Construction Of A Model Of Uncertainty In Illness For The Postoperative Patients With Digestive System Tumors Undergoing Chemotherapy

Objectives To explore the experience of uncertainty in illness and coping styles ofdigestive system cancer patients during chemotherapy period. To describe uncertaintylevel and its influence factors of the postoperative patients with digestive system tumorsundergoing chemotherapy, construct a model of uncertainty in illness based on Mishel’stheory of uncertainty in illness in a sample of the postoperative patients with digestivesystem tumors undergoing chemotherapy.Methods Section1: This study used phenomenological research approach.15digestivesystem cancer patients who undergoing chemotherapy were selected from a top threehospital in Anhui Province were semi-structured interviewed. The data were analyzedwith phenomenological seven-step analysis method. Section2: During December2011-October2012,448postoperative patients with digestive system cancer undergoingchemotherapy were recruited in the study by convenient method. The demographic form,the Mishel Uncertainty in Illness Scale for Adult, Memorial Symptom Assessment Scale,Social Support Rating Scale, Cancer Coping Modes Questionnaire, Growth ThroughUncertainty Scale were used. The SPSS18.0software was used to analyse data, and theAMOS17.0software was used to construct a model of uncertainty in illness.Results Section1: The experiences of uncertainty in illness of digestive system cancerpatients during chemotherapy period including:①Uncertainty of the severity and significance of symptoms.②Not clear about the treatment-related information.③Ambiguity of disease-related knowledge and information.④Difficult to predict diseaseprognosis.⑤Uncertainty about the various types of social support. The main copingstyles including:①Seeking faith.②Repressing, avoiding and venting.③Being eagerand seeking social support.④Taking the initiative to seek knowledge or informationand changing lifestyles.⑤Adjusting to adapting, now or never. Section2:①Theaverage score of uncertainty of postoperative digestive system cancer patients duringchemotherapy was89.86±11.84, the level of uncertainty was middle.②The level ofuncertainty in illness is different among different age, education level, occupation,family residence, family income, payment of medical expenses, tumor location,operation measure, transfer or not. Multiple regression showed that symptom distress,social support, treatment environment familiarity, family monthly income can beexplained20.2%variation of uncertainty in illness.③Uncertainty has a direct effect andan indirect effect on personal growth by coping styles of confront and avoid.④Modelof uncertainty in illness of the postoperative digestive system cancer patients duringchemotherapy shows that the antecedents of uncertainty include two aspects, namely,stimuli frame and structure providers. Stimuli framework include two variables ofsymptom distress and treatment environment familiarity, structure providers include twovariables of social support and family monthly income, structure provider can reducesthe level of uncertainty in illness directly or indirectly, uncertainty in illness candecrease the level of personal growth.Conclusion Section1: The uncertainty experience of digestive system cancer patientswho are going through chemotherapy in China is consistent with Mishel’s theory andhas its own cultural characteristics at the same time, namely, uncertain about materialsupport and professional social support, so health care workers should pay attention toprovide social support. Section2: The level of uncertainty of postoperative digestive system cancer patients during chemotherapy was middle, health care workers shouldpay attention to it. Health care workers should assess and analysis the patient’suncertainty vary from person to person, and focus on patients who have serioussymptom distress, low level of social support, poor treatment environment familiarityand family monthly income, evaluate and optimize the patient’s coping styles, therebygaining more personal growth. The model suggest us that provide professional socialsupport, symptom manage, help patients familiar with the medical environment,optimize their coping styles are very important for uncertainty management.