Positive Metacognition, Family Avoidance of Cancer Communication, and Psychological Distress in Breast Cancer Patients and Their Spouses: A Longitudinal Actor-Partner Interdependence Model

Abstract

Aim To examine longitudinal changes in positive metacognition and meta-emotion, family avoidance of cancer communication (FACC), and psychological distress in breast cancer patients and their spouses, and to test the mediating and cross-partner effects of FACC. Methods 265 patient-spouse dyads were recruited by convenience sampling from a tertiary hospital between January and December 2025, and 230 dyads completing all three assessments were analysed. The Positive Metacognitions and Positive Meta-Emotions Questionnaire, the Family Avoidance of Communication about Cancer scale, and the 10-item Kessler Psychological Distress Scale were administered at baseline (T1, within 1 week after surgery), 6 weeks (T2) and 12 weeks (T3) postoperatively; follow-up was completed in March 2026. Repeated-measures ANOVA and a cross-lagged actor-partner interdependence mediation model were used. Results PMCEQ scores increased while FACC and K10 scores decreased over time in both partners (all P < 0.001). FACC significantly mediated the PMCEQ-K10 association in patients (β = 0.037, P < 0.001) and spouses (β = 0.016, P < 0.01); because higher PMCEQ predicted less avoidance and more avoidance predicted greater distress, these coefficients denote protective indirect associations (higher PMCEQ → lower avoidance → lower distress). Partner effects were also significant (patient PMCEQ → spouse FACC → spouse K10, β = 0.019, P < 0.05; spouse PMCEQ → patient FACC → patient K10, β = 0.040, P < 0.001). Distress showed positive dyadic spillover (β = 0.21–0.25, P < 0.001), indicating that higher distress in one partner predicted higher subsequent distress in the other. Conclusions In marital dyads, positive metacognition and meta-emotion increased while avoidance communication and distress declined across the early postoperative period. FACC mediated these associations bidirectionally across partners, suggesting that couple-based interventions targeting metacognitive emotion regulation and family communication may help mitigate the cross-person transmission of distress.