Download Uncertainty in patients with primary brain tumors

Presenter: Lin Lin, PhD, RN
Department of Family Health
UTHealth School of Nursing
Elizabeth W. Quinn Oncology Research Award
The University of Texas Health Science Center at Houston,
School of Nursing
Use of the Modified Mishel Uncertainty in Illness Scale (MUIS) in
Patients with Primary Brain Tumors (PI: Lin Lin) (2009-2010)
Dean's Research Award
The University of Texas Health Science Center at Houston,
School of Nursing
Develop an Uncertainty Management Intervention for Patients with
Primary Brain Tumors (PI: Lin Lin) (2011-2012)
 Uncertainty
is defined as the inability to
determine the meaning of illness-related
events.
 Uncertainty is a cognitive state created
when the individual cannot adequately
structure or categorize an illness event
because of insufficient cues.
 Uncertainty exists in illness situations that
are ambiguous, complex, unpredictable,
and when information is unavailable or
inconsistent.
(Mishel, 1988; Mishel & Clayton, 2008)
Mishel (1988)
 Tumors
that begin in brain tissue are known
as primary tumors of the brain.
 The most common primary brain tumors are
gliomas. A grade IV astrocytoma is usually
called a glioblastoma multiforme (GBM).
 Overall, the chance that a person will
develop a malignant tumor of the brain or
spinal cord in his or her lifetime is less than
1% (about 1 in 150 for a man and 1 in 185
for a woman).
(ACS, 2012)
5-Year Relative Survival Rate
Age
Type of Tumor
20-44
45-54
55-64
Low-grade (diffuse) astrocytoma
59%
40%
NA*
Anaplastic astrocytoma
49%
29%
8%
Glioblastoma
16%
6%
3%
Oligodendroglioma
85%
77%
65%
Anaplastic oligodendroglioma
66%
53%
33%
Ependymoma/anaplastic ependymoma
91%
85%
84%
(ACS, 2012)



The treatment options for brain and spinal cord tumors depend on
several factors, including the type and location of the tumor and
how far it has grown or spread. Surgery is often the first treatment
when it can be done.
Some tumors (e.g., glioblastomas) are not curable by surgery.
After maximal safe surgical resection, chemotherapy wafers may
be placed in or near any remaining tumor at this time. Radiation
therapy is then given, usually along with or followed by
chemotherapy if the person's health allows.
Temozolomide is the chemotherapy drug most commonly used to
treat these tumors. It is often given along with radiation therapy, as
it appears to make it more effective. It is then continued after the
radiation is completed.
(ACS, 2012)
 Cancer
recurrence
 Progressed/controlled
 Response to treatment:
pseudoprogression or pseudoresponse
 Effects of the tumor and its treatment
http://www.cancer.org/Cancer/BrainCNSTumorsinAdults
/DetailedGuide/brain-and-spinal-cord-tumors-inadults-after-follow-up
(N=186)
Employment Status
Gender
Male
99 (53%)
Employed (part-time, full-time, homemaker)
94 (52%)
Female
87 (47%)
Employed (sick leave, disability)
24 (13%)
Retired
18 (10%)
31 (17%)
Ethnic Background
Asian or Pacific Islander
11 (6%)
Unemployed due to diagnosis of tumor
Black
10 (6%)
Unemployed prior to diagnosis of tumor, student
White
Other
149 (86%) Level of Education
3 (2%)
Hispanic
Yes
No
172 (93%)
13 (8%)
Marital Status
Divorced, Separated, Widowed
Married
Single
13 (7%)
19 (10%)
139 (75%)
28 (15%)
Some high school or high school
34 (18%)
Some college
46 (25%)
College graduate
53 (29%)
Post graduate/advanced degree
53 (29%)
Recurrence
Yes
No
Patient Groups
Newly Diagnosed
On treatment with MRI
On treatment without MRI
Follow-up without active treatment
Tumor Grade
Grade I
Grade II
Grade III
Grade IV (69 GBM)
Location
Left
Right
Midline
KPS
≤80
≥90
(N=186)
74 (40%)
112 (60%)
32 (17%)
64 (34%)
21 (11%)
69 (37%)
3 (2%)
38 (21%)
59 (32%)
84 (46%)
103 (55%)
78 (42%)
5 (3%)
36 (20%)
150 (81%)
 33-item
 4-factors
Ambiguity (13 items)
Inconsistency (7 items)
Complexity (7 items)
Unpredictability (5 items)
 2-factors
Ambiguity (16 items)
Complexity (12 items)
 Content Validity
 Construct Validity
 Reliability
 Feasibility
Journal of Neuro-Oncology
 Uncertainty
was significantly correlated
with symptom severity (p<.01) and
symptom interference (p<.01).
 Uncertainty was significantly correlated
with symptom subscales of affective
(p<.01), cognitive (p<.01), focal
neurological deficit (p<.01),
constitutional, generalized, and GIrelated symptoms (all with p<.01).
MUIS
overall
score
inter- symptom
cogMDASI-BT overall ference severity affective nitive
neurotx
general/
logic related disease
Pearson
**
**
Correlation .465 .504
.394**
.395**
.275**
.273**
.272**
.357** .227**
Sig.
(2-tailed)
.000
.000
.001
.001
.001
.000
.000
.000
GI
.005
 Uncertainty
was positively correlated to
five POMS-SF subscales, anger,
confusion, depression, fatigue, and
tension (all with p<.01).
 Uncertainty was negatively correlated
with vigor subscale (p<.01).
POMS
Pearson
MUIS Correlation
overall
score Sig.
(2-tailed)
depression
vigor
confusion
tense
anger
fatigue
.441**
-.412**
.500**
.520**
.387**
.298**
.000
.000
.000
.000
.000
.000
ChiSquare
SRMR
RMSEA
Estimate
RMSEA
90% CI
CFI
TLI
Tension
0.43
0.99
0.99
0.03
0.01
0.000-0.069
Anger
0.57
1.00
1.00
0.03
0.00
0.000-0.059
Depression
0.28
0.99
0.99
0.04
0.03
0.000-0.074
Fatigue
0.21
0.99
0.98
0.04
0.04
0.000-0.079
Confusion
0.26
0.99
0.99
0.04
0.03
0.000-0.075
Model
CFI= Comparative Fit Index
TLI= Tucker Lewis Fit Index
SRMR=Standardized Root Mean Square Residual
RMSEA= Root Mean Square Error of Approximation
90% CI= 90 Percent Confidence Interval
 Problem
solving/Information seeking
 Cognitive reframing
 Patient-provider communication
 Symptom management
Hui-Hsun-Chiang, MS, RN;
Alvina A. Acquaye, MS;
Elizabeth Vera-Bolanos, MS;
Jennifer E. Cahill, MSN, RN;
Mark R. Gilbert, MD;
Terri S. Armstrong, PhD, ANP-BC, FAANP