Abstract |
Ιllness perceptions determine the way individuals react to their illness. Patients’
psychological adjustment to their illness includes: 1) illness representation, 2) coping,
3) appraisal. These stages are mutually affected and are dynamically inter-related
through time.
According to the common sense model, representations consist of 5 dimensions: 1)
illness identity, 2) causes, 3) time-line, 4) consequences and 5)
controllability/curability.
Carer’s ways of reaction to their patient’s illness and their behavior towards them is
affected by the ideas they shape about the illness of their relatives. The degree of
congruence between carers’ and patients’ representations has been so far, studied in
patients suffering from myocardial infarction.
Undoubtedly, cancer patients suffer from depression due to the possibility of a painful
death.
Individuals form different illness perceptions for different illnesses, although illness
perception components are the same. There is also a different point of view for
different kind of illnesses between patients. At this point, the present study contributes
with important information on the structure of cancer patients’ undergoing
chemotherapy representations
Moreover, the present study contributes to the knowledge regarding the degree of
congruence between cancer patients’ and their main caregivers’ illness perceptions,
mainly because this fact has not yet been studied in the field of cancer, although it has
been studied on myocardial infarction patients.
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The present study aims to: 1) assess cancer patients’ illness perceptions and the
psychometric properties of the Greek translation of the Revised Illness Perceptions
Questionnaire (IPQ-R) 2) assess the levels of depression in cancer patients and their
main caregivers, 3) assess the relationship between illness perceptions and depression
both in patients and caregivers, 4) assess the degree of congruence of illness
perceptions between cancer patients and caregivers, 5) assess the affect of the degree
of congruence in illness perceptions on both patients’ and caregivers’ depression and
finally, 6) assess possible changes of illness perceptions within a period of three
months after the first assessment.
Hypotheses:
Hypothesis 1: The structure of cancer patients’ illness perceptions are similar to the
structure of illness perceptions in patients suffering from other chronic conditions,
with a difference in the structure of causal attributions. However, the structure of
causal attributions are similar to the causal attribution theory. The assessment of the
psychometric properties of the Greek translation of the Revised Illness Perception
Questionnaire provides satisfactory results.
Hypothesis 2: Participants score high in depression scales.
Hypothesis 3: Illness perceptions components are related to depression levels both in
patients and caregivers.
Hypothesis 4: Patients’ illness perceptions components differ significantly from
caregivers’ illness perceptions components.
Hypothesis 5: The degree of congruence between patients’ and caregivers’ illness
perceptions is related to the levels of depression and is a predictive factor for
depression.
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Hypothesis 6: There are significant changes in illness perceptions components three
months following the first assessment.
METHOD
A total of 252 cancer patients of the University Hospital of Heraklion and 176 main
caregivers took part in the study.
A Greek translation of the Revised Illness Perception Questionnaire (IPQ-R), which
psychometric properties are assessed as part of the study, was handed out to the
participants in order to assess their illness perceptions. Moreover, the standardized in
Greek version of the Beck Depression Inventory (B.D.I.) was also handed out to the
participants in order to assess their levels of depression. Demographic and medical
information was also gathered from patients’ medical file.
RESULTS
Hypothesis 1: Cancer patients’ illness perceptions reveal a similar structure to the one
suggested by the common sense model, with the only difference being that
consequences and emotional representations loaded to the same factor, providing a
model of six, instead of seven factors of the original questionnaire. As far as causal
representations are concerned, our hypothesis was confirmed, since their structure was
different, however in accordance with causal attribution theory. Moreover, the
psychometric properties of the scale provided satisfactory results and suggest that it is
safe to use for the purposes of the specific study.
Hypothesis 2: High levels of depression were found for the participants, since 55% of
the patients and 44% of the caregivers scored high on the depression scale.
Hypothesis 3: Correlations between patients’ illness perceptions components and
levels of depression were significant for all the dimensions, except for the dimension
of external causal attributions. Caregivers’ levels of depression were related
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significantly with consequences and emotional representations, acute/chronic timeline
and illness identity.
Hypothesis 4: Patients and caregivers differ significantly only in the dimension of
consequences and emotional representations, with caregivers scoring higher.
Hypothesis 5: A percentage between 22% and 36% of the patient-caregiver dyads had
congruent beliefs about the illness. Personal control was the only dimension which
incongruence between patients and caregivers was significantly related to patients’
levels of depression. Also, treatment control was the dimension which incongruence
was significantly related to caregivers’ levels of depression. With only those two
significant correlations, it was not a surprise that none of the illness perceptions
incongruences was found to be a predictive factor for participants’ depression.
Hypothesis 6: Three months after the first assessment, and as far as patients are
concerned, the only difference was found in the dimension of acute/chronic timeline
with patients forming the belief that their illness is more chronic after the three month
period. As far as caregivers are concerned, the only difference was found in the illness
coherence dimension with caregivers scoring higher in the second assessment. Fewer
dimensions were found to be significantly related to the levels of depression than in
the first assessment. Significantly different beliefs between patients and caregivers
were found in the dimension illness coherence, in contrast to the first assessment,
where differences were significant only on the dimension consequences and
emotional representations. Congruent illness beliefs were found on a percentage
between 27% and 41% of the patients-caregivers dyads.
CONCLUSIONS
Translation of the IPQ-R has good reliability and similar structure to that of the
original. The need for more specific standardization of the scale for cancer patients
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has been revealed, as the authors have suggested. Participants showed high levels of
depression, significantly correlated to their illness perceptions. The degree of
congruence of personal control was related to patients’ levels of depression and the
degree of congruence of treatment control was related to caregivers’ levels of
depression. A percentage between 22% and 36% of the patient-caregivers dyads,
depending on the illness perceptions components, had divergent perceptions.
Common sense model plays an important role for a more integrated assessment of the
cancer patient and his caregiver.
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