Greater Sense Of Control Research Articles

Are the poverty histories of neighbourhoods associated with psychosocial well-being among a representative sample of California mothers? An observational study

BackgroundWe examine the association between the poverty histories of neighbourhoods and three indicators of psychosocial well-being—depressive symptoms, sense of control and number of stressors—in an observational study of mothers of...

Quality of Life among Cancer Patients.

Introduction:Cancer is a leading cause of death. People living with cancer experience a variety of symptoms. Quality of life (QOL) is a major concern of patients with terminal cancer. Symptoms affect their QOL. Management of symptoms improves distress and QOL.Objective:The objective of the study was to assess the QOL among cancer patients.Materials and Methods:A survey was conducted among 768 cancer patients selected by a convenient sampling technique. Data was collected from cancer patients by interview technique using structured and validated interviewed schedule.Results:Out of 768 cancer patients, 30.2% patients were in the age group of 51–60 years, majority with head–and-neck cancer (40.1%), and 57.7% had stage III disease. QOL of majority of patients was influenced by their symptoms. 82.3% of them had low QOL scores.Conclusion:Cancer patients experienced many symptoms that affected their QOL. There is a need to develop interventions for effective management of symptoms that will empower the patients to have a greater sense of control over their illness and treatment and to improve the QOL.

The relationship of tobacco and alcohol use with ageing self-perceptions in older people in Ireland

BackgroundHealth behaviour patterns in older groups, including tobacco and alcohol use, are key factors in chronic disease prevention. We explore ageing self-perceptions as motivating factors behind smoking and drinking alcohol in older adults, and the complex reasons why individuals engage harmfully in these behaviours.MethodsCigarette and alcohol use was assessed in a large cross-sectional national sample aged 50 years and above from the Irish Longitudinal Study on Ageing (TILDA) (n = 6,576). The Brief Ageing Perceptions Questionnaire (BAPQ) assessed individual’s views of their own ageing across five domains. Study hypothesis that stronger beliefs on each of the BAPQ domains would be related to drinking and smoking was examined using multinomial logit models (MNLM). Regression parameter estimates for all variables were estimated relative risk ratios (RRR).ResultsMore women were non-drinkers (30 % vs. 20 %) and men displayed significantly higher alcohol use patterns. One in five older Irish adults was a current smoker (16.8 % of women, 17 % of men), and smoking and harmful drinking were strongly associated (P < .001). Some domains of ageing perceptions were significantly associated with harmful drinking and smoking. While the risk of being be harmful drinker decreased with stronger beliefs about the positive consequences of ageing (RRR 0.89), it increased with higher scores on both emotional representation and control positive domains.Greater awareness of ageing and stronger emotional reaction to ageing increased likelihood of smoking. A greater sense of control over the outcomes of ageing was associated with increased risk of both harmful drinking (RRR control positive 1.16) and smoking (RRR control and consequences negative 1.25). This suggests optimistic bias in relation to perceived health risk from smoking and harmful drinking as a potential adverse effect of perceptions of control.Risks of concurrent smoking and harmful drinking increased with chronic awareness of ageing (RRR 1.24), and negative emotional responses to it (RRR 1.21), and decreased with stronger perceptions of the positive consequences of ageing (RRR 0.85).ConclusionsThe relationship between ageing perceptions, smoking and drinking is complex. Altering perceptions of ageing may be a useful intervention target aimed at facilitating engagement in preventative health behaviours in older people.

Evaluation of a Coping Effectiveness Training intervention in patients with chronic heart failure - a randomized controlled trial.

Impaired emotional well-being has detrimental effects on health outcomes in patients with chronic heart failure (CHF). To evaluate a nurse-led Coping Effectiveness Training (CET) group intervention for patients with CHF. It was hypothesized that CET would increase emotional well-being (primary outcome) and health-related quality (HRQoL) of life and improve clinical outcomes. Furthermore, changes in appraisal and coping as mediators of the intervention effect were examined. Participants were randomized to either control group (n=51) receiving standard health care or CET intervention group (n=52). Self-assessments of positive affect, negative affect, depression, anxiety, HRQoL, illness perception, coping strategies and social support were performed pre- and post-intervention and after six weeks, six months and 12 months. Time to death and hospitalizations were measured during the entire follow-up (median 35 months, interquartile range 11 months). No significant improvements for emotional well-being and HRQoL in the intervention group compared with the control group were found. After excluding patients with clinical anxiety and depression at baseline the intervention group had significantly lower negative affect (p = 0.022). There were no significant differences regarding cardiovascular events between the groups. The intervention group had greater sense of control over their illness in the short-term (p = 0.036). CET intervention was found to increase sense of control over the illness in the short term. Psychosocial support programmes, like CET, for patients with CHF is currently lacking evidence for implementing in clinical practice. However, the results provide a basis for future studies with a modified CET intervention design and increased study size.

The Influence of Sociodemographic and Psychosocial Factors on Advance Care Planning

ABSTRACTThis study investigated sociodemographic and psychosocial factors that enhance or impede the completion of advance care planning, analyzing data from the Health and Retirement Study. The analytic subsample included the panel participants who died between 2006 and 2010 and who had answered the psychosocial and lifestyle questionnaire when they were alive. Multinomial logistic regression was executed to answer the research question (N = 1,056). The study found that persons who were older, who were women, who identified themselves as White, and who had higher levels of income and education were more likely to be motivated to complete advance care planning. Having greater sense of control was found to weaken the adverse relationship between being African American and the completion of advance directives. Having cancer, suffering from the illnesses for longer periods of time, and having experience of nursing home institutionalization also predicted the completion of advance care planning. Implications include incorporating a culturally tailored approach for racial/ethnic minorities and using advance directives that are clear and easily understood. In addition, future research needs to include a larger minority population and examine the extent to which variations between racial/ethnic groups exist in relation to advance care planning.

Associations of Mindfulness with Glucose Regulation and Diabetes.

To evaluate whether dispositional mindfulness is associated with glucose regulation and type 2 diabetes. Study participants (N = 399) were from the New England Family Study, a prospective birth cohort, with median age 47 years. Dispositional mindfulness was assessed using the Mindful Attention Awareness Scale (MAAS). Type 2 diabetes and "normal plasma glucose" were defined using American Diabetes Association criteria. Multivariable-adjusted regression analyses demonstrated that participants with high versus low MAAS scores were significantly more likely to have normal plasma glucose levels (prevalence ratio = 1.35 (95% confidence interval (CI): 1.08,1.87)), and were not significantly associated with type 2 diabetes (prevalence ratio = 0.83, 95% CI: 0.38,1.79), adjusted for age, sex, race/ethnicity, family history of diabetes and childhood socioeconomic status. Mediation analyses provided evidence of mediation via obesity and sense of control, where indirect effects were prevalence ratios (95% CI) of 1.03 (1.00,1.10) and 1.08 (1.00,1.21), respectively. Dispositional mindfulness may be associated with better glucose regulation, in part because of a lower likelihood of obesity and greater sense of control among participants with higher levels of mindfulness. These findings need to be replicated by prospective studies to establish causality and to evaluate potential implications for mindfulness-based interventions to reduce risk of type 2 diabetes.

Leading Systemic Dialogue: From Silos to the Whole System

This article explores how a global team successfully transitioned from the trap of operating in separate units (or “silos”) to working as a unified whole. To overcome duplication of work, mistakes going undetected and festering frustrations, this team engaged in a different kind of conversation. Their dialogue enabled them to see the bigger picture and improve their ability to execute their global operations more seamlessly. The limitations of silo working are becoming increasingly apparent. Many of us have experienced the frustration of working in organisations where rivalry between departments undermines collective performance, infighting between divisions creates unhealthy in-house competition and lack of communication causes blindspots that could have been avoided. Gillian Tett, a writer at the “Financial Times”, has recently published her new book The Silo Effect. By looking at the root cause of great financial crisis in 2008, she explores both the upside and downside of silo-isation. Division of labour, the hallmark of our market economy, has led to benefits, at least in the short-term. Tett highlights how highly structured Sony, for example, in the 1970s, was a leading light for innovation with its Walkman and Trinitron TV. Specialization can, at times, lead to improve efficiency, increase profits and generate a greater sense of control. Silo-working has, however, now become so taken-for-granted that we may miss seeing its dark side. As we become buried in our corner of the organization or immersed in our specialism, we are more likely to develop tunnel vision. Dividing an organization, and its people, into “departments”, “divisions” and “units” (the language itself is revelatory) has the unintended impact of stopping collaboration in its tracks. Despite our interconnectedness – news can flash across the planet at lightening speed – our lives and organisations are “crazily fragmented”, according to Tett.

A reflective learning report about the implementation and impacts of Psychological First Aid (PFA) in Gaza.

Psychological First Aid (PFA) is the recommended immediate psychosocial response during crises. As PFA is now widely implemented in crises worldwide, there are increasing calls to evaluate its effectiveness. World Vision used PFA as a fundamental component of their emergency response following the 2014 conflict in Gaza. Anecdotal reports from Gaza suggest a range of benefits for those who received PFA. Though not intending to undertake rigorous research, World Vision explored learnings about PFA in Gaza through Focus Group Discussions with PFA providers, Gazan women, men and children and a Key Informant Interview with a PFA trainer. The qualitative analyses aimed to determine if PFA helped individuals to feel safe, calm, connected to social supports, hopeful and efficacious – factors suggested by the disaster literature to promote coping and recovery (Hobfoll et al., 2007). Results show positive psychosocial benefits for children, women and men receiving PFA, confirming that PFA contributed to: safety, reduced distress, ability to engage in calming practices and to support each other, and a greater sense of control and hopefulness irrespective of their adverse circumstances. The data shows that PFA formed an important part of a continuum of care to meet psychosocial needs in Gaza and served as a gateway for addressing additional psychosocial support needs. A “whole-of-family” approach to PFA showed particularly strong impacts and strengthened relationships. Of note, the findings from World Vision's implementation of PFA in Gaza suggests that future PFA research go beyond a narrow focus on clinical outcomes, to a wider examination of psychosocial, familial and community-based outcomes.

Adapting SBIRT for Batterer Intervention Program groups using motivational approaches

Background To present a public health initiative to adapt SBIRT for Batterer Intervention Programs (BIP) using Motivational Interviewing (MI) approaches. While studies concur that substance use is not the underlying cause of Interpersonal Violence (IPV), approximately 50% of men in BIP are reported to be using substances at unhealthy levels. The Massachusetts Department of Public Health (MDPH) initiated a pilot to address risky substance use in BIP participants, with the Institute for Health & Recovery (IHR), providing curriculum development, training, and technical assistance. The curriculum employs an innovative application of SBIRT designed for use in groups, allowing BIP group leaders to provide substance use health education to men in groups. Some studies indicate that MI can result in better engagement with participants than the typical directive, confrontational approaches often used with individuals involved with the criminal justice system. It uses MI strategies adapted to allow the group members to describe the benefits and costs of substance use themselves rather than a more traditional ‘health education’ lecture by a group leader. Validated single item screening tools, for alcohol and for other drugs, were completed in silence during the group, and open-ended questions were asked as the Brief Intervention; leaders were encouraged to ask permission before sharing information in order to give participants a greater sense of control and ownership of their place on the road to change.

Entrepreneurs Acting as Mentorsin Online Communities for Students Enrolled in MA Studies

The importance of teaching entrepreneurship for non-business students in the last couple of years have been accepted by Romanian academia but the adoption of successful teaching methods experienced in the Northern countries should be adapted to the students particularities.People exposed to entrepreneurship frequently express that they have more opportunity to exercise creative freedoms, higher self-esteem and an overall greater sense of control over their own lives, which means that entrepreneurship should be regarded as a rather successful career outcome for most people (Parker 2009).There have been conducted several studies on the importance on teaching entrepreneurship using some, let's say, “offline” methods: presentations by entrepreneurs, trainings in entrepreneurship on different topics or workshops with entrepreneurs. This paper will try to approach an “online” based method, online mentoring or eMentoring (Martin &Strunga, 2010), how entrepreneurs should and could be engaged as mentors for students in non-business studies interested in developing their entrepreneurship competences and put their ideas into practice. There will be presented some solutions for setting-up an online community of entrepreneurs, what should be the “eMentoring” skills for an entrepreneur and how this type of community could be sustained by universities and entrepreneurs networks.

PTU-129 Do gastrointestinal cancer patients want to decide where they have tests and surgery? a questionnaire study of provider choice and information needs

Introduction Choice of provider has been an important strategy among policy makers over recent years, intended, in part, to drive improvements in quality and efficiency of health care. Provider choice has been relatively under-studied among patients with cancer, compared with benign disease. This study examines decision-making experiences, preferences and information needs among patients who have had surgery for gastrointestinal cancer. Method This questionnaire study used the single-item Control Preferences Scale to determine patients’ experiences and preferences when being referred for tests, and choosing where to have surgery. Participants used a Likert scale to rate the importance of 23 information items covering a variety of structures, process and outcomes at hospital- and department-level. Participants were recruited by post and online. Results 463 responses were included. Where indicated, 334 of 415 (80.5%) respondents had upper gastrointestinal cancer. Postal response rates were higher than online (47.2% vs 23.1%, p .001). Patients reported very low levels of involvement in provider choice, with their doctor deciding where they underwent tests or surgery in 77.0% and 81.8% of cases, respectively. Over two-thirds of participants would have preferred greater involvement in provider choice. Information on how long cancer patients wait for treatment, annual operative volume and postoperative mortality rate, as well as retained foreign bodies and infection rates were considered very important. Conclusion There is a substantial unmet desire for greater involvement in provider choice among gastrointestinal cancer patients. Participants in this study attached particular importance to surgery-specific information. Improving involvement and information provision will require a coordinated approach in both primary and secondary care. Greater involvement in decision-making may increase satisfaction and contribute to a greater sense of control among these patients. Disclosure of interest None Declared.

Half the Battle

In this article, I explore the function of social support among women with breast or gynecologic cancers. Semi-structured interviews were conducted with women who received services from a community health organization located in northern California. Findings suggest that the path to wellness for women with cancer is one that involves negotiable interactions with family, friends, and the medical community, such as decision-making regarding treatment and lifestyle choices. Distinctions were made between the support received from other women with cancer, and that received from family and friends. In addition to having emotional and instrumental functions, social support involves the exchange of information, resulting in a greater sense of control over the cancer experience. Health care providers and others who interact with women with cancer will benefit by recognizing the importance of social support throughout the healing process.

Fundamental movement skills proficiency in children with developmental coordination disorder: does physical self-concept matter?

Purpose: The purpose of this study was to (1) examine differences in fundamental movement skills (FMS) proficiency, physical self-concept, and physical activity in children with and without developmental coordination disorder (DCD), and (2) determine the association of FMS proficiency with physical self-concept while considering key confounding factors. Method: Participants included 43 children with DCD and 87 age-matched typically developing (TD) children. FMS proficiency was assessed using the Test of Gross Motor Development – second edition. Physical self-concept and physical activity were assessed using self-report questionnaires. A two-way (group by gender) ANCOVA was used to determine whether between-group differences existed in FMS proficiency, physical self-concept, and physical activity after controlling for age and BMI. Partial correlations and hierarchical multiple regression models were used to examine the relationship between FMS proficiency and physical self-concept. Results: Compared with their TD peers, children with DCD displayed less proficiency in various components of FMS and viewed themselves as being less competent in physical coordination, sporting ability, and physical health. Physical coordination was a significant predictor of ability in object control skills. DCD status and gender were significant predictors of FMS proficiency. Conclusions: Future FMS interventions should target children with DCD and girls, and should emphasize improving object control skills proficiency and physical coordination.Implications for RehabilitationChildren with DCD tend to have not only lower FMS proficiency than age-matched typically developing children but also lower physical self-concept.Self-perceptions of physical coordination by children with DCD are likely to be valuable contributors to development of object control skills. This may then help to develop their confidence in performing motor skills.Children with DCD need supportive programs that facilitate the development of object control skills. Efficacy of training programs may be improved if children experience a greater sense of control and success when performing object control skills.

MBCT for Patients with Respiratory Conditions Who Experience Anxiety and Depression: A Qualitative Study

Patients with asthma and chronic obstructive pulmonary disease (COPD) often experience anxiety and depression in relation to their respiratory condition. Anxiety and depression in this population are associated with decreased activity. The aim of this phenomenological study was to carry out in-depth qualitative interviews with a purposive sample of patients with asthma and COPD taking part in an 8-week mindfulness-based cognitive therapy (MBCT) course to explore their experiences of MBCT. In particular, we were interested in how the mindfulness approach helped them, or not, and their awareness of any meaningful changes in relation to their breathlessness, activity levels, anxiety or low mood. Twenty-two patients were recruited from primary and secondary care to receive an 8-week course in MBCT. Two groups of MBCT were taught by qualified MBCT teachers in a community setting. Of the 22 patients who attended the MBCT course, 12 patients were purposively sampled to take part in an in-depth qualitative interview 2 months after completing the MBCT course. Interviews were digitally recorded and transcribed verbatim. Analysis was thematic. The themes that emerged included greater acceptance and reduced sense of disease-related stigma; noticing subtle bodily sensations to detect early warning signs of breathlessness; linking pulmonary rehabilitation advice with mindfulness; developing a new relationship to breathing, activity and associated thoughts; having a greater sense of control; being creative around limitations and removing psychological barriers to being more active. Findings offer, for the first time, qualitative evidence on how MBCT benefits patients with asthma and COPD who experience anxiety and depression. These data provide a useful adjunct to existing quantitative evidence in this area.

Contemporary calendar management: Exploring the intersections of groupware and personal calendars

1. IntroductionBoundary theory explores how individuals create and maintain boundaries as a means of simplifying and ordering their environment (Ashforth, Kreiner, & Fugate, 2000). Based on people's individual preferences for integration and segmentation, they may establish 'weak' or 'strong' boundaries between their work and personal domains (Nippert-Eng, 1996b). Research has found that technologies such as mobile phones, email, voicemail, PDAs, and pagers can be a useful tool for boundary management (Boswell & Olson-Buchanan, 2007; Fenner & Renn, 2009). Contemporary 'groupware' calendars such as Microsoft Oudook allow employees constant accessibility, as well as the capability to synchronize calendar data across their calendars and to share calendar data with others.Flowever, technological affordances such as synchronization and sharing have changed the landscape of calendaring in paradoxical ways. In the case of groupware, users have access to increased integration capabilities, which can give them a greater sense of control; but using such integration can make them more vulnerable to others' time demands because of the shared and public nature of groupware calendars. Managing this increased permeability requires effort and forethought, and may sometimes result in boundary violations when employees are not able to maintain their desired level of boundary management. We suggest that the embedded structures of groupware tools can affect social systems and individual time management processes (Lee, 2003; Paien, 1999; Van den Elooff, 2004, Payne, 1993), shaping people's boundary management capabilities.Our qualitative study analyzes interview data from 22 US business professionals regarding use of their organization's electronic calendar systems. We investigate how electronic calendars are used as a boundary management tool through two research questions: (1) what processes do people use to manage their boundaries given the wide array of calendars available? and (2) what factors influence how employees use groupware calendars? The justification for these questions will be explained below.The paper is organized in six sections. Following this first introductory section, section 2 reviews current research on boundary management, technolog)', and electronic calendars to demonstrate the relevance of and linkages between boundary management concepts and individuals' groupware calendar management strategies. Section 3 describes our research objectives, methods, and data collection. Results are discussed in section 4, section 5 offers a discussion of the implications, and section 6 offers directions for future boundary management research and a conclusion.2. Theoretical background2.1 Boundary managementBoundary management theory is the foundation of work family research that attempts to explain how and why workers establish temporal and spatial boundaries between their roles. According to this model, people do proactive boundary work to create and maintain their desired psychological, physical, or behavioral boundaries to separate and categorize their various roles and life domains (Ashforth et ah, 2000; Kossek, Noe, & DeMarr, 1999; Nippert-Eng, 1996b). The permeability of boundaries can vary along a continuum from strong boundaries, which create strict divisions between life roles, to weak boundaries, which allow more blending and blurring of the divisions between roles. People tend to have a preference for stronger or weaker boundaries, and adopt corresponding strategies which vary on the continuum of segmentation to integration (Kossek et al., 1999; Rothbard, Phillips, & Dumas, 2005).Empirical research has demonstrated a number of strategies employees can use to establish and maintain boundaries between their work and family roles (Kreiner, Hollensbe, & Sheep, 2009; Moen, Lam, Ammons, & Kelly, 2013; Fonner & Stache, 2012). For example, professionals may develop strategies of consciously prioritizing nonwork demands for family, health, and leisure above job demands, or use triage (Kreiner, Elollensbe, & Sheep, 2009) to determine which tasks really need to be done. …

Feature: Volunteering and managing change in the health sector

Volunteering has increasingly been cited as important in the future success of healthcare services and in making the quality of care as important as the quality of treatment. As public health responsibilities move into local government across the UK, the relationship between health and the community will be closer than ever, and effective management will be key in ensuring volunteering schemes are successful.Published in February 2013, the Francis report highlighted a clear reminder to us all that good healthcare is not just about treatment and cure, and created a sense of urgency for compassion to be prioritised at the forefront of healthcare delivery. The recently published UK government response to the Francis recommendations, Patients First and Foremost,1 sets out a series of promises to work towards in line with the values of the NHS, including a commitment to working with compassion, and commitments to quality of care and improving lives.Responding to these challenges that the NHS currently faces will involve the engagement of four key groups: patients, service users and their families, frontline health and care staff; leadership teams and management boards; and external group structures, including commissioners and government committees.1 The Department of Health's Strategic Vision for Volunteering2 highlights the untapped potential of volunteers in our communities: utilising volunteers is one of many ways to respond positively to the challenges and promises of care quality that the government has made.1 Developing a volunteer workforce is a way for public health programmes to better engage with the local community, and volunteers can be a big local asset in the delivery of health messages and changing unhealthy behaviours: a central public health aim. This has led to the development of many community-based volunteering schemes, including the Community Health Champions Scheme.Community health champions are volunteers who are trained and engaged to support and influence their family, friends and community in making positive lifestyle changes and in leading healthier lives.3 Investing time in getting to know people and investing resources in community development allows for a greater sense of equality in health and wellbeing, and a greater sense of control. Recognising the importance of this has led the RSPH qualifications team to develop and offer a Youth Health Champions qualification, aimed at engaging volunteer support from a younger age. The RSPH also offers support and training for those wishing to set up their own health champion schemes, in order to enable effective scheme management to help with improving service quality.What is the value of volunteers?Volunteers are increasingly becoming an important part of the care team, adding significant value to the work of paid staff, and an estimated three million people in England currently volunteer in the healthcare sector: across the NHS, health charities and social care organisations.4Newly published research by the King's Fund4 highlights four ways that volunteers add value in the health and care sector:* Improving care and support experiences;* Strengthening the relationship between public services and communities;* Improving public health and reducing inequalities in health; and* Strengthening integrated care for those with multiple physical or mental health needs.The published report Volunteering in health and care: Securing a Sustainable Future4 took research from focus groups of both patients and volunteers, as well as in-depth interviews with the providers and commissioners of health and social care services. They conclude that volunteers are well-placed to help organisations in meeting key Francis recommendations, as long as they are managed effectively.5Effective volunteer managementThe Kings Fund is calling for a strategic approach to volunteering throughout the health care system and health service providers. …

Evaluation of an Interdisciplinary Program for Chronic Pain After Spinal Cord Injury

To assess efficacy of an interdisciplinary pain program adapted for persons with spinal cord injury (SCI) and chronic pain. Prospective cohort. University-affiliated rehabilitation hospital. Twenty-two persons with traumatic or nontraumatic SCI and chronic pain of at least 6 months' duration. Subjects participated in an interdisciplinary pain program consisting of biweekly group sessions for 10 consecutive weeks. Sessions incorporated patient education on chronic pain and associated pain mechanisms, cognitive behavioral therapy, self-management strategies (eg, energy conservation, ergonomics, goal setting, stress management, anger management, and coping skills), group discussions and activities, and either exercise or guided relaxation at the end of each session. Multidimensional Pain Inventory SCI, Coping Inventory of Stressful Situations, Pain Stages of Change Questionnaire, and Life Satisfaction Questionnaire. After participation in an interdisciplinary pain program, persons with SCI and chronic neuropathic pain demonstrated increased involvement in learning and maintenance of coping strategies for chronic pain. Participation also led to less pain interference in daily life and a greater sense of control over one's life. Participation in an interdisciplinary pain program does not reduce pain severity, but it can help persons with SCI and chronic neuropathic pain cope with pain, lessen interference of pain, and improve their sense of control.

Psychological Control and Morbidity/Mortality in Breast Cancer Patients: A 20-Year Follow-Up Study

The purpose of this paper was to examine the longitudinal effects of psychological sense of control and control-related coping strategies on breast cancer outcomes. Utilizing the California Cancer Registry, follow-up data on cancer recurrence and all-cause mortality were obtained for 54 of 58 women originally diagnosed with breast cancer in 1992 to 1994. Relationships between cancer outcomes and psychological control and mood at 4 and 8 months post-diagnosis were examined. Results of the study showed that a greater sense of control at 8 months was associated with less cancer recurrence, while higher desire for control at both 4 and 8 months was associated with greater likelihood of recurrence. Utilization of an accepting mode of control appeared to mitigate the negative effects of desire for control on recurrence. No significant relationships were observed between mood and mortality or recurrence. These findings suggest the potential value of examining psychological control and control-related coping on cancer outcomes in future epidemiological and clinical studies.

“It's a Tube Up Your Bottom; It Makes People Nervous”

This study aimed to prospectively consider the effect of colonoscopy on patients' experiences of anxiety at 4 time points related to an initial colonoscopy, using a qualitative approach. The study involved a sample of 13 patients undergoing an initial colonoscopy at a public hospital and followed for 12 months. Four exploratory interviews were conducted with each participant: before the procedure, 1 week, 2 weeks, and 12 months after the procedure. Thematic analysis was conducted to summarize patients' responses. In these participants, colonoscopy was associated with stigma. The discussion of the procedure was perceived as stressful and embarrassing and led to anxiety. Irrational expectations regarding the procedure were also contributing to anxiety, as was a doctor-patient relationship based on unequal powers and lack of control. Before the procedure, fear of a serious diagnosis contributed to anxiety; however, postprocedure, an unclear or functional diagnosis also appeared to increase anxiety. Anticipating the preparation for the procedure was also reported as an important factor in preprocedure anxiety. A shift toward a biopsychosocial approach to healthcare, such as providing patients with a greater sense of control by participating in decision making, should be recommended as it may reduce anxiety.

Pushing the Envelope of Electronic Patient Portals to Engage Patients in Their Care

In this issue, Delbanco and colleagues' study involved a program that allowed patients direct access to their primary care providers' electronic progress notes through patient portals. The editoria...