Illness Perceptions in patients with lung cancer

Lung cancer is one of the most common types of cancer. In the Netherlands there
are 10,000 new cases a year. With 9500 deaths annually, lung cancer is
responsible for the highest mortality of all malignancies. Although the
incidence in men has stabilised, the incidence in women is still rising.
Current medicine is still unable to cure most of the patients, which accounts
for the high mortality rate. This makes psychosocial care extra important to
offer patients the best possible quality of life. Recent studies have pointed
out the importance of psychosocial interventions in patients with lung cancer.

In the Self Regulation Model (SRM), Leventhal described the process with which
people react to a perceived health threat. First, the individual forms an image
of his complaints and the disease, the illness perception. These perceptions
influence the coping of the individual with this disease, which again
influences appraisal, expectations and evaluation of the perceived health
threat. This model shows the influence of illness perceptions on the way
patients feel and act. These perceptions are important to consider in good
biopsychosocial care aimed at the highest possible quality of life. There has
been some research about illness perceptions in lung cancer patients, but not
extensively. Research found that patients experience their disease as
worrisome, chronic and severe. Dutch patients appear to feel low levels of
control over their disease.

Research into illness perceptions often uses the Illness Perception
Questionnaire. A revised version was published in 2002. Broadbent et. al. have
published a shortened form of this questionnaire, the Brief Illness Perceptions
Questionnaire. (B-IPQ) From this, a numerical score of the patient*s illness
perceptions can be derived. This research uses the BIPQ, because it is
validated as an effective tool to study illness perceptions and is not as long
and time-consuming as the extended version.

These questionnaires only give a global impression of patient*s perceptions. To
gain more insight into the details of patient*s thought, additional methods of
research are necessary.

A relatively new development in the research into illness perceptions is the
use of drawings. These can give a visual representation of the patient*s
perspective and give more insight than a questionnaire because patients are
able to give their own interpretation and are not bound to closed questions.
The drawings are also clinically relevant. In patients with heart failure there
is a correlation between the degree of change in their drawings and the
clinical indicators of disease. The drawings were a better predictor of
clinical outcomes than were biomedical measurements. This shows that this type
of research can be a valuable addition to the insights in patients* disease.
Similar results were found with headaches, vestibular schwannomas and
post-partum haemorrhages.

The aim of this research is to gain a more detailed insight into the illness
perceptions of patients with lung cancer. With this insight it is our aim to
improve biopsychosocial care for these patients.
Research question: What are the illness perceptions of patients with lung
cancer?

This is a cross-sectional research consisting of four components:
Biomedical characteristics: tumorstage and Karnofsky score, treatment, age,
sex, education and employment
Two drawings of the lungs, one healthy and one with disease
The Brief Illness Perceptions Questionnaire
An interview led by the answers to the BIPQ
The BIPQ is a short questionnaire consisting of nine questions. Patients will
be asked to fill out this form. After patients have filled out the
questionnaire, the researcher asks them to elucidate on these answers. In
patients* answers, themes are immediately identified and recorded.

The two drawings of the lungs are compared and the drawn changes are recorded
and categorised. The answers of the interview are also classified in different
themes. The occurrence of these themes is recorded.
With this data, specific illness perceptions can be found. Also, the
correlation between biomedical, socio-economic and biopsychosocial
characteristics will be analysed.

Time: participation will take about one hour for each patient.
Physical risks: None involved
Emotional burden: Patients are asked to talk about their disease, which may be
distressing to them.
Patients often find it relieving to be able to talk about their emotions to
someone who listens to them. This research gives them this chance. Patients who
do not want to talk about their disease will not take part in this research.
This minimises the emotional burdens on the patients.
Without talking about the disease, there can be no research into illness
perceptions. In the long run, a better knowledge of patients understanding of
their disease will benefit treatment for all patients.