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.
