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Ambulatory treatment for cancer has increased patients' self-care requirements and placed demands on family members to manage the illness and treatment side effects at home. This exploratory study was undertaken to assess family caregiving demands (load) and to examine caregivers' appraisals of the illness/caregiving experience. Forty-seven persons involved in the care of patients receiving radiotherapy for cancer were observed. Appraisal of stress was measured with the Appraisal of Caregiving Scale (ACS). This newly developed measure, derived from cognitive appraisal theory, is designed to assess the intensity of four possible appraisals of caregiving: harm/loss, threat, challenge, or benign. Participants also completed the Caregiver Load Scale, a measure of the time spent in caregiving activities. Satisfactory reliabilities were obtained for both measures. Family caregivers reported spending the most time in providing transportation, giving emotional support, and in extra household tasks. They received the most assistance from family and friends, and made minimal use of professional services. Caregiver load was correlated positively with the length of time on treatment and with patient dependency. Caregivers in the poorest health, those with less education, and those of lower socioeconomic status had higher scores on the ACS appraisals of harm/loss and threat. Older caregivers had significantly higher challenge and benign appraisals. There was a strong positive correlation between caregiver load and the harm/loss and threat appraisals. Findings suggest a need for frequent reassessment of demands on family caregivers throughout the course of treatment and offer direction for future research.

In this descriptive study of 30 men with chronic genitourinary cancer, subjects were found to have minimal emotional distress in response to a periodic diagnostic procedure (cystoscopy). State anxiety levels and critical thinking ability measured preprocedure were not significantly different from levels obtained six to eight weeks postprocedure in subjects with negative biopsy results. Routine hospitalization for diagnostic monitoring was found, during COPE interview (Weisman & Worden, 1976), to be less stressful than regular work or financial and family concerns. Subjects with higher concurrent life stress had higher state anxiety and achieved less resolution of problems. Although anxiety levels for the group were within normal limits, 33% of the sample were categorized as having high anxiety on at least one testing occasion. This high-anxiety group had more severe behavioral responses, including feelings of depression, helplessness, and inability to set priorities.

Three studies to develop and test an instrument to measure hospitalized patients' satisfaction with nursing care are reported. Content validation procedures involved both clinicians and patients (N = 75). An inverse relationship of satisfaction scores to negative mood states demonstrated evidence of construct validity. Factor analytic procedures (N = 664) failed to confirm the existence of the subscales initially conceptualized for this instrument and others in common use. Three new factors were identified: dissatisfaction, interpersonal support, and good impression. The dissatisfaction subscale explained 73.6% of the variance and had a high internal consistency (alpha = .91); the reliability coefficients of the other subscales also were high (alpha = .92 and .89). Reliability coefficients for the total instrument in successive testings were .92 (N = 100) and .95 (N = 533).