{"http:\/\/dx.doi.org\/10.14288\/1.0096664":{"http:\/\/vivoweb.org\/ontology\/core#departmentOrSchool":[{"value":"Applied Science, Faculty of","type":"literal","lang":"en"},{"value":"Nursing, School of","type":"literal","lang":"en"}],"http:\/\/www.europeana.eu\/schemas\/edm\/dataProvider":[{"value":"DSpace","type":"literal","lang":"en"}],"https:\/\/open.library.ubc.ca\/terms#degreeCampus":[{"value":"UBCV","type":"literal","lang":"en"}],"http:\/\/purl.org\/dc\/terms\/creator":[{"value":"Salton, Christine Ann","type":"literal","lang":"en"}],"http:\/\/purl.org\/dc\/terms\/issued":[{"value":"2010-06-14T01:53:46Z","type":"literal","lang":"en"},{"value":"1986","type":"literal","lang":"en"}],"http:\/\/vivoweb.org\/ontology\/core#relatedDegree":[{"value":"Master of Science in Nursing - MSN","type":"literal","lang":"en"}],"https:\/\/open.library.ubc.ca\/terms#degreeGrantor":[{"value":"University of British Columbia","type":"literal","lang":"en"}],"http:\/\/purl.org\/dc\/terms\/description":[{"value":"This exploratory, descriptive study was designed to describe health care preferences among cancer patients receiving radiotherapy for the first time. In addition, the relationship between selected demographic variables and patients' health care preferences was examined as was the relationship between patients' anxiety and their health care preferences.\r\nA convenience sample of forty newly-diagnosed cancer patients was selected from the population of patients receiving radiotherapy at a large urban cancer treatment facility. The sample included 21 women and 19 men ranging in age from 36 to 79 years. From medical records, the researcher collected relevant demographic information. Patients completed the Health Care Preference Survey, a seven-item forced-choice questionnaire. Each item presented a clinical situation and offered a choice between a cognitive or an affective nursing intervention. Anxiety was measured by the subjects' responses to the State-Trait Anxiety Inventory(STAI).\r\nIn most situations, patients preferred cognitive over affective interventions and the preference for cognitive interventions was largely independent of demographic variables. Clinical situation and timing may have affected intervention preference. Patients' anxiety levels significantly affected their preferences for health care interventions. Patients who had high State anxiety scores preferred affective rather than cognitive interventions.\r\nIncidental findings included subjects' comments about participation in the study and attitudes toward their illness experiences and obtaining information. Implications for nursing practice and recommendatons for further research are discussed.","type":"literal","lang":"en"}],"http:\/\/www.europeana.eu\/schemas\/edm\/aggregatedCHO":[{"value":"https:\/\/circle.library.ubc.ca\/rest\/handle\/2429\/25730?expand=metadata","type":"literal","lang":"en"}],"http:\/\/www.w3.org\/2009\/08\/skos-reference\/skos.html#note":[{"value":"PREFERENCES FOR INTERVENTION AMONG CANCER PATIENTS RECEIVING RADIOTHERAPY FOR THE FIRST TIME By C h r i s t i n e Ann S a l t o n A., The U n i v e r s i t y o f B r i t i s h C o l u m b i a , 1977 THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE IN NURSING i n THE FACULTY OF GRADUATE STUDIES S c h o o l o f N u r s i n g We a c c e p t t h i s t h e s i s a s c o n f o r m i n g t o t h e r e q u i r e d s t a n d a r d THE UNIVERSITY OF BRITISH COLUMBIA Ju n e 1986 (&) C h r i s t i n e Ann S a l t o n , 1986 In presenting t h i s thesis i n p a r t i a l f u l f i l m e n t of the requirements for an advanced degree at the University of B r i t i s h Columbia, I agree that the Library s h a l l make i t f r e e l y available for reference and study. I further agree that permission for extensive copying of t h i s thesis for scholarly purposes may be granted by the head of my department or by his or her representatives. I t i s understood that copying or publication of t h i s thesis for f i n a n c i a l gain s h a l l not be allowed without my written permission. Department of JflLjAAt^ The University of B r i t i s h Columbia 1956 Main Mall Vancouver, Canada V6T 1Y3 DE-6 (3\/81) ABSTRACT T h i s e x p l o r a t o r y , d e s c r i p t i v e s t u d y was d e s i g n e d t o d e s c r i b e h e a l t h c a r e p r e f e r e n c e s among c a n c e r p a t i e n t s r e c e i v i n g r a d i o t h e r a p y f o r t h e f i r s t t i m e . I n a d d i t i o n , t h e r e l a t i o n s h i p between s e l e c t e d d e m o g r a p h i c v a r i a b l e s and p a t i e n t s ' h e a l t h c a r e p r e f e r e n c e s was examined a s was t h e r e l a t i o n s h i p between p a t i e n t s ' a n x i e t y and t h e i r h e a l t h c a r e p r e f e r e n c e s . A c o n v e n i e n c e s a mple o f f o r t y n e w l y - d i a g n o s e d c a n c e r p a t i e n t s was s e l e c t e d f r o m t h e p o p u l a t i o n o f p a t i e n t s r e c e i v i n g r a d i o t h e r a p y a t a l a r g e u r b a n c a n c e r t r e a t m e n t f a c i l i t y . The sample i n c l u d e d 21 women and 19 men r a n g i n g i n age f r o m 36 t o 79 y e a r s . From m e d i c a l r e c o r d s , t h e r e s e a r c h e r c o l l e c t e d r e l e v a n t d e m o g r a p h i c i n f o r m a t i o n . P a t i e n t s c o m p l e t e d t h e H e a l t h C a r e P r e f e r e n c e S u r v e y , a s e v e n - i t e m f o r c e d - c h o i c e q u e s t i o n n a i r e . E a c h i t e m p r e s e n t e d a c l i n i c a l s i t u a t i o n and o f f e r e d a c h o i c e between a c o g n i t i v e o r an a f f e c t i v e n u r s i n g i n t e r v e n t i o n . A n x i e t y was measured by t h e s u b j e c t s ' r e s p o n s e s t o t h e S t a t e - T r a i t A n x i e t y I n v e n t o r y ( S T A I ) . In most s i t u a t i o n s , p a t i e n t s p r e f e r r e d c o g n i t i v e o v e r a f f e c t i v e i n t e r v e n t i o n s and t h e p r e f e r e n c e f o r c o g n i t i v e i n t e r v e n t i o n s was l a r g e l y i n d e p e n d e n t o f d e m o g r a p h i c v a r i a b l e s . C l i n i c a l s i t u a t i o n and t i m i n g may have a f f e c t e d i n t e r v e n t i o n p r e f e r e n c e . P a t i e n t s ' a n x i e t y l e v e l s s i g n i f i c a n t l y a f f e c t e d t h e i r p r e f e r e n c e s f o r h e a l t h c a r e i n t e r v e n t i o n s . P a t i e n t s who had h i g h S t a t e a n x i e t y s c o r e s p r e f e r r e d a f f e c t i v e r a t h e r t h a n c o g n i t i v e i n t e r v e n t i o n s . I n c i d e n t a l f i n d i n g s i n c l u d e d s u b j e c t s ' comments a b o u t p a r t i c i p a t i o n i n t h e s t u d y and a t t i t u d e s t o w a r d t h e i r i l l n e s s e x p e r i e n c e s and o b t a i n i n g i n f o r m a t i o n . I m p l i c a t i o n s f o r n u r s i n g p r a c t i c e and recommendatons f o r f u r t h e r r e s e a r c h a r e d i s c u s s e d . i i i TABLE OF CONTENTS A b s t r a c t i i T a b l e o f C o n t e n t s i v L i s t o f T a b l e s v i i Acknowledgements v i i i C h a p t e r 1: INTRODUCTION O v e r v i e w 1 B a c k g r o u n d and S i g n i f i c a n c e 2 P r o b l e m 5 P u r p o s e s 6 D e f i n i t i o n o f Terms 6 A s s u m p t i o n s and L i m i t a t i o n s 8 C h a p t e r 2: REVIEW OF RELEVANT LITERATURE I n t r o d u c t i o n 9 C o g n i t i v e I n t e r v e n t i o n s : P a t i e n t E d u c a t i o n .... 11 A f f e c t i v e I n t e r v e n t i o n s : E m o t i o n a l S u p p o r t . . . . 16 P a t i e n t P r e f e r e n c e s f o r H e a l t h C a r e I n t e r v e n t i o n 19 A n x i e t y 24 E f f e c t s o f a n x i e t y 27 Measurement o f a n x i e t y 28 Summary 29 C h a p t e r 3: METHODOLOGY I n t r o d u c t i o n 31 I n s t r u m e n t s and I n s t r u m e n t D e v e l o p m e n t 31 Demo g r a p h i c q u e s t i o n n a i r e 31 H e a l t h C a r e P r e f e r e n c e S u r v e y 32 S t a t e - T r a i t A n x i e t y I n v e n t o r y 33 S e t t i n g 34 S u b j e c t s 35 Human R i g h t s and E t h i c s 36 Data C o l l e c t i o n 37 D a t a A n a l y s i s 38 C h a p t e r 4: PRESENTATION AND DISCUSSION OF RESULTS I n t r o d u c t i o n 41 S e c t i o n 1. The Sample 41 Age and s e x 42 M a r i t a l s t a t u s 42 E d u c a t i o n a l l e v e l s 42 E t h n i c i t y 44 i v O c c u p a t i o n 44 Home r e g i o n 45 P e r f o r m a n c e s t a t u s 45 D i s e a s e s i t e 46 Number o f t r e a t m e n t s 47 N a t u r e o f t r e a t m e n t 47 The sample and o t h e r p o p u l a t i o n s 48 S e c t i o n 2. The H e a l t h C a r e P r e f e r e n c e S u r v e y . . 4 9 R e s p o n s e s t o t h e HCPS 49 C o n c u r r e n t v a l i d i t y 56 S e c t i o n 3. The HCPS and Dem o g r a p h i c V a r i a b l e s . 5 7 Age 57 Sex 58 M a r i t a l s t a t u s 59 E d u c a t i o n 59 E t h n i c o r i g i n 59 O c c u p a t i o n . .60 Home r e g i o n 61 P e r f o r m a n c e s t a t u s 61 D i s e a s e s i t e 62 Number o f t r e a t m e n t s 62 P r i m a r y o r a d j u v a n t t r e a t m e n t 62 S e c t i o n 4. HCPS S c o r e s and STAI S c o r e s 63 C o r r e l a t i o n s between S - A n x i e t y and T - A n x i e t y s c a l e s 66 HCPS s c o r e s and S t a t e a n x i e t y s c o r e s 66 HCPS s c o r e s and T r a i t a n x i e t y s c o r e s 67 S e c t i o n 5. O t h e r F i n d i n g s 68 I n t r o d u c t i o n 68 A t t i t u d e s o f s u b j e c t s 69 Comments a b o u t t h e q u e s t i o n n a i r e s 70 Comments a b o u t i n f o r m a t i o n 71 Comments a b o u t i n f o r m a t i o n and s e n s o r y p r o b l e m s 72 Summary 73 C h a p t e r 5: SUMMARY, CONCLUSIONS, IMPLICATIONS AND RECOMMENDATIONS Summary 77 C o n c l u s i o n s 82 I m p l i c a t i o n s f o r N u r s i n g P r a c t i c e 83 Recommendations f o r F u r t h e r S t u d y 85 BIBLIOGRAPHY 87 v APPENDICES A p p e n d i x A. D e m o g r a p h i c Q u e s t i o n n a i r e and B a c k g r o u n d I n f o r m a t i o n 97 A p p e n d i x B. H e a l t h C a r e P r e f e r e n c e S u r v e y 100 A p p e n d i x C. L e t t e r o f I n t r o d u c t i o n 107 A p p e n d i x D. P a t i e n t I n f o r m a t i o n S h e e t 110 v i L I S T OF TABLES T a b l e Page I . D i s t r i b u t i o n o f S u b j e c t s by Age and Sex 43 I I . M a r i t a l S t a t u s 43 I I I . E d u c a t i o n a l L e v e l s 44 IV. O c c u p a t i o n 45 V. P e r f o r m a n c e S t a t u s 46 V I . D i s e a s e S i t e s 47 V I I . Number o f R a d i o t h e r a p y T r e a t m e n t s 48 V I I I . I n t e r v e n t i o n C h o i c e s on t h e H e a l t h C a r e P r e f e r e n c e S u r v e y f o r I n d i v i d u a l Items..50 IX. D i f f e r e n c e s Between Items 52 X. C o n t e n t o f HCPS Items w i t h R e s p o n s e s . . . . 54 X I . C o n c u r r e n t V a l i d i t y Q u e s t i o n 56 X I I . S t a t e S c o r e s 63 X I I I . T r a i t S c o r e s 64 v i i ACKNOWLEDGEMENTS I would l i k e t o t h a n k Nod M i r h a d y , who s u p p o r t e d t h i s t h e s i s i n i n n u m e r a b l e ways and w i t h o u t whose h e l p i t would n e v e r have been c o m p l e t e d . He gave u n s t i n t i n g l y o f h i s t i m e , e n e r g y , s l e e p and l o v e t o s e e a dream f u l f i l l e d . F o r t h e i r e f f o r t s i n g u i d i n g me t h r o u g h t h e r e s e a r c h p r o c e s s , I am i n d e b t e d t o Dr. M. W i l l m a n , B a r b a r a Warren, Sue R o t h w e l l and B e t t y J o h n s o n . I would l i k e t o t h a n k Dr W i l l m a n f o r h e r i n s i g h t f u l comments and f o r a c c e p t i n g t h e d i f f i c u l t t a s k o f c h a i r i n g my t h e s i s c o m m i t t e e i n m i d - s t r e a m . B a r b a r a Warren's e n t h u s i a s m , c r i t i c a l comments and u n f l a g g i n g s u p p o r t o f my t h e s i s o v e r t h e l a s t f i v e y e a r s w i l l l o n g be remembered w i t h g r a t i t u d e . I would a l s o l i k e t o t h a n k Dr. J a c k s o n , t h e r a d i o t h e r a p y s t a f f a t t h e C a n c e r C o n t r o l Agency o f B.C., and t h e p a t i e n t s who p a r t i c i p a t e d and gave s o g e n e r o u s l y o f t h e i r t i m e t o make t h i s s t u d y p o s s i b l e . v i i i CHAPTER 1 INTRODUCTION O v e r v i e w The d i a g n o s i s and t r e a t m e n t o f c a n c e r a r e g e n e r a l l y a c k n o w l e d g e d t o be s t r e s s f u l p s y c h o s o c i a l e x p e r i e n c e s f o r p a t i e n t s . F e a r , a n x i e t y and e m o t i o n a l d i s t r e s s a r e o f t e n t h e c o n s e q u e n c e s o f t h e p u b l i c p e r c e p t i o n o f c a n c e r a s a l i f e - t h r e a t e n i n g i l l n e s s . Over and above t h e e m o t i o n a l t h r e a t s p o s e d by t h e d i s e a s e i t s e l f a r e t h e o f t e n e q u a l l y p o t e n t t h r e a t s p o s e d by t h e d i a g n o s t i c p r o c e d u r e s , s u r g e r y and c h e m o t h e r a p y o r r a d i o t h e r a p y . H e a l t h c a r e w o r k e r s have a c h o i c e o f i n t e r v e n t i o n s f o r d e a l i n g w i t h t h e p s y c h o s o c i a l p r o b l e m s o f c a n c e r p a t i e n t s . F o r t h e p u r p o s e s o f t h i s s t u d y , t h e s e have been p l a c e d i n two c a t e g o r i e s , a f f e c t i v e and c o g n i t i v e . The p r i m a r y g o a l o f a f f e c t i v e i n t e r v e n t i o n s i s t h e a m e l i o r a t i o n o f t h e e m o t i o n a l d i s t r e s s w h i c h u s u a l l y a c c o m p a n i e s t h e d i a g n o s i s and t r e a t m e n t o f c a n c e r . The p r i m a r y o b j e c t i v e o f c o g n i t i v e i n t e r v e n t i o n s , on t h e o t h e r hand, i s t o a s s i s t p a t i e n t s t o u n d e r s t a n d and c o p e w i t h t h e m u l t i p l e , complex and u n f a m i l i a r p r o c e d u r e s i n v o l v e d i n t h e t r e a t m e n t o f c a n c e r . A l t h o u g h n o t t h e p r i m a r y aim, t h e l a t t e r may a l s o s e r v e t o a m e l i o r a t e e m o t i o n a l d i s t r e s s . G i v e n l i m i t e d r e s o u r c e s o f t i m e , e n e r g y and m a t e r i e l , t h e h e a l t h c a r e w o r k e r o f t e n f a c e s a c h o i c e between p u t t i n g e f f o r t i n t o a f f e c t i v e o r 1 c o g n i t i v e i n t e r v e n t i o n s . The l i t e r a t u r e does not pr o v i d e much guidance f o r d e l i v e r i n g a p p r o p r i a t e , t i m e l y and e f f e c t i v e i n t e r v e n t i o n s . L i k e w i s e , t h e r e i s l i t t l e l i t e r a t u r e on which type o f h e a l t h care i n t e r v e n t i o n p a t i e n t s themselves p r e f e r . Background and S i g n i f i c a n c e A survey i n the USA noted t h a t people ranked the f e a r of cancer h i g h e r than the t h r e a t o f a n u c l e a r h o l o c a u s t or v i o l e n t crimes (Cantor, 1978). The d i a g n o s i s of cancer evokes many powerful emotions and i s g e n e r a l l y acknowledged t o be a very a n x i e t y - p r o v o k i n g experience ( G u l l o , C h e r i c o _ Shadick, 1974; V e t t e s e , 1976; Blumberg, F l a h e r t y & Lewis, 1980). Cantor'<1978) d e s c r i b e s the a n x i e t y response as one of the most d i s r u p t i v e o f the emotional r e a c t i o n s t o cancer. The a n x i e t y evoked by the d i s e a s e can become the primary experience o f the d i s e a s e . When t h i s happens, a n x i e t y has not prepared us f o r a c t i o n , i t has produced an apprehensive s e l f - a b s o r p t i o n t h a t obscures the very nature of what t h r e a t e n s us. (p. 19) However, i t i s not j u s t the d i s e a s e which b r i n g s on a n x i e t y . Bond (1982) found t h a t p a t i e n t s had s i g n i f i c a n t l e v e l s of a n x i e t y and d e p r e s s i o n as a r e s u l t o f having r a d i o t h e r a p y as the primary mode of treatment. Over 50*s of cancer p a t i e n t s w i l l r e c e i v e r a d i o t h e r -apy a t some p o i n t i n t h e i r i l l n e s s (Sarna, 1981). A consensus e x i s t s among h e a l t h c a r e workers t h a t these p a t i e n t s should be gi v e n some form o f p r e p a r a t o r y 2 i n f o r m a t i o n (Creech, 1975; Peck & Boland, 1977; Johnson & F l a h e r t y , 1980; B a t t l e s , 1981; Bouchard-Kurtz & Speese-Owen, 1981; C a s s i l e t h , Heiberger, March & Sutton-Smith, 1982). T h i s i n f o r m a t i o n may take many forms, but has the o v e r a l l goal o f h e l p i n g the p a t i e n t t o e f f e c t -i v e l y cope with the d i s e a s e and treatment experience. Before a course o f treatment begins, h e a l t h care workers are l e g a l l y bound t o meet requirements o f informed consent, namely the complete and reasonable d i s c l o s u r e o f p o t e n t i a l r i s k s , b e n e f i t s and s i d e e f f e c t s of the proposed treatment (Rozovsky, 1979; Magnet-Rogers, 1980; O'Connor, 1981; S t o r c h , 1982). During the course of r a d i o t h e r a p y , a d d i t i o n a l i n f o r m a t i o n should be presented t o enable the p a t i e n t and h i s f a m i l y t o e f f e c t i v e l y manage the p r e d i c t a b l e s i d e e f f e c t s o f treatment which can occur when the p a t i e n t r e t u r n s home (Webb, 1979). A l l o f t h i s i n f o r m a t i o n must be c a r e f u l l y t a i l o r e d t o the needs and a b i l i t i e s of p a t i e n t s t o comprehend i t (Bahnson, 1975). Information they are give n may not correspond with what they want or need. Lauer, Murphy, and Powers (1981) noted t h a t p a t i e n t s and h e a l t h c a r e workers d i f f e r s i g n i f i c a n t l y i n p e r c e p t i o n s of l e a r n i n g needs and of what c o n s t i t u t e s important i n f o r m a t i o n . 3 S e v e r a l authors have observed t h a t a n x i e t y from whatever source i n t e r f e r e s with l e a r n i n g new i n f o r m a t i o n ( I z a r d & Tompkins, 1966; Lader & Marks, 1971; P o h l , 1978). I t i s not s u r p r i s i n g , t h e r e f o r e , t h a t r e c e n t r e s e a r c h has documented t h a t cancer p a t i e n t s , i n p a r t i c u l a r , r e t a i n l i t t l e o f the i n f o r m a t i o n t h a t i s imparted to them (Dodd, 1982a; Dodd & Mood, 1981; I s r a e l & Mood, 1982; Mcintosh, 1974). Cancer poses t h r e a t s t o a p a t i e n t ' s b i o l o g i c a l , p s y c h o l o g i c a l and s o c i a l i n t e g r i t y . I t i s t o cope with the l a s t two of these t h r e a t s t h a t many of the same authors who promote the p r o v i s i o n of p r e p a r a t o r y i n f o r m a t i o n , Bahnson (1975) and Creech (1975) i n p a r t i c u l a r , a l s o recommend the p r o v i s i o n of emotional support t o cancer p a t i e n t s . A f f e c t i v e h e a l t h care i n t e r v e n t i o n s have two b e n e f i t s f o r cancer p a t i e n t s . The f i r s t and most d i r e c t e f f e c t i s t o help the p a t i e n t f e e l more comfortable, l e s s anxious and l e a s e m o t i o n a l l y d i s t r e s s e d . The second, co n c u r r e n t e f f e c t i s t o help c r e a t e the emotional c o n d i t i o n s i n which l e a r n i n g can best take p l a c e . A f f e c t i v e i n t e r v e n t i o n s may i n c l u d e l i s t e n i n g , encouraging the v e n t i l a t i o n of f e e l i n g s , i d e n t i f y i n g f e a r s and concerns, t e a c h i n g s t r e s s reduct-ion or r e l a x a t i o n techniques and t a l k i n g about o u t s i d e a s p e c t s of a p a t i e n t ' s l i f e (Gordon, Fried e n b e r g s , 4 D i l l e r , Hibbard, Wolf, L e v i n s , L i p k i n s , E z r a c h i & Lucido, 1980). Thus, h e a l t h care p r a c t i t i o n e r s are f a c e d with a dilemma. Are they t o fo c u s t h e i r e f f o r t s on c o g n i t i v e i n t e r v e n t i o n s or a f f e c t i v e i n t e r v e n t i o n s , or both? Much of the l i t e r a t u r e , as w i l l be seen i n Chapter 2, recom-mends a comprehensive i n t e r v e n t i o n program t o address p s y c h o s o c i a l problems, but does l i t t l e t o i d e n t i f y p a t i e n t s a t g r e a t e s t r i s k or i n g r e a t e s t need of the d i f f e r e n t k i n d s o f i n t e r v e n t i o n . Does the c h r o n o l o g i c a l order o f the types of i n t e r v e n t i o n make a d i f f e r e n c e ? There are recommendations f o r a f f e c t i v e i n t e r v e n t i o n s (emotional support) b e f o r e i n f o r m a t i o n i s pr o v i d e d , but the o p p o s i t e recommendation i s a l s o made. Furthermore, l i t e r a t u r e concerning p a t i e n t p r e f e r e n c e s p r o v i d e s very l i t t l e i n f o r m a t i o n about whether p a t i e n t s p r e f e r c o g n i t i v e or a f f e c t i v e i n t e r v e n t i o n s or what demographic or p s y c h o l o g i c a l f a c t o r s may a f f e c t the p r e f e r e n c e . Problem L i t t l e i s known about p r e f e r e n c e s of cancer p a t i e n t s f o r c o g n i t i v e or a f f e c t i v e i n t e r v e n t i o n s p r i o r t o or d u r i n g a course o f r a d i o t h e r a p y or how a n x i e t y may a f f e c t these p r e f e r e n c e s . T h e r e f o r e , t h i s study seeks t o add t o a v a i l a b l e knowledge i n these a r e a s . 5 Purposes The study i s designed t o f u l f i l l the f o l l o w i n g purposes: 1. To d e s c r i b e h e a l t h care p r e f e r e n c e s , as measured by the Health Care P r e f e r e n c e Survey [HCPS], among cancer p a t i e n t s r e c e i v i n g r a d i o t h e r a p y f o r the f i r s t time. 2. To examine the r e l a t i o n s h i p between s e l e c t e d demographic v a r i a b l e s and p a t i e n t s ' h e a l t h care p r e f e r e n c e s 3. To examine the r e l a t i o n s h i p between p a t i e n t s ' a n x i e t y , as measured by the S t a t e - T r a i t Anxiety Inventory CSTAI3, and t h e i r h e a l t h c a r e p r e f e r -ences . D e f i n i t i o n o f Terms Health Care P r e f e r e n c e : The s e l e c t i o n o f or pr e f e r e n c e f o r a c o g n i t i v e h e a l t h care i n t e r v e n t i o n or f o r an a f f e c t i v e h e a l t h c a r e i n t e r v e n t i o n as d e s c r i b e d i n the items o f the HCPS. C o g n i t i v e (Health Care) I n t e r v e n t i o n : i s d e f i n e d by the items o f the HCPS as the p r o v i s i o n by a h e a l t h care worker of f a c t s , i n f o r m a t i o n or the explan-a t i o n o f procedures. A f f e c t i v e (Health Care) I n t e r v e n t i o n : i s d e f i n e d by the items of the HCPS as the p r o v i s i o n by a h e a l t h care worker of emotional support. S t a t e A n x i e t y : Defined by S p i e l b e r g e r , (1977) f o r the STAI as: a t r a n s i t o r y emotional s t a t e or c o n d i t i o n o f the human organism t h a t v a r i e s i n i n t e n s i t y and f l u c t u a t e s over time. T h i s c o n d i t i o n i s c h a r a c t e r i z e d by s u b j e c t i v e c o n s c i o u s l y p e r c e i v e d f e e l i n g s o f t e n s i o n and apprehens-i o n , and a c t i v a t i o n o f the autonomic nervous system. L e v e l of A-State should be high i n circumstances t h a t are p e r c e i v e d by an i n d i v i d u a l t o be t h r e a t e n i n g , i r r e s p e c t i v e of the o b j e c t i v e danger; A-State i n t e n s i t y should be low i n circumstances i n which an e x i s t i n g danger i s not p e r c e i v e d as t h r e a t e n i n g . ( p . 39) Threat: Defined by S p i e l b e r g e r (1977) as: an i n d i v i d u a l ' s i d i o s y n c r a t i c p e r c e p t i o n o f a p a r t i c u l a r s i t u a t i o n as p h y s i c a l l y or psycho-l o g i c a l l y dangerous. The a p p r a i s a l o f a s i t u a t i o n as dangerous or t h r e a t e n i n g w i l l be determined, i n p a r t , by an i n d i v i d u a l ' s p e r s o n a l i t y d i s p o s i t i o n and past experience with s i m i l a r s i t u a t i o n s . (p. 30) T r a i t a n x i e t y : Defined by S p i e l b e r g e r , (1977) f o r the STAI as: r e l a t i v e l y s t a b l e i n d i v i d u a l d i f f e r e n c e s i n a n x i e t y proneness, t h a t i s , t o d i f f e r e n c e s i n the d i s p o s i t i o n t o p e r c e i v e a wide range of st i m u l u s s i t u a t i o n s as dangerous or t h r e a t e n -i n g and i n the tendency t o respond t o such t h r e a t s with A-State r e a c t i o n s . A - T r a i t may a l s o be regarded as r e f l e c t i n g i n d i v i d u a l d i f f e r e n c e s i n the frequency and the i n t e n s i t y with which A-States have been manifested i n the p a s t , and i n the p r o b a b i l i t y t h a t such s t a t e s w i l l be experienced i n the f u t u r e .