What stage of change is a patient in who is aware of their cancer diagnosis and the need for surgery, but is hesitant due to fear of complications?

Stage of Change: Contemplation

This patient is in the Contemplation stage (B), as he is aware of his cancer diagnosis and the need for surgery but is actively weighing the risks and benefits while experiencing fear about complications.

Understanding the Stages of Change Framework

The Transtheoretical Model (Stages of Change) describes how individuals progress through behavioral change:

• Precontemplation: The patient is unaware of the problem or denies the need for change 1
• Contemplation: The patient acknowledges the problem and is actively considering change but has not yet committed to action 1
• Action: The patient has made the decision and is actively implementing the behavioral change 1

Why This Patient is in Contemplation

The patient demonstrates classic contemplation characteristics:

• He is aware of his cancer diagnosis (not in denial or precontemplation) 1
• He recognizes the need for surgery as a treatment option 1
• He is actively weighing the decision, specifically concerned about surgical complications 1
• He has not yet committed to proceeding with surgery (not in action stage) 1

This represents "anxious preoccupation" where the patient reacts to diagnosis with persistent anxiety and apprehension about treatment outcomes 1.

Clinical Context and Decision-Making Barriers

Fear-based hesitation is common and well-documented in cancer patients facing treatment decisions:

• Approximately 59% of actual cancer patients express desire to select their own treatment, compared to 69% of healthy volunteers given hypothetical diagnoses, suggesting that the reality of cancer diagnosis creates decision-making paralysis 1
• Patients may avoid active decision-making due to inadequate knowledge, inability to process information, or wish to deflect potential self-blame in case of poor outcomes 1
• The diagnosis of life-threatening illness creates immediate psychosocial distress, and fear is a rational response to a real threat 2

Psychological Distress and Treatment Decisions

This patient's fear represents significant distress that can interfere with treatment adherence:

• Distress is defined as an unpleasant emotional experience that may interfere with the ability to cope effectively with cancer and its treatment 1
• Failure to recognize and treat distress leads to trouble making decisions about and adhering to treatment 1
• Approximately 25.7% of new cancer patients score above cut-off points for psychological distress requiring intervention 2

Moving from Contemplation to Action

To facilitate progression to the Action stage, address the following:

• Provide specific, detailed information about surgical risks, benefits, and expected outcomes to reduce illness uncertainty 3
• Acknowledge that younger patients and those with higher baseline fears tend to report lower satisfaction and higher post-visit fears 4
• Recognize that engagement coping strategies (active coping, planning, seeking support, positive reframing) moderate the negative effects of distress on quality of life 1
• Offer immediate psychosocial support, as early evaluation and screening for distress leads to better medical management 1

Common pitfall: Healthcare providers often respond to the content of patients' concerns with medical information but rarely acknowledge the affective (emotional) aspect of the concerns 5. This patient needs both factual information about surgical safety AND explicit acknowledgment of his fears as legitimate and manageable.