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Open Access Article
Outcomes of an Uncertainty Management Intervention in Younger African American and Caucasian Breast Cancer Survivors
Purpose/Objectives: To determine whether breast cancer survivors (BCSs) who received an uncertainty management intervention, compared to an attention control condition, would have less uncertainty, better uncertainty management, fewer breast cancer-specific concerns, and more positive psychological outcomes.
Design: A 2 × 2 randomized block, repeated-measures design, with data collected at baseline and two other points postintervention, as well as a few days before or after either a mammogram or oncologist visit.
Setting: Rural and urban clinical and community settings.
Sample: 313 female BCSs aged 50 or younger; 117 African Americans and 196 Caucasians.
Methods: Participants were blocked on ethnicity and randomly assigned to intervention or control. The intervention, consisting of a scripted CD and a guide booklet, was supplemented by four scripted, 20-minute weekly training calls conducted by nurse interventionists. The control group received the four scripted, 20-minute weekly training calls.
Main Research Variables: Uncertainty in illness, uncertainty management, breast cancer-specific concerns, and positive psychological outcomes.
Findings: BCSs who received the intervention reported reductions in uncertainty and significant improvements in behavioral and cognitive coping strategies to manage uncertainty, self-efficacy, and sexual dysfunction.
Conclusions: The intervention was effective as delivered in managing uncertainties related to being a younger BCS.
Implications for Nursing: The intervention can realistically be applied in practice because of its efficient and cost-effective nature requiring minimal direct caregiver involvement. The intervention allows survivors who are having a particular survival issue at any given point in time to access information, resources, and management strategies.
Knowledge Translation: Materials tested in CD and guide booklet format could be translated into online format for survivors to access as issues arise during increasingly lengthy survivorship periods. Materials could be downloaded to a variety of electronic devices, fitting with the information needs and management styles of younger BCSs.
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References
American Cancer Society. (2012). Cancer facts and figures, 2012. Atlanta, GA: Author.
Antoni, M. H., Lechner, S. C., Kazi, A., Wimberly, S. R., Sifre, T., Urcuyo, K. R., … Carver, C. S. (2006). How stress management improves quality of life after treatment for breast cancer. Journal of Consulting and Clinical Psychology, 74, 1143-1152.
Avis, N. E., Crawford, S., & Manuel, J. (2005). Quality of life among younger women with breast cancer. Journal of Clinical Oncology, 23, 3322-3330.
Aziz, N. M., & Rowland, J. H. (2002). Cancer survivorship research among ethnic minority and medically underserved groups. Oncology Nursing Forum, 29, 789-801. doi:10.1188/02.ONF.789-801
Bandura, A. (1997). Self-efficacy: The exercise of control. New York, NY: W. H. Freeman.
Bastien, C. H., Vallieres, A., & Morin, C. M. (2001). Validation of the insomnia severity index as an outcome measure for insomnia research. Sleep Medicine, 2, 297-307.
Baucom, D. H., Porter, L. S., Kirby, J. S., Gremore, T. M., & Keefe, F. J. (2005). Psychosocial issues confronting young women with breast cancer. Breast Diseases, 23, 103-113.
Baucom, D. H., Porter, L. S., Kirby, J. S., Gremore, T. M., Wiesenthal, N., Aldridge, W., … Keefe, F. J. (2009). A couple-based intervention for female breast cancer. Psycho-Oncology, 18, 276-283. doi:10.1002/pon.1395
Bloom, J. R., Stewart, S. L., D'Onofrio, C. N., Luce, J., & Banks, P. J. (2008). Addressing the needs of young breast cancer survivors at the five-year milestone: Can a short-term, low-intensity intervention produce change? Journal of Cancer Survivorship, 2, 190-204. doi:10.1007/s11764-008-0058-x
Box, R. C., Reul-Hirche, H. M., Bullock-Saxton, J. E., & Furnival, C. M. (2002). Shoulder movement after breast cancer surgery: Results of a randomized controlled study of postoperative physiotherapy. Breast Cancer Research and Treatment, 75, 35-50.
Friedlander, M., & Thewes, B. (2003). Counting the costs of treatment: The reproductive and gynaecological consequences of adjuvant therapy in young women with breast cancer. Internal Medicine Journal, 33, 372-379.
Ganz, P. A., Greendale, G. A., Petersen, L., Kahn, B., & Bower, J. E. (2003). Breast cancer in younger women: Reproductive and late health effects of treatment. Journal of Clinical Oncology, 21, 4184-4193. doi:10.1200/JCO.2003.04.196
Germino, B. B., Mishel, M. H., Alexander, A. R., Jenerette, C., Blyler, D., Baker, C., … Long, D. C. (2011). Engaging African American breast cancer survivors in an intervention trial: Culture, responsiveness, and community. Journal of Cancer Survivorship, 5, 82-91. doi:0.1007ls11764-010-0150-1
Harris, S. R., Hugi, M. R., Olivotto, I. A., Levine, M., & the Steering Committee for Clinical Practice Guidelines for the Care and Treatment of Breast Cancer. (2001). Clinical practice guidelines for the care and treatment of breast cancer: 11. Lymphedema. Canadian Medical Association Journal, 164, 191-199.
Horowitz, M., Wilner, N., & Alvarez, W. (1979). Impact of Events scale: A measure of subjective stress. Psychosomatic Medicine, 41, 209-218.
Jukkala, A. M., Azuero, A., McNees, P., Bates, G. W., & Meneses, K. (2010). Self-assessed knowledge of treatment and fertility preservation in young women with breast cancer. Fertility and Sterility, 3, 43. doi:10.1016/j.fertnstert.2010.03.043
Kantsiper, M., McDonald, E. L., Geller, G., Shockney, L., Snyder, C., & Wolff, A. C. (2009). Transitioning to breast cancer survivorship: Perspectives of patients, cancer specialists, and primary care providers. Journal of General Internal Medicine, 24(Suppl. 2), S459-S466. doi:10.1007/s11606-009-1000-2
Knobf, M. T. (2001). The menopausal symptom experience in young mid-life women with breast cancer. Cancer Nursing, 24, 201-210.
Kornblith, A. B., Powell, M., Regan, M. M., Bennett, S., Krasner, C., May, B., … Winer, E. (2007). Long-term psychosocial adjustment of older versus younger survivors of breast and endometrial cancer. Psycho-Oncology, 16, 895-903. doi:10.1002/pon.1146
Lev, E. L., Daley, K. M., Conner, N. E., Reith, M., Fernandez, C., & Owen, S. V. (2001). An intervention to increase quality of life and self-care self-efficacy and decrease symptoms in breast cancer patients. Scholarly Inquiry in Nursing Practice, 15, 277-294.
Lorig, K., Chastain, R. L., Ung, E., Shoor, S., & Holman, H. R. (1989). Development and evaluation of a scale to measure perceived self-efficacy in people with arthritis. Arthritis and Rheumatism, 32, 37-44.
Marcus, A. C., Garrett, K. M., Cella, D., Wenzel, L., Brady, M. J., Fairclough, D., … Flynn, P. J. (2010). Can telephone counseling post-treatment improve psychosocial outcomes among early stage breast cancer survivors? Psycho-Oncology, 19, 923-932. doi:10.1002/pon.1653
Mast, M. (1995). Survivors of breast cancer: Illness uncertainty, positive reappraisal, and emotional distress. Oncology Nursing Forum, 25, 555-562.
Maxwell, C., & Viale, P. H. (2005). Cancer treatment-induced bone loss in patients with breast or prostate cancer. Oncology Nursing Forum, 32, 589-603. doi:10.1188/05.ONF.589-603
Mehnert, A., Berg, P., Henrich, G., & Herschbach, P. (2009). Fear of cancer progression and cancer-related intrusive cognitions in breast cancer survivors. Psycho-Oncology, 18, 1273-1280. doi:10.1002/pon.1481
Meneses, K., McNees, P., Azuero, A., & Jukkala, A. (2010). Evaluation of the fertility and cancer project (FCP) among young breast cancer survivors. Psycho-Oncology, 19, 1112-1115. doi:10.1002/pon.1648
Mishel, M. H. (1981). The measurement of uncertainty in illness. Nursing Research, 30, 258-263.
Mishel, M. H. (1983). Adjusting the fit: Development of uncertainty scales for specific clinical populations. Western Journal of Nursing Research, 5, 355-370.
Mishel, M. H. (1984). Perceived uncertainty and stress in illness. Research in Nursing and Health, 7, 163-171.
Mishel, M. H. (1988). Uncertainty in illness. Image: Journal of Nursing Scholarship, 20, 225-232.
Mishel, M. H. (1999). Uncertainty in chronic illness. Annual Review of Nursing Research, 17, 269-294.
Mishel, M. H., Belyea, M., Germino, B. B., Stewart, J. L., Bailey, D. E., Robertson, C., & Mohler, J. L. (2002). Helping patients with localized prostate carcinoma manage uncertainty and treatment side effects: Nurse-delivered psychoeducational intervention over the telephone. Cancer, 94, 1854-1866.
Mishel, M. H., & Fleury, J. (1997). The growth through uncertainty scale. Unpublished manuscript.
Mishel, M. H., Germino, B. B., Belyea, M., Stewart, J. L., Bailey, D. E., Mohler, J., & Robertson, C. (2003). Moderators of an uncertainty management intervention: For men with localized prostate cancer. Nursing Research, 5, 89-97.
Mishel, M. H., Germino, B. B., Gil, K. M., Belyea, M., LeNay, I. C., Stewart, J., … Clayton, M. F. (2005). Benefits from an uncertainty management intervention for African American and Caucasian older long-term breast cancer survivors. Psycho-Oncology, 14, 962-978. doi:10.1002/pon.909
Morin, C. M. (1993). Insomnia: Psychological assessment and management. New York, NY: Guilford Press.
Pinto, B. M., & Trunzo, J. J. (2004). Body esteem and mood among sedentary and active breast cancer survivors. Mayo Clinic Proceedings, 79, 181-186.
Piper, B. F., Dibble, S. L., Dodd, M. J., Weiss, M. C., Slaughter, R. E., & Paul, S. M. (1998). The revised Piper Fatigue Scale: Psychometric evaluation in women with breast cancer. Oncology Nursing Forum, 25, 677-684.
Pistrang, N., & Barker, C. (1992). Disclosure of concerns in breast cancer. Psycho-Oncology, 1, 183-192. doi:10.1002/pon.2960010307
Porter, L. S., Keefe, F. J., Baucom, D. H., Hurwitz, H., Moser, B., Patterson, E., & Kim, H. J. (2009). Partner-assisted emotional disclosure for patients with gastrointestinal cancer: Results from a randomized controlled trial. Cancer, 115, 4326-4338. doi:10.1002/cncr.24578
Rosen, A., Rodriguez-Wallberg, K. A., & Rosenzweig, L. (2009). Psychosocial distress in young cancer survivors. Seminars in Oncology Nursing, 25, 268-277. doi:10.1016/j.soncn.2009.08.004
Rosenbaum, M. (1983). Learned resourcefulness as a behavioral repertoire for the self-regulation of maternal events: Issues and speculations. In M. Rosenbaum, C. M. Frands, & Y. Jaffe (Eds.), Perspectives on behavior therapy in the Eighties (pp. 54-73). New York, NY: Springer.
Russell, K. M., Von Ah, D. M., Giesler, R. B., Storniolo, A. M., & Haase, J. E. (2008). Quality of life of African American breast cancer survivors: How much do we know? Cancer Nursing, 31, E36-E45. doi:10.1097/01.NCC.0000339254.68324.d7
Sammarco, A. (2009). Quality of life of breast cancer survivors: A comparative study of age cohorts. Cancer Nursing, 32, 347-356. doi:10.1097/NCC.0b013e31819e23b7
Savard, J., Simard, S., Ivers, H., & Morin, C. M. (2005). Randomized study on the efficacy of cognitive-behavioral therapy for insomnia secondary to breast cancer. Part II: Immunologic effects. Journal of Clinical Oncology, 23, 6097-6106. doi:10.1200/JCO.2005.12.513
Schwartz, A. L. (2000). Daily fatigue patterns and effect of exercise in women with breast cancer. Cancer Practice, 8, 16-24.
Spencer, S. M., Lehman, J. M., Wynings, C., Arena, P., Carver, C. S., Antoni, M. H., … Love, N. (1999). Concerns about breast cancer and relations to psychosocial well-being in a multiethnic sample of early-stage patients. Health Psychology, 18, 159-168.
Stiegelis, H. E., Hagedoorn, M., Sanderman, R., Bennenbroek, G. T., Buunk, B. P., van den Bergh, A. C., … Ranchor, A. V. (2004). The impact of an informational self-management intervention on the association between control and illness uncertainty before and psychological distress after radiotherapy. Psycho-Oncology, 13, 248-259. doi:10.1002/pon.738
Thewes, B., Butow, P., Girgis, A., & Pendlebury, S. (2004). The psychosocial needs of breast cancer survivors: A qualitative study of the shared and unique needs of younger versus older survivors. Psycho-Oncology, 13, 177-189. doi:10.1002/pon.710
Vickberg, S. M. (2003). The Concerns About Recurrence Scale (CARS): A systematic measure of women's fears about the possibility of breast cancer recurrence. Annals of Behavioral Medicine, 25, 16-24.
Ware, J. E., Jr., & Sherbourne, C. D. (1992). The MOS 36-item short-form health survey (SF-36). 1. Conceptual framework and item selection. Medical Care, 30, 473-483.
Watson, D., Clark, L. A., & Tellegen, A. (1988). Development and validation of brief measures of positive and negative affect: The PANAS scale. Journal of Personality and Social Psychology, 54, 1063-1070.