title: The role of self-efficacy in quality of life for disadvantaged men with prostate cancer.
abstract: OBJECTIVE
  Self-efficacy is associated with increased participation in treatment decision making and improved health related quality of life. We examined the influence of perceived efficacy in patient-physician interactions on health related quality of life among low income, uninsured men with prostate cancer during a 2-year period.
  
  
  METHODS
  We analyzed data derived on participants enrolled in a state funded program providing free prostate cancer treatment and care to indigent men. We used validated instruments to measure patient self-efficacy (confidence in interacting with physicians), and the general and prostate specific health related quality of life outcomes of urinary, sexual and bowel bother, symptom distress, psychological well-being and vitality. We performed repeated measures analysis with general linear mixed modeling to estimate the association of sociodemographic and clinical covariates with health related quality of life.
  
  
  RESULTS
  Our cohort included a total of 472 observations in 99 men. Self-efficacy had a measurable effect on subjective measurements of general and disease specific health related quality of life. Men with the lowest self-efficacy had inferior mean health related quality of life scores across all outcomes. Low self-efficacy was significantly associated with worse bowel bother and general symptom distress during the 2-year study period. Similar health related quality of life outcomes trajectories were observed across self-efficacy categories.
  
  
  CONCLUSIONS
  Of disadvantaged men with clinically localized prostate cancer those with the lowest self-efficacy in physician interactions fared worst across all measured domains of health related quality of life. Interventions to improve patient-physician communication in this population may provide physicians with a supplemental method by which to address health perceptions, mitigate symptom experience and improve health outcomes.
authors.affiliation: Department of Urology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California 90095-1772, USA.
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Heckman
authors.forename: Karim
authors.initials: K
authors.lastname: Chamie
authors.forename: Sally L
authors.initials: SL
authors.lastname: Maliski
authors.forename: Arlene
authors.initials: A
authors.lastname: Fink
authors.forename: Lorna
authors.initials: L
authors.lastname: Kwan
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Connor
authors.forename: Mark S
authors.initials: MS
authors.lastname: Litwin
mesh_terms: D000368:Aged; D006801:Humans; D008297:Male; D017057:Medically Uninsured; D008875:Middle Aged; D015999:Multivariate Analysis; D011203:Poverty; D011471:Prostatic Neoplasms / Q000453:epidemiology / Q000523:psychology*; D011788:Quality of Life; D020377:Self Efficacy; D013315:Stress, Psychological / Q000453:epidemiology; D016896:Treatment Outcome