title: Family Avoidance of Communication about Cancer: A Dyadic Examination.
abstract: OBJECTIVE
  This study aimed to examine the following questions: to what extent do patients and caregivers perceive their family members to be avoidant of communication regarding patient's cancer, and to what extent do these perceptions interrelate; and how do such perceptions influence their own and each other's communication behaviors, communication outcome, mental health, and quality of life.
  
  
  METHODS
  A national survey was performed with 990 patient-caregiver dyads (participation rate, 76.2%). To examine the dyadic interaction, we developed linked patient and family member questionnaires, including the Family Avoidance of Communication about Cancer (FACC) scale.
  
  
  RESULTS
  The mean scores (standard deviations) of patient- and caregiver-perceived FACC were low at 10.9 (15.5) and 15.5 (17.5), respectively (p < 0.001), and concordance was low, a well (Spearman's rho, 0.23). Patient-perceived FACC was associated with lower levels of disclosure and behaviors of holding back communication, as well as lower levels of mental health outcome and quality of life. The same was true for caregivers (all p < 0.05). Patient-perceived FACC was associated with caregiver holding back, caregiver's depression level, and caregiver quality of life (all p < 0.05). Both patient- and caregiver-perceived FACC were independently associated with communication difficulty within the family.
  
  
  CONCLUSIONS
  Future research would benefit from the measurement of FACC from both patients and caregivers, and promote family intervention to enhance openness to communication, which would be helpful for improving mental health and quality of life for both patients and caregivers.
authors.affiliation: Department of Family Medicine and Health Promotion Center, Seoul National University Hospital, Seoul, Korea ; Cancer Survivorship Clinic, Seoul National University Cancer Hospital, Seoul, Korea.
authors.forename: Dong Wook
authors.initials: DW
authors.lastname: Shin
authors.affiliation: Department of Counseling Psychology, Hanyang Cyber University, Seoul, Korea.
authors.forename: Jooyeon
authors.initials: J
authors.lastname: Shin
authors.affiliation: Cancer Policy Branch, National Cancer Control Institute, National Cancer Center, Goyang, Korea.
authors.forename: So Young
authors.initials: SY
authors.lastname: Kim
authors.affiliation: Cancer Policy Branch, National Cancer Control Institute, National Cancer Center, Goyang, Korea.
authors.forename: Hyung-Kook
authors.initials: HK
authors.lastname: Yang
authors.affiliation: Department of Health Sciences and Technology, SAHIST and School of Medicine, Sungkyunkwan University, Seoul, Korea, Korea ; Department of Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA ; Department of Epidemiology, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Juhee
authors.initials: J
authors.lastname: Cho
authors.affiliation: Department of Preventive Medicine and Public Health, Chonbuk National University School of Medicine, Cheonju, Korea.
authors.forename: Jung Ho
authors.initials: JH
authors.lastname: Youm
authors.affiliation: Colorectal Cancer Center, Kyungpook National University Medical Center, Kyungpook National University School of Medicine, Daegu, Korea.
authors.forename: Gyu Seog
authors.initials: GS
authors.lastname: Choi
authors.affiliation: Department of Preventive Medicine, Kyungpook National University School of Medicine, Daegu, Korea.
authors.forename: Nam Soo
authors.initials: NS
authors.lastname: Hong
authors.affiliation: Department of Family Medicine and Health Promotion Center, Seoul National University Hospital, Seoul, Korea ; Cancer Survivorship Clinic, Seoul National University Cancer Hospital, Seoul, Korea.
authors.forename: BeLong
authors.initials: B
authors.lastname: Cho
authors.affiliation: Cancer Policy Branch, National Cancer Control Institute, National Cancer Center, Goyang, Korea ; College of Medicine/Graduate School of Health Science Business Convergence, Chungbuk National University, Cheongju, Korea.
authors.forename: Jong-Hyock
authors.initials: JH
authors.lastname: Park
mesh_terms: D017028:Caregivers / Q000523:psychology; D003142:Communication; D004522:Educational Status; D005190:Family / Q000523:psychology*; D005192:Family Health; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology*; D011788:Quality of Life; D011795:Surveys and Questionnaires
keywords: Avoidance; Caregivers; Communication; Neoplasms; Openness