Antecedents of Uncertainty in Adults with Oncologic Diagnosis: Literature Integrative Review

Barboza-Solano, Nelson; Solano-Flores, Karol; Solano-López, Ana Laura

doi:10.32635/2176-9745.RBC.2025v71n3.5096EN

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Literature Review • Rev. Bras. Cancerol. 71 (3) • 2025 • https://doi.org/10.32635/2176-9745.RBC.2025v71n3.5096EN linkcopy

Antecedents of Uncertainty in Adults with Oncologic Diagnosis: Literature Integrative Review

Antecedentes da Incerteza em Adultos com Diagnóstico Oncológico: Revisão Integrativa da Literatura

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

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

Database	Search strategy	Filters
Embase	('uncertainty'/exp OR uncertainty) AND ('neoplasms'/exp OR neoplasms OR 'cancer'/exp OR cancer OR 'tumor'/exp OR tumor OR carcino- OR onco-) AND ([embase]/lim NOT ([embase]/lim AND [medline]/lim) OR ([medline]/lim NOT ([embase]/lim AND [medline]/lim) NOT ([embase classic]/lim AND [medline]/lim))) AND (2010:py OR 2011:py OR 2012:py OR 2013:py OR 2014:py OR 2015:py OR 2016:py OR 2017:py OR 2018:py OR 2019:py OR 2020:py OR 2021:py OR 2022:py) AND ([adult]/lim OR [aged]/lim OR [middle aged]/lim OR [very elderly]/lim OR [young adult]/lim) AND ('article'/it OR 'review'/it)	Age Date of publication Type of publication Full text
ProQuest Dissertations and Global Thesis	(uncertainty AND (neoplasms OR cancer OR tumor OR carcino- OR onco-)) AND (la.exact("ENG" OR "POR" OR "SPA") AND diskw.exact(("Cancer" OR "Breast cancer" OR "Nursing" OR "Prostate cancer" OR "Uncertainty") AND ("Quality of life" OR "Social support" OR "Depression" OR "Oncology" OR "Anxiety" OR "Metastasis" OR "Cancer survivors" OR "Breast Cancer" OR "Cancer screening" OR "Radiotherapy" OR "Tumor" OR "Ovarian cancer")) AND pd(20100101-20221108))	Date of publication Language Full text
ScienceDirect	uncertainty AND (neoplasms OR cancer OR tumor OR carcino- OR onco-)	Date of publication Full and open text Journals subscribed Theme: nursing and health professionals
LILACS	uncertainty AND (neoplasms OR cancer OR tumor OR carcino- OR onco-) AND (fulltext:("1") AND db:("LILACS") AND la:("es" OR "pt" OR "en")) AND (year_cluster:[2010 TO 2022])	Date of publication Language Full text

Author (year) Country	Objective	Design	Sample	LE*
Maher y de Vries (2011)¹² United Kingdom	Explore the experience of living with relapsed multiple myeloma	Qualitative, phenomenological, hermeneutic	5 men and 3 women diagnosed with myeloma, aged 48-74 years	VI
Wall et al. (2011)¹³ United Kingdom	Identify and describe the essences of patient's experiences during the period leading up to the diagnosis of non-Hodgkin lymphoma (NHL)	Qualitative, phenomenological, descriptive	15 men and 16 women with NHL, aged 56 years (age-range 29-79)	VI
Yusuf et al. (2013)¹⁴ Malaysia	Explore the experience of Malaysian and Chinese women newly diagnosed with breast cancer at the Malaysia peninsular eastern coast	Qualitative, phenomenological, longitudinal	20 women with primary breast cancer, aged 34-59 years	VI
Inan et al. (2016)¹⁵ Turkey	Describe the experiences of Turkish women during diagnosis of breast cancer	Qualitative phenomenological	9 women with breast cancer. Mean age 42.22 years, age range 33-55 years	VI
Hillen et al. (2017)¹⁶ The Netherlands	Investigate deeply the evolution of uncertainty of second opinions on breast cancer	Qualitative exploratory	24 men with prostate cancer. Mean age 65 years (age range 52-73)	VI
Appleton et al. (2018)¹⁷ United Kingdom	Explore how oncologic services promote and support the well-being of patients during their oncologic treatment	Qualitative exploratory	30 participants, 18 men and 12 women with colorectal, head and neck and lung cancer with curative or palliative intent. Age range 52-88 years	VI
Ramírez-Perdomo et al. (2018)¹⁸ Colombia	Describe the meaning of the experience in face of a cancer diagnosis in the construction of the individual and subjective reality developed	Qualitative, phenomenological, hermeneutic	6 participants, 2 with testicle cancer, 1, with breast cancer, 1, with ovary cancer and 2 with cervical cancer. Age-range 24-36 years	VI
Vedelø et al. (2018)¹⁹ Denmark	Identify and describe the patient's experiences and care needs during the diagnosis of an integrated brain cancer pathway	Qualitative case report	4 participants, 2 men and 2 women with brain tumor. Age range 63-78 years	VI
Lidington et al. (2021)20 United Kingdom	Explore the psychosocial and practical experiences of young adults diagnosed with cancer in the United Kingdom and during their treatment	Qualitative phenomenological	65 participants with multiple types of tumors, the most frequent were sarcomas (n=13; 20.0 %), breast cancer (n=12; 18.5 %) and central nervous system tumors (n=12; 18.5 %). Age range 25-39 (mean 33.6 years)	VI
Volungholen Sollid et al. (2021)²¹ Norway	Explore and describe experiences of older patients with cancer throughout their radiotherapy treatment, from diagnosis until follow-up after treatment	Qualitative, descriptive, exploratory	12 participants (7 men and 5 women) with cancer reaching the end of radiotherapy. Age-range 66-80 years (mean 73 years)	VI
Kim et al. (2012)²² South Korea	Compare the levels of symptoms and uncertainty, their associated factors, relationships between them and predictors of uncertainty by treatment trajectory among breast cancer survivors	Quantitative, cross-sectional, correlation, descriptive	252 breast cancer survivors, mean-age 47.5 years (range 27-73 years)	IV
Jeon et al. (2016)²³ South Korea	Examine the relationships between gastrointestinal symptoms, uncertainty, and perceived recovery in gastric cancer patients after gastrectomy	Quantitative, cross-sectional, correlation, descriptive	146 participants with gastric cancer submitted to gastrectomy (92 men and 54 women). Mean age 54.7, age-range 30-78 years)	IV
Traeder (2015)²⁴ USA	Determine whether women who have access to a patient navigator during breast cancer decision-making better manage uncertainty and experience greater patient satisfaction with the overall care experience than women who do not have access to a patient navigator	Mixed methods	124 breast cancer survivors. Mean age 35 years (age-range 18-55)
Ghodraty Jabloo et al. (2017)²⁵ Canada	Comprehensive understanding of the antecedents and outcomes of uncertainty in older adults with cancer in the existing literature	Scoping review	44 studies were included (30 qualitative, 12 quantitative and 2 mixed methods). The studies enrolled individuals with several types of cancer (n=12), prostate cancer (n=11), breast cancer (n=6), gastrointestinal cancer (n=6), lung cancer (n=4), hematological cancer (n=3), head and neck cancer (n=1) and kidney cancer (n=1)	V

Antecedents of uncertainty		Codes identified
Category	Subcategory	Codes identified
Stimuli frame	Symptoms pattern	Distinctiveness of symptoms¹⁴,¹⁸
	Symptoms pattern	Inconsistency of symptoms¹⁸,²⁰
	Event familiarity	Self experience¹³,²¹
		Vicarious experience¹⁸,²³
		System guidelines¹⁷,²¹
		Routines disruption¹²,²⁰
	Event congruence	Inconsistency between expected and experienced¹²,¹⁹,²⁰
Cognitive capacity		Age²²,²⁵
		Emotional chaos¹⁵,¹⁶,²⁰
		Internal physiologic events¹⁹,²²
Structure providers	Credible authority	Credible authority as generator of knowledge¹²,¹⁷,²¹,²⁴
	Credible authority	Quality and stability of the professional-individual relation¹⁸-²¹,²⁴
	Social support	Human interaction as source of information¹³,¹⁷,¹⁸,²⁰
		Emotional support¹²,¹⁴,¹⁵
		Instrumental support¹⁵,²¹
	Education	Knowledge as base of meaning and context¹³,¹⁵,¹⁶,¹⁸,²¹
		Complex and fragmented information¹⁶,¹⁹,²¹
		Education level²²,²³,²⁵

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[TFN1] Source: Polit and Beck¹⁰.

[TFN2] ^*
Caption: LE = Level of evidence.