1
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Ma C. The mediating effect of uncertainty in illness between heart failure symptoms and health-related quality of life among rural patients with heart failure: A multi-center cross-sectional study. Heart Lung 2024; 66:71-77. [PMID: 38593676 DOI: 10.1016/j.hrtlng.2024.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 04/04/2024] [Accepted: 04/05/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND The health-related quality of life (HRQoL) of patients with heart failure (HF) in rural settings in China remains unclear. Limited studies explored the mediating effect of uncertainty in illness between heart failure symptoms and HRQoL in this population. OBJECTIVES To explore the status of HRQoL in rural patients with HF; assess the impact of HF symptoms and uncertainty in illness on HRQoL; and examine the mediating effect of uncertainty in illness on the relationship between symptoms and HRQoL in rural patients with HF. METHODS Overall, 298 rural patients with HF were recruited from five township hospitals of Taishan and Jinzhong City in China between November 2021 and August 2022. Three variables, namely HF symptoms, uncertainty in illness, and HRQoL were measured using three validated scales. RESULTS The average score of HRQoL in rural patients with HF was 43.19. Of the participants, 60.4 %, 35.23 %, and 4.37 % exhibited poor, moderate, and good HRQoL, respectively. The HF symptoms (β = -0.47) and uncertainty in illness (β = -0.34) directly influenced HRQoL. Moreover, the HF symptoms also indirectly affected HRQoL through uncertainty in illness (β = -0.07). The indirect effect accounted for 12.96 % of the total effect of HF symptoms on HRQoL. CONCLUSION Rural patients with HF exhibited poor HRQoL. In this population, HF symptoms and uncertainty in illness were negatively associated with HRQoL. Uncertainty in illness mediated the relationship between HF symptoms and HRQoL. Tailored healthcare services should be developed for the rural population to alleviate HF symptoms, reduce uncertainty in illness, and enhance their HRQoL.
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Affiliation(s)
- Chunhua Ma
- School of Nursing, Guangzhou Medical University, 195 Dongfengxi Rd., Guangzhou, Guangdong 510180, China.
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2
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Gittus M, Harris T, Ong AC. Patient Perspectives on ADPKD. ADVANCES IN KIDNEY DISEASE AND HEALTH 2023; 30:294-302. [PMID: 37088530 DOI: 10.1053/j.akdh.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 12/21/2022] [Accepted: 01/06/2023] [Indexed: 04/25/2023]
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is the most common inherited kidney disease. It has been associated with a significant physical and psychological burden, leading to a reduced quality of life. The purpose of this literature review is to summarize the patient perspective on ADPKD based on the current published literature. A systematic literature review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Publications reporting a patient or caregiver/relative perspective of ADPKD were included. Sources searched included Medline (PubMed), Embase (Ovid), Cochrane Library, and Web of Science from inception to April 2022. This was followed by a subsequent reference and citation search. A total of 1011 articles were identified by the search process, with 28 studies included in the review. An inductive thematic analysis identified six key themes: diagnosis, monitoring, and screening; symptoms; lifestyle and dietary interventions; psychological, physical, and social impact; future planning; and interaction with the health care system. The findings of this review highlight the burden and uncertainty associated with ADPKD from a patient's perspective. This impacts patients and their caregivers/relatives at each stage of the patient's journey from screening to initiation of renal replacement therapy and future planning.
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Affiliation(s)
- Matthew Gittus
- Academic Nephrology Unit, Department of Infection, Immunity, and Cardiovascular Disease, The Medical School, University of Sheffield, Sheffield, UK; Sheffield Kidney Institute, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
| | | | - Albert Cm Ong
- Academic Nephrology Unit, Department of Infection, Immunity, and Cardiovascular Disease, The Medical School, University of Sheffield, Sheffield, UK; Sheffield Kidney Institute, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
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3
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Özdemir MA, Topak D, Turgut C, Telek M, Doğar F. Evaluation of depression, anxiety, and stress status in parents of patient with congenital clubfoot treated with Ponseti method: A prospective study. Medicine (Baltimore) 2022; 101:e31654. [PMID: 36343081 PMCID: PMC9646646 DOI: 10.1097/md.0000000000031654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Congenital diseases have been reported to increase the incidence of depression, anxiety, and stress among parents. In this study, we aimed to investigate the depression, anxiety, and stress status in parents of patients with congenital clubfoot before and after treatment with the Ponseti method. A total of 20 patients diagnosed with congenital clubfoot at our clinic and treated with the Ponseti method were included in this study. The Depression Anxiety Stress Scale-21 (DASS-21) was used to evaluate the depression, anxiety, and stress status of the parents before and after treatment. We considered the following parameters to investigate the effects of these on the parents: the educational level of the parents; economic status of the family; gender; birth order of the child in the family; time of diagnosis (prenatal or postnatal). The mean DASS and subdomain scores after treatment were significantly lower than those before treatment (P < .05). Moreover, there was a significant difference in the pre- and posttreatment mean DASS and depression scores of the participants in terms of the education level (P < .05). The pre- and posttreatment DASS and depression scores of the participants with an education level of primary school and below were lower than those of the participants with an education level of secondary and high school. Parents may be less concerned during this process if they are fully informed by the orthopedic surgeons about the treatment protocol and the near-perfect results of the Ponseti method as well as are counseled by healthcare professionals.
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Affiliation(s)
- Mustafa Abdullah Özdemir
- Kahramanmaras Sutcu Imam University, Faculty of Medicine, Department of Orthopaedic and Traumatology, 46040, Kahramanmaras, Turkey
- *Correspondence: Mustafa Abdullah Özdemir, Kahramanmaraş Sütçü İmam Üniversitesi Tip Fakültesi Avşar Mahallesi Bati Çevreyolu Blv. No:251\A, 46040-Onikişubat\Kahramanmaraş, Türkiye (e-mail: )
| | - Duran Topak
- Kahramanmaras Sutcu Imam University, Faculty of Medicine, Department of Orthopaedic and Traumatology, 46040, Kahramanmaras, Turkey
| | - Celaleddin Turgut
- Kahramanmaras Sutcu Imam University, Faculty of Medicine, Department of Psychiatry, 46040, Kahramanmaras, Turkey
| | - Mikail Telek
- Kahramanmaras Sutcu Imam University, Faculty of Medicine, Department of Orthopaedic and Traumatology, 46040, Kahramanmaras, Turkey
| | - Fatih Doğar
- Kahramanmaras Sutcu Imam University, Faculty of Medicine, Department of Orthopaedic and Traumatology, 46040, Kahramanmaras, Turkey
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4
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Büyükçolpan H, Ozdemir NK. The influences on happiness and life satisfaction of young people during COVID-19 pandemic: Evidence for positive youth development. CURRENT PSYCHOLOGY 2022; 42:1-10. [PMID: 35935746 PMCID: PMC9343243 DOI: 10.1007/s12144-022-03548-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2022] [Indexed: 11/03/2022]
Abstract
COVID-19 pandemic has brought about many uncertainties and adversities for young people, negatively influencing their mental health. The present study investigated the mediation role of intolerance to uncertainty (IU) in the relationship between social emotional learning (SEL) skills and happiness, and between SEL skills and life satisfaction (LS) of young people, within the framework of Positive Youth Development (PYD). The study included 589 university students (51% women) aged 18-24, and the participants completed a Demographic form, Social Emotional Learning Scale-Young Adult Form, Intolerance to Uncertainty Scale, Satisfaction with Life Scale, and Oxford Happiness Questionnaire. In the study, the mediating role of IU on the relationship between SEL skills and happiness (Model 1) and between SEL skills and LS (Model 2) were tested. The analysis first indicated positive direct relations of SEL skills with happiness and LS, as well as negative direct relations with IU. In addition, there were negative associations between IU and happiness, and between IU and LS. The results also demonstrated the mediation role of IU on the relationships between SEL skills and both happiness and LS. These findings confirmed the pivotal role that SEL skills play in happiness and LS by reducing the impact of IU, thus promoting PYD during the pandemic.
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Affiliation(s)
- Hakan Büyükçolpan
- Faculty of Education, Guidance and Psychological Counseling, Hacettepe University, Beytepe, Ankara 06800 Turkey
| | - Nurten Karacan Ozdemir
- Faculty of Education, Guidance and Psychological Counseling, Hacettepe University, Beytepe, Ankara 06800 Turkey
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5
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Wang C, Tang N, Zhen D, Wang XR, Zhang J, Cheong Y, Zhu Q. Need for cognitive closure and trust towards government predicting pandemic behavior and mental health: comparing United States and China. CURRENT PSYCHOLOGY 2022; 42:1-14. [PMID: 35813568 PMCID: PMC9255507 DOI: 10.1007/s12144-022-03327-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/30/2022] [Accepted: 06/09/2022] [Indexed: 12/13/2022]
Abstract
Residents of the United States and China have responded very differently to the implementation of COVID-19 preventive measures. This study introduces the uncertainty reduction theory and the need for cognitive closure (NFC) framework into the context of a public health crisis and compares models across the United States and China. Specifically, we collected survey data to examine how NFC, trust in government, and attitudes toward preventive measures predicted pandemic compliance behaviors, depressive symptoms, and life satisfaction among 745 college students (399 from China and 346 from the United States). Chinese participants trusted their government more, believed COVID preventive measures to be more beneficial, and reported more pandemic compliance and fewer depressive symptoms than U.S. PARTICIPANTS Trust in government and attitudes towards preventive measures mediated the relationships between NFC and pandemic compliance behaviors among Chinese participants but not U.S. PARTICIPANTS NFC predicted better mental health outcomes among participants in China compared to U.S. PARTICIPANTS Trust in government mediated NFC and mental health outcomes among Chinese participants. Trust in government predicted better mental health (fewer depressive symptoms and more life satisfaction) in both the United States and China. Theoretical and practical implications of these findings for promoting mental health and pandemic compliance behavior during the COVID-19 pandemic are discussed.
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Affiliation(s)
- Cixin Wang
- Department of Counseling, Higher Education, & Special Education, University of Maryland, College Park, USA
| | - Ningyu Tang
- Antai College of Economics and Management, Shanghai Jiao Tong University, Shanghai, China
- Management School, Hainan University, Haikou, China
| | - Danlei Zhen
- Antai College of Economics and Management, Shanghai Jiao Tong University, Shanghai, China
| | | | - Jingshu Zhang
- Antai College of Economics and Management, Shanghai Jiao Tong University, Shanghai, China
| | - Yeram Cheong
- Asian American Studies Program, University of Maryland, College Park, USA
| | - Qianyu Zhu
- Department of Counseling, Higher Education, & Special Education, University of Maryland, College Park, USA
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6
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Goutzamanis S, Spelman T, Harney B, Dietze P, Stoove M, Higgs P, Thompson A, Doyle JS, Hellard M. Patient-reported outcomes of the Treatment and Prevention Study: A real-world community-based trial of direct-acting antivirals for hepatitis C among people who inject drugs. J Viral Hepat 2021; 28:1068-1077. [PMID: 33880820 DOI: 10.1111/jvh.13516] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 03/22/2021] [Indexed: 12/09/2022]
Abstract
The impact of hepatitis C cure with direct-acting antivirals (DAAs) on patient-reported outcomes (PROs) in community settings remains unclear. We aimed to assess changes in PROs over time and whether treatment was associated with sustained improved PROs in a cohort of people who inject drugs. This study is a sub-analysis of the Treatment and Prevention Study, a nurse-led trial where people who inject drugs and their injecting partners were recruited in a community setting, in Melbourne, Australia. Three participant groups were characterized: treatment, untreated and non-viremic (hepatitis C RNA negative at screening). PROs included assessment of health-related quality of life using the Short Form-8 (SF-8) Survey and life satisfaction using Personal Wellbeing Index (PWI). PROs were measured at baseline and every 12 weeks until week 84. Generalized estimating equations were used to measure whether treatment was associated with longitudinal PRO change. A total of 215 participants were included in this analysis. PWI scores were significantly higher at week 12 for both treatment group (p = 0.0309) and non-viremic group (p = 0.0437) compared to baseline. However, treatment was not associated with longitudinal change in PRO scores. In conclusion, we found DAA treatment did not significantly improve PRO scores compared to those not receiving treatment and without hepatitis C. The measures used in this study may not be sensitive enough to capture the hepatitis C specific improvements in quality of life that treatment affords or factors other than treatment may be influencing quality of life scores in this cohort.
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Affiliation(s)
- Stelliana Goutzamanis
- Burnet Institute, Melbourne, Vic., Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
| | - Timothy Spelman
- Burnet Institute, Melbourne, Vic., Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
| | - Brendan Harney
- Burnet Institute, Melbourne, Vic., Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia.,Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Vic., Australia
| | - Paul Dietze
- Burnet Institute, Melbourne, Vic., Australia.,National Drug Research Institute, Curtin University, Perth, WA, Australia
| | - Mark Stoove
- Burnet Institute, Melbourne, Vic., Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
| | - Peter Higgs
- Burnet Institute, Melbourne, Vic., Australia.,Department of Public Health, La Trobe University, Bundoora, Vic., Australia
| | | | - Joseph S Doyle
- Burnet Institute, Melbourne, Vic., Australia.,Department of Public Health, La Trobe University, Bundoora, Vic., Australia
| | - Margaret Hellard
- Burnet Institute, Melbourne, Vic., Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia.,Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Vic., Australia
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7
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Confirmatory Factor Analysis of MUIS-C Scale Among Baby Boomers With Hepatitis C. J Nurs Meas 2021; 29:166-181. [PMID: 33593989 DOI: 10.1891/jnm-d-19-00089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE The purpose of this study was to evaluate Mishel Uncertainty in Illness Scale-Community (MUIS-C), used to gauge level of uncertainty among baby boomers with hepatitis C virus (HCV) infection, as a reliable two-factor instrument. METHODS A CFA was conducted to test MUIS-C. There were minor deviations from normality. Subsequently, 130 participants were used to examine the factor structure and the model fit. A robust maximum likelihood (ML) estimation using the Wishart distribution was implemented in R version 3.3.1. RESULTS A very good model fit was obtained (χ 2(101) = 118.32, p = .115, TLI = 0.977, CFI = 0.983, RMSEA = 0.036, 90%CI(0.000, 0.061), and SRMR = 0.057). All indicators showed significant positive factor loadings, with standardized coefficients ranging from 0.511 to 0.868. CONCLUSIONS The MUIS-C was a reliable two-factor instrument and suitable for use as such in baby boomer population with HCV.
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8
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Ozawa N, Sato K, Sugimura A, Maki S, Tanaka T, Yamamoto K, Ito T, Ishizu Y, Kuzuya T, Honda T, Ishigami M, Fujishiro M, Ishikawa T, Ando S. Quality of Life in patients with nonalcoholic fatty liver disease: Structure and related factors focusing on illness uncertainty. Jpn J Nurs Sci 2021; 18:e12415. [PMID: 33709507 DOI: 10.1111/jjns.12415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/05/2021] [Accepted: 02/10/2021] [Indexed: 12/22/2022]
Abstract
AIM Patients with nonalcoholic fatty liver disease (NAFLD) have a low quality of life (QOL) and illness uncertainty. This study examined the structure of QOL and associated factors, including illness uncertainty, among individuals with NAFLD. METHODS A cross-sectional survey was conducted using a self-administered questionnaire for outpatients with NAFLD. QOL was measured using the Short Form-8. Dietary habits, physical activity level, illness uncertainty, health locus of control, and knowledge of NAFLD were assessed. Path analysis was used to study the associated factors of QOL and their structure, including uncertainty of disease. RESULTS Path analysis of 168 NAFLD patients indicated that a high Physical Component Summary score on the Short Form-8-representing physical QOL-was predicted by a body mass index <25 kg/m2 and high educational level. A high Mental Component Summary score-representing mental QOL-was predicted by being male, good dietary habits, low illness uncertainty, and presence of consultants. The model showed satisfactory goodness-of-fit without being rejected by the chi-square test (goodness-of-fit index = .947, adjusted goodness-of-fit index = .917, comparative fit index = .967, root mean square error of approximation = 0.023). CONCLUSIONS Nurses need to work closely with NAFLD patients as consultants, providing adequate information about the causes, treatments, and dietary habits, and focusing on the individual's perception of health. This could reduce illness uncertainty and contribute to the improvement of QOL.
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Affiliation(s)
- Naoki Ozawa
- Department of Nursing, Doctoral Course, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuki Sato
- Nursing for Advanced Practice, Division of Integrated Health Sciences, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Ayumi Sugimura
- Nursing for Advanced Practice, Division of Integrated Health Sciences, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | | | - Taku Tanaka
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kenta Yamamoto
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takanori Ito
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoji Ishizu
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Teiji Kuzuya
- Department of Gastroenterology and Gastroenterological Oncology, Fujita Health University, Japan
| | - Takashi Honda
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masatoshi Ishigami
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Mitsuhiro Fujishiro
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tetsuya Ishikawa
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shoko Ando
- Nursing for Advanced Practice, Division of Integrated Health Sciences, Nagoya University Graduate School of Medicine, Nagoya, Japan
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9
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Hansen L, Chang MF, Lee CS, Hiatt S, Firsick EJ, Dieckmann NF, Lyons KS. Physical and Mental Quality of Life in Patients With End-Stage Liver Disease and Their Informal Caregivers. Clin Gastroenterol Hepatol 2021; 19:155-161.e1. [PMID: 32289544 PMCID: PMC7554075 DOI: 10.1016/j.cgh.2020.04.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 03/20/2020] [Accepted: 04/03/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Management of end-stage liver disease (ESLD) has implications for not only patients' quality of life (QOL), but also their caregivers'. We aimed to identify characteristics of patients with ESLD and their caregivers that are associated with QOL. METHODS We obtained cross-sectional baseline data from patients and their caregivers (132 dyads; 62% were married or partners), recruited from outpatient hepatology clinics within 2 healthcare centers. Patients were included if their model for end-stage liver disease score was 15 or more; caregivers were identified by the patient as the primary informal caregiver. QOL was measured by the SF-36 and relationship quality using the mutuality scale. We measured uncertainty using the uncertainty in illness scales for patients and caregivers. Multilevel modeling was used to analyze the data. RESULTS Refractory ascites was associated with worse physical QOL for patients (unstandardized beta [B], -9.19; standard error [SE], 2.28) and caregivers (B, -5.41; SE, 2.33); history of hepatic encephalopathy was associated with worse patient physical QOL (B, -3.86; SE, 1.65). High levels of uncertainty were associated with worse physical and mental QOL for both members of the dyads; relationship quality was significantly associated with patient mental QOL (B, 2.73; SE, 1.19). CONCLUSIONS Clinicians and researchers should consider the effects of ESLD on caregivers as well as their patients to optimize the QOL for both.
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Affiliation(s)
- Lissi Hansen
- School of Nursing, Oregon Health & Science University, Portland, Oregon.
| | - Michael F Chang
- Gastroenterology & Hepatology, VA Portland Health Care System, Portland OR 97239, USA
| | - Christopher S Lee
- William F. Connell School of Nursing, Boston College, Boston MA 02467, USA
| | - Shirin Hiatt
- School of Nursing, Oregon Health & Science University, Portland OR 97239, USA
| | - Evan J Firsick
- School of Nursing, Oregon Health & Science University, Portland OR 97239, USA
| | - Nathan F Dieckmann
- School of Nursing, Oregon Health & Science University, Portland OR 97239, USA
| | - Karen S Lyons
- William F. Connell School of Nursing, Boston College, Boston MA 02467, USA
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10
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Heathcote LC, Loecher N, Simon P, Spunt SL, Jordan A, Tutelman PR, Cunningham S, Schapira L, Simons LE. Symptom appraisal in uncertainty: a theory-driven thematic analysis with survivors of childhood cancer. Psychol Health 2020; 36:1182-1199. [DOI: 10.1080/08870446.2020.1836180] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Lauren C. Heathcote
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Nele Loecher
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Pamela Simon
- Department of Pediatric Hematology-Oncology, Lucile Packard Children’s Hospital Stanford, Palo Alto, CA, USA
| | - Sheri L. Spunt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Abbie Jordan
- Department of Psychology & Centre for Pain Research, University of Bath, Bath, UK
| | - Perri R. Tutelman
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sarah Cunningham
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Lidia Schapira
- Department of Medical Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Laura E. Simons
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
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11
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Miller DP, Allen MT, Servatius RJ. Partial Predictability in Avoidance Acquisition and Expression of Wistar-Kyoto and Sprague-Dawley Rats: Implications for Anxiety Vulnerability in Uncertain Situations. Front Psychiatry 2020; 11:848. [PMID: 32973587 PMCID: PMC7466649 DOI: 10.3389/fpsyt.2020.00848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 08/04/2020] [Indexed: 11/20/2022] Open
Abstract
Individual differences or vulnerabilities must exist which bias some individuals toward psychopathology while others remain resilient in the face of trauma. Recent work has studied the effects of uncertainty on individuals expressing behavioral inhibition (BI). The current study extended this work with uncertainty to Wistar Kyoto (WKY) rats which are a behaviorally inhibited inbred strain that models learning vulnerabilities for anxiety disorders and posttraumatic stress disorder (PTSD). WKY rats exhibit superior avoidance performance in a signaled bar press avoidance task in which a tone conditioned stimulus (CS) signals a foot shock unconditional stimulus (US) when compared with non-inhibited Sprague-Dawley (SD) rats. In addition, WKY rats express enhanced eyeblink conditioning. Recent work with behaviorally inhibited humans has indicated that this enhanced eyeblink conditioning is more evident in conditions that insert CS- or US-alone trials into CS-US paired training, resulting in uncertain and suboptimal learning conditions. The current study examined the effects of partial predictability training, in which the CS signaled the US only one-half of the time, on the acquisition and expression of avoidance. Standard training with a fixed 60-s CS which predicted shock on 100% of trials was compared with training in which the CS predicted shock on 50% of trials (partial predictability) using a pseudorandom schedule. As expected, WKY rats acquired avoidance responses faster and to a greater degree than SD rats. Partial predictability of the US essentially reduced SD rats to escape responding. Partial predictability also reduced avoidance in WKY rats; however, adjusting avoidance rates for the number of potential pairings of the CS and US early in training suggested a similar degree of avoidance expression late in the last session of training. Enhanced active avoidance expression, even in uncertain learning conditions, can be interpreted as behaviorally inhibited WKY rats responding to the expectancy of the shock by avoiding, whereas non-inhibited SD rats were responding to the presence of the shock by escaping. Future work should explore how WKY and SD rats as well as behaviorally inhibited humans acquire and extinguish avoidance responses in uncertain learning situations.
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Affiliation(s)
- Daniel Paul Miller
- Neuroscience Department, Carthage College, Kenosha, WI, United States.,Department of Psychiatry, Stress and Motivated Behavior Institute, Upstate Medical University, Syracuse, NY, United States
| | - Michael Todd Allen
- Department of Psychiatry, Stress and Motivated Behavior Institute, Upstate Medical University, Syracuse, NY, United States.,School of Psychological Sciences, University of Northern Colorado, Greeley, CO, United States
| | - Richard J Servatius
- Department of Psychiatry, Stress and Motivated Behavior Institute, Upstate Medical University, Syracuse, NY, United States.,Department of Veterans Affairs, Syracuse Veterans Affairs Medical Center, Syracuse, NY, United States
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12
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Abstract
BACKGROUND Young adults with congenital heart disease (CHD) are at risk for chronic illness uncertainty in 4 domains: ambiguity about the state of their illness; lack of information about the disease, its treatment, and comorbidities; complexity of the healthcare system and relationship with healthcare providers; and unpredictability of the illness course and outcome. Chronic uncertainty has been associated with posttraumatic stress symptoms (PTSS) and posttraumatic stress disorder (PTSD). OBJECTIVE The aims of this study were to explore how young adults with CHD experience uncertainty and to describe the relationship between PTSS and the appraisal and management process. METHODS An exploratory, mixed methods design was used. Data were collected in person and via Skype from 25 participants (19-35 years old), who were diagnosed with CHD during childhood and able to read and write English. In-depth interviews and the University of California at Los Angeles Posttraumatic Stress Disorder Reaction Index were used to collect data. Qualitative data were analyzed using the constant comparative method. RESULTS The 4 domains of uncertainty were evident in the narratives. The PTSD mean (SD) score was 31.3 (7.7). Six participants met criteria for PTSD. Narrative analysis revealed a relationship between severity of PTSS and the appraisal and management of uncertainty. Participants with PTSD used management strategies that included avoidance, reexperiencing, and hyperarousal. CONCLUSIONS Young adults with CHD may be at risk for the development of long-term psychological stress and PTSD in the setting of chronic uncertainty. Regular monitoring to identify PTSS/PTSD may be a means to promote treatment adherence and participation in healthcare.
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13
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14
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Uncertainty and Quality of Life in Women With Breast Cancer: Moderating Role of Coping Styles. Cancer Nurs 2019; 41:484-490. [PMID: 29489477 DOI: 10.1097/ncc.0000000000000552] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The negative relationship between uncertainty and quality of life is well reported in the literature. Also, there is abundant research linking coping strategies to cancer patients' quality of life. However, there exists a paucity of information on the moderating effect of coping styles on the relationship between uncertainty and quality of life in cancer patients. OBJECTIVE The aim of this study was to examine whether uncertainty in illness is negatively correlated with quality of life and whether this relationship is moderated by coping strategies, namely, problem-focused, avoidant, and active emotional coping. METHODS A convenience sample of 135 Malaysian women with breast cancer participated in the study. Participants completed measures of uncertainty in illness, quality of life, and coping styles. RESULTS Uncertainty in breast cancer was negatively related to quality of life (β = -0.379, P < .001), and active emotional coping was found to moderate this negative relationship (β = 0.155, P < .05). The model explained 22.20% of the variance of quality of life. CONCLUSION Lack of information about breast cancer, treatment, hospitalization, and disease recurrence is related to poorer quality of life. However, this negative relationship becomes weaker when active emotional coping strategies are used. IMPLICATIONS FOR PRACTICE Nurses and health providers should help patients reduce their uncertainty in illness by providing them information on breast cancer or referring them to relevant sources. Moreover, they could reduce the deleterious effect of uncertainty on quality of life by encouraging patients to use more active emotional coping strategies.
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Petrongolo JL, Zelikovsky N, Keegan RM, Furth SL, Knight A. Examining Uncertainty in Illness in Parents and Children With Chronic Kidney Disease and Systemic Lupus Erythematosus: A Mediational Model of Internalizing Symptoms and Health-Related Quality of Life. J Clin Psychol Med Settings 2019; 27:31-40. [PMID: 30989366 DOI: 10.1007/s10880-019-09617-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
To examine if parent illness uncertainty is indirectly associated with child depression, anxiety, and HRQOL in the CKD/SLE population. Parent-child dyads (N = 31) from outpatient rheumatology and nephrology clinics included children (ages 9-18) diagnosed with CKD (Stage 1, 2, or nephrotic syndrome) or SLE. Parents completed demographic and uncertainty measures and children completed uncertainty, depression, anxiety, and HRQOL measures. This cross-sectional study examined mediational models using the percentile bootstrapping method. Parent uncertainty had an indirect effect on child depression, anxiety, and HRQOL through the mediator, child uncertainty. In other words, parents' illness uncertainty regarding their child's condition correlates to the child's illness uncertainty, which then is associated with the child's mental health and wellbeing. Reverse mediations illustrated that parent uncertainty did not mediate child uncertainty and outcome variables. Results extend previous research by examining parent and child illness uncertainty in understudied conditions (CKD/SLE) and the relationship to outcome variables commonly related to depression (e.g., anxiety and HRQOL). Findings allow health psychologists and medical personnel to understand the impact of uncertainty on the child's wellbeing and HRQOL. Clinical implications, including using specialized interventions to address illness uncertainty, are discussed.
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Affiliation(s)
- Jennifer L Petrongolo
- Department of Psychology, La Salle University, 1900 West Olney Avenue, Philadelphia, PA, 19141, USA.
| | - Nataliya Zelikovsky
- Department of Psychology, La Salle University, 1900 West Olney Avenue, Philadelphia, PA, 19141, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania and the Children's Hospital of Philadelphia, 34th Street and Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Rachel M Keegan
- Department of Psychology, La Salle University, 1900 West Olney Avenue, Philadelphia, PA, 19141, USA
| | - Susan L Furth
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania and the Children's Hospital of Philadelphia, 34th Street and Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Andrea Knight
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania and the Children's Hospital of Philadelphia, 34th Street and Civic Center Blvd, Philadelphia, PA, 19104, USA
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Al-Yateem N, Brenner M, Alrimawi I, Al-Shujairi A, Al-Yateem S. Predictors of uncertainty in parents of children living with chronic conditions. Nurs Child Young People 2019:e1102. [PMID: 31468904 DOI: 10.7748/ncyp.2019.e1102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND Uncertainty in illness implies no meaning has been attributed to an illness event. Although many studies focus on this issue in adults, there is limited research into children with chronic illnesses. Parental uncertainty has been associated with increased risk of post-traumatic stress, which can in turn adversely affect child and parent coping strategies. AIM To identify the characteristics of parents who are at greater risk of uncertainty and the associated characteristics of their children's chronic illnesses. METHOD An exploratory, cross-sectional study design was adopted across three different sites in the United Arab Emirates. Data were collected from parents who accompanied their children, who were receiving treatment, using a validated, culturally adapted Parent Perception of Uncertainty Scale. RESULTS Scores for illness uncertainty ranged from 86.5 to 92.6, on a scale of 31-155, with higher scores indicating greater uncertainty. The highest scores were found in parents of children being cared for in ward settings who had previously been hospitalised, parents of children up to two years of age or those approaching adolescence, fathers, and parents whose first language was Arabic. CONCLUSION The groups of parents with the highest illness uncertainty may benefit most from interventions to improve communication and psychological support.
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Affiliation(s)
- Nabeel Al-Yateem
- Department of Nursing, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates, adjunct lecturer and researcher, School of Nursing, Midwifery and Indigenous Health, Faculty of Science, Charles Sturt University and Research Institute for Medical and Health Science, University of Sharjah, United Arab Emirates
| | - Maria Brenner
- School of Nursing and Midwifery, Trinity College Dublin, The University of Dublin, Ireland
| | | | - Arwa Al-Shujairi
- Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
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Djambazov SN, Giammanco MD, Gitto L. Factors That Predict Overall Patient Satisfaction With Oncology Hospital Care in Bulgaria. Value Health Reg Issues 2019; 19:26-33. [PMID: 30641294 DOI: 10.1016/j.vhri.2018.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 11/07/2018] [Accepted: 11/29/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND The relevance of studies focusing on patient satisfaction becomes imperative for patients with cancer, who often face major changes in their lifestyles. Their perceived uncertainty in illness and their personal experiences with the services received are crucial factors for a qualitatively adequate assistance. OBJECTIVES To assess the determinants of patient satisfaction, using a sample of 306 Bulgarian oncology outpatients. METHODS The hypotheses tested concern the extent to which patient satisfaction depends on the uncertainty in illness; the patients' assessment of technical and interpersonal skills of nurses and medical staff; the information provision; and some organizational aspects. Patients were asked to answer a questionnaire composed of internationally validated scales assessing the determinants of patient satisfaction (measured through the European Organization for Research and Treatment of Cancer), uncertainty in illness (assessed through the Mishel Uncertainty in Illness Scale), and patients' health status (assessed through the EuroQol 5-dimensional questionnaire and the visual analogue scale). An ordered logit model was run, using the level of overall patient satisfaction as a dependent variable. RESULTS This is one of the first studies carried out in Bulgaria for oncology patient satisfaction of subjective factors related to the frailty of the oncology patient status such as age, self-assessed health-related quality of life, and uncertainty in illness. Nevertheless, other determinants, reflecting the quality of the care provided, also have an impact on patient satisfaction, namely, the assessment of the nonmedical personnel, the perception of medical technical skills, and the access to a medical center. CONCLUSIONS Results stress the relevance of reducing uncertainty in illness in patients with cancer by implementing a satisfactory patient-physician relationship in the management of the disease.
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Affiliation(s)
| | | | - Lara Gitto
- CEIS Sanità EEHTA, University of Rome "Tor Vergata", Rome, Italy
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Uncertainty and Quality of Life in Systemic Lupus Erythematosus: A Cross-sectional Study. Rehabil Nurs 2019; 44:2-10. [DOI: 10.1097/rnj.0000000000000118] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Burris JL, Rivera-Rivera JN, Armeson K, Zapka J, Alberg AJ, Day TA, Sterba KR. Causal attributions and their impact on psychosocial functioning in head and neck cancer patient-caregiver dyads: a preliminary, longitudinal study. Qual Life Res 2018; 28:1105-1109. [PMID: 30515660 DOI: 10.1007/s11136-018-2078-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE This longitudinal study explores causal attributions in newly diagnosed head/neck cancer (HNC) patients and their caregivers. METHODS Perceptions of causal attributions and associated level of responsibility regarding each patient's HNC diagnosis at baseline (n = 72 dyads) were described and then tested as predictors of depressive symptoms, cancer worry, and perceived support 6 months later. RESULTS When causes were reported, tobacco and alcohol use topped the list of both patients and caregivers. Three-quarters of dyads agreed about perceptions of the patients' responsibility in causing their HNC. Some dyad-level patterns of causal attribution were associated with patients' and caregivers' cancer worry (p < 0.05) and caregivers' perceived support (p < 0.05) in unadjusted models. CONCLUSIONS This preliminary study indicates that causal attributions warrant further exploration in HNC patient-caregiver dyads specifically, as well as studies of quality of life in patient-caregiver dyads more broadly considered.
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Affiliation(s)
- Jessica L Burris
- Department of Psychology and Markey Cancer Center, University of Kentucky, 307 Combs Cancer Research Building, Lexington, KY, 40536-0096, USA.
| | - Jessica N Rivera-Rivera
- Department of Psychology and Markey Cancer Center, University of Kentucky, 307 Combs Cancer Research Building, Lexington, KY, 40536-0096, USA
| | - Kent Armeson
- Department of Public Health Sciences and Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Jane Zapka
- Department of Public Health Sciences and Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Anthony J Alberg
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, USA
| | - Terry A Day
- Department of Otolaryngology and Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Katherine R Sterba
- Department of Public Health Sciences and Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
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The role of illness uncertainty in the relationship between disease knowledge and patient-reported outcomes among adolescents and adults with congenital heart disease. Heart Lung 2018; 48:325-330. [PMID: 30471879 DOI: 10.1016/j.hrtlng.2018.10.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 10/23/2018] [Accepted: 10/24/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Greater general disease knowledge predicts better patient-reported outcomes (PROs) among congenital heart disease (CHD) survivors, but higher illness uncertainty is associated with elevated emotional distress and poorer well-being among patients with chronic disease. OBJECTIVES This study explored the relationship of illness uncertainty and disease knowledge with emotional distress and health-related quality of life (HRQoL) among patients with CHD. METHODS Individuals with CHD (N = 169, ages 15-39) completed self-report measures of disease knowledge (general and risk-related), illness uncertainty, depressive and anxiety symptoms, and HRQoL. Pearson correlations and regressions analyses were utilized. RESULTS Greater risk-related knowledge was associated with greater anxiety (b = .41, p = .03, 95% CI = [.04, .77]) and poorer emotional HRQoL (b = -.53, p = .03, 95% CI = [-1.02, -.05]) when illness uncertainty was higher. CONCLUSION When individuals with CHD feel uncertain about their disease course and outcomes, knowledge about future cardiovascular risks may result in higher levels of distress.
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Chen TY, Kao CW, Cheng SM, Chang YC. Uncertainty and depressive symptoms as mediators of quality of life in patients with heart failure. PLoS One 2018; 13:e0205953. [PMID: 30427855 PMCID: PMC6235604 DOI: 10.1371/journal.pone.0205953] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 10/04/2018] [Indexed: 01/26/2023] Open
Abstract
Uncertainty in illness is regarded as a source of stress in many chronic diseases and is negatively related to health-related quality of life (HRQoL). However, studies on the relationship between uncertainty and HRQoL in patients with heart failure are limited. This study used Mishel's theory of uncertainty in illness to investigate the mediating role of uncertainty in illness and depressive symptoms between symptom distress and HRQoL in patients with heart failure. This study used a cross-sectional correlation design. Participants were recruited by convenience sampling from outpatient services and medical wards of cardiology departments of a medical center in northern Taiwan. Data were collected for uncertainty, depressive symptoms, symptoms distress of heart failure, and HRQoL using self-report questionnaires. Demographics and clinical characteristics were analyzed with descriptive statistics. The mutual effects of disease characteristics, symptom distress, uncertainty in illness, depressive symptoms and HRQoL, as well as the overall model fitness, were analyzed by with structural equation modeling. We collected 147 qualified questionnaires. The mean score for the Mishel Uncertainty in Illness Scale for patients with heart failure was 73.5 (SD = 18.55); 65.3% of participants had a score of ≧13 on the Beck Depressive Inventory-II, indicating mild depression. Uncertainty, depressive symptoms, and HRQoL were directly related to symptom distress. Symptom distress and depressive symptoms were both mediators between uncertainty and depressive symptoms. Depressive symptoms also mediated emotional support and HRQoL. Uncertainty and depressive symptoms were important factors in the pathway between symptom distress and HRQoL for heart failure patients. We suggest providing heart failure patients with tailored interventions for effective self-management of symptoms based on Mishel's theory of uncertainty in illness, which could help control disease symptoms, alleviate uncertainty and depression as well as improve HRQoL.
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Affiliation(s)
- Ting-Yu Chen
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
- Chung-Jen Junior College of Nursing, Health Sciences and Management, Chiayi, Taiwan
| | - Chi-Wen Kao
- Department of Nursing, Tri-Service General Hospital, Taipei, Taiwan
- School of Nursing, National Defense Medical Center, Taipei, Taiwan
| | - Shu-Meng Cheng
- Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- National Defense Medical Center, School of Medicine, Taipei, Taiwan
| | - Yue-Cune Chang
- Department of Mathematics, Tamkang University, Taipei, Taiwan
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Dodd S, Mitchell PB, Bauer M, Yatham L, Young AH, Kennedy SH, Williams L, Suppes T, Lopez Jaramillo C, Trivedi MH, Fava M, Rush AJ, McIntyre RS, Thase ME, Lam RW, Severus E, Kasper S, Berk M. Monitoring for antidepressant-associated adverse events in the treatment of patients with major depressive disorder: An international consensus statement. World J Biol Psychiatry 2018; 19:330-348. [PMID: 28984491 DOI: 10.1080/15622975.2017.1379609] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES These recommendations were designed to ensure safety for patients with major depressive disorder (MDD) and to aid monitoring and management of adverse effects during treatment with approved antidepressant medications. The recommendations aim to inform prescribers about both the risks associated with these treatments and approaches for mitigating such risks. METHODS Expert contributors were sought internationally by contacting representatives of key stakeholder professional societies in the treatment of MDD (ASBDD, CANMAT, WFSBP and ISAD). The manuscript was drafted through iterative editing to ensure consensus. RESULTS Adequate risk assessment prior to commencing pharmacotherapy, and safety monitoring during pharmacotherapy are essential to mitigate adverse events, optimise the benefits of treatment, and detect and assess adverse events when they occur. Risk factors for pharmacotherapy vary with individual patient characteristics and medication regimens. Risk factors for each patient need to be carefully assessed prior to initiating pharmacotherapy, and appropriate individualised treatment choices need to be selected. Some antidepressants are associated with specific safety concerns which were addressed. CONCLUSIONS Risks of adverse outcomes with antidepressant treatment can be managed through appropriate assessment and monitoring to improve the risk benefit ratio and improve clinical outcomes.
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Affiliation(s)
- Seetal Dodd
- a School of Medicine, Barwon Health , Deakin University, IMPACT SRC (Innovation in Mental and Physical Health and Clinical Treatment - Strategic Research Centre) , Geelong , Australia.,b Department of Psychiatry , University of Melbourne , Melbourne , Australia.,c Mental Health Drug and Alcohol Services , University Hospital Geelong, Barwon Health , Geelong , Australia.,d Orygen The National Centre of Excellence in Youth Mental Health , Parkville , Australia
| | - Philip B Mitchell
- f School of Psychiatry , University of New South Wales, and Black Dog Institute , Sydney , Australia
| | - Michael Bauer
- g Department of Psychiatry and Psychotherapy , University Hospital Carl Gustav Carus, Technische, Universität Dresden , Dresden , Germany
| | - Lakshmi Yatham
- h Department of Psychiatry , University of British Columbia , British Columbia , BC , Canada
| | - Allan H Young
- i Department of Psychological Medicine , Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK & South London and Maudsley NHS Foundation Trust , London , UK
| | - Sidney H Kennedy
- j Department of Psychiatry , University of Toronto , Toronto , ON , Canada
| | - Lana Williams
- a School of Medicine, Barwon Health , Deakin University, IMPACT SRC (Innovation in Mental and Physical Health and Clinical Treatment - Strategic Research Centre) , Geelong , Australia
| | - Trisha Suppes
- k Department of Psychiatry & Behavioral Sciences , School of Medicine, Stanford University , Stanford , CA , USA
| | | | - Madhukar H Trivedi
- m Department of Psychiatry , University of Texas Southwestern Medical Center , Dallas , TX , USA
| | - Maurizio Fava
- n Division of Clinical Research , Massachusetts General Hospital and Harvard Medical School , Boston , MA , USA
| | - A John Rush
- o Duke-National University of Singapore Medical School , Singapore , Singapore
| | - Roger S McIntyre
- j Department of Psychiatry , University of Toronto , Toronto , ON , Canada.,p Mood Disorders Psychopharmacology Unit, University of Toronto , Toronto , ON , Canada.,q Brain and Cognition Discovery Foundation , Toronto , ON , Canada
| | - Michael E Thase
- r Department of Psychiatry, Perelman School of Medicine , University of Pennsylvania , Pennsylvania , PA , USA
| | - Raymond W Lam
- h Department of Psychiatry , University of British Columbia , British Columbia , BC , Canada
| | - Emanuel Severus
- g Department of Psychiatry and Psychotherapy , University Hospital Carl Gustav Carus, Technische, Universität Dresden , Dresden , Germany
| | - Siegfried Kasper
- s Department of Psychiatry and Psychotherapy , Medical University of Vienna , Wien , Austria
| | - Michael Berk
- a School of Medicine, Barwon Health , Deakin University, IMPACT SRC (Innovation in Mental and Physical Health and Clinical Treatment - Strategic Research Centre) , Geelong , Australia.,b Department of Psychiatry , University of Melbourne , Melbourne , Australia.,c Mental Health Drug and Alcohol Services , University Hospital Geelong, Barwon Health , Geelong , Australia.,d Orygen The National Centre of Excellence in Youth Mental Health , Parkville , Australia.,e The Florey Institute of Neuroscience and Mental Health , Parkville , Australia
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Choi M, Lee J, Oh EG, Chu SH, Sohn YH, Park CG. Factors Associated With Uncertainty in Illness Among People With Parkinson's Disease. Clin Nurs Res 2018; 29:469-478. [PMID: 30019611 DOI: 10.1177/1054773818788492] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
People with Parkinson's disease (PD) reported to experience uncertainty because of gradually progressive disease characteristics with no cure, and variably manifesting and unpredictable symptoms. This study was designed to identify illness-related variables influencing uncertainty in PD patients and to analyze direct and indirect paths between these variables. Data were collected from 206 participants using a structured questionnaire. Path analysis revealed the direct and/or indirect effects of economic status, disease severity, social support, and resilience on uncertainty in people with PD. Disease severity, social support, and resilience were shown to have significant direct effects on uncertainty. Economic status and disease severity had indirect effects on uncertainty, which were mediated by social support. Disease severity and social support also had indirect effects on uncertainty, which were mediated by resilience. Therefore, the efforts of health care professionals should be directed not only toward managing PD symptoms, but also toward facilitating social support and resilience.
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Affiliation(s)
- MoonKi Choi
- Department of Nursing, Bucheon University, South Korea
| | - JuHee Lee
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, South Korea
| | - Eui Geum Oh
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, South Korea
| | - Sang Hui Chu
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, South Korea
| | - Young H Sohn
- College of Medicine, Yonsei University, Seoul, South Korea
| | - Chang Gi Park
- College of Nursing, The University of Illinois at Chicago, USA
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Goutzamanis S, Doyle JS, Thompson A, Dietze P, Hellard M, Higgs P. Experiences of liver health related uncertainty and self-reported stress among people who inject drugs living with hepatitis C virus: a qualitative study. BMC Infect Dis 2018; 18:151. [PMID: 29609552 PMCID: PMC5879642 DOI: 10.1186/s12879-018-3057-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 03/21/2018] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND People who inject drugs (PWID) are most at risk of hepatitis C virus infection in Australia. The introduction of transient elastography (TE) (measuring hepatitis fibrosis) and direct acting antiviral medications will likely alter the experience of living with hepatitis C. We aimed to explore positive and negative influences on wellbeing and stress among PWID with hepatitis C. METHODS The Treatment and Prevention (TAP) study examines the feasibility of treating hepatitis C mono-infected PWID in community settings. Semi-structured interviews were conducted with 16 purposively recruited TAP participants. Participants were aware of their hepatitis C seropositive status and had received fibrosis assessment (measured by TE) prior to interview. Questions were open-ended, focusing on the impact of health status on wellbeing and self-reported stress. Interviews were voice recorded, transcribed verbatim and thematically analysed, guided by Mishel's (1988) theory of Uncertainty in Illness. RESULTS In line with Mishel's theory of Uncertainty in Illness all participants reported hepatitis C-related uncertainty, particularly mis-information or a lack of knowledge surrounding liver health and the meaning of TE results. Those with greater fibrosis experienced an extra layer of prognostic uncertainty. Experiences of uncertainty were a key motivation to seek treatment, which was seen as a way to regain some stability in life. Treatment completion alleviated hepatitis C-related stress, and promoted feelings of empowerment and confidence in addressing other life challenges. CONCLUSION TE scores seemingly provide some certainty. However, when paired with limited knowledge, particularly among people with severe fibrosis, TE may be a source of uncertainty and increased personal stress. This suggests the need for simple education programs and resources on liver health to minimise stress.
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Affiliation(s)
- Stelliana Goutzamanis
- Disease Elimination Program, Burnet Institute, 85 Commerical Rd, Melbourne, VIC, 3004, Australia. .,School of Population Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Joseph S Doyle
- Disease Elimination Program, Burnet Institute, 85 Commerical Rd, Melbourne, VIC, 3004, Australia.,Department of Infectious Diseases, Alfred Health, Melbourne, Australia
| | - Alexander Thompson
- Department of Gastroenterology, St Vincent's Hospital, Melbourne, Australia.,Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Paul Dietze
- Disease Elimination Program, Burnet Institute, 85 Commerical Rd, Melbourne, VIC, 3004, Australia.,School of Population Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Margaret Hellard
- Disease Elimination Program, Burnet Institute, 85 Commerical Rd, Melbourne, VIC, 3004, Australia.,School of Population Health and Preventive Medicine, Monash University, Melbourne, Australia.,Department of Infectious Diseases, Alfred Health, Melbourne, Australia
| | - Peter Higgs
- Disease Elimination Program, Burnet Institute, 85 Commerical Rd, Melbourne, VIC, 3004, Australia.,School of Population Health and Preventive Medicine, Monash University, Melbourne, Australia.,Department of Public Health, La Trobe University, Melbourne, Australia
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LaNoue MD, Gerolamo AM, Powell R, Nord G, Doty AMB, Rising KL. Development and preliminary validation of a scale to measure patient uncertainty: The “Uncertainty Scale”. J Health Psychol 2018; 25:1248-1258. [DOI: 10.1177/1359105317752827] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Research suggests that patient uncertainty related to experiencing symptoms may drive decisions to seek care. The only validated measure of patient uncertainty assesses uncertainty related to defined illness. In prior work, we engaged patients to describe uncertainty related to symptoms and used findings to develop the ‘U-Scale’ scale. In this work, we present results from preliminary scale reliability and validity testing. Psychometric testing demonstrated content validity, high internal consistency, and evidence for concurrent validity. Next steps include administration in diverse populations for continued refinement and validation, and exploration of the potential contribution of uncertainty to healthcare utilization.
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Lifintseva A, Derkach T, Shtolde N. Phenomenon of Uncertainty as a Subjective Experience. КЛИНИЧЕСКАЯ И СПЕЦИАЛЬНАЯ ПСИХОЛОГИЯ 2018. [DOI: 10.17759/cpse.2018070101] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The phenomenon of uncertainty in illness of patients is discussed and analyzed in this article. Uncertainty in illness is a condition that accompanies the patient from the moment of appearance of the first somatic symptoms of the disease and could be strengthened or weakened thanks to many psychosocial factors. The level of uncertainty is related to the level of stress, emotional disadaptation, affective states, coping strategies, mechanisms of psychological defense, etc. Uncertainty can perform destructive functions, acting as a trigger for stressful conditions and launching negative emotional experiences. As a positive function of uncertainty, one can note a possible positive interpretation of the patient's disease. In addition, the state of uncertainty allows the patient to activate the resources of coping with the disease, among which the leading role belongs to social support.
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Hansen L, Lyons KS, Dieckmann NF, Chang MF, Hiatt S, Solanki E, Lee CS. Background and design of the symptom burden in end-stage liver disease patient-caregiver dyad study. Res Nurs Health 2017; 40:398-413. [PMID: 28666053 PMCID: PMC5597485 DOI: 10.1002/nur.21807] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 06/05/2017] [Indexed: 12/25/2022]
Abstract
Over half a million Americans are affected by cirrhosis, the cause of end-stage liver disease (ESLD). Little is known about how symptom burden changes over time in adults with ESLD and their informal caregivers, which limits our ability to develop palliative care interventions that can optimize symptom management and quality of life in different patient-caregiver dyads. The purpose of this article is to describe the background and design of a prospective, longitudinal descriptive study, "Symptom Burden in End-Stage Liver Disease Patient-Caregiver Dyads," which is currently in progress. The study is designed to (i) identify trajectories of change in physical and psychological symptom burden in adults with ESLD; (ii) identify trajectories of change in physical and psychological symptom burden in caregivers of adults with ESLD; and (iii) determine predictors of types of patient-caregiver dyads that would benefit from tailored palliative care interventions. We aim for a final sample of 200 patients and 200 caregivers who will be followed over 12 months. Integrated multilevel and latent growth mixture modeling will be used to identify trajectories of change in symptom burden, linking those changes to clinical events, and quality of life outcomes and characterizing types of patient-caregiver dyads based on patient-, caregiver-, and dyad-level factors. Challenges we have encountered include unexpected attrition of study participants, participants not returning their baseline questionnaires, and hiring and training of research staff. The study will lay the foundation for future research and innovation in ESLD, end-of-life and palliative care, and caregiving.
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Affiliation(s)
- Lissi Hansen
- School of Nursing, Oregon Health and Science University, Portland, Oregon
| | - Karen S Lyons
- School of Nursing, Oregon Health and Science University, Portland, Oregon
| | - Nathan F Dieckmann
- School of Nursing, Oregon Health and Science University, Portland, Oregon
| | - Michael F Chang
- Gastroenterology and Hepatology, VA Portland Healthcare System, Portland, Oregon
| | - Shirin Hiatt
- School of Nursing, Oregon Health and Science University, Portland, Oregon
| | - Emma Solanki
- School of Nursing, Oregon Health and Science University, Portland, Oregon
| | - Christopher S Lee
- School of Nursing, Oregon Health and Science University, Portland, Oregon
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Evaluating the Reliability and Validity of the Arabic Version of the Parents Perceptions of Uncertainty Scale (A-PPUS). J Pediatr Nurs 2017; 36:179-185. [PMID: 28888500 DOI: 10.1016/j.pedn.2017.06.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 06/24/2017] [Accepted: 06/24/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Uncertainty often accompanies illness and may be a major aversive component of the patients' treatment process. There is evidence that parental uncertainty has a negative impact on their own and on their child's coping strategies and may affect family functioning. Key to the provision of competent care, to address uncertainty, is the use of an appropriate validated assessment tool to understand key parental concerns. The 'Parent Perception of Uncertainty Scale' (PPUS) has been widely used for this purpose. AIM This study reports on the validity and reliability testing of the Arabic version of the Parents Perception of Uncertainty Scale (A-PPUS). METHODS The scale was translated to Arabic using the translation-back-translation method. Appropriate statistical tests were performed including measurements of internal consistency, item to total scale correlation, and univariate and multivariate analyses. RESULTS The study included 240 parents of children with chronic illnesses. Cronbach's alpha coefficient of the whole scale was 0.93. All the items were positively correlated to the total score. The univariate and multivariate analysis supported the previous tests and the assertion that the Arabic version of the PPUS provided a relevant measure of the uncertainty level. CONCLUSION This study has identified that the A-PPUS is a reliable tool for parent report of their uncertainty, in the UAE and Arabic population.
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Metta E, Bailey A, Kessy F, Geubbels E, Haisma H. Illness experiences of diabetes in the context of malaria in settings experiencing double burden of disease in southeastern Tanzania. PLoS One 2017; 12:e0178394. [PMID: 28542578 PMCID: PMC5444834 DOI: 10.1371/journal.pone.0178394] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 05/12/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Tanzania is doubly burdened with both non-communicable and infectious diseases, but information on how Tanzanians experience the co-existence of these conditions is limited. Using Kleinman's eight prompting questions the study synthesizes explanatory models from patients to describe common illness experiences of diabetes in a rural setting where malaria is the predominant health threat. METHODS We conducted 17 focus group discussions with adult members of the general community, diabetes patients, neighbours and relatives of diabetes patients to gain insight into shared experiences. To gain in-depth understanding of the individual illness experiences, we conducted 41 in-depth interviews with malaria or diabetes patients and family members of diabetes patients. The analysis followed grounded theory principles and the illness experiences were derived from the emerging themes. RESULTS The illness experiences showed that malaria and diabetes are both perceived to be severe and fatal conditions, but over the years people have learned to live with malaria and the condition is relatively manageable compared with diabetes. In contrast, diabetes was perceived as a relatively new disease, with serious life-long consequences. Uncertainty, fear of those consequences, and the increased risk for severe malaria and other illnesses impacted diabetes patients and their families' illness experiences. Unpredictable ailments and loss of consciousness, memory, libido, and functional incapability were common problems reported by diabetes patients. These problems had an effect on their psychological and emotional health and limited their social life. Direct and indirect costs of illness pushed individuals and their families further into poverty and were more pronounced for diabetes patients. CONCLUSION The illness experiences revealed both malaria and diabetes as distressing conditions, however, diabetes showed a higher level of stress because of its chronicity. Strategies for supporting social, emotional, and psychological well-being that build on the patient accounts are likely to improve illness experiences and quality of life for the chronically ill patient.
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Affiliation(s)
- Emmy Metta
- Ifakara Health Institute, Dar es Salaam, Tanzania
- Population Research Centre, Faculty of Spatial Sciences, University of Groningen, Groningen, The Netherlands
| | - Ajay Bailey
- Population Research Centre, Faculty of Spatial Sciences, University of Groningen, Groningen, The Netherlands
| | | | | | - Hinke Haisma
- Population Research Centre, Faculty of Spatial Sciences, University of Groningen, Groningen, The Netherlands
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Al-Yateem N, Docherty C, Altawil H, Al-Tamimi M, Ahmad A. The quality of information received by parents of children with chronic ill health attending hospitals as indicated by measures of illness uncertainty. Scand J Caring Sci 2017; 31:839-849. [PMID: 28156023 DOI: 10.1111/scs.12405] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 10/06/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND The effectiveness of communication can be defined in terms of one of its outcomes: the uncertainty that it eliminates. Clear unambiguous communication is important for the parents of children to help them understand problems, explore alternative solutions and help make decisions. Persistent uncertainty is known to produce anxiety, unpredictable responses, emotional distress and poor quality of life. The uncertainty experienced by parents is one indicator of quality in the healthcare system which could have diagnostic and predictive value. AIM To assess the uncertainty experienced by parents of children with chronic conditions in the United Arab Emirates (UAE). DESIGN An exploratory descriptive, cross-sectional design was chosen across different sites in the UAE. METHODS Data were collected from parents accompanying children receiving treatment either as an inpatient or outpatient, using the previously validated, culturally adapted 'Parent Perception of Uncertainty Scale' (PPUS). RESULTS Most study participants experienced moderate or high levels of uncertainty. Parents who did not speak the local language, whose child was less than 1 year old or who was acutely ill had significantly more uncertainty than others, as did those parents whose child was approaching adolescence and puberty. CONCLUSIONS As only 5% of all participants reported low levels of uncertainty this should be of major concern as both an indicator of the quality of communication between health professionals and parents, and of the adverse health effects and poor quality of life experienced by parents of patients with chronic illness.
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Affiliation(s)
- Nabeel Al-Yateem
- Department of Nursing, College of Health Sciences, Research Institute of Medical & Health Sciences (RIMHS), University of Sharjah, Sharjah, United Arab Emirates
| | - Charles Docherty
- Department of Nursing, College of Health Sciences, Research Institute of Medical & Health Sciences (RIMHS), University of Sharjah, Sharjah, United Arab Emirates
| | - Hanan Altawil
- Department of Nursing, College of Health Sciences, Research Institute of Medical & Health Sciences (RIMHS), University of Sharjah, Sharjah, United Arab Emirates
| | - Muna Al-Tamimi
- Department of Nursing, College of Health Sciences, Research Institute of Medical & Health Sciences (RIMHS), University of Sharjah, Sharjah, United Arab Emirates
| | - Alaa Ahmad
- Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
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Reinoso H, Türegün M. Examining the factor structure of MUIS-C scale among baby boomers with hepatitis C. Appl Nurs Res 2016; 32:111-116. [PMID: 27969012 DOI: 10.1016/j.apnr.2016.06.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 06/19/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND Baby boomers account for two out of every three cases of hepatitis C infection in the U.S. PURPOSE To conduct an exploratory factor analysis directed at supporting the use of the MUIS-C as a reliable instrument in measuring illness uncertainty among baby boomers with hepatitis C. METHODS The steps of conducting a typical principal component analysis (PCA) with an oblique rotation were used on a sample of 146 participants, the sampling adequacy of items was examined via the Kaiser-Meyer-Olkin (KMO) measure, and the Bartlett's sphericity test was used for appropriateness of conducting a factor analysis. RESULTS A two-factor structure was obtained by using Horn's parallel analysis method. The two factors explained a cumulative total of 45.8% of the variance. CONCLUSIONS The results of the analyses indicated that the MUIS-C was a valid and reliable instrument and potentially suitable for use in baby boomer population diagnosed with hepatitis C.
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Affiliation(s)
- Humberto Reinoso
- Georgia Baptist College of Nursing of Mercer University, 3001 Mercer University Drive, Atlanta, GA, 30341, USA.
| | - Mehmet Türegün
- Barry University, 11300 Northeast 2nd Avenue, Miami Shores, Fl, 33161, USA.
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Doruk A, Dugenci M, Ersöz F, Öznur T. Intolerance of Uncertainty and Coping Mechanisms in Nonclinical Young Subjects. Noro Psikiyatr Ars 2015; 52:400-405. [PMID: 28360747 DOI: 10.5152/npa.2015.8779] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 09/09/2014] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION We aimed to explore the relationship between intolerance of uncertainty (IU) and coping mechanisms in a nonclinical sample with the same age and educational level. METHODS The Coping Orientations to Problems Experienced (COPE) scale was used to evaluate the coping mechanisms. The IU scale was used to evaluate IU situations. RESULTS We found that the negative impact of uncertainty on the action in female students was greater than males. While female students used more planning, instrumental support, reinterpretation, religion, emotional support, venting, and mental disengagement coping styles, male students used more humor, denial, and alcohol/drug abuse coping styles. Subjects with psychological problems had higher IU scores and used some more coping mechanisms (restraint, acceptance, behavioral disengagement, and alcohol/drug abuse) than the others. CONCLUSION Our results suggest that healthy subjects use different coping styles and respond differently to uncertainty in both genders.
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Affiliation(s)
- Ali Doruk
- Department of Psychiatry, Gülhane Military Medical Academy, Ankara, Turkey
| | - Muharrem Dugenci
- Department of Industrial Engineering, Karabuk University, Karabük, Turkey
| | - Filiz Ersöz
- Department of Industrial Engineering, Karabuk University, Karabük, Turkey
| | - Taner Öznur
- Department of Psychiatry, Gülhane Military Medical Academy, Ankara, Turkey
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Silva LD, Cunha CCD, Cunha LRD, Araújo RF, Barcelos VM, Menta PL, Neves FS, Teixeira R, Rocha GA, Gontijo ED. Depression rather than liver impairment reduces quality of life in patients with hepatitis C. BRAZILIAN JOURNAL OF PSYCHIATRY 2015; 37:21-30. [PMID: 25806552 DOI: 10.1590/1516-4446-2014-1446] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Accepted: 06/15/2014] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Patients with chronic hepatitis C (CHC) have a poorer quality of life than those with other chronic liver diseases. However, some of the factors that determine health-related quality of life (HRQOL) in these patients, such as the degree of liver fibrosis, are still controversial. Therefore, the aim of the present study was to investigate the impact of CHC on HRQOL by conducting clinical, psychiatric, and sociodemographic evaluations. METHODS One hundred and twenty-four consecutive patients attending a referral center for hepatitis were evaluated using the Mini-International Neuropsychiatry Interview, the Hamilton Depression Rating Scale, the Hospital Anxiety and Depression Scale, and the Medical Outcomes Study 36-Item Short-Form Health Survey. Multiple linear regression analyses were used to quantify independent associations between HRQOL and the clinical, psychiatric, and sociodemographic variables of interest. RESULTS Reduced HRQOL was independently associated with major depressive disorder (MDD) and with elevated levels of alanine aminotransferase, but was not associated with hepatic cirrhosis. CONCLUSIONS MDD rather than the grade of liver fibrosis was strongly associated with HRQOL impairment in patients with CHC. These findings highlight that, in patients with CHC, the psychological effects of the disease deserve more attention and the implementation of integrated medical, psychiatric, and psychological care may be helpful.
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Affiliation(s)
- Luciana D Silva
- Viral Hepatitis Outpatient Clinic, Instituto Alfa de Gastroenterologia, School of Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Cláudia C da Cunha
- Viral Hepatitis Outpatient Clinic, Instituto Alfa de Gastroenterologia, School of Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Luciana R da Cunha
- Viral Hepatitis Outpatient Clinic, Instituto Alfa de Gastroenterologia, School of Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Renato F Araújo
- Viral Hepatitis Outpatient Clinic, Instituto Alfa de Gastroenterologia, School of Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Vanessa M Barcelos
- Viral Hepatitis Outpatient Clinic, Instituto Alfa de Gastroenterologia, School of Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Penélope L Menta
- Viral Hepatitis Outpatient Clinic, Instituto Alfa de Gastroenterologia, School of Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Fernando S Neves
- Department of Mental Health, School of Medicine, UFMG, Belo Horizonte, MG, Brazil
| | - Rosangela Teixeira
- Viral Hepatitis Outpatient Clinic, Instituto Alfa de Gastroenterologia, School of Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Gifone A Rocha
- Laboratory of Research in Bacteriology, School of Medicine, UFMG, Belo Horizonte, MG, Brazil
| | - Eliane D Gontijo
- Department of Preventive and Social Medicine, School of Medicine, UFMG, Belo Horizonte, MG, Brazil
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Giammanco MD, Gitto L, Barberis N, Santoro D. Adaptation of the Mishel Uncertainty of Illness Scale (MUIS) for chronic patients in Italy. J Eval Clin Pract 2015; 21:649-55. [PMID: 25913189 DOI: 10.1111/jep.12359] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/03/2015] [Indexed: 11/30/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Uncertainty is a component of the illness experience and is likely to increase the burden of managing chronic illness, as cardiac pathologies and renal diseases. The impact of uncertainty should be taken into account and addressed with targeted intervention programmes. The purpose of this study is to contribute to the diffusion of the assessment of uncertainty in illness by validating the Mishel uncertainty in illness scale (MUIS) on chronic Italian patients. METHOD The MUIS questionnaire was administered to 200 patients suffering from cardiac diseases and 50 patients with renal diseases. A confirmatory factor analysis was run for each of the MUIS dimensions (ambiguity, inconsistency, complexity and unpredictability). RESULTS After some item reduction, three of the four MUIS scales, namely, ambiguity, inconsistency and complexity, exhibited satisfactory reliability coefficients (with Cronbach's alphas of, respectively, 0.796, 0.778 and 0.705), highly significant standardized regression weights and satisfactory/highly satisfactory fit indexes. Nevertheless, as the correlations among the scales mentioned earlier were high (all above 0.8) and statistically significant, the three subsets of ambiguity, complexity and inconsistency items were allowed to load onto a new single factor. A monodimensional uncertainty construct, grouping the majority of the items encompassed by these three MUIS scales, was successfully validated. CONCLUSIONS This study provides researchers with an easy-to-administer instrument which is useful to investigate a crucial aspect related with patients' quality of life. Although a unique uncertainty construct is proposed, the in-depth analysis of the replies to each single item of the MUIS could help to monitor patients' emotional responses to the diagnosis and to the course of this disease and it might be useful to define appropriate strategies of coping and to focus on patients' quests for simplicity and clarity of treatment.
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Affiliation(s)
| | - Lara Gitto
- CEIS EEHTA (Economic Evaluation and Health Technology Assessment), University of Roma 'Tor Vergata', Roma, Italy
| | - Nadia Barberis
- Section of Psychology, Department of Human and Social Sciences, University of Messina, Messina, Italy
| | - Domenico Santoro
- Department of Clinical and Experimental Medicine Nephrology, Dialysis University of Messina, Messina, Italy
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Sajjadi M, Rassouli M, Bahri N, Mohammadipoor F. The correlation between perceived social support and illness uncertainty in people with human immunodeficiency virus/acquired immune deficiency syndrome in iran. Indian J Palliat Care 2015; 21:231-5. [PMID: 26009679 PMCID: PMC4441187 DOI: 10.4103/0973-1075.156508] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Illness uncertainty is a source of a chronic and pervasive psychological stress for people living with human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) (PLWH), and largely affects their quality of life and the ability to cope with the disease. Based on the uncertainty in illness theory, the social support is one of the illness uncertainty antecedents, and influences the level of uncertainty perceived by patients. AIM To examine uncertainty in PLWH and its correlation with social support in Iran. MATERIALS AND METHODS This cross-sectional correlational study was conducted with 80 PLWH presenting to AIDS Research Center, Tehran, Iran in 2013. The data collected using illness uncertainty and social support inventories were analyzed through Pearson's correlation coefficient, Spearman's correlation coefficient, and regression analysis. RESULTS The results showed a high level of illness uncertainty in PLWH and a negative significant correlation between perceived social support and illness uncertainty (P = 0.01, r = -0.29). CONCLUSION Uncertainty is a serious aspect of illness experience in Iranian PLWH. Providing adequate, structured information to patients as well as opportunities to discuss their concerns with other PLWH and receive emotional support from their health care providers may be worthwhile.
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Affiliation(s)
- Moosa Sajjadi
- Department of Medical-Surgical Nursing, Faculty of Nursing and Midwifery, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Maryam Rassouli
- Nursing and Midwifery School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Narges Bahri
- Department of Medical-Surgical Nursing, Faculty of Nursing and Midwifery, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Fatemeh Mohammadipoor
- Nursing and Midwifery School, Lorestan University of Medical Sciences, Khorramabad, Iran
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Hoth KF, Wamboldt FS, Ford DW, Sandhaus RA, Strange C, Bekelman DB, Holm KE. The social environment and illness uncertainty in chronic obstructive pulmonary disease. Int J Behav Med 2015; 22:223-32. [PMID: 25008041 PMCID: PMC4289471 DOI: 10.1007/s12529-014-9423-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE Illness uncertainty is associated with worse outcomes in patients with chronic health conditions. Research on social factors associated with uncertainty has focused on the beneficial role of social support. The goal of this study was to develop a more nuanced understanding of the social factors that are associated with uncertainty. METHODS Four hundred sixty-two individuals with alpha-1 antitrypsin deficiency (AATD)-associated chronic obstructive pulmonary disease (COPD) completed a mailed questionnaire. Measures of the social environment included general family functioning, perceived criticism from family members, whether the participant had family members with AATD or COPD, and participation in support groups. Uncertainty was measured using the Mishel Uncertainty in Illness Scale including subscales for ambiguity (uncertainty about physical cues and symptoms) and complexity (uncertainty about treatment and the medical system). Hierarchical regression was used to identify social correlates of ambiguity and complexity while adjusting for demographic and medical characteristics and psychological distress. RESULTS Perceived criticism was associated with more complexity (b = 0.21, SE = 0.09, p = 0.015) and ambiguity (b = 0.40, SE = 0.12, p = 0.001). Having a family member with AATD or COPD was associated with more ambiguity (b = 3.28, SE = 1.00, p = 0.001). Participation in support groups was associated with less ambiguity. Individuals who attended three or more support groups in the prior year reported less ambiguity than individuals who had not attended any (b = -3.31, SE = 1.29, p = 0.010). CONCLUSIONS The social environment is complex and encompasses more than social support. Multiple aspects of the social environment are associated with uncertainty, including perceived criticism, having a family member with a similar illness, and participation in support groups.
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Affiliation(s)
- Karin F Hoth
- Department of Psychiatry, University of Iowa Carver College of Medicine, 200 Hawkins Drive, W278GH, Iowa City, IA, 52242, USA,
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Rolstad EB. Perceptions of Men With Moderate to Severe Hemophilia Regarding the Management of Their Chronic Disorder and Utilization of Community-Based Support. Am J Mens Health 2014; 9:486-95. [DOI: 10.1177/1557988314551360] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Hemophilia is a genetic bleeding disorder that almost exclusively affects men. There is a nationwide network of nonprofit organizations providing support to men with hemophilia, which are affiliated with localized agencies that serve affected individuals within specific regions of the country. This community-based study was implemented in response to a local Utah agency’s concern that men with hemophilia may be disengaged from and underserved by their local support network. The goal of the study was to gain a better understanding of the (a) unique challenges, (b) adaptations, and (c) physical, financial, psychological, and social needs of adult men with moderate to severe hemophilia from the local community. Over a period of 9 months, verbal qualitative interviews were conducted with 10 affected individuals, and written interviews were obtained from 3 additional participants. Using a grounded-theory approach, six themes were identified, based on men’s commentary from interviews, across a spectrum of physical, social, communal, personal, medical, and vocational dimensions. Resilience theory, which explores internal resources that assist in coping with adverse situations, was used as a framework for interpreting research results. Findings indicate that men value the array of educational, social, and medical services that are available to them but choose to manage their hemophilia independently from the community and access support according to their individual needs. Understanding this dynamic may be helpful in developing services that are more specifically tailored to the physical and psychosocial needs of adult men with hemophilia and, potentially, men with other chronic health disorders.
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Iranmanesh S, Tirgari B, Tofighi M, Forouzi MA. Spiritual wellbeing and perceived uncertainty in patients with multiple sclerosis in south-east Iran. Int J Palliat Nurs 2014; 20:483-92. [DOI: 10.12968/ijpn.2014.20.10.483] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
| | - Batool Tirgari
- Assistant Professor, Haft Bagh BLV, Neuroscience Research Center, Neuropharmacology Institute of Kerman University of Medical Sciences
| | - Maryam Tofighi
- MSc student, Haft Bagh BLV, School of Nursing and Midwifery
| | - Mansooreh Azizzadeh Forouzi
- Haft Bagh BLV, Neuroscience Research Center, Neuropharmacology Institute of Kerman University of Medical Sciences, Kerman, Iran
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Colagreco JP, Bailey DE, Fitzpatrick JJ, Musil CM, Afdhal NH, Lai M. Watchful waiting: role of disease progression on uncertainty and depressive symptoms in patients with chronic hepatitis C. J Viral Hepat 2014; 21:727-33. [PMID: 25280230 PMCID: PMC4185928 DOI: 10.1111/jvh.12207] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Accepted: 09/11/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS New therapies for HCV are rapidly emerging and providers are advising select patients to defer treatment and elect 'watchful waiting'. During the watchful waiting period, patients have been shown to have high rates of illness uncertainty and depression. We sought to answer the question of whether reassuring histological data (showing minimal fibrosis or no fibrosis progression over time) is associated with less illness uncertainty and depressive symptoms. METHODS This was a single-centre outpatient prospective cohort study to determine whether stage of fibrosis, fibrosis progression and reasons for treatment deferral were related to illness uncertainty and depressive symptoms in patients following watchful waiting. RESULTS Illness uncertainty was significantly related to depressive symptoms (r = 0.49, P < 0.01). More than half of the participants (54%) had moderate levels of uncertainty. About 40% of the participants were at risk for clinical depression (21.7% at mild to moderate risk and 18.5% at high risk). Treatment naïve subjects had lower mean scores on both the CES-D (depressive symptoms measure) and the MUIS-A (illness uncertainty measure) total score, MUIS-A Ambiguity subscale and MUIS-A Inconsistency subscale than subjects who failed treatment or were interferon intolerant or ineligible. Surprisingly, liver fibrosis stage and progression were not significantly associated with overall illness uncertainty or depressive symptoms. CONCLUSION Patients with chronic hepatitis C on watchful waiting are at high risk for significant illness uncertainty and depressive symptoms. Reassuring histological data does not seem to correlate with less uncertainty or depressive symptoms.
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Affiliation(s)
| | | | | | - Carol M. Musil
- Frances Payne Bolton School of Nursing, Case Western Reserve University
| | | | - Michelle Lai
- Harvard University, Beth Israel Deaconess Medical Center
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Hill R, Pfeil M, Moore J, Richardson B. Living with hepatitis C: a phenomenological study. J Clin Nurs 2014; 24:428-38. [PMID: 24811299 DOI: 10.1111/jocn.12620] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2014] [Indexed: 02/06/2023]
Abstract
AIMS AND OBJECTIVES To explore the experience of adults living with hepatitis C over time. BACKGROUND Hepatitis C virus is a growing problem affecting thousands of people worldwide. The majority of individuals infected develop chronic liver disease, but treatment is not always successful, leaving many to live with the virus indefinitely. Experiences of living with hepatitis C are poorly understood yet essential to meet the needs of an increasing number of affected people. DESIGN A qualitative study using a descriptive phenomenological methodology. METHODS Unstructured interviews were conducted with 23 hepatitis C-positive individuals in the East of England; participants were interviewed twice within a year. RESULTS Data analysis revealed six themes of the experience of living with hepatitis C: hepatitis C and self; hepatitis C, self and others; self and handling hepatitis C; self and handling hepatitis C treatment issues; living with the consequences of hepatitis C; self, hepatitis C and thoughts of the future. CONCLUSIONS Diagnosis of hepatitis C can disrupt people's sense of identity and trigger a life transition. A complex range of factors create uncertainty for people living with hepatitis C. Many struggle to make a healthy transition to life with the condition, instead living in a state of sustained uncertainty. RELEVANCE TO CLINICAL PRACTICE Nurses working within a chronic care framework of ongoing advice and support can improve experiences for those living with hepatitis C. Practice aimed at reducing both the disruptive effect of the diagnosis and the uncertainties it creates can help facilitate a transition to life with the disease.
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Sajjadi M, Rassouli M, Abbaszadeh A, Alavi Majd H, Zendehdel K. Psychometric properties of the Persian version of the Mishel's Uncertainty in Illness Scale in patients with cancer. Eur J Oncol Nurs 2013; 18:52-7. [PMID: 24183257 DOI: 10.1016/j.ejon.2013.09.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Revised: 09/14/2013] [Accepted: 09/21/2013] [Indexed: 01/29/2023]
Abstract
PURPOSE Uncertainty is a major component in the illness experiences which extraordinarily can affect the psychological adjustment and the illness outcomes. Uncertainty in illness is defined as inability to define the illness-related events to the illness or disability in predicting the illness outcomes. The present study aimed to translate the Persian version of Uncertainty in Illness Scale (MUIS-A) and to investigate its psychometric properties on patients with cancer. METHOD In this methodological study, validation of the Persian version of MUIS-A was performed in Iran on 420 cancer patients attending two major hospitals in Tehran, Iran. The scale was translated into Persian and back translated into English and revised according to editorial comments of the scale designers. Then, content and face validity, construct validity, internal consistency reliability and stability of the Persian version were measured. Data were analyzed using SPSS version 16 and LISREL 8.5. RESULTS Mean of the participants MUIS-A score was 90.1 (16.8). Confirmatory factor analysis confirmed validity of the whole instrument and its four subscales. The consistency of the instrument with a three-week interval was r = 0.91. Cronbach's alpha was 0.89 for the whole scale of 32 MUIS-A items and α = 0.58-0.86 for its four factors. CONCLUSIONS The Persian version of the MUIS-A has good psychometric properties. It can be used to assess uncertainty in illness in Iranian patients with cancer.
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Affiliation(s)
- Moosa Sajjadi
- Nursing & Midwifery School, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Gonabad University of Medical Sciences, Gonabad, Iran
| | - Maryam Rassouli
- Nursing & Midwifery School, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Pediatric Nursing Department, Nursing & Midwifery School, Shahid Beheshti University of Medical Sciences, Vali-e Asr Street, Niyayesh Cross, Tehran, Iran.
| | - Abbas Abbaszadeh
- Department of Nursing, Nursing & Midwifery School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Alavi Majd
- Department of Biostatistics, School of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kazem Zendehdel
- Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
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44
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Rosen NO, Ivanova E, Knäuper B. Differentiating intolerance of uncertainty from three related but distinct constructs. ANXIETY STRESS AND COPING 2013; 27:55-73. [PMID: 23849047 DOI: 10.1080/10615806.2013.815743] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Individual differences in uncertainty have been associated with heightened anxiety, stress and approach-oriented coping. Intolerance of uncertainty (IU) is a trait characteristic that arises from negative beliefs about uncertainty and its consequences. Researchers have established the central role of IU in the development of problematic worry and maladaptive coping, highlighting the importance of this construct to anxiety disorders. However, there is a need to improve our understanding of the phenomenology of IU. The goal of this paper was to present hypotheses regarding the similarities and differences between IU and three related constructs--intolerance of ambiguity, uncertainty orientation, and need for cognitive closure--and to call for future empirical studies to substantiate these hypotheses. To assist with achieving this goal, we conducted a systematic review of the literature, which also served to identify current gaps in knowledge. This paper differentiates these constructs by outlining each definition and general approaches to assessment, reviewing the existing empirical relations, and proposing theoretical similarities and distinctions. Findings may assist researchers in selecting the appropriate construct to address their research questions. Future research directions for the application of these constructs, particularly within the field of clinical and health psychology, are discussed.
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Affiliation(s)
- Natalie O Rosen
- a Psychology & Neuroscience , Dalhousie University , Halifax , Nova Scotia , Canada
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45
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Taha S, Matheson K, Cronin T, Anisman H. Intolerance of uncertainty, appraisals, coping, and anxiety: the case of the 2009 H1N1 pandemic. Br J Health Psychol 2013; 19:592-605. [PMID: 23834735 DOI: 10.1111/bjhp.12058] [Citation(s) in RCA: 197] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Revised: 04/15/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Although ambiguous and uncertain situations, such as those dealing with the threat of widespread viral illness, may have pronounced psychological ramifications, there have been few studies that examined the factors that contributed to such outcomes. The purpose of the present investigation was to examine emotional reactions to a health threat. DESIGN A structural equation model examined the interplay between anxiety and intolerance of uncertainty, as sequentially mediated by appraisals and coping strategies. METHODS Adult participants over the age of 18 (N = 1,027) completed online self-report measures during the H1N1 pandemic in 2009. RESULTS Greater intolerance of uncertainty was related to lower appraisals of self- and other control, which predicted low levels of problem-focused coping and greater reports of H1N1-related anxiety. Additionally, individuals with a high intolerance of uncertainty were more likely to perceive the pandemic as threatening and also were more apt to use emotion-focused coping strategies, and both of these factors predicted elevated levels of anxiety. CONCLUSIONS Together, these data indicate that threats, such as those related to a potential pandemic, not only have implications for physical health, but also for psychological distress, and that such outcomes vary with a constellation of appraisal and coping factors. STATEMENT OF CONTRIBUTION What is already known on this subject? It has been established that the public is often confused by the threat that a potential pandemic virus poses and that they are unsure of what information related to the disease they can trust. Government health agencies often walk the line of minimizing the threat to prevent panic, but simultaneously emphasize the importance of action (vaccination) to prevent a worldwide pandemic. What does this study add? Beyond the physical threat of a pandemic, a significant psychological toll may occur for certain individuals. Anxiety regarding H1N1 is heightened amongst those who cannot tolerate uncertainty. Appraisals of threat, control, and the use of emotion-focused coping mediate the above relationship.
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Affiliation(s)
- Sheena Taha
- Department of Neuroscience, Carleton University, Ottawa, Ontario, Canada
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46
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Hoth KF, Wamboldt FS, Strand M, Ford DW, Sandhaus RA, Strange C, Bekelman DB, Holm KE. Prospective impact of illness uncertainty on outcomes in chronic lung disease. Health Psychol 2013; 32:1170-4. [PMID: 23772888 DOI: 10.1037/a0032721] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To determine which aspect of illness uncertainty (i.e., ambiguity or complexity) has a stronger association with psychological and clinical outcomes over a 2-year period among individuals with a genetic subtype of chronic obstructive pulmonary disease (COPD). Ambiguity reflects uncertainty about physical cues and symptoms, and complexity reflects uncertainty about treatment and the medical system. METHOD Four-hundred and 7 individuals with alpha-1 antitrypsin deficiency-associated COPD completed questionnaires at baseline, 1- and 2-year follow-up. Uncertainty was measured using the Mishel Uncertainty in Illness Scale. Outcomes were measured using the Hospital Anxiety and Depression Scale, St. George's Respiratory Questionnaire, and MMRC Dyspnea Scale. Ambiguity and complexity were examined as predictors of depressive symptoms, anxiety, quality of life, and breathlessness using linear mixed models adjusting for demographic and health characteristics. RESULTS Ambiguity was associated with more depressive symptoms (b = 0.09, SE = 0.02, p < .001) and anxiety (b = 0.13, SE = 0.02, p < .001), worse quality of life (b = 0.57, SE = 0.10, p < .001), and more breathlessness (b = 0.02, SE = 0.006, p < .001). Complexity did not have an independent effect on any outcome. Interactions between ambiguity and time since diagnosis were not statistically significant. CONCLUSIONS Ambiguity was prospectively associated with worse mood, quality of life, and breathlessness. Thus, ambiguity should be targeted in psychosocial interventions. Time since diagnosis did not affect the association between ambiguity and outcomes, suggesting that the impact of ambiguity is equally strong throughout the course of COPD.
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47
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Perzynski AT, Terchek JJ, Blixen CE, Dawson NV. Playing the numbers: how hepatitis C patients create meaning and make healthcare decisions from medical test results. SOCIOLOGY OF HEALTH & ILLNESS 2013; 35:610-627. [PMID: 23009649 DOI: 10.1111/j.1467-9566.2012.01516.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
In this article we describe how patients assign meanings to medical test results and use these meanings to justify their actions. Evidence is presented from lay interpretations of medical tests for monitoring hepatitis C viral infection (HCV) to show how numeracy becomes embodied in the absence of physical symptoms. Illness narratives from 307 individuals infected with HCV were collected from the internet and analysed qualitatively. As part of standard medical care, chronically infected HCV patients are required to have periodic blood tests for laboratory testing. The lab results are presented numerically and compared with established physiological standards. HCV patients' knowledge and interpretations of test results have important consequences for their health behaviour and their medical decisions. In their stories, the patients described their decisions to begin, delay or stop treatment and developed strategies to alter their diet, exercise and use alternative therapies according to changes in their test result. The perceived meanings of test results are powerful signifiers that are capable of altering the course of HCV patients' illness, lives and stories. An interpretive model of health numeracy has the advantage of promoting understanding between patients and healthcare providers over a model that views innumeracy as a skill deficit.
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Affiliation(s)
- Adam T Perzynski
- Center for Health Care Research and Policy, Case Western Reserve University at MetroHealth Medical Center, Cleveland OH 44109–1998, USA.
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48
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Jiwani NS, Gul RB, Ali A, Salih M, Hanzala M. Experiences and Perceptions of Patients Living With Hepatitis C in Karachi, Pakistan. J Transcult Nurs 2013; 24:297-304. [DOI: 10.1177/1043659613481674] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Purpose: Hepatitis C (HCV) is a chronic disease that affects an individual’s physical, financial, social, and emotional well-being throughout the illness. Although extensive literature is available on experiences of patients with hepatitis C in developed countries, very little exists in developing countries, particularly in Pakistan. This article describes experiences of patients living with HCV in Karachi, Pakistan. Method: Using descriptive exploratory design, data were collected through semistructured interviews from 10 patients with HCV. The interviews were tape recorded and transcribed verbatim. Findings: The three categories—perceptions and misperceptions, challenges and sufferings, support and shortcomings—were subsumed under the theme “deadly, dangerous, and devastating.” Conclusion and implications for practice: Patients with HCV experience profound challenges that are influenced by their level of education, financial capacity, cultural norms, family support, and the sensitivity of health care professionals. Several cultural practices existing in Pakistan identify the need for public awareness. The findings on health care professionals have implications for nursing and allied health continuing education.
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Affiliation(s)
| | | | - Asho Ali
- The Aga Khan University, Karachi, Pakistan
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49
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Oprescu F, Campo S, Lowe J, Andsager J, Morcuende JA. Managing uncertainty in the context of clubfoot care: exploring the value of uncertainty management theory and the sense of virtual community. THE IOWA ORTHOPAEDIC JOURNAL 2013; 33:142-148. [PMID: 24027474 PMCID: PMC3748870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Serious health conditions, such as clubfoot, could be a major source of uncertainty and stress for parents of children affected. How parents deal with uncertainty and stress as related to their child's health condition is of interest for medical professionals and health communicators alike. While physicians remain a preferred source of health information, during medical encounters or via phone and email communication, many individuals seek out health information on the Internet, including in online support communities. This study explored the connections between Uncertainty Management Theory (UMT) constructs and the potential contribution of the sense of virtual community (SOVC) to the UMT framework. The results of this research suggest that the UMT needs to be adapted for use in online contexts. One way is to include theoretical constructs, such as the sense of virtual community, specifically developed to measure online interactions. A modified and updated Uncertainty Management Theory could be useful in exploring, analyzing and understanding online behaviors related to health conditions such as clubfoot and thus contribute substantially to what we know about caregivers in their role as uncertainty managers.
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Affiliation(s)
- Florin Oprescu
- University of the Sunshine Coast, Sippy Downs, QLD, Australia
| | | | - John Lowe
- University of the Sunshine Coast, Sippy Downs, QLD, Australia
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50
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Miller ER, McNally S, Wallace J, Schlichthorst M. The ongoing impacts of hepatitis c--a systematic narrative review of the literature. BMC Public Health 2012; 12:672. [PMID: 22900973 PMCID: PMC3505729 DOI: 10.1186/1471-2458-12-672] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Accepted: 08/13/2012] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Many countries have developed, or are developing, national strategies aimed at reducing the harms associated with hepatitis C infection. Making these strategies relevant to the vast majority of those affected by hepatitis C requires a more complete understanding of the short and longer term impacts of infection. We used a systematic approach to scope the literature to determine what is currently known about the health and psychosocial impacts of hepatitis C along the trajectory from exposure to ongoing chronic infection, and to identify what knowledge gaps remain. METHODS PubMed, Current Contents and PsychINFO databases were searched for primary studies published in the ten years from 2000-2009 inclusive. Two searches were conducted for studies on hepatitis C in adult persons focusing on: outcomes over time (primarily cohort and other prospective designs); and the personal and psychosocial impacts of chronic infection. All retrieved studies were assessed for eligibility according to specific inclusion/exclusion criteria, data completeness and methodological coherence. Outcomes reported in 264 included studies were summarized, tabulated and synthesized. RESULTS Injecting drug use (IDU) was a major risk for transmission with seroconversion occurring relatively early in injecting careers. Persistent hepatitis C viraemia, increasing age and excessive alcohol consumption independently predicted disease progression. While interferon based therapies reduced quality of life during treatment, improvements on baseline quality of life was achieved post treatment--particularly when sustained viral response was achieved. Much of the negative social impact of chronic infection was due to the association of infection with IDU and inflated assessments of transmission risks. Perceived discrimination was commonly reported in health care settings, potentially impeding health care access. Perceptions of stigma and experiences of discrimination also had direct negative impacts on wellbeing and social functioning. CONCLUSIONS Hepatitis C and its management continue to have profound and ongoing impacts on health and social well being. Biomedical studies provided prospective information on clinical aspects of infection, while the broader social and psychological studies presented comprehensive information on seminal experiences (such as diagnosis and disclosure). Increasing the focus on combined methodological approaches could enhance understanding about the health and social impacts of hepatitis C along the life course.
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Affiliation(s)
- Emma R Miller
- Discipline of General Practice, School of Population Health, University of Adelaide, Adelaide, 5005, South Australia
| | - Stephen McNally
- Australian Research Centre in Sex, Health & Society, La Trobe University, Melbourne, Australia
| | - Jack Wallace
- Australian Research Centre in Sex, Health & Society, La Trobe University, Melbourne, Australia
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