The experience of cancer challenges the body and the mind. A solid body of evidence has amassed on what help breast cancer patients cope with adversities. In the field of positive psychology, the concepts of hope and optimism further our understanding of the role future expectancies play in goal-directed pursuits and in psychological adjustment to adverse events. 　　Snyder’s theory of hope (2002) conceptualizes that goal directed behaviours have two components -- pathways and agency thinking. Pathways thinking is associated with finding the routes to achieve a desired goal. Agency thinking provides the mental energy to initiate and persist in pursuing goals. Hope is consistently linked with better outcomes in academics, athletic, health care and community settings (Snyder et al., 2005). 　　The literature on optimism (Scheier & Carver, 1985) describes the characteristics of optimists and pessimists. Optimists hold positive future expectancies with positive emotions keeping individuals actively engaged in their goals despite frustrations. Pessimists are more inclined to use avoidant coping in response to the negative emotions engendered in their negative expectancies. 　　In the present project, hope and optimism are investigated in a group of breast cancer patients who are recently diagnosed with recurrent, advanced or metastatic disease in Hong Kong. To the best of the author’s knowledge, no other studies have investigated future expectancies in advanced breast cancer patients in a longitudinal design. Findings suggested that agency hope and optimism together account for 27 - 29% of the variation in concurrent distress; and 52 - 54% of the distress three months later. Optimism was an independent predictor of concurrent and three-month psychological distress. However agency hope was not an independent predictor. The results of the present study are compared with a published study (Ho, et al., 2011) of hope and optimism in a group of oral cavity cancer survivors, who did not have an active disease. In both the advanced breast and oral cavity cancer patient groups, hope and optimism together predicted distress. But optimism was a stronger predictor relative to agency hope in the advanced breast cancer patients whose disease outcome was less certain. 　　The present study also attempts to decipher the cognitive processes postulated to be mediators in the relationship between future expectancies and psychological adjustment. In the advanced breast cancer group, attention to negative information mediated the relationship between optimism and concurrent anxiety and depression. In the oral cavity cancer survivors, negative cancer-related rumination mediated in the relationship between agency hope and depression, and in the relationship between optimism and anxiety and depression. The implications of the findings are discussed in light of the possible different cognitive processes of patients who are faced with two different disease conditions. / published_or_final_version / Clinical Psychology / Doctoral / Doctor of Psychology

Breast cancer patients consistently reported psychosocial adjustment difficulty in their sense of femininity after breast removal surgery. In view of this, the present study aimed to explore the effects of three femininity-related concepts on emotional reactions towards breast removal surgery – femininity schema, femininity loss appraisals, and femininity contingency of self-worth. 212 women without breast cancer history participated in this study. They completed a questionnaire which included a hypothetical scenario of breast removal. Results showed that women who considered the breast of a high relative importance in femininity schema, and depended their self-worth highly on sense of femininity, reported greater increase in negative emotions after hypothetical breast removal. This effect was mediated by femininity loss appraisals. Implications and future directions were discussed. / published_or_final_version / Clinical Psychology / Master / Master of Social Sciences

Substantial studies have investigated homogeneity of psychological distress level among cancer patients by using cross-sectional and longitudinal study design. Nonetheless, as proposed by Bonnano (2004), heterogeneity characteristics of psychological distress following stressful event could not be neglected and he further suggested that the majority of individuals were resilient in response to stressful events. To test this postulation, recent studies employed growth mixture modelling method to examine the heterogeneity characteristics of psychological distress trajectory among cancer patients. Furthermore, identifying relevant factors differentiate the psychological distress trajectories is an integral part for developing effective interventions for cancer patients in dealing with illness demands. However, only a few studies have examined these issues among Chinese colorectal cancer patients, a second most common cancer in Hong Kong. Therefore, it is of important need to address this knowledge gap. This study had two major aims: 1) to explore the patterns of psychological distress among Chinese patients with colorectal cancer from shortly after diagnosis but before surgery (i.e. 1-day prior operation) to 1-year post-surgery and to testify Bonnano’s theory on resilience; 2) to identify the effects of cancer-related intrusive thoughts, physical symptom intrusiveness and dispositional optimism on differentiating psychological distress trajectories. A total of 246 Chinese patients with colorectal cancer were recruited for the current study. Altogether, 5 consecutive face-to-face interviews were conducted on one day prior to surgery (baseline), 1-, 4-, 8- and 12-month post-surgery (T2-T5). Patients’ psychological distress (i.e. anxiety and depression), physical symptom intrusiveness, cancer-related intrusive thoughts, dispositional optimism, demographic and medical information were assessed by a standardised questionnaire with valid and reliable psychometric instruments. Growth mixture modelling was used to estimate and specify the psychological distress trajectories. Multinomial logistic regression was adopted to assess the proposed factors in relation to differentiate the trajectory patterns. Growth mixture modelling suggested three distinct trajectories were identified for both anxiety and depression model. The majority of patients with colorectal cancer were identified as resilient (i.e. maintaining low and stable distress level across time) for both models (anxiety: 82.3%, depression: 82.7%). Additionally, for anxiety trajectory model, the remaining 12.3% and 5.4% of patients were classified as moderately-low anxiety group (i.e. maintaining moderate to low distress level) and increasing anxiety group (i.e. increased from moderate level of distress at initial to subsequently high distress level) respectively. For depression trajectory model, the remaining 12.6% and 4.7% of the patients were grouped as delayed depression (i.e. delayed level of distress over time) and recovery depression (i.e. recovered from high distress level to low across time). Multinomial logistic regression showed that cancer-related negative intrusive thoughts, physical symptom intrusiveness and dispositional optimism were significant factors to differentiate anxiety and depression trajectories respectively. This study highlighted the heterogeneous feature of psychological distress among Chinese patients with colorectal cancer. Physical symptom intrusiveness, cancer-related negative intrusive thoughts and dispositional optimism played important role on predicting cancer patient’s psychological distress respectively. Nonetheless, further investigations are much needed to clarify the underlying mechanism. / published_or_final_version / Public Health / Master / Master of Philosophy

This study examined changes in adult learning, adaptation, and anxiety that occurred as the result of the adult cancer education program "I Can Cope." The study utilized a repeated measures descriptive design. A volunteer sample of 19 subjects participated in this study. Changes in each person's pre-mid-post-test scores were measured against their pre-mid-post-test scores on three instruments: (a) Course Inquiry Test; (b) Purpose in Life Test; and (c) A-State Anxiety Inventory. A comparison of scores measured whether any short-term adult learning, adaptation and change in anxiety occurred as a result of the "I Can Cope" Program. The study did demonstrate that an organized adult patient education program could foster and enhance adult learning and adaptation as well as influence anxiety of participants.

published_or_final_version / Clinical Psychology / Master / Master of Social Sciences

Patients’ perception of being a burden to others, termed self-perceived burden (SPB), is a phenomenon commonly reported by terminally-ill patients. SPB elicits psychological outcomes such as loss of dignity, hopelessness, anxiety, and depression (Wilson et al., 2005). To extend our knowledge on this understudied construct, this project employed a multi-method approach with three studies to examine the experience of SPB among Chinese cancer patients. Study 1 is the first longitudinal investigation on the relationship between SPB and non-terminal cancer patients’ trajectories of psychological adjustment. Results from hierarchical linear modeling showed that patients with higher levels of SPB reported higher levels of depression and anxiety, as well as lower levels of mental health over time. Results also revealed that SPB predicted cancer patients’ pattern of change in anxiety over time. As the high SPB group had a higher anxiety level at baseline, their anxiety level remained higher than that of the low SPB group despite a sharper decrease. Study 2 is the first quantitative study to scrutinize the psychological process of how cancer patients attempted to cope with SPB. A new Self-perceived Burden Coping Scale was developed. Our findings indicated that the scale displayed good content, construct, and discriminant validities, and most subscales show acceptable reliability. Results from principal components analysis showed that cancer patients adopted six coping modes in an attempt to deal with SPB: (a) positive outlook, (b) managing the needs of others, (c) resigned acceptance, (d) making preparations, (e) entitlement, and (f) concealing need. Specially, the coping modes of resigned acceptance and concealing need were related to poorer adjustment, whereas managing the needs of others and entitlement were related to better adjustment. Stress-buffering effects of managing the needs of others and making preparations were also found. Finally, Study 3 adopted a qualitative paradigm to explore perception as care-receivers, aspects of SPB, and coping with SPB among Chinese non-terminal cancer patients. Narratives from patients revealed four perspectives regarding to their perception as care-receivers: self-reliance, acceptance, overwhelming, and SPB. Results revealed that the SPB experience among Chinese non-terminal cancer patients was similar to those observed in Western terminal cancer patients, with a new aspect of financial burden. In addition to the six coping modes of SPB found in Study 2, a potential new coping mode of being compliant with others was found, which may be unique among Chinese cancer patients in the context of SPB. Findings from these studies may advance our knowledge on SPB, provide insights for future research, as well as shed lights on the development of counseling services, psychological interventions, and public policies for cancer patients. / published_or_final_version / Psychology / Doctoral / Doctor of Philosophy

published_or_final_version / Clinical Psychology / Doctoral / Doctor of Psychology

published_or_final_version / Clinical Psychology / Master / Master of Social Sciences

Cancer, the most common cause of death in Hong King, poses marked psychological impacts through treatment into cancer survivorship. Literature indicated that internal health locus of control was associated with better psychosocial adjustment (Wang et al., 2013). Meanwhile, fatalistic view was related to avoidant coping and poor psychological adjustment (Chan, 2000). However, fatalism might have a different meaning for the Chinese (Ho et al., 2003). The present study examined the relationship of health locus of control, fate Control and subjective well-being among Chinese cancer patients. Ninety-nine cancer patients were assessed with Multidimensional Health Locus of Control Scale, Fate Control Scale from Social Axiom Survey and Functional Assessment of Cancer Therapy Scale-General during active treatment (Time 1) and with WHO-5 Well-Being Index at a six-month follow-up (Time 2). At Time 1, results indicated positive correlation between powerful others health locus of control and functional well-being. At Time 2, internal health locus of control was positively correlated with WHO-5 while social well-being at Time 1 was positively correlated with WHO-5. Implication of findings and limitations of study were discussed. / published_or_final_version / Clinical Psychology / Master / Master of Social Sciences

The purpose of this study was to understand the meaning of transformation in surviving terminal cancer. An existential-phenomenological approach was used to interview five participants who had lived at least five years beyond the diagnosis of widely metastatic or terminal cancer. Review of the literature which addressed the issue of transformation suggested that life-threatening illness is an opportunity for growth. There are many cross-cultural accounts of transformation, and many studies of survivorship qualities, but little research into the transformation process as it is experienced by cancer survivors. Participants told the story of their recovery from cancer and how it changed their lives. Cochran's (1986) dramaturgical approach provided the model for capturing the meaning of this experience in story form. Each interview lasted from 2½to 5 hours. Interviews were audio-recorded and transcribed. Analysis of the interviews followed Colaizzi's (1978) method. Significant statements were extracted from the protocols, themes were formulated, and a description of the experience was written. Other sources of data were used in addition to interviews. An autobiography and a series of articles were collected from two participants. This written material was analyzed in the same way as the interviews. The experience of the researcher also served as data, and was analyzed through reflective and descriptive methods. Conducting interviews, soliciting written descriptions and including the researcher's experience allowed the data to be more broadly supported. Results of the study were validated by the participants in a second interview. They confirmed that the 38 themes and the common pattern of transformation derived from the five participants accurately reflected their own experience. The results indicated that psychological transformation in survivors of terminal cancer is a spiritual journey. In allowing a life-threatening disease to become an opportunity for personal awareness and growth, people can transform their illness into a spiritual teaching. Serious illness can teach people about the meaning of life., and give their own lives purpose and direction. Through this affirmation of life, and by following their purpose and path, healing can occur. This healing not only moves people toward wholeness, but it holds the potential for transforming and healing the problems of others. This pattern of transformation has practical implications for the nature of support useful for people experiencing a health crisis, and has implications for the designing of effective psychosocial support for cancer patients. / Education, Faculty of / Educational and Counselling Psychology, and Special Education (ECPS), Department of / Graduate