Skip to main content
SpringerLink
Log in

Correlates of illness uncertainty in cancer survivors and family caregivers: a systematic review and meta-analysis

  • Review
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Purpose

Illness uncertainty is widely recognized as a psychosocial stressor for cancer survivors and their family caregivers. This systematic review and meta-analysis aimed to identify the sociodemographic, physical, and psychosocial correlates that are associated with illness uncertainty in adult cancer survivors and their family caregivers.

Methods

Six scholarly databases were searched. Data synthesis was based on Mishel’s Uncertainty in Illness Theory. Person’s r was used as the effect size metric in the meta-analysis. Risk of bias was assessed using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies.

Results

Of 1116 articles, 21 articles met the inclusion criteria. Of 21 reviewed studies, 18 focused on cancer survivors, one focused on family caregivers, and 2 included survivors and family caregivers. Findings identified distinct correlates for illness uncertainty in cancer survivors, including sociodemographic factors (e.g., age, gender, race), stimuli frame (e.g., symptom, family history of cancer), structure providers (e.g., education), coping, and adaptation. Notable effect sizes were observed in the correlations between illness uncertainty and social support, quality of life, depression, and anxiety. Caregivers’ illness uncertainty was associated with their race, general health, perception of influence, social support, quality of life, and survivors’ prostate-specific antigen levels. Insufficient data precluded examining effect size of correlates of illness uncertainty among family caregivers.

Conclusion

This is the first systematic review and meta-analysis to summarize the literature on illness uncertainty among adult cancer survivors and family caregivers. Findings contribute to the growing literature on managing illness uncertainty among cancer survivors and family caregivers.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Mishel M (1988) Uncertainty in illness. J Nurs Scholarsh 20(4):225–232. https://doi.org/10.1111/j.1547-5069.1988.tb00082.x

    Article  CAS  Google Scholar 

  2. Ghodraty Jabloo V, Alibhai SMH, Fitch M, Tourangeau AE, Ayala AP, Puts MTE (2017) Antecedents and outcomes of uncertainty in older adults with cancer: a scoping review of the literature. Oncol Nurs Forum 44(4):E152–EE67. https://doi.org/10.1188/17.ONF.E152-E167

    Article  PubMed  Google Scholar 

  3. Guan T, Guo P, Santacroce SJ, Chen DG, Song L (2020) Illness uncertainty and its antecedents for patients with prostate cancer and their partners. Oncol Nurs Forum 47(6):721–731. https://doi.org/10.1188/20.Onf.721-731

    Article  PubMed  PubMed Central  Google Scholar 

  4. Garofalo JP, Choppala S, Hamann HA, Gjerde J (2009) Uncertainty during the transition from cancer patient to survivor. Cancer Nurs 32(4):E8–E14. https://doi.org/10.1097/NCC.0b013e31819f1aab

    Article  PubMed  PubMed Central  Google Scholar 

  5. Wonghongkul T, Dechaprom N, Phumivichuvate L, Losawatkul S (2006) Uncertainty appraisal coping and quality of life in breast cancer survivors. Cancer Nurs 29(3):250–257. https://doi.org/10.1097/00002820-200605000-00014

    Article  PubMed  Google Scholar 

  6. Guan T, Qan’ir Y, Song L (2021) Systematic review of illness uncertainty management interventions for cancer patients and their family caregivers. Support Care Cancer 29(8):4623–4640. https://doi.org/10.1007/s00520-020-05931-x

    Article  PubMed  PubMed Central  Google Scholar 

  7. Lisy K, Langdon L, Piper A, Jefford M (2019) Identifying the most prevalent unmet needs of cancer survivors in Australia: a systematic review. Asia Pac J Clin Oncol 15(5):e68–e78. https://doi.org/10.1111/ajco.13176

    Article  PubMed  Google Scholar 

  8. Kang H-Y, Choi E-Y (2019) Factors influencing quality of life in patients with multiple myeloma. Contemp Nurse 55(2-3):109–121. https://doi.org/10.1080/10376178.2019.1623699

    Article  PubMed  Google Scholar 

  9. Sammarco A (2001) Perceived social support, uncertainty, and quality of life of younger breast cancer survivors. Cancer Nurs 24(3):212–219. https://doi.org/10.1097/00002820-200106000-00007

    Article  CAS  PubMed  Google Scholar 

  10. Bhise V, Rajan SS, Sittig DF, Morgan RO, Chaudhary P, Singh H (2018) Defining and measuring diagnostic uncertainty in medicine: a systematic review. J Gen Intern Med 33(1):103–115. https://doi.org/10.1007/s11606-017-4164-1

    Article  PubMed  Google Scholar 

  11. Freeston MH, Rhéaume J, Letarte H, Dugas MJ, Ladouceur R (1994) Why do people worry? Pers Individ Differ 17(6):791–802. https://doi.org/10.1016/0191-8869(94)90048-5

    Article  Google Scholar 

  12. Heart N (2021) Lung, and Blood Institute. Study quality assessment tools Available from:https://www.nhlbi.nih.gov/health-topics/study-quality-assessment-tools

  13. Sullivan GM, Feinn R (2012) Using effect size-or why the P value is not enough. J Grad Med Educ 4(3):279–282. https://doi.org/10.4300/JGME-D-12-00156.1

    Article  PubMed  PubMed Central  Google Scholar 

  14. Rosenthal R (1995) Writing meta-analytic reviews. Psychol Bull 118(2):183–192. https://doi.org/10.1037/0033-2909.118.2.183

    Article  Google Scholar 

  15. Peterson RA, Brown SP (2005) On the use of beta coefficients in meta-analysis. J Appl Psychol 90(1):175–181. https://doi.org/10.1037/0021-9010.90.1.175

    Article  PubMed  Google Scholar 

  16. Borenstein M, Hedges LV, Higgins JP, Rothstein HR (2021) Introduction to meta-analysis. John Wiley & Sons

    Book  Google Scholar 

  17. Higgins JP, Thomas J, Chandler J, Cumpston M, Li T, Page MJ et al (2019) Cochrane handbook for systematic reviews of interventions. John Wiley & Sons.

    Book  Google Scholar 

  18. You W-Y, Yeh T-P, Lee K-C, Ma W-F (2020) A preliminary study of the comfort in patients with leukemia staying in a positive pressure isolation room. Int J Environ Res Public Health 17(10). https://doi.org/10.3390/ijerph17103655

  19. Park H, Kim K (2020) Impact of psycho-social factors on fatigue among breast cancer patients who are currently undergoing radiotherapy. Int J Environ Res Public Health 17(17). https://doi.org/10.3390/ijerph17176092

  20. Song L, Tan X, Bredle J, Bennett AV, Northouse L (2020) Psychometric properties of the FACT-G quality of life scale for family caregivers of cancer patients. Qual Life Res 29(8):2241–2252. https://doi.org/10.1007/s11136-020-02477-7

    Article  PubMed  PubMed Central  Google Scholar 

  21. Varner S, Lloyd G, Ranby KW, Callan S, Robertson C, Lipkus IM (2019) Illness uncertainty, partner support, and quality of life: a dyadic longitudinal investigation of couples facing prostate cancer. Psychooncology 28(11):2188–2194. https://doi.org/10.1002/pon.5205

    Article  PubMed  Google Scholar 

  22. Kuba K, Esser P, Scherwath A, Schirmer L, Schulz-Kindermann F, Dinkel A et al (2017) Cancer-and-treatment–specific distress and its impact on posttraumatic stress in patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT). Psychooncology 26(8):1164–1171. https://doi.org/10.1002/pon.4295

    Article  PubMed  Google Scholar 

  23. Tarhani M, Goudarzi F, Hasanv S, Ebrahimzadeh F, Rassouli M (2020) Uncertainty, anxiety, depression and the quality of life in patients with cancer. Onkologia i Radioterapia 13(4):124–130

    Google Scholar 

  24. Zhang Y, Kwekkeboom K, Petrini M (2015) Uncertainty, self-efficacy, and self-care behavior in patients with breast cancer undergoing chemotherapy in China. Cancer Nurs 38(3):E19–E26. https://doi.org/10.1097/NCC.0000000000000165

    Article  PubMed  Google Scholar 

  25. Jeon BH, Choi M, Lee J, Noh SH (2016) Relationships between gastrointestinal symptoms, uncertainty, and perceived recovery in patients with gastric cancer after gastrectomy. Nurs Health Sci 18(1):23–29. https://doi.org/10.1111/nhs.12219

    Article  PubMed  Google Scholar 

  26. Shun S-C, Chou Y-J, Chen C-H, Yang J-C (2018) Change of uncertainty in illness and unmet care needs in patients with recurrent hepatocellular carcinoma during active treatment. Cancer Nurs 41(4):279–289. https://doi.org/10.1097/NCC.0000000000000487

    Article  PubMed  Google Scholar 

  27. Lin L, Chien L-C, Acquaye AA, Vera-Bolanos E, Gilbert MR, Armstrong TS (2015) Significant predictors of patients’ uncertainty in primary brain tumors. J Neuro-Oncol 122(3):507–515. https://doi.org/10.1007/s11060-015-1756-7

    Article  Google Scholar 

  28. Adarve SE, Osorio JH (2020) Factors associated with uncertainty in patients scheduled to undergo hematopoietic stem cell transplantation. Cancer Nurs 43(6):E335–EE41. https://doi.org/10.1097/NCC.0000000000000773

    Article  PubMed  Google Scholar 

  29. Hagen KB, Aas T, Lode K, Gjerde J, Lien E, Kvaloy JT et al (2015) Illness uncertainty in breast cancer patients: validation of the 5-item short form of the Mishel Uncertainty in Illness Scale. Eur J Oncol Nurs 19(2):113–119. https://doi.org/10.1016/j.ejon.2014.10.009

    Article  PubMed  Google Scholar 

  30. Sharif SP (2017) Locus of control, quality of life, anxiety, and depression among Malaysian breast cancer patients: the mediating role of uncertainty. Eur J Oncol Nurs 27:28–35. https://doi.org/10.1016/j.ejon.2017.01.005

    Article  Google Scholar 

  31. Lee I, Park C (2020) The mediating effect of social support on uncertainty in illness and quality of life of female cancer survivors: a cross-sectional study. Health Qual Life Outcomes 18(1):143. https://doi.org/10.1186/s12955-020-01392-2

    Article  PubMed  PubMed Central  Google Scholar 

  32. Ahadzadeh AS, Sharif SP (2018) Uncertainty and quality of life in women with breast cancer: moderating role of coping styles. Cancer Nurs 41(6):484–490. https://doi.org/10.1097/NCC.0000000000000552

    Article  PubMed  Google Scholar 

  33. Sharif SP, Ahadzadeh AS, Perdamen HK (2017) Uncertainty and quality of life of Malaysian women with breast cancer: mediating role of coping styles and mood states. Appl Nurs Res 38:88–94. https://doi.org/10.1016/j.apnr.2017.09.012

    Article  Google Scholar 

  34. Guan T, Santacroce SJ, Chen DG, Song L (2020) Illness uncertainty, coping, and quality of life among patients with prostate cancer. Psychooncology. https://doi.org/10.1002/pon.5372

  35. Parker PA, Davis JW, Latini DM, Baum G, Wang X, Ward JF et al (2016) Relationship between illness uncertainty, anxiety, fear of progression and quality of life in men with favourable-risk prostate cancer undergoing active surveillance. BJU Int 117(3):469–477. https://doi.org/10.1111/bju.13099

    Article  PubMed  Google Scholar 

  36. Mishel MH (1990) Reconceptualization of the uncertainty in illness theory. J Nurs Scholarsh 22(4):256–262. https://doi.org/10.1111/j.1547-5069.1990.tb00225.x

    Article  CAS  Google Scholar 

  37. Grupe DW, Nitschke JB (2011) Uncertainty is associated with biased expectancies and heightened responses to aversion. Emotion 11(2):413–424. https://doi.org/10.1037/a0022583

    Article  PubMed  PubMed Central  Google Scholar 

  38. Ervik B, Nordoy T, Asplund K (2013) In the middle and on the sideline: the experience of spouses of men with prostate cancer. Cancer Nurs 36(3):E7–E14. https://doi.org/10.1097/NCC.0b013e31824fe1ef

    Article  PubMed  Google Scholar 

  39. Rusbult CE, Van Lange PA (2003) Interdependence, interaction, and relationships. Annu Rev Psychol 54:351–375. https://doi.org/10.1146/annurev.psych.54.101601.145059

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors are grateful to Angela Bardeen who helped to develop the search terms and identify search databases. We also would like to thank Dr. Jordan Wingate for his editorial assistance.

Funding

Guan’s work was supported by University of North Carolina at Chapel Hill Royster Dissertation Completion Fellowship.

Author information

Authors and Affiliations

  1. Syracuse University, School of Social Work, 226 White Hall, Syracuse, Syracuse, NY, 13244, USA

    Ting Guan

  2. University of North Carolina at Chapel Hill, School of Social Work, Chapel Hill, NC, USA

    Mimi V. Chapman & Lisa de Saxe Zerden

  3. School of Medicine Johns Hopkins University, Baltimore, MD, USA

    Anjalee Sharma

  4. College of Health Solutions, Arizona State University, Phoenix, AZ, USA

    Ding-Geng Chen

  5. Department of Statistics, University of Pretoria, Pretoria, South Africa

    Ding-Geng Chen

  6. UT Health San Antonio, School of Nursing, San Antonio, TX, USA

    Lixin Song

Authors
  1. Ting Guan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mimi V. Chapman
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lisa de Saxe Zerden
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Anjalee Sharma
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ding-Geng Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Lixin Song
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Ting Guan, Mimi V. Chapman, Lisa de Saxe Zerden, and Lixin Song contributed to the study conception and design. Systematic searching of the literature at title and abstract, as well as full text, was performed by Ting Guan and Anjalee Sharma. Data analysis was performed by Ting Guan and Ding-Geng Chen. The draft of the manuscript was written by Ting Guan, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Ting Guan.

Ethics declarations

Ethics approval

This is a systematic review and meta-analysis study. No ethical approval is required.

Consent to participate

This study involved secondary analysis of publicly available articles; hence, formal consent is not required.

Consent for publication

Not applicable; this is a systematic review and meta-analysis study. Data were abstracted from published articles.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Guan, T., Chapman, M.V., de Saxe Zerden, L. et al. Correlates of illness uncertainty in cancer survivors and family caregivers: a systematic review and meta-analysis. Support Care Cancer 31, 242 (2023). https://doi.org/10.1007/s00520-023-07705-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00520-023-07705-7

Keywords

Search

Navigation