The role of hope and rumination in childhood cancer adjustment

Abstract

In support of Snyder’s cognitive theory, hope has been found to be a positive factor in psychological adjustment among adult cancer patients and non-cancer paediatric patients with various illnesses. Nonetheless, Snyder’s cognitive theory of hope has not been specifically examined among childhood cancer patients and survivors. Unlike adult cancer patients, childhood cancer patients and survivors are characterized by early onset age in their cancer diagnosis which may mean that they face different psychological and physiological challenges. The identification of positive factors that attenuate negative psychological adjustment outcomes may be crucial in the development of effective therapeutic interventions. Despite that previous studies support the correlation between hope and positive adjustment outcomes, the exact cognitive mechanism that underpins the cognitive theory of hope remains underexplored. Although Snyder postulated that hope is goal-directed thinking which comprises willpower and waypower, he failed to establish any association between hope and rumination. The role of rumination in predicting the onset of mood symptoms and maintaining psychopathology has been well-researched, but it is conceptually meaningful to investigate the potential association between hope and rumination and their respective roles in affecting psychological adjustments in cancer experiences. The current thesis improves on the understanding of relationships between hope, rumination and cancer adjustment, and expands on studies of cancer adjustment by tapping into both positive and negative psychological outcomes, and examines how these two juxtaposed outcomes are associated with hope as mediated by positive and negative ruminations respectively. Eighty-nine childhood cancer survivors from the Children’s Cancer Foundation in Hong Kong took part in questionnaires that measured their levels of hope, rumination, mood symptoms and self-perceived positive changes or post-traumatic growth (PTG). The findings suggest that hope is negatively correlated with depression and anxiety, which are specifically mediated by negative cancer-related rumination. Hope is also positively correlated with PTG, which is specifically mediated by positive cancer-related rumination. These results provide empirical evidence to support the postulation by Snyder that low hope individuals adjust poorly because they are more likely to have negative rumination. High hope individuals adjust better as they are more likely to engage in positive rumination which is associated with PTG. The overall findings provide a possible explanation for the cognitive mechanism that underlies hope. A supplementary pilot study conducted measuring 20 childhood cancer patients’ hope level and mood symptoms over a period of nine months post-acute treatment also suggests patients have fewer prospective depressive symptoms have higher hope level in early measurement. The findings of the current thesis have important clinical implications. The understanding of hope and its association with rumination and cancer adjustment may inform the specific development of hope-based therapeutic interventions for childhood cancer patients and survivors, such as the hope-based storybook developed in this study with the aim to increase the hope levels of childhood cancer patients.