PL3242: Health Psychology - Critique Paper

Critique of Position Paper D on Cancer

Critique by Tan Jia Xin Jacinth, Group 1

Question addressed:

The question addressed was “What would be the key features of a program for helping Singapore cancer patients deal with their diagnosis?”

Critique of paper:

The current paper examined has primarily explored a number of factors that affect how cancer patients cope with their disease, upon which the key features suggested for the cancer program was based. Factors that influence patients’ adjustment to cancer such as age, pre-surgical adjustment, having a choice of treatment and availability of social support were raised.

Apart from identifying these factors, a major strength of the paper would be that due consideration was given to the fact that individual differences among cancer patients exist and appropriate attempts were made by the author at developing a flexible program that could cater to different types of patients. Age and personality variation within patients were looked into in particular which brought about feasible coping methods such as distraction strategies for younger patients during treatment and having experts such as health psychologists to guide patients through their unique cancer experiences. Promoting active coping among cancer patients was also accurately highlighted as an essential element in the program, since substantial research findings has largely supported such coping as self efficacious which predicts better adaptation to the illness (Arraras et al, 2002).

The author has also demonstrated the understanding that cancer diagnosis has extended impact on the family members of patients as well, which can in turn affect the patients directly when they seek social support. Hence, a suggestion was made at extending the cancer coping program to the family members, which seems valid. On the whole, the paper illustrated an important and salient theme that psychosocial interventions, on top of physiological treatment, are indispensable in coping with cancer.

Nevertheless, while a multitude of ideas were presented as possible features that could be included in the cancer coping program, there were a number of points raised, which seem to be problematic and inadequate in addressing how exactly those methods aid in coping. Certain coping strategies that were recommended also appeared to be limited in bringing about the desired effect in the cancer patients.

Firstly, the author made a claim that a child with cancer will “definitely need more counseling and social support as compared to an older person since it is unexpected and evokes a sense of being robbed of life at an early stage.” While I would concur that the perception of a child and an adult regarding their cancer diagnosis would differ, it does not necessarily follow that a child would need more help and support than an adult. In comparing a child who is highly optimistic and adaptive to his condition to an adult with strong feelings of helplessness to his illness, it is more likely for the adult to require more support and guidance in coping since his lack of self efficacy is associated with poorer adjustment to cancer (Arraras et al, 2002).

In this sense, the issue at hand where age differences are concerned should be the nature of approach, rather than the quantity of help to be provided. For instance, a meta-analysis conducted by Aldridge & Roesch (2006) indicated that the use of avoidant and emotion focused coping strategy instead of problem focused ones were actually associated with better adjustment for children to their illness, which is contrary to the typical strategy that adults are recommended to use. This provides a case against varying the amount of help given as a means of dealing with age differences in cancer coping.

Secondly, the author highlighted the stage at which cancer is detected as an important feature that should be addressed in the program. Although it was rightly pointed out that different stages of detection would affect the perception and appraisal of their prognosis, the author appeared to be making use of this relationship as a justification for promoting early cancer detection per se, as opposed to how it aids coping with the illness. However, in my opinion, having knowledge of the stage of cancer should be applied to directing doctors, patients and caregivers to the appropriate measures associated with differences in needs arising from early or late detection, rather than to underscore risk communication. Therefore, the suggestion of establishing screening centers and having campaigns to bring about the public’s risk awareness to cancer seems irrelevant to the cancer coping program.

It was also mentioned in the paper that having informational support about the illness is crucial to helping cancer patients develop active coping with their condition. As such, the author indicated that patients should “actively ask many questions” to gain a better understanding of their illness which would guide subsequent decisions that they would have to make regarding treatment issues. Nevertheless, the author seemed to have made the implicit assumption that all patients are in that proper state of mind and have the capacity to “actively ask many questions”, which is ironic to the agreement that patients vary in how they perceive their illness according to their personality. It would be unlikely for a patient with Type C personality to want to know more about their condition and do something about it. Hence, the cancer coping program should include having health professionals to guide patients towards seeking informational support and highlight to them its importance instead of simply pointing out that they should actively seeking information.

The author proposed an interesting method known as the modeling technique which involves upward comparisons where patients learn from other cancer patients who are coping better than them, or downward comparison where patients come to know about patients who do not cope as well as them which could aid in building their self esteem. While developing self esteem could help patients become more self-efficacious in dealing with their condition, the sustainability of such self esteem by means of downward comparison is questionable. Upward comparison appears more sustainable in that when patients are inspired by those who are coping well with their illness, they could be motivated to learn from them and model their strategy. On the other hand, the self esteem built from downward comparison stems from the fact that others are worse off than them but does not equip them with any coping methods that they could employ on themselves. As such, although downward comparison may seem plausible, its effects may not be as sustainable as that of upward comparison.

Lastly, there was an emphasis on provision of social support in the program for coping with cancer as seen from the wealth of methods that were suggested, relating to increasing social support. They include the media and community support groups to promote their availability in providing social support to the cancer patients, as well as interacting with other cancer patients and family members. Indeed, social support has been found to predict longer survival and better adjustment to cancer (Maunsell et al, 1995; cited in Henderson & Baum, 2002). However, not all studies have demonstrated this similar relationship. Some studies have revealed that disease type and severity of the illness as possible moderators that may affect the relationship between social support and cancer adjustment (Henderson & Baum, 2002). For instance, for people diagnosed with a terminal stage of cancer, social support may not result in better adjustment for it may seem pointless to adjust well when they know they are going to die.

In addition, the effectiveness of social support also depends on the personality of the individual. People with high on traits of anger, cynicism and hostility could be more irritable, sensitive and as a result, often misinterpret the concern of family members as something negative. Therefore, while social support appears to be a good buffer of stress for cancer patients, the effectiveness is not always expressed.

In sum, the author has recognized and highlighted the importance of psychosocial interventions on top of the usual physiological treatments, instead of regarding them as dichotomous, in developing a program to help cancer patients cope with their conditions. Furthermore, numerous factors that influence cancer adjustment and appropriate coping strategies were proposed in an attempt to tailor to a flexible program that takes into account individual differences and needs. Nonetheless, the author should look into some of the suggestions made which were not clearly explained in terms of how it aids coping, as well as have in mind the limitations of some of the apparently effective features that can be included in the program.


References

Aldridge, A.A & Roesch, Scott C. (2006). Coping and adjustment in children with cancer: a meta-analytic study. Journal of Behavioural Medicine. 30(2): 115-129

Arraras, J.I., Wright, S.J., Jusue, G., Tejedor, M. & Calvo, J.I. (2002). Coping style, locus of control, psychological distress and pain-related behaviours in cancer and other diseases. Psychology, Health & Medicine. 7(2): 181-187

Henderson, B.N. & Baum A. (2002). Neoplasms. Handbook of clinical health psychology: Volume 1. Medical disorders and behavioral applications. (pp. 37-64).