Research concerning distress in couples coping with cancer was integrated using meta-analysis and narrative critical appraisal. Individual levels of distress were determined more by gender than by the role of being the person with cancer versus that person's partner. That is, women reported consistently more distress than men regardless of their role (standardized mean difference = 0.31). The association between patient and partner distress within couples was only moderate (r = .29) but is sufficient to warrant further consideration of the notion that these couples react as an emotional system rather than as individuals. It is noteworthy that this association is not moderated by gender. With a general lack of comparison groups, the question of how much distress can be ascribed to the cancer experience cannot be answered decisively; elevations in distress are probably modest. We critically discuss these results, identify important unanswered questions, and indicate directions for future research. Attention needs to be directed toward factors other than cancer as direct influences of distress in these couples and to mediators and moderators of the cancer experience.

The goal of the present study was to further knowledge on gender and role (i.e. patient versus partner) differences in psychological distress and quality of life as a consequence of dealing with cancer. There is some evidence that being the patient or the caregiver makes more difference for men than for women. In total, 173 couples facing various forms of cancer (two samples) and a control group of 80 couples completed the CES‐D and Cantril's Ladder. Analyses of variance revealed that both female patients and female partners of patients perceived more psychological distress and a lower quality of life than women in healthy couples. In contrast, role did have an effect on men. Specifically, male patients scored as high on psychological distress and as low on quality of life as female patients and female partners, but psychological distress and quality of life did not differ between male partners of patients and their healthy controls. However, this effect was found in only one patient sample. The finding that female partners perceived more psychological distress and a lower quality of life than male partners could not be accounted for by differences in the physical condition of the patient or the partner.

This cross-sectional study assessed 3 ways of providing spousal support. Active engagement means involving the patient in discussions and using constructive problem-solving methods; protective buffering means hiding one's concerns; and overprotection refers to underestimation of the patient's capabilities, resulting in unnecessary help and excessive praise for accomplishments. Ratings of received spousal support by 68 patients with cancer revealed findings similar to those of partners' ratings of provided support. The positive association between active engagement and the patient's marital satisfaction was stronger for patients with a rather poor psychological and physical condition than for those with a rather good condition. Furthermore, protective buffering and overprotection were negatively associated with marital satisfaction only when patients experienced relatively high levels of psychological distress or physical limitations.

SummaryA re®ned exit, voice, loyalty, and neglect (EVLN) typology (Farrell, 1983) was examined. It was argued that the category of voice responses, that is, attempts to improve the situation, should be divided into two forms: considerate voice and aggressive voice. Considerate voice consists of attempts to solve the problem taking into account one's own concerns as well as those of the organization, and aggressive voice consists of eorts to win, without consideration for the concerns of the organization. In line with Farrell (1983), all categories of behavioral responses were assumed to dier on two dimensions, namely, destructive±constructive and active±passive. It was assumed that the responses can be ordered in a circumplex structure. Factor analyses of data from 233 teachers and maternity nurses demonstrated the empirical separability of the ®ve categories of behavioral responses and supported the two-dimensional structure of the model. Job satisfaction, especially satisfaction with supervision, seemed to promote considerate voice and loyalty (that was relabeled as patience), and suppress exit, aggressive voice, and neglect. Furthermore, the correlations between job satisfaction and the ®ve responses provided additional support for the circumplex structure of the re®ned model. The pattern of responses runs in the following order: considerate voice, aggressive voice, exit, neglect, patience.

This study has contributed to disentangling how dyadic coping behaviors influence couples' adjustment. Interventions may focus on reducing negative dyadic coping and strengthening common dyadic coping, and be attentive to the different effects of dyadic coping on patients and partners.