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Influence of Personal and Contextual Factors and Cognitive Appraisal on Quality of Life Over Time in Persons Newly Diagnosed with Cancer

Tuesday, 23 July 2013: 3:50 PM

Theresa A. Kessler, PhD, RN, ACNS-BC, CNE
College of Nursing, Valparaiso University, Valparaiso, IN

Learning Objective 1: The learner will be able to describe how cognitive appraisals and quality of life change over time following a new diagnosis of cancer.

Learning Objective 2: The learner will be able to describe how personal, contextual factors, and cognitive appraisals explain quality of life over time in persons diagnosed with cancer.

Purpose: As cancer treatment has become more successful, measurement of outcomes focusing on quantity, such as disease free survival, mortality, and cancer relapse rates, are insufficient. It is important to understand how individuals newly diagnosed with cancer perceive their experience and manage the day to day effects of treatment over time. The purpose of this study was to assess personal and contextual factors and cognitive appraisals and their impact on quality of life over time for individuals facing a new diagnosis of cancer.

Methods: Using a longitudinal design, 120 individuals were recruited from 3 oncology offices. Data were collected at 3 points: initial diagnosis, 4 months and 12 months following diagnosis. Based on the Transactional model of stress and coping, constructs were measured by a researcher developed instrument to assess personal and contextual factors, the Cognitive Appraisal of Health Scale, and the Quality of Life Index.

Results: The subjects (n = 84) ranged in age from 23 – 78 (M = 62, SD = 13.2).  The majority were female (71%), married (79%), and retired 43%.  The top 3 cancer diagnoses were: 39% breast, 18% lung, and 11% colon. 43% received chemotherapy as their initial treatment. The 7 independent variables of age, number of symptoms, time since diagnosis, cognitive appraisals of threat, challenge, harm/loss, and benign irrelevant explained 86% (F=64.77, p<.001) of the variance in quality of life scores at initial diagnosis, 79% (F=17.08, p<.001) of the variance at 4 months, and 90% (F=35.79, p<.001) of the variance at 12 months. 

Conclusion: The findings provide theoretical support for the impact personal and contextual factors and cognitive appraisals have on quality of life following a diagnosis of cancer. An improved understanding of the cancer experience enhances the health care community’s ability to support survivors and prevent adverse outcomes.

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