Systematic review and empirical investigation of adjustment to cancer diagnosis: Predicting clinically relevant psychosocial outcomes and testing Lazarus's Transactional Model of stress
Hulbert-Williams, Nicholas James
Cancer is one of the leading causes of death in the UK. The Cancer Reform Strategy (2007) highlighted the need for integration of psychological services into routine cancer care. Previous research into psychosocial aspects of adjustment is, however, inconsistent This thesis opens with a background on cancer epidemiology and policy the psychological impact of cancer and, the shortcomings of previous intervention-based research. The Transactional Model is introduced as a potential framework for modelling adjustment. The thesis aimed to test this model for cancer patients in order to provide evidence to better inform the provision of psychological services for cancer patients. A systematic review summarised the literature exploring the extent to which personality, appraisals and emotions were associated with psychosocial outcome. 68 studies were included. A number of small meta-analyses were performed using the Hunter and Schmidt method. Findings demonstrated a lack of consistency, and a number of research questions still unanswered. A methodological critique was provided based on systematic quality assessment. The empirical study had two purposes: prediction of clinical outcome and theory development 160 recently diagnosed colorectal, breast, lung and prostate cancer patients were recruited. Measures of personality, appraisal, emotion, coping and outcome (anxiety, depression and quality of life) were collected at baseline, three- and six-month follow-up. Analyses demonstrated that the data generally fitted the model but adaptations were proposed. Clinically, between 47 and 74% of variance in psychosocial outcome was explained by these predictor variables, with cognitive appraisals most predictive of all Transactional Model components. Statistical theory testing of cognition-emotion processes did not confirm the Transactional Model (Lazarus, 1999). These findings question the prescriptive nature of the theory and further testing is suggested, particularly in response to chronic stressors. Guidelines for methodological improvements are provided. The thesis concludes with proposals for further research, including suggestions for theory- informed interventions.
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