ADJUSTMENT TO LIFE-THREATENING ILLNESSES & TREATMENTS

本提案的长期目标是探讨如何 人们在认知和情感上适应了威胁生命的 疾病及其治疗;检查患者如何调整 当他们选择接受危及生命的治疗时， 最终失败的疾病;并绘制如何多次失败， 治疗努力影响患者的心理调整 患有危及生命的疾病 该提案详细介绍了一套 对乳腺癌患者的纵向访谈研究， 肾移植患者和晚期癌症患者。 的 第一项针对乳腺癌患者的研究， 加州最近的一项法令规定， 提供有关手术选择的详细信息。 我们 访谈研究将评估这种被迫的选择是否会对 不想参与这一进程的妇女，如果愿意， 用什么方法多久 我们还将研究如何乳房 癌症患者适应成功或失败的治疗结果， 这取决于他们是否想要并获得 在治疗决策过程中发挥积极作用。 一 数百名新诊断的I期和II期乳腺癌患者将 他们的愿望是积极参与他们的活动。 手术的选择，他们的看法， 积极参与他们的手术选择， 一旦确定了是否需要对疾病进行调整， 癌症是否缓解 在第二项研究中， 移植患者，我们将研究患者对 移植成功与失败的结果作为一个函数， 他们在决策过程中的感知选择。 在 第三项针对II期癌症患者的研究，我们检查了 多次失败的控制努力，通过比较患者， 接受过一两次癌症治疗， 反复发作。 研究四是纵向对应研究 三，并遵循第二阶段癌症患者通过几个 不成功的治疗 研究的最终目的是 建立一个理论模型，分析对不成功努力的反应 通过系统地整合来自 认知失调理论，习得性无助理论， 反应理论和认知适应。 此外该 理解选择和参与决策的影响- 使这些研究将提供将有影响， 如何以及何时让患者积极参与治疗决策 和知情同意程序，特别是在 其中治疗可能失败。

The long-term objectives of this proposal are to explore how people adapt cognitively and emotionally to life-threatening illnesses and their treatments; to examine how patients adjust when they choose to undergo a treatment for life-threatening disease that ultimately fails; and to chart how multiply-failed treatment efforts effect the psychological adjustment of patients suffering from life-threatening disease. The proposal details a set of longitudinal interview studies with breast cancer patients, renal transplantation patients, and advanced cancer patients. The first study, with breast cancer patients, arises in response to California's recent mandate that diagnosed breast cancer patients be given detailed information concerning surgical options. Our interview study will assess if this enforced choice is stressful for women who do not want to be involved in the process, and if so, in what ways and for how long. We will also examine how breast cancer patients adjust to successful or failed treatment outcomes, depending upon whether or not they wanted and obtained an active role in the treatment decision-making process. One hundred newly-diagnosed Stage I and II breast cancer patients will be assessed for: their desire to participate actively in their surgical choice, their perceptions as to whether or not they participated actively in their surgical choice, and their adjustment to illness once it has been determined whether the cancer is in remission or not. In a second study involving renal transplantation patients, we will examine how patients react to successful versus failed outcomes of the transplant as a function of their perceived choice in the decision-making process. In the third study with Stage II cancer patients, we examine reactions to multiple failed efforts at control by comparing patients who have undergone either one or two cancer treatments and sustained recurrences. Study Four is the longitudinal counterpart to Study Three and follows Stage II cancer patients through several unsuccessful treatments. The ultimate goal of the research is to develop a theoretical model of reactions to unsuccessful efforts at control by integrating systematically predictions from cognitive dissonance theory, learned helplessness theory, reactance theory, and cognitive adaptation. In addition, the understanding of the effects of choice and participatory decision- making that these studies will provide will have implications for how and when to involve patient actively in treatment decisions and for informed consent procedures, especially in circumstances in which treatment failure is likely.