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A Dyadic Affair: Who Is to Blame for Causing and Controlling the Patient's Lung Cancer?

Lobchuk, Michelle M. PhD, RN; Murdoch, Tammy MN, RN; McClement, Susan E. PhD, RN; McPherson, Christine PhD, RN

doi: 10.1097/01.NCC.0000339253.68324.19

Couples facing lung cancer may be at an increased risk of relationship distress in relation to unresolved blame and anger. Using a comparative design, we conducted preliminary analyses of illness attributions as reported by 100 patients and their primary support persons. Patients and support persons responded to a series of 5-point Likert-type questions to capture locus of causality and controllability as well as attribution-related cognitions and emotions. Most patients and support persons had a smoking history. Both patients and support persons ascribed the locus of causality and controllability for lung cancer as the patient. Between-group analyses revealed that patients and support persons ascribed more negative attributions toward oneself and more positive attributions toward their partner. However, within-group analysis revealed that support persons tended to ascribe more responsibility, fault, and blame toward the patient. We speculated that patients may be responding to negative signals received from their support persons that perpetuated their self-blame. The care of patients, particularly those who used tobacco, might be approached from a "shared line of attack," wherein both patients and support persons are encouraged to examine and understand their attributions to "soften" the blame and anger toward oneself or their partner.

Authors' Affiliations: Faculty of Nursing, University of Manitoba, Canada (Dr Lobchuk, Ms Murdoch, and Dr McClement); School of Nursing, University of Ottawa, Canada (Dr McPherson).

Funding Source: This study was funded by a research grant from the National Cancer Institute of Canada and an establishment grant awarded to the first author from the Manitoba Health Research Council.

Corresponding author: Michelle M. Lobchuk, PhD, RN, Faculty of Nursing, University of Manitoba, Rm 315, 89 Curry Place, Winnipeg, Manitoba, Canada R3T 2N2 (

Accepted for publication March 11, 2008.

© 2008 Lippincott Williams & Wilkins, Inc.