The role of metacognition and its indirect effect through cognitive attentional syndrome on fear of cancer recurrence trajectories: A longitudinal study

担心 元认知 心理学 认知 置信区间 多项式logistic回归 内科学 医学 焦虑 精神科 机器学习 计算机科学
作者
Danielle Wing Lam Ng,CC Foo,Simon S.M. Ng,Ava Kwong,Dacita Suen,Miranda Chan,Amy Or,Oi Kwan Chun,Brenna F. S. Fielding,Wwt Lam
出处
期刊:Psycho-oncology [Wiley]
卷期号:29 (2): 271-279 被引量:25
标识
DOI:10.1002/pon.5234
摘要

Abstract Objective This longitudinal study mapped distinct trajectories of fear of cancer recurrence (FCR) over 12 months among patients with breast (BC) or colorectal (CRC) cancer, and examined if metacognition, indirectly via attentional bias, intrusive thoughts and avoidance (hallmarks of cognitive attentional syndrome; CAS) predicted FCR trajectory membership. Methods Two hundred and seventy BC (n = 163) or CRC (n = 107) patients were assessed at 8‐weeks, 3‐, 6‐, and 12‐months postsurgery on a measure of FCR (FCRI‐SF). Metacognition (MCQ‐30), Intrusive and Avoidant Thoughts (CIES‐R) and attentional bias (dot‐probe tasks) were assessed at baseline. Latent growth mixture modeling identified FCR trajectories. Fully‐adjusted Multinomial Logistic Regression identified whether direct and indirect effects of metacognition through CAS determined FCR trajectory membership. Results Three distinct FCR trajectories were identified, namely, low‐stable (62.4%), high‐stable (29.2%), and recovery (8.3%). Negative beliefs about worry, cognitive confidence, and age predicted FCR trajectories ( χ 2 (6) = 38.31, P <.001). Compared with Low‐stable group, Recovery FCR patients held greater Negative beliefs about worry (OR = 1.13, P = .035) and High‐stable FCR patients reported poorer Cognitive confidence (OR = 1.12, P = .004). The effect of Negative beliefs about worry was partially mediated by avoidance ( β = .06, 95% CIs 0.03‐0.12) and fully mediated by intrusive thoughts ( β = .14, 95% CIs 0.08‐0.20). Attentional bias did not predict FCR trajectories. Conclusions While most patients experienced low level of FCR, 3 in 10 persistently worried about cancer returning over the first 12‐months postsurgery. Modifying metacognitive knowledge to interrupt maladaptive cognitive processing including intrusion and avoidance may be an effective therapeutic intervention for patients at risk of persistent FCR.

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