High and low self-esteem and patients’ responses to poor diagnoses’ communication

Our aim is to increase scientific knowledge of psychological defences activated in patients who are aware of their death (Verona’s Breast Unit). Up to date research has shown that they are brought to react in ways that foster sickness, rather than healing processes (Solomon, Greenberg & Pyszczynski, 2015). Studies conducted from the terror management theory (TMT) framework (Greenberg, Pyszczynski, & Solomon, 1986; Greenberg, Solomon, & Pyszczynski, 1997) indicate that conscious thoughts of death are threatening and thus often suppressed from awareness through proximal and/or distal defenses (Arndt, Greenberg, Pyszczynski, & Solomon, 1997). While some proximal and distal defences enhance the likelyhood of acting in order to meet the goals set, others foster counterproductive behaviours (Solomon et al., 2015). TMT posits that high self esteem protects subjects against death related thoughts and death related anxiety. We assume that cancer patient low and high in self esteem, who have to undergo breast surgery, will present two different narrative structures and content of their personal experience pertinent to the period after diagnosis and poor prognosis until the moment they decide to undergo surgery. We will have an experimental condition where we’ll manipulate self esteem and then proceed in a semi structured interview; a control condition where self esteem will also be manipulated but in a different moment that is after the interview. Ethical issues suggest to give the positive feedback to both groups (before and after the interview) in order to both support women and respect experiment’s conditions. Self-esteem will be manipulated by giving a positive feed-back to a personality test. The dependent variable (Interviews’ content) will be recorded and coded (1) bottom-up grounded procedures, and (2) top down procedures, starting from two integrated theoretical perspectives (a) Lazarus taxonomy of traumatic experiences (b) Posttraumatic Growth theory (PTG, Lykins, Segerstrom, Averill, Evans, & Kemeny, 2015; Calhoun & Tedeschi, 1999, 2001; Tedeschi & Calhoun, 2004). We will follow Smith’s (1995) procedural and methodological recommendations for analyzing qualitative data drawn from interviews. The interpretation process (coding) will follow Strauss and Corbin's (1990, 2008) level of abstraction. The number of interviewed women will depend on the theoretical sampling (Strauss & Corbin, 2008). Data analysis will be performed using Nvivo 11 and SPSS 21.0. The core category of the traumatic experience associated to the poor prognosis after cancer diagnosis will be identified. We expect to 1) identify professionals’ and practitioners’ counter-productive behaviour which exponentially public health costs; 2) identify environmental and individual difference variables influencing poor prognosis 49 cancer patients’ unhealthy attitudes and behaviours 3) identify individual difference variables which enhance patients’ compliance.