Illness representations and psychological wellbeing in adults with cancer

Background: Research has shown that the emotional impact of cancer can be more difficult to cope with than practical or physical demands and a diagnosis can have significant short- and long-term psychological sequalae including depression, anxiety, difficulties in adjustment and coping and associated poor quality of life (Vachon, 2006). The common-sense model of illness representations has been widely cited as a useful theoretical framework to explain how individuals with chronic illnesses such as cancer think about and respond to their condition (Leventhal & Nerenz, 1985). Aims: Two systematic reviews were conducted to identify studies that had measured the prospective relationship between illness representations and the psychological health of cancer patients (Review 1) and to identify studies that had developed interventions to modify the illness perceptions of cancer patients to improve their psychological health (Review 2). Methods: Using best practice guidelines for systematic reviews (Centre for Reviews and Dissemination, 2009) two independent systematic reviews were conducted. Results: Review 1 identified seven studies that had measured the prospective relationship between illness perceptions and psychological health outcomes in cancer patients. The majority of these studies found that patients with the most negative illness perceptions had the poorest psychological health in the future. Review 2 identified thirteen studies that had developed interventions to either directly target illness perceptions or had hypothesised that other types of intervention would indirectly change patient’s cancer related illness perceptions. Findings revealed some interventions were more effective than others in improving the psychological health of cancer patients, largely depending on their design and content. Discussion: Illness perceptions were overall predictive of several psychological health outcomes in cancer patients although there was a lack of methodological consistency in the measurement of illness perceptions making synthesis challenging. Interventions were more likely to be effective if they did not specifically target illness perceptions and if they were comprised multiple ‘active’ components including increased access to social support, homework based activity, group discussion, skills based training and improving the expression of emotions. Relaxation training appeared to be a significant component useful in facilitating psychological improvements in this patient group. Conclusions: Future research would benefit from further exploration of the process of change in such complex interventions in order determine which ingredients or indeed combination of ingredients are necessary for interventions to be effective in improving psychological health.