Illness Uncertainty In Patients Research Articles

Validation of the Dutch version of the Mishel Uncertainty in Illness Scale-C in patients with advanced cancer receiving systemic treatment

Abstract Background: An emerging group of patients with advanced cancer receiving systemic treatment lives long term with ongoing uncertainty, but no valid measure of uncertainty was available for this group. Our aims were to translate the Mishel Uncertainty in Illness Scale-Community (MUIS-C) into the Dutch language and evaluate its psychometric properties in patients with advanced cancer receiving systemic treatment. Methods: Patients (N = 111) with diverse advanced cancer diagnoses and treatments (53% male, mean age 66 years) completed the MUIS-C, which was translated into the Dutch language using a forward-backward translation procedure. Floor and ceiling effects, structural validity, internal consistency, and construct validity were evaluated. Results: No floor and ceiling effects for the MUIS-C were found. Exploratory factor analysis revealed two factors (lack of clarity, unpredictability). Internal consistency was adequate (Cronbach's α = 0.82). All a priori hypotheses regarding convergent and divergent validity were confirmed and supported construct validity. Conclusions: Results suggest that the Dutch MUIS-C is a valid and reliable measure for assessing illness uncertainty in patients with advanced cancer and support its use in future studies among patients with advanced cancer receiving systemic treatment.

Illness uncertainty and dysphagia in Chinese oral cancer patients: the mediation effect of catastrophic cognition.

Dysphagia, a serious symptom of oral cancer, is also the most common. Further, patients who are more uncertain regarding their illness tend to catastrophize, which may affect their rehabilitation and long-term survival rate. Considering this relationship, this study aimed to investigate the occurrence of dysphagia in Chinese patients with oral cancer and explore the correlation between catastrophic cognition, illness uncertainty, and dysphagia. Applying a cross-sectional design, convenience sampling was used to recruit 180 patients with oral cancer. Advanced statistical methods were employed to analyze the mediating effects of catastrophic cognition on illness uncertainty and dysphagia. Chinese patients with oral cancer had a mean dysphagia score of 52.88 ± 10.95. Catastrophic cognition and illness uncertainty in patients with oral cancer were significantly positively correlated (r = 0.447, P < 0.001). There was a significant negative correlation between dysphagia score and catastrophic cognition (r = -0.385, P < 0.001), and between dysphagia and illness uncertainty (r = -0.522, P < 0.001). Bootstrapping results indicated that the mediating effect of catastrophic cognition between illness uncertainty and dysphagia was -0.07 (95% CI: [-0.15, -0.03]) and significant, and the mediation effect accounted for 15.6% of the total effect. Chinese patients with oral cancer have poor swallowing function. Results suggest that catastrophic cognition partially mediated the relationship between illness uncertainty and dysphagia in patients with oral cancer. Medical staff can improve patients' swallowing function by reducing the level of catastrophic cognition via decreasing the level of illness uncertainty.

Illness uncertainty, resilience, and perceived social support among patients with moyamoya disease: a cross-sectional study.

The present study aims to investigate the levels of illness uncertainty in patients with moyamoya disease and to determine the association of socio-demographic characteristics, perceived social support and resilience with illness uncertainty in patients with moyamoya disease. A cross-sectional survey using convenience sampling was conducted in two hospitals in China from August to December 2023.A socio-demographic characteristics questionnaire, the Chinese versions of Mishel's Unsurety in Disease Scale (MUIS), the Chinese version of Connor-Davidson Resilience Scale (CD-RISC), and the Chinese version of Multidimensional Scale of Perceived Social Support (MSPSS) were used to perform this research. The collected data were analyzed using SPSS 24.0 statistical software. The t-test, one-way analysis of variance (ANOVA), pearson correlation analysis and hierarchical regression analysis were used to identify associated factors. A total of 263 patients with moyamoya disease were recruited in this survey. The score of illness uncertainty was at a moderate level of (100.03 ± 18.59). The present study identified a negative correlation between illness uncertainty with resilience perceived social support. Hierarchical regression analysis showed that gender, occupation, education level, resilience and perceived social support were the related factors of illness uncertainty. Patients with moyamoya disease experienced moderate disease uncertainty on average, which was related to gender, occupation, education level, resilience and perceived social support. Future research is needed to better explore the complex relationships between illness uncertainty, resilience, and perceived social support with different types of moyamoya disease using longitudinal research.

Impact of Illness Uncertainty on Health-Related Quality of Life in Patients With Unruptured Intracranial Aneurysms After Coil Embolization.

BACKGROUND: This study aimed to identify the impact of illness uncertainty on physical and mental health-related quality of life (HRQoL) in patients with unruptured intracranial aneurysms (UIAs) after coil embolization. METHODS: A cross-sectional study was conducted and HRQoL was evaluated using the Short Form-12 Health Survey Questionnaire, which assesses physical and mental HRQoL. RESULTS: The participants had a mean age of 56.4 years, and among them, 190 (71.2%) were women. Physical and mental HRQoL were negatively correlated with physical symptoms, anxiety, depression, and illness uncertainty. Mental HRQoL was positively correlated with social support. Physical HRQoL was significantly influenced by depression (β = -0.26, P = .004) and was not influenced by illness uncertainty (β = -0.10, P = .101). Mental HRQoL was significantly influenced by anxiety (β = -0.45, P < .001), depression (β = -0.19, P = .003), social support (β = 0.14, P = .004), and illness uncertainty (β = -0.14, P = .005). The finding that illness uncertainty influences HRQoL suggests a basis for interventions aimed at improving mental HRQoL by reducing illness uncertainty in patients with UIAs. CONCLUSION: The physical and mental HRQoL in patients with UIAs after coil embolization is negatively influenced by depression, whereas mental HRQoL is also affected by anxiety, illness uncertainty, and social support. These results may serve as reference data for the design and development of interventions to improve HRQoL in patients with UIAs after coil embolization.

The Relationship Between Illness Uncertainty and Social Support Among Cancer Patients: A Meta-analysis.

As a common psychological problem in cancer patients, illness uncertainty has attracted wide attention from scholars. Some studies have pointed out that the level of social support may affect illness uncertainty in patients with cancer, but the results of these studies remain controversial. The aim of this study was to evaluate the correlation between illness uncertainty and social support in patients with cancer using meta-analysis. PubMed, Web of Science, EMBASE, EBSCO, Cochrane Library, China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform, and VIP Citation Database were searched for articles published up to 2022. The screening of the literature, data extraction, and quality assessment of the included studies were performed independently by 2 researchers. Stata 17.0 software was used to analyze the overall and moderation effects. Notably, 41 studies involving 5403 patients were included. The results showed that the illness uncertainty of adults with cancer was moderately negatively correlated with social support (r = -0.33). Country, publication year, cancer type, and instrument used to measure social support moderated the association between illness uncertainty and social support. Improving the level of social support can reduce illness uncertainty experienced by adults with cancer to a certain extent. This review provides a clear direction for implementing precise interventions to reduce illness uncertainty among adults with cancer. Furthermore, patients with cancer with high morbidity and mortality rates deserve greater attention from healthcare personnel and family caregivers.

Illness Uncertainty of the Patients With Unruptured Intracranial Aneurysms Treated by Coil Embolization.

BACKGROUND: Patients with unruptured intracranial aneurysms (UIAs) treated by coil embolization may experience illness uncertainty despite successful treatment. This study aimed to investigate illness uncertainty in patients with UIAs treated by coil embolization and to identify the factors affecting illness uncertainty. METHODS: This cross-sectional study involved data collected from 267 patients with UIAs who received coil embolization within 2 years at a tertiary hospital in South Korea. The data were collected through structured questionnaires and the patients' medical records. The questionnaires included information on sociodemographic characteristics, the Hospital Anxiety and Depression Scale, the Multidimensional Scale of Perceived Social Support, and Mishel Uncertainty in Illness Scale data. We collected clinical characteristics through the medical records. Data analysis was performed using descriptive statistics, an independent t test, a 1-way analysis of variance, and a Pearson correlation test. We used a multiple linear regression analysis with significant variables in the univariate analysis to determine which variables had a significant impact on illness uncertainty. RESULTS: The mean Mishel Uncertainty in Illness Scale score was 52.33 (12.93). We identified age ( P = .002), education level (high school graduation, P = .014; college or higher, P < .001), anxiety ( P < .001), and social support ( P < .001) as factors affecting illness uncertainty. CONCLUSION: Patients with UIAs who underwent coil embolization did not exhibit severe illness uncertainty. The factors affecting illness uncertainty were age, educational level, anxiety, and social support. This study provides insight into illness uncertainty in this patient population and may help develop appropriate nursing interventions.

The mediating role of psychological capital between post-traumatic growth and uncertainty in illness among patients with Parkinson's disease.

With the application of positive psychology in health management, many studies have confirmed the close relationship between post-traumatic growth, psychological capital and uncertainty in illness. However, there is still a lack of attention to the positive psychology of patients with Parkinson's disease, and previous studies have not clarify the specific relationship. Therefore, the present study sought to explore the multiple mediating roles of psychological capital between post-traumatic growth and uncertainty in illness among patients with Parkinson's disease. We conducted a cross-sectional survey, a total of 268 patients with Parkinson's disease were investigated by the Post-Traumatic Growth Inventory, the Positive Psychological Capital Questionnaire and the Mishel Uncertainty in Illness Scale - Adults from November 2021 to June 2022 in the Parkinson's specialist outpatient department of three 3a-grade hospitals in Tianjin, China. The results showed that the score of post-traumatic growth was (51.78±17.872), the score of uncertainty in illness was (68.08±17.555), and the score of self-efficacy, resilience, hope, and optimism dimensions of psychological capital were (28.93±10.511), (28.79±11.553), (27.57±8.558) and (25.35±9.768). Post-traumatic growth was negatively correlated with uncertainty in illness and positively correlated with all four dimensions of psychological capital (p<0.01), and uncertainty in illness was negatively correlated with all four dimensions of psychological capital (p<0.01). Bootstrap test showed that the direct effect of post-traumatic growth on uncertainty in illness of patients with Parkinson's disease was not significant; the total indirect effect of psychological capital between post-traumatic growth and uncertainty in illness was significant. The mediating effects of resilience and hope were significant, accounting for 53.07% and 19.41% of the total indirect effects, respectively. Based on the research results, psychological capital played a completely mediating role between post-traumatic growth and uncertainty in illness of patients with Parkinson's disease. Post-traumatic growth affected uncertainty in illness through two dimensions: resilience and hope. Healthcare professionals should pay attention to the level of psychological capital of patients with Parkinson's disease and implement targeted positive psychological interventions focusing on the two dimensions of resilience and hope, to enhance post-traumatic growth and reduce the level of uncertainty in illness.

Effect of illness uncertainty on alanine transaminase levels and aspartate aminotransferase levels in patients with nonalcoholic fatty liver disease.

Patients with nonalcoholic fatty liver disease (NAFLD) have illness uncertainty. The purpose of this longitudinal study was to investigate the effect of the degree of illness uncertainty in patients with NAFLD on liver function values. We conducted a questionnaire survey and collected blood samples from outpatients with NAFLD. The items in the questionnaire were measured for illness uncertainty using the Japanese version of the Mishel Uncertainty in Illness Scale-Community (MUIS-C). Blood samples were collected at baseline and after 1 year. We divided the patients into two groups: one with high illness uncertainty and the other with low illness uncertainty. We then compared changes in alanine transaminase (ALT) and aspartate aminotransferase (AST) levels over time from baseline using multiple regression analysis. This study analyzed 148 patients with NAFLD; 75 were male and 73 were female, with a mean age of 58.4 ± 12.3 years. The group with higher illness uncertainty had significantly higher ALT and AST levels at 1 year (β = .185 and .183, respectively) than the group with lower illness uncertainty. High illness uncertainty in patients with NAFLD can lead to higher ALT and AST levels. Healthcare providers must focus on reducing illness uncertainty in patients with NAFLD.

Psychological distress, understanding of cancer and illness uncertainty in patients with Cancer of Unknown Primary.

Patients diagnosed with Cancer of Unknown Primary (CUP) experience high levels of psychological distress and report poor understanding of their cancer. We aimed to investigate: (1) if CUP patients with poorer understanding of their cancer diagnosis and testing experience more symptoms of psychological distress than those with better understanding; (2) if the relationship between patients' understanding of their cancer and psychological distress is mediated by illness uncertainty; and (3) explore whether patients' degree of understanding of their cancer can be predicted by clinical and socio-demographic factors. 209 CUP patients completed a questionnaire measuring anxiety, depression, illness uncertainty, fatigue, pain, sleep and understanding of their cancer. Using an apriori theoretical framework, we employed structural equation modelling to investigate predictors of patient's understanding of their cancer and psychological distress and the relationships between understanding, illness uncertainty and distress. The structural equation model displayed good fit indices and supported the hypothesised relationship of patient's understanding of their cancer and the extent of psychological distress, which was mediated via illness uncertainty. Physical symptoms were positively associated with psychological distress and illness uncertainty. Younger age was predictive of lower patient's understanding of their cancer and higher levels of psychological distress. Patients with CUP, particularly those who are younger and experiencing more physical symptoms, report higher levels of psychological distress and may require additional mental health support. Our findings highlight a need to improve CUP patient's understanding about their illness, which could help reduce their illness uncertainty and alleviate psychological distress.

Stigma and illness uncertainty among patients with visible burn scars: A cross-sectional study

The purpose of this research was to understand the current status of stigma and illness uncertainty in patients with visible burns and explore the correlation between them. Measures to help patients alleviate shame and uncertainty in illness are also discussed. A cross-sectional study was conducted in a tertiary hospital from November 2020 to March 2021 for patients with burns on exposed parts of the face, neck, or limbs. The scales used in this study include demographic data questionnaires, the Social Impact Scale (SIS), and the Mishel Uncertainty in Illness Scale for Adults (MUIS-A). A two-tailed independent t-test was used to evaluate the differences in the respondents’ sociodemographic characteristics, stigma, and illness uncertainty. The total stigma and illness uncertainty scores of 146 patients were 57.03 ± 6.762 and 68.59 ± 12.901, respectively. Spearman correlation analysis showed that stigma was positively correlated with illness uncertainty (r = 0.398, p < 0.01). Multiple regression analysis showed a relationship between stigma and uncertainty of illness (B = 0.215, p = 0.000), itching (B = 2.555, p = 0.01), residence (B = 2.545, p = 0.029), and age (B = 0.074, p = 0.037). The stigma level of patients with visible burns increased with increasing uncertainty regarding illness. Therefore, reducing the patients’ uncertainty in illness is a way to intervene in stigma.

Illness Uncertainty in Patients Awaiting Liver Transplant.

Illness uncertainty is prevalent in patients awaiting liver transplant. We described high levels of illness uncertainty in these patients and examined relationships between uncertainty and person factors and the antecedents of uncertainty. Mishel uncertainty in illness scale was used to measure illness uncertainty. We used modes and interquartile range (IQR) to describe illness uncertainty levels in 115 patients. Multiple logistic and linear regression models estimated the associations of uncertainty with hypothesized antecedents. High total illness uncertainty score was reported by 15.6% of the patients. After adjusting for all variables, illness uncertainty was associated with two antecedents of uncertainty, low social well-being (OR = 0.816; p = .025) and low self-efficacy (OR = 0.931; p = .013). Complexity was negatively associated with social well-being; ambiguity and inconsistency were negatively associated with self-efficacy. One in seven patients experienced high illness uncertainty. Social well-being and self-efficacy were negatively related to illness uncertainty.

Relationships between depression, family function, physical symptoms, and illness uncertainty in female patients with chronic kidney disease.

This study investigated the relationship between depression, family function, physical symptoms, and illness uncertainty in women with chronic kidney disease. Data were collected through structured questionnaire that was completed by 120 women undergoing hemodialysis. Assessment instruments consisted of the Family Adaptability, Partnership, Growth, Affection, Resolve Scale, Symptom Experience Scale, Mishel's Uncertainty in Illness Scale for Adults, and the Center for Epidemiological Studies-Depression Scale. The higher the uncertainty about illness and physical symptoms, the higher is the level of depression, and the better the family function, the lower is the level of depression. Greater uncertainty was associated with poorer family function and worsening physical symptoms. A regression model explained 41% of the variance in depression. Significant predictors of depression were physical symptoms, living alone, illness uncertainty, and "poor" subjective health status. To improve depression of women with chronic kidney disease, nurses need to reduce physical symptoms and illness uncertainty in these patients and improve their subjective health status. In addition, the establishment of a therapeutic support system considering living arrangement will help to reduce depression in women with chronic kidney disease.

Феномен неопределенности как субъективный опыт пациента в ситуации болезни

The phenomenon of uncertainty in illness of patients is discussed and analyzed in this article. Uncertainty in illness is a condition that accompanies the patient from the moment of appearance of the first somatic symptoms of the disease and could be strengthened or weakened thanks to many psychosocial factors. The level of uncertainty is related to the level of stress, emotional disadaptation, affective states, coping strategies, mechanisms of psychological defense, etc. Uncertainty can perform destructive functions, acting as a trigger for stressful conditions and launching negative emotional experiences. As a positive function of uncertainty, one can note a possible positive interpretation of the patient's disease. In addition, the state of uncertainty allows the patient to activate the resources of coping with the disease, among which the leading role belongs to social support.

Study of uncertainty in illness among patients with hepatocellular carcinoma intending to undergo transcatheter artery chemoembolization

Objective To describe uncertainty in illness of patients with hepatocellular carcinoma intending to undergo transcatheter artery chemoembolization (TACE) and to identify the related factors. Methods A descriptive and correlative design was used. By convenience sampling, 95 patients with hepatocellular carcinoma were recruited from Sun Yat-Sen University Cancer Center in this study. Mishel Uncertainty in Illness Scale was used to assess uncertainty in illness and information needs of patients with hepatocellular carcinoma intending to undergo TACE and the demographic questionnaire and Information Needs Assessment Scale were used to measure demographic data, disease and treatment characteristics and information needs of patients. Results The level of uncertainty in illness in most patients with hepatocellular carcinoma intending to undergo TACE was middle (77.61±9.15) points. The mean score of indeterminacy subscale was (50.16 ± 6.16) points. Uncertainty in illness of patients with hepatocellular carcinoma intending to undergo TACE was affected by the degree of education background, domicile, family economic status, way to pay for the medical expenses, course of diseases, how many times he (she) used to undergo assisted treatments and the level of information needs. Conclusions The level of uncertainty in illness in most patients with hepatocellular carcinoma intending to undergo TACE was middle and it is important to assess patients' uncertainty in illness at clinical work and to take effective interventions to content patients' information needs to decrease the level of uncertainty. Key words: Liver neoplasms; Transcatheter artery chemoembolization; Uncertainty in illness; Information needs

Correlation study between illness uncertainty and coping style in recurrent or metastatic breast cancer patients

Objective To investigate illness uncertainty and coping style in patients with recurrent or metastatic breast cancer, and analyze the correlation between illness uncertainty and coping style. Methods A total of 98 patients with recurrent or metastatic breast cancer were investigated using Chinese version of Mishel′s uncertainty in illness scale (MUIS) and medical coping mode questionnaire (MCMQ). Results The average score of illness uncertainty in patients with recurrent or metastatic breast cancer was (62.50±10.89), and the level of illness uncertainty was intermediate. The score of coping style in patients with recurrent or metastatic breast cancer were higher than domestic norm. The scores of avoidance in coping style between two groups was significantly different (P 0.05). Conclusions Coping style of patients with recurrent or metastatic breast cancer is correlated with their illness uncertainty. Nurses should evaluate illness uncertainty in patients with recurrent or metastatic breast cancer and help them to take effective coping style so as to decrease illness uncertainty and improve therapeutic adherence and confidence in these patients. Key words: Breast cancer; Illness uncertainty; Coping style

Investigation on the uncertainty in illness of patients with total hysterectomy and psychological nursing intervention

Objective To analyze the uncertainty in illness of patients with total hysterectomy and psychological nursing intervention.Methods A total of 150 patients with total hysterectomy were selected in the department of gynaecology and obstetrics of our hospital from 2006 June to 2012 June.The questionnaires were used to investigate them with basic information and the uncertainty in illness.The effects of different ages,education,marital status and religion on the uncertainty in illness were observed.The scores of the uncertainty and negative emotions were compared before and after nursing.Results The score of the uncertainty in illness of aged,low cultural degree,married,no religious beliefs patients was higher than that of other patients (P ＜ 0.05) ; After receiving pertinent nursing intervention,the scores of the uncertainty in illness and the negative emotions of the patients were obviously lower than those of before (P ＜ 0.05) receiving nursing care.Conclusions The patients with total hysterectomy generally have different degrees of uncertainty in illness,aged,low education level,married,no religious beliefs in patients with the disease uncertainty score is particularly high.Taking pertinence nursing interventions can significantly reduce the patient's disease uncertainty and negative emotions. Key words: Total hysterectomy; Sense of uncertainty in illness; Psychological nursing intervention

Correlation research of uncertainty in illness and social support of patients before percutaneous coronary intervention

Objective To describe the uncertainty in illness and social support of patients before percutaneous coronary intervention (PCI) and explore the correlation between them.Methods By descriptive and correlation study,sixty patients before PCI were recruited in the study and were investigated with Mishel Uncertainty in Illness Scale (MUIS) and social support rating scale (SSRS).Results The total score of uncertainty in illness of patients before PCI was(90.72 ± 13.97 ) and was in the medium range.Among the four dimensions,the average score of ambiguity (40.27 ±6.87) was the highest.The total score of social support was(44.35 ±7.65 )and was at middle or high level.The uncertainty in illness of patients was negatively related with their social support(r =- 0.31 P ＜ 0.05 ).Conclusions Nurses should pay attention to the patients' uncertainty in illness before PCI and take advantage of their social support adequately.In this way,patients' uncertainty in illness can be decreased. Key words: Uncertainty in illness; Social support; Percutaneous coronary intervention