Psychological control and morbidity/mortality in breast cancer patients: a 20-year follow-up study.

The purpose of this paper was to examine the longitudinal effects of psychological sense of control and control-related coping strategies on breast cancer outcomes. Utilizing the California Cancer Registry, follow-up data on cancer recurrence and all-cause mortality were obtained for 54 of 58 women originally diagnosed with breast cancer in 1992 to 1994. Relationships between cancer outcomes and psychological control and mood at 4 and 8 months post-diagnosis were examined. Results of the study showed that a greater sense of control at 8 months was associated with less cancer recurrence, while higher desire for control at both 4 and 8 months was associated with greater likelihood of recurrence. Utilization of an accepting mode of control appeared to mitigate the negative effects of desire for control on recurrence. No significant relationships were observed between mood and mortality or recurrence. These findings suggest the potential value of examining psychological control and control-related coping on cancer outcomes in future epidemiological and clinical studies.

Coping with loss of control in the practice of medicine.

Although the quest for active control and mastery can be seen as a central thread that ties together important aspects of human experience, we are frequently confronted with the reality that much of what is encountered in life lies outside our active instrumental control. Control must involve finding healthy and life-affirming ways to exercise personal mastery, and identifying constructive ways to respond to the lack of control that pervades the human condition. In this article we explore a number of professional areas in which physicians may experience significant feelings of loss or lack of personal control-difficult encounters with patients, dealing with patient nonadherence, end-of-life care, confronting the uncertainty and ambiguity that are frequently a part of illness, as well as institutional and systemic factors that can result in loss of various forms of autonomy and control over decision-making. We then consider maladaptive ways in which physicians sometimes attempt to address such losses of control and suggest that personal stress and burnout and difficulty developing effective therapeutic relationships with patients may be the consequence, in part, of these efforts. Finally, we discuss an empirically derived, multidimensional theoretical model for better understanding control dynamics, and identifying more optimal strategies physicians can employ in their efforts to gain and regain a sense of control in caring for patients.