Rural and urban breast cancer patients: health locus of control and psychological adjustment

Social power may be associated with health through positive emotion

Increased social power-defined as one's influence on another's behavior-guides activation of one's behavioral activation system which, in turn, elicits greater positive emotion. Positive emotion has also been linked to greater health. The current research assessed whether power and positive emotion are related to health. In Study 1, participants (N = 403; Mage = 48.33 years) wrote a narrative about a time in which they felt powerful or powerless. Greater self-reported feelings of power, concurrent with more frequent use of positive emotional words within the narrative, was associated with fewer references to health within the narrative. In Study 2, participants (N = 401; Mage = 33.05 years) primed with the concept of power (vs. powerlessness) reported greater health competency through enhanced positive emotion. Findings provided preliminary data supporting the continued study of power to better understand the link between positive emotion and health. Future research should elucidate the long-term relationships between these variables to examine whether increased power can produce downstream positive effects on health and health behavior.

The Potential Mediating Effect of Symptom Burden on Demoralization Through Locus of Control and Coping Strategies in Chinese Patients With Cancer

BACKGROUND

Demoralization is a psychological syndrome that is highly prevalent in patients with cancer and detrimental to individuals' physical and mental health. To explore effective intervention, we first determined the relationships between locus of control, coping strategies, symptom burden, and demoralization.

OBJECTIVE

The aim of this study was to determine the relationship between symptom burden, locus of control, coping strategies, and demoralization in patients with cancer.

METHODS

In this descriptive-correlational study, 273 valid patients were selected with convenience sampling method from a hospital in China. Data were collected using the Chinese version of the M.D. Anderson Symptom Inventory, the Chinese version of the Multidimensional Health Locus of Control Scale, the Chinese version of the Medical Coping Modes Questionnaire, and the Mandarin version of the Demoralization Scale. Data were analyzed using descriptive and inferential statistics using SPSS and AMOS.

RESULTS

A total of 115 patients (42.12%) experienced clinical demoralization (Mandarin version of the Demoralization Scale > 30). Symptom burden (β = 0.295, P < .001), confrontation (β = -0.117, P = .028), and resignation (β = 0.456, P < .001) had direct effects on demoralization. Symptom burden also had an indirect effect on demoralization through the mediating role of resignation (β = 0.026, P = .002). Meanwhile, locus of control can affect demoralization entirely through the indirect mediating role of coping strategies (chance locus of control via resignation [β = 0.138, P < .01], powerful locus of control via confrontation [β = -0.017, P < .05]).

CONCLUSIONS

Symptom burden affects demoralization not only directly but also indirectly. Coping strategies play an important mediating role between symptom burden, locus of control, and demoralization in patients with cancer.

IMPLICATIONS FOR PRACTICE

It is urgent to screen demoralization and identify patients with high symptom burden, maladaptive locus of control, or coping strategies. For the patients targeted, a more comprehensive and systematic approach to symptom management and more appropriate guidance related to adaptive coping strategies are needed.

Longitudinal comparison of health locus of control and subjective well-being in older women with breast cancer

OBJECTIVE

To investigate the dynamic changes in the health locus of control (HLC) and subjective well-being (SWB) of older women with breast cancer, to explore the relationship between the HLC and SWB of these patients at different time points.

DESIGN

The research method adopted was a longitudinal study. Convenience sampling was used to select older women with breast cancer and their HLC and SWB at different times were evaluated. The ages of the patients were ≥60 years. The survey was conducted starting from the day of admission and at 1 month, 3 months, and 6 months after surgery.

MAIN OUTCOME MEASURES

HLC and SWB.

RESULTS

The HLC and SWB of older women with breast cancer changed dynamically (P < 0.05), and the patients were in poor condition at T1. At each time point, the internal HLC (IHLC) for these patients was positively correlated with the total SWB score. Additionally, powerful others HLC (PHLC), chance HLC (CHLC), and SWB were negatively correlated (P < 0.05).

CONCLUSION

The HLC and SWB of older women with breast cancer change dynamically. Medical staff should pay more attention to the HLC and SWB of patients 1 month after surgery. SWB can be improved by improving the patients' IHLC and reducing their PHLC and CHLC.

Flourishing or Languishing? The Relationship Between Mental Health, Health Locus of Control and Generalised Self-Efficacy

Mental health is a core component of overall wellbeing and can contribute to positive functioning and purpose in life. Mental health is purportedly related to the constructs of generalised self-efficacy (GSE) and health locus of control (LOC). Most research, however, has explored GSE and LOC and their relationship with psychopathology, or defined mental health as a lack of psychopathology indicators. This contradicts the two continua model of mental health, as it does not incorporate positive mental functioning. The current study sought to re-examine the relationship between health LOC, GSE, and mental health, whilst controlling for potential confounding factors. It was anticipated that health LOC and GSE would predict mental health. A sample of 224 adults completed an online survey comprised of validated psychometric tools scales. Regression analyses were conducted to determine whether health LOC and GSE predicted mental health, after controlling for self-esteem, social support, and coping. Results indicated that GSE was a significant unique positive predictor of mental health. Health locus of control was not a significant predictor of mental health. Limitations were present, including a cross-sectional research design and use of convenience sampling. This study builds upon existing research in providing a better understanding of contributors to mental health, which may assist in the development of evidence-based mental health promotion interventions.

"All Hands on Deck": Psychological Characteristics of Women with Experience of Oncological Disease Participating in Sailing Cruise-A Pilot Study

BACKGROUND

In addition to searching for effective methods of treatment, interventions are sought to support well-being, quality of life, mental health, and recovery. Sailing has its specific features, including task orientation, challenges, contact with people, and nature. This specificity may be treated as a potential therapeutic factor, but it is also likely that people with certain psychological characteristics are involved in it. Therefore, the study aimed to assess some psychological features of women with cancer experience who decided to take part in the Onco-Cruise (Polish: Onko-Rejs).

METHODS

Participants were 56 women (M = 46.73; SD = 9.21). We used NEO-FFI, the Zimbardo Time Perspective Inventory, and The Multidimensional Health Locus of Control Scale.

RESULTS

Onco-Cruises participants were characterized by a high level of extraversion (M = 32.48; SD = 7.02; sten score M = 7.21; Mo = 7), openness (M = 31.50; SD = 6.31; sten score M = 7.41; Mo = 8), low neuroticism (M = 21.62; SD = 9.33; sten score M = 4.96), predominance of present hedonistic (M = 12.55, SD = 1.46) and future time perspective (M = 11.39; SD = 2.67), and the internal health locus of control (M = 23.25, SD = 5.43).

CONCLUSION

Group sailing can be favorable for broadly understood health and cancer recovery, but people who choose this activity have certain psychological predispositions, especially indicating high needs for stimulation. Permanent features should be taken into account when proposing various interventions for oncology patients to best suit them to their natural possibilities and preferences and, thus, make them most effective.

Psychosocial well-being and supportive care needs of cancer patients and survivors living in rural or regional areas: a systematic review from 2010 to 2021

Purpose

To summarise what is currently known about the psychosocial morbidity, experiences, and needs of people with cancer and their informal caregivers, who live in rural or regional areas of developed countries.

Methods

Eligible studies dating from August 2010 until May 2021 were identified through several online databases, including MEDLINE, EMBASE, PsychINFO, and RURAL (Rural and Remote Health Database). Results were reported according to the PRISMA guidelines and the protocol was registered on PROSPERO (CRD42020171764).

Results

Sixty-five studies were included in this review, including 20 qualitative studies, 41 quantitative studies, and 4 mixed methods studies. Qualitative research demonstrated that many unique psychosocial needs of rural people remain unmet, particularly relating to finances, travel, and accessing care. However, most (9/19) quantitative studies that compared rural and urban groups reported no significant differences in psychosocial needs, morbidity, or quality of life (QOL). Five quantitative studies reported poorer psychosocial outcomes (social and emotional functioning) in urban cancer survivors, while three highlighted poorer outcomes (physical functioning, role functioning, and self-reported mental health outcomes) in the rural group.

Conclusion

Recent research shows that rural people affected by cancer have unique unmet psychosocial needs relating to rurality. However, there was little evidence that rural cancer survivors report greater unmet needs than their urban counterparts. This contrasts to the findings from a 2011 systematic review that found rural survivors consistently reported worse psychosocial outcomes. More population-based research is needed to establish whether uniquely rural unmet needs are due to general or cancer-specific factors.

Improving Survivors' Quality of Life Post-Treatment: The Perspectives of Rural Australian Cancer Survivors and Their Carers

Simple Summary

Existing programs to support cancer survivors post-treatment tend to be delivered face-to-face, reducing their accessibility to those living in rural and remote locations. Additionally, little is known about the acceptability of urban-developed survivorship care programs among rural cancer survivors who may have unique values and different attitudes towards help-seeking. The purpose of this study was to explore the experiences of cancer survivors who return to their rural communities upon completion of active treatment, and to identify the challenges these survivors experience in engaging with quality of life-related support services. The findings of this study will inform the design and development of new interventions, or modification of existing interventions, to better meet the preferences and needs of rural survivors. Identifying the specific challenges and intervention preferences of rural cancer survivors will help to ensure they benefit as much as urban survivors, from efforts to improve post-treatment quality of life.

Abstract

The transition from urban centres back to rural and remote communities can be challenging for rural cancer survivors after treatment. This study aimed to (a) provide deeper understanding of the experiences of rural survivors who have completed active cancer treatment and returned to their rural communities, and (b) determine strategies to re-orient existing services or develop new interventions to more appropriately meet rural survivors’ service preferences and needs. Semi-structured interviews were conducted with 22 adults (64% female) who lived outside of a metropolitan area and had completed active cancer treatment (n = 13), were the carer for a rural/remote cancer survivor (n = 6), or were both a survivor and carer (n = 3). Thematic analysis was conducted to identify dominant themes in the qualitative data. A range of physical, psychological and practical challenges that impact quality of life among rural survivors post-treatment were found. These challenges appeared to be compounded by a lack of trust in local rural healthcare services and a lack of clear post-treatment pathways to quality of life-enhancing support services. Acceptable strategies to overcome barriers included nurse-led, telephone-based, or face-to-face interventions, initiated and continued by the same service provider, and that included support to manage emotional challenges associated with post-treatment survivorship. The findings will inform the design of interventions to better meet rural cancer survivors’ post-treatment support needs.

Understanding the strategies rural cancer patients and survivors use to manage financial toxicity and the broader implications on their lives

PURPOSE

To explore strategies rural Australians use to cope with the financial consequences of their cancer diagnosis and how that impacts on their lives.

METHODS

Twenty adult cancer patients/survivors residing in regional-remote areas of Australia were purposively sampled and participated in audio-recorded, semi-structured interviews. When data saturation was reached, thematic analysis was employed to analyse the data.

RESULTS

Participants were 20-78 years (M=60), 70% female, 35% were undergoing treatment and the remaining 65% had finished treatment within the past 5 years. Three themes provide context to rural financial toxicity-related experiences (travelling to access cancer treatment away from home is expensive, being single or lacking family support exacerbates the financial strain, and no choice other than to adopt cost-saving strategies if wanted to access treatment). Strategies commonly employed to minimise financial toxicity include: accessing travel-related support, changes to lifestyle (buying cheaper food, saving on utilities), accessing savings and retirement funds, missing holidays and social activities, reduced car use and not taking a companion to cancer-related appointments at metropolitan treatment areas. Although cost-saving strategies can effectively increase the ability of rural people to cover cancer treatment-related and other costs, most have broader negative psychological, social and practical consequences for them and their families.

CONCLUSIONS

Increasing rural cancer patients' and survivors' awareness of various cost-saving strategies and their impact (positive and negative) may decrease their risk of experiencing financial toxicity and unexpected unintended consequences of adopting cost-saving measures.

Feasibility of Synchronous Online Focus Groups of Rural Breast Cancer Survivors on Web-Based Distress Self-Management

PURPOSE

To obtain rural breast cancer survivors' perceptions of CaringGuidance™ After Breast Cancer Diagnosis, a web-based, psychoeducational, distress self-management program, and explore the feasibility of gathering survivors' perceptions about CaringGuidance using online focus groups (OFGs).

PARTICIPANTS & SETTING

23 survivors of early-stage breast cancer, a mean of 2.5 years postdiagnosis, living in rural Nebraska.

METHODOLOGIC APPROACH

Participants reviewed the CaringGuidance program independently for an average of 12 days prior to their designated OFG. The extent of participants' pre-OFG review was verified electronically. Four synchronous, moderated OFGs were conducted. Demographic and OFG participation data were used to assess feasibility. Transcripts of OFGs were analyzed using directed content analysis.

FINDINGS

All enrolled women participated in their designated OFG. Five themes of the quality and usability of CaringGuidance were identified. Recommendations were used to modify CaringGuidance prior to the pilot efficacy trial.

IMPLICATIONS FOR NURSING

The findings contribute to nurses' knowledge and guide assessment and interventions pertaining to psychosocial needs of rural women with breast cancer, OFGs, and qualities rural women seek in web-based psychological interventions.

Urban-Rural Variations in Quality-of-Life in Breast Cancer Survivors Prescribed Endocrine Therapy

The number of breast cancer survivors has increased as a result of rising incidence and increased survival. Research has revealed significant urban-rural variation in clinical aspects of breast cancer but evidence in the area of survivorship is limited. We aimed to investigate whether quality of life (QoL) and treatment-related symptoms vary between urban and rural breast cancer survivors prescribed endocrine therapy. Women with a diagnosis of stages I-III breast cancer prescribed endocrine therapy were identified from the National Cancer Registry Ireland and invited to complete a postal survey (N = 1606; response rate = 66%). A composite measure of urban-rural classification was created using settlement size, population density and proximity to treatment hospital. QoL was measured using the Functional Assessment of Cancer Therapy (FACT-G) and an endocrine subscale. The association between urban-rural residence/status and QoL and endocrine symptoms was assessed using linear regression with adjustment for socio-demographic and clinical covariates. In multivariable analysis, rural survivors had a statistically significant higher overall QoL (β = 3.81, standard error (SE) 1.30, p < 0.01), emotional QoL (β = 0.70, SE 0.21, p < 0.01) and experienced a lower symptom burden (β = 1.76, SE 0.65, p < 0.01) than urban survivors. QoL in breast cancer survivors is not simply about proximity and access to healthcare services but may include individual and community level psychosocial factors.

The relationship between risk factors and medication adherence among breast cancer survivors: What explanatory role might depression play?

OBJECTIVE

Despite the efficacy of clinical treatments (eg, adjuvant hormonal therapy) for breast cancer survivors (BCS), nonadherence rates remain high, increasing the risk of recurrence and mortality. The current study tested a theoretical model of medical nonadherence that proposes depression to be the most proximal predictor of medical nonadherence among BCS.

METHODS

Breast cancer survivors were recruited from radiation clinics in Missouri. Survey data were collected 12 months after the end of primary treatment. The sample size included 133 BCS.

RESULTS

Findings show substantial support for the model, demonstrating that depression mediated the relation between physical symptoms, cognitive symptoms, social support, and adherence to medication. This finding was replicated with a measure of mood disturbance.

CONCLUSIONS

These findings support the prediction that medication nonadherence among BCS multiply determined process and have compelling implications for healthcare providers and interventions designed to increase medication adherence among BCS.

Health locus of control in Indonesian women with breast cancer: a comparison with healthy women

The aims of this study were to assess whether Indonesian women with breast cancer havea higher external health locus of control (HLC) than healthy women, and to explore the association between HLC and symptoms of anxiety and depression. In this study, 120 consecutive women with breast cancer were recruited at the outpatient surgical oncology clinic at the Hasan Sadikin Hospital in Bandung. One hundred and twenty two healthy women were recruited from the Bandung area as controls. A standard demographic form, Form C of the Multidimensional Health Locus of Control, as well as the Hospital Anxiety and Depression Scale and patients' medical records were used. Data were analyzed using descriptive statistics, t-test, Pearson's correlation, MANOVA and multiple linear regressions. Women with breast cancer had higher scores on all external HLC subscales, i.e. chance, doctor, powerful others and God, and lower internal HLC compared to healthy women. High God LHC scores were associated with a high level of anxiety (β=0.21, p<0.05), whereas none of the HLC subscales were associated with depression. Our results suggest that women with breast cancer tend to have high external HLC, while healthy women tend to have high internal HLC. A strong belief in an external source of control, i.e. God, might be negatively associated with patient emotional adjustment. Further research is needed to give an insight into the direction of this association.

Fatalistic Beliefs and Cervical Cancer Screening Among Mexican Women

Fatalistic beliefs about cervical cancer were studied in 464 Mexican women, and how such beliefs relate to participation in cervical cancer screening was evaluated. Rural women were less likely than urban women to have had a Pap test and more likely to believe that the illness is due to bad luck or fate. These were also the beliefs most associated with nonscreening among rural women, whereas for urban women the belief most associated with nonscreening was "there is not much I can do to prevent cervical cancer."

Psychosocial service use: a qualitative exploration from the perspective of rural Australian cancer patients

PURPOSE

This study aims to identify key issues associated with the provision of psychosocial care from the perspective of rural Australian cancer patients and determine culturally appropriate methods that may reduce barriers to service use.

METHOD

Seventeen purposively sampled adult South Australians who lived outside metropolitan Adelaide, had a diagnosis of cancer and various demographic and medical histories participated in semi-structured, face-to-face interviews. Participants also completed a demographic questionnaire. Qualitative data were analysed using thematic analysis.

RESULTS

Five key themes were identified: (1) psychosocial support is highly valued by those who have accessed it, (2) having access to both lay and professional psychosocial support is vitally important, (3) accessing psychosocial services is made difficult by several barriers (lack of information about services, initial beliefs they are unnecessary, feeling overwhelmed and concerns about stigma and dual relationships), (4) medical staff located in metropolitan treatment centres are not sufficiently aware of the unique needs of rural patients and (5) patients require better access to psychosocial services post-treatment. Methods through which rural patients believe access to psychosocial services could be improved include: (1) providing more rural-specific information on psychosocial care, (2) improving communication between health care providers and referral to psychosocial services and (3) making psychosocial services a standard part of care.

CONCLUSIONS

Rural cancer patients want their unique needs to be recognised and to be treated differently to their urban counterparts. There is a need for more targeted and rurally relevant information for rural cancer patients, both to inform them of, and change their attitudes towards, psychosocial services. Other practical recommendations are also discussed.

Effects of optimism, social support, fighting spirit, cancer worry and internal health locus of control on positive affect in cancer survivors: a path analysis

The psychological impact of a cancer diagnosis can extend through treatment, well into cancer survivorship and can be influenced by a range of psychosocial resources. At different stages in this trajectory, optimism is known to affect well-being directly. This study focusing upon the potential to flourish after cancer, investigates the relationship between optimism and positive affect during cancer survivorship together with four possible mediators: social support, fighting spirit, internal health locus of control and cancer worry, all of which have been shown to be important predictors of well-being in cancer patients. Participants (n = 102) from online cancer forums completed standardized questionnaires, and path analysis confirmed that optimism had a direct effect on positive affect in cancer survivors. Social support and fighting spirit were also shown to be significant mediators of this relationship, accounting collectively for 50% of the variance in positive affect. Whilst cancer worry and internal health locus of control could be predicted from levels of optimism, they did not mediate the optimism-positive affect relationship. Efforts to promote optimism and thus encourage fighting spirit at diagnosis through treatment may be worthwhile interventions, as would ensuring appropriate social support through the trajectory.

Cancer patients' preferences for control at the end of life

The achievement of a death consistent with personal preferences is an elusive outcome for most people with cancer. Maintaining a sense of control is a core component of a dignified death; however, control might be a Western bioethical notion with questionable relevance to culturally diverse groups. Thus, the purpose of our study was to explore the meaning of control and control preferences in a group of racially and ethnically diverse patients with an advanced cancer diagnosis. Using a hermeneutic, phenomenological approach, we interviewed 20 patients with advanced cancer and uncovered two themes: (a) preferences for everyday control over treatment decisions, family issues, final days of life, and arrangements after death, vs. (b) awareness that cancer and death are controlled by a higher power. Although the sample included non-Hispanic Whites, African Americans, and Hispanics, participants shared common views that are characteristic of American cultural norms regarding the value of autonomy.

Psychosocial well-being and supportive care needs of cancer patients living in urban and rural/regional areas: a systematic review

PURPOSE

The aim of this study was to describe what is known about levels of morbidity and the experience and needs of people with cancer, and their informal caregivers, living in rural areas.

METHODS

A search of online databases for English language papers describing or assessing the prevalence of psychosocial morbidity or needs in a population of rural or regional cancer patients was employed. The following were excluded: intervention studies, discussion of service delivery, effectiveness of support groups or support via videoconferencing, concentrated on medical outcomes or survival rates, reported differences in the uptake of cancer screening or concentrated on health attitudes or treatment decision making.

RESULTS

There were 37 studies in the review, including 25 quantitative studies (all surveys), 11 of which included a control group of urban patients and 12 qualitative studies. Until recently, most studies had methodological shortcomings. Only two prospective studies were identified, most studies focused on breast cancer and few addressed psychological morbidity. The majority of controlled studies reported worse outcomes for rural patients, who appear to have higher needs in the domains of physical/daily living. This may reflect more limited access to resources, a more self-sufficient lifestyle and personal characteristics, for example, being more stoical and less likely to ask for help. The need to travel for treatment caused many practical, emotional and financial problems for patients and burdened them with additional worry concerning family and work commitments. Some patients reported benefits in sharing experiences with others also forced to stay away from home, but most agreed that staying at home was preferable.

CONCLUSION

This review highlights that whilst we are beginning to get some insight into the needs of people with cancer in rural areas, much is still unknown. Population-based, prospective studies including people with heterogeneous cancers from rural and urban settings are needed.

Predictors of the health-related quality of life of patients who are newly diagnosed with lung cancer in China

The purpose of this study was to explore the level and predictors of the health-related quality of life among patients who were newly diagnosed with lung cancer in China. A descriptive survey design was used to collect the data from 108 patients. The relationships among the variables were analyzed by using Pearson's correlation and multiple regression analyses. The results indicated that the patients in this sample had a poor quality of life in the physical, psychological, and environmental domains of the World Health Organization Quality of Life Questionnaire. Their age, annual family income, social support, and three dimensions of the health locus of control (internal, external, and chance) correlated significantly with the global quality of life. The stepwise multiple regressions showed that only the internal locus of control was statistically significant in predicting the patients' quality of life. The results suggest that healthcare professionals should pay particular attention to demographic characteristics, such as age and family income, and personal characteristics, such as the health locus of control and social support, when treating this patient group.

Predictors of depressive symptoms among breast cancer patients during the first year post diagnosis

It is important to identify predictors of psychological health among breast cancer patients that can be relatively easily identified by medical care providers. This article investigates the role of one class of such potential predictors: easily identified demographics that have potential social and/or practical implications. Specifically, we examined whether income, marital status, presence of children in the home, education, travel distance, age and rurality interact with time to predict psychological health over the first year post diagnosis. Two hundred and twenty five breast cancer patients receiving radiation treatment completed four surveys over the course of 13 months that included measures of both their physical health and depressive symptoms. The results revealed that women who were not married had children living in the home or had to travel long distances to receive radiation treatment reported higher levels of depressive symptoms across the entire study. Women with lower incomes reported increased depressive symptoms, but only after the completion of treatment. Younger women reported elevated depressive symptoms during initial treatment, but this effect dissipated after the completion of treatment. The current results suggest that demographic patient characteristics may indeed be useful in identifying both when and for whom depressive symptoms are particularly likely to be problematic.

Psychosocial determinants of mammography follow-up after receipt of abnormal mammography results in medically underserved women

This article targets the relationship between psychosocial determinants and abnormal screening mammography follow-up in a medically underserved population. Health belief scales were modified to refer to diagnostic follow-up versus annual screening. A retrospective cohort study design was used. Statistical analyses were performed examining relationships among sociodemographic factors, psychosocial determinants, and abnormal mammography follow-up. Women with lower mean internal health locus of control scores (3.14) were two times more likely than women with higher mean internal health locus of control scores (3.98) to have inadequate follow-up (OR=2.53, 95% CI=1.12-5.36). Women with less than a high school education had lower cancer fatalism scores than women who had completed high school (47.5 vs. 55.2, p-value=.02) and lower mean external health locus of control scores (3.0 vs. 5.3) (p-value<.01). These constructs have implications for understanding mammography follow-up among minority and medically underserved women. Further comprehensive study of these concepts is warranted.

Age, Relative Autonomy and Change in Health Locus of Control Beliefs

Health locus of control (HLC) describes an individual’s characteristic attribution of health outcomes to internal or external causes. This four-year longitudinal study examined changes in HLC beliefs among 124 members of a health-promotion facility, related to their age (22—81) and relative autonomy toward health-related goals. HLC beliefs changed with age as developmental theories of control striving would predict. Holding age aside, the pursuit of health goals with more relative autonomy significantly offset the growth of external-chance HLC beliefs. Lack of autonomy thus appears to permit development of fatalistic attributions that may affect later coping with adverse health events.

Are rural Ohio Appalachia cancer survivors needs different than urban cancer survivors?

INTRODUCTION

Limited information is available about rural cancer survivors' needs and if they differ from urban cancer survivors.

METHODS

A convenience sample of cancer survivors completed a self-administered survey.

RESULTS

Rural Appalachia (n = 99) and urban non-Appalachia (n = 107) cancer survivors completed the survey. Urban survivors reported more needs than rural survivors (p < 0.001), but worry about cancer recurrence and concern about fatigue were reported most often by both urban and rural survivors. Urban survivors (n = 87; 81.3%) and rural survivors (n = 72; 72.9%) indicated that they searched for cancer information, but rural survivors were more likely to obtain information from family members and healthcare providers (p < 0.05). Rural survivors differed from urban survivors by reporting less effort to get the information they needed (p < 0.05) and less concern about the quality of the information (p < 0.01), but they reported having a harder time understanding the information they found (p < 0.05).

DISCUSSION

Rural and urban survivors' most frequent needs focused on cancer recurrence and fatigue. Rural survivors reported fewer needs compared to urban survivors; however, our findings suggest certain needs may be more important to rural survivors. While most survivors reported searching for information about cancer, rural and urban survivors use different sources for finding information and have varying experiences in their searches.

IMPLICATIONS FOR CANCER SURVIVORS

There is an ongoing need to provide survivorship care that is tailored to the unique needs of cancer survivors. It is essential to provide educational materials for all cancer survivors, but using different communication channels for urban versus rural survivors may be beneficial.

Culturecology, Women, and African-Centered HIV Prevention

The Healer Women Fighting Disease Integrated Substance Abuse and HIV Prevention Program for African American women is based on a conceptual framework called “culturecology” and an African-Centered Behavioral Change Model (ACBCM). Culturecology poses that an understanding of African American culture is central to both behavior and behavioral transformation. The ACBCM model suggests that behavioral change occurs through a process of resocialization and culturalization. These processes minimize negative social conditions and maximize prosocial and life-affirming conditions. The participants were 149 women—105 in the intervention group and 44 in the comparison group. Findings show significant changes among participants from pretest to posttest in (1) increasing motivation and decreasing depression (cultural realignment ), (2) increasing HIV/AIDS knowledge and self-worth (cognitive restructuring ), and (3) adopting less risky sexual practices (character development ). The African-centered approach demonstrates promise as a critical component in reducing and/or eliminating health disparities in the African American community.

Validación de la versión castellana del Inventario de Fatalismo de Powe en población mexicana con cáncer

Objetivo: validar la versión en español del Inventario de Fatalismo de Powe (SPFI) en población mexicana con cáncer. Método: Se aplicó el SPFI a 133 mujeres con cáncer de mama. Se realizó un análisis factorial con rotación Oblimin. Posteriormente se evaluó la consistencia interna con el coeficiente Alfa de Cronbach y por último se realizaron análisis de correlación entre los factores del cuestionario. El instrumento resultante se nombró Inventario de Fatalismo de Powe en Español-Cáncer (IFPE-C).Resultados: Se eliminaron siete de los 15 reactivos originales y se conservaron ocho, todos ellos con cargas factoriales superiores a 0,40. Se obtuvo una estructura de tres factores que explicaron el 73,7% de la varianza y se llamaron: Inutilidad del tratamiento con un α=0,85, Predestinación con un α=0,918 y Pensamientos de muerte con un α=0,73. La consistencia interna para la escala global fue de α =0,80. Se obtuvieron correlaciones estadísticamente significativas entre los factores. Conclusión: el IFPE-C demostró ser un instrumento valido y confiable, que puede ser utilizado tanto en entornos clínicos como de investigación para identificar las creencias fatalistas acerca del cáncer de los pacientes.