American Journal of Public Health Research
ISSN (Print): 2327-669X ISSN (Online): 2327-6703 Website: Editor-in-chief: Apply for this position
Open Access
Journal Browser
American Journal of Public Health Research. 2018, 6(2), 72-83
DOI: 10.12691/ajphr-6-2-10
Open AccessSpecial Issue

Conceptual Model of the Psychosocial Effects of Beryllium Sensitization and Chronic Beryllium Disease

Jeffrey R. Miller1, , Gregory C. Petty2, Paul C. Erwin2 and Donna L. Cragle1

1Oak Ridge Associated Universities, P.O. Box 117, Oak Ridge, TN 37831-0117

2The University of Tennessee, Department of Public Health, 1914 Andy Holt Ave., 369 HPER, Knoxville, TN 37996-3430

Pub. Date: March 22, 2018

Cite this paper:
Jeffrey R. Miller, Gregory C. Petty, Paul C. Erwin and Donna L. Cragle. Conceptual Model of the Psychosocial Effects of Beryllium Sensitization and Chronic Beryllium Disease. American Journal of Public Health Research. 2018; 6(2):72-83. doi: 10.12691/ajphr-6-2-10


The objective of this research was to develop a theoretical model that describes the psychosocial effects of beryllium sensitization (BeS) and chronic beryllium disease (CBD). The medical, nursing, health education, and psychological literature was reviewed to identify theories that might support the development of a psychosocial model of BeS and CBD. A proposed model was synthesized based upon elements from multiple academic disciplines. The conceptual model is based on three prominent psychological theories: 1) health, stress, and coping, 2) uncertainty and illness, and 3) psychosocial adjustment to illness. The model hypothesizes that workers who are diagnosed with BeS or CBD experience a great deal of uncertainty that has a detrimental effect on their health quality of life. The focal relationship in this model is between the independent variable uncertainty and the dependent variable health quality of life. It is further hypothesized that the relationship between these two variables is affected by an intermediate variable, the ability to make psychosocial adjustments to disease. Creating this model is a step toward filling a void in our understanding of the natural history of CBD. Once validated it will establish a foundation for future research, interventions and program evaluations and may lead to changes in the psychological, social, financial, and disease management support provided to this population.

Beryllium berylliosis uncertainty in illness psychosocial adjustment stress and coping

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit


[1]  Jaskula B. 2010. 2008 Minerals Yearbook, Beryllium (Advance Release): U.S. Department of the Interior, U.S. Geological Survey.
[2]  Council NR. 2007. Health effects of beryllium exposure: A literature review Washington, DC: National Research Council of the National Academies, Committee on Toxicology, Committee on Beryllium Alloy Exposures.
[3]  Rossman MD, Preuss OP, Powers MB, editors. 1991. Beryllium: Biomedical and environmental issues. Baltimore, MD: Williams & Wilkins.
[4]  Kolanz ME. 2001. Introduction to beryllium: Uses, regulatory history, and disease. App Occ Env Heal 16: 559-567.
[5]  Jaskula B. 2011. U.S. Geological Survey, Mineral Commodity Summaries. In: Interior USDo editor. p 28-29.
[6]  Kelly TD, Matos GR. 2011. U.S. Geological Survey, historical statistics for mineral and material commodities in the United States: U.S. Geological Survey data series 140.
[7]  Cullen MR, Cherniack MG, Kominsky JR. 1986. Chronic beryllium disease in the United States. Seminars in Respiratory Critical Care Medicine 7: 203-209.
[8]  Infante PF, Newman LS. 2004. Beryllium exposure and chronic beryllium disease. Lancet 363: 415-416.
[9]  Samuel G, Maier LA. 2008. Immunology of chronic beryllium disease. Current Opinion in Allergy and Clinical Immunology 8: 126-134 110.1097/ACI.1090b1013e3282f1824a1094.
[10]  Kreiss K, Mroz MM, Zhen BG, Martyny JW, Newman LS. 1993. Epidemiology of beryllium sensitization and disease in nuclear workers. Am Rev Resp Dis 148: 985-991.
[11]  Kreiss K, Newman LS, Mroz MM, Campbell PA. 1989. Screening blood test identifies subclinical beryllium disease. J Occ Env Med 31: 603-608.
[12]  Kreiss K, Mroz MM, Zhen B, Wiedemann H, Barna B. 1997. Risks of beryllium disease related to work processes at a metal, alloy, and oxide production plant. Occ Env Med 54: 605-612.
[13]  Kreiss K, Mroz MM, Newman LS, Martyny J, Zhen B. 1996. Machining risk of beryllium disease and sensitization with median exposures below 2 μg/m3. Am J Ind Med 30: 16-25.
[14]  Maier LA. 2002. Genetic and exposure risks for chronic beryllium disease. Clinics in Chest Medicine 23: 827-839.
[15]  Schuler CR, Kitt MM, Henneberger PK, Deubner DC, Kreiss K. 2008. Cumulative sensitization and disease in a beryllium oxide ceramics worker cohort. J Occ Env Med 50: 1343-1350.
[16]  Kreiss K, Day GA, Schuler CR. 2007. Beryllium: A modern industrial hazard. Ann Rev Pub Heal 28: 259-277.
[17]  Day GA, Dufresne A, Stefaniak AB, Schuler CR, Stanton ML, Miller WE, Kent MS, Deubner DC, Kreiss K, Hoover MD. 2006. Exposure pathway assessment at a copper–beryllium alloy facility. Ann Occ Hyg 51: 67-80.
[18]  Newman LS, Mroz MM, Balkissoon R, Maier LA. 2005a. Beryllium sensitization progresses to chronic beryllium disease - A longitudinal study of disease risk. Am J Resp Crit Care Med 171: 54-60.
[19]  Newman LS, Mroz MM, Balkissoon R, Maier LA. 2005b. Screening for chronic beryllium disease. Am J Resp Crit Care Med 172: 1230-1231.
[20]  Council NR. 2008. Managing health effects of beryllium exposure Washington, DC: National Research Council of the National Academies, Committee on Toxicology, Committee on Beryllium Alloy Exposures.
[21]  Middleton DC. 1998. Chronic beryllium disease: Uncommon disease, less common diagnosis. Env Heal Perspectives 106: 765-767.
[22]  Van Orsdstrand HS, Hughes R, DeNardi JM, Carmody MG. 1945. Beryllium poisoning. JAMA 129: 1084-1090.
[23]  Hardy HL, Tabershaw IR. 1946. Delayed chemicial pneumonitis occurring in workers exposed to beryllium compounds. Journal of Industrial Hygiene Toxicology 28: 197-211.
[24]  Cummings K, Stefaniak A, Abbas V, Kreiss K. 2009. A reconsideration of acute beryllium disease Research Triangle Park, NC: US Department of Health and Human Services. 7 p.
[25]  Newman LS, Lloyd J, Daniloff E. 1996. The natural history of beryllium sensitization and chronic beryllium disease. Env Heal Perspectives 104: 937-943.
[26]  Eisenbud M, Lisson J. 1983. Epidemiological aspects of beryllium-induced nonmalignant lung disease: A 30-year update. J Occ Env Med 25: 196-202.
[27]  Müller-Quernheim J, Gaede KI, Fireman E, Zissel G. 2006. Diagnoses of chronic beryllium disease within cohorts of sarcoidosis patients. European Respiratory Journal 27: 1190-1195.
[28]  Maier LA, Raynolds MV, Young DA, Barker EA, Newman LS. 1999. Angiotensin-1 converting enzyme polymorphisms in chronic beryllium disease. Am J Resp Crit Care Med 159: 1342-1350.
[29]  Sood A. 2009. Current treatment of chronic beryllium disease. J Occ Env Hyg 6: 762-765.
[30]  Sood A, Beckett WS, Cullen MR. 2004. Variable response to long-term corticosteroid therapy in chronic beryllium disease. Chest 126: 2000-2007.
[31]  Newman LS. 1996. Immunology, genetics, and epidemiology of beryllium disease. Chest 109: S40-S43.
[32]  Maier LA. 2001. Beryllium health effects in the era of the beryllium lymphocyte proliferation test. App Occ Env Heal 16: 514-520.
[33]  Newman LS. 1995. Beryllium disease and sarcoidosis: Clinical and laboratory links. Sarcoidosis 12: 7-19.
[34]  Deubner DD, Goodman M, Iannuzzi J. 2001. Variability, predictive value, and uses of the beryllium blood lymphocyte proliferation test (BLPT): Preliminary analysis of the ongoing workforce survey. App Occ Env Heal 16: 521-526.
[35]  Stange AW, Furman FJ, Hilmas DE. 2004. The beryllium lymphocyte proliferation test: Relevant issues in beryllium health surveillance. Am J Ind Med 46: 453-462.
[36]  Mroz MM, Kreiss K, Lezotte DC, Campbell PA, Newman LS. 1991. Reexamination of the blood lymphocyte-transformation test in the diagnosis of chronic beryllium disease. Journal of Allergy and Clinical Immunology 88: 54-60.
[37]  Middleton DC, Mayer AS, Lewin MD, Mroz MM, Maier LA. 2011. Interpreting borderline belpt results. Am J Ind Med 54: 205-209.
[38]  Middleton DC, Lewin MD, Kowalski PJ, Cox SS, Kleinbaum D. 2006. The BeLPT: Algorithms and implications. Am J Ind Med 49: 36-44.
[39]  Greene M, Smith SM. 2008. Consenting to uncertainty: challenges for informed consent to disease screening-a case study. Theoretical Medicine and Bioethics 29: 371-386.
[40]  Ward EM, Okun A, Ruder A, Fingerhut M, Steenland K. 1992. A mortality study of workers at seven beryllium processing plants. Am J Ind Med 22: 885-904.
[41]  Steenland K, Ward EM. 1991. Lung Cancer incidence among patients with beryllium disease: A cohort mortality study. J Nat Cancer Inst 83: 1380-1385.
[42]  Sanderson WT, Ward EM, Steenland K, Petersen MR. 2001. Lung cancer case–control study of beryllium workers*. Am J Ind Med 39: 133-144.
[43]  Schubauer-Berigan MK, Couch JR, Petersen MR, Carreón T, Jin Y, Deddens JA. 2010. Cohort mortality study of workers at seven beryllium processing plants: update and associations with cumulative and maximum exposure. Occ Env Med.
[44]  Program NT. 2009. Report on Carcinogens, Beryllium (CAS No. 7440-41-7) and beryllium compounds. 11th ed. Washington, DC: U.S. Department of Health and Human Services, Public Health Service, National Toxicology Program
[45]  Cancer IAfRo. 1993. Monographs on the Evaluation of Carcinogenic Risks to Humans: Beryllium, Cadmium, Mercury, and Exposures in the Glass Manufacturing Industry International Agency for Research on Cancer.
[46]  Health NIfOSa. 2011. Preventing sensitization and disease from beryllium exposure: Department of Health and Human Services, Centers for Disease Control and Prevention
[47]  Registry AfTSaD. 2002. Toxicological profile for beryllium Atlanta, GA: U.S. Department of Health and human Services, Public Health Service
[48]  Groth DH. 1980. Carcinogenicity of beryllium: Review of the literature. Env Res 21: 56-62.
[49]  Henneberger PK, Goe SK, Miller WE, Doney B, Groce DW. 2004. Industries in the United States with airborne beryllium exposure and estimates of the number of current workers potentially exposed. J Occ Env Hyg 1: 648-659.
[50]  Stange AW, Hilmas DE, Furman FJ, Gatliffe TR. 2001. Beryllium sensitization and chronic beryllium disease at a former nuclear weapons facility. App Occ Env Heal 16: 405-417.
[51]  Newman LS, Mroz MM, Maier LA, Daniloff EM, Balkissoon R. 2001. Efficacy of serial medical surveillance for chronic beryllium disease in a beryllium machining plant. J Occ Env Med 43: 231-237.
[52]  Henneberger PK, Cumro D, Deubner DD, Kent MS, McCawley M, Kreiss K. 2001. Beryllium sensitization and disease among long-term and short-term workers in a beryllium ceramics plant. International Archives of Occupational and Environmental Health 74: 167-176.
[53]  Maier LA, Martyny JW, Liang J, Rossman MD. 2008. Recent chronic beryllium disease in residents surrounding a beryllium facility. AM J Resp Crit Care Med 177: 1012-1017.
[54]  Eisenbud M, Wanta RC, Dustan C, Steadman LT, Harris WB, Wolf BS. 1949. Non-occupational berylliosis. J Ind Hyg Tox 31: 282-294.
[55]  Hardy HL. 1955. Epidemiology, clinical character, and treatment of beryllium poisoning. AMA Archives Industrial Health 11: 273-279.
[56]  Stange AW, Furman FJ, Hilmas DE. 1996a. Rocky Flats beryllium health surveillance Research Triangle Park, NC: U.S. Department of Health and Human Services. 6 p.
[57]  Stange AW, Hilmas DE, Furman FJ. 1996b. Possible health risks from low level exposure to beryllium. Toxicology 111: 213-224.
[58]  Sackett HM, Maier LA, Silveira LJ, Mroz MM, Ogden LG, Murphy JR, Newman LS. 2004. Beryllium medical surveillance at a former nuclear weapons facility during cleanup operations. J Occ Env Med 46: 953-961.
[59]  Welch L, Ringen K, Bingham E, Dement J, Takaro T, McGowan W, Chen A, Quinn P. 2004. Screening for beryllium disease among construction trade workers at Department of Energy nuclear sites. Am J Ind Med 46: 207-218.
[60]  Rodrigues EG, McClean MD, Weinberg J, Pepper LD. 2008. Beryllium sensitization and lung function among former workers at the Nevada Test Site. Am J Ind Med 51: 512-523.
[61]  Arjomandi M, Seward J, Gotway MB, Nishimura S, Fulton GP, Thundiyil J, King TEJ, Harber P, Balmes JR. 2010. Low prevalence of chronic beryllium disease among workers at a nuclear weapons research and development facility. J Occ Env Med 52: 647-652 610.1097/JOM.1090b1013e3181e36439.
[62]  Mikulski MA, Leonard SA, Sanderson WT, Hartley PG, Sprince NL, Fuortes LJ. 2011. Risk of beryllium sensitization in a low-exposed former nuclear weapons cohort from the cold war era. Am J Ind Med 54: 194-204.
[63]  Energy Do. 1999. Chronic beryllium disease prevention program: final rule Washington DC: Federal Register. p 64:68854-68914.
[64]  Energy Do. 2011a. Beryllium-Associated Worker Registry Summary, October 2010: Department of Energy.
[65]  Energy Do. 2011b. Former Worker Medical Screening Program, 2010 Annual Report: Department of Energy.
[66]  Newman LS. 2007. Unanswered questions from patients, workers, (and their doctors). The 3rd Annual International Conference on Beryllium Disease Philadelphia, PA.
[67]  Cragle DL. 2007. Beryllium health effects: Research directions from the persepctive of an occupational epidmeiologist. The 3rd Annual International Conference on Beryllium Disease Philadelphia, PA.
[68]  Henneberger PK, Kreiss K. 1999. Current NIOSH epidemiologic research on beryllium sensitization and disease. Beryllium: Effect on Worker health Washington, DC.
[69]  McCawley M. 2008. Beryllium research needs. Third International Symposium on Beryllium Particulates and Their Detection Albuquerque, NM.
[70]  Cannon WB. 1929. Bodily changes in pain, hunger, fear and rage: An account of recent research into the function of emotional excitement. 2nd ed. New York, NY: Appleton-Century-Crofts,.
[71]  Selye H. 1936. A syndrome produced by diverse nocuous agents. Nature 138.
[72]  Selye H. 1956. The Stress of Life New York, NY: McGraw-Hill Book Company.
[73]  Lazarus RS. 1966. Psychological stress and the coping process New York, NY: McGraw-Hill Book Company, Inc.
[74]  Selye H. 1975. Confusion and controversy in the stress field. Journal of Human Stress 1: 37-44.
[75]  Holroyd KA, Lazarus RS. 1982. Stress, coping and somatic adaptation. In: Goldberger LEaB, S. editor. Handbook of Stress: Theoretical and Clinical Aspects New York, NY: Free Press. p pp. 21-35.
[76]  Lazarus RS, Folkman S. 1991. Stress and coping: An anthology. In: Monat A, Lazarus RS editors. The Concept of Coping. 3rd ed. New York, NY: Columbia University Press. p 189-206.
[77]  O'Leary A. 1990. Stress, emotion, and human immune function. Psychological Bulletin 108: 363-382.
[78]  Folkman S, editor 2011. The Oxford handbook of stress, health, and coping. New York, NY: Oxford University Press.
[79]  Glanz K, Rimer BK, Viswanath K, editors. 2008. Health behavior and health education: Theory, research, and practice. San Francisco: Jossey-Bass.
[80]  Lazarus RS, Folkman S. 1984. Stress, appraisal, and coping New York, NY: Springer.
[81]  Taylor SE. 1983. Adjustment to threatening events. The American Psychologist 38: 1161.
[82]  Kalman TP, Wilson PG, Kalman CM. 1983. Psychiatric morbidity in long-term renal transplant recipients and patients undergoing hemodialysis. The Journal of the American Medical Association 250: 55-58.
[83]  Zyzanski SJ, Stanton BA, Jenkins CD, Klein MD. 1981. Medical and psychosocial outcomes in survivors of major heart surgery. J Psychosomatic Res 25: 213-221.
[84]  Mechanic D. 1978. Medical sociology. 2nd ed. New York, NY: The Free Press.
[85]  Livneh H, Antonak RF. 1997. Psychosical adaptation to chronic illness and disability Gaithersburg, MD: Aspen Publishers, Inc.
[86]  Cassileth BR, Lusk EJ, Strouse TB, Miller DS, Brown LL, Cross PA, Tenaglia AN. 1984. Psychosocial status in chronic illness. A comparative analysis of six diagnostic groups. New England J Med 311: 506-511.
[87]  Derogatis LR, Abeloff MD, Melisaratos N. 1979. Psychological coping mechanisms and survival time in metastatic breast cancer. The Journal of the American Medical Association 242: 1504-1508.
[88]  Derogatis LR, Morrow GR, Fetting J, Penman D, Piasetsky S, Schmale AM, Henrichs M, Carnicke CLM. 1983. The prevalence of psychiatric disorders among cancer patients. The Journal of the American Medical Association 249: 751-757.
[89]  Derogatis LR. 1986. The psychosocial adjustment to illness scale (PAIS). J Psychosomatic Res 30: 77-91.
[90]  Merluzzi TV, Martinez-Sanchez MA. 1997. Factor structure of the psychosocial adjustment to illness scale (self-report) for persons with cancer. Psychological Assessment 9: 269-276.
[91]  Rodrigue JR, Kanasky WF, Jackson SI, Perri MG. 2000. The psychosocial adjustment to iIllness scale--self-seport: Factor structure and item stability. Psychological Assessment 12: 409-413.
[92]  Cain EN, Kohorn EI, Quinlan DM, Latimer K, Schwartz PE. 1986. Psychosocial benefits of a cancer support group. Cancer 57: 183-189.
[93]  Jenkins PL, Linington A, Whittaker JA. 1991. A retrospective study of psychosocial morbidity in bone marrow transplant recipients. Psychosomatics 32: 65-71.
[94]  Northouse L, Mood DW, Templin T, Mellon S, George T. 2000. Couples' patterns of adjustment to colon cancer. Social Science & Medicine 50: 271-284.
[95]  Greer S, Moorey S, Baruch JD, Watson M, Robertson BM, Mason A, Rowden L, Law MG, Bliss JM. 1992. Adjuvant psychological therapy for patients with cancer: a prospective randomised trial. British Med J 304: 675-680.
[96]  Soskolne V, De-Nour AK. 1989. The psychosocial adjustment of patients and spouses to dialysis treatment. Social Science & Medicine 29: 497-502.
[97]  De-Nour AK. 1982. Psychological adjustment to illness scale (PAIS): A study of chronic hemodialysis patients. J Psychosomatic Res 26: 11-22.
[98]  Stubbing D, Haalboom P, Barr P. 1998. Comparison of the psychosocial adjustment to iIllness scale-self report and clinical judgment in patients with chronic lung disease. Journal of Cardiopulmonary Rehabilitation and Prevention 18: 32-36.
[99]  Browne G, Byrne C, Brown B, Pennock M, Streiner D, Roberts R, Eyles P, Truscott D, Dabbs R. 1985. Psychosocial adjustment of burn survivors. Burns 12: 28-35.
[100]  Pakenham KI. 1999. Adjustment to multiple sclerosis: Application of a stress and coping model. Health Psychology 18: 383-392.
[101]  Folkman S, Greer S. 2000. Promoting psychological well-being in the face of serious illness: When theory, research and practice inform each other. Psycho-Oncology 9: 11-19.
[102]  Rehse B, Pukrop R. 2003. Effects of psychosocial interventions on quality of life in adult cancer patients: Meta analysis of 37 published controlled outcome studies. Patient Education and Counseling 50: 179-186.
[103]  Sharpe L, Curran L. 2006. Understanding the process of adjustment to illness. Social Science & Medicine 62: 1153-1166.
[104]  Brashers DE. 2001. Communication and uncertainty management. Journal of Communication 51: 477-497.
[105]  Babrow AS, Hines SC, Kasch CR, editors. 2000. Managing uncertainty in illness Explanation: An application of problematic integration theory. Hillsdale, NJ: Erlbaum.
[106]  Norton RW. 1975. Measurement of ambiguity tolerance. Journal of Personality Assessment 39: 607.
[107]  Babrow A, Kasch C, Ford L. 1998. The many meanings of uncertainty in illness: Toward a systematic accounting. Health Communication 10: 1-23.
[108]  Mishel MH. 1981. The measurement of uncertainty in illness. Nursing Research 30: 258-263.
[109]  Mishel MH. 1983. Adjusting the fit: development of uncertainty scales for specific clinical populations. West J Nurs Res 5: 355-370.
[110]  Mishel MH. 1984. Perceived uncertainty and stress in illness. Research Nursing Health 7: 163-171.
[111]  Mishel MH, Braden CJ. 1988. Finding meaning: Antecedents of uncertainty in illness. Nursing Research 37: 98-103.
[112]  Mishel MH, Hostetter T, King B, Graham V. 1984. Predictors of psychosocial adjustment in patients newly diagnosed with gynecological cancer. Cancer Nursing 7: 291-300.
[113]  Mishel MH, Murdaugh CL. 1987. Family adjustment to heart transplantation: Redesigning the dream. Nursing Research 36: 332-338.
[114]  Mishel MH. 1988. Uncertainty in illness. J Nur Schol 20: 225-232.
[115]  Mishel MH. 1990. Reconceptualization of the uncertainty in illness theory. J Nur Schol 22: 256-262.
[116]  Christman NJ, McConnell EA, Pfeiffer C, Webster KK, Schmitt M, Ries J. 1988. Uncertainty, coping, and distress following myocardial infarction: Transition from hospital to home. Research in Nursing & Health 11: 71-82.
[117]  Mishel MH. 1997. Uncertainty in acute illness. Ann Rev Nursing Res 15: 57-80.
[118]  Mishel MH, Padilla GV, Grant MM, Sorenson DS. 1991. Uncertainty in illness theory: A replication of the mediating effects of mastery and coping. Nursing Research 40: 236-240.
[119]  Webster KK, Christman NJ, Mishel MH. 1988. Perceived uncertainty and coping post myocardial Infarction. W J Nurs Res 10: 384-400.
[120]  White RE, Frasure-Smith N. 1995. Uncertainty and psychologic stress after coronary angioplasty and coronary bypass surgery. Heart & Lung: The Journal of Acute and Critical Care 24: 19-27.
[121]  Johnson LM, Zautra AJ, Davis MC. 2006. The role of illness uncertainty on coping with fibromyalgia symptoms. Health Psychology 25: 696-703.
[122]  Bailey D, Barroso J, Muir A, Sloane R, Richmond Ji, McHutchison J, Patel K, Landerman L, Mishel M. 2010. Patients with chronic hepatitis C undergoing watchful waiting: Exploring trajectories of illness uncertainty and fatigue. Research in Nursing & Health 33: 465-473.
[123]  Sammarco A, Konecny L. 2008. Quality of life, social support, and uncertainty among latina breast cancer survivors. Oncology Nursing Forum 35: 844-849.
[124]  McCormick KM. 2002. A concept analysis of uncertainty in iIllness. J Nur Schol 34: 127-131.
[125]  Neville KL. 2003. Uncertainty in illness: an integrative review. Orthopaedic Nursing 22: 206-214.
[126]  Cohen MH. 1993. The unknown and the unknowable-managing sustained uncertainty. W J Nurs Res 15: 77-96.
[127]  Babrow AS, Kline KN. 2000. From "reducing" to "coping with" uncertainty: Reconceptualizing the central challenge in breast self-exams. Social Science & Medicine 51: 1805-1816.
[128]  Society AC. 2010. Cancer Facts & Figures. Special Section: Prostate Cancer Atlanta, GA: American Cancer Society p23-36.
[129]  Tombal B. 2006. Over- and underdiagnosis of prostate cancer: The dangers. European Urology Supplements 5: 511-513.
[130]  Eton DT, Lepore SJ. 2002. Prostate cancer and health-related quality of life: A review of the literature. Psycho-Oncology 11: 307-326.
[131]  Warlick CA, Allaf ME, Carter HB. 2006. Expectant treatment with curative intent in the prostate-specific antigen era: Triggers for definitive therapy. Urologic Oncology: Seminars and Original Investigations 24: 51-57.
[132]  Oliffe JL, Davison BJ, Pickles T, Mroz L. 2009. The self-management of uncertainty among men undertaking active surveillance for low-risk prostate cancer. Qualitative Health Research 19: 432-443.
[133]  Germino BB, Mishel MH, Belyea M, Harris L, Ware A, Mohler J. 1998. Uncertainty in prostate cancer. Ethnic and family patterns. Cancer Practice 6: 107-113.
[134]  Shaha M, Cox CL, Talman K, Kelly D. 2008. Uncertainty in breast, prostate, and colorectal cancer: implications for supportive care. J Nur Schol 40: 60-67.
[135]  Wallace M. 2003. Uncertainty and quality of life of older men who undergo watchful waiting for prostate cancer. Oncol Nurs Forum 30: 303-309.
[136]  Bailey DE, Jr., Wallace M, Mishel MH. 2007. Watching, waiting and uncertainty in prostate cancer. Journal Clinical Nursing 16: 734-741.
[137]  Kazer MW, Bailey DE, Colberg J, Kelly WK, Carroll P. 2011. The needs for men undergoing active surveillance (AS) for prostate cancer: Results of a focus group study. Journal of Clinical Nursing 20: 581-586.
[138]  Bailey Jr D, Wallace M, Latini D, Hegarty J, Carroll P, Klein E, Albertsen P. 2011. Measuring illness uncertainty in men undergoing active surveillance for prostate cancer. App Nurs Res In Press, Corrected Proof.
[139]  Mishel MH, Belyea M, Germino BB, Stewart JL, Bailey DE, Robertson C, Mohler J. 2002. Helping patients with localized prostate carcinoma manage uncertainty and treatment side effects. Cancer 94: 1854-1866.
[140]  Steginga SK, Turner E, Donovan J. 2008. The decision-related psychosocial concerns of men with localised prostate cancer: Targets for intervention and research. World Journal of Urology 26: 469-474.
[141]  Mishel MH, Germino BB, Lin L, Pruthi RS, Wallen EM, Crandell J, Blyler D. 2009. Managing uncertainty about treatment decision making in early stage prostate cancer: A randomized clinical trial. Patient Education and Counseling 77: 349-359.
[142]  Chambers S, Pinnock C, Lepore S, Hughes S, O'Connell D. 2011. A systematic review of psychosocial interventions for men with prostate cancer and their partners. Patient Education and Counseling.
[143]  Kershaw TS, Mood DW, Newth G, Ronis DL, Sanda MG, Vaishampayan U, Northouse LL. 2008. Longitudinal analysis of a model to predict quality of life in prostate cancer patients and their spouses. Ann Behavorial Med 36: 117-128.
[144]  Song L, Northouse LL, Braun TM, Zhang LN, Cimprich B, Ronis DL, Mood DW. 2010. Assessing longitudinal quality of life in prostate cancer patients and their spouses: a multilevel modeling approach. Quality of Life Research 20: 371-381.