Fairfield University School of Nursing, Fairfield, CT 06824, USA.
BJU Int. 2013 Mar;111(3 Pt B):E84-91. doi: 10.1111/j.1464-410X.2012.11439.x. Epub 2012 Sep 18.
Study Type - Therapy (attitude prevalence) Level of Evidence 2a What's known on the subject? and What does the study add? Marked differences in uncertainty among patients have been found relating to race and social environment indicating that as uncertainty increases, social functioning declines. Correlations have been found between uncertainty and patients' coping, psychological adjustment and perceptions of their health and illness. Studies suggest the detrimental effect of uncertainty among patients with prostate cancer in the perception of their quality of life. These studies underline the potential benefit of targeted intervention. The study provides a unique insight into the impact of uncertainty and perception of danger on overall satisfaction with treatment outcomes in men with prostate cancer. Its results suggest that possible disparities related to patient racial background and education may exist in the perception of cancer-related uncertainty. Racial and educational disparities, coupled with a mild to moderate association of uncertainty or danger perception and overall outcome satisfaction, suggest an unmet need for healthcare and nursing services for men undergoing treatment for prostate cancer.
To investigate patient uncertainty and perception of danger regarding prospects for clinical prostate cancer control. To determine the impact of these factors on satisfaction with overall prostate cancer treatment outcome.
Men who had undergone primary treatment for early stage prostate cancer and who were participants in the Prostate Cancer Outcomes and Satisfaction with Treatment Quality Assessment (PROSTQA) prospective cohort study of prostate cancer outcomes (the parent study) were offered the opportunity to participate in the present study. Centralized phone interviews were conducted to determine patient-reported uncertainty regarding cancer status (measured by the Mishel Uncertainty in Illness Scale-Community Form), perception of danger (measured by Folkman and Lazarus' Appraisal Scale) and satisfaction with treatment outcome (measured by the Service Satisfaction Scale for Cancer Care). The study used the same centralized telephone interview centre as was used in the parent study. Data were collected at 48, 60 or 72 months after the completion of prostate cancer treatment. Relationships among measures were characterized by Spearman rank correlation coefficients (r).
A total of 338 agreed to participate, representing 76% of those who were invited. Younger patients experienced less uncertainty (r = 0.20, P < 0.001), yet reported greater perception of danger (r = -0.12; P = 0.03) concerning their previously treated prostate cancer. African-American patients showed greater uncertainty than other ethnic groups (P = 0.005) but did not have a greater perception of danger (P = 0.36). Education played a major role in uncertainty; patients with lower levels of education tended to report higher degrees of uncertainty (r = -0.25; P < 0.001). There was a mild to moderate general association between the three outcomes. A greater sense of uncertainty was associated with a greater perception of danger (r = 0.34, P < 0.001), and as danger and uncertainty increased, satisfaction with treatment outcome tended to decrease (r was between -0.30 and -0.34, P < 0.001).
Results suggest that possible disparities related to patient racial background and education may exist in the perception of cancer-related uncertainty. Racial and educational disparities, coupled with a mild to moderate association of uncertainty or danger perception and overall outcome satisfaction, suggest an unmet need for healthcare and nursing services for men undergoing treatment for prostate cancer.
本研究旨在调查患者对临床前列腺癌控制前景的不确定性和危险感知，并确定这些因素对整体前列腺癌治疗结局满意度的影响。
本研究纳入了参加前列腺癌结局和治疗质量评估（PROSTQA）前瞻性队列研究的早期前列腺癌初治男性患者，并为其提供了参与本研究的机会。通过集中电话访谈，确定患者对癌症状态的报告性不确定性（采用米舍尔社区形式疾病不确定感量表评估）、对危险的感知（采用福克曼和拉扎勒斯评估量表评估）和对治疗结局的满意度（采用癌症护理服务满意度量表评估）。本研究使用了与 PROSTQA 研究相同的集中电话访谈中心。在前列腺癌治疗完成后 48、60 或 72 个月收集数据。采用 Spearman 秩相关系数（r）描述各指标之间的关系。
共有 338 人同意参与，占受邀人数的 76%。年轻患者的不确定性较低（r = 0.20，P < 0.001），但对其先前治疗过的前列腺癌的危险感知较高（r = -0.12；P = 0.03）。非裔美国患者比其他族裔患者表现出更大的不确定性（P = 0.005），但对危险的感知却没有更大（P = 0.36）。教育在不确定性中起主要作用；受教育程度较低的患者往往报告更高程度的不确定性（r = -0.25；P < 0.001）。这三个结果之间存在轻度到中度的一般关联。更大的不确定性感与更大的危险感知相关（r = 0.34，P < 0.001），随着危险和不确定性的增加，治疗结局的满意度趋于下降（r 值在-0.30 到-0.34 之间，P < 0.001）。
结果表明，患者的种族背景和受教育程度可能与对癌症相关不确定性的感知存在差异。种族和教育差异，加上不确定性或危险感知与整体结局满意度的轻度到中度关联，表明接受前列腺癌治疗的男性需要更多的医疗保健和护理服务。
