Investigating the relationships between stress, coping, benefit-finding and Quality of Life in Colorectal Cancer Survivors: A longitudinal study.

The primary aim of this thesis was to conduct a longitudinal study, to investigate the quality of life (QOL) in a large sample of people diagnosed with colorectal cancer (CRC), immediately post-diagnosis and one-year later. Various measures were utilised to capture the multifaceted concept of QOL, including psychological distress, satisfaction with life, positive affect and cancer-related quality of life. The investigation was conducted within Lazarus and Folkman’s stress and coping framework. Specifically, this research aimed to test the utility of the stress and coping framework in the context of CRC, and to explore the role of benefit-finding within the context of the stress and coping model components. One thousand, eight hundred participants (1078 men and 722 women) with a CRC diagnosis duration of 1 to 12 months, completed a telephone interview and written questionnaire, assessing demographics, disease/treatment characteristics, threat appraisal, social support, optimism, coping, benefit-finding and quality of life domains, at approximately five- and 12-months post-diagnosis. To identify CRC-specific coping strategies, the Coping with Colorectal Cancer measure was developed in the initial study. The eight factor structure was confirmed, and the subscales (Positive Perceptual Change; Religion/Spirituality; Rumination; Acceptance; Humour; Palliative; Seeking Social Support; and Lifestyle Reorganisation) found to have reliability and preliminary criterion-related validity within the context of the stress and coping framework. As predicted, regression analyses showed that, after controlling for demographics, disease/treatment characteristics and stress/coping variables, the coping subscales uniquely predicted Time 1 QOL outcomes, with Seeking Social Support continuing to predict Time 2 Positive Affect. In the second study, the benefit-finding domains specific to those with CRC were identified, and relationships with quality of life outcomes assessed, to determine the inclusion of benefit-finding in the path model. Based on completed data from 1757 of the initial 1800 participants, confirmatory factor analyses revealed three domains of benefit-finding: Personal Growth; Interpersonal Growth and Acceptance. As hypothesised, regressions analyses found that benefit-finding domains at Time 1 was associated with Time 1 QOL outcomes, specifically, Positive Affect and Cancer-related Quality of Life (both the aggregate score and its Social/Family, Functional and Colorectal Cancer-specific Well-being subscales). Time 1 Personal Growth also predicted Time 1 Psychological Distress. After controlling for Time 1 Positive Affect, Personal Growth continued to predict Time 2 Positive Affect. The final study drew on the results of the first two studies, which informed the coping strategies and benefit-finding domains to be included in regression analyses initially, and then, structural equation modelling. The final study included 1276 complete data sets of the initial 1800 participants. Parameters of the initial hypothesised model of the stress and coping framework, including relationships with benefit-finding (based on empirical findings) failed to fit the model to the data. After several revisions, the analysis revealed that the final model fit the data, where stress, coping and benefit-finding accounted for 63% of the variance in Time 1 QOL. The model showed that threat appraisal, coping resources, avoidant coping and benefit-finding directly impacted on Time 1 QOL, while threat appraisal, social support and approach coping directly impacted on benefit-finding. In this study, the approach coping strategies included in the path model could also be conceptualised as meaning-based coping strategies, as they appeared to facilitate a meaning-making process. However, benefit-finding, which some researchers have suggested is also a meaning-based coping strategy, had differential relationships with stress, coping and outcome variables, compared with the approach coping strategies. These results indicate that benefit-finding is an empirically distinct construct in the context of CRC. Finally, in this study, the impact of stress, coping and benefit-finding on Time 2 QOL, was indirect, being mediated by Time 1 QOL outcomes. The accumulated findings of these three studies have extended the cancer coping and benefit-finding research by revealing new relations between stress, coping and benefit-finding and QOL in a mixed-gender, older population with CRC. There are implications for measurement of, and theory building around benefit-finding. Finally, these studies inform the development of clinical interventions to enhance the quality of life in the short- and longer-term for individuals diagnosed with CRC