Systematic misperception: oncology patients self-reported affective states and their care-givers perceptions

Care-givers frequently misperceive how patients feel but no systematic studies have been found which show whether they accentuate or minimize the patientʼs feelings. The purpose of this study was to determine whether there was congruence between care-giversʼ evaluations of oncology patientsʼ levels of anxiety, hostility, and depression, and the oncology patientsʼ self-reported levels of these three affective states. A control hypothesis was also tested by evaluating the patientsʼ levels of denial. Twenty-eight terminally ill hospitalized oncology patients were asked to complete a denial test and the Multiple Adjective Affect Check List (MAACL) which measures levels of anxiety, hostility, and depression. Twenty-eight care-givers who were each familiar with one of the patients were requested to fill out the MAACL as they believed the patient would fill it out. Analysis of variance revealed a statistically significant discrepancy between patient-care-giver paired perceptions for all three affective states (p ranged from 0.01 to 0.001).For each affective state the care-giver rated the patients as feeling considerably worse than the patients themselves reported feeling; correlational procedures ruled out denial as affecting patientsʼ self-reported states. These findings are discussed in light of Wrightʼs requirement of mourning hypothesis, a theoretical formulation that states that care-givers need to see clients as feeling negatively in order to reassure themselves (care-givers) that their value systems, emphasizing health, are intact. Additional selected demographic data on care-givers and patients are discussed and nursing implications are explicated.