APPLICANT?S DESCRIPTION: Despite the proliferation of hundreds of
health-related quality of life (HRQL) questionnaires, most do not provide
information about individually meaningful problems that are amenable to
intervention. Perhaps one reason for this difficulty is that the vast majority
of the available assessments do not focus upon personally relevant goals which
vary across people and which are differentially affected by illness and
treatment. Given significant theoretical and empirical support for the
centrality of goal pursuit to well-being, we propose to test a
theoretically-derived, patient-rated assessment of illness-and
treatment-related interference with progress toward personal goals as a
clinical outcome measure. The psychometric properties of the Goal Interference
Scale will be rigorously evaluated using both Rasch item response theory and
classical test theory methods. Goal interference may be an important mechanism
by which physical symptoms affect global perception of HRQL. Demonstration of
such a mechanism would provide guidance for interventions that aim to decrease
the impact of symptoms on HRQL, even when it is not possible to significantly
relieve the symptoms themselves. Therefore, we will also evaluate whether goal
interference mediates the relationship between illness- and treatment-related
symptoms and global quality of life perceptions. Furthermore, both theory and
empirical evidence suggest that people will attempt to respond to goal
interference in a variety of ways: goal perseverance, goal shifting, goal
disengagement. The psychosocial outcomes of these major goal pursuit categories
may be modified by factors such as rate of progress, expectations regarding
rate of progress, and goal importance. An understanding of these processes has
significant implications for clinical interventions with cancer patients.
However, to date, there is little data on even the most basic questions
regarding responses to goal interference. Therefore, we will explore both the
prevalence and the psychosocial consequences of these goal pursuit categories
among cancer patients. These three specific aims will be examined in a
longitudinal study of 300 oncology patients (150 early stage and 150 late stage
patients). The results from this investigation could facilitate the assessment
and treatment of cancer patients whose symptoms are interfering with their
ability to make progress toward important goals.
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