Systematic Review and Meta-analysis of Psychosocial Uncertainty Management Interventions

Abstract

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.

Systematic review of illness uncertainty management interventions for cancer patients and their family caregivers

“…Informational support is the key to helping cancer patients and their family caregivers manage uncertainty. Our findings corroborate those of two previous literature reviews of psychosocial interventions for managing uncertainty in childhood cancer patients and adult patients with different chronic illnesses [14,15]. Findings from these reviews may also collectively indicate that individualized educational interventions provide information that empowers patients to successfully develop positive coping mechanisms.…”

“…Most interventions were delivered using either inperson and telephone or in-person formats. This finding contrasts with Zhang et al's systematic review and metaanalysis of patients with chronic illnesses, which identified written educational materials as the most frequently used mode of intervention delivery [15]. Given the complexity of information provision and cancer patients' potential for psychosocial distress, in-person meetings may be the preferred mode of intervention delivery.…”

“…In their integrative literature review of uncertainty among children with chronic illnesses and their families, Gunter and Duke concluded that the education and psychosocial support is important in reducing uncertainty [14]. In their recent meta-analysis of psychosocial uncertainty management interventions among adult patients with various diagnoses (e.g., cancer, HIV, heart disease) and their family caregivers [15], Zhang et al reported that psychosocial interventions are effective in reducing short-and long-term uncertainty both among patients and their family caregivers [15].…”

Turkish adaptation of the Mishel uncertainty in illness scale‐community form

“…The negative effects of multiple sclerosis, myocardial infarction, diabetes mellitus, fibromyalgia, rheumatoid arthritis and cancer, HIV, and other chronic conditions‐related uncertainty have been reported 7 . Meeting patients' need for information and counseling is an important initiative for healthcare professionals to reduce disease uncertainty 3,4,8,9 …”

Illness Uncertainty at 40

“…The scale has been adapted for specific populations to include family members caring for an acutely ill person, parents with a seriously ill child, people living in the community with a chronic condition, and children and adolescents with cancer (Mishel, 1997;Stewart et al, 2010); the scale has been translated into more than 12 languages. Two theories of illness uncertainty in acute and chronic illness (Mishel, 1988(Mishel, , 1990) allowed for the exploration of illness uncertainty in descriptive studies followed by a series of randomized controlled clinical trials that established the illness uncertainty scale as a mediator, moderator or outcome measure in studies of people with cancer, HCV, HIV, and other chronic conditions (Bailey et al, 2009;Brashers et al, 2017;Dudas et al, 2013;Hall et al, 2014;Zhang et al, 2020).…”