Perceived control over the medical procedure and its association with adjustment to a low-control situation: the case of infertility.

Illness perceptions were shown to be related to emotional and physical outcomes, as proposed by Leventhal's self-regulation model. These perceptions include the illness identity, its timeline, consequences, causes, and controllability, which later research found to include self-control and treatment control. The current study aimed to examine the role of a third type of perceived control: Control over the treatment procedures. We hypothesized that this type of control would be important for women undergoing infertility treatments, which are characterized by high uncertainty and low personal control. The sample included 194 Israeli women who were undergoing infertility treatments, 70% recruited in hospitals and the remainder in a fertility counseling center and website. All participants were married religious Jewish women, which added to the stress inherent in infertility. Study measures included the Illness Perception Questionnaire-Revised (IPQ-R), adapted to infertility, with an additional subscale assessing control over the procedure, and infertility-specific distress and well-being scales. Exploratory and confirmatory factor analyses supported the factor structure, including the distinct new subscale. A structural equations model showed that perceived consequences were most strongly related to distress and well-being. The three types of control were positively intercorrelated but differed in their associations with distress and well-being: Self-control over the problem and treatment control were unrelated to either measure while self-control over the procedure was related to greater well-being. These findings suggest that when control over the condition or the treatment outcomes is impossible, individuals may still benefit from control over external factors such as their health care. Healthcare providers can support them by seeking ways to increase their control over their treatment procedures, which may contribute to better psychological adjustment. Future studies should examine the role of perceived control over the procedures in other low-control situations (e.g., newly diagnosed cancer; aging-related declines).

Where to die? That is the question: A study of cancer patients in Israel.

OBJECTIVE: Most patients prefer to die at home, but barely 30% do so. This study examines the variables contributing to dying at home. METHODS: The participants were 326 cancer patients, of both genders, with a mean age of 63.25 years, who died from 2000 to 2008 and were treated by the palliative care unit of the Barzilai Hospital. Some 65.7% died at home and 33.4% in a hospital. The data were extracted from patient files. The examined variables were demographic (e.g., age, gender, marital status, ethnic background, number of years in Israel until death), medical (e.g., age at diagnosis, diagnosis, nature of last treatment, patient received nursing care, patient given the care of a social worker, patient had care of a psychologist, family received care of a social worker, patient had a special caregiver), and sociological (e.g., having insurance, having worked in Israel, living alone or with family, living with one's children, living in self-owned or rented house, family members working). RESULTS: The findings indicate that the chances of dying at home are higher if the patient is non-Ashkenazi, the family got social worker care, the patient lived in a self-owned house, the patient lived with his family, the family members worked, and the patient's stay in Israel since immigration was longer. Logistic regression showed that all the predictors together yielded a significant model accounting for 10.9-12.3% of the variance. SIGNIFICANCE OF RESULTS: The findings suggest that dying at home requires maintaining continued care for the patient and family in a community context.