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“Uncertainty, Mood States, and symptoms in patients with primary brain tumors”

“Uncertainty, Mood States, and symptoms in patients with primary brain tumors”. Presenter: Lin Lin, PhD, RN Department of Family Health UTHealth School of Nursing. Funding. Elizabeth W. Quinn Oncology Research Award The University of Texas Health Science Center at Houston,

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“Uncertainty, Mood States, and symptoms in patients with primary brain tumors”

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  1. “Uncertainty, Mood States, and symptoms in patients with primary brain tumors” Presenter: Lin Lin, PhD, RN Department of Family Health UTHealth School of Nursing

  2. Funding 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)

  3. Uncertainty in Illness 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)

  4. Uncertainty in Illness Theory (UIT) Mishel (1988)

  5. Primary Brain Tumors (PBTs) 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 glioblastomamultiforme (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)

  6. Survival Rates (ACS, 2012)

  7. Treatment 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. Temozolomideis 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)

  8. Uncertainty in PBTs 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-in-adults-after-follow-up

  9. Demographics (N=186)

  10. Clinical Data

  11. Mishel’s Uncertainty in Illness Scale (MUIS) 33-item 4-factors Ambiguity (13 items) Inconsistency (7 items) Complexity (7 items) Unpredictability (5 items) 2-factors Ambiguity (16 items) Complexity (12 items)

  12. MUIS-Brain Tumor Form Content Validity Construct Validity Reliability Feasibility Journal of Neuro-Oncology

  13. Uncertainty vs. Symptoms 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 GI-related symptoms (all with p<.01).

  14. Uncertainty vs. Symptoms

  15. Uncertainty vs. Mood States 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).

  16. Uncertainty vs. Mood States

  17. Model Fit Statistics 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

  18. SEM-Tension

  19. SEM-Anger

  20. SEM-Depression

  21. SEM-Fatigue

  22. SEM-Confusion

  23. Managing Uncertainty Interventions Problem solving/Information seeking Cognitive reframing Patient-provider communication Symptom management

  24. Thank You!! 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

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