Evolving couple identity
An overarching theme of ‘evolving couple identity’ emerged from the data. Couple identity refers to the sense of ‘us’ or ‘we-ness’ in the relationship. Three core themes were identified:
Couple relationships—integrating/managing old and new relational dynamics;
Work and finances: challenges, buffers, and new directions; and
Development of social connections and impact on social activities. The impact of PCa on younger couples led to significant changes to couples’ relationships, parenthood and family functioning, work and finances, social activities, and connections. Subsequently, these impacts triggered various
‘engagement strategies and behaviours’ within couples’ relationships which influenced their adjustment to PCa and therefore couples’ sense of ‘we-ness’, their collective identity as a couple (see Fig. 1, online resource
4). The theme associated with parenthood and family functioning has been previously published [
8]; thus the other three themes will be the focus of this article.
‘What he has found hard, is he used to have to look after me, especially when my muscles seize and I can barely walk, and now he’s swapped roles. Every time I did something, he’d say “I’m meant to be looking after you”’ (Dyad 5, wife, 45–49, Chemo & HT, ST).
‘I was used to looking after her, but then I couldn’t look after her, and that made me more depressed. I’d do all the ironing and things like that used to hurt (wife), but I just didn’t have any energy’ (Dyad 5, husband, 50–54, Chemo & HT, ST).
Although wives often already played an active role in providing emotional and practical support to men, this role seemed to be magnified by the impact of PCa, as women often described feeling the pressure and need to be strong for their husband and family by keeping it together. Subsequently, this sometimes led women to neglect themselves (‘I just don’t have time to think about myself. I just make sure I look after him, after everybody and put me to the back of it’, Dyad 16, wife, 50–54, RP).
The impact of PCa and side effects of treatment triggered different engagement strategies and behaviours within couples’ relationships, which influenced their adjustment to PCa. Engagement strategies and behaviours pertain to how couples interacted with one another and included relational communication, distancing from unfamiliarity, mindset towards PCa, and distraction, which are highlighted throughout the core themes.
‘I hit a really low point still suffering from incontinence, so I think it does knock your confidence dealing with the after effects really. I started getting anxiety and depression, so I was flying off the handle at work, and then I couldn’t face going to work in the morning… I had to take a little bit of time off work’ (Dyad 19, husband, 50–54, RP).
In some cases, their wives’ ability to work was also impacted by the PCa diagnosis and their own worries about their future as a couple (‘I was aware I was not performing as well. I was very forgetful, because I was in a position of responsibility and managing the team and I was aware that I needed to be cut a bit of slack maybe’, Dyad 3, wife, 50–54, EBR, HT).
The financial impact of PCa varied across couples. For many, financial buffers helped their situation, e.g. critical illness cover, personal independence payments (PIPs), (‘I was fortunate enough to have insurance for critical illness insurance so that pay saw me through the cash flow for the period that I was unable to work […]’, Dyad 22, husband, 55–59, RP). Couples in which one or both members were self-employed often found seeking financial welfare benefits difficult compared with those working for an employer. For some couples, in which the men took early retirement due to the impact of PCa, their wives sometimes reported feeling a financial burden due to one income in the household and therefore placed a pressure upon them to continue to work:
‘I'm still working because our finances have dropped considerably. You look forward to your futures when your children have grown up and sort of think when we retire but of course my husband has already retired and I’m still working, so I’m still talking when I retire, but there is the financial, I feel a financial burden’ (Dyad 6, wife, 55–59, RP & EBR).
Some couples were advised of financial support such as PIPs through charities. However, the benefits they received were not enough for them to enjoy activities which they used to, and so their social activities and travels abroad were curtailed. Guidance on where to access financial support was a commonly reported unmet need by couples (‘I think I needed somebody to talk to financially about where to go and stuff like that’, Dyad 19, husband, 50–54, RP).
For some couples, distraction was a helpful coping strategy from PCa. Couples often had busy lives, as the majority of couples were working which meant that cancer could be put to the back of their minds (‘I think there was so much going on in our lives, particularly with work, that (husband’s) cancer actually took a backseat, and sometimes you’d forget it until you thought about it because we were concentrating on life […]’, Dyad 11, wife, 45–49, OT).
A few women enjoyed having work as a distraction from thinking about PCa and a way for them to carry on life as normal (‘When I was working and nobody at work really knew because I could just kind of get away from it, I could just go and get on with working and that was good for me’, Dyad 25, wife, < 45, RP).