The illness intrusiveness theoretical framework maintains that illness-induced lifestyle disruptions compromise quality of life in chronic life-threatening conditions and that this effect is moderated by social, psychological, and contextual factors. Considerable evidence indicates that lifestyle disruptions compromise quality of life in cancer and other diseases and that the effects differ across life domains. The hypothesis that contextual factors (e.g. age, education, income, stressful life events) moderate these effects has not been tested extensively. We investigated whether age, income, education, and/or recent stressful life events modify the experience of illness intrusiveness across three central life domains (Relationships and Personal Development, Intimacy, and Instrumental life) in six common cancers. A sample of 656 cancer outpatients with one of six common cancers (breast, prostate, lymphoma, lung, head and neck, and gastrointestinal, all n's>100) completed the Illness Intrusiveness Ratings Scale while awaiting follow-up appointments with an oncologist. Results indicated statistically significant (all p's<0.05) interactions involving each of the hypothesized moderator variables and the Life Domain factor. In each case, greatest divergence was evident when illness intrusiveness involved instrumental life domains (e.g. work, finances, health, and active recreation). The findings substantiate the illness intrusiveness theoretical framework and support its relevance for people with cancer. The psychosocial impact of chronic life-threatening disease differs across life domains and depends on the context in which it is experienced.
Analysis of longitudinal data for 145 children [51 healthy, 40 with cystic fibrosis (CF), and 54 with congenital heart disease (CHD)] was conducted: (a) to ascertain whether behavioral problems evident in older medically compromised children would be reported as early as 2–3 years-of-age; and (b) to test theoretical predictions concerning the role of infant-mother attachment in the etiology of behavior problems. As predicted, children with a medical diagnosis received higher scores from parents on the Child Behavior Checklist (CBCL), primarily on the Internalizing scale. Reports of somatic symptoms did not account for this effect. Contrary to predictions, children with CHD were reported to have more behavior problems than those with CF. Secure attachment was associated with lower CBCL scores for internalizing problems regardless of medical status. The increase in behavior problem reports associated with insecure attachment was shown to reflect an effect of avoidance rather than insecurity per se. The importance of distinguishing effects of different types of insecurity and the need for meta-analytic strategies to do so is emphasized.
A prospective longitudinal study assessed the development of the mother-child relationship within the context of other important aspects of transition to parenthood. In the prenatal phase, 238 women who were 8 months pregnant with their first child completed a set of questionnaires. At 1 month postpartum, 165 of these women completed a second set of questionnaires, and a subset of 86 were observed for 1 hour at home with their infants. When their child was 2 years old, 62 of the 86 mothers completed questionnaires and were observed in interaction with their toddler in the laboratory. The several hundred individual variables were reduced to internally consistent composite variables, 5 in the prenatal phase, 7 postpartum, and 14 in the toddler phase. Preliminary analyses reported in this paper assessed the structure of relationships among the composite variables within each phase (Pearson correlations) and whether there was significant prediction from one dimension to another across the phases, beyond stability in the predicted dimension (multiple regressions). Causal modeling analyses are still in progress.The results indicate that the development of maternal attachment is a gradual process and that feelings of attachment are related to a number of other measures of women's psychological well-being. Parenting confidence was found to play a central role in adaptation to motherhood within each phase, as well as from the prenatal to postpartum and postpartum to toddler phases. R!%UM& Une ktude longitudinale a kvalut le dkveloppement de la relation mbre-enfant dans le contexte d'autres aspects importants de la transition ii la condition de parents. Dans la phase prknatale, 238 femmes enceintes de huit mois de leur premier enfant ont rempli une serie de questionnaires. Un mois apres la naissance, 165 de ces femmes ont rempli une deuxitme skrie de questionnaires et un groupe de 86 mbres a ttk observe pendant une heure chez elles avec leur enfant. Quand leur enfant avait deux ans, 62 des 86 meres ont rempli des questionnaires et ont ttk observkes, en laboratoire, dans leur interaction avec leur enfant qui commence a marcher. Les centaines de variables individuelles ont t t t reduites A quelques
In view of Canada's commitment to immigration, understanding the sources of successful adaptation by immigrant and refugee children is vital. This paper reviews the literature on the mental health of migrant children and suggests an agenda for future research.
Measuring patient's satisfaction with their physician is gaining interest but requires a questionnaire that is valid, reliable and acceptable to patients. We previously published a self-administered visit-specific satisfaction with physician questionnaire for cancer patients. Eighty outpatients at a Canadian Cancer Center completed the Princess Margaret Hospital Patient Satisfaction with Doctor Questionnaire and the FACT-G questionnaires along with demographic information just after clinic visit and again 3-5 days later. Exploratory factor analysis extracted two factors, labeled 'physician disengagement' and 'perceived support,' with average coefficient alpha values of 0.93 and 0.90. Test-retest reliability was 0.83 and 0.73, respectively, for the two factors. Confirmatory factor analysis applied to the data from 174 patients in the original study indicated excellent goodness of fit. PMH/PSQ-MD correlated moderately with FACT-G (average r=0.37, p<0.005). The PMH/PSQ-MD questionnaire is a brief, valid and reliable questionnaire that taps two complementary facets of patient satisfaction.
The interaction of patients with their doctors impacts the experience of disease at many levels. It is thus important to measure patient satisfaction with such interaction as an outcome of care. Our goal was to investigate whether tumor status influences patient satisfaction with interaction with their doctors. Specifically, we investigated whether patients with no evidence of disease (NED), localized, or metastatic cancers seen in routine follow-up differ in their satisfaction with the oncologist. Outpatients attending clinics at a major cancer center completed a battery of questionnaires, including the Patient Satisfaction with Doctor (PSQ-MD) questionnaire, a 24-item, self-report instrument. It taps two facets of the doctor-patient exchange: perceived support and physician disengagement. Data concerning tumor status and satisfaction were obtained for 569 patients, sampled to include equivalent numbers of women and men with breast, head and neck, gastrointestinal, genitourinary, or lung cancer, or lymphoma. Controlling for age, marital status, annual family income, stressful life events, and employment status, patients with metastatic disease felt somewhat less supported by their physicians (mean=3.26+/-0.06) than those with localized disease (mean=3.42+/-0.04) or NED (mean=3.42+/-0.03), (analysis of covariance, p< 0.05). Physician disengagement did not differ across the groups (means=1.54+/-0.06, 1.43+/-0.04, and 1.47+/-0.03 respectively). These findings were consistent across cancer diagnoses. Patients with metastatic disease may feel less physician support than those with less advanced cancers. Increasing attention to satisfaction of different patient groups can pave the way to improved quality of care.
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