Causal Attribution in a Cancer Diagnosis

Sunday, November 1, 2009

Yasemin E. Turkman, RN, MPH
School of Nursing, Yale University, New Haven, CT

Learning Objective 1: list 3 frequent causal attributions that cancer patients report.

Learning Objective 2: describe the common causal attributions in the top most prevalent cancer diagnoses (e.g. prostate, colon, and breast).

Significance:  Cognitive representations of illness may influence the ways in which cancer patients respond to the disease and treatment (Stewart, 2001; Lowery, 1993). Research in this field has further indicated that patients with dissimilar types of cancer may attribute their illnesses differently as a result of varied cognitive frameworks (Salander, 2007; Stewart, 2001; Taylor, 1984).Understanding more about attribution in cancer and developing appropriate interventions could lead to enhanced patient quality of life and improved health outcomes.
Purpose:  The aim of this work is to better understand causal attribution in a cancer diagnosis so that responsive interventions can be developed to improve quality of life and increase treatment adherence.
Methods:  This research is an analysis of secondary data originally gathered by the American Cancer Society (ACS) in 2007. A supplement was inserted into the ACS survey for Connecticut residents to ascertain whether there may be an association between the ways cancer survivors understand the cause of their diagnosis and other factors such as quality of life. The insert asked two questions on causal attribution: “Have you ever thought ‘Why me?’” “Why do you think you got your cancer?”
Results:  Preliminary analysis of the responses (n=855) to these questions indicates that there are particular attributional themes that arise with more frequency than others. “Heredity,” “smoking,” “hormonal therapies,” “chance,” “stress,” “diet,” and “environmental toxins” were typical replies with “not knowing” being the most common answer (n=237). Moreover, participants often provided multiple responses.
Conclusions:  The research contributes to our understanding of attributional factors that affect health behaviors and quality of life in cancer survivors. Information on causal attribution is valuable in assessing a patient’s ability to cope with cancer. This research forms a basis upon which interventions can be developed to facilitate adjustment to disease and treatment leading to better health outcomes.