Monitoring style of coping with cancer related threats: a review of the literature

Abstract

Building on the Cognitive-Social Health Information-Processing model, this paper provides a theoretically guided review of monitoring (i.e., attend to and amplify) cancer-related threats. Specifically, the goals of the review are to examine whether individuals high on monitoring are characterized by specific cognitive, affective, and behavioral responses to cancer-related health threats than individuals low on monitoring and the implications of these cognitive-affective responses for patient-centered outcomes, including patient-physician communication, decision-making and the development of interventions to promote adherence and adjustment. A total of 74 reports were found, based on 63 studies, 13 of which were intervention studies. The results suggest that although individuals high on monitoring are more knowledgeable about health threats, they are less satisfied with the information provided. Further, they tend to be characterized by greater perceived risk, more negative beliefs, and greater value of health-related information and experience more negative affective outcomes. Finally, individuals high on monitoring tend to be more demanding of the health providers in terms of desire for more information and emotional support, are more assertive during decision-making discussions, and subsequently experience more decisional regret. Psychoeducational interventions improve outcomes when the level and type of information provided is consistent with the individual's monitoring style and the demands of the specific health threat. Implications for patient-centered outcomes, in terms of tailoring of interventions, patient-provider communication, and decision-making, are discussed.

Predictors of adherence to follow-up recommendations after an abnormal Pap smear among underserved inner-city women

“…This finding is consistent with previous research on dispositional monitoring indicating that an abnormal Pap smear test result has a greater negative impact on patients with a high monitoring style compared to individuals with a low monitoring style [25]. When faced with a chronic and intense stressor, such as an unresolved cervical abnormality for 6 months, high monitors appear to experience prolonged elevated threat, distress [21,23], and uncertainty [40]. Although this study only used baseline assessment, results in other health contexts [41] suggest that chronically elevated risk perceptions and emotional distress among high monitors can prevent women from engaging in their goal to adhere to 6-month follow-up recommendations.…”

“…Emotionally, because high monitors perceive themselves to be at greater personal risk for disease, they exhibit greater levels of intrusive risk related distress and use avoidant coping style, especially when the risk is more intense or prolonged [21]. Under conditions of low threat, such as routine screening (e.g., adherence to Pap screening), high monitors’ attentiveness to threat promotes adherence [21,23]. However, when the threat level rises, such as when an abnormality is detected after a Pap smear and uncertainty is raised, high monitors become overly anxious and preoccupied with threat [23–26].…”

“…Under conditions of low threat, such as routine screening (e.g., adherence to Pap screening), high monitors’ attentiveness to threat promotes adherence [21,23]. However, when the threat level rises, such as when an abnormality is detected after a Pap smear and uncertainty is raised, high monitors become overly anxious and preoccupied with threat [23–26]. This preoccupation, in turn, may undermine sustained adherence to follow-up over time [27], in an effort to manage and reduce distress.…”

“…We also examine the role of distress in a more exploratory fashion given the inconsistencies in the literature [7,18,22]. In addition, since past research demonstrates high monitors ultimately experience greater concerns, more prolonged distress, and greater sensitivity to and side effects from diagnostic regimens, they tend to increasingly avoid cues that trigger such effects, i.e., dealing with abnormal Pap smear test results [23,25,27,34]. Hence, we hypothesize high monitors have poorer adherence over long-term follow-up compared to low monitors.…”

Effects of a randomized trial comparing standard and enhanced counseling for men at high risk of prostate cancer as a function of race and monitoring style

“…For example, Miller et al (2001) showed that first-degree relatives of PCa patients are characterized by a distinctive psychological profile, notably a high perceived risk and the belief that the disease is not preventable. The model also identifies the extent to which individuals attend to and amplify ambiguous, potentially threatening health information (high monitoring), or the degree to which they distract from and attenuate potentially threatening cues (low monitoring) (Miller, 1995; Roussi and Miller, 2014). Because high monitors tend to focus on threat, they tend to seek more information, they are typically more knowledgeable, they tend to hold negative beliefs regarding the nature of the threat, and they experience more distress.…”