SUMMARY OF STUDY HYPOTHESES

The p resen t stu d y assessed adolescent patients and their p a re n ts as th ey experienced the stresses of a cancer diagnosis an d the su b seq u en t treatm en t. Families w ere recruited on initial p resen tatio n to the adolescent u nit and follow ed prospectively for the first year of diagnosis. M ood states, dispositional optim ism , illness perceptions, activity levels, coping strategies, family environm ent, social s u p p o rt an d h ealth locus of control w ere m easured u sin g questionnaires. Below are the stu d y hypotheses;

Anxiety, depressiona n da n g erhypotheses;

• That m others an d d au g h ters w o u ld show greater anxiety an d depression at diagnosis and d u rin g the year th an fathers an d sons.

• That girls w o u ld have h igher levels of state anger th a n boys.

• That state anxiety an d depression w o u ld be correlated th ro u g h o u t the year in all fam ily m em bers.

• That state anger w o u ld be positively related to state anxiety an d depression in adolescent patients, m others an d fathers.

• That anger w o u ld be h igher in those adolescent patien ts w ith extensive disease at diagnosis.

• That adolescent cancer patients w o u ld h ave hig h er levels of anxiety an d depression, at the tim e of diagnosis, co m p ared w ith control adolescents.

• That m others an d fathers w o u ld have h ig h er levels of anxiety a t the tim e of diagnosis th an stan d ard ised norm s.

• That there w o u ld be relationships betw een anxiety in the adolescent patients an d their parents, an d depression in the adolescent p atients an d their parents.

• That the perio d of treatm ent w o u ld influence the adolescent p atien ts' reports of anxiety, depression an d anger w ith increases d u rin g the treatm en t p erio d and decreases by 12 m onths, p ro v id in g tre atm e n t h ad been com pleted.

• That m other's an d father's rep o rts of anxiety an d d epression w o u ld n o t decrease over the year follow ing diagnosis.

• That anger scores w o u ld increase at the tim e of relapse in adolescent patients, m others an d fathers.

Dispositional optimism hypotheses;

• That optim ism scores w o u ld b e negatively correlated w ith anxiety, d epression an d anger in adolescent patients, m others a n d fathers.

Illnessr epresentationhypotheses;

• That there w o u ld be a positive relationship b etw een the n u m b e r of sym ptom s rep o rted , w h eth er d u e to tre atm e n t or disease, an d anxiety, d epression an d anger.

• That optim ism w o u ld be negatively correlated w ith physical sym ptom rep o rtin g b y the adolescent patients.

• That there w o u ld be relationships betw een dim ensions on the IPQ an d som e coping strategies; particularly the d im ension of consequences

and the less ad ap tiv e coping strategies.

• That there w o u ld be differences in illness representations in adolescent patients w h o w ere <14 years an d those > 15 years a t diagnosis.

• That the adolescent patients w ho perceive their sy m p to m s to be

treatm en t related w o u ld have better psychological w ell-being th a n those w ho perceive their sym ptom s to be d u e to their cancer.

• That the relatively naive adolescent p atien t w o u ld change their beliefs about the cause, consequences, tim e line an d cure dim ensions of illness rep resen tatio n over the course of their illness.

Copin g strategieshypotheses;

• That there w o u ld be negative correlations betw een the use of seeking

emotional an d instrum en tal social su p p o rt as coping strategies an d anxiety an d depression in the adolescent p atients a n d their m others and fathers.

• That the use of positive re-interpretation and g row th, active coping, and p la n n in g w o u ld be negatively correlations w ith anxiety an d depression.

• That th e coping strategies of behavioural an d m ental disengagem ent

w o u ld be related to p o o rer psychological w ell being.

• That those w ho did n o t use acceptance as a coping strategy at diagnosis w o u ld use m ore denial and disengagem ent strategies over the year and have p o o rer psychological w ell being.

• That acceptance w o u ld be frequently u sed as a coping strateg y in all fam ily m em bers.

• That the coping strategy of behavioural disengagem ent w o u ld n o t generally be used.

• That optim ism w o u ld be positively correlated w ith acceptance, planning an d h u m o u r as coping strategies.

• That optim ism w o u ld be negatively correlated w ith the coping strategies of avoidance an d behavioural disengagem ent.

Coping and sex;

• That fathers w ill endorse the active coping strategies of planning,

suppression o f com peting activities an d restraint coping m ore th a n m o th ers. • That m others an d adolescent girls w ill use the social s u p p o rt coping

strategies of seeking em otional an d in stru m en ta l su p p o rt m ore frequently th an fathers an d adolescent boys.

• That adolescent boys w ill use the coping strategy of denial m ore th an girls.

• That m others w ill use religion m ore th en fathers in attem p tin g to cope w ith their child's cancer.

• That boys w ill use m ore h um ou r th an girls.

• That anger an d the coping strategy of religion w o u ld be negatively correlated.

Coping and the fam ily;

• That initially differing coping strategies ad o p ted by fam ily m em bers w o u ld becom e m ore sim ilar w ith the disease history.

• That the coping strategies a d o p ted by in d iv id u al fam ily m em bers, p articu larly parents, w o u ld have an im pact on other fam ily m em ber's psychological well-being.

C oping strategies and disease history;

• That the n u m b er of coping strategies initially en d o rsed b y each fam ily m em ber w o u ld decrease over the 12 m o n th stu d y p erio d w ith the exception of acceptance.

• That there m ay be differences in psychological w ell-being an d the coping strategies ad o p ted by the adolescent p atients d ep e n d in g on w h eth er or n o t they are receiving treatm ent.

• That it m ay be possible to identify coping strategies a d o p te d w h en an adolescent p atien t experiences a cancer relapse.

C oping and demographic variables;

• That low er incom e families w o u ld ad o p t m ental and behavioural

Family en v ir o n m en t hypotheses;

• T hat the ad o p tio n o f fo ste rin g fa m ily integration an d m ain tain in g of

self-stability (CHIP) by p aren ts w o u ld result in low er anxiety an d depression scores in the adolescent patients.

• T hat there w o u ld be a relationship b etw een the cohesive scale of the FAME an d use of the coping strategies of seeking social su p p o rt for

in stru m en ta l an d em otional reasons, as w ell as the rep o rted num b er

an d satisfaction scores on the social su p p o rt questionnaire.

• T hat there w o u ld b e a negative relationship betw een state an g er an d

conflict resolution in the adolescent patients an d their parents. • T hat anger scores w o u ld be negatively related to the cohesion an d

conflict resolution scales of the FAME questionnaire.

Socialsupporthypotheses;

• That m others an d d a u g h ters w o u ld rep o rt h igher scores for of n u m ber

an d satisfaction w ith social su p p o rt th an fathers an d sons.

• That num ber and satisfaction w ith social su p p o rt w o u ld be negatively related to anxiety an d depression in all fam ily m em bers.

Healthlocusofcontrolhypotheses;

• T hat the internal dim ension of the HLOC scale w o u ld be related to age in the adolescent patients an d control adolescents.

• That the adolescent p atien ts' internal an d external dim ensions w o u ld change over the year w ith experience of illness.

• T hat adolescent patients w ith hig h external scores (chance or po w erfu l others) w o u ld have better psychological w ell-being th a n those w h o have low external scores.

• T hat there w o u ld be no relationship betw een adolescent p atien ts and p a re n ts' HLOC dim ensions.

CH A PTER 3: M ETH O D

This prospective, long itu d in al questionnaire stu d y w as desig n ed to assess the psychological im pact of a diagnosis of cancer on adolescent p atien ts an d their fam ily d u rin g th e y ear after diagnosis. The s tu d y w as c o n d u c te d o n th e A d o lescen t C ancer U n it at th e M iddlesex H o sp ital. E thical a p p ro v a l w as given b y the M iddlesex H o sp ital's Ethical Review C om m ittee. N ew referrals to th e u n it w ere suitable for the stu d y p ro v id in g th ey fulfilled th e follow ing criteria:

A dolescent p atien t aged b etw een 12 an d 19 years inclusive Recent diagnosis of cancer, preferably w ith in 1 m o n th N o significant previous illness e.g.: cancer, cystic fibrosis A dequate com m and of spoken an d w ritte n English A vailability for follow -up

Absence of k n o w n pre-existing psychopathology e.g.: depression, anxiety

Able to give inform ed consent

A p ilo t stu d y w as co n d u cted to ascertain th e acceptability of psychological research an d the feasibility of the stu d y to the adolescent cancer patients, their fam ilies, an d to staff on the A dolescent Cancer Unit.