Appraisal Of Illness Research Articles

“I too have a responsibility for my partner's life”: Communal coping among Malawian couples living with HIV and cardiometabolic disorders

RationaleHIV and cardiometabolic disorders including hypertension and diabetes pose a serious double threat in Malawi. Supportive couple relationships may be an important resource for managing these conditions. According to the theory of communal coping, couples will more effectively manage illness if they view the illness as “our problem” (shared illness appraisal) and are united in shared behavioral efforts. MethodsThis study qualitatively investigated communal coping of 25 couples living with HIV and hypertension or diabetes in Zomba, Malawi. Partners were interviewed separately regarding relationship quality, shared illness appraisal, communal coping, and dyadic management of illness. ResultsMost participants (80%) were living with HIV, and more than half were also living with hypertension. Most participants expressed high levels of unity and the view that illness was “our problem.” In some couples, partners expected but did not extend help and support and reported little collaboration. Communal coping and dyadic management were strongly gendered. Some women reported a one-sided support relationship in which they gave but did not receive support. Women were also more likely to initiate support interactions and offered more varied support than men. In couples with poor relationship quality and weak communal coping, dyadic management of illness was also weak. Partner support was particularly crucial for dietary changes, as women typically prepared meals for the entire family. Other lifestyle changes that could be supported or hindered by a partner included exercise, stress reduction, and medication adherence. ConclusionWe conclude that gendered power imbalances may influence the extent to which couple-level ideals translate into actual communal coping and health behaviors. Given that spouses and families of patients are also at risk due to shared environments, we call for a shift from an illness management paradigm to a paradigm of optimizing health for spouses and families regardless of diabetes or hypertension diagnosis.

Cognitive appraisal of illness versus expectations towards doctors and health-related behaviours in individuals with short- and long-standing diagnosis of type 2 diabetes

Introduction: Patients with diabetes need to be actively involved in the treatment process, i.e. treatment regimens and regular health check-ups. The aims of the study were to assess the profiles of illness cognitive appraisals in individuals with type 2 diabetes, and to recognize the relationships between illness cognitive appraisals and both expectations towards doctors and readiness to health-related behaviours. Materials and methods: A total number of 99 participants with type 2 diabetes were divided into short- and long-standing diagnosis sub-groups. Illness-Related Appraisals Scale, The Patient Requests Form, Health-Related Behavior Inventory were administered. Results: The comparison of most representative profiles showed significant differences between sub-groups in perceiving the illness as threat, benefit, obstacle/loss. In both sub-groups, treating the illness as a benefit determined patient’s expectations of emotional support from doctors. In patients with long-standing diagnosis also threat, value, obstacle/loss and harm impact significantly on the patients’ expectations towards doctors. Treating the illness as a challenge explained about 24% of variability of eating habits and 29% of preventive behaviours. Conclusions: Participants with long-standing diagnosis treat their illness as threatening and disturbing. In these patients many dimensions of cognitive appraisal are related to seeking information about the illness and to a need of emotional support from doctors. On the contrary, in individuals with short-standing diagnosis, only perceiving their illness as a benefit is associated with the expectation towards their doctors to provide emotional support and explanation of the illness. Our study proved that perceiving the long-lasting illness as a challenge contributes to readiness to follow health-related behaviours. Keywords: type 2 diabetes, health-related behaviour, attitude to illness

Assessment and acceptance of cancer in prostate cancer patients

Background: Malignant prostate cancer is associated with many negative psychological consequences in patients. Therefore, it is reasonable to explore intensity of the acceptance of cancer and the factors that determine its level. This study aims to determine which types of the appraisal of illness predict the acceptance of illness and to what extent. Patients and methods: This study was conducted in a group of forty-five prostate cancer inpatients for radiotherapy. The following tools measuring the appraisal of illness and acceptance of illness were used: the Disease-Related Appraisals Scale (DRAS) by Janowski, Steuden, Kurylowicz and Nieśpiałowska- Steuden, and the Acceptance of Illness Scale (AIS) by Janowski and Steuden. Results: Higher levels of satisfaction with life despite the disease were associated with a lower level of appraisal of illness as an obstacle/loss, a lower sense of harm and a greater tendency to interpret illness as a value. Reconcilement with the disease was negatively associated with the appraisal of illness as a threat and obstacle/loss. Self-distancing from the disease was negatively associated with the appraisal of illness as a threat and significant situation. The overall acceptance of illness score was negatively associated with the appraisal of illness as a threat and significant situation. Conclusions: The appraisal of illness as a challenge and obstacle/loss was the most common predictor of the acceptance of illness in prostate cancer patients. A greater level of appraisal of illness as a challenge contributes to a greater level of acceptance of illness in patients. A lower level of appraisal of illness as an obstacle/loss contributes to a greater level of acceptance of illness in prostate cancer patients.

Factors associated with sleep health in young women after breast cancer treatment.

Young women with breast cancer (YWBC) report physical and psychological symptom distress after therapy but little is known about their sleep health. The purpose of this study was to identify sociodemographic, clinical, and psychosocial factors associated with sleep health and assess the potential role of appraisal of illness and coping on sleep health. An adapted cognitive appraisal and coping conceptual framework guided the study. We used a cross-sectional design with 159 women who were diagnosed with stage I-III breast cancer ≤50 years old. Sleep health was measured by the Pittsburgh Sleep Quality Index (PSQI). The mean age was 43.6 years (SD = 6.8), the majority of whom were non-Hispanic White (84%) and completed chemotherapy or radiotherapy (>70%). More than half of participants (55%) reported poor sleep health (PSQI > 8), and those with worse family functioning and from a racial/ethnic minority group were significantly more likely to have poor sleep health. Cognitive appraisal had a minimal mediation effect for anxiety on sleep health, and coping did not mediate the effect of any psychosocial variables on sleep health. Poor sleep health is a significant clinical problem in YWBC. Further research is needed to explore sleep health disparities among diverse cancer survivors and to examine sleep health in the context of family. Sleep assessment, management, and appropriate referrals to sleep providers should be part of routine survivorship care.

Narratives of Patients with Osteoarthritis from Yucatan: A Focus Group Interview Study

Introduction: Narrative Medicine serves to accompanying the patient through the experience of illness, listening to his/her story in a simplified therapeutic role. The aim of this interview-based study was to explore in a group of patients with OA from Yucatan the content of their narratives regarding their illness. Methods: Eight patients with OA participated in five focus group interviews that were tape recorded and transcribed verbatim. Narrative analysis considered the number of mentions and theoretical saturation with three dimensions: pain, stiffness and functional capacity.Results: Pain was associated with quality of life, religiosity and social interactions. Regarding stiffness and functional capacity, participants expressed the appraisal of illness as an inevitable deterioration and a rather passive coping response.Conclusions: Narrative-based evidence on how patients with OA perceive and manage their illness underscore health as a concept where the physical and psychological dimensions are in an ongoing interaction; thus, calling for more sensitivity from the medical community and for a comprehensive interdisciplinary treatment.

Predictors of quality of life and depression among Korean-American cancer patients and their family caregivers.

This study examined social, cultural, and appraisal factors associated with Korean-American cancer patients' and their family caregivers' quality of life (QOL) and depression. Data were from Korean-American cancer patients and their family caregivers (N=60 dyads) living in the United States. Study aims were examined using descriptive statistics and multiple regression. For patients, higher social support and lower negative appraisal of illness predicted higher patient QOL; negative appraisal of illness also predicted higher patient depression. For caregivers, older age, having fewer traditional Korean values, and more modern (individualistic) values predicted higher caregiver QOL. Caregivers who held more modern values also had less depression. Higher support and less negative appraisal predicted better QOL in patients. For caregivers however, the type of cultural values they held (tradition or modern) was a key factor that predicted level of QOL and depression. Assessment of support and appraisal as well as attention to cultural values may enhance their QOL and reduce depression.

Optimism, Symptom Distress, Illness Appraisal, and Coping in Patients With Advanced-Stage Cancer Diagnoses Undergoing Chemotherapy Treatment.

To explore the relationships between optimism, self-efficacy, symptom distress, treatment complexity, illness appraisal, coping, and mood disturbance in patients with advanced-stage cancer. . Cross-sectional study. . Smilow Cancer Hospital at Yale New Haven in Connecticut, an outpatient comprehensive cancer center. . A convenience sample of 121 adult patients with stages III-IV cancer undergoing active chemotherapy. . Participants completed common self-report questionnaires to measure variables. Treatment hours and visits were calculated from data retrieved from medical record review. Mediation and path analysis were conducted to identify direct and indirect pathways from the significant antecedent variables to mood disturbance. . Dispositional optimism, self-efficacy, social support, treatment complexity, symptom distress, illness appraisal, coping, and mood disturbance. . Greater optimism and self-efficacy were associated with less negative illness appraisal, less avoidant coping, and decreased mood disturbance. Conversely, greater symptom distress was associated with greater negative illness appraisal, greater avoidant coping, and greater mood disturbance. In the final model, optimism and symptom distress had direct and indirect effects on mood disturbance. Indirect effects were partially mediated by illness appraisal. . Mood disturbance resulted from an interaction of disease stressors, personal resources, and cognitive appraisal of illness. Avoidant coping was associated with greater disturbed mood, but neither avoidant nor active coping had a significant effect on mood in the multivariate model. . Illness appraisal, coping style, and symptom distress are important targets for intervention. Optimism is a beneficial trait and should be included, along with coping style, in comprehensive nursing assessments of patients with cancer.

Pictorial representation of illness and self-measure as an instrument for diagnostic of illness representation in youth with ultra-high risk for psychosis

IntroductionPictorial representation of illness and self-measure (PRISM) was developed as screening tool assessing implicit reaction to somatic illnesses. Conclusion is based on comparisons of the positions of illness-related (“Illness” and major symptoms) and unrelated (“Me”, “Family”, “Work/study”) objects on the list.ObjectivesDue to its easiness and implicitness PRISM could be promising addition to illness representation questionnaires in mental illnesses.Aim was to reveal validity of the PRISM in youth with ultra-high risk for psychosis.MethodsEighty-one male patients 16–25 years old meeting criteria of ultra-high risk for psychosis; preliminary diagnoses of mood disorders 34, personality disorders 26, schizotypal disorder 21 patients) filled PRISM, beck cognitive insight scale, symptom checklist 90-r, illness perception questionnaire, quality of life and enjoyment questionnaire and happiness scale.ResultsAccording to hierarchical regression, conditional “Self-Illness” distance (after control for mean distances on the list) was related to less psychopathological complaints, lower subjective illness severity and emotional representations, higher treatment control and better quality of life. “Self-symptoms” distance was related to better cognitive insight, lower emotional representations and consequences and moderated the relationship between “Self-Illness” distance and appraisals of illness length and dynamic.ConclusionsConditional “Self-Illness” distance in PRISM could reflect cognitive appraisal of illness based on symptoms and related to life satisfaction while “Self-Symptoms” distance reflects merely emotional reaction based on cognitive insight.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Personality, psychopathological symptoms and illness perception in mental disorders: Results from Russian MMPI-2 validation study

IntroductionAccording to common-sense model illness representation regulates her coping both in somatic and mental illnesses.ObjectivesAs a personal reaction illness representation should partially depend not only on diagnosis and symptoms but also on personality. Aim is to identify direct and indirect effects of personality and psychopathological complaints in illness representation in mental disorders.MethodsEighty patients (20 males) from MMPI-2 validation sample (Butcher et al., 2001) filled revised version of Illness Perception Questionnaire and Symptom Checklist 90-R. Eleven patients met ICD-10 criteria for addictions, 28 – for mood disorders, 20 – for schizophrenia and schizotypal disorder, 21 – for acute stress reactions.ResultsAccording to moderation analysis, illness-related beliefs in mental disorders are relatively independent on clinical diagnosis and specific symptoms, but are associated with the overall level of psychopathological complaints. Regardless of the clinical group and complaints, depressive traits are associated with negative and emotional appraisal of illness. Social introversion and hypomanic activation serve as moderators of the relationship between complaints, illness duration and emotional representations.ConclusionsPersonality and overall level of psychopathological symptoms could be stronger predictor of illness-related beliefs than specific clinical factors in mental illness. Preliminary diagnostics of personality in mental illnesses could be used to reveal high-risk group for poor insight and non-compliance due to unrealistic beliefs. Research supported by the grant of President of the Russian Federation for the state support for young Russian scientists, project MK2193.2017.6.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Deficits awareness in persons with mild cognitive impairment and family care partners.

An emerging perspective of dyadic coping with chronic illness argues that concordance in the appraisal of illness is crucial for collaborative attempts at seeking information, making treatment decisions, and planning for long-term management of the illness and psychological and physical adjustments of both the care provider and care recipient. The present study examined whether persons with mild cognitive impairment (PwMCIs) and their family care partners (CPs) exhibited concordance in their awareness of deficits in the PwMCIs. Furthermore, this study explored the differences in concordance based on the relationship of the informant to the PwMCI, specifically spouse CP (SCP) versus adult child CP (ACCP). PwMCI-SCP pairs (n = 55) and PwMCI-ACCP (n = 14) pairs provided reports on their awareness of PwMCI's functional and cognitive deficits. CPs also reported their knowledge about dementia. SCPs, but not ACCPs, reported greater deficits in everyday activity than PwMCIs' self-reports. Additionally, compared to SCPs, ACCPs had more accurate knowledge about dementia, and their perception of PwMCI deficits corresponded more closely to PwMCI's self-perception. These findings demonstrate that concordance in awareness of PwMCI deficits varies across functional and cognitive areas and types of dyads. The results also highlight the importance of mild cognitive impairment-related education and support programs for care dyads to strengthen concordance, which is likely an important underpinning for effective coping as the illness progresses. (PsycINFO Database Record

Parent illness appraisals, parent adjustment, and parent-reported child quality of life in pediatric cancer

ABSTRACTPsychosocial distress is a salient construct experienced by families of children with newly diagnosed cancer, but little is known about parental appraisal of the child's illness and the subsequent impact this may have on child and parent functioning. The goal of the present study was to examine the interrelationships among multiple parent illness appraisals, parent adjustment outcomes, and parent-reported child quality of life in parents of children diagnosed with cancer. Parents completed measures of illness appraisal (illness uncertainty and attitude toward illness), parent adjustment (general distress, posttraumatic stress, parenting stress), and child quality of life (general and cancer-related). Path analysis revealed direct effects for parent illness uncertainty and illness attitudes on all 3 measures of parent adjustment. Illness uncertainty, but not illness attitudes, demonstrated a direct effect on parent-reported child general quality of life; parenting stress had direct effects on general and cancer-related quality of life. Exploratory analyses indicated that parent illness uncertainty and illness attitudes conferred indirect effects on parent-reported general and cancer-related quality of life through parenting stress. Negative parent illness appraisals appear to have adverse impacts on parents' psychosocial functioning and have implications for the well-being of their child with cancer.

Anxiety, bulimia, drug and alcohol addiction, depression, and schizophrenia: what do you think about their aetiology, dangerousness, social distance, and treatment? A latent class analysis approach.

Mental illness stigma is a serious societal problem and a critical impediment to treatment seeking for mentally ill people. To improve the understanding of mental illness stigma, this study focuses on the simultaneous analysis of people's aetiological beliefs, attitudes (i.e. perceived dangerousness and social distance), and recommended treatments related to several mental disorders by devising an over-arching latent structure that could explain the relations among these variables. Three hundred and sixty university students randomly received an unlabelled vignette depicting one of six mental disorders to be evaluated on the four variables on a Likert-type scale. A one-factor Latent Class Analysis (LCA) model was hypothesized, which comprised the four manifest variables as indicators and the mental disorder as external variable. The main findings were the following: (a) a one-factor LCA model was retrieved; (b) alcohol and drug addictions are the most strongly stigmatized; (c) a realistic opinion about the causes and treatment of schizophrenia, anxiety, bulimia, and depression was associated to lower prejudicial attitudes and social rejection. Beyond the general appraisal of mental illness an individual might have, the results generally point to the acknowledgement of the specific features of different diagnostic categories. The implications of the present results are discussed in the framework of a better understanding of mental illness stigma.

Quality of life among women with breast cancer living in Wuhan, China

BackgroundQuality of life is an important indicator in patients with breast cancer. Studies here reported that the quality of life in patients with breast cancer is low and many factors contribute to this poor quality of life. PurposeTo examine the relationships among demographic characteristics, optimism, social support, illness related factors, appraisal of illness, coping strategies and the quality of life of Chinese women with breast cancer residing in Wuhan, China. MethodsA convenience sample of 156 Chinese women with breast cancer was recruited from five teaching hospitals in Wuhan, China. Participants completed the Revised Life Orientation Test, the Perceived Social Support Scale, the Symptom Distress Scale, the Appraisal of Illness Scale, the Medical Coping Modes Questionnaire, and the Functional Assessment of Cancer Therapy-Breast. Path analysis was used to examine factors influencing quality of life. ResultsSignificant relationships were found between optimism, symptom distress, social support, appraisal of illness, a give-in coping mode and quality of life. Optimism, social support, symptom distress, lymph node status, appraisal of illness, and a give-in coping mode accounted for 66.6% of the variance in quality of life. ConclusionsThe findings of this study underscore the importance of helping women reduce symptoms distress, appraise their illness positively, use less negative coping modes, and maintain optimism, maintain good social support, because all of these factors indirectly or directly affect their quality of life.

Pain in primary Sjögren’s syndrome: the role of catastrophizing and negative illness perceptions

Objectives: Pain is a major factor in health quality in Sjögren’s syndrome (SS), but little is known about the factors that contribute to pain severity. Because pain perception has been linked to catastrophizing in other diseases, we assessed subjects with primary SS (pSS) to explore a possible link between pain, illness appraisal, and catastrophizing.Method: A total of 92 subjects who met American–European consensus criteria for the diagnosis of pSS completed a questionnaire that included health history, medication use, illness perceptions, pain severity, mood, fatigue, pain anxiety, and pain catastrophizing. Linear regression was used to test the effect of each variable on pain severity. Multivariate models were constructed using backwards elimination to assess the significant predictors of pain severity.Results: From linear regression analysis, catastrophizing was more strongly predictive of pain severity than age, fatigue, depression, or anxiety in both seropositive and seronegative pSS patients. In the multivariate model identified using backwards selection, four variables (pain catastrophizing, fibromyalgia status, serological status, and the conviction that illness would have severe consequences) predicted 55% of the variance in pain severity.Conclusions: Pain catastrophizing was a significant predictor of pain severity in both seropositive and seronegative pSS patients. This study suggests that behavioural interventions designed to reduce pain catastrophizing and negative appraisal of illness could be of benefit in pSS patients. Research is needed to test the effect of psycho-educational therapies on key patient-reported outcomes, particularly pain, depression, and fatigue, in pSS.

The influence of developmental life stage on quality of life in survivors of prostate cancer and their partners

Although prostate cancer is prevalent, little information is available on how it affects couples' quality of life (QOL) according to their age cohort. The purpose of this study was to examine how quality of life, self-efficacy and appraisal of the illness experience vary among men with prostate cancer and their partners according to age cohort: middle age (50-64); young-old (65-74); and old-old (75-84). Using an Adult Developmental and Family Stress framework, this study focuses on how normative (developmental stage) and non-normative stressors (prostate cancer) may affect a couple's ability to adapt. A descriptive, comparative design was used to examine age-related differences in quality of life and selected psychosocial variables in 69 men with prostate cancer and their spouses. Cross-sectional data were obtained using standardized instruments with adequate reliability and validity. ANCOVA and MANCOVA were used to determine differences among age groups. Findings indicated that patients who were ages 65-74 had better QOL and higher self-efficacy than patients ages 50-64 and less negative appraisal of illness than the other two groups. Spouses ages 50-64 reported the most distress related to sexual changes in their husbands. Spouses in both the middle age and old-old group had more bother related to hormone therapy than the young-old spouses. Findings suggest that interventions should be tailored to dyads' developmental life stage. Younger and older prostate cancer survivors and their partners may benefit from tailored interventions designed to improve their quality of life and confidence in managing their treatment outcomes during the survivorship period.

Randomized clinical trial of a family intervention for prostate cancer patients and their spouses

Few intervention studies have been conducted to help couples manage the effects of prostate cancer and maintain their quality of life. The objective of this study was to determine whether a family-based intervention could improve appraisal variables (appraisal of illness or caregiving, uncertainty, hopelessness), coping resources (coping strategies, self-efficacy, communication), symptom distress, and quality of life in men with prostate cancer and their spouses. For this clinical trial, 263 patient-spouse dyads were stratified by research site, phase of illness, and treatment; then, they were randomized to the control group (standard care) or the experimental group (standard care plus a 5-session family intervention). The intervention targeted couples' communication, hope, coping, uncertainty, and symptom management. The final sample consisted of 235 couples: 123 couples in the control group and 112 couples in the experimental group. Data collection occurred at baseline before randomization and at 4 months, 8 months, and 12 months. At 4-month follow-up, intervention patients reported less uncertainty and better communication with spouses than control patients, but they reported no other effects. Intervention spouses reported higher quality of life, more self-efficacy, better communication, and less negative appraisal of caregiving, uncertainty, hopelessness, and symptom distress at 4 months compared with controls, and some effects were sustained to 8 months and 12 months. Men with prostate cancer and their spouses reported positive outcomes from a family intervention that offered them information and support. Programs of care need to be extended to spouses who likely will experience multiple benefits from intervention.

Living With Prostate Cancer: Patients' and Spouses' Psychosocial Status and Quality of Life

Despite the high prevalence of prostate cancer, little information is available on the quality of life of men and their spouses during the phases of illness. This study assessed patients' and spouses' quality of life, appraisal of illness, resources, symptoms, and risk for distress across three phases of prostate cancer: newly diagnosed, biochemical recurrence, and advanced. The sample consisted of 263 patient/spouse dyads. A stress-appraisal conceptual model guided the selection of variables which were then assessed with established instruments. Study variables were examined for phase effects (differences in dyads across three phases), role effects (patients v spouses), and phase-by-role interactions (differences within dyads across phases) using analysis of variance (ANOVA). More phase effects than role effects were found, indicating that the psychosocial experiences of patients and their spouses were similar, but differed from dyads in other phases. Dyads in the advanced phase were at highest risk for distress. These patients had the lowest physical quality of life, and their spouses had the lowest emotional quality of life of all participants. Dyads in the biochemical recurrence and advanced phases had more negative appraisals of illness and caregiving, greater uncertainty, and more hopelessness compared with dyads in the newly diagnosed phase. Spouses, in contrast to patients, had less confidence in their ability to manage the illness and perceived less support across all phases of illness. Phase-specific programs of care are needed to assist both men with prostate cancer and their spouses to manage the effects of illness.

Recherche et facteurs environnementaux

In 2002, the Inserm (...) published an expert appraisal of Child and Adolescent Mental Illness. This report emphasised that research should fulfil the demands of EBM (evidence-based medicine), if it wished to be viewed as scientific, which is rarely seen in French research. Thus, we decided to discover what is in fact the case, by examining the research published in one of the best-known journal in France, between 1985 and 2002. This literature review (which was based on more than 40 related studies of the environmental factors in the psychology and psychopathology of development) led us to conclude that even though French research does not often fulfil the criteria detailed by Inserm, it has several advantages: it is better adapted to our cultural context, it is more easily applied to clinical situations where comorbidity is the rule, and it is more clinically relevant as an awareness of the importance of meaning is an essential ingredient in the diagnostic and therapeutic approach.

Effects of a family intervention on the quality of life of women with recurrent breast cancer and their family caregivers

The purpose of this study was to determine if patients with advanced breast cancer and their family caregivers, who participated in a family based intervention, report better quality of life and other psychosocial outcomes than dyads who received standard care alone. Using a randomized clinical trial, 134 patients and their family caregivers were assigned to usual care (control) or to usual care plus the family intervention (experimental condition). Dyads were assessed at baseline, three- and six-months later. The intervention consisted of five sessions and addressed family involvement, optimistic attitude, coping effectiveness, uncertainty reduction, and symptom management. Patients in the family intervention reported significantly less hopelessness and less negative appraisal of illness than controls; their family caregivers reported significantly less negative appraisal of caregiving. Intervention effects were evident at three-months, but were not sustained at six-months. No difference was found in the quality of life of dyads in experimental or control conditions. Although the family intervention had positive effects initially, these effects were not sustained over time. Future studies need to consider program dose and duration of effect, outcome measures that are more sensitive to change, and realistic end-points for patients with advanced cancer.

African-American and White Women's Appraisal of Their Breast Cancer

African-American women are less likely to be diagnosed with breast cancer than are White women but are more likely to be adversely affected. Although differences in incidence and mortality have been explored in some depth, little attention has been paid to how these women cope with the disease or whether their appraisal of their breast cancer differs from that of White women. Using a comparative design, this study analyzed the differences in appraisal between African-American and White women with breast cancer. The findings suggest that no differences exist between African-American and White women's appraisal of their breast cancer. The type of primary appraisal used most by both groups was harm to their health, safety, and physical well-being. The secondary appraisal used most was that breast cancer was an experience they had to accept. Possible links between appraisal and cognitive representations of illness and suggestions for further research on the appraisal are discussed.