| The diagnosis of cancer is considered a stressful and low-control situation, that evokes adaptational responses of the individual. However, the diagnosis of cancer entails other stressful events, such as treatments and their effects. While in many studies, these events together are viewed as contributing to the level of stress experienced by the patient, in the present study the various stressors will be specified, and both their specific impact and their cumulative impact on perceptions of control and psychological well-being will be examined. Perceived control, the beliefs that persons have that they are in control of their own life, is considered to be a key factor to an individual's well-being. In general, strong perceptions of control are related to a better adaptation to stressful circumstances. This has been established irrespective of the actual possibilities to exert control. However, control can change as a result of confrontation with a low-control situation. Indeed, cancer patients react to the diagnosis of cancer with decreased levels of control. Still, there are individual differences: patients can maintain high levels of control, they can adjust their levels of control to lower levels, or they maintain low levels of control. These different patterns can result from various mechanisms/processes (realistic appraisal, illusory control, compensation mechanisms; realistic adjustment, fatalistic adjustment). It is not clear whether the adaptive value of high levels of control holds true for all mechanisms. Systematic research examining prevalence and the adaptive value of these various mechanisms has not been carried out yet. In addition, it has not been examined properly to which extent cognitive and behavioural variables mediate the relation between control and well-being. RESEARCH QUESTIONS (1) Examining the course of psychological well-being, in relation to disease-related events during the disease process; (2) Examining changes in perceived personal control in cancer patients, in relation to disease-related events during the disease process; (3) Identifying mechanisms for maintenance and adjustment of control that are prevalent within cancer patients and exploring the role of the mechanisms in the adaptation to cancer, in terms of psychological well-being; (4) Examining the mediating effects of cognitive and behavioural strategies in the relation between perceptions of control and the adaptation to cancer. PLAN OF INVESTIGATION Newly diagnosed breast cancer patients (N = 140) who are treated curatively will be recruited from various hospitals in the northern part of the Netherlands. They will be followed during their treatment (before and after surgery, after completion of adjuvant treatments) and up to five months after final treatment (two assessment points). At all assessment points, they will fill in self-report questionnaires assessing their perceptions of control, their psychological well-being, their engagement in important social roles and illness perceptions. The aforementioned mechanisms will be identified by constructing control profiles on the basis of general perceptions of control, illusory perceptions of control (i.e. the belief that the course of disease is under one's control) and disease severity (as an indication of controllability of the disease). In addition, patients will be interviewed twice about the processes underlying these control profiles, during the treatment period and after final treatment. Our study will result in more in-depth knowledge about the role of control in the adaptation to cancer, that can be used in designing preventive psychosocial interventions directed towards the maintenance of control perceptions. |
