Coping in children with cancer: Examining the goodness of fit hypothesis

Abstract

Seventy-six children and adolescents diagnosed with cancer participated in a study examining coping and appraisals of control as predictors of psychological distress. Appraisals of control and coping strategies were assessed in response to five stressful events; one non-cancer related event and four cancer related events in the areas of school, friendships, family and medical treatment. The cognitive-phenomenological model of stress and coping provided the theoretical framework. The role of family environment in predicting coping was also examined. Participants were administered a semi-structured coping interview assessing stressful events, coping strategies used in response to the events, and perceived control over the event. Coping items were classified as either emotion-focused or problem-focused. Symptoms of depression and anxiety were assessed using age-appropriate measures. The child's parent completed the Child Behavior Checklist and the Family Adaptability and Cohesion Evaluation Scale. Problem focused coping was expected to be used most often in situations perceived as controllable, while emotion focused coping was expected to be used in situations perceived as uncontrollable. The goodness of fit of the match between appraisals of control and coping was expected to predict psychological distress. Subjects who matched their coping and appraisals of control were expected to have low levels of psychological distress, while those who mismatched coping and control were expected to have high levels of distress. Family environment was also hypothesized to influence coping. Specifically, family cohesion and adaptability were expected to predict match between coping and perceived control. Match between problem focused coping and appraisals of control were found for four of the five stressors. Match between emotion focused coping and control were found for three of the stressors for the younger cohort (ages 8--13), and two of the stressors for the older cohort (ages 14--18). Mismatch predicted psychological distress for hospital and family stressors and their interaction and was associated with distress for school problems. Family environment did not significantly predict match between coping and perceived control.