Systematic review of illness uncertainty management interventions for cancer patients and their family caregivers

Trajectories of illness uncertainty among parents of children with atypical genital appearance due to differences of sex development

OBJECTIVE

The present study aimed to identify distinct trajectories of parental illness uncertainty among parents of children born with atypical genital appearance due to a difference of sex development over the first year following diagnosis. It was hypothesized that four trajectory classes would emerge, including "low stable," "high stable," "decreasing," and "increasing" classes, and that select demographic, familial, and medical factors would predict these classes.

METHODS

Participants included 56 mothers and 43 fathers of 57 children born with moderate to severe genital atypia. Participants were recruited from eleven specialty clinics across the U.S. Growth mixture modeling (GMM) approaches, controlling for parent dyad clustering, were conducted to examine classes of parental illness uncertainty ratings over time.

RESULTS

A three-class GMM was identified as the best-fitting model. The three classes were interpreted as "moderate stable" (56.8%), "low stable" (33.0%), and "declining" (10.3%). Findings suggest possible diagnostic differences across trajectories.

CONCLUSIONS

Findings highlight the nature of parents' perceptions of ambiguity and uncertainty about their child's diagnosis and treatment the year following their child's birth/diagnosis. Future research is needed to better understand how these trajectories might shift over the course of the child's development. Results support the development of tailored, evidence-based interventions to address coping with uncertainty among families raising a child with chronic health needs.

Integrative model for self-perception of well-being in cancer

PURPOSE

Continual illness uncertainty can affect how people perceive and interpret their well-being. Some cognitive and spiritual factors may be involved in the management of disruptive thoughts and emotions that can emerge during the experience of cancer.

MATERIAL AND METHODS

An evidence-based integrative model was developed to evaluate and show the role that mindfulness, acceptance, self-efficacy, uncertainty, meaning, and purpose in life play in the self-perception of well-being in individuals with cancer. This evidence-based integrative model was conducted using relevant and selected studies.

RESULTS

An integrative model for self-perception of well-being has been proposed. This model integrates evidence-based findings and provides clear principles for clinicians and researchers. This integrative model proposes that mindfulness, acceptance, self-efficacy perception, and uncertainty can predict how people with cancer perceive their well-being. The model also posits that meaning and purpose in life can act as mediators or moderators of this prediction.

CONCLUSIONS

This integrative model involves the multidimensionality of human beings and facilitates the understanding of some key factors for the design of therapeutic approaches such as Acceptance & Commitment Therapy or Meaning-Centered Psychotherapy.IMPLICATIONS FOR REHABILITATIONMindfulness, acceptance, self-efficacy, uncertainty, meaning, and purpose in life can be highly relevant for clinical oncology.An integrative model is proposed to understand the combined influence of these factors on patients with cancer.This model may favor a better integration of well-known interventions, such as Mindfulness-based approaches, Acceptance and Commitment Therapy (ACT), and Meaning-Centered Psychotherapy (MCP).

Caregiver Burden and Readiness in Patients with Moderate and Severe Traumatic Brain Injury: The Chain Mediation Effect of Disease Uncertainty and Mental Resilience

OBJECTIVE

To analyze the mediating effects of caregiver illness uncertainty and psychological resilience in caregiver burden and readiness in patients with moderate-to-severe traumatic brain injuries (TBIs). This can help improve caregiver readiness in patients with moderate-to-severe TBIs.

METHODS

A purposive sampling method was used to recruit patients with moderate-to-severe TBIs, and their caregivers, who were hospitalized in the Department of Neurosurgery of the Affiliated Hospital of Yangzhou University between October 2022 and August 2023. The Zarit Caregiver Burden Interview, Mishel Uncertainty In Scale for Family Member, Connor-Davidson Resilience Scale, and Caregivers Preparedness Scale, as well as general information questionnaire, were used to conduct the survey.

RESULTS

Caregiver readiness correlated with caregiver burden, illness uncertainty, and psychological resilience in patients with moderate-to-severe TBI (P < 0.01). Caregiver readiness was not only directly affected by caregiver burden (95% confidence interval: -0.510, -0.196) but was also affected through the chain mediation of illness uncertainty and psychological resilience (95% confidence interval: -0.146, -0.011).

CONCLUSIONS

Caregiver burden in patients with moderate-to-severe TBI influences caregiver readiness levels and is mediated by illness uncertainty and psychological resilience. By improving caregivers' illness uncertainty and increasing their psychological resilience, the impact of low caregiver readiness caused by high caregiver burden could be reduced.

Personal Health Planning in Adult-Child Former Caregivers of Parents Living With Dementia

PURPOSE

To examine how former caregivers for parents living with dementia engage in personal health planning.

DESIGN

An inductive, qualitative study.

SETTING

Virtual, audio-recorded, semi-structured interviews.

PARTICIPANTS

Thirty-two midlife former primary caregivers for parents who died following advanced dementia 3 months to 3 years prior.

METHOD

Participants responded to a series of open-ended interview prompts. Interview recordings were transcribed and evaluated by a trained, diverse team to generate Consensual Qualitative Research (CQR) domains and categories.

RESULTS

Caregivers developed health planning outlooks (ie, mindsets regarding willingness and ability to engage in personal health planning) that guided health planning activities (ie, engaging in a healthy lifestyle, initiating cognitive/genetic testing, maintaining independence and aging in place, ensuring financial and legal security). An agentic outlook involved feeling capable of engaging in health planning activities and arose when caregivers witnessed the impact and feasibility of their parents' health planning. Anxiety-inducing and present-focused outlooks arose when caregivers faced barriers (eg, low self-efficacy, lack of social support, perception that parent's health planning did not enhance quality of life) and concluded that personal health planning would not be valuable or feasible.

CONCLUSION

Caregiving for a parent living with dementia (PLWD) shapes former caregivers' personal health planning. Interventions should support former caregivers who have developed low self-efficacy or pessimistic views on healthy aging to support them in addressing health planning activities.

A Nursing Pre-Transplant Intervention to Reduce Patients' Uncertainty about Allogeneic Hematopoietic Stem Cell Transplantation

Patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT) procedures often experience high levels of uncertainty. In this study, we developed and implemented a nursing intervention program to help patients recognize and reduce pre-transplant uncertainty. This study used a pretest-posttest single-group design without a control group. Eighteen patients undergoing HSCT participated in the intervention program-which included informational support, confirmation that the patients understood the information provided, and emotional support. Outpatients received the intervention at their initial outpatient visits after their procedure dates were determined, while inpatients received it at discharge following their procedures. The Universal Uncertainty in Illness Scale (UUIS), which consists of 26 items and six subscales, was used as the primary outcome measure. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and the Hospital Anxiety and Depression Scale were used as secondary outcome measures. The sample included 18 individuals (13 male and five female participants; median age, 52 years). Most participants had acute lymphoblastic leukemia and had previously undergone bone marrow transplantations. Following our intervention, the total UUIS score significantly decreased, from 80.83 ± 18.42 before the intervention to 63.06 ± 23.53 afterward (t = 4.98, p < .001). Furthermore, significant post-intervention reductions were observed for all six subscales of the UUIS. There were no significant differences in the functional EORTC QLQ-C30 scale scores; however, the symptom scale showed a significant decrease in fatigue (pre = 35.19 ± 19.53, post = 25.93 ± 17.04, Z = -1.99, p < 0.046) and constipation (pre = 20.37 ± 20.26, post = 7.41 ± 14.26, Z = -2.11, p = 0.035). There were no significant differences in anxiety and depression levels pre- and post-intervention. Overall, the intervention effectively reduced both UUIS total and subscale scores related to pre-HSCT uncertainties. Assessing uncertainty prior to HSCT is vital to assisting patients in coping with the procedure. Nurses not only provide information but also tailor the information to the patients' cognitive abilities, thereby simplifying their understanding of the disease and its treatment.

The effect of multimodal care based on Peplau's interpersonal relationship theory on postoperative recovery in lung cancer surgery: a retrospective analysis

BACKGROUND

Lung cancer remains a major global health concern due to its high incidence and mortality rates. With advancements in medical treatments, an increasing number of early-stage lung cancer cases are being detected, making surgical treatment the primary option for such cases. However, this presents challenges to the physical and mental recovery of patients. Peplau known as the "mother of psychiatric associations" has formulated a theory of interpersonal relationships in nursing. Through effective communication between nurses and patients over four periods, she has established a good therapeutic nurse-patient relationship. Therefore, this study aimed to explore the effect of perioperative multimodal nursing based on Peplau's interpersonal relationship theory on the rehabilitation of patients with surgical lung cancer.

METHODS

We retrospectively analyzed 106 patients with non-small cell lung cancer who underwent thoracoscopic lobectomy at our department between June 2021 and April 2022. Patients were categorized into two groups according to the different nursing intervention techniques. The Peplau's group comprised 53 patients who received targeted nursing interventions, and the control group comprised 53 patients who received conventional nursing care. We observed the patients' illness uncertainty, quality of life, and clinical symptoms in both groups.

RESULTS

Patients in the Peplau's group had significantly lower illness uncertainty scores and a significantly higher quality of recovery than those in the control group. However, there were no significant differences in length of post-anesthesia care unit stay, complication rates, and visual analog scores between both groups.

CONCLUSION

The multimodal perioperative nursing based on Peplau's interpersonal relationship theory not only reduces the illness uncertainty of patients with lung cancer surgery and improves their QoR but also expands the application of this theory in clinical practice, guiding perioperative nursing of patients with lung cancer.

IMPLICATIONS

These findings provide practical information for standardized care in a hectic anesthetic care setting.

IMPACT

The assessed anesthesia nursing model helps reduce uncertainty and promote early recovery in patients with cancer at various stages of their disease, which expands the scope of therapeutic practice and existing theories. It also serves as a guide for care in the anesthesia recovery room.

REPORTING METHOD

We adhered to the relevant Equator guidelines and the checklist of items in the case-control study report.

PATIENT OR PUBLIC CONTRIBUTION

Patients cooperated with medical staff to complete relevant scales.

The effectiveness of pretreatment video-based psychoeducation for patients with breast cancer

OBJECTIVES

This study confirms the effectiveness of pretreatment video-based psychoeducation on stress management and relaxation in reducing depression, anxiety, and uncertainty among patients with breast cancer.

METHODS

We conducted a nonrandomized trial with 86 pretreatment patients with breast cancer who were divided equally into intervention and control groups, and stratified according to cancer stages and patient ages. Omitting the excluded participants, 35 intervention group and 36 control group participants were asked to complete the Hospital Anxiety and Depression Scale and Universal Uncertainty in Illness Scale (UUIS) before the psychoeducational intervention (baseline, hereafter "BL ") as well as 1 and 3 months later. Then, a 2 group (intervention and control groups) × 3 time points (BL and 1 and 3 months post-intervention) mixed models repeated measures (MMRM) analysis was implemented.

RESULTS

Analysis confirmed interaction between 2 group × 3 time points for depression, anxiety, and UUIS. Multiple comparisons revealed that each score in the intervention group was significantly lower 1 and 3 months post-intervention compared to BL. Meanwhile, in the control group, the depression score was significantly higher at 3 months post-intervention compared to pre-intervention. The anxiety scores and UUIS of the same group were not significantly different between 1 and 3 months post-intervention. The effect size values 3 months post-intervention were -0.57 for depression, -0.25 for anxiety, and 0.05 for uncertainty.

SIGNIFICANCE OF RESULTS

Pretreatment psychoeducation reduced depression, anxiety, and uncertainty in the intervention group of patients with breast cancer compared to the control group. The effect sizes at 3 months post-intervention were moderate for depression and small for anxiety. These results suggest the effectiveness of psychoeducation for patients with breast cancer, using videos on stress management and relaxation, early at the pretreatment stage.

The Mediating Effect of Uncertainty in Illness on Cancer Coping in Patients With Primary Malignant Brain Tumors

BACKGROUND

Patients with primary malignant brain tumors (PMBTs) experience uncertainty in illness (UI) because of the high recurrence rate and symptoms that occur during treatment.

OBJECTIVE

To develop and test a model based on the Uncertainty in Illness Theory to predict the UI and cancer coping experienced by PMBT patients.

METHODS

This was a cross-sectional study using path analysis. The participants were adults diagnosed with PMBT who completed a questionnaire about demographic and disease-related characteristics, UI, cancer coping, brain tumor symptoms, and social support. Clinical data (eg, the diagnosis, tumor location, and grade) were obtained from electronic health records. Data were analyzed using SPSS 26.0 and the MVN , psych , and lavaan packages in R 4.1.0.

RESULTS

This study included 203 PMBT patients. The hypothesized model satisfied all statistical criteria (comparative fit index = 0.998, root mean square error of approximation = 0.044, standardized root mean square residual = 0.016). The indirect and direct associations of UI in the path from social support to cancer coping were all significant with a 95% bootstrapping confidence interval. Although the indirect and direct associations of UI in the path of brain tumor symptoms and cancer coping did not have direct or total effects, the indirect effect was statistically significant.

CONCLUSIONS

Uncertainty in illness mediated brain tumor symptoms and social support to predict cancer coping.

IMPLICATIONS FOR PRACTICE

A nurse-led intervention for cancer coping among PMBT patients can be developed by considering symptoms and social support and UI as a mediator.

The relationship between uncertainty and acute procedure anxiety among surgical patients in Chinese mainland: the mediating role of resilience

BACKGROUND

Surgery, as one of the main diagnostic and treatment methods, is a routine work in medical settings. Patients undergoing surgery often experience acute procedure anxiety due to uncertainty. There is ample evidence showing that uncertainty is a risk factor for the acute procedure anxiety in surgical patients. However, little is known about the psychological processes mediating this relationship. Therefore, this study aims to evaluate resilience as a mediator of the association between uncertainty and anxiety.

METHODS

A population-based cross-sectional survey with a convenience sampling method was conducted, involving 243 surgical patients in Jiaxing, Zhejiang province of China was carried out. Relevant data were collected by self-reporting questionnaires, including demographic characteristics questionnaire, Amsterdam Preoperative Anxiety and Information Scale (APAIS-C), Mishel's Illness Uncertainty Scale (MUIS), Connor-Davidson Resilience Scale (CD-RISC). Pearson correlation analysis was employed to examine correlations between various variables. A path model was used to assess the mediation effect of resilience with respect to uncertainty and acute procedure anxiety.

RESULTS

In the path model, uncertainty have an indirect effect on acute procedure anxiety through resilience. The results suggest that resilience has a mediating role in uncertainty and acute procedure anxiety among surgical patients.

CONCLUSIONS

These findings call for the development of interventions targeting the role of resilience in effectively predicting and preventing acute procedure anxiety and uncertainty among surgical patients.

The roles of chaplains in dispelling cancer myths in Nigeria: A narrative review

Background and Aims

The epidemiological burden of cancer in Africa, and Nigeria in particular, has been increasing significantly over the past few decades due to exposure to numerous risk factors as well as belief in various myths and misconceptions. Chaplains can play crucial roles in dispelling these myths and misconceptions about cancer among people. Therefore, this study seeks to review the epidemiological burden, risk factors, and myths relating to cancer and the roles of chaplains in dispelling cancer myths in Nigeria.

Methods

This paper is a narrative review that relied on secondary sources obtained through a thorough literature search of relevant articles on multiple electronic databases including PubMed, Google Scholar, and Web of Science. Published books, journal articles, and other published materials that were written in English were consulted in line with the objectives of this study. Both theoretical and empirical papers were used for this review.

Results

Cancers are associated with risk factors including exposure to chemicals, ultraviolet radiation, harmful tobacco and alcohol use, exposure to human papillomavirus (HPV), and these factors may vary with age, cultural beliefs (myths and misconceptions), and socioeconomic factors among others. Chaplains, however, have crucial roles to play in dispelling cancer myths in Nigeria. These roles include counseling, advocacy, education, and psycho-social support which may be limited by challenges such as spiritual ambiguity, inadequate training of healthcare providers and limited time/resources. These challenges can be addressed by training healthcare providers and incorporating chaplain practice in Nigerian healthcare.

Conclusion

The role of chaplains in dispelling cancer myths in Nigeria is crucial despite the numerous challenges. Hence, an urgent address of these challenges will be instrumental in ensuring effective chaplain practice in Nigeria.

Correlates of illness uncertainty in cancer survivors and family caregivers: a systematic review and meta-analysis

PURPOSE

Illness uncertainty is widely recognized as a psychosocial stressor for cancer survivors and their family caregivers. This systematic review and meta-analysis aimed to identify the sociodemographic, physical, and psychosocial correlates that are associated with illness uncertainty in adult cancer survivors and their family caregivers.

METHODS

Six scholarly databases were searched. Data synthesis was based on Mishel's Uncertainty in Illness Theory. Person's r was used as the effect size metric in the meta-analysis. Risk of bias was assessed using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies.

RESULTS

Of 1116 articles, 21 articles met the inclusion criteria. Of 21 reviewed studies, 18 focused on cancer survivors, one focused on family caregivers, and 2 included survivors and family caregivers. Findings identified distinct correlates for illness uncertainty in cancer survivors, including sociodemographic factors (e.g., age, gender, race), stimuli frame (e.g., symptom, family history of cancer), structure providers (e.g., education), coping, and adaptation. Notable effect sizes were observed in the correlations between illness uncertainty and social support, quality of life, depression, and anxiety. Caregivers' illness uncertainty was associated with their race, general health, perception of influence, social support, quality of life, and survivors' prostate-specific antigen levels. Insufficient data precluded examining effect size of correlates of illness uncertainty among family caregivers.

CONCLUSION

This is the first systematic review and meta-analysis to summarize the literature on illness uncertainty among adult cancer survivors and family caregivers. Findings contribute to the growing literature on managing illness uncertainty among cancer survivors and family caregivers.

Undergoing radical treatment for prostate cancer and its impact on wellbeing: A qualitative study exploring men's experiences

INTRODUCTION

Quality of life in prostate cancer survivorship is becoming increasingly important, with mental and social wellbeing recognised as key components. However, limited global evaluation of psychosocial challenges experienced after treatment exists. Therefore, we aimed to explore the lived experiences of men who underwent radical treatment, and its psychosocial impact.

MATERIAL AND METHODS

This qualitative study was conducted using 19 men who had undergone radical treatment (prostatectomy or radiotherapy) for their cancer. Semi-structured interviews were conducted exploring lived experiences of men after treatment. A Structured thematic analysis of collected data was undertaken, with an inductive co-construction of themes through the lens of the biopsychosocial model. Themes generated were considered within a psychological, social, and physical wellbeing framework.

RESULTS

An initial knowledge gap meant mental wellbeing was strongly impacted initially leading to a 'Diagnostic Blow and the Search for Clarity'. Doubt over individuals' future resulted in 'An Uncertain Future' in many men. Once treatment was completed a 'Reflective journey' began, with men considering their outcomes and decisions made. Social wellbeing was also impacted with many identifying the 'Emotional Repercussions' on their relationships and the impact their diagnosis had on their partner and family. Many subsequently sought to increase their support through 'The Social Network and Advocacy', while physical changes led to an increased need for 'Social Planning'. Finally, physical wellbeing was highlighted by a continual acknowledgement of the 'Natural process of ageing' leading to a reluctancy to seek help, whilst simultaneously attempting to improve existing health via 'The Health Kick'.

CONCLUSIONS

Radical treatments have a considerable impact on mental and social wellbeing of individuals. Anxiety after diagnosis and significant uncertainty over individual futures exist, with physical complications of treatment leading to social repercussions. Future research should aim to identify forms of support to improve quality of life of these men.

An emotional roller coaster - family members' experiences of being a caregiver throughout a cancer trajectory

Purpose

To explore family members’ experiences of caregiving throughout a cancer trajectory from diagnosis until around one year after chemotherapy and radiation treatment ended.

Method

We conducted a longitudinal qualitative study using in-depth interviews with 13 family members at one to three points of time: before, during, and after treatment. To analyse the interviews, we leaned on Braun and Clark procedure for thematic analysis.

Result

The analysis revealed three themes in family members’ experiences of being a caregiver to a cancer patient throughout a cancer trajectory. These were: (1) From the time of diagnosis—overwhelming and uncertain; (2) During and after treatment—invisible and not involved; (3) Throughout the cancer trajectory—an emotional roller coaster.

Conclusion

The results indicated that the family members felt invisible and not involved and they experienced being a caregiver throughout the cancer trajectory as an emotional roller coaster. Our empirical findings thus indicate that in cancer care, family perspectives are yet to be implemented in daily practice. This is in contrast to explicit goals in current health policies underlining support and involvement of family members as a core aspect in cancer care.

A Study on the Relationship between Sense of Disease Uncertainty and Family Strength and Mental Resilience in Guardians of Children with Inflammatory Bowel Disease

Background

Inflammatory bowel disease is difficult to cure, which seriously affects the physical and mental health of children and brings negative psychological stress to guardians. Uncertainty in illness of guardians reduces the ability of care and is not conducive to the treatment and recovery of children. Therefore, it is of great significance to explore the related factors of uncertainty in illness.

Objective

The aim of this study is to explore the relationship between sense of disease uncertainty and family strength and mental resilience in guardians of children with inflammatory bowel disease (IBD).

Method

A total of 146 guardians of 88 children with inflammatory bowel disease were investigated. The guardians' sense of disease uncertainty, family strength, and mental resilience were evaluated by Mishel uncertainty in illness scale-family member (MUIS-FM), family hardiness index (FHI), and Connor-Davidson resilience sca1e (CD-RISC), respectively. Spearman correlation was used for analyzing the correlation between the guardian's sense of disease uncertainty and family resilience.

Results

The guardian's MUIS-FM score from lowest to highest was complexity, unpredictability, lack of information, and uncertainty. The average scores of FHI and CD-RISC were lower than the average score of CD-RISC of the general community in China 65.4 (t = -4.36, P < 0.05). The score of MUIS-FM was significantly correlated with the scores of FHI and CD-RISC (P < 0.05). Multiple linear regression analysis showed that the challenge score in the FHI scale and the fortitude score and the strength score in the CD-RISC scale were the main influencing factors of guardians' sense of disease uncertainty in children with IBD (P < 0.05).

Conclusion

The guardians of children with IBD had a more serious sense of disease uncertainty, which was related to family strength and mental resilience.

Identifying strategies to support gynaecological cancer patients and carers during COVID-19: Learning from patient-charity interactions

Objectives

Supporting cancer patients during COVID‐19 has posed unique challenges for health care providers. We investigated patient and carer–charity interactions to explore the role of charities and identify concerns expressed by patients. The study aims to address these concerns and learn how health care providers can support patients.

Methods

Digital interactions on forum posts and social media were collected from four gynaecological cancer charities from March‐May 2019 (before COVID‐19) and 2020 (during COVID‐19). Thematic analysis of forum posts and semistructured charity staff interviews investigated patient and charity‐focused perspectives.

Results

Thematic analysis of forum posts and charity staff interviews (n = 8) revealed three consistent themes: (1) Health care changes and the effect on cancer management concerns; (2) psychological impact of lockdown isolation and anxiety of changed treatment; (3) the complexity of shielding guidance on self‐risk assessment. Patients valued cancer charities' responses through digital and conventional methods (webinars, social media, forums, and websites).

Conclusion

Gynaecological cancer patients had concerns about the risk and impact of changed treatment plans, contacting charities as the first port of call when anxious not to burden health systems. Real‐time analysis of charities' communications can be used to identify concerns and to proactively provide patient support, together with health care providers.

The impact of COVID-19 on cancer patients, their carers and oncology health professionals: A qualitative study

OBJECTIVE

Cancer patients, carers and oncology health professionals have been impacted by the COVID-19 pandemic in many ways, but their experiences and psychosocial responses to the pandemic are still being explored. This study aimed to document the experience of Australians living with cancer, family carers, and Oncology health professionals (HPs) when COVID-19 first emerged.

METHODS

In this qualitative study, participants (cancer patients currently receiving treatment, family carers and HPs) completed a semi-structured interview exploring their experiences of COVID-19 and the impact it had on cancer care. Participants also completed the Hospital Anxiety and Depression Scale (patients) and the Depression, Anxiety and Stress Scale (carers and HPs) to assess emotional morbidity. Thematic analysis was undertaken on qualitative data.

RESULTS

32 patients, 16 carers and 29 HPs participated. Qualitative analysis yielded three shared themes: fear and death anxiety, isolation, and uncertainty. For HPs, uncertainty incorporated the potential for moral distress and work-stress. Patients and carers scoring high on anxiety/depression measures were more likely to have advanced disease, expressed greater death anxiety, talked about taking more extreme precautionary measures, and felt more impacted by isolation.

CONCLUSION

Cancer and COVID-19 can have compounding psychological impacts on all those receiving or giving care.

PRACTICE IMPLICATIONS

Screening for distress in patients, and burnout in HPs, is recommended. Increased compassionate access and provision of creative alternatives to face-to-face support are warrented.

Fear of the Unknown: Can We Help Individuals With a Systemic Autoimmune Rheumatic Disease Deal With Uncertainty?

Unfortunately, not much is certain in systemic autoimmune rheumatic diseases (SARDs). People with a SARD such as systemic lupus erythematosus (SLE) and systemic sclerosis (SSc) are dealing with a chronic, inflammatory, and often unpredictable autoimmune condition that might cause them to experience illness-related uncertainty.^1,2.

Further validation of the Perceptions of Uncertainties in Genome Sequencing (PUGS) scale among patients with cancer undergoing tumor sequencing

It is important to understand how individuals perceive uncertainties and the consequent impact on their psychological well-being and health behavior. The Perceptions of Uncertainty in Genome Sequencing (PUGS) scale measures clinical, affective, and evaluative uncertainties about information from sequencing. The PUGS scale has been shown to be valid and reliable among individuals receiving results about their genomes. This study assessed whether its validity generalized to patients with cancer undergoing tumor sequencing. Exploratory factor analysis (EFA) was conducted on data from the Molecular Screening and Therapeutics Program (n=310) to identify a measurement model. Confirmatory factor analysis (CFA) was used to determine the adequacy of the resulting fit. EFA identified the same three-factor structure reported previously. CFA confirmed that the measurement model yielded a good fit (χ2/df=3.72, CFI=0.96, SRMR=0.05, RMSEA=0.09) and satisfied convergent and discriminant validity. These findings provide further evidence of the validity and reliability of the PUGS scale in measuring three types of uncertainty. Continued application will facilitate an evidence-based approach to intervention and enhance understanding of what it is like to receive results. In turn, this will improve clinical outcomes as undergoing sequencing becomes an increasingly common experience. This article is protected by copyright. All rights reserved.

Effect Evaluation of Mental Nursing in Nursing of Young Cancer Patients Based on Big Data

The field of mental health nursing has always been special, dynamic, and flexible in terms of enhancing individuals' quality of life. Mental health nursing is all about caring for individuals with mental health disorders with the aim of helping them recover from illness, thereby improving their living conditions. Health Education of mental nursing emphasizes on providing special care to patients and optimally fulfills the clinical outcomes of the patients. It has been widely accepted that mental illness negatively influences the well-being of individuals, irrespective of their age, origin, demography, social status, and economic status. Young patients diagnosed with cancer report that they have a poor quality of life, as they undergo several physical and psychological needs, especially after the surgery and other cancer-related treatments. Thus, this study aims to examine the effect of mental health nursing on nursing young patients with cancer, based on the big data. Thus, the study conducts longitudinal analysis of the data gathered from the young patients with cancer, monitored by mental health nurse, with advanced practice nurse (APN) interventions. Results of the study stated that APN interventions positively impacted the physical as well as psychological needs of the research subjects. Mental nursing interventions resulted in positive clinical outcomes of the patients.

Exploring Resilience Among Black Women Living With HIV in the Southern United States: Findings From a Qualitative Study

ABSTRACT

Black women living with HIV (WLWH) face individual and sociostructural challenges. Despite these challenges, many exemplify remarkable levels of resilience and coping. Yet, research on resilience and coping in this population is limited. Twenty Black WLWH in the Southern United States completed semi-structured interviews that explored challenges facing WLWH. We identified six themes related to resilience and coping: self-acceptance, disclosure, self-compassion, social support, will to live, and service. Of these, social support was a driving protective element and an essential component to building and sustaining resilience and coping. Women who experienced positive support often expressed a will to live as well as a desire to support other WLWH. Resilience and social support were characterized by patterns of reciprocity, in that they were mutually sustaining, stabilizing, and strengthening.

Illness uncertainty, self-perceived burden and quality of life in patients with chronic myeloid leukaemia: A cross-sectional study

AIMS AND OBJECTIVES

To investigate the relationship between illness uncertainty, self-perceived burden and quality of life and explore the mediating role of self-perceived burden between illness uncertainty and quality of life in patients with chronic myeloid leukaemia.

BACKGROUND

Patients with chronic myeloid leukaemia need long-term, potentially lifelong therapy to control the disease, which affects their quality of life. There is a need for exploring potentially changeable factors to develop interventions. Little is known about the effects of illness uncertainty and self-perceived burden on quality of life in this population.

DESIGN

A cross-sectional study.

METHODS

A convenience sample of 248 patients with chronic myeloid leukaemia was recruited from four university hospitals from February to August 2020. Participants were assessed with the Mishel Uncertainty in Illness Scale, Self-Perceived Burden Scale, and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire. The STROBE checklist was used to report the results.

RESULTS

Illness uncertainty and self-perceived burden were negatively associated with quality of life in patients with chronic myeloid leukaemia. Self-perceived burden partially mediated the relationship between illness uncertainty and quality of life. The indirect effect was -0.101, accounting for 22.9% of the total effect.

CONCLUSION

The findings revealed the relationship between illness uncertainty, self-perceived burden and quality of life in patients with chronic myeloid leukaemia. Self-perceived burden exerted a mediating role between illness uncertainty and quality of life in this population.

RELEVANCE TO CLINICAL PRACTICE

This study alerts healthcare providers to pay attention to patients' illness uncertainty and self-perceived burden, which can contribute to develop effective interventions to improve the quality of life among patients with chronic myeloid leukaemia in the clinical practice.

Importance de la thromboembolie veineuse liée au cancer : Premier article de la série « Prévenir la thrombose »

Dans la documentation sur les soins infirmiers en oncologie, les besoins d’apprentissage des patients atteints de cancer sont largement étudiés et les publications abondent; toutefois, on tient rarement compte de la nécessité d’y inclure la thrombose associée au cancer (Cancer-Associated Thrombosis, ou CAT en anglais).

Les patients cancéreux ont peu d’information sur la thromboembolie veineuse (TEV) et son lien avec le cancer (Aggarwal et al., 2015 ). En 2015, une étude qualitative menée par le Dr Simon Noble a révélé que les patients cancéreux sous chimiothérapie à risque élevé en savaient davantage sur la neutropénie fébrile que sur les signes et symptômes de la thromboembolie veineuse, malgré le risque plus élevé de la seconde dans l’absolu. Chose préoccupante puisque la thrombose associée au cancer est la première cause de décès des patients sous chimiothérapie. En général, les patients et leur famille, mais aussi les fournisseurs de soins de santé, sont peu informés sur la thrombose associée au cancer. La recherche indique que beaucoup de patients en ayant reçu un diagnostic ont eu l’impression que leur médecin traitant manquait de connaissances sur le sujet puisqu’il avait considéré d’autres diagnostics avant de poser celui de la thrombose, et ce, malgré l’apparition de signes et la présence des symptômes classiques de la maladie thromboembolique veineuse (Noble et al., 2015 ).

Survenant fréquemment, la thromboembolie veineuse est une complication grave chez les patients cancéreux : c’est en fait la première cause de morbidité et la deuxième cause de mortalité pour eux (Noble et al., 2015 ). Malgré son importance, les patients, les proches aidants et les fournisseurs de soins de santé en savent peu sur la thrombose associée au cancer. Le présent article est le premier d’une série intitulée « Prévenir la thrombose » qui vise à sensibiliser les infirmières en oncologie afin d’améliorer l’enseignement aux patients sur cet important sujet.

The significance of VTE in cancer: Introduction of the 'Spot the CLOT' series

Learning needs of patients with cancer have been examined and published widely in oncology nursing literature. However, the topic of cancer-associated thrombosis (CAT) is rarely considered a necessary inclusion. Awareness by individuals with cancer about venous thromboembolism (VTE) and its association with cancer is low (Aggarwal et al., 2015). A 2015 qualitative study by Dr. Simon Noble revealed that high-risk cancer patients receiving active chemotherapy knew more about febrile neutropenia than signs and symptoms of VTE, despite a higher absolute risk of VTE. This is concerning given that CAT is the number one cause of death for patients undergoing chemotherapy treatment. Awareness of CAT is generally low not only in patients and their families, but also in healthcare providers. Research has found that many patients diagnosed with CAT perceived a significant knowledge deficit in their treating physicians because alternative diagnoses were considered before CAT, despite classic signs and symptoms of VTE (Noble et al., 2015). VTE is a common and often severe complication in cancer patients, being the leading cause of morbidity and second leading cause of mortality (Noble et al., 2015). Despite its significance, however, the awareness of CAT is low in patients, caregivers, and healthcare providers. This article is the first in a series entitled, 'Spot the CLOT', which is aimed at promoting the awareness of CAT in oncology nurses with the goal of improving patient education on this important topic.

Uncertainty in illness and coping styles: Moderating and mediating effects of resilience in stroke patients

BACKGROUND

Stroke has a great influence on the patient’s mental health, and reasonable psychological adjustment and disease perception can promote the recovery of mental health.

AIM

To explore the relationships among resilience, coping style, and uncertainty in illness of stroke patients.

METHODS

A retrospective study was used to investigate 154 stroke patients who were diagnosed and treated at eight medical institutes in Henan province, China from October to December 2019. We used the Mishel Uncertainty in Illness Scale, the Connor-Davidson Resilience Scale, and the Medical Coping Modes Questionnaire to test the uncertainty in illness, resilience, and coping style, respectively.

RESULTS

Resilience had a significant moderating role in the correlation between coping style and unpredictability and information deficiency for uncertainty in illness (P < 0.05). Further, the tenacity and strength dimensions of resilience mediated the correlation between the confrontation coping style and complexity, respectively (P < 0.05). The strength dimension of resilience mediated the correlation between an avoidance coping style and the unpredictability of uncertainty in illness (P < 0.05), as well as correlated with resignation, complexity, and unpredictability (P < 0.05).

CONCLUSION

Resilience has moderating and mediating roles in the associations between coping style and uncertainty in illness, indicating that it is vital to improve resilience and consider positive coping styles for stroke patients in the prevention and control of uncertainty in illness.

Describing Unmet Supportive Care Needs among Young Adults with Cancer (25-39 Years) and the Relationship with Health-Related Quality of Life, Psychological Distress, and Illness Cognitions

Few studies describe supportive care needs among young adults (YAs) with cancer ages 25 to 39 using validated questionnaires. Previous findings identified the need for psychological and information support and suggest that gender, age, psychological distress, and coping may be associated with greater need for this support. To substantiate these findings, this study aimed to (1) describe the supportive care needs of YAs in each domain of the Supportive Care Needs Survey and (2) explore the relationship between unmet supportive care needs and clinical and demographic factors, health-related quality of life, psychological distress, illness cognitions, and service needs using latent class analysis. Clinical teams from six hospitals in England invited eligible patients to a cross-sectional survey by post. A total of 317 participants completed the survey online or on paper. YAs expressed the most need in the psychological and sexuality domains. Using latent class analysis, we identified three classes of YAs based on level of supportive care need: no need (53.3%), low need (28.3%), and moderate need (18.4%). In each class, median domain scores in each domain were similar. Low and moderate need classes were associated with worse health-related quality of life and greater helplessness. Unmet service needs were associated with the moderate-need class only. Patients with unmet supportive care needs should be offered holistic care across supportive care domains.