Abstract
Introduction
Mental adjustment to cancer is one of the important factors correlating with quality of life and psychological distress. Accurate assessment of mental adjustment to cancer and changes across the course of disease are important. Psychological morbidity associated with cancer has been shown in many studies and the coping strategies employed are important determinants of such morbidity. Adjustment to cancer can be assessed using Bandura’s Socio-Cognitive Theory (SCT) to conclude which adjustment dimensions lead to learn how to live with cancer. Accordingly, the focus of this study was to explore changes in mental adjustment to the diagnosis of colon cancer over time and to identify how these adjustment dimensions are correlated with SCT’s constructs.
Method
A convergent mixed methods approach was chosen and data were collected over a 6 month period. Qualitative and quantitative data were collected at two time points: after surgery and 4-6 months after surgery and in the interviews participants were asked to reflect their adjustment responses immediately after diagnosis, while awaiting surgery, immediately after surgery, a few weeks after surgery and 4-6 months later. Through semi-structured interviews, the concepts of the study, mental adjustment to cancer, self-efficacy, self-regulation, outcome expectations, social support and general health status were explored. The same constructs were explored quantitatively through the Mini-Mac Scale, Self-Efficacy Scale, Cognitive Emotion Regulation Questionnaire (CERQ), Revised Life Orientation Test (LOT-R), Multidimensional Scale of Perceived Social Support (MSPSS) and SF-12V2 Health Survey. Directed (deductive) content analysis was completed with the qualitative data and descriptive and analytic statistics were used to explore differences over time and relationships between constructs within quantitative data.
Results
A total of sixteen and twelve participants were interviewed at time point one and time point two, respectively. All participants were New Zealand Europeans, most were male (62% & 58%) and over seventy years old (56% & 58%). The majority of participants were married (56%) and living with their husband/wife or partner (44% & 50%). More than half of the sample showed a religious affiliation (56.25% & 58.32%). After receiving the diagnosis of colon cancer, the most frequently demonstrated adjustment response were ‘Anxious preoccupation’ whereas a ‘Fighting spirit’ response was the most frequently demonstrated one both after surgery and 4-6 months after surgery. The responses of ‘Anxious preoccupation’ and ‘hopelessness/helplessness’ decreased over time, but the ‘Fatalism’ response was increased over time. High to moderate self-efficacy status was correlated with a ‘Fighting spirit’ response while ‘Hopelessness/helplessness’, ‘Anxious preoccupation’ and ‘Fatalism’ were correlated with low self-efficacy. A ‘Fighting spirit’ response was more common among participants who reported task perception, setting goals and enacting self-regulation efforts. ‘Optimistic expectations’ was correlated to ‘Fighting spirit’ and ‘Fatalism’ responses whereas ‘Uncertainty’ was mostly correlated with ‘Anxious preoccupation’, ‘Hopelessness/helplessness’ and ‘Fatalism’. The majority of participants with high perceived social support participants reported a ‘Fighting spirit’ adjustment response.
A total of 20 participants completed the questionnaires at both time points. The level of “Anxious preoccupation” dramatically decreased 4-6 months after surgery. High levels of self-efficacy were correlated with lower levels of “Fatalism” and high levels of optimism were correlated with low levels of “Fatalism” and “Hopelessness/helplessness”. Overall, higher levels of positive refocusing and acceptance were reported 4-6 months after surgery.
Discussion
The study suggests that post treatments participants demonstrated less ‘anxious preoccupation’ and ‘hopelessness/helplessness’; however, some levels of uncertainty remained and many had a fatalistic outlook. Participants who demonstrated high self-efficacy were more determined to fight the illness and saw cancer as a challenge; conversely, participants who were unsure if they could manage this new situation described feeling hopeless and anxious and expressed a fatalistic view. The findings suggest that when participants set goals to get over the cancer and get back to normal life, they were more likely to adopt a ‘fighting spirit’ adjustment response. The commitment to goals, accepting limitations and changing life style were associated with this adjustment response. Optimistic expectations were linked to a ‘fighting spirit’ response in the present study, while feeling uncertain about outcome expectations was accompanied by ‘hopelessness/helplessness’ and ‘anxious preoccupation’ responses. High perceived social support, described as social connections (marriage, friendship or membership of religious groups) were helpful in managing the new situation providing empathy and caring, offering service or even companionship. Participants with high perceived social support were more likely to demonstrate a ‘Fighting spirit’ response and therefore a more positive mental adjustment to cancer.
Despite the limitations inherent within the study, this research has contributed to knowledge on mental adjustment to colon cancer over time using a socio-cognitive approach. The results have significant implications for healthcare professionals and policy-makers around the allocation the psycho-oncological services for people with newly diagnosed colon cancer patients in working towards supporting mental adjustment.