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Ko E, Lee Y. The Effects of Coping Strategies Between Uncertainty and Quality of Life of Korean Women With Gynecological Cancer: Evaluation of Uncertainty in Illness Theory and Stress and Coping Theory. ANS Adv Nurs Sci 2024; 47:E84-E95. [PMID: 37498078 DOI: 10.1097/ans.0000000000000507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
The objective of this study was to explore the mediation effects of coping strategies on the relationship between uncertainty and quality of life in Korean women with gynecological cancer. Mishel's Uncertainty in Illness Theory and Lazarus and Folkman's Stress and Coping Theory were used to guide the study. Three coping strategies (problem-focused, active emotional, and avoidant emotional) partially mediated the relationship between uncertainty and quality of life. This work provides evidence that reducing uncertainty has significant effects on coping strategies and positively affects the quality of life in women with gynecological cancer.
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Affiliation(s)
- Eungil Ko
- Author Affiliations: Department of Nursing, Asan Medical Center, Seoul, Republic of Korea (Ms Ko); and College of Nursing, The Catholic University of Korea, Seoul, Republic of Korea (Dr Lee)
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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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Cloyes KG, Mansfield KJ, Wawrzynski SE, Vega M, Kent-Marvick J, Guo JW. Cancer Survivors' and Care Partners' Audio Diaries on Stress and Social Support Resources During the COVID-19 Pandemic. Semin Oncol Nurs 2024; 40:151623. [PMID: 38538507 PMCID: PMC11045306 DOI: 10.1016/j.soncn.2024.151623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 02/25/2024] [Accepted: 02/29/2024] [Indexed: 04/28/2024]
Abstract
OBJECTIVES To describe cancer survivors' and care partners' perceived stress and social support during the COVID-19 pandemic and assess the feasibility of audio diaries for assessing role-related needs and resources. METHODS Participants (N = 51; n = 28 survivors, n = 23 care partners) recorded three monthly audio diaries reporting stress and support experiences. Diaries were transcribed and content-analyzed using a hybrid approach. Stress-related content was inductively coded, and social support content was deductively coded by type (instrumental, information, emotional, companionship, appraisal; κ = 0.75) then inductively coded. Descriptive statistics summarized sociodemographic data and compared coding frequencies by role. We developed narrative summaries of stress and support categories and selected quotes for contextual detail. RESULTS Cancer-related stressors were most prevalent (28.8%), followed by work (26.8%), family (23.1%), social isolation (13.4%), and finances (8.0%). While no significant difference in reporting frequency was observed between roles, cancer-related stress was more prevalent for survivors while work-related stress was mentioned more by care partners. Emotional support was the most prevalent support type (32.1%), followed by companionship (25.3%), appraisal (17.9%), instrumental (16.67%), and informational support (8%). Survivors reported more appraisal support than care partners (χ2 = 6.48, df = 1, P = .011) and more support for self-care, while care partners expressed more other-oriented concerns and focused more on managing responsibilities and interactions outside the household. CONCLUSIONS The pandemic complicated and intensified role-based stressors already present in the survivorship context. Our findings highlight the importance of informal social support networks, particularly when access to formal services is limited, and suggest that audio diaries can be an effective tool for assessing support needs and resources. IMPLICATIONS FOR NURSING PRACTICE Nurses and healthcare providers should tailor social support assessments to address the distinct support needs and individual resources of cancer survivors and their care partners. This is especially critical in contexts that limit access to care and formal services.
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Affiliation(s)
- Kristin G Cloyes
- School of Nursing, Oregon Health & Science University, Portland, OR.
| | - Kelly J Mansfield
- College of Nursing, University of Utah College of Nursing, Salt Lake City, UT
| | - Sarah E Wawrzynski
- Center for Healthcare Delivery Science, Nemours Children's Health, Wilmington, DE
| | - Marilisa Vega
- College of Nursing, University of Utah College of Nursing, Salt Lake City, UT
| | | | - Jia-Wen Guo
- College of Nursing, University of Utah College of Nursing, Salt Lake City, UT
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Wu S, Guo X, Tang H, Li Y, Dong W, Lu G, Hou C, Chen C. The Relationship Between Illness Uncertainty and Social Support Among Cancer Patients: A Meta-analysis. Cancer Nurs 2024:00002820-990000000-00223. [PMID: 38447045 DOI: 10.1097/ncc.0000000000001328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
BACKGROUND As a common psychological problem in cancer patients, illness uncertainty has attracted wide attention from scholars. Some studies have pointed out that the level of social support may affect illness uncertainty in patients with cancer, but the results of these studies remain controversial. OBJECTIVE The aim of this study was to evaluate the correlation between illness uncertainty and social support in patients with cancer using meta-analysis. METHODS PubMed, Web of Science, EMBASE, EBSCO, Cochrane Library, China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform, and VIP Citation Database were searched for articles published up to 2022. The screening of the literature, data extraction, and quality assessment of the included studies were performed independently by 2 researchers. Stata 17.0 software was used to analyze the overall and moderation effects. RESULTS Notably, 41 studies involving 5403 patients were included. The results showed that the illness uncertainty of adults with cancer was moderately negatively correlated with social support (r = -0.33). Country, publication year, cancer type, and instrument used to measure social support moderated the association between illness uncertainty and social support. CONCLUSION Improving the level of social support can reduce illness uncertainty experienced by adults with cancer to a certain extent. IMPLICATIONS FOR PRACTICE This review provides a clear direction for implementing precise interventions to reduce illness uncertainty among adults with cancer. Furthermore, patients with cancer with high morbidity and mortality rates deserve greater attention from healthcare personnel and family caregivers.
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Affiliation(s)
- Sijia Wu
- Author Affiliations: Institute of Nursing and Health, School of Nursing and Health (Mss Wu, Guo, Tang, Li, Dong, and Hou, and Dr Chen); and Institute of Business Administration, School of Business (Dr Lu), Henan University, Kaifeng, China
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Pearce E, Raj H, Emezienna N, Gilkey MB, Lazard AJ, Ribisl KM, Savage SA, Han PK. The Use of Social Media to Express and Manage Medical Uncertainty in Dyskeratosis Congenita: Content Analysis. JMIR INFODEMIOLOGY 2024; 4:e46693. [PMID: 38224480 PMCID: PMC10825764 DOI: 10.2196/46693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 11/09/2023] [Accepted: 11/28/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND Social media has the potential to provide social support for rare disease communities; however, little is known about the use of social media for the expression of medical uncertainty, a common feature of rare diseases. OBJECTIVE This study aims to evaluate the expression of medical uncertainty on social media in the context of dyskeratosis congenita, a rare cancer-prone inherited bone marrow failure and telomere biology disorder (TBD). METHODS We performed a content analysis of uncertainty-related posts on Facebook and Twitter managed by Team Telomere, a patient advocacy group for this rare disease. We assessed the frequency of uncertainty-related posts, uncertainty sources, issues, and management and associations between uncertainty and social support. RESULTS Across all TBD social media platforms, 45.98% (1269/2760) of posts were uncertainty related. Uncertainty-related posts authored by Team Telomere on Twitter focused on scientific (306/434, 70.5%) or personal (230/434, 53%) issues and reflected uncertainty arising from probability, ambiguity, or complexity. Uncertainty-related posts in conversations among patients and caregivers in the Facebook community group focused on scientific (429/511, 84%), personal (157/511, 30.7%), and practical (114/511, 22.3%) issues, many of which were related to prognostic unknowns. Both platforms suggested uncertainty management strategies that focused on information sharing and community building. Posts reflecting response-focused uncertainty management strategies (eg, emotional regulation) were more frequent on Twitter compared with the Facebook community group (χ21=3.9; P=.05), whereas posts reflecting uncertainty-focused management strategies (eg, ordering information) were more frequent in the Facebook community group compared with Twitter (χ21=55.1; P<.001). In the Facebook community group, only 36% (184/511) of members created posts during the study period, and those who created posts did so with a low frequency (median 3, IQR 1-7 posts). Analysis of post creator characteristics suggested that most users of TBD social media are White, female, and parents of patients with dyskeratosis congenita. CONCLUSIONS Although uncertainty is a pervasive and multifactorial issue in TBDs, our findings suggest that the discussion of medical uncertainty on TBD social media is largely limited to brief exchanges about scientific, personal, or practical issues rather than ongoing supportive conversation. The nature of uncertainty-related conversations also varied by user group: patients and caregivers used social media primarily to discuss scientific uncertainties (eg, regarding prognosis), form social connections, or exchange advice on accessing and organizing medical care, whereas Team Telomere used social media to express scientific and personal issues of uncertainty and to address the emotional impact of uncertainty. The higher involvement of female parents on TBD social media suggests a potentially greater burden of uncertainty management among mothers compared with other groups. Further research is needed to understand the dynamics of social media engagement to manage medical uncertainty in the TBD community.
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Affiliation(s)
- Emily Pearce
- Division of Cancer Epidemiology and Genetics, Clinical Genetics Branch, National Cancer Institute, National Institutes of Health, Rockville, MD, United States
| | - Hannah Raj
- Team Telomere, Coeur d'Alene, ID, United States
| | - Ngozika Emezienna
- Division of Cancer Epidemiology and Genetics, Clinical Genetics Branch, National Cancer Institute, National Institutes of Health, Rockville, MD, United States
| | - Melissa B Gilkey
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Allison J Lazard
- Hussman School of Journalism and Media, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Kurt M Ribisl
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Sharon A Savage
- Division of Cancer Epidemiology and Genetics, Clinical Genetics Branch, National Cancer Institute, National Institutes of Health, Rockville, MD, United States
| | - Paul Kj Han
- Division of Cancer Control and Population Sciences, Behavioral Research Program, National Cancer Institute, National Institutes of Health, Rockville, MD, United States
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Eppel-Meichlinger J, Mayer H, Steiner E, Kobleder A. From existential uncertainty to a new mindset promoting recovery: Exploring the development of uncertainty experience in women with vulvar neoplasia - A qualitative longitudinal study. BMC Womens Health 2024; 24:35. [PMID: 38218781 PMCID: PMC10788007 DOI: 10.1186/s12905-024-02889-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 01/06/2024] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND Women with vulvar neoplasia continue to experience uncertainty up to six months post-surgery. Uncertainty in illness is considered a significant psychosocial stressor, that negatively influences symptom distress, self-management strategies and quality of life. According to the Reconceptualized Uncertainty in Illness Theory, the appraisal of uncertainty changes positively over time in chronic illness. We aimed at exploring whether and how the experience of uncertainty develops in women with vulvar neoplasia. METHODS We selected a purposive sample of seven women diagnosed with vulvar neoplasia in four Swiss and one Austrian women's clinic. By means of a qualitative longitudinal study, we conducted 30 individual interviews at five points of time during one year after diagnosis. We applied Saldaña's analytical questions for longitudinal qualitative research. RESULTS First, participants experienced uncertainty as an existential threat, then an inherent part of their illness, and finally a certainty. Women initially associated the existential threat with a high risk for suffering from severe health deteriorations. Participants that could reduce their individually assessed risk by adopting health promoting behaviors, accepted the remaining uncertainty. From now on they reframed uncertainty into a certainty. This new mindset was based on a belief of promoting recovery and reducing the risk of recurrence. CONCLUSIONS The long-lasting and oscillating nature of uncertainty should receive attention in supportive oncology care. Uncertainty concerning existential issues is of special importance since it can inhibit a positive development of uncertainty experience.
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Affiliation(s)
- Jasmin Eppel-Meichlinger
- Department of General Health Studies, Division Nursing Science with focus on Person-centred Care Research, Karl Landsteiner University of Health Sciences, Dr. Karl-Dorrek-Straße 30, Krems, Austria.
- Vienna Doctoral School of Social Sciences, University of Vienna, Vienna, Austria.
| | - Hanna Mayer
- Department of General Health Studies, Division Nursing Science with focus on Person-centred Care Research, Karl Landsteiner University of Health Sciences, Dr. Karl-Dorrek-Straße 30, Krems, Austria
| | - Enikö Steiner
- Department of Obstetrics and Gynecology, Vienna General University Hospital, Vienna, Austria
| | - Andrea Kobleder
- Institute of Applied Nursing Science, Eastern Switzerland University of Applied Sciences, St.Gallen, Switzerland
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Miranda-Galvis M, Tjioe KC, Balas EA, Agrawal G, Cortes JE. Disparities in survival of hematologic malignancies in the context of social determinants of health: a systematic review. Blood Adv 2023; 7:6466-6491. [PMID: 37639318 PMCID: PMC10632659 DOI: 10.1182/bloodadvances.2023010690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/22/2023] [Accepted: 08/20/2023] [Indexed: 08/31/2023] Open
Abstract
Social determinants of health (SDHs) have been reported as relevant factors responsible for health inequity. We sought to assess clinical data from observational studies conducted in the United States evaluating the impact of SDHs on the outcomes of patients with hematologic malignancies. Thus, we performed a systematic review in 6 databases on 1 September 2021, in which paired reviewers independently screened studies and included data from 41 studies. We assessed the risk of bias using the Joanna Briggs Institute appraisal tools and analyzed the data using a descriptive synthesis. The most common SDH domains explored were health care access and quality (54.3%) and economic stability (25.6%); others investigated were education (19%) and social and community context (7.8%). We identified strong evidence of 5 variables significantly affecting survival: lack of health insurance coverage or having Medicare or Medicaid insurance, receiving cancer treatment at a nonacademic facility, low household income, low education level, and being unmarried. In contrast, the reports on the effect of distance traveled to the treatment center are contradictory. Other SDHs examined were facility volume, provider expertise, poverty, and employment rates. We identified a lack of data in the literature in terms of transportation, debt, higher education, diet, social integration, environmental factors, or stress. Our results underscore the complex nature of social, financial, and health care barriers as intercorrelated variables. Therefore, the management of hematologic malignancies needs concerted efforts to incorporate SDHs into clinical care, research, and public health policies, identifying and addressing the barriers at a patient-based level to enhance outcome equity (PROSPERO CRD42022346854).
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Affiliation(s)
| | | | - E. Andrew Balas
- Institute of Public and Preventive Health, Augusta University, Augusta, GA
| | - Gagan Agrawal
- School of Computing, University of Georgia, Athens, GA
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Lin H, Ye M, Lin Y, Chen F, Chan S, Cai H, Zhu J. Mobile App for Gynecologic Cancer Support for Patients With Gynecologic Cancer Receiving Chemotherapy in China: Multicenter Randomized Controlled Trial. J Med Internet Res 2023; 25:e49939. [PMID: 37955943 PMCID: PMC10682921 DOI: 10.2196/49939] [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: 06/13/2023] [Revised: 09/01/2023] [Accepted: 10/24/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND Patients with gynecologic cancer receiving chemotherapy often report unmet supportive care needs. Compared with traditional face-to-face clinical interventions, mobile health can increase access to supportive care and may address patients' needs. Although app-based support programs have been developed to support patients with gynecologic cancer, their efficacy has not been adequately tested. OBJECTIVE The aim of this study was to examine the efficacy of a mobile app for gynecologic cancer support (MGCS) for patients with gynecologic cancer receiving chemotherapy in China. METHODS A multicenter randomized controlled trial was conducted in 2 university-affiliated hospitals in China. A total of 168 Chinese patients with gynecologic cancer were recruited and randomized to receive routine care or MGCS program plus routine care for 24 weeks. The Mishel uncertainty in illness theory guided the development of MGCS program, which has 4 modules: weekly topics, emotional care, discussion center, and health consultation. The primary outcome of this program was the assessment of the uncertainty in illness. The secondary outcomes were quality of life, symptom distress, and social support. All health outcomes were evaluated at baseline (T0), 12 weeks (T1), and 24 weeks (T2). Repeated measures analysis of covariance was used to assess the efficacy of the MGCS program. RESULTS In this trial, 67 patients in the control group and 69 patients in the intervention group completed 2 follow-up assessments (response rate, 136/168, 81%). At 12 weeks, no significant differences were observed in any of the health outcomes between the 2 groups. At 24 weeks, compared to patients in the control group, those in the intervention group reported significant decreased uncertainty in illness (P<.001; d=-0.60; adjusted mean difference -7.69, 95% CI -11.31 to -4.07) and improved quality of life (P=.04; d=0.30; adjusted mean difference 4.77, 95% CI 0.12-9.41). CONCLUSIONS The MGCS program demonstrated efficacy in supporting patients with gynecologic cancer receiving chemotherapy. This trial illustrates that an app-based program can be incorporated into routine care to support patients with cancer and suggests that allocation of more resources (grants, manpower, etc) to mobile health in clinics is warranted. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR2000033678; https://www.chictr.org.cn/showproj.html?proj=54807.
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Affiliation(s)
- Huicong Lin
- School of Medicine, Xiamen University, Xiamen, Fujian Province, China
- Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, Fujian Province, China
| | - Mingzhu Ye
- Department of Gynecology and Obstetrics, Zhongshan Hospital, Xiamen University, Xiamen, Fujian Province, China
| | - Yanjuan Lin
- Department of Nursing, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
| | - Fuhong Chen
- Department of Nursing, First Affiliated Hospital, Xiamen University, Xiamen, Fujian Province, China
| | - Sally Chan
- President Office, Tung Wah College, Hongkong, China
| | - Hongxia Cai
- Department of Gynecology and Obstetrics, First Affiliated Hospital, Xiamen University, Xiamen, Fujian Province, China
| | - Jiemin Zhu
- Department of Nursing, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, China
- Cancer Care Research Unit, Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, Australia
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Akkuş Y, Menekli T. Determining the Relationship Between Intolerance of Uncertainty and Attitudes Toward Complementary and Alternative Medicine in Patients With Cancer. Holist Nurs Pract 2023; 37:277-284. [PMID: 37595120 DOI: 10.1097/hnp.0000000000000600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/20/2023]
Abstract
Disease-related uncertainty and the factors associated with uncertainty in patients with cancer have not been adequately investigated. This study aimed to determine the relationship between intolerance of uncertainty and attitudes toward complementary and alternative medicine (CAM) in patients with cancer. This cross-sectional descriptive study included 351 patients treated in the oncology clinic of a university hospital. All participants completed the Holistic Complementary and Alternative Medicine Questionnaire (HCAMQ) and the 12-item Intolerance of Uncertainty Scale (IUS-12). Most patients (84.3%) said that they had information about CAM, 39.7% reported obtaining this information from their social environment, 83.2% said that they believed that CAM methods are effective, and 76.0% reported not telling health care professionals about their CAM use. Mean IUS-12 and HCAMQ total scores were 46.53 ± 2.05 and 32.11 ± 2.32, respectively, and showed a weak negative correlation. The patients in our study showed high intolerance of uncertainty and a moderately positive attitude toward CAM, and most patients did not notify health care professionals of their CAM use. Therefore, we recommend assessing intolerance of uncertainty and CAM use in this patient group. By identifying patients experiencing uncertainty and seeking different treatment, nurses can support patients physiologically, psychologically, and socially, and can explain the effects of CAM use.
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Affiliation(s)
- Yeliz Akkuş
- Department of Nursing, Health Science Faculty, Kafkas University, Kars, Turkey (Dr Akkuş); and Department of Nursing, Health Science Faculty, Turgut Ozal University, Malatya Turkey (Dr Menekli)
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Doyle C, Ko E, Lemus H, Hsu FC, Pierce JP, Wu T. Living Alone, Physical Health, and Mortality in Breast Cancer Survivors: A Prospective Observational Cohort Study. Healthcare (Basel) 2023; 11:2379. [PMID: 37685413 PMCID: PMC10486593 DOI: 10.3390/healthcare11172379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/16/2023] [Accepted: 08/17/2023] [Indexed: 09/10/2023] Open
Abstract
Living alone, particularly for individuals with poor physical health, can increase the likelihood of mortality. This study aimed to explore the individual and joint associations of living alone and physical health with overall mortality among breast cancer survivors in the Women's Healthy Eating and Living (WHEL). We collected baseline, 12-month and 48-month data among 2869 women enrolled in the WHEL cohort. Living alone was assessed as a binary variable (Yes, No), while scores of physical health were measured using the RAND Short Form-36 survey (SF-36), which include four domains (physical function, role limitation, bodily pain, and general health perceptions) and an overall summary score of physical health. Cox proportional hazard models were used to evaluate associations. No significant association between living alone and mortality was observed. However, several physical health measures showed significant associations with mortality (p-values < 0.05). For physical function, the multivariable model showed a hazard ratio (HR) of 2.1 (95% CI = 1.02-4.23). Furthermore, the study examined the joint impact of living alone and physical health measures on overall mortality. Among women with better physical function, those living alone had a 3.6-fold higher risk of death (95% CI = 1.01-12.89) compared to those not living alone. Similar trends were observed for pain. However, regarding role limitation, the pattern differed. Breast cancer survivors living alone with worse role limitations had the highest mortality compared to those not living alone but with better role limitations (HR = 2.6, 95% CI = 1.11-5.95). Similar trends were observed for general health perceptions. Our findings highlight that living alone amplifies the risk of mortality among breast cancer survivors within specific health groups.
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Affiliation(s)
- Cassie Doyle
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA 92182, USA; (C.D.); (H.L.)
| | - Eunjeong Ko
- School of Social Work, San Diego State University, San Diego, CA 92182, USA;
| | - Hector Lemus
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA 92182, USA; (C.D.); (H.L.)
| | - Fang-Chi Hsu
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC 27101, USA;
| | - John P. Pierce
- Moores Cancer Center, School of Medicine, University of California, San Diego, CA 92037, USA;
| | - Tianying Wu
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA 92182, USA; (C.D.); (H.L.)
- Moores Cancer Center, School of Medicine, University of California, San Diego, CA 92037, USA;
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Kim SH, Choe YH, Choi J, Park JY, Yi E. Factors Associated With Quality of Life Among Posttreatment Cancer Survivors in Korea: A Meta-analysis. Cancer Nurs 2023:00002820-990000000-00162. [PMID: 37523733 DOI: 10.1097/ncc.0000000000001273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
BACKGROUND Identification of factors associated with quality of life (QOL) among cancer survivors is crucial for identifying potential targets for intervention. OBJECTIVES We aimed to provide evidence of factors associated with the QOL among posttreatment cancer survivors in Korea. METHODS We performed a systematic literature search from January 2000 to September 2022 using PubMed, EMBASE, CINAHL, PsycINFO, and Korean databases (RISS, SCIENCEON). We evaluated study quality using the Joanna Briggs Institute Quality Appraisal Checklists for Analytical Cross-sectional Studies and performed statistical analysis using the R 3.0 software (R Foundation for Statistical Computing, Vienna, Austria) package. We analyzed the pooled effect sizes of potential QOL correlates by the random-effects model. RESULTS This meta-analysis included 31 studies with 8934 participants. The pooled estimates were significantly large for economic status (r = -0.53); significantly medium for fatigue (r = -0.39), anxiety (r = -0.29), depression (r = -0.42), self-efficacy (r = 0.37), and social support (r = 0.30); and significantly small for education level (r = -0.18), job status (r = -0.09), cancer stage (r = -0.20), and time since diagnosis (r = -0.26). CONCLUSIONS Low education level, having no job, low economic status, advanced cancer stage, short disease period, fatigue, anxiety, and depression were significantly associated with worse QOL, whereas self-efficacy and social support were significantly associated with better QOL. IMPLICATIONS FOR PRACTICE The findings have potential implications for identifying "at-risk survivors" of deteriorated QOL and for suggesting powerful strategies (eg, enhancing self-efficacy or social support) for improving QOL.
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Affiliation(s)
- Soo Hyun Kim
- Author Affiliations: Department of Nursing, Inha University, Incheon, South Korea
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Shen H, Masingboon K, Samartkit N. Factors related to preoperative uncertainty among patients with breast cancer in Wenzhou, China: A cross-sectional study. BELITUNG NURSING JOURNAL 2023; 9:236-243. [PMID: 37492757 PMCID: PMC10363974 DOI: 10.33546/bnj.2648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 04/30/2023] [Accepted: 06/02/2023] [Indexed: 07/27/2023] Open
Abstract
Background One of the most prevalent psychological signs of breast cancer is uncertainty, which is more prevalent in Chinese patients during the preoperative period. Despite the numerous factors contributing to preoperative uncertainty, there is limited relevant research conducted in China. Objective This study aimed to describe the current state of preoperative uncertainty and to investigate the relationship between anxiety, illness perception, social support, and preoperative uncertainty in patients with breast cancer in Wenzhou, China. Methods This cross-sectional research used a simple random sampling technique to select 122 participants from a university hospital in Wenzhou, China, from July 2022 to December 2022, employing validated instruments. Descriptive statistics and Pearson's correlation coefficient were utilized to analyze the data. Results The average preoperative uncertainty scores of the patients fell within a moderate range (M = 61.92, SD = 7.51). Significant correlations were found between anxiety (r = 0.638, p <0.01), illness perception (r = 0.704, p <0.01), social support (r = -0.481, p <0.01), and preoperative uncertainty. Conclusions The results can assist healthcare professionals, especially nurses, in recognizing the factors contributing to uncertainty before surgery in patients with breast cancer. This knowledge enables them to promptly address and minimize this issue, leading to improved outcomes.
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Affiliation(s)
- Huaiyu Shen
- Faculty of Nursing, Burapha University, Chon Buri, Thailand
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Zeilani RS, Younis WY, Albusoul R, Hasanien A, Hamdan-Mansour A. The buffering role of social support on the severity of physical symptoms among patients living with cancer. Int J Palliat Nurs 2023; 29:204-215. [PMID: 37224097 DOI: 10.12968/ijpn.2023.29.5.204] [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: 05/26/2023]
Abstract
BACKGROUND The role of perceived social support (the individual's perception that family, friends and others are available as psychological, social and material support) and its moderating effect on the psychological and physical factors among patients suffering medical problems is still debated. AIM To explore the effect of perceived social support on the relationship between psychological and health-related factors on the severity of physical symptoms among patients with cancer. METHODS A descriptive-correlational, cross-sectional design was used to recruit 459 patients with cancer from three major hospitals in Jordan. Data were collected using a self-administered questionnaire. RESULTS Social support was significantly correlated to the severity of physical symptoms (p>.05) among patients with cancer, while psychological distress, sadness, disturbed body image and anxiety were not (p<.05). The multiple hierarchal regression model showed that social support has no significant moderation effect on the relationship between psychological and health-related factors and the severity of physical symptoms controlling for sociodemographic factors among patients with cancer. CONCLUSION Patients with cancer suffering physical and psychological disturbances do not benefit from social support as a way of controlling the severity of their symptoms. Palliative nurses need to tailor a social support intervention to their patients with cancer, in order to use both professional and family resources.
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Affiliation(s)
| | | | | | - Amer Hasanien
- Assistant Professor, The University of Jordan, Jordan
| | - Aman Hamdan-Mansour
- Professor-Psychiatric and Mental Health Nursing, The University of Jordan, Jordan
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Guan T, Chapman MV, de Saxe Zerden L, Sharma A, Chen DG, Song L. Correlates of illness uncertainty in cancer survivors and family caregivers: a systematic review and meta-analysis. Support Care Cancer 2023; 31:242. [PMID: 36977804 DOI: 10.1007/s00520-023-07705-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 03/22/2023] [Indexed: 03/30/2023]
Abstract
PURPOSE Illness uncertainty is widely recognized as a psychosocial stressor for cancer survivors and their family caregivers. This systematic review and meta-analysis aimed to identify the sociodemographic, physical, and psychosocial correlates that are associated with illness uncertainty in adult cancer survivors and their family caregivers. METHODS Six scholarly databases were searched. Data synthesis was based on Mishel's Uncertainty in Illness Theory. Person's r was used as the effect size metric in the meta-analysis. Risk of bias was assessed using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. RESULTS Of 1116 articles, 21 articles met the inclusion criteria. Of 21 reviewed studies, 18 focused on cancer survivors, one focused on family caregivers, and 2 included survivors and family caregivers. Findings identified distinct correlates for illness uncertainty in cancer survivors, including sociodemographic factors (e.g., age, gender, race), stimuli frame (e.g., symptom, family history of cancer), structure providers (e.g., education), coping, and adaptation. Notable effect sizes were observed in the correlations between illness uncertainty and social support, quality of life, depression, and anxiety. Caregivers' illness uncertainty was associated with their race, general health, perception of influence, social support, quality of life, and survivors' prostate-specific antigen levels. Insufficient data precluded examining effect size of correlates of illness uncertainty among family caregivers. CONCLUSION This is the first systematic review and meta-analysis to summarize the literature on illness uncertainty among adult cancer survivors and family caregivers. Findings contribute to the growing literature on managing illness uncertainty among cancer survivors and family caregivers.
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Affiliation(s)
- Ting Guan
- Syracuse University, School of Social Work, 226 White Hall, Syracuse, Syracuse, NY, 13244, USA.
| | - Mimi V Chapman
- University of North Carolina at Chapel Hill, School of Social Work, Chapel Hill, NC, USA
| | - Lisa de Saxe Zerden
- University of North Carolina at Chapel Hill, School of Social Work, Chapel Hill, NC, USA
| | - Anjalee Sharma
- School of Medicine Johns Hopkins University, Baltimore, MD, USA
| | - Ding-Geng Chen
- College of Health Solutions, Arizona State University, Phoenix, AZ, USA
- Department of Statistics, University of Pretoria, Pretoria, South Africa
| | - Lixin Song
- UT Health San Antonio, School of Nursing, San Antonio, TX, USA
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The Mediating Effects of Social Support on the Relationship between Uncertainty and Quality of Life among Patients with Chronic Low Back Pain: A Cross-Sectional Survey. Healthcare (Basel) 2022; 10:healthcare10091805. [PMID: 36141416 PMCID: PMC9499006 DOI: 10.3390/healthcare10091805] [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] [Received: 08/11/2022] [Revised: 09/13/2022] [Accepted: 09/16/2022] [Indexed: 11/18/2022] Open
Abstract
Background: This study aimed to investigate the mediating effects of social support on the relationship between uncertainty and quality of life (QOL) in patients with chronic low back pain (LBP). Methods: From 1 July 2019 to 25 March 2020, data were collected using a structured questionnaire from inpatients and outpatients > 20 years of age with chronic LBP lasting > 3 months. Inpatients included patients waiting for surgery and those recovering after surgery. The exclusion criteria were cancer and other serious pathological diseases. The relationships between uncertainty, social support, and QOL were analyzed using Pearson’s correlation coefficients. Results: Uncertainty, the independent variable, exerted a significant effect on social support, the mediator (B = 0.33, p < 0.001). In addition, both uncertainty (B = 0.37, p < 0.001) and social support (B = 0.45, p < 0.001) exerted statistically significant effects on QOL, the dependent variable. Conclusions: Disease-related uncertainty can reduce QOL in patients with chronic LBP, and this relationship is mediated by the level of social support. To develop strategies for strengthening social support from healthcare providers, family, and friends, future studies should examine the experiences of patients with chronic LBP from various perspectives, including pain intensity and duration.
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Yu Z, Sun D, Sun J. Social Support and Fear of Cancer Recurrence Among Chinese Breast Cancer Survivors: The Mediation Role of Illness Uncertainty. Front Psychol 2022; 13:864129. [PMID: 35369168 PMCID: PMC8966644 DOI: 10.3389/fpsyg.2022.864129] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 02/24/2022] [Indexed: 12/01/2022] Open
Abstract
Objective To examine the relations between social support, illness uncertainty (IU), and fear of cancer recurrence (FCR). Methods Using data from a convenience sample of 231 breast cancer survivors in China to perform structural equation modeling with bootstrapping estimation. Participants were recruited from a general hospital in Shenyang, China. Participants completed the Perceived Social Support Scale, Mishel Uncertainty in Illness Scale, and Fear of Cancer Recurrence Inventory- Shorter Form. Results The majority of breast cancer survivors have FCR (67.5%). FCR was significantly negatively associated with social support, and was significantly positively associated with IU (both P < 0.01). Moreover, IU was found to mediate the relationship between social support and FCR (standardized indirect effect = -0.18; bias-corrected 95% confidence interval: -0.255, -0.123). Conclusion The findings support the final model. Good social support can directly mitigate FCR, while illness uncertainty can play a mediation role between social support and FCR. Further studies should be conducted to explore effective interventions for social support and IU to ultimately mitigate FCR in cancer survivors.
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Affiliation(s)
- Zhichao Yu
- Intensive Care Unit, Shengjing Hospital of China Medical University, Shenyang, China
| | - Di Sun
- School of Nursing, Liaoning University of Traditional Chinese Medicine, Shenyang, China
| | - Jia Sun
- Department of Obstetrics, Shengjing Hospital of China Medical University, Shenyang, China
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Zhang N, Tang XQ, Lu K, Dong Q, Kong LN, Jiang TT, Xu LY. Illness uncertainty, self-perceived burden and quality of life in patients with chronic myeloid leukaemia: A cross-sectional study. J Clin Nurs 2021; 31:2935-2942. [PMID: 34786783 DOI: 10.1111/jocn.16123] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 10/15/2021] [Accepted: 10/27/2021] [Indexed: 11/26/2022]
Abstract
AIMS AND OBJECTIVES To investigate the relationship between illness uncertainty, self-perceived burden and quality of life and explore the mediating role of self-perceived burden between illness uncertainty and quality of life in patients with chronic myeloid leukaemia. BACKGROUND Patients with chronic myeloid leukaemia need long-term, potentially lifelong therapy to control the disease, which affects their quality of life. There is a need for exploring potentially changeable factors to develop interventions. Little is known about the effects of illness uncertainty and self-perceived burden on quality of life in this population. DESIGN A cross-sectional study. METHODS A convenience sample of 248 patients with chronic myeloid leukaemia was recruited from four university hospitals from February to August 2020. Participants were assessed with the Mishel Uncertainty in Illness Scale, Self-Perceived Burden Scale, and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire. The STROBE checklist was used to report the results. RESULTS Illness uncertainty and self-perceived burden were negatively associated with quality of life in patients with chronic myeloid leukaemia. Self-perceived burden partially mediated the relationship between illness uncertainty and quality of life. The indirect effect was -0.101, accounting for 22.9% of the total effect. CONCLUSION The findings revealed the relationship between illness uncertainty, self-perceived burden and quality of life in patients with chronic myeloid leukaemia. Self-perceived burden exerted a mediating role between illness uncertainty and quality of life in this population. RELEVANCE TO CLINICAL PRACTICE This study alerts healthcare providers to pay attention to patients' illness uncertainty and self-perceived burden, which can contribute to develop effective interventions to improve the quality of life among patients with chronic myeloid leukaemia in the clinical practice.
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Affiliation(s)
- Nan Zhang
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiao-Qiong Tang
- Department of Hematology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Kai Lu
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qian Dong
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ling-Na Kong
- School of Nursing, Chongqing Medical University, Chongqing, China
| | - Tian-Tian Jiang
- Department of Hematology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Liu-Yue Xu
- Department of Hematology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Luo Z, Chen C, Xu W, Wang P, Wang Y. A qualitative study on the experience of empowerment from the perspectives of breast cancer survivors. Nurs Open 2021; 8:2429-2438. [PMID: 34313022 PMCID: PMC8363359 DOI: 10.1002/nop2.1000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 06/19/2021] [Accepted: 07/10/2021] [Indexed: 02/05/2023] Open
Abstract
AIM To describe the experience of empowerment for breast cancer survivors in order to increase quality of life after treatment. DESIGN We adopted a qualitative design in this study. METHODS A qualitative descriptive approach guided by interpretive description methodology as the theoretical framework was used in this study. Semi-structured group and individual interviews were conducted with eleven female Chinese breast cancer survivors (mean age 54.18 years, 100% female). RESULTS Many survivors reported that they continued to experience disease-related discomfort from the physiological aspect, but they use multiple ways to improve quality of life. Breast cancer survivors experienced empowerment after treatment. Empowerment mainly required three components: a belief in good health, capability of self-management and acquisition of a good social support system.
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Affiliation(s)
- Zebing Luo
- Shantou University Medical CollegeShantouChina
- Guangdong Provincial Key Laboratory of Breast Cancer Diagnosis and TreatmentShantouChina
| | - Chujun Chen
- Guangdong Provincial Key Laboratory of Breast Cancer Diagnosis and TreatmentShantouChina
- Cancer Hospital of Shantou University Medical CollegeShantouChina
| | - Wanzhu Xu
- Guangdong Provincial Key Laboratory of Breast Cancer Diagnosis and TreatmentShantouChina
- Cancer Hospital of Shantou University Medical CollegeShantouChina
| | - Peiru Wang
- Shantou University Medical CollegeShantouChina
- Guangdong Provincial Key Laboratory of Breast Cancer Diagnosis and TreatmentShantouChina
| | - Yiru Wang
- Guangdong Provincial Key Laboratory of Breast Cancer Diagnosis and TreatmentShantouChina
- Cancer Hospital of Shantou University Medical CollegeShantouChina
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Fekih-Romdhane F, Saadallah F, Mbarek M, Bouzaiene H, Cheour M. Prevalence and correlates of hopelessness in Tunisian women with benign breast disease and breast cancer. J Psychosoc Oncol 2021; 40:677-694. [PMID: 34328072 DOI: 10.1080/07347332.2021.1943103] [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: 11/12/2022]
Abstract
BACKGROUND There is limited research suggesting that women with Benign Breast Disease (BBD) experience psychological distress similar to breast cancer (BC) women. We aimed to examine hopelessness and its related factors in BC and BBD women. METHOD This was a cross-sectional study. The Beck Hopelessness Scale and the Beck Depression Inventory were administered to 51 BBD and 52 BC women. RESULTS BC women had higher hopelessness scores as compared to those with BBD (6.9 ± 4.8 vs. 4.9 ± 3.6; p = .018). After controlling for confounding variables, depression and suicidal ideation/behavior were significantly associated with hopelessness in the BBD group, while only a lower socioeconomic status was associated with higher hopelessness scores in the BC group. CONCLUSION We found that not only BC but also BBD lead to a psychological burden. Early detection and handling of hopeless feelings and thoughts that may arise in this population are recommended.
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Affiliation(s)
- Feten Fekih-Romdhane
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.,Razi Hospital, Manouba, Tunisia
| | - Fatma Saadallah
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.,Salah Azaiez Institute, Tunis, Tunisia
| | - Mahdi Mbarek
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.,Salah Azaiez Institute, Tunis, Tunisia
| | - Hatem Bouzaiene
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.,Salah Azaiez Institute, Tunis, Tunisia
| | - Majda Cheour
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.,Razi Hospital, Manouba, Tunisia
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Elements of Suffering in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: The Experience of Loss, Grief, Stigma, and Trauma in the Severely and Very Severely Affected. HEALTHCARE (BASEL, SWITZERLAND) 2021; 9:healthcare9050553. [PMID: 34065069 PMCID: PMC8150911 DOI: 10.3390/healthcare9050553] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/03/2021] [Accepted: 05/04/2021] [Indexed: 12/23/2022]
Abstract
People who are severely and very severely affected by Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) experience profound suffering. This suffering comes from the myriad of losses these patients experience, the grief that comes from these losses, the ongoing stigma that is often experienced as a person with a poorly understood, controversial chronic illness, and the trauma that can result from how other people and the health care community respond to this illness. This review article examines the suffering of patients with ME/CFS through the lens of the Fennell Four-Phase Model of chronic illness. Using a systems approach, this phase framework illustrates the effects of suffering on the patient and can be utilized to help the clinician, patient, family, and caregivers understand and respond to the patient's experiences. We highlight the constructs of severity, uncertainty, ambiguity, and chronicity and their role in the suffering endured by patients with ME/CFS. A composite case example is used to illustrate the lives of severely and very severely affected patients. Recommendations for health care providers treating patients with ME/CFS are given and underscore the importance of providers understanding the intense suffering that the severely and very severely affected patients experience.
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