Facing epistemic and complex uncertainty in serious illness: The role of mindfulness and shared mind

Epstein, Ronald M.

doi:10.1016/j.pec.2021.07.030

Cited by 13 publications

(7 citation statements)

References 83 publications

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“…Uncertainty-induced anxiety among cancer patients may reflect uncertainty related to treatment probability, such as the likelihood a particular treatment will work; ambiguity, such as the treatment works in some cases but not in others; and complexity, such as conflicting information about treatment benefits and risks [38] . Additionally, cancer patients have experienced distress during the pandemic with the “unknowable unknown” of the future, such as whether one will get infected with COVID-19, whether this infection will be deadly, and when their cancer care will return to normal 39 , 40 . To mitigate psychological and emotional distress, it is imperative for clinicians to help patients find ways to cope with and tolerate uncertainty [41] .…”

Section: Introductionmentioning

confidence: 99%

Managing uncertainty and responding to difficult emotions: Cancer patients’ perspectives on clinician response during the COVID-19 pandemic

Street¹,

Treiman²,

Wu³

et al. 2022

Patient Education and Counseling

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Section: Introductionmentioning

confidence: 99%

Managing uncertainty and responding to difficult emotions: Cancer patients’ perspectives on clinician response during the COVID-19 pandemic

Street¹,

Treiman²,

Wu³

et al. 2022

Patient Education and Counseling

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“…Due to psychological and age-related variables, aging patients undergoing total hysterectomy have difficulty categorizing and perceiving disease-related information throughout the treatment process, resulting in a generally low sense of self-efficacy and a high grade of disease uncertainty [7,8]. Increased self-efficacy reduced the sense of disease uncertainty in patients and has been further used as an effective approach to enhance self-management capability.…”

Section: Discussionmentioning

confidence: 99%

Evaluation on the efficacy of nursing intervention based on the self-efficacy theory model in elderly patients undergoing total laparoscopic hysterectomy

2023

European Journal of Gynaecological Oncology

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The effectiveness of nursing interventions based on the self-efficacy in elderly patients receiving total laparoscopic hysterectomy was assessed. 100 senior patients undergoing total laparoscopic hysterectomy were committed to our hospital from January 2020 to February 2021. Patients were randomized into the study group (n = 51) and control group (n = 49), according to the time of surgery. The control group was given a conventional care plan, while the study group was given conventional care plus a nurse intervention based on a self-efficacy plan. The total post-operative disease uncertainty scores were relatively lower than before surgery both in the control group and the study group (p < 0.05). In particular, the disease uncertainty scale in the post-operative group was reduced in the study group as compared to that in the control group (p < 0.05). The post-operative self-efficacy scale scores of patients in the control group and the study group were increased than that in the pre-operative patients (p < 0.05). In particular, the post-operative self-efficacy scale scores of patients in the study group were higher than that in the control group. Patients in the study group had a lower incidence of post-operative complications than that in the control group. After one year of follow-up, the overall Pelvic Floor Distress Inventory-20 (PFDI-20) scores at 3 months and 12 months were statistically significant higher than pre-operative scores (p < 0.05). In particular, the post-operative patients’ pelvic floor function in the study group were lower than that in the control group. It seems that a self-efficacy-based nursing intervention program applied to elderly patients after laparoscopic total hysterectomy was effective in improving patients’ disease uncertainty and self-efficacy, shortening the length of hospital stay and reducing the incidence of postoperative complications, with little impact on pelvic floor function.

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“…Second, prognostic perceptions are malleable, but if oncologists encourage caregivers to be more optimistic or pessimistic, it could theoretically benefit one half of the patient‐caregiver dyad at the expense of the other. It may be useful for oncologists to describe a range of foreseeable quality‐of‐life trajectories and help caregivers in tolerate uncertainty, 39 much in the same way clinicians commonly frame remarks about expected survival. Second, oncologists can ask caregivers about how they believe the illness may impact patient quality of life and use this information strategically to guide care.…”

Section: Discussionmentioning

confidence: 99%

Patient, caregiver, and oncologist predictions of quality of life in advanced cancer: Accuracy and associations with end‐of‐life care and caregiver bereavement

et al. 2022

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Background Informed treatment decision‐making necessitates accurate prognostication, including predictions about quality of life. Aims We examined whether oncologists, patients with advanced cancer, and caregivers accurately predict patients’ future quality of life and whether these predictions are prospectively associated with end‐of‐life care and bereavement. Materials & Methods We conducted secondary analyses of clinical trial data. Patients with advanced cancer (n = 156), caregivers (n = 156), and oncologists (n = 38) predicted patient quality of life 3 months into the future. Patients subsequently rated their quality of life 3 months later. Medical record data documented chemotherapy and emergency department (ED)/inpatient visits in the 30 days before death (n = 79 decedents). Caregivers self‐reported on depression, anxiety, grief, purpose, and regret 7‐months post‐mortem. In mixed‐effects models, patient, caregiver, and oncologist quality‐of‐life predictions at study entry were used to predict end‐of‐life care and caregiver outcomes, controlling for patients’ quality of life at 3‐month follow‐up, demographic and clinical characteristics, and nesting within oncologists. Results Caregivers (P < 0.0001) and oncologists (P = 0.001) predicted lower quality of life than what patients actually experienced. Among decedents, 24.0% received chemotherapy and 54.5% had an ED/inpatient visit. When caregivers’ predictions were more negative, patients were less likely to receive chemotherapy (P = 0.028) or have an ED/inpatient visit (P = 0.033), and caregivers reported worse depression (P = 0.002), anxiety (P = 0.019), and grief (P = 0.028) and less purpose in life (P < 0.001) 7‐months post‐mortem. Conclusion When caregivers have more negative expectations about patients’ quality of life, patients receive less intensive end‐of‐life care, and caregivers report worse bereavement outcomes.

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Facing epistemic and complex uncertainty in serious illness: The role of mindfulness and shared mind

Cited by 13 publications

References 83 publications

Managing uncertainty and responding to difficult emotions: Cancer patients’ perspectives on clinician response during the COVID-19 pandemic

Managing uncertainty and responding to difficult emotions: Cancer patients’ perspectives on clinician response during the COVID-19 pandemic

Evaluation on the efficacy of nursing intervention based on the self-efficacy theory model in elderly patients undergoing total laparoscopic hysterectomy

Patient, caregiver, and oncologist predictions of quality of life in advanced cancer: Accuracy and associations with end‐of‐life care and caregiver bereavement

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