Adjustment and coping

Many patients show emotional adjustment reactions following the first presentation of a physical illness or its subsequent progression. Anxiety is common in the early stages, when symptoms have been noticed but no firm diagnosis made. If investigations confirm that a serious, progressive medical condition is present, some patients are actually relieved to know what they have to face. Others, not having suspected their diagnosis previously, go through a period of 'denial' in which they do not seem to appreciate the gravity of the situation, and/or experience acute distress or anger. This is followed by depression or sadness before the final stage of acceptance can be reached. The pattern and the time course of the adjustment process varies markedly, depending on many factors: the nature of the physical illness, the patient's personality and social circumstances, and relationships with health-care staff.

The majority of patients with serious physical disease adjust successfully, through a variety of 'coping styles'. In general, those who take positive action toward understanding and mastery of their illness tend to adapt better than those whose reaction is passive or helpless. Sometimes the illness brings psychological benefits such as closer family relationships, keener appreciation of life, and a sense of greater maturity. A minority of patients show persistent 'maladaptive' reactions, which may include anxiety, depression, anger, or denial. These always impair quality of life, and may cause poor cooperation with, and response to, medical treatments.

Even patients who remain well after initial treatment for a serious disease such as cancer may have their lives permanently overshadowed by fear of recurrence and death, and become hypochondriacal about minor bodily symptoms. When incurable progressive disease is a reality, many physical, psychological, social, and spiritual issues arise, and the palliative care (hospice) movement is concerned with optimizing all these aspects of care for patients with advanced cancer and other serious illnesses.

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