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This cross-sectional study examined relationships among predictors of breast self-examination (BSE) derived from the Health Belief Model and behavioral self-regulation theory. Subjects were 427 gynecology outpatients. Although 64% indicated that they had practiced BSE at least once during the past year, only 27% indicated they practiced BSE monthly. The majority of the subjects knew about most of the recommended BSE steps. The most frequently endorsed reasons for completing BSE were early detection, recommendation from a doctor, and peace of mind. The most frequently endorsed barrier was forgetting/being too busy. Multivariate analysis showed that several psychological variables--including reasons for doing BSE, self-efficacy, and barriers to doing BSE--were related to frequency of BSE. Overall, the variables in this model accounted for about 37% of the variance in BSE frequency.

By means of cluster analytic techniques, four subtypes of psychosocial adjustment were identified in a sample of 122 breast cancer patients who completed the Psychosocial Adjustment to Illness Scale. Internal consistency and internal validity of the derived typology were suggested by the finding that two different hierarchical agglomerative clustering methods (average linkage between groups, Ward's) produced similar solutions. Three of the derived subtypes reported normal affect levels but different patterns of relative strengths and dysfunctions, while the fourth subtype appeared to be highly distressed and globally maladjusted. External validation was demonstrated by differentiating the subtypes on variables of negative affect, avoidance coping, and fighting spirit. The clinical and heuristic implications of these findings are discussed. The findings highlight the need for comprehensive assessment of psychosocial functioning of cancer patients. They demonstrate that even non-emotionally distressed patients can have very different profiles of adjustment and may benefit from correspondingly individually tailored psychosocial interventions.

Relationships between anxiety in medical situations and age, gender, duration of illness, and communication problems with friends or relatives were examined in a heterogeneous sample of 117 adult cancer patients. The relationships between the same demographic, medical, and psychosocial variables and chemotherapy-related problems in a subsample of 79 patients receiving chemotherapy also were examined. Results indicated that females and patients who reported more communication problems with friends or relatives reported more anxiety in medical situations. Female patients and patients who reported more communication problems with friends or relatives also reported more chemotherapy-related problems. Duration of illness was not related significantly to either dependent measure. Clinical implications of these results are discussed.

This cross-sectional study examined predictors of skin self-examination (SSE) in a population at increased risk for skin cancer. Subjects were 384 hospital employees participating in a worksite skin cancer screening. Although 61% reported that they performed SSE at least once during the past year, only 20% reported monthly SSE. Only a minority of the subjects were knowledgeable about most of the recommended SSE steps. Based on behavioral self-regulation theory, multivariate analysis showed that a variety of psychological factors (including optimism, knowledge about SSE, perceived self-efficacy, and number of reasons for doing SSE) correlated positively with frequency of SSE. Demographic variables accounted for about 6% of the variance in frequency of SSE. Overall, the variables in this model accounted for about 25% of the variance.

A collaborative multidisciplinary study was conducted to assess both physical and psychosocial needs of 117 adults with various types of cancers. Although these patients functioned adequately in many areas of their lives, they reported that cancer and its treatment had an impact on energy, physical and recreational activities, communication with spouse, sexual and emotional functioning, occupational matters, and treatment-related situations. Younger patients reported more psychosocial, sexual, and treatment-related problems than did older patients. Female patients reported more chemotherapy-related problems than did male patients. Implications for clinicians treating cancer patients were discussed.

The relationship of dispositional optimism, daily life stress, and domestic environment to two types of coping methods was examined in a group of 94 cancer patients. As expected, dispositional optimism and domestic environment made significant contributions to the prediction of avoidance coping. Dispositional optimism contributed significantly to the prediction of active-behavioral coping. Specifically, a significant positive relationship was obtained between active-behavioral coping and optimism. A significant positive relationship also was found between avoidance coping and both daily stress and domestic environment. Avoidance coping was negatively related to dispositional optimism. In multivariate analyses, gender and disease-related variables did not make significant contributions to the prediction of coping method. Suggestions for future research were made.

The Global Assessment Scale was used by multiple clinicians to rate 108 chronically mentally ill outpatients for 18 months. With prior training, high interrater reliability was obtained. Analysis suggests that fluctuations in patients' scores were not attributable to measurement error due to the sequential ratings of multiple clinicians. Moreover, GAS means were inversely correlated with decompensations over the study period. Results indicate that the DMS-III-R recommended use of the GAS in multiple-rater outpatient facilities can be both reliable and clinically useful when supported by thorough staff training.

A patient with pulmonary hypertension (PH) complicating mixed connective tissue disease (MCTD) is described. The patient died suddenly after catheterization documenting the pulmonary hypertension. Pathologic examination demonstrated marked medial hypertrophy and intimal proliferation of the pulmonary arterial vessels. Review of the literature revealed few and differing reports concerning the pathology of PH as seen in MCTD. Sudden death in patients with pulmonary hypertension undergoing invasive procedures is not an uncommon occurrence.

Higher rates of recurrence-free survival at 5- and 10-year follow-up have been reported for breast cancer patients who initially responded to cancer with attitudes of "fighting spirit" or denial. We report here a factor analytic attempt, utilizing questionnaire data, to objectify these attitudes. A reliable factor structure replicated in breast and mixed cancer samples, yielding three factors: (1) Fighting Spirit or belief in the ability to fight back, conquer, and recover from cancer; (2) Information-Seeking behavior; and (3) Denial. Adequate 1-month test-retest correlations were obtained for Fighting Spirit and Information Seeking factor scores. A pattern of differential correlations with other measures (affect, coping, and optimism) distinguished Fighting Spirit and Information Seeking. The Denial factor appeared to be less stable and did not correlate significantly with other measures.

Fifty-seven women with breast cancer completed measures of family adaptability and cohesion, marital adjustment, and psychosocial adjustment to illness. Using a circumplex model of family systems, we examined whether subjects who perceived their families at moderate levels of cohesion and adaptability reported better psychosocial adjustment than subjects from families with extreme levels of cohesion and adaptability. The results indicated that the patients who reported the best adjustment to breast cancer and in their marriages, also reported the highest levels of family cohesion. There was not a significant relationship between adjustment to illness and adaptability. The implications for the treatment of women with breast cancer and for the families of these patients were discussed.

The duty of therapists to warn or protect third parties when a patient expresses a threat was established by the court in the Tarasoff decision. Confidentiality, disclosure, and prediction of violence are clinical, ethical, and legal issues that the therapist must address in the context of a therapeutic relationship. Clinical case material from the literature, as well as cases from the authors' experiences, indicate that when confidentiality is breached and a potential victim is warned, the therapeutic results may be positive, especially if the patient participated in the process. Other methods of protection, such as commitment, use of medications, police involvement, and confiscation of a weapon, may be necessary. Each case deserves individual consideration as to what appropriate and necessary steps should be taken. Through careful assessment of a patient's threats, concern for the patient and victim, adherence to ethical standards of care, and knowledge of the law, one can often protect a victim as well as engage the patient in an ongoing therapeutic relationship.