Background
Psychosocial uncertainty management interventions (UMIs) targeting patients and their family members might help to alleviate the negative influences of illness-related uncertainty, such as diminished quality of life and poor adjustment.
Objectives
The aims of this study were to evaluate the key characteristics of psychosocial UMIs and assess intervention effects on patients' and their family members' short-term and long-term illness-related uncertainty.
Methods
We conducted a systematic review and meta-analysis of psychosocial UMIs published through 2017. We performed a comprehensive electronic search and manual review. The outcome indicator was illness-related uncertainty experienced by patients or their family members.
Results
We included 29 studies in the systematic review and 14 studies in the meta-analysis. The main intervention components were information and resource provision, coping skills training, social and emotional support, communication skills, symptom management and self-care, coordination of care, and exercise. Compared to usual care, patients who received UMIs reported less uncertainty immediately after intervention delivery (g = −0.44, 95% confidence interval [CI] [−0.71, −0.16]) and at later follow-up points (g = −0.47, 95% CI [−0.91, −0.03]). Family members who received UMIs also reported less uncertainty immediately after intervention delivery (g = −0.20, 95% CI [−0.33, −0.06]) and at later follow-up points (g = −0.20, 95% CI [−0.36, −0.04]).
Discussion
Psychosocial UMIs had small to medium beneficial effects for both patients and their family members. Questions remain regarding what intervention components, modes of delivery, or dosages influence effect size. More rigorously designed randomized controlled trials are needed to validate intervention effects on patients' and family members' uncertainty management.
Shade-tolerant non-native invasive plant species may make deep incursions into natural plant communities, but detecting such species is challenging because occurrences are often sparse. We developed Bayesian models of the distribution of Microstegium vimineum in natural plant communities of the southern Blue Ridge Mountains, USA to address three objectives: (1) to assess local and landscape factors that influence the probability of presence of M. vimineum; (2) to quantify the spatial covariance error structure in occurrence that was not accounted for by the environmental variables; and (3) to synthesize our results with previous findings to make inference on the spatial attributes of the invasion process. Natural plant communities surrounded by areas with high human activity and low forest cover were at highest risk of M. vimineum invasion. The probability of M. vimineum presence also increased with increasing native species richness and soil pH, and decreasing basal area of ericaceous shrubs. After accounting for environmental covariates, evaluation of the spatial covariance error structure revealed that M. vimineum is invading the landscape by a hierarchical process. Infrequent longdistance dispersal events result in new nascent subpopulations that then spread via intermediate-and short-distance dispersal, resulting in 3-km spatial aggregation pattern of sub-populations. Containment or minimisation of its impact on native plant communities will be contingent on understanding how M. vimineum can be prevented from colonizing new suitable habitats. The hierarchical invasion process proposed here provides a framework to organise and focus research and management efforts.
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