Date of Degree

9-2020

Document Type

Dissertation

Degree Name

Ph.D.

Program

Psychology

Advisor

Tracey A. Revenson

Committee Members

Joel Erblich

Allison Applebaum

Laura Reigada

Evelyn Behar

Subject Categories

Clinical Psychology | Health Psychology | Psychology

Keywords

advanced cancer, intolerance of uncertainty, experiential avoidance, advanced care planning, social support, trust in physician

Abstract

The social-cognitive processing model of adaption to cancer posits that both intrapersonal and interpersonal factors influence psychological adjustment (Lepore, 2001). In this dissertation, two intrapersonal factors, intolerance of uncertainty (IU) and experiential avoidance (EA), were examined in relation to emotional distress (psychological outcome) and advanced care planning (behavioral outcome) among patients living with advanced cancer. EA (efforts intended to avoid negative emotions, thoughts, images or memories) was hypothesized to mediate the relationship between IU (the ability to tolerate uncertainty or the unknown) and emotional distress. In line with the social-cognitive model, two interpersonal factors, social support from family and friends and patient trust in physician, were proposed to buffer the indirect influence of IU on distress through EA. IU and EA were hypothesized to interact to predict advanced care planning (ACP), such that those higher on IU and EA would engage in less ACP compared to those higher on IU but lower on EA. The sample included 108 adults with Stage III or IV cancer (53% female; Mage = 63 years). All constructs were measured by standardized self-report scales with acceptable to strong internal consistency reliability (i.e., Intolerance of Uncertainty Scale-Short Form; The Brief Experiential Avoidance Questionnaire; The Duke-UNC Functional Social Support Questionnaire; Trust in Physician Scale; Hospital Anxiety and Depression Scale; Advanced Care Planning Checklist). The PROCESS macro for SPSS was used to conduct mediation, moderation, and conditional process analyses. IU evidenced both direct and indirect relationships with anxiety and depressive symptoms. However, the indirect influence of IU through EA was not contingent on social support. Patient trust in physician did moderate the indirect relationship between IU and anxiety (but not depressive symptoms), albeit in an unanticipated direction. Specifically, the indirect relationship between IU and anxiety symptoms (through EA) was significant for those with moderate to high physician trust but not low trust. Moreover, moderation analyses showed that EA did not influence the positive direct association between IU and ACP. Post-hoc multiple regression analysis, including age, emotional distress, interpersonal factors (social support and trust in physician) and intrapersonal factors (IU and EA), demonstrated that only age and EA remained significant predictors of ACP. Accounting for other factors, older participants engaged in more ACP and those who were more experientially avoidant engaged in less ACP. Although this dissertation used a social-cognitive processing model in which intrapersonal and interpersonal factors interact to predict adjustment, the overall findings provide stronger support for the salience of intrapersonal factors in influencing emotional distress and ACP. IU and, in particular, EA are identified as targets for intervention aimed at helping individuals with advanced cancer manage the emotional impact of illness and make end-of-life decisions.

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