Abstract: The study examined the impact of worry on formation of illness representations among individuals newly diagnosed with lung cancer. Worry, a cognitive process driven by anxiety and fears, is a common phenomenon among individuals with a new cancer diagnosis. Cognitive representations are learned knowledge structures that guide adjustment to the illness. Worry may influence the formation of cognitive representations of illness by biasing perceptions and facilitating formation of threat-laden representations that lead to further anxiety and poorer adjustment. The study examined relationships between: (1) worry and formation of cognitive representations of illness over time, and (2) selected patient and disease factors on worry and the cognitive representation of illness. A theoretical framework of person-environment compatibility from a cognitive map perspective was used. Forty-two volunteers (27 males, 15 females) aged 37 to 83 years, mean age 63.7 ± 10.8, with confirmed and suspected lung cancer were assessed in the early post-diagnostic period, and about 3 to 4 weeks following surgery. Participants were tested with measures of worry (Penn State Worry Questionnaire, Cancer-Related Worry Questionnaire) and cognitive representation of illness (Conceptual Cognitive Map, Illness Perception Questionnaire) at both assessments. In addition, measures of social support, optimism, cognitive functioning, state-trait anxiety, and the illness experience were used. Correlation and regression analyses were used to determine relationships between worry measures and the cognitive representations of illness, and to determine possible covariates. Repeated measures ANOVA were used to determine changes in worry and representation of illness measures over time. The findings showed relationship between higher worry and negative dimensions of the cognitive representation of illness. The high worriers were more likely to have higher psychological and risk attributions, higher emotional distress, lower perceived personal and treatment control, and lower perceptions of illness coherence, in comparison to the low worriers over time. State anxiety predicted cancer-related worry, and trait anxiety predicted generalized worry. State anxiety, the illness experience, optimism, and cognitive functioning were predictors of dimensions of the cognitive representation. The findings have implications for design of nursing interventions aimed towards modifying worry and negative effects on the cognitive representation of illness in lung cancer.
Keywords: Health and environmental sciences, Worry, Illness, Cancer, Cognition