School of Nursing, University of Rochester Medical Center, Rochester, New York, USA.
Division of Hematology/Oncology, Department of Medicine, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York, USA.
Psychooncology. 2022 Jun;31(6):1041-1049. doi: 10.1002/pon.5895. Epub 2022 Feb 20.
One primary source of psychological distress in patients with cancer and their caregivers is uncertainty. However, the uncertainty trajectory and its relationship between older adults with advanced cancer and their caregivers have rarely been examined. This study describes the uncertainty trajectory in patient-caregiver dyads, explores the effect of geriatric assessment (GA) intervention on trajectory, and examines the interdependent relationship of uncertainty.
This secondary analysis used longitudinal data from a national cluster-randomized controlled trial examining a GA intervention compared to usual care. Participants completed the modified 9-item Mishel Uncertainty in Illness Scale at enrollment, 4-6 weeks, 3 months, and 6 months. The dyadic growth model and cross-lagged actor-partner interdependence model were used.
A total of 397 dyads (patient age M = 76.81 ± SD5.43; caregiver age M = 66.69 ± SD12.52) were included. Both had a trend of decreased uncertainty over time (b = -0.16, p < 0.01). There was a greater decrease in uncertainty among caregivers in the GA group than those in the usual care group (b = -0.46, p = 0.02). For both patients and caregivers, their past uncertainty was a significant predictor of their own current uncertainty (i.e., actor effect, p < 0.01). The individual's past uncertainty was a significant predictor of the other dyad member's current uncertainty (i.e., partner effect, p < 0.05), indicating an interdependent relationship between patient and caregiver uncertainty over time.
Findings suggest patient and caregiver function as a unit with uncertainty levels affecting each other. Future interventions could build on GA to address uncertainty for older patients with advanced cancer and caregivers.
癌症患者及其照顾者心理困扰的一个主要来源是不确定性。然而，年龄较大的晚期癌症患者及其照顾者的不确定性轨迹及其关系很少被研究。本研究描述了患者-照顾者对子的不确定性轨迹，探讨了老年评估（GA）干预对轨迹的影响，并检验了不确定性的相互关系。
这是一项使用全国性聚类随机对照试验的纵向数据分析，该试验比较了 GA 干预与常规护理。参与者在入组时、4-6 周、3 个月和 6 个月时完成了修改后的 9 项米舍尔疾病不确定感量表。使用了对偶增长模型和交叉滞后演员-伙伴相互依存模型。
共纳入 397 对（患者年龄 M=76.81±5.43；照顾者年龄 M=66.69±12.52）。两者的不确定性都呈随时间降低的趋势（b=-0.16，p<0.01）。GA 组照顾者的不确定性降低幅度大于常规护理组（b=-0.46，p=0.02）。对于患者和照顾者来说，他们过去的不确定性是他们当前不确定性的一个重要预测因素（即演员效应，p<0.01）。个体过去的不确定性是另一个对子成员当前不确定性的重要预测因素（即伙伴效应，p<0.05），表明患者和照顾者的不确定性在时间上是相互依存的。
研究结果表明，患者和照顾者作为一个整体发挥作用，其不确定性水平相互影响。未来的干预措施可以在 GA 的基础上，针对晚期癌症老年患者及其照顾者的不确定性问题。
