Adjustment to a brain tumour diagnosis: A mixed methods investigation

A primary brain tumour diagnosis is known to elicit higher distress compared to other forms of cancer, and is related to high depressive symptomatology. It poses unique challenges in the process of psychosocial adjustment, with social networks and roles often being disrupted. Despite emerging evidence regarding the importance of social support in maintaining well-being when living with a chronic condition, literature on adjustment to living with a brain tumour rarely focuses on social relationships. The current mixed methods project was therefore designed to address an overarching research question: How do people cope with a brain tumour diagnosis in the context of their social relationships? The aim of the first study was to examine the associations between insecure attachment dimensions and coping strategies, with a proposed mediating role of perceived availability of social support. In this cross-sectional study, participants diagnosed with primary brain tumours (N = 480) were recruited online. Multiple regression analyses revealed significant positive associations between both attachment anxiety and avoidance and helplessness/hopelessness. Attachment anxiety was found to be significantly related to anxious preoccupation, while attachment avoidance was associated with fighting spirit and fatalism. Mediation analyses indicated that perceived social support mediated the relationships between both attachment dimensions and helplessness/hopelessness and fatalism. The findings indicate that individuals higher on insecure attachment dimensions seem to respond with a more maladaptive coping repertoire when adjusting to a diagnosis. The second study sought to gain an in-depth understanding of the lived experience of being diagnosed with a brain tumour, with a focus on exploring participants’ understandings of the meaning of social support. Twelve individuals took part in semi-structured interviews, which were analysed using Interpretative Phenomenological Analysis framework. Five inter-related themes were identified: (1) Making sense of the diagnosis, (2) Working it out in the family, (3) Giving and receiving support, (4) Feeling appreciative, and (5) Negotiating a new normal. The results emphasise that the diagnosis does not affect only the individual but a whole network of closest relationships, often with a price or negotiation that needs to take place within these relationships. Collectively, the results of the project highlight that coping is never an individual task. Both studies were integrated and interpreted jointly through narrative and joint display methods. Overall, the project portrays a complex interplay between family dynamics and individual coping and concludes by proposing that coping is deeply socially embedded. Implications of the findings are discussed. Keywords: Coping, adjustment, brain tumour, adult attachment, social support, mixed method