Influence Factors Of Uncertainty In Illness And Effect Of Personalized Information Support On Uncertainty In Illness Among Breast Cancer Patients Undergoing Chemotherapy

BackgroundDue to the increasing incidence year by year, breast cancer has been the most common malignant tumor among Chinese women. As an effective therapy, chemotherapy has been one of the most important therapy means in breast cancer patients. But the complex chemotherapy procedure and chemotherapy-induced adverse effects make breast cancer patients unable to forecast the disease progress and prognosis, which could cause uncertainty in illness. Uncertainty in illness is defined as"the inability to determine the meaning of illness-related events and occurs in situations where the decision maker is unable to assign definite values to objects and events and/or is unable to accurately predict outcomes because sufficient cues are lacking". As a major component of the illness experience, uncertainty can dramatically affect psychosocial adaption and outcomes of disease states. Those negative moods caused by uncertainty in illness could not only interfere with the patients'ability to seek the disease-related information, but also cause the behavioral degeneration and treatment interruption. Previous studies show that uncertainty in illness is common among breast cancer patients. Uncertainty in illness is negatively related to social support and quality of life, positively related to anxiety and depression. However, none of current domestic literatures are found to examine the state of uncertainty in illness and the correlations between uncertainty in illness and illness related knowledge cognitive level and chemotherapy-induced adverse effects among breast cancer patients undergoing chemotherapy.ObjectiveThe purpose of this study is to investigate uncertainty in illness state and its influence factors, to explore the correlations between uncertainty in illness and cognitive level of breast cancer and chemotherapy-related knowledge and the level of chemotherapy-induced adverse effects, to explore the state and its influence factors of information needs among breast cancer patients undergoing chemotherapy, and to examine the practical effect of personalized information support on uncertainty in illness in breast cancer patients undergoing chemotherapy.MethodsPartⅠ: With a comparative descriptive design, a convenience sampling method was conducted to recruit study subjects who were admitted to the Department of Breast Surgery, some Grade A Class Three Hospital in Nanjing. Eighty-five breast cancer patients undergoing chemotherapy from December 2007 to April 2008 were assessed with Demographic and Disease-related Information Questionnaire, Chinese Version of Mishel's Uncertainty in Illness Scale (MUIS), Breast Cancer and Chemotherapy-related Knowledge Questionnaire and Chemotherapy-induced Adverse Effects Evaluation Form.PartⅡ: According to the result that the score of uncertainty in illness was negatively related to the cognitive level of breast cancer and chemotherapy-related knowledge, 132 breast cancer patients undergoing chemotherapy from June 2008 to February 2009 who were not at the last chemotherapy course were assessed with MUIS firstly, and 103 patients with high and moderate level in uncertainty in illness were recruited as study subjects. Those study subjects were also the patients who were admitted to the Department of Breast Surgery, some Grade A Class Three Hospital in Nanjing. Those 103 subjects were surveyed with Self-made Information Needs Questionnaire in order to investigate the patients'personalized information needs and the state of information needs and its influence factors. The first 51 subjects were assigned to the comparison group, other 52 subjects were assigned to the experimental group so as to decrease mutual interference between the subjects. The comparison group received routine health instruction, while the experimental group received information support according to the patients'personalized information needs. All subjects were assessed with MUIS once again before being discharged at the next chemotherapy course. Self-contrast method was used to compare the MUIS scores of pre and post information support in order to evaluate the effect of personalized information support in decreasing uncertainty in illness among breast cancer patients undergoing chemotherapy.The data were analyzed with descriptive statistics, analysis of variance (ANOVA), multiple stepwise regression analysis, Pearson linear correlation, Chi-square test and t test by SPSS16.0 Software Package. P values of less than 0.05 were considered statistically significant.ResultsIn PartⅠ, the total scores in their uncertainty in illness was 48～97 (73.72±13.90). 17.65% of the patients were at high level in uncertainty in illness and 63.53% of them at moderate level, and 18.82% of them at low level. Educational level, disease stage and having complications were the main influence factors of uncertainty in illness among breast cancer patients undergoing chemotherapy. The score of uncertainty in illness was negatively related to the cognitive level of breast cancer and chemotherapy-related knowledge (P<0.05), positively related to the score of chemotherapy-induced adverse effects (P<0.05).In PartⅡ, information needs were negatively related to educational level in patients with high and moderate level in uncertainty in illness (P<0.05). There were no statistical differences in terms of the general score and its two dimensions of uncertainty in illness between the two groups before information support (P>0.05). There were no statistical differences on uncertainty in illness level of comparison group cases after receiving routine health instruction(P>0.05). However, after receiving personalized information support, the uncertainty in illness level of experimental group cases showed a significant decrease, and so did two dimensions of uncertainty in illness(P<0.05).ConclusionsThe general level of uncertainty in illness is moderate in breast cancer patients undergoing chemotherapy. There are significant correlations between uncertainty in illness and the cognitive level of breast cancer and chemotherapy-related knowledge, and the level of chemotherapy-induced adverse effects. Nurses should attach full importance to the negative impacts of uncertainty in illness originated from lacking of illness-related knowledge and chemotherapy-induced adverse effects. Nurses also should concern about and satisfy the higher information needs in breast cancer patients undergoing chemotherapy with lower educational level. Information support according to the patients'personalized information needs can significantly reduce uncertainty in illness level in breast cancer patients who received chemotherapy.