Antecedents of Uncertainty in Adults with Oncologic Diagnosis: Literature Integrative ReviewABSTRACT
Introduction: The uncertainty frequently occurs in individuals with oncological diagnoses, when the individual cannot assign a defined value to the events and accurately predict the results. Currently, there is no organized evidence about the antecedents of uncertainty in adult individuals with cancer.
Objective: To identify the antecedents of uncertainty in adults with cancer in the available literature.
Method: Integrative literature review of articles from 2010 to 2022 at the electronic databases EMBASE, ProQuest Dissertations & Theses Global, LILACS, and ScienceDirect. The selected articles were assessed for their quality and analyzed using the constant comparison method and uncertainty theory.
Results: Regarding the structure of the stimulus, antecedents of uncertainty have been found as distinctiveness and inconsistency of the symptoms, self- and vicarious experience, system orientation and routine disruption, and consistency between the expected and the experienced. Age, emotional chaos, and physiological events are cognitive antecedents. And knowledge, constant and quality human interaction, emotional and instrumental support and education are important antecedents of structure providers.
Conclusion: Understanding uncertainty in illness and its antecedents allows to know and guide the caring needs of the oncologic population, providing theoretical knowledge that can be applied in clinical practice.
Key words:
Adult; Oncology Nursing; Uncertainty; Neoplasms/epidemiology; Nursing Theory
RESUMEN
Introducción: La incertidumbre ocurre frecuentemente en personas con diagnósticos oncológicos, situación en la que el individuo no puede asignar un valor definido a los eventos y no puede predecir los resultados con precisión. Actualmente no existe evidencia organizada acerca de los antecedentes de incertidumbre en personas adultas con cáncer.
Objetivo: Identificar en la literatura disponible los antecedentes de la incertidumbre en la persona adulta con diagnóstico oncológico.
Método: Revisión integradora de artículos de investigación que abordaron los antecedentes de la incertidumbre frente al cáncer del 2010 al 2022, cualitativos, cuantitativos, mixtos o revisiones. Las bases de datos incluidas fueron EMBASE, ProQuest Dissertations & Theses Global, LILACS y ScienceDirect. Los artículos seleccionados fueron evaluados en su calidad y analizados con el método de comparación constante y la teoría de la incertidumbre.
Resultados: Con respecto al marco de los estímulos se encontraron antecedentes de la incertidumbre como la distinción y la inconsistencia de los síntomas, la experiencia propia y vicaria, la orientación en el sistema y la disrupción de rutinas, y la coherencia entre lo esperado y lo experimentado. La edad, el caos emocional y los eventos fisiológicos son antecedentes cognitivos. Y el conocimiento, la interacción humana constante y de calidad, el soporte emocional e instrumental y la educación fueron importantes antecedentes de los proveedores de estructura.
Conclusión: Comprender la incertidumbre frente a la enfermedad y sus antecedentes permite conocer y orientar las necesidades de cuidado de la población oncológica, aportando conocimiento teórico que puede ser aplicado en la práctica clínica.
Palabras clave:
Adulto; Enfermería Oncológica; Incertidumbre; Neoplasia/epidemiología; Teoría de Enfermería
RESUMO
Introdução: A incerteza ocorre com frequência em pessoas com diagnóstico de câncer, uma situação em que o indivíduo não tem a possibilidade de atribuir um valor definitivo aos eventos, assim como de prever os resultados com precisão. Atualmente, não há evidências organizadas sobre os antecedentes da incerteza em adultos com câncer.
Objetivo: Identificar na literatura disponível os antecedentes da incerteza em pessoas adultas com diagnóstico de câncer.
Método: Revisão integrativa de artigos de pesquisa de 2010 a 2022 nas bases eletrônicas de dados: EMBASE, ProQuest Dissertations & Theses Global, LILACS e ScienceDirect. Os artigos selecionados foram avaliados quanto à qualidade e analisados utilizando o método de comparação constante e a teoria da incerteza.
Resultados: Com relação à estrutura de estímulo, foram encontrados antecedentes de incerteza, como distinção e inconsistência dos sintomas, experiência própria e vicária, orientação do sistema e interrupção das rotinas, e consistência entre o esperado e o experimentado. Idade, caos emocional e eventos fisiológicos são antecedentes cognitivos. E o conhecimento, a interação humana constante e de qualidade, o apoio emocional e instrumental e a educação foram importantes antecedentes dos provedores de estrutura.
Conclusão: A compreensão da incerteza diante da doença e de seus antecedentes nos permite conhecer e orientar as necessidades de cuidados da população oncológica, fornecendo conhecimento teórico que tem a possibilidade de ser aplicado na prática clínica.
Palavras-chave:
Adulto; Enfermagem Oncológica; Incerteza; Neoplasia/epidemiologia; Teoria de Enfermagem
INTRODUCTION
The uncertainty in face of a disease is related to the individuals’ inability to assign value to their health processes or conditions1. It occurs frequently in case of oncologic diagnoses at any moment during the course of the disease, in the context of several stressors, signs and symptoms and the unpredictable evolution of cancer which makes the understanding of treatments and prognostic difficult, causing negative physical and emotional impacts on how they will cope with the disease and quality of life; the uncertainty occurs not only at the moment of the diagnoses but it can grow or decline while the disease evolves2.
The social and scientific relevance of identifying and understanding its antecedents lies on the impacts over the health outcomes and care provided to the individuals. Health professionals should guide the individuals through their uncertain trajectory, detecting their needs and creating trustworthy relations, offering a customized support that stimulates their ability to face the obstacles; additionally, it can improve the emotional well-being of the individual with cancer but changes their experience, favoring a more effective adjustment and improving their quality of life3.
The theory of uncertainty of Merle Mishel explains how the individuals process cognitively the illness-related stimuli and assign values to these events. Uncertainty events evaluated as danger, imply harm and coping strategies are implemented to overcome it1. On the other hand, whether seen as an opportunity, it can imply in positive outcome and coping strategies to keep the uncertainty are implemented1.
The information processed by the individual to create their cognitive schema originates from the antecedents as: 1) stimuli frame, 2) cognitive capacity and 3) structure providers1. Stimuli frame refers to the form, composition and structure of the stimuli that the individual perceives and has three components1: 1) symptom pattern (the degree to which symptoms present with sufficient consistency to be perceived as having a pattern), 2) event familiarity (the degree to which the situation is habitual, repetitive or contains recognized cues) and 3) event congruence (consistency between the expected and the experienced in illness-related events).
The components of the stimuli frame reduce the uncertainty4 and are influenced by other antecedents: the cognitive capacity and structure providers1. Cognitive capacity refers to the information-processing abilities of the individual1. Only a limited amount of information can be processed at any one time. Limited cognitive capacity will reduce the ability to perceive symptom pattern, event familiarity and event congruence1. Structure providers refer to resources available to assist the individual in the interpretation of the stimuli frame and reduce the state of uncertainty both directly and indirectly1. Structure providers are: 1) educational level, 2) social support and 3) credible authority1.
Currently, there is a systematic review and meta-analysis aimed to identify variables correlates that are associated with illness uncertainty according to Mishel theory in adult cancer survivors and their families5. In this study, important antecedents can be found as sociodemographic aspects as age, sex and race, stimuli frame (symptoms and cancer history) and structure providers (education)5. However, there are no literature reviews able to identify specific antecedents of the adult population with cancer at any stage of the illness and not even of the population of survivors. The objective of this study is to identify the antecedents of the uncertainty in adult individuals with oncologic diagnosis in the available literature (stimuli frame, cognitive capacity and structure providers).
METHOD
The integrative literature review followed the stages of Whittemore and Knafl6. The research question is: What are the antecedents of uncertainty of the adult individual with oncologic diagnosis according to the scientific literature available?
The search was made at the following databases: EMBASE (Medline), ProQuest Dissertations and Theses Global, LILACS, ScienceDirect.
The inclusion criteria are:
-
Scientific production addressing uncertainty in face of cancer.
-
Adult population with oncologic diagnosis at any stage of the course of the disease.
-
Articles published in the period 2010-2022, that, according to a librarian's early literature review, is a period with great production of uncertainty publications in general and not only for individuals with cancer.
-
Primary experimental and non-experimental researches, mixed qualitative researches, secondary researches, thesis or dissertations.
The exclusion criteria were :
-
Unavailable articles.
-
Essays, reports, abstracts and experts criteria.
The terms selected for the search were based on Health Science Descriptors (DeCS) and Medical Subject Headings (MeSH) in Spanish, English and Portuguese and Boolean operators "AND" and "OR" (Chart 1). The next step was the application of filters: elimination of duplicates, reading of titles and abstracts and later, the full text, in addition to PRISMA flowchart7 to demonstrate the selection process.
The critical appraisal tools of the Joanna Briggs Institute were utilized to appraise the methodological quality of the articles and the Mixed Methods Appraisal Tool (MMAT)9 for mixed design studies, further to Polit and Beck10 appraising evidence levels.
The articles included were coded and relevant information as the characteristics of the article (author, year, country, objective, design and sample) and main results (antecedents) were extracted. The method of constant comparison with four phases was applied to analyze the data: summary, visualization, comparison, conclusions and verification6. The software QDA Miner11 lite was adopted to support the analysis of the texts.
Categories and subcategories have been determined a priori for each antecedent of uncertainty (1. Stimuli frame (symptoms pattern, event familiarity, event congruence), 2. Cognitive capacity and 3. Structure providers (credible authority, social support and education)), the emerging codes of each prior category or subcategory have been determined according to the main results.
Each investigator selected, evaluated and analyzed the data independently and later the results were compared to reach a consensus.
RESULTS
2,596 articles have been identified, 14 of which were analyzed. Figure 1 depicts the selection process.
The articles were published between 2011 and 2021 in ten countries, with qualitative, quantitative, mixed design and a scoping review (Chart 2). The scores of the evaluation of the quality ranged between 70% and 100% and evidence level between hierarchy level IV and VI; no article was excluded for that matter.
The articles included individuals from 18 to 88 years of age, with different oncologic diagnoses, with predominance of breast cancer followed by solid tumors of colon, head and neck, lung, testicle, ovary, cervix, sarcoma, kidney, gastric and prostate, in addition to hematologic tumors as myeloma and non-Hodgkin lymphoma managed in different phases (diagnostic, treatment (chemotherapy, radiotherapy, surgery) and palliative) (Chart 212–25).
Chart 3 portrays the antecedents of uncertainty identified.
STIMULI FRAME
Poor distinctiveness or clarity of symptoms prior to the diagnosis and the inconsistency between the number and frequency of symptoms, mainly during the oncologic treatment, may cause more uncertainty within the concept of symptoms pattern20,22.
In addition, situations that led to establish or not an event familiarity (cancer) with impact on uncertainty have been identified. The knowledge acquired with the self-experience contributed to assign meaning to what the individual with cancer is living13. The vicarious experience has also contributed for the familiarity with cancer, allowing to best anticipate the symptoms and prognosis of the illness with impacts on uncertain situations18,23. The practical guidelines of the health system, particularly organizational routines, schedules, proper signaling and be welcomed by health professionals helped the patient to feel in safe hands17,21. On the other hand, routines disruption due to medication toxic effects, constant visits and admission to the hospital negatively impacted the familiarization due to hostile and complex environments the patient is submitted to12,20.
Regarding events congruence, it was possible to identify that signs of relapse12, confirmation of the diagnosis19 and results of the treatment20 led to inconsistency between the expected and the experienced, making difficult to understand the meaning of the events.
COGNITIVE CAPACITY
The moment when the individual receives the diagnosis is traumatic, causing emotional chaos, hampering the processing of the information and consequently to understand its meaning and how to use it, provoking high levels of uncertainty15,16,20. Internal physiological events as pain and fatigue can change the capacity to understand and absorb the information19,22. Furthermore, as older the patient, high is the uncertainty22,25, and age is connected to the cognitive capacity because of alterations of memory, processing speed and attention, which makes difficult the understanding of the illness and its management20,23. The findings indicate that the interpretation of the meaning of the events associated with the illness become more complex for older adults22,25.
STRUCTURE PROVIDERS
Within the concept of credible authority, health professionals create knowledge that allow the individual to understand the context of the illness12,17,21,24. In addition, the quality and stability of the professional-individual relationship ensures reliability and reduces the uncertainty when good communication, empathy and frequency along time occur18–21,24.
Social support favors the understanding of the symptoms, treatments secondary effects and situations pertinent to the oncologic disease through human interaction as source of information, facilitating the regularity of the experience and adaptation13,17,18,20. Furthermore, family, friends and support group provide emotional context that help to overcome the uncertainty12,14,15. Social support is also instrumental to fill in the gaps of daily life as caring for children, transportation and recollecting information, which helps to diminish the uncertainty15,21.
Education creates knowledge as a base of meaning and context. The individuals use information to assign meaning to symptoms and control the information provided by a health professional13,15,16,18,21. However, difficulties to understand and assign meaning to processes or situations associated with health condition appear if the information is complex or fragmented, is poorly phrased and biased in relation to the speciality16,19,21 often neglecting the needs of the individuals. Additionally, there is a negative relation between the education level and uncertainty, as low the education level is, high is the uncertainty22,23,25.
These results will be integrated into the model of the theory of uncertainty for best theoretical understanding of the antecedents in the context of the individual with cancer (Figure 2).
Antecedents of uncertainty identified in adult individuals with oncologic diagnosis categorized within the conceptual schema of the theory of uncertainty in illness
DISCUSSION
The present investigation identified the specific and different antecedents of uncertainty in adults with cancer, most of them middle-aged or older where cancer incidence is high26,27. The articles included samples with several types of cancer and phases with the most representative results.
The evaluation of symptoms prior to diagnostic confirmation can be difficult because at that phase the symptoms may not be so evident and they should be palpable to be included in the symptoms pattern in the context of stimuli frame28. Symptoms evaluation is based on their number, intensity, frequency, duration and site that can change in each phase of the disease; if these characteristics are inconsistent, it is not possible to determine a pattern which creates uncertainty1,29. The unpredictable and changing nature of the symptoms in the diagnosis or during treatment favors a negative evaluation of the physical symptoms and influence how to cope with and adapt to the illness30.
Self and vicarious experience are elements that the individual utilizes to create a cognitive schema and familiarity with the illness13,18,21,23. Knowing that other individuals are experiencing the same situation provides references for behavior, actions and decision-making, in addition to new perspectives of understanding, opportunities sharing and helps to best absorb the experience and adaptation31.
Several studies indicate that learning from self and vicarious experience helps to clarify what is still unknown in the disease, treatment, complications and care, in addition to potential doubts and obtain support from others living the same difficulties; therefore, it is possible to achieve a psychological impact that is able to diminish the uncertainty of coping with the disease31–33.
New health-related aspects hamper the development of events familiarity. System's guidelines make these new aspects more manageable and the individuals feel less disturbed and in control when their environment is familiar and meaningful17. Steer the individuals through the hospital environment, lab tests and procedures can help them to manage uncertain situations and develop the required skills to adapt positively to the events, as opposed to the loss of safety and poor familiarity when they have to tackle unknown hospital environments34. On the other hand, routines disruption, very common in cancer, interrupt the activities of daily life swiftly, pushing the individual to cope with new situations12,20 and this may undermine the psychological well-being and recovery. Poor familiarity exacerbates feelings of uncertainty14,23.
Furthermore, in cases of inconsistencies between the expected and the experienced raises doubts about the predictability and stability of the cancer events1. The consistency is strongly influenced by the information provided to the individual according to the stage of the disease that can trigger unrealistic expectations that do not materialize in a later phase, failing to achieve the event congruence, which impacts the status of uncertainty29.
Cognitive capacity favors or restrains the subjective interpretation of the illness and treatments35. Elements that can interfere with the processing skills of the information have been identified, impeding the cognitive structuring of the stimuli frame1. Firstly, the age: previous findings indicate that the interpretation of the meaning of the symptoms becomes more complex for older adults, given their reduced skills of concentration and memory22,25. Older adults have low cognitive functioning in the domains of attention and concentration, speed of information processing, ability to learn and memorize potentialized by secondary symptoms or effects of the oncologic treatment which hinders the interpretation of the stimuli frame27,36.
Secondly, the emotional chaos generated after the diagnosis of cancer can diminish the skills of information processing15,16,20. When individuals perceive the health environment as a danger, the cognitive efficiency diminishes and less signals are processed, hazardous situations tend to expand the level of arousal, which shifts the attention to the most important aspects of the situation18,35. When they attempt to recollect the events, only the most evident are accessible, reducing the ability to associate incoming stimuli with pre-existing cognitive schema18,35. Therefore, the interpretation of the stimuli frame is impacted, reducing the ability to interpret correctly the information related to their own health35.
The proper moment to provide information is crucial to avoid the individuals to feel overwhelmed to process highly complex information soon after they receive the diagnosis; health professionals can appraise their emotional chaos after they become aware of the cancer diagnosis and adjust the time and amount of information to be provided subsequently34,35.
Finally, internal physiological events can change the skills of concentration and absorbing the information19, inducing modifications of utilization of resources and compete with other attention demanding stimuli29. Pain, fatigue and poor nutrition can monopolize the cognitive capacity and deteriorate the individuals’ processing skills37.
The credible authority generates knowledge to understand the context of the illness and help to strengthen the stimuli frame12,17,21,24. Health professionals provide information about the causes and consequences of the symptoms, share information about manifestations of the illness and functioning of the health system, which improves the event familiarity and congruence while ensuring a frame to interpret the experiences as the individuals go through them1,15.
An effective professional-personal relation can improve the perceptions and appraisals about a situation or circumstance38, former studies indicate that individuals with oncologic diagnosis express several interpretations of their experiences with the illness, which requires a close relation with health professionals to enhance education and validate or stabilize the symptoms and experiences that potentially minimizes the uncertainty30; however, how the diagnosis is communicated and an impersonal relation may create uncertainty34. In addition, the uncertainty can persist for many years after the treatment as the individual has no more frequent contact with the health professionals, which impedes the clarification of new symptoms (new symptoms are related to the secondary effects of the treatment versus cancer relapse or a new health problem) and the risk of cancer relapse, which increases the uncertainty39.
Health signs are better addressed by a credible authority; however, internal concerns, interpretation of physical signs and symptoms, organization of the life and personal responsibilities are better approached through the interaction with other relevant individuals1. The opportunity to clarify a situation through discussion and supportive interactions with others help to overcome the obstacles and stimulates the individuals to create a cognitive schema, indirectly reducing the uncertainty and fostering a better understanding of symptoms pattern40,41; sharing these experiences and knowledge facilitates the opportunity to search common grounds and stabilization of the experience and adaptation14. It is crucial to count with a social support network focused to continuous education to expand the knowledge about the illness31,36.
Social support in the form of instrumental and emotional support helps to reduce uncertain situations to ensure the stability of the environment30,41. Empathy, help with the activities of daily life at home and transportation to hospitals are important to manage the uncertainty with the illness12,14,15,21. Emotional and instrumental support is a protective factor for individuals with cancer, it is the main source for the emotional well-being, care and adherence to the treatment. Individuals who perceive they are supported, have a positive self-perception of their illness42,43.
Education is utilized to broaden the knowledge that grants meaning and context to events related to the oncologic illness13,15,16,18,21, allows the individuals to articulate the information they received to understand and assign meaning to the diagnosis and to detect the secondary effects of the treatments44; scarce information can predict uncertainty resulting from the inability to determine the meaning of the facts, which places the individual with cancer on an unfavorable position that can change their psychological well-being and ability to respond44–46.
In addition, widen the knowledge through complex or fragmented information provided by the health professional can hinder the structuring of events within the stimuli frame16,19,21 due to its volume, complexity, inconsistency and unpredictability16. Many studies indicate that the use of complex and fragmented language hampers the discussion about the diagnosis, treatment and prognosis of the illness, since the individual does not understand correctly the information, creating insecurities or inaccurate beliefs. Health professionals should provide the individual clear, accurate, required and sufficient information to make the message understandable, contributing to the management and reduction of uncertainty21,34,47.
When education in itself is investigated, it is evident the direct impact it has on uncertainty and individuals with low education tend to have less opportunities to obtain information and understand the illness22,23,25. This condition can determine the prompt access to health services and delays the beginning of the treatment, which contributes to the increase of uncertainty and helps to deteriorate the well-being of the individual with cancer45,48. On the other hand, individuals with better education level have better opportunities for timely diagnosis and treatment justified by three main aspects: availability of means for early diagnosis with frequent lab tests, clinical exams and diagnostic confirmation; improved working relations with formal jobs, helping to boost the individual's contribution and finally, the education level potentializes the adoption of more effective coping strategies that allow best understanding and tackle the infirmity42.
How health professionals understand the uncertainty of the illness and its antecedents allow to know and guide the care to the oncologic population, bringing theoretical knowledge that can be applied in clinical practice, strengthening the cognitive capacity of the individuals with cancer and their families, modifying the stimuli and favoring the adaptation to the health-illness process for preventive, curative, rehabilitation or palliative goals.
Future investigations or reviews can explore the differences of the antecedents according to diverse cultures, ethnicity, age, type and cancer staging because these factors could generate distinct antecedents of uncertainty.
The most important limitation was the scarce scientific production of the antecedents of the uncertainty utilizing the theory in the context of individuals with cancer, particularly in Latin America, which negatively affects the representativeness of the results.
CONCLUSION
Distinct and inconsistent symptoms, self and vicarious experiences, health system guidelines and routines disruption as modulators of the adverse events and discrepancies between the expected and the experienced are antecedents that change how the individual with cancer perceives the form, composition and structure of the stimuli that are not structured within a cognitive setting which creates uncertainty.
Demands that monopolize cognitive resources and factors that modify the cognitive ability as age, emotional chaos and internal physiologic events interrupt the processing of the information that structures the stimuli frame. Structure providers generate knowledge through clear, accurate, necessary and sufficient information that ensures individuals to understand the new experience they go through, most of all for those with low education level.
Likewise, a quality and consistent relation with the credible authority based on trust, and the emotional and practical support from the family, peers and friends help to clarify the situation and creates a cognitive setting, reducing the unpredictability of the events of the oncologic disease.
DATA AVAILABILITY STATEMENT
All content underlying the text of the article is contained in the manuscript.
REFERENCES
-
1 Mishel MH. Uncertainty in illness. Image J Nurs Sch. 1988;20(4):225-32. doi: https://doi.org/10.1111/j.1547-5069.1988.tb00082.x
» https://doi.org/10.1111/j.1547-5069.1988.tb00082.x -
2 Zhang Y. Uncertainty in illness: theory review, application, and extension. Oncol Nurs Forum. 2017;44(6):645-9. doi: https://doi.org/10.1188/17.onf.645-649
» https://doi.org/10.1188/17.onf.645-649 - 3 Paez C, Randazzo P, Sánchez V. La incertidumbre en el paciente con leucemia aguda al inicio del tratamiento: una propuesta de cuidado [tesis de maestría]. Bogotá: Pontificia Universidad Javeriana: 2019.
- 4 Alligood MR. Modelos y teorías en enfermería. 10. ed. Barcelona: Elsevier; 2022.
-
5 Guan T, Chapman MV, Saxe Zerden L, et al. Correlates of illness uncertainty in cancer survivors and family caregivers: a systematic review and meta-analysis. Support Care Cancer. 2023;31(4):242. doi: https://doi.org/10.1007/s00520-023-07705-7
» https://doi.org/10.1007/s00520-023-07705-7 -
6 Whittemore R, Knafl K. The integrative review: updated methodology. J Adv Nurs. 2005;52(5):546-53. doi: https://doi.org/10.1111/j.1365-2648.2005.03621.x
» https://doi.org/10.1111/j.1365-2648.2005.03621.x -
7 Moher D, Liberati A, Tetzlaff J, et al. Principais itens para relatar revisões sistemáticas e meta-análises: a recomendação PRISMA. Epidemiol Serv Saúde. 2015;24(2):335-42. doi: https://doi.org/10.5123/S1679-49742015000200017
» https://doi.org/10.5123/S1679-49742015000200017 -
8 Joanna Briggs Institute. JBI levels of evidence [Internet]. Australia: Joanna Briggs Institute; 2013 [acceso 2025 nov 1]. Disponible en: https://jbi.global/sites/default/files/2019-05/JBI-Levels-of-evidence_2014_0.pdf
» https://jbi.global/sites/default/files/2019-05/JBI-Levels-of-evidence_2014_0.pdf -
9 Hong QN, Pluye P, Fàbregues S, et al. Mixed Methods Appraisal Tool (MMAT) [Internet]. version 2018. Montréal: McGill; 2018. [acceso 2025 nov 1]. Disponible en: http://mixedmethodsappraisaltoolpublic.pbworks.com/w/file/fetch/127916259/MMAT_2018_criteria-manual_2018-08-01_ENG.pdf
» http://mixedmethodsappraisaltoolpublic.pbworks.com/w/file/fetch/127916259/MMAT_2018_criteria-manual_2018-08-01_ENG.pdf - 10 Polit DF, Beck CT. Essentials of nursing research: appraising evidence for nursing practice. 10. ed. Filadelfia: Lippincott Williams & Wilkins; 2021.
-
11 QDA Miner [Internet]. Versão lite. São Paulo: Normand Peladeau; 2004. [acceso 2025 mar 15]. Disponible en: https://provalisresearch.com/
» https://provalisresearch.com/ -
12 Maher K, De Vries K. An exploration of the lived experiences of individuals with relapsed Multiple Myeloma. Euro J Cancer Care. 2011;20(2):267-75. doi: https://doi.org/10.1111/j.1365-2354.2010.01234.x
» https://doi.org/10.1111/j.1365-2354.2010.01234.x -
13 Wall C, Glenn S, Poole H. Experiences prior to diagnosis of non-Hodgkin lymphoma: a phenomenological study. J Advanc Nurs. 2011;67(11):2363-72. doi: https://doi.org/10.1111/j.1365-2648.2011.05657.x
» https://doi.org/10.1111/j.1365-2648.2011.05657.x -
14 Yusuf A, Ab Hadi IS, Mahamood Z, et al. Understanding the breast cancer experience: a qualitative study of Malaysian women. Asian Pac J Cancer Prev. 2013;14(6):3689-98. doi: https://doi.org/10.7314/apjcp.2013.14.6.3689
» https://doi.org/10.7314/apjcp.2013.14.6.3689 -
15 Inan FŞ, Günüşen NP, Üstün B. Experiences of newly diagnosed breast cancer patients in Turkey. J Transcult Nurs. 2016;27(3):262-9. doi: https://doi.org/10.1177/1043659614550488
» https://doi.org/10.1177/1043659614550488 -
16 Hillen MA, Gutheil C, Smets EMA, et al. The evolution of uncertainty in second opinions about prostate cancer treatment. Health Expect. 2017;20(6):1264-74. doi: https://doi.org/10.1111/hex.12566
» https://doi.org/10.1111/hex.12566 -
17 Appleton L, Poole H, Wall C. Being in safe hands: Patients’ perceptions of how cancer services may support psychological well-being. J Adv Nurs. 2018;74(7):1531-43. doi: https://doi.org/10.1111/jan.13553
» https://doi.org/10.1111/jan.13553 -
18 Ramírez-Perdomo CA, Rodríguez-Velez ME, Perdomo-Romero AY. Incertidumbre frente al diagnóstico de cáncer. Texto contexto - enferm. 2018;27(4):1-9. doi: https://doi.org/10.1590/0104-07072018005040017
» https://doi.org/10.1590/0104-07072018005040017 -
19 Vedelø TW, Sørensen JCH, Delmar C. Patients’ experiences and care needs during the diagnostic phase of an integrated brain cancer pathway: a case study. J Clin Nurs. 2018;27(15-16):3044-55. doi: https://doi.org/10.1111/jocn.14372
» https://doi.org/10.1111/jocn.14372 -
20 Lidington E, Vlooswijk C, Stallard K, et al. ‘This is not part of my life plan’: A qualitative study on the psychosocial experiences and practical challenges in young adults with cancer age 25 to 39 years at diagnosis. Eur J Cancer Care. 2021;30:e13458. doi: https://doi.org/10.1111/ecc.13458
» https://doi.org/10.1111/ecc.13458 -
21 Volungholen Sollid MI, Kirkevold Ø, Slaaen M, et al. Experiences of older patients with cancer from the radiotherapy pathway - aqualitative study. Eur J Oncol Nurs. 2021;53:101999. doi: https://doi.org/10.1016/j.ejon.2021.101999
» https://doi.org/10.1016/j.ejon.2021.101999 -
22 Kim SH, Lee R, Lee KS. Symptoms and uncertainty in breast cancer survivors in Korea: differences by treatment trajectory. J Clin Nurs. 2012;21(7-8):1014-23. doi: https://doi.org/10.1111/j.1365-2702.2011.03896.x
» https://doi.org/10.1111/j.1365-2702.2011.03896.x -
23 Jeon BH, Choi M, Lee J, et al. Relationships between gastrointestinal symptoms, uncertainty, and perceived recovery in patients with gastric cancer after gastrectomy. Nurs Health Sci. 2016;18(1):23-9. doi: https://doi.org/10.1111/nhs.12219
» https://doi.org/10.1111/nhs.12219 - 24 Traeder TL. Cancer communication, uncertainty, and patient satisfaction: investigating the effect of patient navigators on the breast cancer treatment decision-making process [tesis doctoral]. Pennsylvania: Pennsylvania State University; 2015.
-
25 Ghodraty Jabloo V, Alibhai SMH, Fitch M, et al. Antecedents and outcomes of uncertainty in older adults with cancer: a scoping review of the literature. Oncol Nurs Forum. 2017;44(4):E152- 67. doi: https://doi.org/10.1188/17.onf.e152-e167
» https://doi.org/10.1188/17.onf.e152-e167 -
26 Ferlay J, Ervik M, Lam F, et al. Global Cancer Observatory: cancer today [Internet]. Lyon, France: International Agency for Research on Cancer; 2020 [acceso 2020 ene 28]. Disponible en: https://gco.iarc.fr/today
» https://gco.iarc.fr/today - 27 Verduzco-Aguirre HC, Navarrete-Reyes AP, Negrete-Najar JP, et al. Cáncer en el adulto mayor en Latinoamérica: cooperación interdisciplinaria entre oncología y geriatría. Rev. Salud Pública. 2020;22(3):337-45.
- 28 Smith MJ, Liehr PR, Carpenter R. Middle range theory for nursing. New York: Springer Publishing Company, LLC; 2024.
-
29 Arias Rojas EM, Carreño Moreno SP, Chaparro Díaz OL. Incertidumbre ante la enfermedad crónica. Revisión integrativa. Rev Latinoam Bioét. 2019;36(1):93-106. doi: https://doi.org/10.18359/rlbi.3575
» https://doi.org/10.18359/rlbi.3575 -
30 Fernandez-Araque A, Gomez-Castro J, Giaquinta-Aranda A, et al. Mishel's model of uncertainty describing categories and subcategories in fibromyalgia patients, a scoping review. Int J Environ Res Public Health. 2020;26;17(11):3756. doi: https://doi.org/10.3390/ijerph17113756
» https://doi.org/10.3390/ijerph17113756 -
31 Panader-Torres A, Cerinza-León K, Echavarría-Arévalo X, et al. Experiencias de educación interpares para favorecer el autocuidado del paciente oncológico. Duazary. 2020;17(2):45-57. doi: https://doi.org/10.21676/2389783X.3234
» https://doi.org/10.21676/2389783X.3234 -
32 Wakiuchi J, Marcon SS, Oliveira DC, et al. Rebuilding subjectivity from the experience of cancer and its treatment. Rev Bras Enferm. 2019;72(1):125-33. doi: https://doi.org/10.1590/0034-7167-2018-0332
» https://doi.org/10.1590/0034-7167-2018-0332 -
33 Mbachu C, Dim C, Ezeoke U. Effects of peer health education on perception and practice of screening for cervical cancer among urban residential women in south-east Nigeria: a before and after study. BMC Womens Health. 2017;17(1):41. doi: https://doi.org/10.1186/s12905-017-0399-6
» https://doi.org/10.1186/s12905-017-0399-6 -
34 Nurhidayah I, Nurhaeni N, Allenidekania A, et al. Uncertainty of parents due to having children with cancer: a concept analysis. Belitung Nurs J. 2023;9(3):218-26. doi: https://doi.org/10.33546/bnj.2612
» https://doi.org/10.33546/bnj.2612 -
35 Marin Y, Flores de Bishop C. La incertidumbre frente al diagnostico de cancer de lengua: Proceso de atención de enfermeria en salud mental. Enfoque. 2024;34(30):78-108. doi: https://doi.org/10.48204/j.enfoque.v34n30.a4708
» https://doi.org/10.48204/j.enfoque.v34n30.a4708 -
36 Geue K, Götze H, Friedrich M, et al. Perceived social support and associations with health-related quality of life in young versus older adult patients with haematological malignancies. Health Qual Life Outcomes. 2019;17(1):145. doi: https://doi.org/10.1186/s12955-019-1202-1
» https://doi.org/10.1186/s12955-019-1202-1 -
37 Feng LR, Regan J, Shrader JA, et al. Cognitive and motor aspects of cancer-related fatigue. Cancer Med. 2019;8(13):5840-9. doi: https://doi.org/10.1002/cam4.2490
» https://doi.org/10.1002/cam4.2490 -
38 Taş Bora S, Buldukoğlu K. Using the uncertainty in illness theory to provide care for the caregiver: a case report. J Psychiatric Nurs. 2020;11(1):70-7. doi: https://dx.doi.org/10.14744/phd.2019.44365
» https://dx.doi.org/10.14744/phd.2019.44365 -
39 Yu Z, Sun D, Sun J. Social support and fear of cancer recurrence among chinese breast cancer survivors: the mediation role of illness uncertainty. Front Psychol. 2022;13:864129. doi: https://doi.org/10.3389/fpsyg.2022.864129
» https://doi.org/10.3389/fpsyg.2022.864129 -
40 Alhusban RY. Changed body image as perceived by jordanian women undergoing breast cancer treatment. Asian Pac J Cancer Prev. 2019;20(3):767-73. doi: https://doi.org/10.31557/apjcp.2019.20.3.767
» https://doi.org/10.31557/apjcp.2019.20.3.767 -
41 Mejía-Rojas ME, Contreras-Rengifo A, Hernández-Carrillo M. Calidad de vida en mujeres con cáncer de mama sometidas a quimioterapia en Cali, Colombia. Biomédica. 2020;40(2):349-61. doi: https://doi.org/10.7705/biomedica.4971
» https://doi.org/10.7705/biomedica.4971 -
42 Ruiz-Doria SC, Valencia-Jiménez NN, Ortega-Montes JE. Living conditions and coping strategies of women with breast cancer in Córdoba, Colombia. Anales de Psicología. 2020;36(1):46-55. doi: https://dx.doi.org/10.6018/analesps.36.1.351701
» https://dx.doi.org/10.6018/analesps.36.1.351701 -
43 Pérez-Hernández S, Okino-Sawada N, Díaz-Oviedo A, et al. Espiritualidad y calidad de vida en mujeres con cáncer de mama: una revisión integrativa. Enferm. univ. 2019;16(2):185-95. doi: https://doi.org/10.22201/eneo.23958421e.2019.2.643
» https://doi.org/10.22201/eneo.23958421e.2019.2.643 -
44 Martínez-Royert J, Orostegui Santander MA, Forero Ocampo MC, et al. Incertidumbre frente a la enfermedad renal crónica. Rev Salud Uninorte. 2020;36(2):489-505. doi: https://doi.org/10.14482/sun.36.2.616.6
» https://doi.org/10.14482/sun.36.2.616.6 -
45 Pastuña-Doicela R, Sanhueza-Alvarado O. Influencia de la autoeficacia en la incertidumbre y la calidad de vida de mujeres con cáncer de mama. Revisión integrativa. Enfermería (Montev.). 2021;10(2):124-44. doi: https://doi.org/10.22235/ech.v10i2.2603
» https://doi.org/10.22235/ech.v10i2.2603 -
46 Lopes JV, Bergerot CD, Barbosa LR, et al. Impact of breast cancer and quality of life of women survivors. Rev Bras Enferm. 2018;71(6):2916-21. doi: https://doi.org/10.1590/0034-7167-2018-0081
» https://doi.org/10.1590/0034-7167-2018-0081 -
47 Valderrama-Sanabria ML, Alvarez-Najar JP, Loboa-Rodríguez NJ, et al. Incertidumbre en la toma de citología cérvico uterina. Rev cienc cuidad. 2022;19(2):31-9. doi: https://doi.org/10.22463/17949831.3219
» https://doi.org/10.22463/17949831.3219 -
48 Adarve SE, Osorio JH. Factors associated with uncertainty in patients scheduled to undergo hematopoietic stem cell transplantation. Cancer Nurs. 2020;43(6):E335-41. doi: https://doi.org/10.1097/ncc.0000000000000773
» https://doi.org/10.1097/ncc.0000000000000773
Edited by
-
Associate-editor:
Fernando Lopes Tavares de Lima. Orcid iD: https://orcid.org/0000-0002-8618-7608
-
Scientific-editor:
Anke Bergmann. Orcid iD: https://orcid.org/0000-0002-1972-8777
Publication Dates
-
Publication in this collection
22 Aug 2025 -
Date of issue
2025
History
-
Received
27 Jan 2025 -
Accepted
16 June 2025
Source: Adapted from Prisma
Source: The authors, based on the uncertainty theory in illness