'I Just Focus on the Positives!'

"I just focus on the positives" is a very common statement I hear from patients with advanced lung cancer. It also seems to be a common method of coping. How patients accomplish this is very interesting to me.

It is not a Pollyanna outlook on life, nor is it denial. However, they make a conscious choice to get up every morning and live each day to the fullest. They believe that each day is a gift with no time to waste in self-pity. Do they wish that they didn't have cancer? Do they get sad or sometimes "bummed out"? Absolutely. But what is astounding is that they relish the gift of life and do not dwell in the valley of "what if?"

Some patients focus on doing something for others that may mean sending encouraging notes via the computer instead of physically being present. Other patients focus on family, friends, or hobbies, but a common theme is an outlook directed away from self rather than towards self. They are fully aware of their prognosis and fully acknowledge that the ultimate outcome will be death.

There is research that supports having a positive attitude helps with coping with advanced cancer, and there is research opposing these findings. In 2010, O'Brien & Morrey systematically reviewed eight articles published on the qualities of a fighting spirit, positive attitude, sense of coherence, coping, and adjustment among patients with advanced cancer. Their conclusion was that while several of the studies provided some evidence of an association between positive attitude, self-efficacy, and better emotional adjustment, overall, there were major methodological flaws making conclusions speculative at best.

Chochinov & colleagues (2000) published their research looking at patients with advanced cancer and prognostic awareness. Results showed that a diagnosis of depression was correlated with a denial of prognosis and depression was three times greater in those patients who denied their prognosis. Another interesting finding was that there was no significant correlation between hopelessness and prognostic awareness. Chochinov and colleagues remind clinicians that for some patients, there is a need to "titrate reality" (p. 502) at their own pace.

This is an interesting topic, and sometimes I think we are too quick to label a patient as being in denial, when in fact the patient is "titrating reality" or perhaps processing a new normal. What has been your experience?

References:

• O'Brien, C.W., Moorey, S. (2010). Outlook and adaptation in advanced cancer: a systematic review. Psycho-Oncology 19: 1239-1249.
• Chochinov, H.M., Tataryn, D.J., Wilson, K.G., Enns, M., Lander, S. (2000). Prognostic awareness and the terminally ill. Psychosomatics 41:500-504.