RELATIONSHIP OF HEAD AND NECK CANCER PATIENTS\u27 HEALTH BELIEFS, ANXIETY, AND DEPRESSION TO THEIR DECISIONS TO ACCEPT OR REFUSE SURGERY

Head and neck site cancer patients\u27 refusal of surgery was examined as medical nonadherence arising from a decision made under conditions of high emotional stress and conflict. The decision process was hypothesized to be the result of an interaction of antecedent and mediating factors, as described by Janis\u27 and Mann\u27s Conflict Theory Model, and the product of a costs and benefits evaluation. Antecedents include the threats of surgery and illness, history of cancer, trait anxiety, and demographic variables. Mediating factors are conditions such as emotional reaction, and value-weighted beliefs about treatment outcome and illness arising from the evaluation of the threats. Under stress, beliefs may not be objective appraisals of the situation. An integrative model was proposed to explain the relationship of these variables to each other and to surgery decision. Subjects were 32 accepters and 13 refusers of head and neck cancer surgery. Patients were interviewed to obtain self-ratings for beliefs about expected surgery impact on functions, appearance, symptoms, and confidence in the surgery. They were administered measures of situational stress: the State form of the State-Trait Anxiety Inventory and the Zung Self-Rating Depression Scale. A scale was devised to measure patients\u27 attitudes toward physicians and medical science, a hypothesized factor in the belief about treatment outcome. Trait Anxiety Scale, Crowne-Marlowe Social Desirability Scale and the K-scale MMPI items were used to measure antecedent patient characteristics predicted to affect the appraisal of threat. Results only partially supported the proposed model. Patients accepting surgery showed lower state anxiety, higher regard for physicians and medicine, and belief that surgery would yield greater benefits, than those refusing surgery. What was significant was that although selected variables demonstrated impressive predictive capability for surgery decision, the model did not successfully explain the decision. Some findings such as incongruous beliefs and unexpected emotional responses were perplexing and raised questions about effectiveness of the model in explaining behavior under conditions of very high stress. Nevertheless, the study was successful in identifying factors related to surgery decision and to better understand patients\u27 experiences in making a very difficult decision