Threatening Medical Situations Inventory Research Articles

The association of cognitive coping style with patient preferences in a patient-led follow-up study among colorectal cancer survivors

IntroductionAmidst the rising number of cancer survivors and personnel shortages, optimisation of follow-up strategies is imperative, especially since intensive follow-up does not lead to survival benefits. Understanding patient preferences and identifying the associated patient profiles is crucial. Coping style may be a key determinant in achieving this. Our study aims to evaluate preferences, identify coping styles and their associated factors, and explore the association between coping style and patients’ preferences in colorectal cancer (CRC) follow-up.MethodsIn a prospective multicentre implementation study, patients completed the Threatening Medical Situations Inventory (TMSI) to determine their coping style. Simultaneously patients choose their follow-up preferences for the CRC trajectory regarding frequency of tumour marker determination, location of blood sampling, and manner of contact.ResultsA total of 188 patients completed the TMSI questionnaire after inclusion. A more intensive follow-up was preferred by 71.5% of patients. Of all patients, 52.0% had a coping style classified as ‘blunting’ and 34.0% as ‘monitoring’. Variables such as a younger age, female gender, higher educational level, and lower ASA scores were associated with having higher monitoring scores. However, there were no significant associations between follow-up preferences and patients’ coping styles.ConclusionThis study suggests that none of the provided options in a patient-led follow-up are unsuitable for patients who underwent curative surgery for primary CRC, based on coping style determined at baseline. Low-intensity surveillance after curative resection of CRC may, therefore, be suitable for a wide range of patients independent of coping styles.

The association of having a monitoring or blunting coping style with psychological distress, health-related quality of life and satisfaction with healthcare in gastrointestinal stromal tumour (GIST) patients

Background There are two main coping styles regarding information seeking under medical threat; monitoring (information-seeking) and blunting (information-avoiding). The aim of this study is to (1) determine factors associated with a monitoring or blunting coping style in gastro-intestinal stromal tumour (GIST) patients and (2) investigate its association with psychological distress, cancer-related concerns, health-related quality of life and satisfaction with healthcare. Methods In a cross-sectional study, Dutch GIST patients completed the shortened version of the Threatening Medical Situations Inventory to determine their coping style, the Hospital Anxiety and Depression Scale, Cancer Worry Scale, EORTC QLQ-C30 and part of the EORTC QLQ-INFO25. Results A total of 307 patients were classified as blunters (n = 175, 57%) or monitors (n = 132, 43%). Coping style was not associated with tumour or treatment variables, but being a female (OR 2.5; 95%CI 1.5–4.1; p= <.001) and higher educated (OR 5.5; 95%CI 2.5–11.9, p= <.001) were associated with higher odds of being a monitor. Monitors scored significantly lower on emotional functioning (mean = 86.8 vs mean = 90.9, p=.044), which is considered a trivial difference, more often experienced severe fear of cancer recurrence or progression (53.0% vs 37.7%, p=.007), and had more concerns about dying from GIST in the future (60.6% vs 47.4%, p=.025). Compared to blunters, monitors were less satisfied with the received healthcare and information, and would have liked to receive more information. Conclusion GIST patients with a monitoring coping style experience a higher emotional burden. Additionally, monitors exhibit a greater need for information. Although this need for information could potentially result in fears and concerns, recognising it may also create an opening for tailored communication and information.

Quality of life and coping in Dutch homozygous familial hypercholesterolemia patients: A qualitative study

Background and aimsHomozygous familial hypercholesterolemia (HoFH) is characterized by severely elevated low-density lipoprotein cholesterol (LDL-C) levels leading to extremely premature atherosclerotic cardiovascular disease. Therefore, healthcare professionals consider HoFH to have major impact on patients’ life. Remarkably, little is known on how patients deal with their condition. The aim of this study is to investigate how Dutch patients experience and cope with HoFH in daily life. MethodsAdult patients with genetically confirmed HoFH, treated at the 3 specialized HoFH-centers in the Netherlands, were interviewed in-depth. Interview transcripts were analyzed according to grounded theory. Health-related quality of life (QoL) and coping were measured with the EuroQol (EQ)-5D-5L questionnaire and the Threatening Medical Situations Inventory (TMSI), respectively. Results20 Dutch HoFH patients were interviewed: 50% women, median age 38 years, 60% with cardiovascular disease, 10% on apheresis. Coding of the transcripts resulted in a conceptual model, with disease perception as the central theme. Individual TMSI-results corresponded to the interviews, with most patients showing both monitoring (information-seeking behavior) and blunting (distractive strategies) coping styles. The median EQ-5D-5L health utility score (0.839) was only 5% below the Dutch population (0.887). Transient anxiety was reported when confronted with the consequences of HoFH in daily life. Patients reported high confidence in treatment by a dedicated HoFH center, which helped them cope with their disease. ConclusionsDutch HoFH patients use a variety of effective coping mechanisms in such a way that their subjective QoL is only slightly affected. Healthcare professionals can use this knowledge to tailor their care to the specific needs of these patients.

Assessing the relationship between patient preferences for recontact after BRCA1 or BRCA2 genetic testing and their monitoring coping style in a Norwegian sample.

Recontacting former patients regarding new genetic information is currently not standard care but might be implemented in the future. Little information is available on the implications of this practice from the point of view of former patients. The aim of this study was to investigate preferences for recontact when new genetic information becomes available among patients tested for BRCA pathogenic variants. We further wanted to investigate whether having a high or low information-seeking coping style (monitoring) impacts preferences. Preferences for recontact were assessed using a self-constructed questionnaire. The Threatening Medical Situations Inventory (TMSI) was used to measure monitoring coping style. The questionnaires were sent to 500 randomly selected patients who had previously been tested for BRCA pathogenic variants within the time frame 2001-2014 at one genetic clinic in Norway. We received 323 completed questionnaires. Most respondents wanted to be recontacted with advances in genetic medicine (81.1%) and to receive highly personalized updates. Genetic counselors/geneticists were believed to be most responsible for recontact. There was a significant relationship between being a high monitor and wanting recontact to learn about own cancer risk and receive ongoing support. Patients have a high interest in being recontacted. The findings indicated a tendency for high monitors to prefer more detailed and personalized information.

Effects of monitoring versus blunting on the public's preferences for information in a hypothetical cancer diagnosis scenario.

Monitoring and blunting are coping styles that characterize how people respond when faced with personally threatening situations. High monitors tend to pay more attention to, scan for, and amplify threatening cues; high blunters tend to avoid information and seek distractions when faced with a threatening event. This study sought to investigate possible differential effects of monitoring and blunting coping styles on information preferences in a hypothetical cancer diagnosis scenario in the adult general public of Minnesota. In a survey administered at a large public venue (2016 Minnesota State Fair), participants were asked to imagine they carried a gene mutation and were diagnosed with colon cancer. They indicated their information preference [modified Cassileth Information Styles Questionnaire (MCISQ)], completed two coping style measures [Miller Behavioral Style Scale (MBSS) and Threatening Medical Situations Inventory (TMSI)], rated their perceived severity of colon cancer (low, moderate, high), and answered demographic questions. Eight hundred fifty-five individuals provided usable data. Participants classified as monitors on the TMSI had significantly higher MCISQ scores (i.e., preferred more information) than those classified as blunters (p=.004). Those scoring high on monitoring and low on blunting on the MBSS preferred significantly more information than those scoring high on both monitoring and blunting (p=.04). Linear regression analysis revealed being a monitor (TMSI), scoring high on monitoring (MBSS), rating colon cancer as more severe, and having a higher education level were significant positive predictors of MCISQ scores. Results suggest individual differences in coping style, perceived severity, and education level affect desire for information. Genetic counselors should consider these patient characteristics (e.g., asking patients about their information preferences) and tailor their approaches accordingly.

Shared decision-making and providing information among newly diagnosed patients with hematological malignancies and their informal caregivers: Not "one-size-fits-all".

To optimize personalized medicine for patients with hematological malignancies (HM), we find that knowledge on patient preferences with regard to information provision and shared decision-making (SDM) is of the utmost importance. The aim of this study was to investigate the SDM preference and the satisfaction with and need for information among newly diagnosed HM patients and their informal caregivers, in relation to sociodemographic and clinical factors, cognitive coping style, and health related quality of life. Newly diagnosed patients and their caregivers were asked to complete the Hematology Information Needs Questionnaire, the Information Satisfaction Questionnaire, and the Threatening Medical Situations Inventory. Medical records were consulted to retrieve sociodemographic and clinical factors and comorbidity by means of the ACE-27. Questionnaires were completed by 138 patients and 95 caregivers. Shared decision-making was preferred by the majority of patients (75%) and caregivers (88%), especially patients treated with curative intent (OR=2.7, P=.041), and patients (OR=1.2, P<.001) and caregivers (OR=1.2, P=.001) with a higher monitoring cognitive coping style (MCCS). Among patients, total need for information was related to MCCS (P=.012), and need for specific information was related to MCCS and several clinical factors. Importantly, dissatisfaction with the information they received was reported by a third of the patients and caregivers, especially patients who wanted SDM (χ2 =7.3, P=.007), and patients with a higher MCCS (OR=0.94, P=.038). The majority of HM patients want to be involved in SDM, but the received information is not sufficient. Patient-tailored information is urgently needed, to improve SDM.

Anxiety and depression symptoms among women attending group-based patient education courses for hereditary breast and ovarian cancer

BackgroundWomen carrying BRCA-mutations are facing significant challenges, including decision making regarding surveillance and risk-reducing surgery. They often report that they are left alone with these important decisions. In order to enhance the genetic counselling session we organized a group-based patient education (GPE) course for women with BRCA-mutations. The study aims were to characterize women attending a group-based patient education (GPE) course for hereditary breast and ovarian cancer, consider the usefulness of the course, evaluate symptoms of anxiety and depression among the participants, and finally investigate whether their levels of anxiety and depression changed from before to after the course session.MethodsA prospective study was conducted. Two weeks before (T1) and 2 weeks after (T2) attending the GPE-course the participants received questionnaires by mail. We collected information on demographic- and medical variables, anxiety and depression using Hospital Anxiety and Depression Scale (HADS), self-efficacy using The Bergen Genetic Counseling Self-Efficacy scale (BGCSES) and coping style using the Threatening Medical Situations Inventory (TMSI). A total of N = 100 (77% response rate) women participated at baseline and 75 (58% response rate) also completed post-course assessment.ResultsThe mean level of anxiety symptoms was elevated among participants but decreased significantly during follow-up. Lower anxiety symptom levels were associated with “longer time since disclosure of gene test result”, “higher levels of self-efficacy” and having experienced “loss of a close relative due to breast or ovarian cancer”. Lower depression symptom levels were associated with “higher levels of education” and “loss of a close relative due to breast or ovarian cancer”.ConclusionThe women in this study seemed to benefit from the GPE course. Women newly diagnosed with a BRCA mutation who reported lower levels of self-efficacy and lower levels of education were more vulnerable. These women need special attention.

Cognitive coping style (monitoring and blunting) and the need for information, information satisfaction and shared decision making among patients with haematological malignancies.

A haematological malignancy is a serious, life-altering disease and may be characterised as an uncontrollable and unpredictable stress situation. In dealing with potentially threatening information, individuals generally utilise two main cognitive coping styles: monitoring (the tendency to seek threat-relevant information) and blunting (avoiding threatening information and seeking distraction). The aim of this study was to obtain insight into the association between cognitive coping style and (a) need for information, (b) satisfaction with information, (c) involvement in decision making, and (d) quality of life (QoL). In this cross-sectional study, coping style was assessed among adult patients diagnosed with a haematological malignancy, using an adapted version of the Threatening Medical Situations Inventory. Information need, information satisfaction, decision-making preference and QoL were measured with validated questionnaires. In total, 458 patients returned the questionnaire (66%). A monitoring coping style was positively related to need for both general and specific information. Blunting was positively and QoL was negatively related to need for information. Monitoring was positively related to involvement in decision-making and negatively to information satisfaction. Using multivariate analysis, this relation between monitoring and information satisfaction disappeared, and for blunting, we found a negatively significant relation. QoL was not related to coping style. Among patients with haematological malignancies, coping style is related to a need for information, information satisfaction, and involvement in treatment decision-making. Therefore, it is important for health care professionals to be aware of individual differences in cognitive coping style.

An appointment with Dr. google: Online searching for health information in times of stress

An appointment with Dr. google: Online searching for health information in times of stress

Monitoring and blunting styles in fluid restriction consultation

Excessive fluid overload is common in hemodialysis patients. Understanding fluid intake behavior in relation to used cognitive coping style would serve the fluid restriction consultation. The aim of this study was to explore whether hemodialysis patients' fluid intake behavior differs as a function of used coping style. Secondary analysis of data from 51 hemodialysis patients regarding cognitive coping style (assessed by the Threatening Medical Situations Inventory) and fluid intake behavior were used. The participants' mean age was 62.9 years (range 27-84), they had received dialysis treatment for 3.9 years on average (range 0-22), 63% were male and they had gained 3.6% (±1.3) of their dry body weight during the interdialytic period. There was a significant difference in fluid intake behavior between coping groups (F = 3.899, d.f. 2, P = 0.027). The difference (P = 0.028) was isolated between patients with cognitive blunting style and patients with neutral coping style. Identification of hemodialysis patients using cognitive avoidance strategies can be advantageous in renal care. Fluid advice provided may have to be adjusted to the used coping style, especially for patients with a blunting coping style. However, the findings need to be confirmed, and the effect of individualized counseling needs to be evaluated in forthcoming studies.

Determinants of the use of a diabetes risk-screening test.

A study was designed to investigate why people do or do not make use of a diabetes risk test developed to facilitate the timely diagnosis of diabetes. Data were collected using a web-based questionnaire, which was based on the Health Belief Model, the Theory of Planned Behavior, and the Threatening Medical Situations Inventory. People who had and had not used the risk test were recruited to complete the survey. The sample consisted of 205 respondents: 44% who had used the test and 56% who had not. The hypothesized relationships between the dependent variable (diabetes risk test use) and the determinants used in this study were tested using logistic regression analysis. Only two significant predictors of diabetes risk test use were found: gender and barriers. More women than men use the test. Furthermore, people who experience more barriers will be less inclined to use the test. The contribution of diabetes screening tests fully depends on people’s willingness to use them. To optimize the usage of such test, it is especially important to address the barriers as perceived by the public. Two types of barriers must be addressed: practical barriers (time to take the test, fear of complexity of the test), and consequential barriers (fear of the disease and treatment, uncertainties about where to go in the case of an increased risk of diabetes).

Usefulness of the Threatening Medical Situations Inventory in individuals considering genetic testing for cancer risk

Objective To assess the psychometric properties of the Threatening Medical Situations Inventory (TMSI) in a community sample (Study 1), and to examine its usefulness in individuals with a strong family history of cancer (Study 2). Methods Study 1 participants ( N = 276) completed 2 online surveys, 14 days apart. Study 2 participants ( N = 311) completed 2 questionnaires, 6 months apart. Results Both studies revealed the inventory was psychometrically sound, although some concerns were raised about the factor structure. High monitors in Study 1 reported desiring more health-related information and an active role in medical decision-making. High monitors in Study 2 had the greatest knowledge increase when they received a detailed decision aid, compared to a brief pamphlet. Conclusion The TMSI is appropriate for use in both community and clinical samples. High monitors in the general community are more likely to prefer receiving as much health-related information as possible and desire an active role in decision-making about their health. Practice implications Familial cancer clinic patients may benefit from tailoring the amount of information they receive to their coping style, such that patients who are vigilant information-seekers may benefit most from receiving more detailed information about genetic testing.

Effects of Controllability, Predictability, and Information-Seeking Style on Interest in Predictive Genetic Testing

The combined contribution of personal style (monitoring) and situational factors (control and certainty) on seeking predictive genetic testing was investigated. Participants were 209 individuals who were randomly divided into four groups; each group offered one hypothetical genetic test characterized by different degrees of controllability and certainty. Participants’ monitoring information-seeking style was measured by the Miller Behavioral Styles Scale (MBSS) and the Threatening Medical Situations Inventory (TMSI), which is a measure specific for medical situations. The authors found that high monitors were generally more interested than low monitors in testing and that this general tendency was especially pronounced under conditions of high certainty/low control. Tests that provide control were generally preferred to tests that do not by high and low monitors alike, whereas tests that provide certainty were preferred to those that do not only by high monitors. These findings were interpreted as indicating similarities and differences in the needs that information about threats fulfills for high and low monitors as well as identifying conditions that limit information-seeking by high monitors.

Cancer patients' coping styles and doctor-patient communication.

Monitoring and blunting styles have become relevant concepts regarding their potential impact on patients' and doctors' behaviors. The present study aimed at investigating the relation between cancer patients' coping styles and doctor-patient communication and global affect. Coping styles were assessed by means of the Threatening Medical Situations Inventory (TMSI). Since a shortened version of the TMSI was used, the validity of this instrument was also evaluated. First, it was examined whether the two factor structure of the original TMSI could be confirmed in our version. Then, the relation between coping style and patients' preferences for information and participation in decision-making was evaluated. Second, the relation between monitoring and blunting and patients' age, sex, education, quality of life and prognosis was investigated. Finally, the relation between patients' coping styles and communicative behaviors and global affect of both patients and physicians during the initial oncological consultation was examined. Patients (N = 123) visited their gynaecologist or medical oncologist for an initial discussion of possible treatment. Patients' coping styles, socio-demographics, preference for information and participation in decision-making, quality of life and prognosis were assessed by postal questionnaire prior to the visit to the outpatient clinic. The consultation was audiotaped and analysed according to Roter's Interaction Analysis System, to identify instrumental and affective communicative behaviors of both patients and physicians. The two factor structure of the TMSI could be confirmed. A monitoring style was related to a preference for detailed information (r = 0.23) and participation in medical decision-making (r = 0.23). A monitoring style was also related to patient question-asking (r = 0.25) and patient dominance (r = 0.23). To conclude, the validity of the shortened TMSI is satisfactory. Also, cancer patients' coping styles are not related to other personal and disease characteristics. Further, a monitoring style seems to have an impact on patients' question-asking and dominance during the oncological consultation.

Cancer patients’ coping styles and doctor–patient communication

Monitoring and blunting styles have become relevant concepts regarding their potential impact on patients’ and doctors’ behaviors. The present study aimed at investigating the relation between cancer patients’ coping styles and doctor–patient communication and global affect. Coping styles were assessed by means of the Threatening Medical Situations Inventory (TMSI). Since a shortened version of the TMSI was used, the validity of this instrument was also evaluated. First, it was examined whether the two factor structure of the original TMSI could be confirmed in our version. Then, the relation between coping style and patients’ preferences for information and participation in decision-making was evaluated. Second, the relation between monitoring and blunting and patients’ age, sex, education, quality of life and prognosis was investigated. Finally, the relation between patients’ coping styles and communicative behaviors and global affect of both patients and physicians during the initial oncological consultation was examined. Patients (N=123) visited their gynaecologist or medical oncologist for an initial discussion of possible treatment. Patients’ coping styles, socio-demographics, preference for information and participation in decisionmaking, quality of life and prognosis were assessed by postal questionnaire prior to the visit to the outpatient clinic. The consultation was audiotaped and analysed according to Roter's Interaction Analysis System, to identify instrumental and affective communicative behaviors of both patients and physicians. The two factor structure of the TMSI could be confirmed. A monitoring style was related to a preference for detailed information (r=0.23) and participation in medical decision-making (r=0.23). A monitoring style was also related to patient question-asking (r=0.25) and patient dominance (r=0.23). To conclude, the validity of the shortened TMSI is satisfactory. Also, cancer patients’ coping styles are not related to other personal and disease characteristics. Further, a monitoring style seems to have an impact on patients’ question-asking and dominance during the oncological consultation. Copyright © 1999 John Wiley & Sons, Ltd.

Coping style and self‐reported health promotion and disease detection behaviour

Objectives. In the present study we investigate the relevance of the monitoring‐blunting concept to the realm of health behaviour, and to health promotion and disease detection behaviour in particular. Design. The study is correlational in character, supplemented with some qualitative data. Methods. Sixty participants of varying sex, age and educational level filled out the Threatening Medical Situations Inventory, measuring the monitoring and blunting coping style, and the newly developed Health Promotion‐Detection Questionnaire, intended to measure the tendencies to exhibit health promotion and disease detection behaviours. In addition, they answered a few open questions concerning their health. Results. It emerged that disease detection behaviour is positively related to age, and it is more often carried out for health reasons than health promotion behaviour. The monitoring coping style is significantly, though modestly, related to both health promotion and disease detection. The latter relation still holds when we controlled for age and gender. No relations with blunting were found, except for individual health behaviours. Conclusion. The results of the present study encourage further investigation of the role of coping styles in the performance of different types of health behaviours. Hereby, the further distinction between health strivings of the approach and the avoidance type may prove useful.

Cancer patients' coping styles and doctor-patient communication

Monitoring and blunting styles have become relevant concepts regarding their potential impact on patients' and doctors' behaviors. The present study aimed at investigating the relation between cancer patients' coping styles and doctor-patient communication and global affect. Coping styles were assessed by means of the Threatening Medical Situations Inventory (TMSI). Since a shortened version of the TMSI was used, the validity of this instrument was also evaluated. First, it was examined whether the two factor structure of the original TMSI could be confirmed in our version. Then, the relation between coping style and patients' preferences for information and participation in decision-making was evaluated. Second, the relation between monitoring and blunting and patients' age, sex, education, quality of life and prognosis was investigated. Finally, the relation between patients' coping styles and communicative behaviors and global affect of both patients and physicians during the initial oncological consultation was examined. Patients (N = 123) visited their gynaecologist or medical oncologist for an initial discussion of possible treatment. Patients' coping styles, socio-demographics, preference for information and participation in decision-making, quality of life and prognosis were assessed by postal questionnaire prior to the visit to the outpatient clinic. The consultation was audiotaped and analysed according to Roter's Interaction Analysis System, to identify instrumental and affective communicative behaviors of both patients and physicians. The two factor structure of the TMSI could be confirmed. A monitoring style was related to a preference for detailed information (r = 0.23) and participation in medical decision-making (r = 0.23). A monitoring style was also related to patient question-asking (r = 0.25) and patient dominance (r = 0.23). To conclude, the validity of the shortened TMSI is satisfactory. Also, cancer patients' coping styles are not related to other personal and disease characteristics. Further, a monitoring style seems to have an impact on patients' question-asking and dominance during the oncological consultation.

Coping with medical threat: An evaluation of the Threatening Medical Situations Inventory (TMSI)

The Dutch Threatening Medical Situations Inventory (TMSI) has been developed to measure cognitive confrontation (‘monitoring’) and cognitive avoidance (‘blunting’) within the domain of medical threat. It consists of four scenarios of threatening medical situations, followed by monitoring and blunting alternatives. Its psychometric properties are investigated in students ( N = 123), dental ( N = 80), HIV-( N = 42) and surgery patients ( N = 123). For both scales, internal consistencies proved to be satisfactory. Slight sex and age effects are found. Furthermore, there is a strong situation effect: the scenario highest in controllability shows relatively high monitoring and low blunting scores. Factor structure is stable across samples and shows a good fit with the predicted factor solution. Both scales are found to converge and diverge in a theoretically meaningful manner with a variety of coping style and anxiety measures. In two samples, a sample specific stress scenario was added, but the psychometric qualities of such an extension should not be taken for granted. In an additional sample of working people ( N = 48) test-retest reliability proved to be good. It is concluded that the TMSI is a useful instrument for assessing cognitive confrontation and avoidance in medical patients. An English as well as a German translation are available.

Coping under experimental threat: Observable and cognitive correlates of dispositional monitoring and blunting

In order to investigate the relation between dispositional coping style and actual coping behaviour under threat, 53 undergraduate psychology students anticipated a mild stressor (bloody slides) in Part I of the experiment. Observable behaviour turned out to be unrelated to dispositional monitoring and blunting as measured by the Miller Behavioral Style Scale (MBSS; Miller, 1987) and the Threatening Medical Situations Inventory (TMSI; van Zuuren and Hanewald, 1993). However, when cognitions were also taken into account, some significant correlations emerged with the MBSS as well as with the TMSI. In Part II (N = 40), intrusive thinking after exposure to the experimental stressor was related to dispositional coping style. High monitors, as compared with low monitors (moderate monitors excluded) were found to elaborate the stressful experience in a more diffuse and extended way.