Mishel Uncertainty Research Articles

Quality of Life of Breast Cancer Survivors

The aims of this study were to examine the differences between older and younger breast cancer survivors in perceived social support, uncertainty, quality of life (QOL), and selected demographic variables, and to explore the role of these variables in explaining and predicting QOL. A descriptive research design was used. A sample of 163 older and 129 younger breast cancer survivors was recruited from the New York metropolitan area. Participants completed the Social Support Questionnaire, Mishel Uncertainty in Illness Scale Community Form, and the Quality of Life Index-Cancer Version III. Significant differences between younger and older cohorts were found in total social support, spouse and nurse social support subscales, and socioeconomic and psychological/spiritual QOL subscales. Uncertainty, additional illnesses, social support, older age, surgical treatment, and mastectomy were significant predictors of QOL. Understanding differences in perceived social support, uncertainty, and QOL of breast cancer survivors within a context of psychosocial stage and place in life may likely facilitate healthcare to better enhance QOL outcomes. Awareness of factors predictive of QOL will help breast cancer survivors in maintaining an acceptable QOL.

Uncertainty, Symptoms, and Quality of Life in Persons With Chronic Hepatitis C

Chronic hepatitis C (CHC) is the most common blood-borne infection in the United States, but little is known about illness uncertainty in these patients. The authors examined the constructs of illness uncertainty. In this cross-sectional study, Mishel's Uncertainty in Illness Scale was used to examine these constructs (ambiguity, complexity, inconsistency, unpredictability) and their relationships with fatigue, pain, depressive symptoms, comorbidity, and quality of life (QOL) in 126 CHC patients undergoing a watchful-waiting protocol. The Ambiguity subscale had the strongest relationships with depressive symptoms, QOL, and fatigue, and three of the four subscales were significantly correlated with pain. The results suggest targets for patient self-management interventions.

Spiritual Well-Being in Individuals With Fibromyalgia Syndrome: Relationships With Symptom Pattern Variability, Uncertainty, and Psychosocial Adaptation

This study examined relationships among symptom pattern variability, uncertainty, spiritual well-being, and psychosocial adaptation in individuals with fibromyalgia syndrome (FMS). A survey design was used with 58 individuals with FMS. The Fibromyalgia Symptom Pattern Questionnaire, Mishel Uncertainty in Illness Scale--Community Form, Spiritual Well-Being Scale, and Psychosocial Adjustment to Illness Scale-Self Report were used to collect data. Positive relationships were found between symptom pattern variability and uncertainty and between uncertainty and poor psychosocial adaptation; spiritual well-being moderated the relationship between uncertainty and psychosocial adaptation. A positive sense of well-being aided adaptation to symptoms and uncertainties of FMS. Spiritual well-being had a greater effect on the relationship between symptom pattern variability and uncertainty than expected.

Health-related Quality of Life in College Students with and without Childhood-Onset Asthma

Objective. The current study investigated whether differences existed in health-related quality of life between individuals who self-identified as having childhood-onset asthma and individuals without a chronic illness. Additionally, the relationship between perceived illness intrusiveness and illness uncertainty to health-related quality of life was explored. Methods. College undergraduates at least 18 years of age who self-identified as having childhood asthma were randomly matched by age and gender to healthy control participants. Participants completed a demographic form, the Mishel Uncertainty in Illness Scale-Community Form, the Illness Intrusiveness Scale, and the SF-36 Health Survey, a measure of health-related quality of life. Results. Participants with asthma had significantly lower scores on the total and mental health-related quality of life scales than did healthy control subjects. There were no significant differences between self-identified participants with asthma and matched healthy control subjects on physical health-related quality of life scales. Illness intrusiveness was not related to either the physical (e.g., physical functioning, general health) or mental health-related quality of life. Higher levels of illness uncertainty were significantly related to higher levels of mental health-related quality of life (e.g., vitality, mental health). In addition, participants with asthma scored significantly lower than healthy controls on the social functioning and role-emotional subscales. Conclusion. The current study adds to the extant literature by examining the relationships between illness intrusiveness, illness uncertainty, and health-related quality of life among a young adult population. College students with asthma appear to be at risk for diminished quality of life compared to a healthy comparison group. Further examination of various domains of health-related quality of life among older adolescents and young adults with childhood asthma is needed.

Uncertainty as a Predictor of Adjustment to an Implantable Cardioverter Defibrillator

Although the implantable cardioverter defibrillator (ICD) has reduced the risk of sudden cardiac death, some recipients experience uncertainty and adjustment problems related to the device. The study's purpose was to test hypotheses that predicted defibrillator recipients with greater uncertainty would have less psychosocial adjustment overall; less adjustment in the domestic, social, and vocational environments and in sexual relationships; and have more psychological distress at 1 and 8 weeks following hospital discharge. A repeated measures, correlational survey design was used with 94 adult defibrillator recipients from 4 hospitals. The Mishel Uncertainty in Illness Scale, Psychosocial Adjustment to Illness Scale Self-Report, and demographics were completed at both time points. The sample was predominantly white, male, and married. There were no gender differences and younger adults had more adjustment problems than older adults. Results supported all but 2 hypotheses as participants had less psychosocial adjustment overall, less adjustment in all domains except vocational environment, and more psychological distress at 1 and 8 weeks after discharge. In conclusion, ICD recipients with greater uncertainty were at greater risk for psychosocial adjustment problems during the first 2 months and may require interventions, particularly younger adults.

The relationship between illness uncertainty and coping style of breast cancer women undergoing chemotherapy

Objective To explore the correlation between illness uncertainty and coping style of breast cancer women undergoing chemotherapy. Methods A descriptive and correlative design was employed. 147 breast cancer women undergoing chemotherapy were recruited in the study. Three instruments were used to collect data, including the demographic form, the Mishel Uncertainty in Illness Scale for Adult (MUIS-A) and the Medical Coping Modes Questionnaire (MCMQ). All information were statistically analyzed through SPSS 11.5. Results The score of illness uncertainty (87.46 ± 9.92) was negatively correlated with confrontation (19.63 ± 4.02) and avoidance (14.81 ± 2.26) (P＜0.01), and it was positively correlated with resignation (9.68±2.67) (P＜0.01). Conclusions The breast cancer women undergoing chemotherapy much adopted the confrontation and avoidance style have lower illness uncertainty, while those much adopted the resignation coping style have higher illness uncertainty. It is suggested that the medical staffs should instruct the breast cancer women undergoing chemotherapy use the effective coping style, so as to reduce the illness uncertainty and improve the physical and mental health. Key words: Breast cancer; Chemotherapy; Illness uncertainty; Coping

Quality of Life, Social Support, and Uncertainty Among Latina Breast Cancer Survivors

To examine the relationship between perceived social support, uncertainty, and their individual and combined effects on quality of life (QOL) among Latina breast cancer survivors. Descriptive, correlational study. Selected private hospitals in Staten Island, Brooklyn, and Manhattan and the American Cancer Society units of Staten Island, Brooklyn, and Queens, New York. 89 Latina breast cancer survivors ages 30-86 years. Participants completed a personal data sheet, the Social Support Questionnaire, the Mishel Uncertainty in Illness Scale-Community form, and the Ferrans and Powers Quality of Life Index-Cancer Version III at home and returned the questionnaires to the investigators via postage-paid envelope. Perceived social support, uncertainty, and QOL. A significant positive correlation was noted between perceived social support and total QOL. A significant negative correlation was found between uncertainty and QOL. Social support predicted 15.1% of QOL variance, and uncertainty predicted 10.4% of additional QOL variance. Together, these two variables predicted 20.5% of QOL variance. Perceived social support and uncertainty play a pivotal role in managing or maintaining QOL in Latina breast cancer survivors. Social support, uncertainty, and QOL are essential variables that should be acknowledged when delivering health care to Latina breast cancer survivors. Nurses cognizant of Latina breast cancer survivors' issues and concerns in areas of social support and uncertainty are in a unique position to enhance QOL.

Quality of life among women after surgery for ovarian cancer.

Difficulties with diagnosis and aggressive, long-term treatment may result in lower quality of life (QOL), including high levels of anxiety, depression, and uncertainty, greater symptom distress, and lower overall QOL among women with ovarian cancer. The purpose of this study was to describe demographic, clinical, and other risk factors associated with compromised QOL among women who have undergone surgery for ovarian malignancies. Subjects were recruited to participate in a clinical trial that tested a specialized nursing intervention addressing psychological and physical care among women post-surgical for ovarian cancer. QOL was measured using five standardized self-report measures: the State-Trait Anxiety Scale (SAS), the Center for Epidemiological Studies Depression Scale (CES-D), the Mishel Uncertainty in Illness Scale (MUIS), the Symptom Distress Scale (SDS), and the Short-Form Health Survey (SF-12). Baseline data were collected while women were hospitalized following surgery. The sample (n=145) included women with ovarian cancer (58%) and other cancers metastasized to the ovaries and abdomen (42%). Mean scores on the measures were consistent with or higher than previously reported means for similar populations. Women reporting the lowest QOL were more likely to be younger, more educated, and have early stage disease. Women who have undergone surgery for ovarian malignancies have psychological needs that are often considered secondary to physical needs. Interventions should include routine screening for distress and referral to appropriate psychological and social services, thereby facilitating quality cancer care.

Influence of health education on uncertainty of patients undergoing extracorporeal shock wave lithotripsy

Objective We discussed the influence of health education on uncertainty of patients undergoing extracorporeal shock wave lithotripsy. Methods We divided 60 patients who were to undergo extracorporeal shock wave lithitripsy into the control group and the test group with 30 eases in each group. The test group implement systemic education according to the health education model. The control group received routine health education. Uncertainty about illness was measured by Mishel uncertainty in illness scale (MUIS) on admission, 1 day before lithotripsy and on discharge from hospital in the two groups. Results The illness uncertainty of the test group 1 day before lithotripsy and on discharge from hospital decreased evidently compared with that of on admission (P<0.01). The decrease amplitude was statistically different from that of the control group (P<0.01). Conclusion Health education through application of health education model could significantly decrease the illness uncertainty of patients undergoing extracorporeal shock wave lithotripsy. Key words: Health education; Illness uncertainty; Extracorporeal shock wave lithotripsy

Effects of a nursing intervention on quality of life outcomes in post-surgical women with gynecological cancers.

Women with gynecological cancers have reported poor health-related quality of life (QOL), with complex physical and psychological needs post-surgery and during chemotherapy treatment. There are no studies reporting interventions addressing these needs post-hospital discharge in this population. Patients were randomized into two groups. The intervention group received 6 months of specialized care by an Advanced Practice Nurse (APN); in addition, women with high distress were evaluated and monitored by a psychiatric consultation-liaison nurse (PCLN). The attention control group was assisted with symptom management by a research assistant. The effects of the 6-month intervention were evaluated using self-report questionnaires at baseline (24-48 h after surgery), 1, 3, and 6 months post- surgery. QOL assessments included the Center for Epidemiological Studies-Depression Scale , the ambiguity subscale of the Mishel Uncertainty in Illness Scale , the Symptom Distress Scale, and the Short-Form Health Survey (SF-12). The sample for the longitudinal analysis included 123 who completed QOL outcome measures across three occasions post-surgery. The APN intervention resulted in significantly less uncertainty than the attention control intervention 6 months after surgery. When the sub-group who received the APN plus PCLN intervention was compared with the total attention control group, the sub-group had significantly less uncertainty, less symptom distress, and better SF-12 mental and physical QOL over time. Nurse tailored interventions that target both physical and psychological aspects of QOL in women recovering from cancer surgery and undergoing chemotherapy produce stronger outcomes than interventions that target solely one QOL aspect.

Predictors of healthy behaviour in long‐term survivors of childhood cancer

The objective of this study was to examine the factors contributing to healthy behaviour in young adult long-term survivors of childhood cancer. Young adult childhood cancer survivors can adopt more healthy behaviour than the general population as a way to minimize the adverse consequences, that is, late effects of cancer and its treatment. Knowledge about the predictors of healthy behaviour in childhood cancer survivors can help providers assist young adult survivors with minimizing late effects. A cross-sectional correlational design and convenience sampling were used. Data were collected by mailed survey. Study measures included an investigator-developed demographic and disease form, the Mishel Uncertainty in Illness Scale-Community, the Post-traumatic Stress Disorder Index and the Health Promoting Lifestyle Profile II. Fifty-one per cent (N = 46) of eligible survivors responded to the survey. Data from 45 participants were used in the analyses. 43.3% of variance in healthy behaviour was explained by a model that included uncertainty (beta = -0.37, p = 0.007), post-traumatic stress symptoms (beta = -0.10, p = -0.44), interactions with primary care providers (beta = 0.33, p = 0.01) and a history of special educational assistance (beta = -0.23, p = 0.06). Young adult childhood cancer survivors who have higher levels of uncertainty, higher levels of symptoms of post-traumatic stress, lower frequency of primary healthcare interaction and poorer cognitive resources were more likely to report lower levels of healthy behaviour. The findings can guide the clinical assessment of young adult survivors with regard to their health behaviours and needs they may have for education and supportive care. Findings also help inform the design of health promotion interventions for this specific group of cancer survivors.

Parenting Stress in Mothers of Children with Congenital Heart Disease

The main purposes of this study were to examine the relationships among uncertainty, social support and parenting stress in mothers of children with congenital heart disease (CHD) and to identify the factors related to parenting stress. This was a survey study using a questionnaire. Fifty-one mothers of children with CHD were recruited at the pediatric cardiac outpatient clinic at one university-affiliated hospital in Seoul between July 14th and September 25th, 2006. Abidin's Parenting Stress Index-Short Form, Mishel's Parents' Perception Uncertainty in Illness Scale, and Brandt and Weinert's Personal Resource Questionnaire were used to collect data. The results of bivariate analysis showed that parenting stress was significantly related to social support, ambiguity, lack of clarity, and lack of information, but was not related to unpredictability, one of the subconcepts of uncertainty. Multiple regression analysis showed that parenting stress was significantly related to social support and Internet information. Mothers who reported they had more social support and less uncertainty showed lower parenting stress. Also, the Internet could be an effective method to obtain information and to share child-rearing experiences with other mothers of children with CHD.

Impact of Uncertainty, Social Support, and Prenatal Coping on the Psychological Well-being of High-risk Pregnant Women

The effects of uncertainty and social support on the psychological well-being of high-risk pregnant women may be influenced by their prenatal coping strategies. The purpose of this study was to investigate whether prenatal coping strategies (preparation for motherhood, avoidance, positive interpretation of events, and prayer) mediate the effects of uncertainty and social support on the psychological well-being of high-risk pregnant women. A cross-sectional, descriptive, correlational design was used. The convenience sample consisted of 105 high-risk pregnant women 18-34 years of age and at 24-36 weeks gestation. The main measures were Mishel Uncertainty in Illness Scale, Medical Outcomes Study Social Support Survey, Prenatal Coping Inventory, and Psychological General Well-Being Index. Data analysis included descriptive statistics, correlational techniques, and path analyses. The women reported low levels of uncertainty, moderate levels of distress, and high levels of social support. Prayer was the most frequently used prenatal coping strategy, whereas avoidance was used least often. Women who reported higher levels of uncertainty also reported less social support (r = -.45, p < .01), less psychological well-being (r = -.48, p < .01), less positive interpretation (r = -.30, p < .01), and more use of avoidance (r = .43, p < .01). The modified path analysis showed good fit with the data. Avoidance significantly mediated the effects of uncertainty on psychological well-being (z = -2.74, p < .01). Social support had a significant direct effect on preparation for motherhood (beta = .43, z = 3.94, p < .001). Avoidance mediated the effect of uncertainty on psychological well-being for the high-risk pregnant women in this sample. The results of the study may help perinatal nurses to better understand how high-risk pregnancy affects these women.

Uncertainty, Posttraumatic Stress, and Health Behavior in Young Adult Childhood Cancer Survivors

Young adult survivors of childhood cancer are at risk for medical late effects, some of which can be managed through health promotion behaviors. However, chronic uncertainty about the future can lead to the development of posttraumatic stress symptoms (PTSS) that can interfere with health promotion behaviors. To test a mediating model for the relationships among uncertainty, PTSS, and health promotion behaviors in young adult survivors of childhood cancer. The design was cross-sectional correlational. A convenience sample was used, and the data were collected using a mailed survey. Study measures included the Mishel Uncertainty in Illness Scale-Community Form, the Posttraumatic Stress Disorder Index, and the Health Promoting Lifestyle Profile II. Forty-six (51.1%) of the eligible survivors responded to the invitation to participate in the study. The analysis was based on data from 45 survivors. The results show that the relationship between PTSS and health promotion behaviors was mediated by uncertainty. Uncertainty is a suitable target for theory-based nursing interventions used to boost health promotion behaviors in young adult survivors of childhood cancer.

The Relationships Between Uncertainty and Posttraumatic Stress in Survivors of Childhood Cancer

The purposes of this study were to understand the levels of uncertainty and posttraumatic stress and to examine their relationships in young adult survivors of childhood cancer. A cross-sectional correlational design was used in this study. Mailed survey was the data collection method. The Mishel Uncertainty in Illness Scale-Community Form was the measure of uncertainty. The University of California at Los Angeles Post Traumatic Stress Disorder Index was the measure of posttraumatic stress. A total of 46 (51.1%) survivors responded to the survey and the analysis was based on data from 45. Participants reported a mean 51.3 (SD = 14.5, range = 23 to 90) level of uncertainty; and a mean 15.7 (SD = 11.0, range = 0 to 43) level of posttraumatic stress. Uncertainty was positively correlated with posttraumatic stress (r = .40, p = .039). The re- conceptualization of the Uncertainty in Illness Theory (UIT) and developmental perspectives can explain the relationships between uncertainty and posttraumatic stress in the young adult survivors of childhood cancer. The re-conceptualization of UIT can serve as a guide for future studies.

Uncertainty Appraisal Coping and Quality of Life in Breast Cancer Survivors

Breast cancer survivors increasingly experience long-term side effects that influence their quality of life. They also experience uncertainty of their future due to recurrence of disease. Descriptive design was conducted. Using convenience sampling, 150 breast cancer survivors of more than 3 years from time of diagnosis were recruited from Maharaj Nakorn Chiang Mai Hospital, Chiang Mai, Thailand. Research instruments included Mishel Uncertainty in Illness Scale, Stress Appraisal Index, Ways of Coping Questionnaire, and Quality of Life: Breast Cancer Version Questionnaire and Demographic Data Questionnaire. Results revealed that breast cancer survivors had moderate levels of uncertainty in their illness. Survivors appraised their illness and found high level of challenges, moderate level of threat, and low level of harm. Overall quality of life was found to be moderate. Among Ways of Coping strategies, seeking social support was used the most and confrontive coping was used the least. Using hierarchical multiple regression, variables influencing quality of life were year of survival, uncertainty in illness, and harm appraisal. All 3 variables explained 21.8% variance of quality of life. Uncertainty and harm appraisal influence quality of life in breast cancer survivors. Suggestions and further implications were included.

Uncertainty, symptom distress, anxiety, and functional status in patients awaiting coronary artery bypass surgery

The study's objective was to (1) describe uncertainty, anxiety, the symptom distress experience, and functional status of patients on a coronary artery bypass graft (CABG) waiting list and express the relationship between these concepts; (2) explore whether length of time waited has an influence on the psychosomatic condition of patients; and (3) explore the use of semistructured interviews within the context of a theoretic framework and compare open-ended responses to quantitative results. A descriptive, correlational, cross-sectional design was used with supplementary telephone interviews using semistructured questions. Quantitative data were collected with a mailed questionnaire. Study instruments included the Mishel Uncertainty in Illness Scale (Community), Symptom Frequency and Symptom Distress Scale, Graphical Anxiety Rating Scale, and Kansas City Cardiomyopathy Questionnaire (Physical and Social Limitation). The Mishel Uncertainty in Illness Theory was used as the guiding theoretic framework. The study took place in one large tertiary care hospital in Winnipeg, Manitoba, Canada. The study included a convenience sample of 42 patients undergoing first-time elective CABG only, 25 of whom participated in the telephone interview. Average uncertainty and anxiety were present at moderate levels and were associated with moderate deterioration of functional status. Reported symptom distress was low; however, presence of symptoms showed a strong relationship with anxiety (P=.0002), and this relationship was confirmed through semistructured interviews. Although the relationship between uncertainty and anxiety was nonsignificant, the interviews suggest positive views of uncertainty as an opportunity may have muted the relationship between uncertainty and anxiety, and that it is possible to experience uncertainty as a danger and an opportunity simultaneously. No statistically significant relationship was found between the study variables and waiting time; however, there was a nonsignificant trend toward deterioration of psychologic and physical condition with longer waits, which may be clinically significant. Psychosocial distress and physical condition among patients on CABG waiting lists should be continually assessed in all patients regardless of how long they have been waiting. Each patient will have a unique presentation of symptoms and a corresponding unique psychologic response.

Long-term quality of life and uncertainty in patients living with an implantable cardioverter defibrillator

This study describes the quality of life (QOL) and uncertainty in patients who have an implantable cardioverter defibrillator (ICD) and predicts QOL at long-term follow-up. Long-term follow-up was defined as 6.9 years +/- 1 year (range 4.11-8.7 years). QOL was measured with the Quality of Life Index, and uncertainty was measured with the Mishel Uncertainty in Illness Scale. The overall QOL and health/functioning were unchanged over time. QOL in the socioeconomic (P = .002) and psychologic/spiritual domains (P = .012) decreased in the first year. From baseline to long-term follow-up, the QOL in the family domain (P = .011) and uncertainty (P = .002) decreased. Uncertainty was a predictor of low QOL. QOL was reasonably good 6.9 years post-ICD implantation. Patients felt less uncertain once they had passed the first year of their illness.

Mitral Valve Prolapse Syndrome Health Concerns, Symptoms, and Treatments

Individuals with mitral valve prolapse syndrome (MVPS) symptoms seek help in emergency rooms, urgent care centers, and primary care offices. Little is known about the profile and effects of these symptoms on individuals' role status and use of health care services. A descriptive cross-sectional design was used to develop a profile of health concerns, symptoms, and treatments and to examine the relationships of symptoms to functional and role status and use of health care services for MVPS patients. A sample of 837 persons completed an MVPS symptom checklist and survey, Mishel Uncertainty Illness Scale, Short Form Health Survey, State-Trait Anxiety Inventory, Medical Outcomes Study Social Support, and Food Frequency Questionnaire. Descriptive statistics, multiple-regression analysis, and structural equation modeling were used to answer the research questions. Findings suggest that older age, lack of social support, higher anxiety, and lack of regular exercise predict MVPS symptoms. There was limited support for the overall theoretical model.

Functional Status and Psychosocial Adjustment in Gynecologic Cancer Patients Receiving Chemotherapy

Purpose: The purpose of this study was to identify the patterns of activities of daily living (ADL) functional status and to examine the relationships between sense of coherence(SOC), depression, and uncertainty in gynecologic cancer patients who were receiving chemotherapy. Method: A prospective, longitudinal design with repeated measures was utilized. W omen reported depression, SOC, and uncertainty at the beginning of the first cycle of chemotherapy, and they recorded ADL functional status everyday for two consecutive treatment cycles. the The instruments used were the Karnofsky Performance Status Index, Orientation to Life Questionnaire, Beck Depression Inventory, and Mishel Uncertainty in Illness Scale-Adult Form. Result: Data from 42 women showed that the ADL functional status during the second cycle was better than that of the first cycle with significant improvement each week. However, it did not completely recover to the baseline level even three weeks after the treatment ended in both cycles. SOC was correlated with depression(r=-.64, p<.001) and uncertainty(r=-.62, p<.001). Uncertainty was related to depression (r=.66, p<.001) and to functional status during the second cycle(r=-.45, p<.05), while the scores of the functional status during the two cycles were not related. Conclusion: Changing patterns and level of functional status during the treatment phase would be useful information for cancer patients to prepare coping strategies for positive health outcomes.