Testing a model of communication, uncertainty, and emotional well-being in older breast cancer survivors
Dr. Margaret F. Clayton
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The uncertainty and disruption caused by ongoing physical symptoms contributes to emotional distress and thoughts of recurrence for older breast cancer survivors. Uncertainty may be due to a lack of information about whether symptoms indicate recurrence, are related to comorbid conditions, or are part of the normal aging process. The purpose of this research was to assess the influence of physical symptoms, age, ethnicity, and patient-provider communication, on the uncertainty and emotional well-being of older breast cancer survivors. Guided by Uncertainty in Illness Theory, a conceptual model was developed and tested using structural equation modeling techniques. Data from 203 recurrence free Caucasian and African American women age 50–91, and 5–9 years post original treatment were used to test the model. Women reported an average of 5 symptoms, with only 12% of women reporting no physical symptoms. In addition, results suggest that high levels of symptom bother may place survivors at risk for adverse emotional well-being. Women reported high levels of symptom bother from weight gain, fatigue, pain, trouble thinking, and arm problems. These were not the most prevalent symptoms. Age was the strongest predictor of emotional well-being. Increasing age predicted less symptom bother, less uncertainty, less mood disturbance, and fewer troublesome thoughts of recurrence. Ethnicity was not significant in predicting either uncertainty or emotional well-being. Larger amounts of patient-provider communication predicted increased troublesome thoughts of recurrence. Possibly women received a more lengthy discussion of their symptoms than desired or expected. Conversely, it may be that a larger number of troublesome thoughts of recurrence triggered more talk between patient and provider. Communication findings showed that over 40% of women were unable to achieve their desired decision-making role. The high level of discrepancy between desired versus attained decision-making roles raises the issue of whether providers are meeting the ethical responsibility of respecting the autonomy of their patients or still adhering to a paternalistic model of care-giving. Future research is needed to investigate the long-term consequences of persistent uncertainty. Additionally, future research will clarify the mechanism by which patient-provider communication influences troublesome thoughts of recurrence for older breast cancer survivors.
This dissertation has also been disseminated through the ProQuest Dissertations and Theses database. Dissertation/thesis number: 3111987; ProQuest document ID: 305311739. The author still retains copyright.
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