Barriers to diabetes management: patient and provider factors.

The extant data linking forgiveness to health and well-being point to the role of emotional forgiveness, particularly when it becomes a pattern in dispositional forgivingness. Both are important antagonists to the negative affect of unforgiveness and agonists for positive affect. One key distinction emerging in the literature is between decisional and emotional forgiveness. Decisional forgiveness is a behavioral intention to resist an unforgiving stance and to respond differently toward a transgressor. Emotional forgiveness is the replacement of negative unforgiving emotions with positive other-oriented emotions. Emotional forgiveness involves psychophysiological changes, and it has more direct health and well-being consequences. While some benefits of forgiveness and forgivingness emerge merely because they reduce unforgiveness, some benefits appear to be more forgiveness specific. We review research on peripheral and central nervous system correlates of forgiveness, as well as existing interventions to promote forgiveness within divergent health settings. Finally, we propose a research agenda.

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Forgiveness, Health, and Well-Being: A Review of Evidence for Emotional Versus Decisional Forgiveness, Dispositional Forgivingness, and Reduced Unforgiveness

The existence of links between religion and spirituality (R/S) and health appear to be firmly established, but much less is known about how these various aspects of R/S are translated into health outcomes. Within a meaning systems framework, this article reviews and integrates findings regarding the many pathways through which R/S may influence physical health and well-being. In particular, evidence for the pathways of body sanctification, meaning in life, social support, health locus of control, health behaviors, positive and negative affect and stress moderation, treatment adherence, and coping is examined. The article concludes with suggestions for future research.

Religiousness/Spirituality and Health: A Meaning Systems Perspective

Cancer survivors' efforts at meaning making may influence the extent to which they successfully make meaning from their experience (i.e., experience posttraumatic growth, find life meaningful, and restore beliefs in a just world), which may, in turn, influence their psychological adjustment. Previous research regarding both meaning making processes and meanings made as determinants of adjustment has shown inconsistent effects, partly because of the lack of clearly articulated theoretical frameworks and problematic research strategies. In a 1-year longitudinal study, the authors distinguished the meaning making process from the outcomes of that process (meanings made), employing specific measures of both. The authors tested pathways through which meaning making efforts led to 3 different meanings made (growth, life meaning, and restored just-world belief) in a sample of 172 young to middle-age adult cancer survivors, and they explored whether those meanings made mediated the effect of meaning making efforts on psychological adjustment. Cross-sectional and longitudinal path models of the meaning making process indicate that meaning making efforts are related to better adjustment through the successful creation of adaptive meanings made from the cancer experience. The authors conclude with clinical implications and suggestions for future research.

Meaning making and psychological adjustment following cancer: The mediating roles of growth, life meaning, and restored just-world beliefs.

Objective: Cancer places many demands on the patient and threatens the person's sense of meaning to life. It has been shown that cancer patients use their spirituality to cope with these experiences. The present literature review summarizes the research findings on the relationship between spirituality and emotional well-being. Special attention is given to the strength of the research findings.

Methods: A literature search was performed in Pubmed and Web of Science. Spirituality does not necessarily coincide with religiosity. Therefore, studies were excluded that focused on religiosity. Forty publications met the inclusion criteria: Twenty-seven studies that investigated the relationship between spirituality and well-being, and 13 publications that explored the relationship between meaning in life and well-being.

Results: The majority of the cross-sectional studies (31 of 36) found a positive association between spirituality and well-being. The four studies with a longitudinal design showed mixed results. The significance of the findings is challenged, because most spirituality questionnaires contain several items that directly refer to emotional well-being.

Conclusions: Despite that the majority of the studies concluded that spirituality was associated with higher well-being, no definitive conclusions on this relationship can be drawn due to major methodological shortcomings of these studies. Longitudinal research utilizing spirituality and well-being measures that do not overlap in content is recommended. Copyright © 2009 John Wiley & Sons, Ltd.

Spirituality and well-being in cancer patients: A review

Personality, psychosocial, demographic and medical variables have been identified as correlates of adjustment to breast cancer and quality of life (QoL). Most studies have examined relationships between personality, social support and adjustment to cancer in predominantly middle-class Caucasian samples, thus limiting the generalizability of their findings. Eighty-one female outpatients at a medical oncology breast clinic in a county general hospital serving primarily indigent Hispanic and African-American patients completed measures assessing demographic and medical information, health-related QoL, cancer-specific distress, mood disturbance, dispositional optimism and satisfaction with social support. Older age, receipt of treatment and greater optimism accounted for 41% of the variance in emotional well-being (p<0.01). Absence of family history of breast cancer, receipt of treatment and optimism accounted for 43% of the variance in functional well-being (p<0.01). Optimism and satisfaction with social support accounted for 43% of the variance in social/family well-being (p<0.01). Absence of treatment (not yet treated) and pessimism accounted for 31% of the variance in cancer-specific distress (p<0.01). Finally, family history of breast cancer and pessimism accounted for 48% of the variance in mood disturbance (p<0.001). Family history of breast cancer and pessimism were related to mood disturbance (p<0.001). No between-group differences were found for race/ethnicity for any of the variables. Encouraging positive expectations and facilitating social support may help women in public sector medical settings cope with the stressful demands of diagnosis and treatment of breast cancer regardless of race/ethnicity.

Optimism, social support and psychosocial functioning among women with breast cancer.

We evaluated whether a self-forgiving attitude and spirituality were related to psychological adjustment among 81 women being treated for breast cancer at a medical oncology clinic in a county general hospital Both a self-forgiving attitude and spirituality were unique predictors of less mood disturbance and better quality of life (p's < 0001) These results are consistent with previous research that has demonstrated a positive relationship between spirituality and well-being The findings also suggest that self-forgiveness should be explored experimentally to determine whether it can protect against the psychological effects of breast cancer-related stress Interventions targeting these characteristics could improve the quality of life and alleviate stress, especially in women with breast cancer in public sector settings

https://catherinerbarberphd.weebly.com/uploads/8/8/1/1/8811695/romero_etal_2006.pdf

Self-forgiveness, spirituality, and psychological adjustment in women with breast cancer

We examined demographic, medical and psychosocial factors related to delay in seeking medical consultation for breast symptoms. In this cross-sectional survey, 124 women with breast symptoms attending an outpatient breast surgery clinic in a county general hospital completed questionnaires measuring demographic, medical and psychosocial variables. Our outcome variable was delay in seeking medical consultation. Younger age (p ≤ 0.05), less education (p ≤ 0.01), absence of a lump (p ≤ 0.05), lower perceived risk (p ≤ 0.001), less spirituality (p ≤ 0.01), cost (p ≤ 0.001) and not wanting to think about breast symptom(s) (p ≤ 0.05) were related to delay. Multivariate analyses showed absence of a breast lump by education interaction (p ≤ 0.05), risk perception (p ≤ 0.001), spirituality (p ≤ 0.01) and cost (p ≤ 0.001) collectively accounted for 38.4% of the variance in delay. Health promotion programs targeting low-income populations should emphasize the importance of breast symptoms other than lumps, especially to younger and less educated women.

Medical and Psychosocial Predictors of Delay in Seeking Medical Consultation for Breast Symptoms in Women in a Public Sector Setting

The purpose of this study was to examine relationships among self-blame for developing breast cancer, a self-forgiving attitude, mood, and quality of life among women with breast cancer. In this cross-sectional study, 123 women with Stages 0–III breast cancer completed questionnaires measuring demographic and medical characteristics, self-blame, self-forgiveness, mood, and quality of life. Women who blamed themselves reported more mood disturbance (p ≤ .001) and poorer quality of life (p < .001) than those who did not blame themselves. Mediational analyses revealed that self-blame for cancer partially mediated the relationships between a self-forgiving attitude and both mood disturbance and quality of life (Z = −2.72, p = .006 and Z = −2.89, p = .004, respectively). Patients may benefit from a discussion with their oncologists and other healthcare providers about self-forgiveness and the potential benefits of reducing self-blame to facilitate adjustment to breast cancer.

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Attribution of blame, self-forgiving attitude and psychological adjustment in women with breast cancer

Married women's adjustment to breast cancer is positively influenced by their husbands' emotional support and by both spouses' active coping strategies. However, little is known about how women's adjustment is related to their husbands' perceptions of their psychosocial impairment. The current study examined the relationships among wives' coping strategies, the extent of congruence between wives' and husbands' perceptions of wives' adjustment, and wives' mood disturbance in 45 women with Stage I or II breast cancer and their husbands. Mediational analyses demonstrated that discrepancies between husbands' perceptions of wives' adjustment and wives' perceptions of their own adjustment mediated the relationship between wives' use of avoidant coping strategies and wives' mood disturbance. The findings suggest that husbands' over- or under-estimation of wives' adjustment may have a negative impact on wives' mood. Implications for future research are discussed.

Catherine Romero

Papers

Optimism, social support and psychosocial functioning among women with breast cancer.

Self-forgiveness, spirituality, and psychological adjustment in women with breast cancer

Medical and Psychosocial Predictors of Delay in Seeking Medical Consultation for Breast Symptoms in Women in a Public Sector Setting

Attribution of blame, self-forgiving attitude and psychological adjustment in women with breast cancer

Husbands' perceptions of wives' adjustment to breast cancer: the impact on wives' mood