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Many people say cancer changed them for the better, and that report is real. What the standard questionnaire measures is less clear: when researchers compared what people said had changed with what had actually changed on the same measures taken before and after the event, the two were largely unrelated, and perceived growth went with more distress while measured growth went with less.
Post-traumatic growth is usually measured with the Post-traumatic Growth Inventory, which asks a person to rate how much they have changed in several domains as a result of the event. That is a demanding cognitive task: it requires recalling how you were, judging how you are, computing the difference, and attributing it to the right cause.
The cleanest test of whether people can do it was not done in cancer. Undergraduates completed measures of the domains the inventory covers at one time point and again two months later. Among the 122 who reported a traumatic event in between, inventory scores "generally were unrelated to actual growth in PTG-related domains". More striking, "perceived growth was associated with increased distress from pre- to posttrauma, whereas actual growth was related to decreased distress, a pattern suggesting that perceived and actual growth reflect different processes", and perceived growth, but not actual growth, went with positive reinterpretation as a coping style. The authors' conclusion: "the PTGI, and perhaps other retrospective measures, does not appear to measure actual pre- to posttrauma change." This study was in students, not cancer patients, and it is cited here because no equivalent prospective comparison in cancer was found in this round, which is itself the point.
A later pair of experiments tested the obvious fix. If the problem is that the four cognitive steps are hard, can people be coached through them? In two experiments with 310 and 306 undergraduates, reaction-time measurement suggested respondents do not in fact engage in the four steps, and when participants were coached to take them they reported less growth, but the resulting scores were "generally unrelated to measures of convergent and predictive validity". The authors concluded that "individuals cannot accurately report PTG, even when explicitly coached."
The critique aimed specifically at cancer care came earlier. A 2010 review in a behavioural medicine journal examined four claims common in the positive psychology literature about people with cancer: that attitudes such as a fighting spirit extend life; that interventions cultivating positive states improve immune function and cancer outcomes; and the evidence for benefit finding and for post-traumatic growth. It found that "Claims about these areas of research routinely made in the positive psychology literature do not fit with available evidence", noted "the incoherence of claims about the adaptational value of benefit finding and post-traumatic growth among cancer patients", and called the idea that such interventions improve prognosis by strengthening the immune system implausible.
What a reader should take from this, stated plainly and in both directions. If you feel that having cancer changed your priorities, your relationships or your sense of what matters, that experience is yours and nothing here contradicts it; people report it consistently and it is associated with meaningful things. What the evidence does not support is the next three steps that are often taken from there: that the questionnaire score measures real change, that growth is a goal of treatment, or that failing to find meaning in an illness is a failure of coping. A person who finds nothing good in it at all is not doing recovery wrong. The tone of a great deal of survivorship writing assumes otherwise, and the measurement literature is the reason to be careful of it.
Retrospective self-report of change requires a person to reconstruct a past self, and reconstruction is biased by the present. Someone currently distressed has reason to perceive change in order to make sense of the distress, which is the mechanism proposed for the finding that perceived growth tracks increased distress while prospectively measured change tracks reduced distress. Until a prospective design is used, a growth score is evidence about how a person is making sense of what happened, not about what happened to them.
Query for this technology: (TITLE:"Post-traumatic growth: what people report, and what the measurement actually captures" OR ABSTRACT:"Post-traumatic growth: what people report, and what the measurement actually captures") AND (cancer OR tumor OR tumour OR oncology OR carcinoma OR lymphoma OR leukemia OR leukaemia OR myeloma OR sarcoma OR melanoma OR glioma). Results are unfiltered search hits about Post-traumatic growth: what people report, and what the measurement actually captures, not a curated reading list.
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