Monitoring versus blunting styles of coping with cancer influence the information patients want and need about their disease. Implications for cancer screening and management

Abstract

Background. Two main psychologic coping styles for dealing with cancer and other health threats have been identified: monitoring (attending to) or blunting (avoiding) potentially threatening information. This article reviews results and implications from this research relevant to cancer screening and management. Methods. The Monitor‐Blunter Style Scale has been used extensively to assess and categorize patients with regard to these coping styles to predict their differential responses to various cancer‐related screening and management regimens. Results. Patients characterized by a monitoring coping style generally are more concerned and distressed about their cancer risk, experience greater treatment side effects, are more knowledgeable about their medical situation, and are less satisfied with and more demanding about the psychosocial aspects of their care. They also prefer a more passive role in clinical decision making, are more adherent to medical recommendations, and manifest greater psychologic morbidity in response to cancer‐related threats. Conclusions. Patients fare better (psychologically, behaviorally, and physiologically) when the information they receive about their medical condition is tailored to their own coping styles: generally those with a monitoring style tend to do better when given more information, and those with a blunting style do better with less information. However, patients with a monitoring style who are pessimistic about their future or who face long term, intensely threatening, and uncontrollable medical situations may require not just more information, but also, more emotional support to help them deal with their disease. Cancer 1995; 76:167–77.

Monitoring coping style moderates emotional reactions to genetic testing for hereditary nonpolyposis colorectal cancer: a longitudinal study

“…Congruent with previous studies [36,43], we found that high monitors were generally more distressed than low monitors. Monitoring was unrelated to depressive symptoms, adding to previous findings associating monitoring with anxiety but not with depression [45,57].…”

“…Similar monitoring  test result interactions were obtained among women undergoing trans-vaginal ultrasound: high monitors responded only to an abnormal test result with elevated distress [58]. These findings are also consistent with predictions of the Monitoring Process Model [36,45], whereby high monitors' distress is activated only when threatened with an aversive event and is not present when stress is low or absent. This results from their tendency to perceive personal risks as higher; to experience more intrusive ideation; and to encode threats as catastrophic [34,37,41,43,44,59,60].…”

“…When faced with a health threat, high monitors are more likely to report heightened distress than are individuals who tend to distract themselves in the face of such information [13,[34][35][36][37][38]. High monitors may be especially likely to opt for predictive genetic testing for cancer because of their threat-related vigilance and information-seeking style [39][40][41][42].…”

QUOTE-geneca: development of a counselee-centered instrument to measure needs and preferences in genetic counseling for hereditary cancer

“…Specifically, a preference for being involved in decisions and considering it important to be listened to carefully, does not imply a desire for taking over control over the process of counseling. As Miller (1995) argued, high monitors may be more inclined 'to yield control over to another, more competent individual' (p. 171). Similarly, Beisecker and Beisecker (1990) suggested, based on their study in 106 rehabilitation medicine patients on their information-seeking behaviors in communicating with doctors, that wanting to be more knowledgeable about one's medical care, does not in effect mean desiring to become more responsible for medical care decisions.…”

The Supply of Information in an Emotional Setting

“…That is, more effort is needed to pass on information to a monitor, who is an information-seeking person, than to a blunter, who is information averse. This is a reasonable assumption based on the literature which points out that information-loving patients are not only more demanding (Miller 1995) but also more 'difficult' than information averse ones (Miksanek 2008).…”