Structural Model of Adjustment to Cancer based on Paradigm Scenarios and mediating Role of Illness Perception

Objective: This study aimed to develop and validate a model of psychological adjustment to cancer based on emotional macro-narratives, with illness perception as a mediating variable.
Methods and Materials: A cross-sectional, correlational study using structural equation modeling (SEM) was conducted among 400 cancer patients from medical centers in Tehran between July and September 2024. Participants were selected via convenience sampling. Inclusion criteria were literacy, age between 35 and 60 years, and willingness to participate. Data collection instruments included the Cancer Adjustment Questionnaire (Leonard & Derogatis, 1990), the Brief Illness Perception Questionnaire (Broadbent et al., 2006), and a researcher-developed Emotional Macro-Narratives Questionnaire. Data analysis was performed using SPSS-24 and AMOS-24. Model fit was assessed using standard SEM indices.
Findings: The proposed model demonstrated excellent fit (CFI = 0.996, RMSEA = 0.001, GFI = 0.923). Emotional macro-narratives (heroic, victimhood, growth, solidarity, acceptance, and emotional contradiction) showed significant direct and indirect effects on adjustment to cancer through illness perception (p < 0.001). Positive narratives (e.g., heroic, growth) enhanced adaptation via positive illness perception, while negative narratives (e.g., victimhood, emotional contradiction) impaired adjustment via negative illness perception. Illness perception was a strong mediator (β = 0.503), and coping strategies further influenced the adjustment process.
Conclusion: Emotional macro-narratives significantly shape how patients adjust to cancer, with illness perception acting as a crucial mediating mechanism. Recognizing and reshaping these narratives may enhance clinical interventions targeting psychological resilience and adjustment in cancer care.