Background. This study evaluated the perceptions of patients with breast cancer of their medical interactions with providers. The determinants and psychological consequences of communication problems also were examined. Methods. Ninety‐seven patients with Stage I or II breast cancer completed a set of validated questionnaires before initiating postoperative therapy. Data on psychological distress were collected at baseline and 3‐month follow‐up, and multivariate models were fit to explain the relationship between pretreatment communication problems and subsequent psychological distress. Data on clinical variables were abstracted from medical records. Results. A substantial proportion of patients (84%) reported difficulties communicating with the medical team. Communication problems were more common among patients who were less optimistic about their disease and had less assertive coping styles. Patient‐reported communication problems were associated with increased anxiety, depression, anger, and confusion at the 3‐month follow‐up. The association between communication problems and mood disturbance remained significant, although small, after adjusting for baseline mood disturbance, demographic, clinical, and coping style variables. Conclusion. Interventions that enhance communication between patients with breast cancer and their providers may improve patients' psychological adjustment to treatment. Conversely, interventions that lower distress and modify coping style may enhance communication.

Background. This study evaluated the perceptions of patients with breast cancer of their medical interactions with providers. The determinants and psychological consequences of communication problems also were examined.Methods. Ninety-seven patients with Stage I or I1 breast cancer completed a set of validated questionnaires before initiating postoperative therapy. Data on psychological distress were collected at baseline and 3-month follow-up, and multivariate models were fit to explain the relationship between pretreatment communication problems and subsequent psychological distress. Data on clinical variables were abstracted from medical records.Results. A substantial proportion of patients (84%) reported difficulties communicating with the medical team. Communication problems were more common among patients who were less optimistic about their disease and had less assertive coping styles. Patient-reported communication problems were associated with increased anxiety, depression, anger, and confusion at the %month follow-up. The association between communication problems and mood disturbance remained significant, although small, after adjusting for baseline mood disturbance, demographic, clinical, and coping style variables.Conclusion. Interventions that enhance communication between patients with breast cancer and their pro-From the

The purpose of this study was to explore, using grounded theory, the process experienced by parents who are dealing with the first recurrence of cancer in their child. The sample of 33 guardians (27 mothers, 1 grandmother, and 5 fathers) was drawn from three pediatric oncology settings. Data were collected through interviews, observations, and medical record review. Thirteen parents were interviewed to validate first the evolving and, later, the complete study findings. Four interactive components emerged: regulating shock, situation monitoring, alternating realizations, and eyeing care-limiting decisions. The overall organizing construct induced from these components was labeled "coming to terms." This construct represents the parents' efforts to overcome shock and despair to make wise decisions about treatment while accepting that the outcome if beyond their control, and to help their child have the optimal chance for cure while preparing for the child's possible death.

The purposes of this paper are to: (1) provide conceptual and empirical descriptions of the most frequently reported children's and teenagers' responses in anticipation of and after the death of a sibling from cancer; (2) describe these behaviours by age groups (3-5, 6-11 and 12-19 years); and (3) discuss the clinical utility of two new scales measuring children's bereavement. The literature review and an exploratory secondary analysis from a prospective longitudinal design were used to develop the empirical criteria for behavioural items indicative of bereavement. Data from four points in time: (1) 2 months before a child's death; (2) 2 weeks after death; (3) 4 months after death; and (4) 12 months after death were treated as a cross-sectional design, because of sample size, to describe bereavement behaviours and to discuss the beginning development of a screening tool for childhood bereavement services

This study investigated the behavioral adjustment of sixty-one children ages four to sixteen years during the terminal illness and first year following a sibling's death from cancer. Using the Child Behavior Checklist, data on behavior problems and competence were collected from parents and teachers. Data collection occurred before death during the terminal phase, and two weeks, four months, and one year post death. The results of data analysis by t-test comparisons generally indicated that the bereaved siblings demonstrated significantly higher levels of behavior problems and significantly lower social competence in comparison to normal children. The implications for practice are discussed.