Pathways to psychological wellbeing for patients with bladder cancer and their partners-in-care.

•Cognitive stress for patients with bladder cancer is multifaceted.•Perceived reduction in function, increased burden, older age and longer disease duration, provide a pathway to cognitive distress.•A negative appraisal of health care can lead to poor outcomes for patients and partners.•There is a significant effect on partners particularly older males, who had negative experiences with the health care system.•Couples with a positive evaluation of family and social supports appear to have lower levels of cognitive distress.