Interest in meaning and meaning making in the context of stressful life events continues to grow, but research is hampered by conceptual and methodological limitations. Drawing on current theories, the author first presents an integrated model of meaning making. This model distinguishes between the constructs of global and situational meaning and between "meaning-making efforts" and "meaning made," and it elaborates subconstructs within these constructs. Using this model, the author reviews the empirical research regarding meaning in the context of adjustment to stressful events, outlining what has been established to date and evaluating the strengths and weaknesses of current empirical work. Results suggest that theory on meaning and meaning making has developed apace, but empirical research has failed to keep up with these developments, creating a significant gap between the rich but abstract theories and empirical tests of them. Given current empirical findings, some aspects of the meaning-making model appear to be well supported but others are not, and the quality of meaning-making efforts and meanings made may be at least as important as their quantity. This article concludes with specific suggestions for future research.

Making Sense of the Meaning Literature: An Integrative Review of Meaning Making and Its Effects on Adjustment to Stressful Life Events.

The authors conducted a meta-analysis to examine the relations of benefit finding to psychological and physical health as well as to a specific set of demographic, stressor, personality, and coping correlates. Results from 87 cross-sectional studies reported in 77 articles showed that benefit finding was related to less depression and more positive well-being but also more intrusive and avoidant thoughts about the stressor. Benefit finding was unrelated to anxiety, global distress, quality of life, and subjective reports of physical health. Moderator analyses showed that relations of benefit finding to outcomes were affected by the amount of time that had passed since stressor onset, the benefit finding measured used, and the racial composition of the sample.

A meta-analytic review of benefit finding and growth.

Purpose
Fear of cancer recurrence (FCR) is among the most commonly reported problems and one of the most prevalent areas of unmet needs for cancer survivors and their carers. This review aims to provide a comprehensive overview of current scientific knowledge on FCR and to formulate recommendations for future research.

Fear of cancer recurrence in adult cancer survivors: a systematic review of quantitative studies

Predictors and outcomes of benefit finding, positive reappraisal coping, and posttraumatic growth were examined using interviews and questionnaires from a longitudinal study of women with early-stage breast cancer followed from primary medical treatment completion to 3 (n=92) and 12 months (n=60) later. Most women (83%) reported at least 1 benefit of their breast cancer experience. Benefit finding (i.e., identification of benefits, number of benefits), positive reappraisal coping, and posttraumatic growth had distinct significant predictors. Positive reappraisal coping at study entry predicted positive mood and perceived health at 3 and 12 months and posttraumatic growth at 12 months, whereas benefit finding did not predict any outcome. Findings suggest that benefit finding, positive reappraisal coping, and posttraumatic growth are related, but distinct, constructs.

The yellow brick road and the emerald city: benefit finding, positive reappraisal coping and posttraumatic growth in women with early-stage breast cancer.

Purpose To estimate prevalence and severity of patients' self-perceived supportive care needs in the immediate post-treatment phase and identify predictors of unmet need. Patients and Methods A multicenter, prospective, longitudinal survey was conducted. Sixty-six centers recruited patients for 12 weeks. Patients receiving treatment for the following cancers were recruited: breast, prostate, colorectal, and gynecologic cancer and non-Hodgkin's lymphoma. Measures of supportive care needs, anxiety and depression, fear of recurrence, and positive and negative affect were completed at the end of treatment (T0) and 6 months later (T1). Results Of 1,850 patients given questionnaire packs, 1,425 (79%) returned questionnaires at T0, and 1,152 (62%) returned questionnaires at T1. Mean age was 61 years; and most respondents were female (69%) and had breast cancer (57%). Most patients had no or few moderate or severe unmet supportive care needs. However, 30% reported more than five unmet needs at baseline, and for 60% of these patients, the situation did not improve. At both assessments, the most frequently endorsed unmet needs were psychological needs and fear of recurrence. Logistic regression revealed several statistically significant predictors of unmet need, including receipt of hormone treatment, negative affect, and experiencing an unrelated significant event between assessments. Conclusion Most patients do not express unmet needs for supportive care after treatment. Thirty percent reported more than five moderate or severe unmet needs at both assessments. Unmet needs were predicted by hormone treatment, negative mood, and experiencing a significant event. Our results suggest that there is a proportion of survivors with unmet needs who might benefit from the targeted application of psychosocial resources.

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Patients' Supportive Care Needs Beyond the End of Cancer Treatment: A Prospective, Longitudinal Survey

Given the marked individual variability in psychological adjustment in response to breast cancer, it is important to specify factors contributing to adaptive survivorship. This longitudinal study of 70 women with Stage I or II breast cancer tested the ability of situation-specific coping strategies and a more stable attribute, hope, to predict adjustment prospectively from the point shortly following diagnosis through the first year. Consonant with previous studies, coping through active acceptance at diagnosis predicted more positive adjustment across time, and avoidance-oriented coping predicted greater fear of cancer recurrence, over and above participant age and initial status on dependent variables. The hypothesis that coping through turning to religion would be more effective for less hopeful women was supported, and mixed support emerged for the hypothesis that approach-oriented coping strategies would yield greater adaptational benefits for women high in hope. Findings suggest that risk and protective factors for adjustment across the first year of survivorship can be identified even prior to definitive surgery for breast cancer, particularly when both dispositional characteristics such as hope and situation-specific coping strategies are considered.

Melissa E. Huggins

Papers

The first year after breast cancer diagnosis: hope and coping strategies as predictors of adjustment.