Cognitive representations of breast cancer, emotional distress and preventive health behaviour: a theoretical perspective

Individuals at high risk for developing breast and/or ovarian cancer are faced with difficult decisions regarding genetic testing, cancer prevention and/or intensive surveillance. Large interindividual differences exist in the uptake of these health‐related services. This paper is aimed at understanding and predicting how people emotionally and behaviourally react to information concerning genetic predisposition to breast/ovarian cancer. For this purpose, the self‐regulation model of illness representations is elaborated. This model suggests that health‐related behaviour is influenced by a person's cognitive and emotional representation of the health threat. These representations generate coping behaviour aimed at resolving the objective health problems (problem‐focussed coping) and at reducing the emotional distress induced by the health threat (emotion‐focussed coping). Based on theoretical considerations and empirical studies, four interrelated attributes of the cognitive illness representation of hereditary breast/ovarian cancer are described: causal beliefs concerning the disease, perceived severity, perceived susceptibility to the disease and perceived controllability. The paper also addresses the complex interactions between these cognitive attributes, emotional distress and preventive health behaviour. Copyright © 2000 John Wiley & Sons, Ltd.

[1]  G. Evers‐Kiebooms,et al.  The psychological complexity of predictive testing for late onset neurogenetic diseases and hereditary cancers: implications for multidisciplinary counselling and for genetic education. , 2000, Social science & medicine.

[2]  A. Clarke,et al.  Why do women attend familial breast cancer clinics? , 2000, Journal of medical genetics.

[3]  K. Demyttenaere,et al.  Predictive testing for hereditary breast and ovarian cancer: a psychological framework for pre-test counselling , 2000, European Journal of Human Genetics.

[4]  T. Marteau,et al.  Impact of genetic testing on causal models of heart disease and arthritis: An analogue study , 2000, Psychology & health.

[5]  J. Allanson,et al.  Psychological and social determinants of women's decisions to undergo genetic counseling and testing for breast cancer , 1999, Clinical genetics.

[6]  A. Cull,et al.  The impact of genetic counselling about breast cancer risk on women's risk perceptions and levels of distress , 1999, British Journal of Cancer.

[7]  Michael J. Watson,et al.  The impact of genetic counselling on risk perception and mental health in women with a family history of breast cancer , 1999, British Journal of Cancer.

[8]  M. Richards.  Genetic counselling for those with a family history of breast or ovarian cancer--current practice and ethical issues. , 1999, Acta oncologica.

[9]  J. Emery,et al.  Patient Understanding of Genetic Principles and Their Expectations of Genetic Services within the NHS: A Qualitative Study , 1998, Public Health Genomics.

[10]  Y. Bignon,et al.  Cancer genetic clinics: why do women who already have cancer attend? , 1998, European journal of cancer.

[11]  B. Biesecker,et al.  Genetic counseling and hereditary cancer , 1997 .

[12]  M. Schwartz,et al.  The influence of psychological distress on use of genetic testing for cancer risk , 1997 .

[13]  S. Shiloh,et al.  Correlates of health screening utilization: The roles of health beliefs and self-regulation motivation , 1997 .

[14]  M. Richards,et al.  Understanding Life's Lottery , 1997, Journal of health psychology.

[15]  M. Richards,et al.  Lay understanding of genetics: a test of a hypothesis. , 1996, Journal of medical genetics.

[16]  D. Easton,et al.  Psychosocial impact of testing (by linkage) for the BRCA1 breast cancer gene: An investigation of two families in the research setting , 1996 .

[17]  R. Eeles,et al.  Familial breast cancer: a controlled study of risk perception, psychological morbidity and health beliefs in women attending for genetic counselling. , 1996, British Journal of Cancer.

[18]  K. Mccaul,et al.  Does Concern About Breast Cancer Inhibit or Promote Breast Cancer Screening , 1996 .

[19]  B. Rimer,et al.  Participation in a women's breast cancer risk counseling trial: Who participates? Who declines? , 1996, Cancer.

[20]  M. Richards,et al.  Family history and perceived vulnerability to some common diseases: a study of young people and their parents. , 1996, Journal of medical genetics.

[21]  S. Michie,et al.  Understanding responses to predictive genetic testing: A grounded theory approach , 1996 .

[22]  M. Richards.  The troubled helix: Families, kinship and genetics , 1996 .

[23]  B. Rimer,et al.  Effects of individualized breast cancer risk counseling: a randomized trial. , 1995, Journal of the National Cancer Institute.

[24]  G. Evers‐Kiebooms,et al.  A stigmatizing effect of the carrier status for cystic fibrosis? , 1994, Clinical genetics.

[25]  A. Howell,et al.  The impact of genetic counselling on risk perception in women with a family history of breast cancer. , 1994, British Journal of Cancer.

[26]  M. Daly,et al.  Attitudes about genetic testing for breast-ovarian cancer susceptibility. , 1994, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[27]  S. West,et al.  Health beliefs and compliance with mammography-screening recommendations in asymptomatic women. , 1994, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[28]  R. Croyle,et al.  Psychological minimization of cholesterol test results: moderators of appraisal in college students and community residents. , 1993, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[29]  P. Engstrom,et al.  Mammography adherence and psychological distress among women at risk for breast cancer. , 1993, Journal of the National Cancer Institute.

[30]  D. Terry,et al.  Appraised controllability as a moderator of the effectiveness of different coping strategies: A test of the goodness of fit hypothesis , 1992 .

[31]  Albert Bandura,et al.  Exercise of personal agency through the self-efficacy mechanism. , 1992 .

[32]  J. Holland,et al.  Psychological distress and surveillance behaviors of women with a family history of breast cancer. , 1992, Journal of the National Cancer Institute.

[33]  V. Champion,et al.  The relationship of selected variables to breast cancer detection behaviors in women 35 and older. , 1991, Oncology nursing forum.

[34]  B. Trock,et al.  Psychological side effects of breast cancer screening. , 1991, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[35]  B. Trock,et al.  Factors associated with repeat adherence to breast cancer screening. , 1990, Preventive medicine.

[36]  G. Smith,et al.  Inheriting heart trouble: the relevance of common-sense ideas to preventive measures , 1989 .

[37]  S Kessler,et al.  Social system responses to Huntington disease. , 1989, Family process.

[38]  Shelley E. Taylor,et al.  Illusion and well-being: a social psychological perspective on mental health. , 1988, Psychological bulletin.

[39]  J. Harvey,et al.  Attributions and adjustment to life-threatening illness. , 1988, The British journal of clinical psychology.

[40]  Howard Leventhal,et al.  Behavioral theories and the problem of compliance , 1987 .

[41]  R. W. Rogers,et al.  Effects of components of protection-motivation theory on adaptive and maladaptive coping with a health threat. , 1987, Journal of personality and social psychology.

[42]  J. V. Wood,et al.  Attributions, beliefs about control, and adjustment to breast cancer. , 1984, Journal of personality and social psychology.

[43]  K. Wallston,et al.  Locus of Control and Health: A Review of the Literature , 1978, Health education monographs.

[44]  Daniel Kahneman,et al.  Availability: A heuristic for judging frequency and probability , 1973 .