Seeking information was also quite common. Many members claim they joined the group to attain relevant knowledge. Language such as “did you have,” “want to know what you all think,” “do you know the percentage,” and “I wonder if you've dealt with” was used to seek information about treatment options, outcomes, and financial costs. Supporters also sought case-specific information about others' side effects and post-treatment activity (e.g., “Did you have a buildup of fluid?” or “You have a Hickman port?”) so that they could provide the most pertinent advice or information.

Information avoidance, or the shrinking from available information (e.g., “I don't know and don't want to”), was almost never practiced in Bosom Buddies discussion or reported as occurring outside of group meetings.

Participants also tended to speak in terms of probability, likelihood, and either more or less certainty. One usage of positive probability or certainty promotion was to address the likelihood of preventing a recurrence of the illness (e.g., “80% chance I wouldn't have it again” or “you will survive”). Negative probability or certainty reduction made the occurrence of an undesired side effect seem less likely or cast doubts about the effectiveness of a treatment so as to prevent unwarranted optimism (e.g., “At best, Tamoxifen only gives you a 50% chance of not re-occurring”).

Support group members also used positive reappraisal. These statements are similar to saying “every cloud has a silver lining” or “when life hands you a lemon, make lemonade.” Women in the group reframed cancer occurrence or diagnosis (e.g., “the gift of cancer” or “maybe I'll get lucky and I'll have caught everything early”) and treatment side effects like the loss of hair to chemotherapy (e.g., “All you gotta do is put your makeup on and slide your hair on, and you're out the door!”).

Bosom Buddies reasoned their way through the occurrence of side effects (e.g., “When you're really large breasted . . . it's going to blister more rapidly”) and larger issues such as how they found the strength to persist through the toughest times (e.g., “When you're near death, you don't realize it; you know you just sort of keep going”). These types of statements help group members sort out the confusing cause and effect sequences related to their disease.

Ironically, given the popular notion of support groups as “emotion fests” and settings for “crying jags,” the disclosure of emotion was not prominent in the BCSG's weekly conversations. Though members were encouraged to share their feelings and did express fear, sadness, anger, and relief, they did not dwell on their feelings to the point of distraction.

Figuring out how women talk when supporting each other as they address the physical, psychological, and social aspects of one of their most notorious killers is at least as important as determining that their meeting is beneficial. To support those we love as they face health challenges, whether in a group setting or one-on-one, we should try to inspire conversation that addresses evaluation, probability, and the sharing of information, emotion, and active reasoning.