Perspectiva Masculina

Abstract

After receiving a cancer diagnosis, couples commonly face significant difficulties such as adjusting to new family roles, diminishing cohesion and communication, and increases in marital conflict. Latina breast cancer survivors report feeling less emotional support from their partners and an intimate partners’ level of distress can have a deleterious influence on the cancer survivor. The current study explores the influence of breast cancer on Latino male partners. Analysis of the data resulted in nine domains that provide significant insight into participant experiences. Results of this study also suggest several implications for counselors.

Keywords

Latino/Latina couples breast cancer machismo

Cancer is the second most common cause of death among all Americans; however, among Latinas, breast cancer is the leading cause of death (American Cancer Association, 2015; Siegel et al., 2015). Thus, it is no surprise that after being diagnosed with breast cancer, individuals experience significant amounts of psychological distress (Ashing-Giwa, Rosales, Lai, & Weitzel, 2013; Tojal & Costa, 2015), and that this psychological distress is increased for minority cancer survivors. In a systematic review of the literature, Luckett et al. (2011) identified 21 articles focusing on investigating psychosocial outcomes (e.g., anxiety, depression, distress, and quality of life [QoL]) for minority and majority cancer survivors and concluded that minority cancer patients did indeed have significantly worse distress (p < .0001), depression (p < .0003), and overall QoL when compared to majority patients. Unfortunately, Latina breast cancer survivors have the least amount of socioemotional support services available to them and also experience more psychological distress than their non-Hispanic counterparts (Ashing-Giwa et al., 2013; Badger et al., 2013; Ell et al., 2005). In short, Latinas struggling with cancer are in need of emotional and social support that can help alleviate some of the psychological burden associated with fighting the disease.

This psychological burden also influences the Latina breast cancer survivors’ intimate relationships. After receiving a cancer diagnosis, couples commonly face adjustment difficulties resulting in changing family roles, decreased intimacy, lower cohesion, challenges with communication, less mutual support, and increased marital conflict (Baik & Adams, 2011; Baucom et al., 2009; Girgis & Lambert, 2009; Manne et al., 2006). Furthermore, research investigating psychological distress for family members indicates that couples and caregivers report similar or increased psychological burden when compared to cancer survivors (Baucom et al., 2009). Matthews (2003) conducted an investigation examining the distress on caregivers that were intimate partners, family members, or friends of the cancer survivors (N = 270) and found that most caregivers were male partners who reported greater psychological distress and fear regarding cancer diagnosis when compared to the cancer survivors themselves. This is consistent with previous research which indicated that while cancer patients were receiving treatment, caregivers, who are often the cancer survivor’s intimate partner, experienced more psychological distress than the cancer patients (Hodges, Humphris, & MacFarlane, 2005). Therefore, previous research has indicated that the breast cancer diagnosis influences the couples’ relationship and that the partners of cancer survivors experience significant distress.

Furthermore, researchers report that an intimate partner’s psychological distress has a reciprocal effect on the cancer patient. Kim, Carver, Spillers, Crammer, and Zhou (2011) surveyed cancer survivors and their intimate partners (N = 361) about their coping skills and QoL after a cancer diagnosis. Results indicated that intimate partners’ state of mental and physical health affected the cancer survivors’ mental and physical health, bolstering the significant role that partnering relationships have in cancer recovery (Kim, Carver, Spillers, Crammer, & Zhou, 2011). In essence, the psychological distress of the intimate partner not only has a deleterious effect on them, but it also worsens the psychological health and QoL of the cancer survivor. Therefore, it is imperative for marriage and family therapists to attend to the intimate partner’s psychological health and relational challenges due to cancer.

Latino Culture and Cancer

To better understand how to support Latina breast cancer survivors and their intimate partners, it is important that we understand their phenomenological experiences and cultural values. For example, in qualitative interviews and focus groups, Latina breast cancer survivors (N = 28) expressed that they felt that their male partners had difficulty demonstrating emotional support after their breast cancer diagnosis (Lopez-Class et al., 2011). One value in the Latino culture, machismo, may partially explain the lack of emotional support Latina breast cancer survivors experienced. Arciniega, Anderson, Tovar-Blank, and Tracey (2008) describe machismo as an umbrella term that consists of two constructs, traditional machismo and caballerismo. Traditional machismo is typically characterized by a discomfort with wives working (Davila, Reifsnider, & Pecina, 2011), hypermasculinity, higher levels of alexithymia, and more aggressive behaviors (Arciniega, Anderson, Tovar-Blank, & Tracey, 2008). In contrast, caballerismo emphasizes positive qualities, such as emotional connectedness, a desire to protect their partner from negative emotions, and a sense of social responsibility (Arciniega et al., 2008; Herrera, Owens, & Mallinckrodt, 2013). Both caballerismo and machismo can affect emotional expression. For example, a Latino exhibiting machismo may avoid emotion because of a lack of emotional awareness (Herrera, Owens, & Mallinckrodt, 2013); however, someone coming from the perspective of caballerismo, although they are aware of their emotions, may still choose to inhibit emotional expression in order to protect their partner. In either case, the lack of emotional support from Latino men during their wives’ hardship with breast cancer may be attributed to these socially constructed and reinforced cultural values (Lopez-Class et al., 2011). However, limited research exists on how Latino men cope with their partner’s diagnosis of cancer, and more research is needed to truly understand how marriage and family counselors (MFCs) can support Latina breast cancer survivors and their partners. Therefore, the purpose of this investigation was to explore the influence of breast cancer on the intimate partners of Latina women and provide counselors and other helping professionals insight into the Latino experience of coping with cancer.

Method

Given the exploratory nature of this investigation and the lack of previous research on this population, we deemed that a qualitative approach was the most appropriate to answer our research question. We selected consensual qualitative research (CQR; Hill et al., 2005; Hill, Thompson, & Williams, 1997) due to the systematic methodology, rigor, and trustworthiness. CQR is a newer form of qualitative research that shares many similarities to its predecessors (e.g., Grounded theory and phenomenological), but highlights the importance of multiple perspectives, the use of a research team, and reaching consensus. The use of a research team allows researchers to use CQR to generate a more rigorous understanding of the data. Therefore, one of the main advantages to CQR is its ability to approach a complex topic by synthesizing several viewpoints and providing researchers with a trustworthy understanding of a phenomenon.

Participants

Hill and colleagues (2005) recommend the use of 8–15 participants. This study is part of a larger research project, where we recruited 15 couples (N = 30) using purposive and chain-referral sampling (i.e., the snowball sampling technique; Biernacki & Waldorf, 1981). Of the 15 recruited, 7 couples agreed to participate (N = 14). In order to appropriately answer our research question, we focused our investigation on the male partners (N = 7). Due to the stigma often associated with cancer (Else-Quest & Jackson, 2014), Latina breast cancer survivors are often difficult to recruit for research studies. Chain-referral sampling is most helpful when dealing with difficult to find populations because it allows researchers to access participants through informal and less obtrusive methods; therefore, it was utilized in the current investigation (Biernacki & Waldorf, 1981). In qualitative research, the adequacy of sample size is dependent on the nature of the problem and the results of the findings and not solely on the specific number of participants (Wertz, 2005; Yeh & Inman, 2007). Hunt (2011) noted that qualitative researchers should avoid focusing on the number of participants and instead focus on how and why researchers selected participants. We believe that given our population, the redundancy in the themes that emerged in our data and the rigor applied to our approach, that our sample is of adequate size to support the findings.

All participants in the study met the following inclusion criteria: (a) had a partner diagnosed with breast cancer, (b) had a partner who was also willing to be interviewed for the study, (c) resided in the state of Florida when the interview took place, and (d) primary cancer treatment was completed for the breast cancer patient. At the time of the interview, participants in our study fluctuated in age from 44 to 72 years, with an average age of 57 years. All participants were fluent in Spanish.

Procedures

Researchers recruited participants via e-mail, phone contact, and face-to-face interaction with cancer-service organizations. We created several flyers in Spanish and English and distributed them throughout our local community (e.g., churches, medical offices, billboards, etc.). We also made contact and presented the study to a local cancer support group. Although many breast cancer survivors were interested in the study, there were concerns that their male partners would not agree to participate. Therefore, one of the challenges we faced involved building trust and confidence with participants in order to overcome the barriers associated with the stigma and the privacy concerns. In order to compensate for time and effort expended, each couple received a USD$100 gift card for completing the study.

After participants completed initial screening, a research team member contacted them via phone, presented them with the informed consent, and scheduled the interview. Prior to the interview, participants were e-mailed a research packet that contained a demographic form and copies of the informed consent. Per the request of participants, six of the interviews took place over the phone and one took place in the participant’s home. Although the research team preferred face-to-face interviews for the sake of examining nonverbal cues, participants seemed significantly more comfortable and uninhibited over the phone. The interview protocol was semistructured and consisted of five open-ended questions. The research team developed the questions to elicit rich descriptions of the partners’ experience and their methods of coping. Participants were asked: (a) Please tell me what it is like living with a partner with breast cancer? (b) How did you cope when you found out your partner had breast cancer? (c) What has been different in your relationship since the breast cancer diagnosis? (d) What has been the most helpful during your partner’s recovery? And (e) What has been the most difficult part of recovery?

The majority of the participants preferred Spanish interviews. Thus, the two Spanish-speaking doctoral students (one male and one female) facilitated the interviews. Researchers often avoid cross-cultural and bilingual qualitative research due to linguistic challenges (Lopez, Figueroa, Connor, & Maliski, 2008). Due to the translinguistic component of these qualitative interviews, the research team took extra care to ensure that we accurately represented our participants including any cultural nuances within the interview. For example, we used bilingual external auditors to review all of the research-related paperwork, including marketing flyers, the interview questions, and the assessments. We also submitted the transcripts to a transcription service that translated them into English and then had the Spanish-speaking team members review the transcripts for accuracy.

Data Analysis

As previously mentioned, one of the hallmarks of CQR is the use of a research team. In the current study, the research team consisted of a counseling professor and three doctoral students (two females and one male). All of the members of the research team had previous CQR and qualitative research training. Additionally, two of the doctoral students were of Latino/Latina descent and spoke Spanish fluently. We analyzed the data using the three phases established by Hill, Thompson, and Williams (1997): (a) create domains, (b) construct core ideas that encapsulate the main ideas of the participants, and (c) cross-analyze the data to identify categories that are consistent across all participants. At every step of this process, the research team discussed to consensus. An external auditor was utilized to ensure that the data were accurately categorized and appropriately reflected the participants’ words accurately (Hill et al., 2005).

Ensuring accuracy and trustworthiness in qualitative research is of the utmost importance, especially given how subjective interpretations of the data may be. Hill and colleagues (1997) developed six criteria for establishing trustworthiness in CQR: (a) trustworthiness of the method, (b) coherence of the results, (c) representativeness to the sample, (d) testimonial validity, (e) applicability of results, and (f) replication across samples. The first three criteria are required and the last three are recommended. In the current study, we met all of the required criteria to ensure the trustworthiness of our design.

In order to maintain the trustworthiness of methods, we closely monitored the collection and the analysis of the data. We formally and informally conducted a bracketing exercise, wherein each team member described the cultural, professional, and personal factors that may influence the collection and interpretation of the data. Each research team member wrote down their assumptions and potential biases regarding the target population and the data collected. In addition, we utilized scripted questions to ensure that interviews were consistent across participants and allowed participants to communicate in the language of their choice (i.e., Spanish or English). We were also mindful of the composition of our sample and the process of reaching consensus within the research team. Finally, we employed the use of an external auditor when appropriate. The use of the multiple perspectives from the research team allowed us to meet the second criterion. Each research team member reviewed and coded the transcripts individually before presenting them to the research team. This allowed us to ensure that the results and conclusions accounted for all data were logical and effectively reflected the research questions. Using a research team to reach consensus is the foundational premise of CQR and allows researchers to synthesize multiple perspectives and reduce researcher bias (Hill et al., 2005). The final required criterion of CQR involves the representativeness of the results to the sample. We met this requirement by reviewing each of the themes and labeling them for frequency of occurrence. We labeled themes as general (over 85%), typical (over 47%), variant (or 28%), or rare based on the percentage of participants that shared the experience or theme. If a theme occurred in more than six of the transcripts, it was labeled as a general theme; whereas if the theme occurred in four or five transcripts, it was labeled as typical; and two or three transcripts, variant. Additionally, if the theme only occurred in one transcript, it was labeled as rare. Having met the above three steps for data trustworthiness, we were confident that our findings provide a sound representation of our participants’ experiences.

Results

Our analysis of the data resulted in nine domains (i.e., topic areas). In keeping with Hill and colleagues’ (2005) recommendations, we clustered the data into categories and labeled the frequency by which these categories emerged. We discovered one category that met the criteria for the general label, six that were typical, five that met the criteria for variant, and five that were rare. In the following section, we report the findings for each domain and their categories. The domains include (a) emotional reactions, (b) support strategies, (c) challenges, (d) changes to intimacy, (e) faith, (f) psychosocial development, and (g) posttraumatic relational growth.

Emotional Reactions

The participants reported experiencing strong emotional reactions to their partners’ diagnosis and treatment of breast cancer. The research team categorized these reactions as either negative emotions of anxiety and sadness or positive emotions of acceptance or respect. We found anxiety and acceptance to be typical occurrences and sadness to be variant in our data.

Participants described feeling anxious after the breast cancer diagnosis (typical). One participant described the challenge of feeling the need to protect their partner from their anxiety, stating “it was a very difficult moment. On the inside, I felt destroyed but I never wanted to show that to her.” In addition, three participants described feeling sadness. For example, one participant stated,

There were many times that we felt desperate and felt the desire to cry because of what was happening to her for the physical changes that she started to have. Many times, we wanted to cry or close ourselves up and had a tendency to get depressed but we could only show her that there was hope.

Other participants described feeling positive emotions. Participants stated that they experienced acceptance, which one participant described as loving “her just the way she is” (typical).

Support Strategies

In addition, male partners reported several methods by which they offered support to their partners and how they received support from others. All of the participants described partner engagement, or becoming involved in their partners’ treatment as best they could, as a support strategy. One participant described engaging in his partner’s treatment by doing research on healthy foods that promote cancer prevention:

I dedicate myself to being a cook and we’ve had a drastic change as far as food. We eat healthier especially for her because … greens and many different kinds of food contribute to the cancer not coming back so that it will not be repeated.

Another participant described his engagement in more broad terms:

Well, from the first moment that the doctor verified that she had breast cancer, I told her that she is my companion and that in every moment I would be there for her. After she had the operation and the doctors told me what was the condition of her operation and that for her to improve, I needed to help her. I have been 100% involved in the condition of her illness for her, going with her to the doctor’s appointments. In the daily things of the house, I would say … I do about 90% of the housework. When she is in fairly stable condition, she participates but when it comes to making big decisions I would say that 10% are made by her, of paying some bills or if it involves speaking English because she is more fluent in English than me. But physical movement, I take care of it.

In addition, participants described community support as being an effective support strategy (typical). These participants described how the immediate support of friends, families, and employers was a significant contributor to their coping with the cancer. Likewise, participants described that keeping a positive attitude and perspective was important when offering support (typical). As one participant explained,

My personality allowed me to take it more like it was part of life. Not good to happen but it happens so we cannot change it. We got to learn how to live with it and go ahead and continue living and don’t give it too much thought. Just proceed with your life and don’t worry too much about it I guess.

This positive outlook emerged as an attitude of acceptance coupled with a recommitment to the relationship (typical). For example, Participant 1 stated, “I have taken it as something that happened and we cannot really take it back. That’s the way it is, and we cannot change it.” Three participants also described empathy as playing a significant role in support. For example, one participant stated,

If knowing she is happy, I will also be happy. Also if she is suffering, I also will feel some suffering because I don’t know how to get to her to try to relieve some of what she is feeling. Instead I have to little by little until I see that she feels happiness, then I can feel the same.

Although the previously mentioned themes appeared most frequently in the data, we believe it is important to note that affirmations was a rare category that appeared with rich description in one of the interviews. This participant offered several examples of how affirmations encouraged his partners’ recovery. He reported, “I told her that she is my companion and that in every moment I would be there for her.” He also shared,

Mami, I know that you are a woman with many values many principles and you are very strong. These were the words I said to her. I told her, Mami, if God gives you the possibility of having this, keep on because I will be at your side always.

Faith

Participants also stated that their faith influenced their ability to cope. Two categories emerged from the faith domain (a) beliefs and (b) behaviors. Overall, participants reported that their faith belief system had a strong influence on their coping. Participants stated that their faith beliefs strengthened their ability to cope with the diagnosis (typical). One participant stated, “We are believers, we believe in God so what we did is found refuge in Him and drowned all of this pain and suffering that this had caused us.” Another added,

Life can hit you hard and this was one hit for us but with God’s help and having faith in God we have been able to continue forward to overcome the illness and what we have to do today is to continue with faith and that we know that everything will be okay.

In terms of faith-oriented behaviors, one participant reported that certain spiritual behaviors helped support their coping. This participant stated,

We started to read it together, we started praying together, we started to kneel together and to spend more quality time together in prayer. And well, with time we learned to rest in God and to have faith in Him.

Challenges

In addition to support and coping strategies, some participants described the difficulties associated with being in a relationship with a cancer survivor. This domain had only one category—physical changes. Three participants reported that one of the major challenges they faced was the unanticipated physical changes that occurred during and after treatment. One participant described,

We [used to do] more physical activities together. We would work out together, go biking, many outdoor activities. Now with her condition, she doesn’t have the same stamina, we practically don’t do these types of activities anymore. Places that we used to frequent, we no longer go to such as going out at night, going to dance like we used to do, that all has changed.

Additionally, another participant stated,

The most difficult was when her physical changes began due to the effects of the medicine. This was very difficult … when she started with chemotherapy, seeing her physical changes, herself seeing how she was changing was very difficult because at this time her self-esteem, her attitude changed, she was very sensitive and it was tremendous for all of us to see what was happening.

Changes to Intimacy

Given the physical changes associated with cancer treatment, the research team anticipated that the couples would experience changes to intimacy. However, we discovered that intimacy changed for some participants but not all. One participant described experiencing no change in their level of intimacy with their partner. Participants described changes in their level of emotional intimacy (typical). One participant stated,

[cancer] has given me the opportunity to enter into some areas that are very personal to her. Such as her feelings her thoughts. It allows me a lot of participation and I have taken advantage of this to be able to unite us.

Two participants described changes to their level of sexual intimacy. These participants stated that their partners were often “self-conscious about her breasts” and one participant described his partner as “hiding” her body from him.

Variant and Rare Domains

Some of our domains were not highly represented in our data. However, they contributed some significant information. For example, the research team noted that some of the participants (n = 2) believed that their cancer experience was moderated by their psychosocial developmental stage. One participant stated that because they were past childbearing years, they were less influenced by the diagnosis and more readily accepted their circumstances. Similarly, one participant discussed how cancer survivors and their partners are often subject to a level of stigma that prevents the patient from seeking help and causes the survivors’ symptoms to worsen. He stated that “if there is someone who will take care of them, give them help and get close to the person who has cancer, they are throwing them a lifesaver and that person will probably get completely better.” Finally, not all participants described the breast cancer diagnosis as being harmful to their relationship. One participant stated, “On the contrary, it has brought us closer. It has brought me closer to her. It helps her that the condition of her illness is as for her as it is for me.” Moreover, he stated, “we learned to make the most of the time that we could spend together, to live moments as if they were the last and that’s what we learned to do.” We categorized this occurrence as posttraumatic relational growth because they exhibited characteristics synonymous with those of posttraumatic growth (Steel, Gamblin, & Carr, 2008).

Discussion

The current investigation provided significant insight into the lived experiences of the partners of Latina breast cancer survivors. The findings demonstrated that, as indicated by previous research (Kim et al., 2011; Matthews, 2003), the partners of cancers survivors do experience a unique level of distress due to their partners’ medical diagnosis. Moreover, the results of the current investigation extend the current body of literature by providing insight into how Latino men cope with their partner’s cancer diagnosis stress in the relationship.

The results indicated that the intimate partners of Latina breast cancer survivors typically experience negative emotions in reaction to their partner’s cancer, and they also occasionally express acceptance. Past research has documented the critical role emotions and emotional reactions play in relationship health (see Carstensen, Gottman, & Levenson, 1995; Greenberg, 2008; Johnson, 2012). Therefore, we believe that the emotional reactions that emerged from the data are important and could serve as determinants of the quality of relationship functioning. It was typical for participants to express feeling sadness and anxiety. However, participants also stated that they attempted to protect their partners from their negative emotional reactions by hiding their true feelings. For example, when describing their sadness, one partner stated, “I felt destroyed but I never wanted to show that to her;” and another stated, “we wanted to cry … and had a tendency to get depressed but we could only show her that there was hope.” This desire to shield their partners from their emotions is consistent with the cultural value of machismo (Arciniega et al., 2008). However, the actions of the Latinos in our study demonstrated caballerismo more so than traditional machismo. Traditional machismo dictates that men should avoid showing the weakness of emotion, especially in the face of difficult times. Additionally, Latinos demonstrating traditional machismo are often unaware of their emotions. In contrast, the Latinos in our study did exhibit emotional awareness, stating that they were sad and scared. Furthermore, they typically expressed being in tune to their partner’s needs (i.e., partner engagement) and inhibited emotion not out of a sense of gender roles, but because they wanted to protect their partners. Therefore, Latino partners may have felt they needed to inhibit their emotional expressions for the sake of strengthening their partners’ resolve. Similarly, Lopez-Class et al. (2011) reported that Latina breast cancer survivors felt their partners were unable to demonstrate emotional support. It is unknown whether this is related to cultural factors, gender socialization, or some other factor.

Arciniega and colleagues (2008) argued that typical definitions of machismo erroneously emphasize negative qualities and disregard the more noble aspects of machismo associated with caballerismo, such as masculine chivalry and a desire to problem solve. Our data indicated caballerismo much more than machismo. Generally, Latinos reported becoming involved in the partner’s treatment in an attempt to problem solve and support their partners. The participants in the current investigation described feeling they were most supportive when they could do something helpful, such as learning to cook healthy foods, researching alternative treatments, or taking over household chores. Although Latina women may perceive their partners as being unsupportive because they often inhibit their emotions, Latino men may consider themselves as being extremely supportive because of their level of partner engagement. Therefore, it is possible that the Latina couple is speaking two different love languages (Chapman, 1992), wherein the male is holding back emotion and behaviorally expressing support and the female is hoping to receive emotional displays of support.

The Spanish cultural values of personalismo and familismo also emerged in our findings. These values describe the importance Latinos place on personal and family relationships, respectively. In the current investigations, participants stated that the involvement of friends and family played a significant role in their ability to cope. This is consistent with previous research (Antshel, 2002; Buki et al., 2008; Fergus & Gray, 2009; Galván, Buki, & Garcés, 2009; Sammarco & Konecny, 2010) and underscores that social support is an important facet of the recovery process for the cancer survivor and their intimate partners.

Spirituality or espiritualidad also emerged from our data. This finding is consistent with the findings of previous researchers who noted the importance of spirituality to Hispanics (Añez, Paris, Bedregal, Davidson, & Grilo, 2005; Gutierrez, Barden, & Tobey, 2014; Kouyoumdjian, Zamboanga, & Hansen, 2003). For the sake of clarity, participants in our study made a distinction between faith-based behaviors and beliefs. Consequently, we discovered that spiritually based beliefs were typically more influential for participants. Participants described how their belief in God alleviated their distress and increased their hope. One participant did describe the benefits of praying with his partner. However, they described it less as a faith-based behavior and more as “spending quality time together” and that eventually this behavior led to a change in perspective and increased faith.

In sum, the results of this study highlight the unique experiences of the Latino partners of breast cancer survivors. Our interpretation of the data found themes similar to the documented Latino cultural values of machismo and espiritualidad. Therefore, we believe it is important for professional counselors and researchers to take into account some of these cultural factors when attempting to understand how Latino couples cope with cancer.

Limitations

As with all research, one should interpret the findings of the current investigation in light of its limitations. Although we have taken considerable steps to ensure the rigor and trustworthiness of our data analysis, the current study is qualitative with a limited sample and we cannot generalize the findings to the experience of all the partners of Latina breast cancer survivors. It is possible that those who chose to participate in this study were qualitatively different from those who selected not to participate. In light of these limitations, we believe that the results from this exploratory study provide a notable contribution to the literature and offer several implications for MFCs and counseling researchers.

Implications for Marriage and Family Counseling

As previous research and the findings of the current investigation illustrate, cancer affects not only the individual with the diagnosis but their significant others as well. Past researchers have noted that Latina breast cancer survivors look to their partners for support and that their support influences the survivor’s health (Kim et al., 2011). Thus, it is important that MFCs tend to the needs of the breast cancer survivors’ intimate partner as well as the cancer survivor. In order to work effectively with partners affected by cancer, MFCs must have a comprehensive understanding of the intimate partners’ experiences and what factors influence their coping.

The current investigation demonstrated that for the male partner of Latina breast cancer survivor, personal values play a salient role in coping and QoL. In order for professional counselors to provide appropriately effective care, they must understand how Latino cultural values influence their client’s ability to cope. For example, in this study, participants stated how they hoped to protect their partners by not expressing how distraught they were. It is possible that when Latino males inhibit their emotional expression in this way their partners see them as being cold or distant. On the other hand, Latinos generally describe partner engagement as an important support strategy. Therefore, one strategy for MFCs would be to offer psychosocial interventions that address emotional expression and increase communication skills especially with Latino partners. Various strategies for increasing communication among couples exist in the literature and are discussed elsewhere in detail (see Chapman, 1992; Daire et al., 2012; Gottman & Gottman, 2015; Stanley, Markman, & Blumberg, 1997). MFCs should encourage Latino partners to discuss openly their feelings regarding the breast cancer diagnosis and allow these couples an opportunity to process feelings and explore their initial resistance to sharing.

Participants also stated that spirituality is an important part of their recovery process. Given that Latinos tend to eschew traditional mental health and family therapy services (Añez et al., 2005; Kouyoumjian, Zamboanga, & Hansen, 2003), it might be beneficial to implement culturally relevant psychosocial interventions through churches or religious institutions. MFCs could work with ministers and faith-based institutions to provide relationship education to men’s groups. Furthermore, spiritually oriented interventions may be more effective than traditional treatments. Thus, MFCs should consider how they integrate spirituality into their work with this population. Given the high lethality of breast cancer for Latinas, it is possible that male partners are struggling with existential concerns and would likely benefit from strategies that help them with religious coping. In sum, results from the current investigation have important implications for MFCs and provide useful strategies for care for the partners of Latina breast cancer survivors.

Suggestion for Future Research

Given the exploratory nature of this study, these findings offer the potential for several avenues of research. Our suggestions for future research include replicating this study with a larger and more diverse sample to support and expand the exploration of coping for Latino men. Additionally, we suggest expanding this study to a quantitative approach with a larger sample. We believe it would be beneficial to explore how using culturally validated instruments that appropriately differentiate between machismo and caballerismo (e.g., Arciniega et al., 2008) can assess the relationships between these cultural values and relationship satisfaction. Lastly, future research is needed on the development of interventions and support services for the male partners of Latina breast cancer survivors. Our data indicated that their experiences are unique and by providing support services, counselors can help strengthen their relationships and provide great relief to them and their partners.

Conclusion

In conclusion, as the Latino population continues to grow in the United States, it is important that marriage and family therapists, professional counselors, and other helping professionals find culturally appropriate ways of meeting their needs. The current investigation helps to extend a limited body of literature on the intimate partners of Latina breast cancer survivors. Results from the current investigation underscore the influence of cultural values on the well-being and health of the cancer survivor and their intimate partner and highlight the importance of adapting psychosocial interventions to be culturally appropriate.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

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