Attribution theorists have argued for thirty years that causal attributions occur following important life events and that the causes given and predictive of adjustment to those events. Theoretically, nurses caring for cancer patients might expect that patients would think about the cause of their illness and that adjustment might be compromised in patients who have not done so. Nurses might also conclude that interventions to encourage causal search and the development of particular attributions would be helpful to patients. Empirical evidence provides a different perspective on attributions and adjustment. Several studies of attributions in ill patients indicate that some patients do not think about """"""""Why me?"""""""" or the cause of their illness. The only study to examine the relationship of causal search to adjustment, found that those who reported a causal search had more affective problems and were less optimistic about their future than those who had not, regardless of the length of the illness. Some studies with cancer and other patients have shown no relationship between particular attributions and adjustment. Other theorists have argued that when events are highly uncontrollable, beliefs that others are in control may be more adaptive for some people. Research with late-stage cancer patients suggests that feelings of personal control enhance adjustment to cancer, but other research with varying stage breast cancer patients suggests that feelings of others being in control are adaptive. Thus, causal thinking, particular attributions, or feelings of control following the diagnosis of breast cancer may not be adaptive and nursing interventions to influence these cognitions may not be appropriate. The purpose of the proposed research is to examine, prospectively over one year the causal thinking and perceptions of control and their relationship to adjustment of 354 newly diagnosed breast cancer patients. Data will be gathered through self-report, ratings of the interviewer, particular causes, and perceived control will be analyses of variance. Techniques for analysis of the adjustment scores across time will include repeated measures analysis of variance. Chi square techniques will be used to analyze the prevalence of causal thinking and the specific causes across time.
