The terminal prognosis : differing reactions of cancer patients as factors affecting their pain experience

In an attempt to investigate the relationship of attributional factors accompanying acceptance or nonacceptance of a terminal prognosis to the severity of their pain experience, 50 Black-American women were presented, with a 20-item questionnaire during their postsurgical stay at a large, metropolitan hospital. The 20-item questionnaire was administered twice, once on the day following their receiving a terminal prognosis from the physician and once 10 days later. Variables assessed by the 20-item questionnaire included a measure of acceptance or nonacceptance of the prognosis, attributional characteristics, social distance/accessibility, and severity of the pain experience. Other measures included assessment of physical barriers to social accessibility in hospital rooms, doctors' and nurses' assessments of the severity of the pain experience, and medication dosage records. Responses to items on the questionnaire assessing attributional characteristics, social distance/accessibility, and severity of the pain experience were submitted to a cross-lagged correlational analysis. The results of the analysis suggest, in part, that the attribution of the cause of pain to cancer as opposed to a benign cause was linked causally to the severity of the pain experience to a statistically significant degree (p<.01). Although not reaching statistical significance, the results also indicated a trend for attribution of pain to cancer as opposed to a benign cause to be linked causally to increasing social distance and decreasing social accessibility. A trend was also indicated for increasing social distance to be linked causally to the severity of the pain experience. Results obtained from correlations of physical barriers to social accessibility in patients' rooms, of hospital staff reports of their impressions of the severity of the pain experience, and of medication dosage records served to lend support to the construct validity of the study and to the validity of the self-reports on pain experience. Theoretical explanations offered for the obtained results suggest that the women in the study responded to their terminal prognoses with some form of acceptance or nonacceptance. If they were accepting of their terminal prognosis, they tended to attribute the causal origin of their pain to their disease, cancer. In so doing, they maintained high anxiety levels associated with knowledge of the disease and its consequences. They tended to withdraw, moving toward greater social distance and to evaluate their pain as 'not to be borne' since they were not going to recover anyway. Thus, as a result of the original attribution of the cause of their pain to cancer, a series of phenomena ensued which served to increase, relatively, the severity of their pain experience. If the women were unaccepting of the terminal prognosis, they tended to reattribute the causal origin of their pain to a benign cause and not retain the attribution of their pain to cancer. In so doing, they reevaluated the pain source as less threatening, consequently reducing the anxiety associated with knowledge of the disease and its consequences. They tended to maintain levels of social distance and contact and to evaluate their pain as 'to be borne' since it was only in the service of recovery. Thus, as a result of the original reattribution of the causes of their pain to a benign source, a series of phenomena ensued that served to decrease, relatively, the severity of their pain experience. A possible alternate explanation of the findings of the study suggested that the women first experienced their pain and then attributed its causal origins, to cancer or to a benign source, such as simple indigestion, as a result of assessing their pain as either relatively severe or mild. A cross-lagged analysis of the data served to contradict this alternate explanation. The results of the cross-lagged analysis showed that the women attributed the source of their pain to either cancer or a benign cause and the attribution was a predominate causal link to the severity or lack of severity of their pain experience.Psychology, Department o