Assessing stress response and adjustment in people with cancer
Adjustment is a complex process by which people are able to respond to the stresses that accompany the experience of cancer and its treatment in ways that enable them to avoid or recover from clinical levels of psychological distress. Related processes have been conceptualised in ways that have highlighted a range of cognitive, affective and social components (see Brennan [2001] 1 for a review and the Social-Cognitive Transition model of adjustment). Given this multiplicity of perspectives, it will come as no surprise that self-report tools designed to assess adjustment-related constructs vary substantially in their choice of foci. In the absence of a gold standard against which their performance can be compared, instruments of this type will typically undergo an ongoing process of construct validation aimed at exploring their strengths and limitations. The following are three very different questionnaires that have been widely used in cancer research.
Impact of Event Scale (IES) 2
This 15-item scale is based on a two-factor intrusion-avoidance model of reactions to stressful life events. Participants rate the frequency of intrusive and avoidant thoughts using a 4-point frequency scale. The scale has since been revised 3 to consist of 22 items that more comprehensively address the diagnostic criteria for post traumatic stress disorder (PTSD) which became a diagnosis after publication of the initial questionnaire. Unlike the other instruments profiled here, the IES has been validated in a sample of Australian cancer patients.4 Both versions of the IES ask participants to report their experience over the past 7 days.
The PAIS (interviewer administered) PAIS-SR (self-report) are 46-item instruments that assess psychosocial adjustment to illness across 7 domains: Health Care Orientation, Vocational Environment, Domestic Environment, Sexual Relationships, Extended Family Relationships, Social Environment, and Psychological Distress. Data contributing to the validity of the PAIS-SR have been published in relation to samples with lung cancer,
5 Hodgkins Disease,
6 breast cancer,
7 and mixed cancer diagnoses.
8 There is also a caregiver version available. Participants are asked to recall their experience over the past 30 days or, if currently an inpatient, the 30 days prior to their admission.
The MAC is a 40-item questionnaire that assesses patients’ adaptation to cancer across five dimensions: Fighting Spirit, Helplessness/Hopelessness, Anxious Preoccupation, Fatalism, and Denial (Avoidance). The Mini-MAC 10 is a validated, 29-item short-form version of the MAC. Patients are asked to report on their status at the present time.
Sharpe L, Curran L. Understanding the process of adjustment to illness. Soc Sci Med. 2006 Mar;62(5):1153-66.
References
1. Brennan J. Adjustment to cancer - coping or personal transition? Psycho-Oncology. Jan-Feb 2001;10(1):1-18.
2. Horowitz MJ, Wilner N, Alvarez W. Impact of Event Scale: A measure of subjective stress. Psychosomatic Medicine Vol 41(3) May 1979, 209-218. 1979.
3. Weiss D, Marmar C. The Impact of Event Scale -Revised. In: Wilson J, Keane T, eds. Assessing psychological trauma and PTSD. New York: Guildford; 1997.
4. Thewes B, Meiser B, Hickie IB. Psychometric properties of the Impact of Event Scale amongst women at increased risk for hereditary breast cancer. Psycho-Oncology Vol 10(6) Nov-Dec 2001, 459-468. 2001.
5. Derogatis LR. The psychosocial adjustment to illness scale (PAIS). Journal of Psychosomatic Research. 1986;30(1):77-91.
6. Morrow GR, Chiarello RJ, Derogatis LR. A new scale for assessing patients' psychosocial adjustment to medical illness. Psychological Medicine. Nov 1978;8(4):605-610.
7. McLachlan SA, Devins GM, Goodwin PJ. Factor analysis of the psychosocial items of the EORTC QLQ-C30 in metastatic breast cancer patients participating in a psychosocial intervention study. Quality of Life Research. Jun 1999;8(4):311-317.
8. Browne GB, Byrne C, Roberts J, et al. The meaning of illness questionnaire: reliability and validity. Nursing Research. Nov-Dec 1988;37(6):368-373.
9. Watson M, Greer S, Young J, Inayat Q, et al. Development of a questionnaire measure of adjustment to cancer: The MAC scale. Psychological Medicine Vol 18(1) Feb 1988, 203-209. 1988.
10. Watson M, Law M, dos Santos M, Greer S, et al. The Mini-MAC: Further development of the Mental Adjustment to Cancer scale. Journal of Psychosocial Oncology Vol 12(3) 1994, 33-46. 1994.
NOTE: When citing information or advice obtained from PoCoG's Quality of Life Office Frequently Asked Questions, please use the following citation:
Psycho-oncology Co-operative Research Group (PoCoG) (2008). Quality of Life Office (online resource).
Last updated: 16th May, 2008
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