Goal processes & self-efficacy related to psychological distress in head & neck cancer patients and their partners

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Abstract

Purpose and objective of the research

In this cross-sectional study we used a self-regulation perspective to better understand the experience of psychological distress in head & neck (H&N) cancer patients and their partners. We examined which goals they valued and the extent to which patients and partners experience goal disturbance. Furthermore, associations were explored between goal disturbance, goal re-engagement, (goal)self-efficacy, and psychological distress.

Methods and sample

H&N cancer patients and their partners, recruited from the Erasmus Medical Center Rotterdam (N = 40), were interviewed and completed questionnaires, assessing the above aspects of the self-regulation theory.

Key results

H&N cancer patients and their partners experienced goal disturbance from the disease. Such disturbances were in patients significantly related to more psychological distress. Higher levels of goal re-engagement were related to less psychological distress, again only significantly in patients. More self-efficacy was significantly associated with less psychological distress in both patients and partners.

Conclusions

Self-regulation abilities as goal re-engagement and self-efficacy may be screened and used as target in future psychological interventions, given their potential to decrease perceived psychological distress. In view of elevated levels of goal disturbances in partners, psychological support for caring relatives in such interventions is recommended.

Introduction

Unlike most cancers, the treatment-related side effects of head and neck (H&N) cancer such as disfigurement, altered speech and inability to swallow are immediately noticeable in social settings (Weymuller and Bhama, 2007). Vital functions can be affected and minor disturbances of anatomy by surgery or chemo/radiation therapy may lead to significant dysfunction and disfigurement, and hence to psychosocial complaints (De Boer et al., 1999). Recent literature suggests that such psychosocial consequences are not only observed in H&N cancer patients themselves. Especially, when the patient's disease is accompanied by social impairments, the impact of the cancer on the partner's life may be profound (Baanders and Heijmans, 2007). Thus research on the psychosocial consequences of H&N cancer should focus on both patients and their partners (Ko et al., 2005).

Although researchers are beginning to find out more about problems encountered by patients with H&N cancer, the different components influencing their psychological well-being still remain poorly understood (Semple et al., 2004). It has been postulated that it might be fruitful to examine adaptation to a stressful event such as cancer from a self-regulatory perspective (Lazarus, 1993, De Ridder and De Wit, 2006). Earlier research in patients with a chronic illness suggests that such a self-regulatory theory is a useful framework for reaching better understanding of patients' psychological adaptation to the illness (Boersma et al., 2006, Van der Veek et al., 2007, Schroevers et al., 2008). In this research we will use such a self-regulation perspective to better understand the experience of psychological distress in H&N cancer patients and their partners.

The definition of self-regulation clearly places goals at the center of the processes. Self-regulation looks upon the individual as an active goal striving agent. People live life by identifying goals and behave in ways aimed at attaining these goals (Carver and Scheier, 1998). Personal goals do not exist in isolation. As discussed in De Ridder and De Wit (2006) they are linked with other goals in a hierarchical structure. Individuals use this structure in order to organize their goals. Mid-order goals are concrete goals that can be achieved within a relative short period. For example, an individual may have a mid-order goal ‘to visit terminal ill patients once a week’. This mid-order goal can be linked to a more abstract higher-order goal ‘to support others in life’. Having a clear vision of these higher-order goals in life is in itself an important predictor of subjective well-being (Emmons, 2003). Confronting unattainable goals may result in a reduced well-being and psychological distress. This may especially be relevant in the context of having a chronic illness, as the illness may lead to obstacles in the attainment of important goals (Stein et al., 1997, Kuijer and De Ridder, 2003). Studies among cardiac patients suggest that the experience of such goal disturbance is indeed related to more emotional distress, not only in patients themselves but also in their partners (Boersma et al., 2006, Joekes, 2004). Little is known about the role of goal disturbance in psychological distress in H&N cancer patients and partners. Therefore, the first aim of this study is to explore which goals are valued and at the same time examine if patients with H&N cancer and their partners experience goal disturbance and whether this is related to perceived psychological distress.

The second goal of the study is to explore the role of two factors that have been related to adaptive self-regulation. First, it has been suggested that adaptive self-regulation in the context of obstructed goals depends on the availability of alternative goals (Wrosch et al., 2003). When goals are unattainable, it seems to be important to be able to find renewed purpose in life elsewhere the, so-called goal re-engagement (Cameron and Leventhal, 2003). Goal re-engagement may buffer the negative emotions associated with the inability to make progress towards a desired goal (Rasmussen et al., 2006). In this study we will examine to which extent goal re-engagement in H&N cancer patients and their partners is related to their perceived psychological distress.

A second factor that seems to play an important role in adaptive self-regulation is self-efficacy. Self-efficacy refers to a person's belief and confidence to perform certain behavior leading to a desired outcome in a particular situation. It has been stated that such a confidence is a prerequisite for actual performance of adaptive self-regulatory strategies (Clark and Dodge, 1999). Self-efficacy has been found to play a central role in psychological well-being in patients with different chronic illnesses (Kuijer and De Ridder, 2003, De Boer et al., 1998). Also among H&N cancer patients with facial disfigurement, self-efficacy appeared to be an important asset in controlling psychological distress (Hagedoorn and Molleman, 2006). In the present study we will focus on two different types of self-efficacy. First, we will examine self-efficacy beliefs regarding adequate self-management of a chronic illness (Lorig et al., 1996). In chronically ill patients, higher levels of this type of self-efficacy were related to patient's perception of better health (Kuijer and De Ridder, 2003). Secondly, we will focus on goal efficacy which refers to the belief that one has the ability to attain personal goals (Joekes, 2004). Research among cardiac patients found that a greater sense of goal self-efficacy was associated with better psychological well-being (Boersma et al., 2006, Joekes, 2004).

In conclusion, the present study explored the goals being important to H&N cancer patients and their partners and whether they experienced disturbances in these goals as a result of the disease. Moreover, we examined the associations of goal disturbance, goal re-engagement, and self-efficacy with levels of psychological distress. We hypothesized that: (1) H&N cancer patients and their partners experience goal disturbance as a result of the disease; (2) Such goal disturbance is related to more psychological distress in H&N cancer patients and their partners; (3) Goal re-engagement and self-efficacy are both negatively related to psychological distress in H&N cancer patients and their partners.

Section snippets

Participants

The sample for this study included twenty adult male patients from which ten were palliative and ten curative cases, and, who either were treated for head and neck cancer or had received their palliative diagnosis in the Erasmus Medical Center Rotterdam, together with their female partners (N = 40 in total). We decided to include only male patients as the majority in the general H&N cancer population are male and because of possible gender differences in perceiving psychological distress and

Sample characteristics

Table 1 summarizes the characteristics of the studied participants.

Descriptives of study variables

See Table 2 for mean scores and standard deviations of the study variables. Using independent-samples t-test, we found no significant differences between patients and partners.

Goal importance and goal disturbance

Table 3 shows mean scores on all 26 higher-order goals, regarding importance and disturbance. A rank order was made for the most important higher-order goals, with the top 5 presented in bold in the column “Importance”. It can be seen that the goals being

Discussion

This study aimed to examine whether a self-regulation approach could lead to a greater insight into factors related to psychological distress in H&N cancer patients and their partners. Results confirmed our hypothesis that H&N cancer patients and their partners experienced goal disturbance. Such disturbances were especially in cancer patients related to more psychological distress. Also consistent with our hypothesis, more reengaging in alternative goals was related to less psychological

Acknowledgements

The authors would like to thank John van de Berg for his contribution to the inclusion of patients and partners.

References (44)

  • K.T. Vakharia et al.

    Quality-of-life impact of participation in a head and neck cancer support group

    Otolaryngology-Head and Neck Surgery

    (2007)
  • P.J. Allison et al.

    Results of a feasibility study for psycho-educational intervention in head and neck cancer

    Psycho-oncology

    (2004)
  • A. Baanders et al.

    The impact of chronic diseases: the partner's perspective

    Family Community Health

    (2007)
  • S.N. Boersma et al.

    Goal processes in relation to goal attainment

    Journal of Health Psychology

    (2006)
  • L.D. Cameron et al.

    The Self-regulation of Health and Illness Behaviour

    (2003)
  • C.S. Carver et al.

    On the Self-regulation of Behavior

    (1998)
  • N.M. Clark et al.

    Exploring self-efficacy as a predictor of disease management

    Health Education & Behavior

    (1999)
  • M.F. De Boer et al.

    Physical and psychosocial correlates of head and neck cancer: a review of the literature

    Otolaryngology Head & Neck Surgery

    (1999)
  • M.F. De Boer et al.

    Psychosocial and physical correlates of survival and recurrence in patients with head and neck carcinoma: results of a 6-year longitudinal study

    Cancer

    (1998)
  • D.T.D. De Ridder et al.

    Self-regulation in health behavior: concepts, theories, and central issues

  • N. Drabe et al.

    Psychiatric morbidity and quality of life in wives of men with long-term head and neck cancer

    Psycho-oncology

    (2008)
  • R.A. Emmons

    The Psychology of Ultimate Concerns: Motivation and Spirituality in Personality

    (2003)
  • A. Field

    Discovering Statistics Using SPSS

    (2005)
  • N.E. Goldstein et al.

    Palliative care for patients with head and neck cancer: “I would like a quick return to a normal lifestyle”

    The Journal of the American Medical Association

    (2008)
  • M. Hagedoorn et al.

    Distress in couples coping with cancer: a meta-analysis and critical review of role and gender effects

    Psychological Bulletin

    (2008)
  • M. Hagedoorn et al.

    Facial disfigurement in patients with head and neck cancer: the role of social self-efficacy

    Health Psychology

    (2006)
  • K. Hirai et al.

    A structural model of the relationships among self-efficacy, psychological adjustment, and physical condition in Japanese advance cancer patients

    Psycho-oncology

    (2002)
  • K. Hodgkinson et al.

    Life after cancer: couples' and partners' psychological adjustment and supportive care needs

    Support Care Cancer

    (2007)
  • G.M. Humphris

    The missing member of the head and neck multidisciplinary team: the psychologis. Why we need them

    Otolaryngology & Head and Neck Surgery

    (2008)
  • K.J. Joekes

    Quality of Life and Self-regulation in Cardiac Patients. A Dyadic Approach

    (2004)
  • R. Katz et al.

    Screening for depression in head and neck cancer

    Psycho-Oncology

    (2004)
  • C.M. Ko et al.

    Problem-solving and distress in prostate cancer patients and their spousal caregivers

    Support Care Cancer

    (2005)
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