A COMPREHENSIVE OVERVIEW OF PSYCHOLOGICAL AND ETHICAL IMPLICATIONS ON THE ROLE OF CAREGIVER IN THE CLINICAL PATHWAY OF PATIENTS NEWLY DIAGNOSED WITH BREAST AND PROSTATE CANCER

In recent years, research on the caregivers’ involvement in the Shared Decision-Making and cancer care has burgeoned in the psychological field; however, knowledge gaps still exist because most studies have failed to acknowledge the multidimensional nature of agreement/disagreement among dyads in the Shared Decision-Making and cancer trajectory, especially during the early phase of the disease (diagnosis and starting of treatments). My Ph.D. thesis focused on the agreement among patient-caregiver dyads along the cancer care pathway, from the diagnosis onward, and their mutual influence on the psychological adjustment to cancer in breast and prostate cancer patients and their caregivers. Along the cancer trajectory, dyads may experience episodes of conflicts, so it has been evaluated the concept of conflict from an ethical standpoint. The current projects highlighted the importance and need for a multidisciplinary approach to dyads, involving physicians, psycho-oncologists, and clinical ethicists. A holistic approach may help patients and caregivers coping with cancer, being supportive to each other and expressing their preferences, fears, and needs. Specifically, four studies addressed the dyadic agreement in the Decision-Making and the interdependence among dyads from a psychological standpoint through quantitative and qualitative methods. In particular, the first study explored the preferences of breast and prostate cancer patients and their caregivers in the Shared Decision-Making. Given the relevance of caregivers’ involvement in the Decision-Making, two studies demonstrated the importance of a renovated family-centered model of cancer care and the need of structuring psychological interventions tailored on the dyads or on the single member. Specifically, although patients often have at least one caregiver by their side, who provide practical and emotional support, it is unclear whether dyads establish their roles and the level of involvement in the Decision-Making process. Indeed, two studies showed that most dyads disagree on the preferences and actual involvement in the Decision-Making. Moreover, caregivers are not just a supporter, as she experiences the disease almost as much as the patients. Dyadic members experience high distress and influence each other’s adjustment to cancer. Findings from the qualitative assessment support the idea of cancer as a family disease. Dyads described the cancer diagnosis as an expected and shocking event, that needs to be addressed together as soon as possible. However, patients and caregivers experience different concerns: patients’ worries refer to the cancer recurrence and the body image, while caregivers’ worries about their ability to support patients. Then, in order to evaluate the caregivers’ involvement at a multilevel, two studies assess the concept of conflict from an ethical standpoint. The first study proposed a taxonomy of the moral conflict that may emerge along the cancer trajectory. Finally, a case report provides the basis for future investigations about the presence of moral conflicts even in the early stage of cancer (diagnosis). In conclusion, findings of this PhD projects suggest the importance of caregivers’ involvement along the cancer care pathway and the need to promote psychological interventions both for patients, caregivers, and the dyads. Finally, the present thesis gives future directions to increase breast and prostate cancer dyad well-being, reducing the Fear of Cancer Recurrence.