Monitors and Blunters: Different Patient Coping Styles

BETHESDA, Md--Compliance problems cost millions of lives each year because patients fail to show up for screening, fail to come in for follow-up visits, don’t stick to their medications, or revert to unhealthy behavior, said Suzanne M. Miller, PhD, director of Psychosocial and Behavior Medicine, and senior member, Division of Population Science, Fox Chase Cancer Center.

"Unfortunately, simply educating people about effective new methods for cancer prevention or control doesn’t translate into better health for patients," Dr. Miller said at the American Society of Preventive Oncology annual meeting. "This is especially true for people whose bodies haven’t done them any harm yet."

How do patients feel and think when facing the threat of cancer? Discovering the different coping styles of cancer patients and tailoring messages to them can increase adherence at every stage, she said.

Dr. Miller broadly characterizes people as either "monitors" or "blunters" in the face of perceived threats. "Monitors are highly attentive and sensitized, and tend to amplify threats," she said. "Blunters avoid and minimize the same threats. Understanding the effects of coping styles on patient adaptation can help physicians increase compliance."

Monitors, she said, may be told "abnormal Pap smear" but hear "cervical cancer." They report greater concerns, perceive greater risk, are less confident of a solution, are more depressed and anxious, and show poorer pain management. They need more reassurance, more time support, and more hand-holding. "They are the sort of people who make an oncologist’s beeper go off in the middle of the night with endless questions that never seem to be answered to their satisfaction," she said.

Blunters, on the other hand, are less attentive to threats, showing little urgency as threats arise. Their distraction tendencies produce even more blunting behavior as real risk increases.

Both coping styles can result in noncompliance, she said. Blunters may underestimate the risks they face and fail to show up for appointments. Monitors may overestimate the same risks out of fear--and also fail to come in.

Doctors should probe patients to find the profile of barriers to action, then tailor their approach with that in mind, Dr. Miller said. She has developed a 3-minute monitor/blunter scale to differentiate the two styles in patients:

Sample Question and Responses From the Monitor-Blunter Style Scale (MBSS)

Vividly imagine that you are afraid of the dentist and have to get some dental work done. Which of the following would you do? Check all statements that might apply to you.

I would want the dentist to tell me when I would feel pain.

I would watch all the dentist’s movements and listen for the sound of the drill.

I would try to think about pleasant memories.

I would do mental puzzles in my mind.

Responses 1 and 2 indicate a monitoring style. Responses 3 and 4 indicate a blunting style.

A simple postdiagnostic follow-up phone call can be more effective when pitched to the patient’s own cognitive style, she said. For example, blunters can be told that they can still have problems in the absence of symptoms and that it is important they should follow the physician’s advice. For monitors, Dr. Miller suggests lowering the threat level by emphasizing the value of early detection and management.