Uncertainty and perception of danger among patients undergoing treatment for prostate cancer

Abstract

OBJECTIVES 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. PATIENTS AND METHODS 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). RESULTS 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). CONCLUSIONS 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.

The Relationship between Intolerance of Uncertainty and Anxiety in Men on Active Surveillance for Prostate Cancer

“…Intolerance of uncertainty and its relationship with anxiety may also vary across practice settings depending on the patient-mix. 28 …”

The Impact of Numeracy on Verbatim Knowledge of the Longitudinal Risk for Prostate Cancer Recurrence following Radiation Therapy

“…Similarly, Hawley et al [5] demonstrated pictographs to be the best format for graphical presentation of shared decision making after administering a survey to 2,412 participants as it was the only graphical format that led to both high verbatim and gist knowledge. Using graphs in patient education tools has been shown to improve perception, understanding, and interpretation of risk information when compared to text/number formats (27, 28). Verbatim knowledge is also improved when raw numbers are presented.…”

Illness Uncertainty and Quality of Life of Patients with Small Renal Tumors Undergoing Watchful Waiting: A 2-year Prospective Study

“…The uncertainty-in-illness theory states that uncertainty increases when patients lack the information or knowledge to understand their condition, their symptoms or outcomes are unpredictable, and resources (eg, social support, medical care, and education) are insufficient to provide patients with a sense of control over their illness [7–9]. Increasing uncertainty results in less problem-oriented coping, more emotion-oriented coping, and poorer psychosocial adjustment [7,8,10]. Illness uncertainty has not been explored in patients with renal tumors.…”