Denial in cancer patients is a well-known concept. The definition of denial, however, is not unequivocal and covers different ways of evading painful events or feelings. This thesis studies denial and its relation to the quality of life in lung cancer patients. To assess the level of denial the 'Denial of Cancer Interview' (DCI) was developed. Denial was measured at different time points in the course of the disease. The key-finding from this study is that patients fare better when they express a moderate level of denial or increase their level of denial from the moment of diagnosis over time. This study shows convincingly that denial in lung cancer patients deserves attention in clinical practice. In this era of self-disclosure it is good to realize that some patients need protection against unbearable facts and feelings. Denial can serve this need and should be respected.
Contents - 8 Chapter 1: Introduction - 10 Chapter 2: 'Doctor, I don't want to know': an investigation of denial in lung cancer patients - 16 Chapter 3: Denial in Cancer Patients, an explorative review - 26 Chapter 4: The Denial of Cancer Interview: development and first assessment of psychometric properties in lung cancer patients - 50 Chapter 5: Denial in lung cancer patients, a longitudinal study - 72 Chapter 6: Denial and physical outcomes in lung cancer patients a longitudinal study - 90 Chapter 7: Denial and social and emotional outcomes in lung cancer patients: the protective effect of denial - 108 Chapter 8: Summary and general discussion - 124 APPENDIX - 140 Samenvatting - 166 Dankwoord - 172 Epiloog - 178 Curriculum vitae - 180