Goal processes & self-efficacy related to psychological distress in head & neck cancer patients and their partners
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)
- et al.
Quality-of-life impact of participation in a head and neck cancer support group
Otolaryngology-Head and Neck Surgery
(2007) - et al.
Results of a feasibility study for psycho-educational intervention in head and neck cancer
Psycho-oncology
(2004) - et al.
The impact of chronic diseases: the partner's perspective
Family Community Health
(2007) - et al.
Goal processes in relation to goal attainment
Journal of Health Psychology
(2006) - et al.
The Self-regulation of Health and Illness Behaviour
(2003) - et al.
On the Self-regulation of Behavior
(1998) - et al.
Exploring self-efficacy as a predictor of disease management
Health Education & Behavior
(1999) - et al.
Physical and psychosocial correlates of head and neck cancer: a review of the literature
Otolaryngology Head & Neck Surgery
(1999) - 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) - et al.
Self-regulation in health behavior: concepts, theories, and central issues