This suggests a preference for personal control over health None of these studies, however, reported a significant finding for 'personal control', although differences were

reported on items making up this subscale (e.g., Furnham & Kirkcaldy, 1 996). It is

possible, however, that the provider control scores reflected a scepticism of conventional

medicine rather than a disclosure about control.

It would

also

appear that the Lau and Ware (1981) measure, like the MHLC scale, comprises a restrictive pre-determined conceptualisation of external control. Provider control and chance health outcomes do not permit of the broader conceptualisation of externality to incorporate concepts such as spiritually that the present study proposes. Also like the MHLC, it is arguable that the scale is more suitable for those who are healthy or have an acute rather than a chronic illness because of the inclusion of items

that relate to

the

potential for

illness.

The distinction between control over treatment outcomes and control in the context of treatment decisions, as identified by Degner and Russsell ( 1 988), is

also

not made in the Lau and Ware ( 1 98 1 ) approach to control. The above mentioned studies that have utilised that

meas

ure may, therefore, have assessed an aspect of control that is focused on outcome control rather than tapping a more generic conceptualisation of control relevant in the decision

making

phase.

The Degner and Russell ( 1 988) approach

also

has limitations. While it accounts for control in the treatment decision-making context, it is essentially a consumerist

approach. In that sense it is

also

not tapping a generic concept of the attribution of control

and

responsibility.

The consumerist approach has, however, identified an important

practical finding from locus of control studies. The conclusion from a number of studies (e.g., Vertinksky, Thompson

&

Uyeno, 1 974; Cassileth et al., 1 980; Haug

&

Lavin, 1 98 1 ; Degner

&

Russell, 1 988) has been that many people, including cancer patients, prefer to share decision making among themselves, family, and

health

professionals. This suggests that in terms of this particular health behaviour, conceptualising locus of control as a dichotomy comprising internal and external styles as mutually exclusive, which tends to

be the basis of a number of locus of control scales, may be inappropriate. As Furnham

and

Beard ( 1 995) suggested, people can be a mixture of

the

two.

There has been some research that has approached the investigation of the role of control in treatment choice decisions outside the MHLC type of framework. Yates et al. (1993), for example, simply used two items to examine cancer patients' attitudes to having control over the decisions made about their cancer and its treatment. The items were: 'I leave it up to my doctor to decide what is best for my cancer' and 'I need to have

control over the decisions made about the treatment for my cancer'. The authors acknowledged the potential lack of reliability of a two-item scale but did report a

Kendall's Tau B correlation of -.3 1 for the two items. One of

the

stated aims of Yates et al. ' s. ( 1 993) study was to determine the beliefs and attitudes of those who chose to use non-conventional medicine in the treatment of their cancer. Since the intention was not to offer an explanation, it is perhaps understandable that no theorising of the role of control was offered. Nevertheless, the study found that those who report a strong desire for control are about six times more likely to use non-conventional treatments for their cancer than those reporting a moderate or weak desire for control.

Subject to the question ofthe reliability of a two-item scale, the finding is reasonably straight-forward and conclusive. Arguably, however, a stated desire for control over treatment decisions may be a somewhat different concept to the attributions of control, responsibility and blame construct as explored in the present study. The former may be a simplistic consumerist approach compared to the latter, which explores the cognitive structures and processes underlying the attribution of control and

responsibility .

Astin ( 1 998) also investigated the need for personal control in the context of the decision to

use

non-conventional medicine.

The

participants in the large sample (1 035) were suffering from a range of illnesses. The study found that although there was a trend towards the

use

of non-conventional medicine among those who wished to retain control,

this variable was not a significant predictor of non-conventional use. It was found,

however, that among those who chose to rely primarily on non-conventional medicine (which was

4.4% of the sample, n =

45) there was a desire to keep control in their own hands.

In the present study a questionnaire developed by Stainton Rogers ( 1 99 1 ) was utilised specifically to avoid some of the limitations inherent in existing locus of control scales, and to accommodate the attributional theoretical basis ofthe control construct. There appears to be two reported studies that have employed the Stainton Rogers ( 1 991)

measure in a treatment choice context. These are

Fumham

( 1 994) and

Furnham

and Beard ( 1 995).

Furnham

( 1 994) found, among a sample of 338 users of non -conventional medicine, that the more they believed in non-conventional medicine, the more they believed in controllable and internal causes of health, illness and recovery. Similarly, belief in non-conventional medicine was negatively correlated with external health

beliefs.

Furnham and

Beard ( 1 995) reported that non-conventional treatment users place emphasis on positive attitudes and general happiness as factors influencing future health and believe more strongly that state of mind and emotions have an important role in heahh and illness in terms of current state of health. Previous models tended not to distinguish between attributions for current and future state ofheahh and effectiveness of recovery in the way the Stainton Rogers ( 1 99 1 ) approach does. They were, therefore, less sensitive or less finely grained in their assessment of internal and external control

attnbutions.

Furnham

and Beard (1995) also found, however, that non-conventional users believed more strongly than conventional users that environmental factors, which are at least partly controlled by external forces, have a role in future health. This demonstrates another of the criticisms

Furnham

( 1 994) and

Furnharn

and Beard ( 1 995) have of health locus of control scales. That is, that people's explanations for health and illness are not based solely on either internal or external attributions but may be a mixture of the two.

Meaning

Researchers who have been interested in the role of meaning in heahh behaviour have tended to explore either illness meaning or meaning in life. In the present study both were investigated. In the previous chapter

the

theoretical basis of the meaning construct was addressed in terms of both its philosophical base and its proposed relationship with treatment choice decisions and the other constructs of interest in the present study_ In the

present chapter research that

has

addressed the role of meaning, as conceptualised in this

In document Cognitive determinants of treatment choice among cancer patients : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Psychology at Massey University (Page 117-121)