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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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Liu J, Bai S, Pan H, Huang L. Caregiver Burden and Readiness in Patients with Moderate and Severe Traumatic Brain Injury: The Chain Mediation Effect of Disease Uncertainty and Mental Resilience. World Neurosurg 2024; 185:e603-e611. [PMID: 38395354 DOI: 10.1016/j.wneu.2024.02.084] [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: 12/22/2023] [Revised: 02/13/2024] [Accepted: 02/14/2024] [Indexed: 02/25/2024]
Abstract
OBJECTIVE To analyze the mediating effects of caregiver illness uncertainty and psychological resilience in caregiver burden and readiness in patients with moderate-to-severe traumatic brain injuries (TBIs). This can help improve caregiver readiness in patients with moderate-to-severe TBIs. METHODS A purposive sampling method was used to recruit patients with moderate-to-severe TBIs, and their caregivers, who were hospitalized in the Department of Neurosurgery of the Affiliated Hospital of Yangzhou University between October 2022 and August 2023. The Zarit Caregiver Burden Interview, Mishel Uncertainty In Scale for Family Member, Connor-Davidson Resilience Scale, and Caregivers Preparedness Scale, as well as general information questionnaire, were used to conduct the survey. RESULTS Caregiver readiness correlated with caregiver burden, illness uncertainty, and psychological resilience in patients with moderate-to-severe TBI (P < 0.01). Caregiver readiness was not only directly affected by caregiver burden (95% confidence interval: -0.510, -0.196) but was also affected through the chain mediation of illness uncertainty and psychological resilience (95% confidence interval: -0.146, -0.011). CONCLUSIONS Caregiver burden in patients with moderate-to-severe TBI influences caregiver readiness levels and is mediated by illness uncertainty and psychological resilience. By improving caregivers' illness uncertainty and increasing their psychological resilience, the impact of low caregiver readiness caused by high caregiver burden could be reduced.
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Affiliation(s)
- Jinteng Liu
- Department of Neurosurgery, Affiliated Hospital of Yangzhou University, Yangzhou, China; School of Nursing, Yangzhou University, Yangzhou, China
| | - Shuo Bai
- School of Nursing, Yangzhou University, Yangzhou, China
| | - Hailong Pan
- Department of Neurosurgery, Affiliated Hospital of Yangzhou University, Yangzhou, China.
| | - Lumei Huang
- School of Nursing, Yangzhou University, Yangzhou, China
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Wongkalasin K, Matchim Y, Kanhasing R, Pimvichai S. Uncertainty among patients with advanced-stage lung cancer. Int J Palliat Nurs 2024; 30:160-169. [PMID: 38630643 DOI: 10.12968/ijpn.2024.30.4.160] [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] [Indexed: 04/19/2024]
Abstract
BACKGROUND Uncertainty is the inability to define the meaning of illness-related events, which may result in anxiety, depression, poor coping, the self-perception of being a burden and low quality of life. Uncertainty among Thai patients with advanced-stage lung cancer (ASLC) has not been well documented. AIMS To assess uncertainty in patients with ASLC. METHODS A cross-sectional survey design was adopted. Data were collected from 60 patients with ASLC at a university hospital. A demographic data form and the Mishel Uncertainty in Illness Scale (MUIS) were used to collect data. The data were analysed using descriptive statistics. RESULTS The patients had moderate levels of uncertainty in illness (83.73±15.25). Ambiguity about the illness and unpredictability of the prognosis scored at a moderate level for patients, while complexity of treatment and the system of care and inconsistency or lack of information, about the diagnosis or severity of the illness were at a low level. CONCLUSION The results of this study may help healthcare professionals better understand and manage uncertainty in patients with ASLC.
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Affiliation(s)
| | - Yaowarat Matchim
- Associate Professor, Faculty of Nursing, Thammasat University, Thailand
| | - Ruankwan Kanhasing
- Assistant Professor, Faculty of Medicine, Thammasat University, Thailand
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Du L, Cai J, Yu J, Chen X, Yang X, Xu X, Zhang X. Relations Between Posttraumatic Growth and Fear of Progression Among Young and Middle-Aged Primary Brain Tumor Patients: The Parallel Mediating Role of Perceived Social Support and Illness Uncertainty. World Neurosurg 2024; 184:e794-e802. [PMID: 38364895 DOI: 10.1016/j.wneu.2024.02.048] [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: 01/23/2024] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 02/18/2024]
Abstract
OBJECTIVE This study aimed to investigate the mediating role of perceived social support and illness uncertainty in posttraumatic growth (PTG) and fear of progression (FoP) among young and middle-aged primary brain tumor (PBT) patients. METHODS A total of 252 young and middle-aged benign PBT patients were investigated. Data were collected by using self-designed general and disease-related data questionnaires, PTG Inventory, FoP Questinaire-Short Form, Mischel Uncertainty in Illness Scale, and Perceived Social Support Scale. Parallel mediation effect models were used to explore the relationship between PTG and FoP mediation effects. Bootstrap analysis was conducted to examine the mediation effect of PTG on FoP. RESULTS The total FoP and PTG scores were 35.15 ± 4.85 and 55.04 ± 7.86. Furthermore, mediation effect analyses revealed that perceived social support and illness uncertainty were partially associated with the mediated relationship between PTG and FoP. (std.β = -0.026, P-value = 0.001, std. β = -0.393, P value <0.001, respectively). CONCLUSIONS Illness uncertainty and perceived social support were identified as partially parallel mediators between PTG and FoP. Thus, we should ensure adequate social support and improve the enthusiasm and input of family members for better patient recovery. Strengthening the nursing support, reducing the uncertainty of young and middle-aged PBT patients, and improving the patients' PTG can help reduce the fear of disease progression.
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Affiliation(s)
- Linjing Du
- Department of Neurosurgery, Affiliated Hospital of Nantong University, Nantong, China; Medical College of Nantong University, Nantong, China
| | - Jing Cai
- Department of Neurosurgery, Affiliated Hospital of Nantong University, Nantong, China; Medical College of Nantong University, Nantong, China
| | - Jiahui Yu
- Department of Neurosurgery, Affiliated Hospital of Nantong University, Nantong, China; Medical College of Nantong University, Nantong, China
| | - Xing Chen
- Department of Neurosurgery, Affiliated Hospital of Nantong University, Nantong, China; Medical College of Nantong University, Nantong, China
| | - Xueni Yang
- Department of Neurosurgery, Affiliated Hospital of Nantong University, Nantong, China; Medical College of Nantong University, Nantong, China
| | - Xiuqun Xu
- Department of Neurosurgery, Affiliated Hospital of Nantong University, Nantong, China; Department of Nursing, Affiliated Hospital of Nantong University, Nantong, China
| | - Xiaomei Zhang
- Department of Neurosurgery, Affiliated Hospital of Nantong University, Nantong, China; Department of Nursing, Affiliated Hospital of Nantong University, Nantong, China.
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Su XE, Wu SH, He HF, Lin CL, Lin S, Weng PQ. The effect of multimodal care based on Peplau's interpersonal relationship theory on postoperative recovery in lung cancer surgery: a retrospective analysis. BMC Pulm Med 2024; 24:59. [PMID: 38281038 PMCID: PMC10822161 DOI: 10.1186/s12890-024-02874-5] [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: 08/11/2023] [Accepted: 01/22/2024] [Indexed: 01/29/2024] Open
Abstract
BACKGROUND Lung cancer remains a major global health concern due to its high incidence and mortality rates. With advancements in medical treatments, an increasing number of early-stage lung cancer cases are being detected, making surgical treatment the primary option for such cases. However, this presents challenges to the physical and mental recovery of patients. Peplau known as the "mother of psychiatric associations" has formulated a theory of interpersonal relationships in nursing. Through effective communication between nurses and patients over four periods, she has established a good therapeutic nurse-patient relationship. Therefore, this study aimed to explore the effect of perioperative multimodal nursing based on Peplau's interpersonal relationship theory on the rehabilitation of patients with surgical lung cancer. METHODS We retrospectively analyzed 106 patients with non-small cell lung cancer who underwent thoracoscopic lobectomy at our department between June 2021 and April 2022. Patients were categorized into two groups according to the different nursing intervention techniques. The Peplau's group comprised 53 patients who received targeted nursing interventions, and the control group comprised 53 patients who received conventional nursing care. We observed the patients' illness uncertainty, quality of life, and clinical symptoms in both groups. RESULTS Patients in the Peplau's group had significantly lower illness uncertainty scores and a significantly higher quality of recovery than those in the control group. However, there were no significant differences in length of post-anesthesia care unit stay, complication rates, and visual analog scores between both groups. CONCLUSION The multimodal perioperative nursing based on Peplau's interpersonal relationship theory not only reduces the illness uncertainty of patients with lung cancer surgery and improves their QoR but also expands the application of this theory in clinical practice, guiding perioperative nursing of patients with lung cancer. IMPLICATIONS These findings provide practical information for standardized care in a hectic anesthetic care setting. IMPACT The assessed anesthesia nursing model helps reduce uncertainty and promote early recovery in patients with cancer at various stages of their disease, which expands the scope of therapeutic practice and existing theories. It also serves as a guide for care in the anesthesia recovery room. REPORTING METHOD We adhered to the relevant Equator guidelines and the checklist of items in the case-control study report. PATIENT OR PUBLIC CONTRIBUTION Patients cooperated with medical staff to complete relevant scales.
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Affiliation(s)
- Xue-E Su
- Centre of Neurological and Metabolic Research, The Second Affiliated Hospital of Fujian Medical University, No.34 North Zhongshan Road, Quanzhou, Fujian Province, 362000, China
- Department of Anesthesia, The Second Affiliated Hospital of Fujian Medical University, No.34 North Zhongshan Road, Quanzhou, Fujian Province, 362000, China
| | - Shan-Hu Wu
- Department of Anesthesia, The Second Affiliated Hospital of Fujian Medical University, No.34 North Zhongshan Road, Quanzhou, Fujian Province, 362000, China
| | - He-Fan He
- Department of Anesthesia, The Second Affiliated Hospital of Fujian Medical University, No.34 North Zhongshan Road, Quanzhou, Fujian Province, 362000, China
| | - Cui-Liu Lin
- Centre of Neurological and Metabolic Research, The Second Affiliated Hospital of Fujian Medical University, No.34 North Zhongshan Road, Quanzhou, Fujian Province, 362000, China
| | - Shu Lin
- Centre of Neurological and Metabolic Research, The Second Affiliated Hospital of Fujian Medical University, No.34 North Zhongshan Road, Quanzhou, Fujian Province, 362000, China.
- Group of Neuroendocrinology, Garvan Institute of Medical Research, 384 Victoria St, Sydney, Australia.
| | - Pei-Qing Weng
- Department of Anesthesia, The Second Affiliated Hospital of Fujian Medical University, No.34 North Zhongshan Road, Quanzhou, Fujian Province, 362000, China.
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Nabi Foodani M, Abbasi Dolatabadi Z, Rahbariyan A, Rasti A, Jafaryparvar Z, Zakerimoghadam M. Perceived Stress and Level of Uncertainty Among Hospitalized COVID-19 Patients. SAGE Open Nurs 2024; 10:23779608241234980. [PMID: 38476571 PMCID: PMC10929029 DOI: 10.1177/23779608241234980] [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: 11/02/2023] [Revised: 01/11/2024] [Accepted: 02/02/2024] [Indexed: 03/14/2024] Open
Abstract
Introduction Disease uncertainty refers to the inability to assign meaning to events related to the illness. Uncertainty of the disease can affect various aspects of human life such as psychological aspects. Objectives This study aims to examine the relationship between disease uncertainty and perceived stress in COVID-19 patients. Methods An analytical cross-sectional study was conducted on 212 hospitalized COVID-19 patients who were initially admitted to the intensive care units (ICUs) and later transferred to general wards within the same hospitals. Three instruments were utilized to collect data for this study. The Demographic Information Questionnaire, Mishel Uncertainty in Illness Scale (MUIS) for disease uncertainty, and Perceived Stress Questionnaire. For data analysis, both descriptive and inferential statistics were employed using IBM SPSS Statistics version 25. Results The Pearson correlation coefficient matrix results showed a positive and significant relationship between uncertainty about the illness (P < .001, r = 0.829), ambiguity (P < .001, r = 0.795), complexity (P < .001, r = 0.835), inconsistency or instability (P < .001, r = 0.787), and unpredictability (P < .001, r = 0.776) with perceived stress in COVID-19 patients transferred from the intensive care units. Conclusion Based on the findings of the current study, both uncertainty and perceived stress are elevated among COVID-19 patients, and a significant and direct relationship exists between these two variables. Healthcare providers, particularly nurses, should address the uncertainties surrounding emerging diseases, both at the hospital and community levels.
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Affiliation(s)
- Mahdi Nabi Foodani
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Abbasi Dolatabadi
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Rahbariyan
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Arezoo Rasti
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Zakiyeh Jafaryparvar
- Ph.D. Candidate of Nursing Research, Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoumeh Zakerimoghadam
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
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Marques FRDM, Laranjeira C, Carreira L, Gallo AM, Baccon WC, Paiano M, Baldissera VDA, Salci MA. Illness Experiences of Brazilian People Who Were Hospitalized Due to COVID-19 and Faced Long COVID Repercussions in Their Daily Life: A Constructivist Grounded Theory Study. Behav Sci (Basel) 2023; 14:14. [PMID: 38247666 PMCID: PMC10813415 DOI: 10.3390/bs14010014] [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: 09/20/2023] [Revised: 12/04/2023] [Accepted: 12/21/2023] [Indexed: 01/23/2024] Open
Abstract
Long COVID is a multisystem condition that has multiple consequences for the physical, mental, and social health of COVID-19 survivors. The impact of the long COVID condition remains unclear, particularly among middle-aged and older adults, who are at greater risk than younger people of persisting symptoms associated with COVID-19. Therefore, we aimed to understand the experiences of middle-aged and older people who had been hospitalized for COVID-19 and the repercussions of long-term COVID symptoms in their daily lives. A qualitative study was carried out, adopting the framework of the constructivist grounded theory (CGT) proposed by Kathy Charmaz. Fifty-six middle-aged and older adult participants from the southern region of Brazil were recruited. Data were gathered from semi-structured telephone interviews. Concomitantly a comparative analysis was performed to identify categories and codes using the MaxQDA® software (version 2022). Three subcategories were identified: (1) experiencing COVID-19 in the acute phase; (2) oscillating between 'good days' and 'bad days' in long COVID; and (3) (re)constructing identity. These concepts interact with each other and converge upon the central category of this study: recasting oneself to the uniqueness of the illness experience of long COVID. Our findings provided insights related to the disruption in the lives of long COVID-19 sufferers who still live with persistent symptoms of the disease, including physical, social, family, emotional and spiritual repercussions. Likewise, this study may aid in developing friendly and welcoming social environments, lowering stigma and prejudice towards patients with long COVID, and fostering prompt and suitable policy support and mental health care for these individuals.
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Affiliation(s)
- Francielle Renata Danielli Martins Marques
- Departamento de Pós-Graduação em Enfermagem, Universidade Estadual de Maringá, Av. Colombo, 5790—Campus Universitário, Maringá 87020-900, PR, Brazil; (F.R.D.M.M.); (L.C.); (A.M.G.); (W.C.B.); (M.P.); (V.D.A.B.); (M.A.S.)
| | - Carlos Laranjeira
- School of Health Sciences, Polytechnic University of Leiria, Campus 2, Morro do Lena, Alto do Vieiro, Apartado 4137, 2411-901 Leiria, Portugal
- Centre for Innovative Care and Health Technology (ciTechCare), Polytechnic University of Leiria, Rua de Santo André-66-68, Campus 5, 2410-541 Leiria, Portugal
- Comprehensive Health Research Centre (CHRC), University of Évora, 7000-801 Évora, Portugal
| | - Lígia Carreira
- Departamento de Pós-Graduação em Enfermagem, Universidade Estadual de Maringá, Av. Colombo, 5790—Campus Universitário, Maringá 87020-900, PR, Brazil; (F.R.D.M.M.); (L.C.); (A.M.G.); (W.C.B.); (M.P.); (V.D.A.B.); (M.A.S.)
| | - Adriana Martins Gallo
- Departamento de Pós-Graduação em Enfermagem, Universidade Estadual de Maringá, Av. Colombo, 5790—Campus Universitário, Maringá 87020-900, PR, Brazil; (F.R.D.M.M.); (L.C.); (A.M.G.); (W.C.B.); (M.P.); (V.D.A.B.); (M.A.S.)
| | - Wanessa Cristina Baccon
- Departamento de Pós-Graduação em Enfermagem, Universidade Estadual de Maringá, Av. Colombo, 5790—Campus Universitário, Maringá 87020-900, PR, Brazil; (F.R.D.M.M.); (L.C.); (A.M.G.); (W.C.B.); (M.P.); (V.D.A.B.); (M.A.S.)
| | - Marcelle Paiano
- Departamento de Pós-Graduação em Enfermagem, Universidade Estadual de Maringá, Av. Colombo, 5790—Campus Universitário, Maringá 87020-900, PR, Brazil; (F.R.D.M.M.); (L.C.); (A.M.G.); (W.C.B.); (M.P.); (V.D.A.B.); (M.A.S.)
| | - Vanessa Denardi Antoniassi Baldissera
- Departamento de Pós-Graduação em Enfermagem, Universidade Estadual de Maringá, Av. Colombo, 5790—Campus Universitário, Maringá 87020-900, PR, Brazil; (F.R.D.M.M.); (L.C.); (A.M.G.); (W.C.B.); (M.P.); (V.D.A.B.); (M.A.S.)
| | - Maria Aparecida Salci
- Departamento de Pós-Graduação em Enfermagem, Universidade Estadual de Maringá, Av. Colombo, 5790—Campus Universitário, Maringá 87020-900, PR, Brazil; (F.R.D.M.M.); (L.C.); (A.M.G.); (W.C.B.); (M.P.); (V.D.A.B.); (M.A.S.)
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Zhang N, Li H, Kang H, Wang Y, Zuo Z. Relationship between self-disclosure and anticipatory grief in patients with advanced lung cancer: the mediation role of illness uncertainty. Front Psychol 2023; 14:1266818. [PMID: 38144996 PMCID: PMC10748434 DOI: 10.3389/fpsyg.2023.1266818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 11/23/2023] [Indexed: 12/26/2023] Open
Abstract
Objective To study the relationship between self-disclosure, illness uncertainty (IU) and anticipatory grief (AG) in patients with advanced lung cancer. Methods This is a cross-sectional study using convenience sampling method, in which 316 patients with advanced lung cancer who were hospitalized in a tertiary hospital in Wuxi City, China, from November 2022 to April 2023 were sampled. The Preparatory Grief in Advanced Cancer Patients, Mishel Uncertainty in Illness Scale, and the Distress Disclosure Index Scale (DDI) were selected to analyse the status quo, correlations, and the mediating effect of illness uncertainty on the relationship between self-disclosure and anticipatory grief in advanced lung cancer patients. Results The total self-disclosure score of advanced lung cancer patients was (36.35 ± 9.25), the total score of IU was (56.92 ± 15.65), and the score of AG was (52.29 ± 9.08); the results of correlation analyses showed that IU was negatively correlated with self-disclosure in advanced lung cancer patients (p < 0.05) and positively correlated with AG (p < 0.05), and self-disclosure was negatively correlated with AG (p < 0.05);the mediating effect rate of IU between self-disclosure and AG in advanced lung cancer patients was 49%. Conclusion The AG of advanced lung cancer patients was at a medium-high level, and IU had a significant mediating effect between self-disclosure and AG of advanced lung cancer patients; by increasing the level of patients' self-disclosure, IU could be effectively alleviated, and ultimately the AG of the patients could be reduced.
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Affiliation(s)
- Nan Zhang
- Wuxi School of Medicine, Jiangnan University, Wuxi, China
| | - Han Li
- Wuxi School of Medicine, Jiangnan University, Wuxi, China
| | - Huaxin Kang
- Wuxi School of Medicine, Jiangnan University, Wuxi, China
| | - Yinglan Wang
- Department of Respiratory Medicine, Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Zhitong Zuo
- Department of Respiratory Medicine, Affiliated Hospital of Jiangnan University, Wuxi, China
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Thomas Hebdon MC, Cloyes KG, Vega M, Rosenkranz SJ, Reblin M, Tay D, Mooney K, Ellington L. Hospice Family Caregivers' Uncertainty, Burden, and Unmet Needs in Prospective Audio Diaries. J Hosp Palliat Nurs 2023; 25:321-329. [PMID: 37851960 PMCID: PMC10843703 DOI: 10.1097/njh.0000000000000975] [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] [Indexed: 10/20/2023]
Abstract
Hospice cancer caregivers' (HCCs') burden and unmet needs are well documented in the literature through retrospective, standardized self-report surveys. Hospice cancer caregiver daily experiences of burden and unmet needs are rarely captured within a real-time context. The purpose of this secondary data analysis was to characterize HCCs' day-to-day burden and unmet needs with prospective HCC (N = 50) audio diary data between hospice enrollment and patient death. Uncertainty theory provided a framework for analysis. Diaries were transcribed, analyzed deductively and inductively, and organized thematically. Uncertainty in day-to-day experiences was an important driver of HCC burden and unmet needs. Unmet needs included unclear/unmet expectations regarding hospice care team support; not understanding the extent of HCC role and involvement; and communication challenges with hospice team members. Sources of HCCs' burden were dissonance between how they "should" feel and how they actually felt; feeling alone/having no outlet to express feelings; concerns about their own health and subsequent patient impact; and feeling helpless/occupying a liminal space. Uncertainty surrounding HCCs' experiences encompassed interactions with hospice care teams and the nature of end-of-life caregiving with symptom management, the dying process, and the HCC role. Hospice care teams can respond to uncertainty through assessment, understanding, and recognition of the daily context of HCCs.
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Affiliation(s)
| | | | | | | | | | - Djin Tay
- University of Utah, College of Nursing
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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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11
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Sato T, Seto M, Sangai T, Norihiko S, Nishimiya H, Kikuchi M, Shimizu A, Iwamitsu Y. The effectiveness of pretreatment video-based psychoeducation for patients with breast cancer. Palliat Support Care 2023:1-8. [PMID: 37937345 DOI: 10.1017/s1478951523001372] [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: 11/09/2023]
Abstract
OBJECTIVES This study confirms the effectiveness of pretreatment video-based psychoeducation on stress management and relaxation in reducing depression, anxiety, and uncertainty among patients with breast cancer. METHODS We conducted a nonrandomized trial with 86 pretreatment patients with breast cancer who were divided equally into intervention and control groups, and stratified according to cancer stages and patient ages. Omitting the excluded participants, 35 intervention group and 36 control group participants were asked to complete the Hospital Anxiety and Depression Scale and Universal Uncertainty in Illness Scale (UUIS) before the psychoeducational intervention (baseline, hereafter "BL ") as well as 1 and 3 months later. Then, a 2 group (intervention and control groups) × 3 time points (BL and 1 and 3 months post-intervention) mixed models repeated measures (MMRM) analysis was implemented. RESULTS Analysis confirmed interaction between 2 group × 3 time points for depression, anxiety, and UUIS. Multiple comparisons revealed that each score in the intervention group was significantly lower 1 and 3 months post-intervention compared to BL. Meanwhile, in the control group, the depression score was significantly higher at 3 months post-intervention compared to pre-intervention. The anxiety scores and UUIS of the same group were not significantly different between 1 and 3 months post-intervention. The effect size values 3 months post-intervention were -0.57 for depression, -0.25 for anxiety, and 0.05 for uncertainty. SIGNIFICANCE OF RESULTS Pretreatment psychoeducation reduced depression, anxiety, and uncertainty in the intervention group of patients with breast cancer compared to the control group. The effect sizes at 3 months post-intervention were moderate for depression and small for anxiety. These results suggest the effectiveness of psychoeducation for patients with breast cancer, using videos on stress management and relaxation, early at the pretreatment stage.
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Affiliation(s)
- Toshiko Sato
- Department of Medical Psychology, Graduate School of Medical Sciences, Kitasato University, Kanagawa, Japan
| | - Makiko Seto
- Department of Nursing, Kitasato University Hospital, Kanagawa, Japan
| | - Takafumi Sangai
- Department of Breast and Thyroid Surgery, Kitasato University School of Medicine, Kanagawa, Japan
| | - Sengoku Norihiko
- Department of Breast and Thyroid Surgery, Kitasato University School of Medicine, Kanagawa, Japan
| | - Hiroshi Nishimiya
- Department of Breast Surgery, Sagamihara Kyodo Hospital, Kanagawa, Japan
| | - Mariko Kikuchi
- Department of Breast and Thyroid Surgery, Kitasato University School of Medicine, Kanagawa, Japan
| | - Ayaka Shimizu
- Department of Medical Psychology, Graduate School of Medical Sciences, Kitasato University, Kanagawa, Japan
| | - Yumi Iwamitsu
- Department of Medical Psychology, Graduate School of Medical Sciences, Kitasato University, Kanagawa, Japan
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12
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Hong S, Lee J, Lee J, Chang JH, Park CG, Kim TH. The Mediating Effect of Uncertainty in Illness on Cancer Coping in Patients With Primary Malignant Brain Tumors. Cancer Nurs 2023; 46:467-476. [PMID: 36480344 DOI: 10.1097/ncc.0000000000001177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Patients with primary malignant brain tumors (PMBTs) experience uncertainty in illness (UI) because of the high recurrence rate and symptoms that occur during treatment. OBJECTIVE To develop and test a model based on the Uncertainty in Illness Theory to predict the UI and cancer coping experienced by PMBT patients. METHODS This was a cross-sectional study using path analysis. The participants were adults diagnosed with PMBT who completed a questionnaire about demographic and disease-related characteristics, UI, cancer coping, brain tumor symptoms, and social support. Clinical data (eg, the diagnosis, tumor location, and grade) were obtained from electronic health records. Data were analyzed using SPSS 26.0 and the MVN , psych , and lavaan packages in R 4.1.0. RESULTS This study included 203 PMBT patients. The hypothesized model satisfied all statistical criteria (comparative fit index = 0.998, root mean square error of approximation = 0.044, standardized root mean square residual = 0.016). The indirect and direct associations of UI in the path from social support to cancer coping were all significant with a 95% bootstrapping confidence interval. Although the indirect and direct associations of UI in the path of brain tumor symptoms and cancer coping did not have direct or total effects, the indirect effect was statistically significant. CONCLUSIONS Uncertainty in illness mediated brain tumor symptoms and social support to predict cancer coping. IMPLICATIONS FOR PRACTICE A nurse-led intervention for cancer coping among PMBT patients can be developed by considering symptoms and social support and UI as a mediator.
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Affiliation(s)
- Soomin Hong
- Author Affiliations: College of Nursing and Brain Korea 21 FOUR Project (Dr Hong), Mo-Im Kim Nursing Research Institute, College of Nursing (Drs J. H. Lee and J. Lee), and Department of Neurosurgery, College of Medicine (Dr Chang), Yonsei University, Seoul, South Korea; College of Nursing, University of Illinois, Chicago (Dr Park); and Division of Nursing, Yongin Severance Hospital, Yonsei University Health System, Gyeonggi, South Korea (Dr Kim)
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13
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Wang F, Chen J, Wang W, Li M, Peng C, Pan S, Zhan C, Zhao K, Li Y, Zhang L, Xu G, Jin J. Quantitative Analysis of Quality of Life and Exploration of Influencing Factors in Patients Undergoing Radical Prostatectomy. Urology 2023; 181:105-111. [PMID: 37586423 DOI: 10.1016/j.urology.2023.06.035] [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: 05/03/2023] [Revised: 06/28/2023] [Accepted: 06/29/2023] [Indexed: 08/18/2023]
Abstract
OBJECTIVE To quantify and evaluate the quality of life of patients undergoing radical prostatectomy using the FACT-P scoring system, and to explore the predictive factors for postoperative quality of life. METHODS Clinical data of 249 patients who underwent radical prostatectomy in our hospital from January 2021 to October 2022 were analyzed. According to the surgical method and whether the subjective quality of life of the patient decreased significantly, the patients were divided into groups, and the predictive factors for changes in subjective quality of life after surgery were analyzed. RESULTS A total of 192 cases were finally obtained (45 cases of fascia internal approach, 147 cases of traditional radical prostatectomy), and patients who underwent fascia internal approach (FACT-P: 110.15 ± 10.55) had better postoperative quality of life than those who underwent extra-fascial radical prostatectomy (FACT-P: 102.30 ± 6.75) (P < .01). One hundred fourteen patients reported a decrease in subjective quality of life, while 78 did not. The preoperative FACT-P score was an independent predictive factor (OR=0.719, P < .01), and when the preoperative score was <116 points, the possibility of no decrease in quality of life after surgery was higher. CONCLUSION Fascia internal approach should be performed as much as possible for suitable surgical patients, and for patients with a preoperative FACT-P score ≥116 points, the possibility of a decrease in quality of life after surgery should be fully communicated.
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Affiliation(s)
- Feiyang Wang
- Department of Urology, Shaoxing People's Hospital, Shaoxing, Zhejiang, China
| | - Jiajun Chen
- Department of Urology, Shaoxing People's Hospital, Shaoxing, Zhejiang, China.
| | - Weihao Wang
- Department of Urology, Shaoxing People's Hospital, Shaoxing, Zhejiang, China
| | - Mengyao Li
- Department of Pathology, Shaoxing People's Hospital, Shaoxing, Zhejiang, China
| | - Chao Peng
- Department of Urology, Shaoxing People's Hospital, Shaoxing, Zhejiang, China
| | - Shouhua Pan
- Department of Urology, Shaoxing People's Hospital, Shaoxing, Zhejiang, China
| | - Chuanchuan Zhan
- Department of Urology, Shaoxing People's Hospital, Shaoxing, Zhejiang, China
| | - Keyuan Zhao
- Department of Urology, Shaoxing People's Hospital, Shaoxing, Zhejiang, China
| | - Yulei Li
- Department of Urology, Shaoxing People's Hospital, Shaoxing, Zhejiang, China
| | - Lulu Zhang
- Scientific Research Center,Shaoxing People's Hospital, Shaoxing, Zhejiang, China
| | - Gang Xu
- Department of Urology, Shaoxing People's Hospital, Shaoxing, Zhejiang, China
| | - Jing Jin
- Department of Urology, Shaoxing People's Hospital, Shaoxing, Zhejiang, China
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14
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Hao R, Zhang M, Zuo J, Qi Y, Hu J. Contribution of coping style to the association between illness uncertainty and demoralisation in patients with breast cancer: a cross-sectional mediation analysis. BMJ Open 2023; 13:e065796. [PMID: 36927587 PMCID: PMC10030480 DOI: 10.1136/bmjopen-2022-065796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
Abstract
OBJECTIVE Demoralisation is a common psychological issue in patients with cancer and aggravates depression, reduces the quality of life and even causes suicidal ideation. There is a lack of knowledge about illness uncertainty, coping style and demoralisation in patients with breast cancer. The current study explored the relationship between illness uncertainty and demoralisation among those patients, as well as the potential mediating role of coping style. DESIGN A cross-sectional study. SETTING Participants were recruited from the Breast Tumor Center in a tertiary hospital in Shijiazhuang, Hebei province. PARTICIPANTS A total of 211 patients with breast cancer completed the survey. OUTCOME MEASURES A total of 211 patients with breast cancer completed the Mishel's Uncertainty in Illness Scale, Trait Coping Style Questionnaire and the Mandarin version of Demoralization Scale (DS-MV). RESULTS Of the patients, 47.40% exhibited symptoms of demoralisation (DS-MV>30), and the mean of demoralisation score was (29.55±13.21). The results demonstrated that illness uncertainty and negative coping styles were positively related to demoralisation (p<0.001), while active coping styles were negatively related to demoralisation (p<0.001). Importantly, coping styles could partially mediate the relationship between illness uncertainty and demoralisation (p<0.01). CONCLUSION Our study illustrated that illness uncertainty was associated with demoralisation in patients with breast cancer, and coping style acted as a mediator in this relationship. The findings highlighted the critical role of reducing negative coping styles to the early prevention and efficient treatment of demoralisation among those patients.
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Affiliation(s)
- Ran Hao
- School of Nursing, Hebei Medical University, Shijiazhuang, Hebei, China
| | - Meng Zhang
- School of Nursing, Hebei Medical University, Shijiazhuang, Hebei, China
- Critical Medicine, Hospital of Qingdao University, Qingdao, Shandong, China
| | - Jinfan Zuo
- School of Nursing, Hebei Medical University, Shijiazhuang, Hebei, China
| | - Yixin Qi
- Department of Breast Center, The Fourth Hospital of Hebei Medical University Cancer Institute, Shijiazhuang, Hebei, China
| | - Jie Hu
- Department of Science and Technology, Hebei Medical University, Shijiazhuang, Hebei, China
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15
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Chou YJ, Wang YC, Lin BR, Shun SC. Resilience process in individuals with colorectal cancer: a qualitative study. Qual Life Res 2023; 32:681-690. [PMID: 36050622 DOI: 10.1007/s11136-022-03242-8] [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: 08/22/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE Resilience is a positive outcome in giving individuals strength to adapt to cancer and have better various aspects of health-related quality of life. However, research focusing on resilience in relation to colorectal cancer (CRC) is limited. Therefore, the aim of this study was to explore the process of resilience in individuals with CRC. METHOD Sixteen individuals diagnosed with stage Ι to III CRC within the last five years were recruited from a CRC surgical outpatient department in a medical center in Northern Taiwan. Semi-structured interviews were used to explore the resilience process of living with CRC. Recorded interviews were transcribed verbatim and were analyzed using modified grounded theory. FINDINGS Resilience is a dynamic three-phase process, including impact of CRC, adaptation or maladaptation following CRC, and growth from CRC experience. Resilience strategies (i.e., attitude adjustment, developing personal strategies to conquer CRC and side effects, setting new goals in life, and viewing death as a normal process), avoidance behaviors, and passive waiting strategy were shown across the resilience process. CONCLUSIONS All individuals showed negative impacts during CRC diagnosis and treatments, but some individuals used the resilience strategies in helping to promote positive adjustment and redirect to develop their resilience process. Furthermore, resilient and maladaptive individuals may change the situation depending on which strategies are used and on the progression of CRC because resilience is dynamic. Oncology clinicians should help individuals use resilience strategies to smoothly go through the resilience process.
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Affiliation(s)
- Yun-Jen Chou
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Division of Colon and Rectal Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Ya-Ching Wang
- School on Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Been-Ren Lin
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.,College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Shiow-Ching Shun
- School of Nursing, Institute of Clinical Nursing, National Yang Ming Chiao Tung University, No.155, Sec.2, Li-Nong Street, Taipei, 112, Taiwan.
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16
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Oftedal A, Bekkhus M, Haugen GN, Czajkowski NO, Kaasen A. The impact of diagnosed fetal anomaly, diagnostic severity and prognostic ambiguity on parental depression and traumatic stress: a prospective longitudinal cohort study. Acta Obstet Gynecol Scand 2022; 101:1291-1299. [PMID: 36106375 PMCID: PMC9812208 DOI: 10.1111/aogs.14453] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 06/06/2022] [Accepted: 08/24/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION The detection of a fetal anomaly during routine obstetric ultrasound is a potentially traumatic experience. The aim of this study is to examine longitudinally the impact of diagnosis of fetal anomaly on symptoms of depression and traumatic stress among mothers and fathers, and to examine how variations in psychological adjustment relate to diagnostic severity and prognostic ambiguity. MATERIAL AND METHODS In this prospective observational study conducted at a tertiary perinatal referral center, 81 mothers and 69 fathers with ultrasound findings of fetal anomaly completed the Edinburgh Postnatal Depression Scale (EPDS) and Impact of Events Scale (IES) at four time points in pregnancy (T1-T4) and 6 weeks after birth (T5). We compared this with depression and traumatic stress in a sample of non-affected parents (n = 110 mothers, 98 fathers). RESULTS Linear mixed effects models indicated that parents who received a diagnosis of fetal anomaly experienced higher levels of depression and traumatic stress over time, compared with non-affected parents. Depression: mean difference mothers = 4.46 ± 0.47, fathers = 2.80 ± 0.42. Traumatic stress: mean difference mothers = 20.04 ± 2.13, fathers = 12.66 ± 1.74. Parents with a more severe diagnosis experienced elevated symptoms compared with parents with a less severe diagnosis. Among mothers, prognostic ambiguity and changes in the anticipated diagnosis after birth were also associated with increased distress, regardless of whether the change was for the better or worse. CONCLUSIONS Diagnosis of fetal anomaly increases risk of depression and traumatic stress in expectant mothers and fathers, both acutely and over time.
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Affiliation(s)
- Aurora Oftedal
- Faculty of Health SciencesOslo Metropolitan UniversityOsloNorway
| | - Mona Bekkhus
- Department of PsychologyPromenta Research Center, University of OsloOsloNorway
| | - Guttorm Nils Haugen
- Division of Obstetrics and GynecologyOslo University HospitalOsloNorway,Institute of Clinical Medicine, University of OsloOsloNorway
| | - Nikolai Olavi Czajkowski
- Department of PsychologyPromenta Research Center, University of OsloOsloNorway,Norwegian Institute of Public HealthOsloNorway
| | - Anne Kaasen
- Faculty of Health SciencesOslo Metropolitan UniversityOsloNorway
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17
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Fisher CL, Kastrinos A, Curley A, Canzona MR, Piemonte N, Wolf B, Pipe T. Helping Diagnosed Mothers and Their Adolescent-Young Adult Daughters Navigate Challenging Breast Cancer Conversations. CANCER CARE RESEARCH ONLINE 2022; 2:e025. [PMID: 38239410 PMCID: PMC10795856 DOI: 10.1097/cr9.0000000000000025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2024]
Abstract
Background Mothers diagnosed with breast cancer describe daughters as a critical source of support. Talking about breast cancer is especially distressing and challenging for mothers and their adolescent-young adult (AYA) daughters. Objective The over-arching study aim was to generate findings to integrate into an intervention to enhance diagnosed mothers' and AYA daughters' communication skills by identifying approaches they find helpful when talking about cancer. Methods We recruited 27 women (12 dyads). Diagnosed mothers and their AYA daughters (aged 18-29) participated in individual, in-depth, semi-structured interviews. Transcripts were thematically analyzed. Mothers'/daughters' perspectives were compared/ triangulated. Results Both mothers and daughters identified 3 approaches that helped them navigate cancer communication: (mothers) initiate conversations, keep communication positive, and limit cancer conversations. Only mothers reported it was helpful to downplay the seriousness of cancer. Only daughters identified it was important for them to reframe their perspective of mothers' disclosures. Conclusions Findings provide clinicians like nurses and families with a "psychosocial map" of communication approaches and associated strategies mothers and AYA daughters can use to talk about breast cancer in ways that promote daughters' comfort and/or alleviate distress. Implications for Practice Findings capture communication skills to focus on when tailoring developmentally focused interventions targeting diagnosed mothers and AYA daughters. Nurses can translate findings into practice to help patients talk to AYA daughters about cancer, thereby promoting a family-centered cancer care approach. What Is Foundational: AYA daughters are especially distressed talking about cancer with their diagnosed mothers. They can both use communication strategies to enhance their communal coping.
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Affiliation(s)
- Carla L. Fisher
- University of Florida, College of Journalism and Communications & College of Medicine, UF Health Cancer Center, Gainesville, Florida
| | | | - Alana Curley
- University of Florida, College of Journalism and Communications & College of Medicine, UF Health Cancer Center, Gainesville, Florida
| | - Mollie R. Canzona
- Wake Forest University, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Nicole Piemonte
- Creighton University, School of Medicine, Phoenix Regional Campus, Phoenix, Arizona
| | - Bianca Wolf
- University of Puget Sound, Tacoma, Washington
| | - Teri Pipe
- Arizona State University, Phoenix, Arizona
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18
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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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19
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Dong W, Lei X, Liu Y. The Mediating Role of Patients' Trust Between Web-Based Health Information Seeking and Patients' Uncertainty in China: Cross-sectional Web-Based Survey. J Med Internet Res 2022; 24:e25275. [PMID: 35275074 PMCID: PMC8956986 DOI: 10.2196/25275] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 05/08/2021] [Accepted: 12/27/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In the physician-patient relationship, patients' uncertainty about diseases and the lack of trust in physicians not only hinder patients' rehabilitation but also disrupt the harmony in this relationship. With the development of the web-based health industry, patients can easily access web-based information about health care and physicians, thus reducing patients' uncertainty to some extent. However, it is not clear how patients' web-based health information-seeking behaviors reduce their uncertainty. OBJECTIVE On the basis of the principal-agent theory and the perspective of uncertainty reduction, this study aims to investigate the mechanism of how web-based disease-related information and web-based physician-related information reduce patients' uncertainty. METHODS A web-based survey involving 337 participants was conducted. In this study, we constructed a structural equation model and used SmartPLS (version 3.3.3; SmartPLS GmbH) software to test the reliability and validity of the measurement model. The path coefficients of the structural model were also calculated to test our hypotheses. RESULTS By classifying patients' uncertainties into those concerning diseases and those concerning physicians, this study identified the different roles of the two types of patients' uncertainty and revealed that web-based disease-related information quality and web-based physician-related information can act as uncertainty mitigators. The quality of disease-related information reduces patients' perceived information scarcity about the disease (β=-.588; P<.001), and the higher the information scarcity perceived by patients, the higher their uncertainty toward the disease (β=.111; P=.02). As for physician-related information, web-based word-of-mouth information about physicians reduces patients' perceived information scarcity about the physician (β=-.511; P<.001), mitigates patients' fears about physician opportunism (β=-.268; P<.001), and facilitates patients' trust (β=.318; P<.001). These factors further influence patients' uncertainty about the physician. In addition, from the test of mediating effect, patients' trust in the physician fully mediates the relationship between their perceived information scarcity about the physician's medical service and their uncertainty about the physician. Patients' trust also partially mediates the relationship between their fear of the physician's opportunism and their uncertainty about the physician. As for the two different types of uncertainty, patients' uncertainty about the physician also increases their uncertainty about the diseases (β=.587; P<.001). CONCLUSIONS This study affirms the role of disease-related web-based information quality and physician-related web-based word-of-mouth information in reducing patients' uncertainties. With regard to the traits of principal-agent relationships, this study describes the influence mechanism based on patients' perceived information scarcity, fears of physicians' opportunism, and patients' trust. Moreover, information about physicians is effective in reducing patients' uncertainties, but only if the information enhances patients' trust in their physicians. This research generates new insights into understanding the impact of web-based health information on patients' uncertainties.
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Affiliation(s)
- Wei Dong
- School of Business, Central South University, Changsha, China.,Department of Information Systems, City University of Hong Kong, Hong Kong, Hong Kong
| | - Xiangxi Lei
- China Mobile Group Hunan Company Limited, Changsha, China
| | - Yongmei Liu
- School of Business, Central South University, Changsha, China
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20
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Boyle MP, Chagachbanian NJ. Uncertainty and Perceived Control as Predictors of Communicative Participation and Mental Health in Adults Who Stutter. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:757-769. [PMID: 35007427 DOI: 10.1044/2021_ajslp-21-00230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE This study examined the role of uncertainty and perceived control in predicting the communicative participation and mental health of adults who stutter. METHOD Two hundred sixty-nine adults who stutter completed measures of uncertainty about stuttering, perceived control of stuttering, communicative participation, and global mental health. In addition, participants self-reported on a variety of demographic and speech-related measures. Correlational analyses and hierarchical regression were performed to determine associations between variables of interest. RESULTS Uncertainty accounted for significant variance in communicative participation and global mental health after statistically controlling for the effects of demographic and speech-related variables. Perceived control accounted for significant variance in communicative participation over and above what was accounted for by demographic variables, speech-related variables, and uncertainty. CONCLUSIONS The findings suggest that uncertainty about stuttering and perceived control of stuttering should be accounted for during assessment and intervention with adults who stutter. Interventions that specifically target uncertainty and perceived control may be useful in improving therapeutic outcomes for individuals who stutter.
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Affiliation(s)
- Michael P Boyle
- Department of Communication Sciences and Disorders, Montclair State University, Bloomfield, NJ
| | - Nicole J Chagachbanian
- Department of Communication Sciences and Disorders, Montclair State University, Bloomfield, NJ
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21
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Psychological variables associated with quality of life in patients with head and neck cancer: the role of body image distress. Support Care Cancer 2022; 30:9127-9139. [PMID: 35997811 PMCID: PMC9633472 DOI: 10.1007/s00520-022-07334-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 08/15/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVE The aim of this cross-sectional study was to explore the relationship between quality of life (QoL) and body image distress in patients with head and neck cancer (HNC), considering relevant psychological variables (i.e., coping strategies, social anxiety symptoms, self-esteem, intolerance of uncertainty, pain, and distress). We also aimed to explore gender differences in patients with HNC in terms of relevant psychological variables in HNC. METHODS Fifty-one HNC patients (37 males and 14 females) completed self-report questionnaires to assess body image distress, physical and mental QoL, and relevant psychological variables in HNC (coping strategies, social anxiety symptoms, self-esteem, intolerance of uncertainty, pain, and distress) before undergoing treatment. Pearson's correlations and four-step hierarchical regressions were performed to assess the relationship between body image distress, QoL, and the abovementioned psychological variables, while one-way analyses of variance and one-way analysis of covariance were employed to assess gender differences. RESULTS Physical QoL was associated with body image distress above and beyond disease duration, distress, coping strategies, pain, mental QoL, and self-esteem, while mental QoL was associated with pain above and beyond distress, coping strategies, physical QoL, self-esteem, and body image distress. Concerning gender differences, females scored higher than males on most of the explored psychological variables, except for physical QoL and intolerance of uncertainty, and showed lower mental QoL and self-esteem than males. CONCLUSION Body image distress and pain emerged as negatively associated with QoL, and almost all the explored psychological variables differed among genders. Psychological interventions targeting body image distress and pain should be promoted in patients with HNC to increase their QoL, while keeping gender differences in mind.
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22
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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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Yoon Y, Park MA, Park S. Seeking adaptation from uncertainty: Coping strategies of South Korean women with endometriosis. Res Nurs Health 2021; 44:970-978. [PMID: 34610161 DOI: 10.1002/nur.22186] [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: 06/10/2021] [Revised: 09/14/2021] [Accepted: 09/22/2021] [Indexed: 11/10/2022]
Abstract
Women with endometriosis may experience uncertainty owing to the characteristics of the disease, including vague symptom patterns, delayed diagnosis, and long-term management with no cure. However, women use various coping strategies to adapt to the uncertainty caused by their endometriosis. This descriptive qualitative study explored the coping experiences of women with endometriosis to reduce their uncertainty about the disease and to achieve successful adaptation to their lives with endometriosis. By using convenience and purposive sampling methods, qualitative data were collected from 14 women in South Korea (mean age = 37.7 years, age range = 27-54 years), who were diagnosed with endometriosis through laparoscopy or open surgery. All interview data were thematically analyzed. Four themes were identified as adaptive coping experiences: (1) gaining self-control over the ambiguous disease; (2) regaining the daily routines destroyed by the disease; (3) being emotionally supported and expressing oneself when feeling unsupported by society; and (4) taking an active role in one's treatment plan by being self-directed. Patients' sense of self-control and self-directedness regarding the disease and the treatment process were important to adapt to life with endometriosis. In addition, regaining stable daily routines as well as being emotionally supported were critical for decreasing their uncertainty. This paper has widespread implications, including the need for training or a continuing education program for health professionals to enhance their competencies when caring for women with endometriosis and the need for social efforts to increase awareness of the disease.
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Affiliation(s)
- Youngsub Yoon
- College of Nursing, Incheon Catholic University, Incheon, South Korea
| | - Min-Ae Park
- Department of Nursing, Kyungbuk College, Yeongju-si, South Korea
| | - Sihyun Park
- Department of Nursing, Chung-Ang University, Seoul, South Korea
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Cal A, Aydin Avci I. Turkish adaptation of the Mishel uncertainty in illness scale-community form. Perspect Psychiatr Care 2021; 57:2006-2013. [PMID: 34121185 DOI: 10.1111/ppc.12874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 05/12/2021] [Accepted: 05/13/2021] [Indexed: 11/28/2022] Open
Abstract
PURPOSE The study aims to conduct the Turkish validity and reliability study of the Mishel uncertainty in illness scale-community form. DESIGN AND METHODS This is a study with a methodological design. It was carried out in a family health center in a province in the Black Sea Region between May and October 2019. The sample of the study consisted of 479 individuals with chronic diseases. The data were analyzed with exploratory and confirmatory factor analysis. FINDINGS The Cronbach's alpha was found to be 0.79. The fit indices of the 20-item scale with three-factor structure are at an acceptable level (root mean square error of approximation: 0.056; comparative fit index: 0.926; incremental fix index: 0.927; goodness of fit index: 0.918; Tucker-Lewis index: 0.915; adjusted goodness of fit index: 0.896; χ2 /SD: 2.481, p < 0.001). PRACTICE IMPLICATIONS The level of uncertainty revealed by the scale gives information about the chronic disease management of individuals.
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Affiliation(s)
- Ayse Cal
- Department of Nursing, Ankara Medipol University School of Health Sciences, Ankara, Turkey
| | - Ilknur Aydin Avci
- Department of Public Health Nursing, Ondokuz Mayıs University Health School, Samsun, Turkey
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25
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Lan CF, Nie CL, Lin YJ. Uncertainty in illness and the coping styles of severe patients with COVID-19: Current status and correlation. Epidemiol Infect 2021; 149:1-22. [PMID: 34233777 PMCID: PMC8365106 DOI: 10.1017/s0950268821001448] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 06/06/2021] [Accepted: 06/28/2021] [Indexed: 11/30/2022] Open
Abstract
This study aimed to investigate the characteristics of uncertainty in illness and the coping styles of patients with severe coronavirus 2019 (COVID-19) and to explore their relationship to provide effective guidance for clinical nursing. A cross-sectional survey was used to investigate 56 severe patients with COVID-19 in a designated hospital in Wuhan. A general information questionnaire, the Mishel Uncertainty in Illness Scale for Adults (MUIS-A) and the Medical Coping Modes Questionnaire (MCMQ) were used to collect the data. A statistical analysis was performed. The total score of the MUIS-A was a 66.29 ± 17.25 which was at a low level, while the total score of the MCMQ was 54.16 ± 6.39. The scores of facing and avoiding were significantly higher than those in the norm. The difference in the yielding dimension of patients with different family economic situations was statistically significant. The total score of MUIS-A correlated negatively with the coping style of facing and avoiding and positively correlated with the coping style of yielding. The coping style of patients was one of the factors influencing uncertainty in illness. Nursing staff need to pay close attention to the psychological state of their patients, understand their coping styles and actively correct negative coping styles to reduce the uncertainty in illness and promote physical as well as mental recovery.
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Affiliation(s)
- Cai-Feng Lan
- Department of Gynecology, Fujian Medical University Union Hospital, Fuzhou350001, China
| | - Cai-Ling Nie
- Department of Gynecology, Fujian Medical University Union Hospital, Fuzhou350001, China
| | - Yan-Juan Lin
- Department of Nursing, Fujian Medical University Union Hospital, Fuzhou350001, China
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26
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Dong L, Chen L, Ding S. Illness uncertainty among patients with COVID-19 in the Mobile Cabin Hospital. Nurs Open 2021; 9:1456-1464. [PMID: 34000092 PMCID: PMC8242768 DOI: 10.1002/nop2.924] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 03/16/2021] [Accepted: 04/14/2021] [Indexed: 12/13/2022] Open
Abstract
Aims To investigate the status and influencing factors of illness uncertainty among patients with coronavirus disease 2019 (COVID‐19) in the mobile cabin hospital. Design A cross‐sectional study. Methods 114 patients with COVID‐19 admitted to a mobile cabin hospital in Wuhan, Hubei Province, in February 2020 were enrolled by a convenience sampling method. The Chinese version of the Mishel Illness Uncertainty Scale (MUIS) was used to assess patients’ degree of illness uncertainty, and multiple regression analysis was used to explore the influencing factors. Results The average total score of MUIS (Chinese version) was 52.22 ± 12.51, indicating a moderate level of illness uncertainty. The dimension unpredictability turned out to have the highest mean score: 2.88 ± 0.90. The multiple stepwise regression analysis showed that female (t = 2.462, p = .015), monthly family income not less than RMB 10,000 (t = −2.095, p = .039), and disease duration of 28 days or more (t = 2.249, p = .027) were independent influencing factors of illness uncertainty. Conclusion Patients with COVID‐19 are at a moderate level of illness uncertainty. Medical staffs should pay more attention to female patients, patients with lower monthly family income, patients with the prolonged disease, and take targeted interventions to help them reduce illness uncertainty. Impact Facing the brand new and unknown infectious disease, patients confirmed of COVID‐19 suffer from immense physical and psychological stress, where illness uncertainty is a major stressor that troubles patients. The present study surveys illness uncertainty among patients with COVID‐19 in the mobile cabin hospital with results revealing a moderate level. Study results will benefit nurses in any setting where care for patients with COVID‐19 is provided, public policymakers and future researchers.
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Affiliation(s)
- Liang Dong
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Lei Chen
- Renmin Hospital of Wuhan University, Wuhan, China
| | - Shu Ding
- Heart Center & Beijing Key Laboratory of Hypertension, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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27
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Krug K, Bossert J, Deis N, Krisam J, Villalobos M, Siegle A, Jung C, Hagelskamp L, Unsöld L, Jünger J, Thomas M, Wensing M. Effects of an Interprofessional Communication Approach on Support Needs, Quality of Life, and Mood of Patients with Advanced Lung Cancer: A Randomized Trial. Oncologist 2021; 26:e1445-e1459. [PMID: 33860592 PMCID: PMC8342586 DOI: 10.1002/onco.13790] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 04/02/2021] [Indexed: 12/16/2022] Open
Abstract
Background To address the support needs of newly diagnosed patients with lung cancer with limited prognosis, the Milestone Communication Approach (MCA) was developed and implemented. The main elements of the MCA are situation‐specific conversations along the disease trajectory conducted by an interprofessional tandem of physician and nurse. The aim of the study was to evaluate the effects of MCA on addressing support needs, quality of life, and mood as compared with standard oncological care. Patients and Methods A randomized trial was conducted with baseline assessment and follow‐up assessments at 3, 6, and 9 months in outpatients with newly diagnosed lung cancer stage IV at a German thoracic oncology hospital. The primary outcome was the Health System and Information Needs subscale of the Short Form Supportive Care Needs Survey (SCNS‐SF34‐G) at 3‐month follow‐up. Secondary outcomes included the other subscales of the SCNS‐SF34‐G, the Schedule for the Evaluation of Individual Quality of Life, the Functional Assessment of Cancer Therapy lung module, the Patient Health Questionnaire for Depression and Anxiety, and the Distress Thermometer. Results At baseline, 174 patients were randomized, of whom 102 patients (MCA: n = 52; standard care: n = 50) provided data at 3‐month follow‐up. Patients of the MCA group reported lower information needs at 3‐month follow‐up (mean ± SD, 33.4 ± 27.5; standard care, 43.1 ± 29.9; p = .033). No effects were found for secondary outcomes. Conclusion MCA lowered patient‐reported information needs but did not have other effects. MCA contributed to tailored communication because an adequate level of information and orientation set the basis for patient‐centered care. Implications for Practice By addressing relevant issues at predefined times, the Milestone Communication Approach provides individual patient‐centered care facilitating the timely integration of palliative care for patients with a limited prognosis. The needs of patients with lung cancer must be assessed and addressed throughout the disease trajectory. Although specific topics may be relevant for all patients, such as information about the disease and associated health care, situations of individual patients and their families must be considered. Additionally, using the short form of the Supportive Care Needs Survey in clinical practice to identify patients’ problems might support individually targeted communication and preference‐sensitive care. Addressing patient information needs in a timely fashion is of paramount importance for preference‐sensitive decisions and patient‐centered care. This article evaluates the Milestone Communication Approach to oncological care.
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Affiliation(s)
- Katja Krug
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Jasmin Bossert
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany.,Thoracic Clinic, Department of Thoracic Oncology, Translational Lung Research Center Heidelberg (TLRC-H), German Center for Lung Research (DZL), University Hospital Heidelberg, Heidelberg, Germany
| | - Nicole Deis
- Thoracic Clinic, Department of Thoracic Oncology, Translational Lung Research Center Heidelberg (TLRC-H), German Center for Lung Research (DZL), University Hospital Heidelberg, Heidelberg, Germany
| | - Johannes Krisam
- Institute of Medical Biometry and Informatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Matthias Villalobos
- Thoracic Clinic, Department of Thoracic Oncology, Translational Lung Research Center Heidelberg (TLRC-H), German Center for Lung Research (DZL), University Hospital Heidelberg, Heidelberg, Germany
| | - Anja Siegle
- Thoracic Clinic, Department of Thoracic Oncology, Translational Lung Research Center Heidelberg (TLRC-H), German Center for Lung Research (DZL), University Hospital Heidelberg, Heidelberg, Germany
| | - Corinna Jung
- Thoracic Clinic, Department of Thoracic Oncology, Translational Lung Research Center Heidelberg (TLRC-H), German Center for Lung Research (DZL), University Hospital Heidelberg, Heidelberg, Germany.,Medical School Berlin, Berlin, Germany
| | - Laura Hagelskamp
- Thoracic Clinic, Department of Thoracic Oncology, Translational Lung Research Center Heidelberg (TLRC-H), German Center for Lung Research (DZL), University Hospital Heidelberg, Heidelberg, Germany
| | - Laura Unsöld
- Thoracic Clinic, Department of Thoracic Oncology, Translational Lung Research Center Heidelberg (TLRC-H), German Center for Lung Research (DZL), University Hospital Heidelberg, Heidelberg, Germany
| | - Jana Jünger
- German National Institute for State Examinations in Medicine, Pharmacy, and Psychotherapy, Mainz, Germany
| | - Michael Thomas
- Thoracic Clinic, Department of Thoracic Oncology, Translational Lung Research Center Heidelberg (TLRC-H), German Center for Lung Research (DZL), University Hospital Heidelberg, Heidelberg, Germany
| | - Michel Wensing
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
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28
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Sisk BA, Friedrich AB, DuBois J, Mack JW. Characteristics of uncertainty in advanced pediatric cancer conversations. PATIENT EDUCATION AND COUNSELING 2021; 104:1066-1074. [PMID: 33109428 PMCID: PMC8052385 DOI: 10.1016/j.pec.2020.10.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/11/2020] [Accepted: 10/05/2020] [Indexed: 05/14/2023]
Abstract
OBJECTIVES To describe the initiation, response, and content of communication about uncertainty in advanced pediatric cancer. METHODS Qualitative analysis of 35 audio-recorded outpatient consultations between physicians and families of children whose cancer recently progressed. We defined uncertainty as "future-oriented lack of clarity in which answers are unknown to all participants involved in the conversation." RESULTS Conversations contained a median of 14 (interquartile range 8.5-19) uncertainty statements related to 6 topics: appropriateness of treatments, acute toxicities and morbidities, prognosis or response to treatment, diagnostic uncertainty, logistical uncertainty, and long-term toxicities. Physicians initiated 63 % of statements (303/489), parents initiated 33 % (165/489), and children initiated 2% (10/489). We identified 14 unique responses to uncertainty: 11 responses provided space for discussion, 3 responses reduced space. Physicians most commonly responded by providing additional information (38 %, 361/947). Parents most often responded with continuing statements, such as "um" or "yeah" (50 %, 313/622). Children seldom responded (<1%, 12/1697). CONCLUSION Physicians initiated most uncertainty discussions, and their responses often provided space for further discussion. Children were seldom involved in these conversations. PRACTICE IMPLICATIONS Clinicians should consider maintaining open conversations about uncertainties in advanced pediatric cancer, and consider engaging children in these discussions.
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Affiliation(s)
- Bryan A Sisk
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA.
| | - Annie B Friedrich
- Albert Gnaegi Center for Health Care Ethics, Saint Louis University, St. Louis, MO, USA
| | - James DuBois
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Jennifer W Mack
- Pediatric Oncology and Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts, and Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA
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29
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Lucas AH, Dimmer A. Palliative Integration Into Ambulatory Oncology: An Advance Care Planning Quality Improvement Project. J Adv Pract Oncol 2021; 12:376-386. [PMID: 34123475 PMCID: PMC8163253 DOI: 10.6004/jadpro.2021.12.4.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Advance care planning (ACP) is essential to ensuring that patient-centered end-of-life goals are respected if a health crisis occurs. Advanced practitioner barriers to ACP include insufficient time and limited confidence in discussions. The purpose of this quality improvement project was to increase advanced cancer patients' electronic health record (EHR) documented surrogate decision maker and ACP documentation by 25% over 8 weeks. A secondary aim was to decrease patients' decisional conflict scores (DCS) related to life-sustaining treatment preferences after a clinical nurse specialist (CNS)-led ACP session. Using the define, measure, analyze, improve, and control (DMAIC) process of quality improvement methodology, an interprofessional team led by a palliative CNS fostered practice change by (a) incorporating a patient self-administered Supportive Care and Communication Questionnaire (SCCQ) to standardize the ACP assessment, (b) creating an EHR nursing and provider documentation template, (c) offering advanced cancer patients a palliative CNS consultation for ACP review and advance directive completion, and (d) evaluating patients' DCS through the four-item SURE tool. Of 126 participants provided with the SCCQ, 90 completed the document, resulting in a 71% return rate. Among the completed SCCQs, 37% (n = 33) requested a CNS consultation, with 76% (n = 25) returning for the ACP session. The CNS intervention yielded an average reduction of 1.4 points in SURE tool findings, a statistically significant decrease determined by a paired sample t-test. The project's interprofessional collaboration promoted a system-wide standardized ACP process throughout ambulatory, acute, and post-hospital settings.
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Affiliation(s)
- Amanda Hudson Lucas
- From University of South Alabama, Mobile, Alabama, and Benefis Medical Group, Great Falls, Montana
| | - Amy Dimmer
- University of South Alabama, Mobile, Alabama
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30
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Woods JA, Katzenellenbogen JM, Murray K, Johnson CE, Thompson SC. Occurrence and timely management of problems requiring prompt intervention among Indigenous compared with non-Indigenous Australian palliative care patients: a multijurisdictional cohort study. BMJ Open 2021; 11:e042268. [PMID: 33727263 PMCID: PMC7970279 DOI: 10.1136/bmjopen-2020-042268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES Anticipation and prompt relief of symptoms among patients with a life-limiting illness is a core element of palliative care. Indigenous Australians commonly encounter cultural barriers in healthcare that may impair outcomes. The Palliative Care Outcomes Collaboration collects patient care data for the purposes of continuous quality improvement and benchmarking, with each recorded care episode divided into phases that reflect a patient's condition. We aimed to investigate differences between Indigenous and non-Indigenous patients in the occurrence and duration of 'unstable' phases (which indicate unanticipated deterioration in a patient's condition or circumstances), and determine attainment of the relevant benchmark (resolution of unstable phases in ≤3 days in 90% of cases) for both groups. DESIGN Cohort study. SETTING Australia-wide hospital-based and community-based specialist palliative care (1 January 2010 to 30 June 2015). PARTICIPANTS 139 556 (1502 Indigenous and 138 054 non-Indigenous) adult patients. OUTCOME MEASURES Indigenous and non-Indigenous patients were compared on (1) the risk of a phase being categorised as unstable, (2) the duration of unstable phases, and (3) the risk of unstable phases being prolonged (>3 days). Crude and adjusted estimates were produced from three-level robust Poisson regression and complementary log-log discrete time survival models. RESULTS Unstable phases occurred with similar frequency overall among Indigenous and non-Indigenous patients (adjusted relative risks 1.06; 95% CI 1.00 to 1.11; not significant after correction for multiple comparisons). The duration and risk of prolongation of unstable phases were similar in both patient groups, with no significant differences evident among subgroups. The benchmark was not met for either Indigenous or non-Indigenous patients (unstable phase duration >3 days in 24.3% vs 25.5%; p=0.398). CONCLUSIONS Despite well-documented shortcomings of healthcare for Indigenous Australians, there is no clear evidence of greater occurrence or prolongation of unanticipated problems among Indigenous patients accessing specialist palliative care services in hospital or the community.
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Affiliation(s)
- John A Woods
- Western Australian Centre for Rural Health, School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Judith M Katzenellenbogen
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Kevin Murray
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Claire E Johnson
- The Australian Health Services Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
- School of Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia
- Eastern Health, Melbourne, Victoria, Australia
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Sandra C Thompson
- Western Australian Centre for Rural Health, School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
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Lin H, Chan SWC, Ye M, Wang Y, Liu H, Li M, Liu S, Zhu J. A multi-centre randomized controlled trial of mobile gynaecological cancer support program for patients with gynaecological cancer undergoing chemotherapy: Study protocol. J Adv Nurs 2021; 77:2539-2548. [PMID: 33624337 DOI: 10.1111/jan.14809] [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: 01/13/2021] [Accepted: 02/03/2021] [Indexed: 11/29/2022]
Abstract
AIM Patients with gynaecological cancer often experience high levels of uncertainty in illness during chemotherapy and report unmet supportive care needs. Mobile applications (apps) are increasing being used as an easily accessible alternative to support these patients, but a lack of rigorous trials have been conducted to explore their effectiveness. Based on Mishel's uncertainty in illness theory, the Mobile Gynaecological Cancer Support (MGCS) program is an app-based program that includes four modules: 1) weekly topics, 2) emotional care, 3) discussion centre and 4) health consultation. The aim of this study is to assess the effectiveness of MGCS for Chinese patients with gynaecological cancer receiving chemotherapy in respect of reducing uncertainty in illness and symptom distress and improving quality of life and social support. DESIGN A multi-centre randomized controlled trial will be used. METHODS One hundred and sixty-eight patients with gynaecological cancer commencing chemotherapy will be recruited from three university affiliated hospitals and assigned to the control or intervention group with block randomization. The control group will only receive routine care. The intervention group will access the MGCS program for 24 weeks and receive routine care. Health outcomes will be evaluated at baseline, 12 weeks, and 24 weeks. Repeated measures multivariate analysis of covariance (intention-to-treat) will be used to assess the effectiveness of MGCS. DISCUSSION This is the first trial to explore the effectiveness of an app-based program for patients with gynaecological cancer using a robust and rigorous study design in China. If effective, this trial will provide evidence for an app-based program to support these patients. IMPACT The knowledge gained can be applied to develop other culturally appropriate app-based programs for cancer groups worldwide, and provide evidence for health policymakers to allocate more resources and train staff for e-health. TRIAL REGISTRATION ChiCTR2000033678 (Chinese Clinical Trial Registry Registered 08 June, 2020).
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Affiliation(s)
- Huicong Lin
- School of Medicine, Xiamen University, Xiamen, Fujian Province, P. R. China
| | - Sally Wai-Chi Chan
- School of Medicine, Xiamen University, Xiamen, Fujian Province, P. R. China.,President Office, Tung Wah College, Hong Kong, P. R. China
| | - Mingzhu Ye
- Department of Gynecology and Obstetrics, Zhongshan Hospital, Xiamen University, Xiamen, Fujian Province, P. R. China
| | - Yanlong Wang
- Department of Gynecology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, Fujian Province, P. R. China
| | - Hongli Liu
- Department of Gynecology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, Fujian Province, P. R. China
| | - Min Li
- Department of Gynecology and Obstetrics, the First Affiliated Hospital, Xiamen University, Xiamen, Fujian Province, P. R. China
| | - Shengjie Liu
- School of Medicine, Xiamen University, Xiamen, Fujian Province, P. R. China
| | - Jiemin Zhu
- School of Medicine, Xiamen University, Xiamen, Fujian Province, P. R. China
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Verduzco-Aguirre HC, Babu D, Mohile SG, Bautista J, Xu H, Culakova E, Canin B, Zhang Y, Wells M, Epstein RM, Duberstein P, McHugh C, Dale W, Conlin A, Bearden J, Berenberg J, Tejani M, Loh KP. Associations of Uncertainty With Psychological Health and Quality of Life in Older Adults With Advanced Cancer. J Pain Symptom Manage 2021; 61:369-376.e1. [PMID: 32822750 PMCID: PMC7854861 DOI: 10.1016/j.jpainsymman.2020.08.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 08/06/2020] [Accepted: 08/08/2020] [Indexed: 02/08/2023]
Abstract
CONTEXT Older adults with advanced cancer face uncertainty related to their disease and treatment. OBJECTIVES To evaluate the associations of uncertainty with psychological health and quality of life (QoL) in older adults with advanced cancer. METHODS Secondary cross-sectional analysis of baseline data from a national clustered geriatric assessment trial. Patients 70 years and older with advanced cancer considering a new line of chemotherapy were recruited. We measured uncertainty using the modified nine-item Mishel Uncertainty in Illness Scale. Dependent variables included anxiety (Generalized Anxiety Disorder-7), depression (Generalized Depression Scale-15), distress (distress thermometer), QoL (Functional Assessment of Cancer Therapy-General), and emotional well-being (Functional Assessment of Cancer Therapy-General subscale). We used multivariate linear regression analyses to evaluate the association of uncertainty with each dependent variable. We conducted a partial least squares analysis with a variable importance in projection (VIP) plot to assess the contribution of individual variables to the model. Variables with a VIP <0.8 were considered less influential. RESULTS We included 527 patients (median age 76 years; range 70-96). In multivariate analyses, higher levels of uncertainty were significantly associated with greater anxiety (β = 0.11; SE = 0.04), depression (β = 0.09; SE = 0.02), distress (β = 0.12; SE = 0.02), as well as lower QoL (β = -1.08; SE = 0.11) and emotional well-being (β = -0.29; SE = 0.03); the effect sizes were considered small. Uncertainty items related to disease and treatment were most strongly associated with psychological health and QoL scores (all VIP >0.8). CONCLUSION Uncertainty among older patients with advanced cancer is associated with worse psychological health and QoL. Tailored uncertainty management strategies are warranted.
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Affiliation(s)
- Haydee C Verduzco-Aguirre
- Department of Hemato-Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Dilip Babu
- Kaiser Permanente, Portland, Oregon, USA
| | - Supriya G Mohile
- James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, New York, USA
| | - Javier Bautista
- James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, New York, USA
| | - Huiwen Xu
- James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, New York, USA
| | - Eva Culakova
- James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, New York, USA
| | - Beverly Canin
- James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, New York, USA
| | - Yingzi Zhang
- University of Rochester School of Nursing, Rochester, New York, USA
| | - Megan Wells
- James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, New York, USA
| | - Ronald M Epstein
- James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, New York, USA; Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA; Department of Family Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA; Department of Medicine, Palliative Care, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Paul Duberstein
- Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, Piscataway, New Jersey, USA
| | - Colin McHugh
- James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, New York, USA
| | - William Dale
- Department of Supportive Care Medicine, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Alison Conlin
- Pacific Cancer Research Consortium National Cancer Institute Community Oncology Research Program (NCORP), Seattle, Washington, USA
| | - James Bearden
- Southeast Clinical Oncology Research Consortium NCORP, Winston-Salem, North Carolina, USA
| | - Jeffrey Berenberg
- Hawaii Minority Underserved National Cancer Institute Community Oncology Research Program (MU-NCORP), Honolulu, Hawaii, USA
| | | | - Kah Poh Loh
- James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, New York, USA.
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Dual effects of social support seeking in patient-centric online healthcare communities: A longitudinal study. INFORMATION & MANAGEMENT 2020. [DOI: 10.1016/j.im.2020.103270] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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The "PalliActive Caregivers" Intervention for Caregivers of Patients With Cancer in Palliative Care: A Feasibility Pilot Study. J Hosp Palliat Nurs 2020; 22:495-503. [PMID: 33044421 DOI: 10.1097/njh.0000000000000696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This pilot study aimed to assess the feasibility and possible effects of the "PalliActive Caregivers," nursing intervention, on the uncertainty in illness and quality of life of family caregivers of patients with cancer receiving palliative care. This pilot study used a randomized controlled design. The participants were 80 family caregivers. The experimental group received the novel "PalliActive Caregivers" intervention. Data were collected using a sociodemographic form, the Uncertainty in Illness Scale, the Quality of Life scale, and an Intervention satisfaction questionnaire. The caregivers who received the intervention "PalliActive Caregivers" reported a high degree of satisfaction (9.74 on a 10-point scale). The intervention showed a significant decrease in uncertainty regarding illness in the experimental group (P = .009), as well as a significant decrease in the psychological well-being of quality of life within the experimental and control groups, before and after the intervention (P = .013, P = .010). It is recommended that future studies using the "PalliActive Caregivers" intervention examine the effects on other variables such as the burden of patient's symptoms, caregiver burden and rewards, self-efficacy in symptom management, competence, unmet needs, and satisfaction with care.
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Zhang Y, Kwekkeboom KL. A Feasibility Study of an Uncertainty Management Intervention for Patient-Partner Dyads Experiencing Breast Cancer. Oncol Nurs Forum 2020; 47:595-608. [PMID: 32830807 DOI: 10.1188/20.onf.595-608] [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] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To examine the feasibility, acceptability, and effects of a dyad-based uncertainty management intervention for breast cancer, including tailored information and coping skills training. SAMPLE & SETTING 16 patient-partner dyads experiencing breast cancer were enrolled from a midwestern comprehensive cancer center. METHODS & VARIABLES A single-group pre-/post-test design was used, and descriptive statistics and Cohen's d were calculated. Measures were completed before the intervention and during each treatment cycle. Feasibility, acceptability, fidelity, uptake, and outcome variables (uncertainty, dyadic coping, family functioning) were included. RESULTS 16 dyads were enrolled during a 13-month period; 15 dyads completed the training for the study, and 13 dyads completed all study activities. Overall, participants reported satisfaction with the intervention. Small to medium effect sizes were observed across the outcomes. IMPLICATIONS FOR NURSING This study highlights the need for nurses to help couples manage uncertainty related to new cancer treatment. Tailored interventions can allow nurses to use their time efficiently by focusing on individuals' actual needs.
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Freeston M, Tiplady A, Mawn L, Bottesi G, Thwaites S. Towards a model of uncertainty distress in the context of Coronavirus (COVID-19). COGNITIVE BEHAVIOUR THERAPIST 2020; 13:e31. [PMID: 34191941 PMCID: PMC7426588 DOI: 10.1017/s1754470x2000029x] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 06/19/2020] [Accepted: 06/27/2020] [Indexed: 12/11/2022]
Abstract
The paper forms part of a series of papers outlining the theoretical framework for a new model of uncertainty distress (this paper), treatment implications arising from the model, and empirical tests of the model. We define uncertainty distress as the subjective negative emotions experienced in response to the as yet unknown aspects of a given situation. In the first paper we draw on a robust body of research on distinct areas including: threat models of anxiety, perceived illness uncertainty and intolerance of uncertainty. We explore how threat and uncertainty are separable in anxiety and how we can understand behaviours in response to uncertainty. Finally, we propose a clinically, theoretically and empirically informed model for uncertainty distress, and outline how this model can be tested. Caveats, clinical applications and practitioner key points are briefly included, although these are more fully outlined in the treatment implications article. While we outline this model in the context of novel coronavirus (COVID-19), the model has broader applications to both mental and physical health care settings. KEY LEARNING AIMS (1)To define the concept of uncertainty distress.(2)To understand the role of threat, over-estimation of threat, perceived uncertainty, actual uncertainty, and intolerance of uncertainty in distress maintenance.(3)To understand how people may behave in response to uncertainty distress.(4)To describe a model of uncertainty distress.
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Affiliation(s)
- Mark Freeston
- School of Psychology, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK
| | - Ashley Tiplady
- Newcastle Hospitals Occupational Health Service, Regent Point, Regent Farm Road, GosforthNE3 3HD, UK
| | - Lauren Mawn
- School of Psychology, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK
- Psychology in Healthcare, Royal Victoria Infirmary, Queen Victoria Road, Newcastle Upon TyneNE1 4LP, UK
| | - Gioia Bottesi
- Department of General Psychology, University of Padova, via Venezia 8, 35131Padova, Italy
| | - Sarah Thwaites
- School of Psychology, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK
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Rising KL, Powell RE, Cameron KA, Salzman DH, Papanagnou D, Doty AM, Latimer L, Piserchia K, McGaghie WC, McCarthy DM. Development of the Uncertainty Communication Checklist: A Patient-Centered Approach to Patient Discharge From the Emergency Department. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:1026-1034. [PMID: 32101919 PMCID: PMC7302334 DOI: 10.1097/acm.0000000000003231] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Clear communication with patients upon emergency department (ED) discharge is important for patient safety during the transition to outpatient care. Over one-third of patients are discharged from the ED with diagnostic uncertainty, yet there is no established approach for effective discharge communication in this scenario. From 2017 to 2019, the authors developed the Uncertainty Communication Checklist for use in simulation-based training and assessment of emergency physician communication skills when discharging patients with diagnostic uncertainty. This development process followed the established 12-step Checklist Development Checklist framework and integrated patient feedback into 6 of the 12 steps. Patient input was included as it has potential to improve patient-centeredness of checklists related to assessment of clinical performance. Focus group patient participants from 2 clinical sites were included: Thomas Jefferson University Hospital, Philadelphia, PA, and Northwestern University Hospital, Chicago, Illinois.The authors developed a preliminary instrument based on existing checklists, clinical experience, literature review, and input from an expert panel comprising health care professionals and patient advocates. They then refined the instrument based on feedback from 2 waves of patient focus groups, resulting in a final 21-item checklist. The checklist items assess if uncertainty was addressed in each step of the discharge communication, including the following major categories: introduction, test results/ED summary, no/uncertain diagnosis, next steps/follow-up, home care, reasons to return, and general communication skills. Patient input influenced both what items were included and the wording of items in the final checklist. This patient-centered, systematic approach to checklist development is built upon the rigor of the Checklist Development Checklist and provides an illustration of how to integrate patient feedback into the design of assessment tools when appropriate.
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Affiliation(s)
- Kristin L. Rising
- K.L. Rising is associate professor and director of acute care transitions, Department of Emergency Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Rhea E. Powell
- R.E. Powell is associate professor, Department of Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, and senior researcher, Mathematica, Princeton, New Jersey
| | - Kenzie A. Cameron
- K.A. Cameron is research professor, Department of Medical Education and Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - David H. Salzman
- D.H. Salzman is associate professor, Department of Emergency Medicine and Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Dimitrios Papanagnou
- D. Papanagnou is associate professor and vice chair for education, Department of Emergency Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Amanda M.B. Doty
- A.M.B. Doty is a research coordinator, Department of Emergency Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Lori Latimer
- L. Latimer is a research coordinator, Department of Emergency Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Katherine Piserchia
- K. Piserchia is a clinical research coordinator, Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - William C. McGaghie
- W.C. McGaghie is professor, Department of Medical Education, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Danielle M. McCarthy
- D.M. McCarthy is associate professor, Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Integrative review of breast cancer survivors’ transition experience and transitional care: dialog with transition theory perspectives. Breast Cancer 2020; 27:810-818. [DOI: 10.1007/s12282-020-01097-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 04/15/2020] [Indexed: 12/16/2022]
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Bergkvist K, Winterling J, Kisch AM. Support in the context of allogeneic hematopoietic stem cell transplantation - The perspectives of family caregivers. Eur J Oncol Nurs 2020; 46:101740. [PMID: 32353737 DOI: 10.1016/j.ejon.2020.101740] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 02/12/2020] [Accepted: 02/16/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND AIM Family caregivers are often involved in helping recipients during allogeneic hematopoietic stem cell transplantation (allo-HSCT). Although the distress that often arises along the trajectory is evident to family caregivers, research on their perceptions of providing and receiving support is limited. The aim of this study was to explore family caregivers' experiences of providing and receiving support during allo-HSCT. METHOD Data were collected through semi-structured interviews with fourteen family caregivers 16 weeks after the recipient's allo-HSCT. Inductive qualitative content analysis was used to analyse the data. RESULTS The analysis revealed four generic categories that focus on prerequisites for family caregivers' ability to provide support: Individual characteristics influence the ability to be supportive, Social context influences the ability to be supportive, Medical information provides knowledge and a sense of participation and Interaction with the healthcare organization provides a sense of participation. These prerequisites are linked in the fifth generic category: Family caregivers' support is multifaceted and dependent on the recipient's health. CONCLUSIONS Family caregivers' risk of experiencing a stronger sense of uncertainty and lack of participation is higher in the absence of the above-mentioned prerequisites. Professional support is thus required, which implies that the healthcare organization is responsible for identifying the needs of each family caregiver and delivering individualized support.
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Affiliation(s)
- Karin Bergkvist
- Sophiahemmet University, Department of Nursing Sciences Stockholm, Sweden; Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
| | - Jeanette Winterling
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Patient Area of Haematology, Theme Cancer, Karolinska University Hospital, Solna, Stockholm, Sweden
| | - Annika M Kisch
- Department of Haematology, Skåne University Hospital, Lund, Sweden; Institute of Health Sciences, Lund University, Lund, Sweden
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Dauphin S, Van Wolputte S, Jansen L, De Burghgraeve T, Buntinx F, van den Akker M. Using Liminality and Subjunctivity to Better Understand How Patients With Cancer Experience Uncertainty Throughout Their Illness Trajectory. QUALITATIVE HEALTH RESEARCH 2020; 30:356-365. [PMID: 31617448 DOI: 10.1177/1049732319880542] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Uncertainty is a central theme in the illness experiences of older cancer patients throughout their illness trajectory. Mishel's popular theory on uncertainty during illness approaches uncertainty as an outcome and is characterized by the patient's inability to find meaning in illness events. This study used the concepts of liminality and subjunctivity to explore uncertainty throughout the illness trajectory of cancer patients. We interviewed 18 older (age range = 57-92 years) patients with breast cancer or gastro-intestinal cancer 3 to 4 years post diagnosis. Our analysis is based on the QUAGOL guide that draws on elements of grounded theory such as constant comparison. We found that liminality and subjunctivity provide a useful frame for understanding uncertainty with a specific focus on its productive potential and meaning making. Health care professionals should be open to acquiring a complete picture of patients' diverse and dynamic experiences of uncertainty in the different stages of their illness trajectory.
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Affiliation(s)
| | | | | | | | - Frank Buntinx
- KU Leuven, Leuven, Belgium
- Maastricht University, Maastricht, The Netherlands
| | - Marjan van den Akker
- KU Leuven, Leuven, Belgium
- Maastricht University, Maastricht, The Netherlands
- Johann Wolfgang Goethe University, Frankfurt am Main, Germany
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Arias-Rojas M, Carreño-Moreno S, Posada-López C. Uncertainty in illness in family caregivers of palliative care patients and associated factors. Rev Lat Am Enfermagem 2019; 27:e3200. [PMID: 31618393 PMCID: PMC6792341 DOI: 10.1590/1518-8345.3185.3200] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 06/29/2019] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE to describe the level of uncertainty in illness in family caregivers of palliative care patients and detect associations between the profile of the caregiver and the levels of uncertainty. METHOD descriptive correlational study conducted with 300 family caregivers of hospitalized patients. The sociodemographic characterization of caregiver and patient was used to assess the caregiver profile, as well as the Uncertainty in Illness scale for family caregivers. Spearman's Rho correlation test was applied to detect associations. RESULTS the average score of illness uncertainty was 91.7 points. The analysis showed significant correlations between the level of uncertainty and patient dependence (r=0.18, p=0.001), symptom assessment (r=0.312, p<0.001), length of service as a caregiver (r=0.131, p=0.023), perception of support from health professionals (r=-0.16, p=0.048), family (r=-0.145, p=0.012) and religious support (r=-0.131, p=0.050). CONCLUSIONS there were high levels of uncertainty in caregivers about their patient's illness. These levels are associated with the health condition and symptoms of the patient who is cared for, the length of service as a caregiver and the perceived support from health professionals, family and religion.
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Affiliation(s)
- Mauricio Arias-Rojas
- Universidad Nacional de Colombia, Facultad de Enfermería, Bogotá, Cund, Colômbia.,Universidad de Antioquia, Facultad de Enfermería, Medellín, Ant, Colômbia
| | - Sonia Carreño-Moreno
- Universidad Nacional de Colombia, Facultad de Enfermería, Bogotá, Cund, Colômbia
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Abstract
OBJECTIVE To evaluate the state of the science on uncertainty in high-risk pregnancy and identify factors that influence uncertainty in women diagnosed with a high-risk pregnancy. DATA SOURCES Primary research articles from CINAHL, Ovid, MEDLINE, Scopus, and PsycINFO written in English, without date restrictions. STUDY SELECTION Nineteen articles were identified, including 14 qualitative studies and 5 quantitative studies. DATA EXTRACTION This integrative review was guided by Whittemore and Knafl's methodology. Studies were graded on level and quality of evidence as per Dearholt, Dang, and Sigma Theta Tau International. DATA SYNTHESIS Studies were synthesized by using constant comparative methods according to factors influencing, outcomes of, and management of uncertainty. CONCLUSION Uncertainty is a prominent theme in women experiencing a high-risk pregnancy. Uncertainty is influenced by various personal, pregnancy-related, demographic, and healthcare-related factors. Findings may offer insight and empathy for healthcare professionals. Nurses who understand significance of uncertainty in adjusting to two conflicting life events have the opportunity to help women in their understanding of a high-risk diagnosis during pregnancy through anticipatory guidance. Future research is needed to explore factors affecting uncertainty and to understand the experience of high-risk pregnancy to develop interventions aimed at mitigating uncertainty in high-risk pregnant women.
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Hill EM, Hamm A. Intolerance of uncertainty, social support, and loneliness in relation to anxiety and depressive symptoms among women diagnosed with ovarian cancer. Psychooncology 2019; 28:553-560. [PMID: 30614141 DOI: 10.1002/pon.4975] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 12/08/2018] [Accepted: 01/01/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Intolerance of uncertainty (IU) is a trait variable that captures an individual's lack of tolerance for unknown outcomes and events. Positive correlations between IU and mental health symptoms have been observed in various populations, while social variables (social support and decreased loneliness) seem to serve as protective factors against psychological distress among individuals with cancer. The present study examined the moderation effect of social support and loneliness in the relationship between IU and mental health symptoms among women diagnosed with ovarian cancer. METHODS This study was a cross-sectional design involving 131 women diagnosed with ovarian cancer recruited through social media and other online sources. Participants completed questionnaires that assessed their IU (prospective and inhibitory), anxiety symptoms, depressive symptoms, social support, and loneliness. Moderated regression analyses were applied to test the hypothesis that low social support and high loneliness would exacerbate the relationship between IU and symptoms of anxiety and depression. RESULTS The hypothesized moderation effects (social support × IU, loneliness × IU) were not supported in the anxiety and depressive symptoms models. Post hoc linear regression analyses indicated that IU and loneliness were predictive of depressive and anxiety symptoms. Loneliness was the strongest predictor in both the anxiety and depressive symptoms models, followed by IU. CONCLUSIONS The findings indicate that loneliness and IU-particularly inhibitory IU-are important considerations in understanding mental health symptoms among women diagnosed with ovarian cancer. Addressing both loneliness and IU may be an important avenue in clinical settings.
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Affiliation(s)
- Erin M Hill
- Department of Psychology, West Chester University, West Chester, Pennsylvania
| | - Andriana Hamm
- Department of Psychology, West Chester University, West Chester, Pennsylvania
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Montalvo Prieto AA, Florez Torres IE, Romero Massa E. Asociación entre el nivel de incertidumbre y el tipo de enfermedad en pacientes hospitalizados en UCI. AVANCES EN ENFERMERÍA 2018. [DOI: 10.15446/av.enferm.v36n3.66508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Objetivo: determinar la asociación entre el nivel de incertidumbre y el tipo de enfermedad en pacientes hospitalizados en unidades de cuidado intensivo de Cartagena, Colombia.Materiales y métodos: estudio observacional de corte transversal.La muestra estuvo constituida por 72 pacientes a quienes les fue aplicada la escala de incertidumbre de Merle Mishel. Se estimaron las asociaciones entre el tipo de enfermedad y la incertidumbre mediante la prueba no paramétrica Kruskal-Wallis.Resultados: la edad promedio de los participantes fue 58,3 años (DE = 19,4), con predominio del sexo femenino en el 54,2 %, la mediana de estancia hospitalaria correspondió a seis días. El 27,8 % presentó enfermedades cardiovasculares, seguidas de las metabólicas en un 19,4 %. El nivel de incertidumbre fue regular en el 63,9 % y alto en el 34,7 %. Respecto a la asociación entre variables, no se encontraron diferencias significativas entre los puntajes promedios de la escala según tipo de enfermedad (Prob. de Kruskal-Wallis > 0,05).Conclusión: la complejidad de la situación, las expectativas relacionadas con el compromiso de la salud, la presentación de los síntomas y los tratamientos médicos o quirúrgicos instaurados originaron incertidumbre independiente del tipo de enfermedad
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