Cause or Effect? The Role of Prognostic Uncertainty in the Fear of Cancer Recurrence.
Cause or Effect? The Role of Prognostic Uncertainty in the Fear of Cancer Recurrence.
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DOI：
10.3389/fpsyg.2020.626038
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发表时间：
2020
影响因子：
3.8
通讯作者：
LaChance JA
中科院分区：
文献类型：
--
作者：
Han PKJ;Gutheil C;Hutchinson RN;LaChance JA
对癌症复发的恐惧（FCR）是癌症幸存者痛苦的一个重要原因，经验证据和理论模型都表明，预后的不确定性在其发展中起着因果作用。然而，预后不确定性和FCR之间的关系并不完全清楚。探讨卵巢癌患者预后不确定感与FCR的关系。一项定性研究进行了利用个人的深入访谈，与一个方便的样本上皮性卵巢癌患者谁完成了一线治疗手术和/或化疗。半结构化访谈探讨了参与者（1）对预后的理解;（2）对预后信息的经验、偏好和态度;（3）应对预后不确定性的策略。归纳定性分析和逐行的软件辅助编码的采访成绩单进行识别的关键主题，并产生理论见解的预后不确定性和FCR之间的关系。该研究样本由21名参与者组成，几乎所有人都报告经历了严重的FCR，他们将其追溯到意识到可能出现不良结果。一些参与者重视并追求预后信息作为应对这种意识的一种手段，这表明预后的不确定性导致FCR。然而，大多数参与者承认，预测信息的确定性和价值都存在根本性的局限性，并采取了各种战略，目的不是减少而是构建和维持预测的不确定性，作为维持对良好结果可能性的希望的一种手段。参与者的评论表明，预后的不确定性，恐惧和希望是由复杂的，双向的因果通路介导的过程，使患者能够科普，构建和保持他们的不确定性。一个临时的双过程的理论模型来捕捉这些途径。在OC患者中，预后的不确定性是FCR的原因和结果-恐惧诱导刺激和持续的反应，通过各种策略构建和维持。需要更多的工作来阐明预后不确定性，恐惧和希望之间的关系，验证和完善我们的理论模型，并制定干预措施，以帮助OC和其他严重疾病的患者实现这些状态之间的最佳平衡。
Fear of cancer recurrence (FCR) is an important cause of suffering for cancer survivors, and both empirical evidence and theoretical models suggest that prognostic uncertainty plays a causal role in its development. However, the relationship between prognostic uncertainty and FCR is incompletely understood. To explore the relationship between prognostic uncertainty and FCR among patients with ovarian cancer (OC). A qualitative study was conducted utilizing individual in-depth interviews with a convenience sample of patients with epithelial ovarian cancer who had completed first-line treatment with surgery and/or chemotherapy. Semi-structured interviews explored participants’ (1) understanding of their prognosis; (2) experiences, preferences, and attitudes regarding prognostic information; and (3) strategies for coping with prognostic uncertainty. Inductive qualitative analysis and line-by-line software-assisted coding of interview transcripts was conducted to identify key themes and generate theoretical insights on the relationship between prognostic uncertainty and FCR. The study sample consisted of 21 participants, nearly all of whom reported experiencing significant FCR, which they traced to an awareness of the possibility of a bad outcome. Some participants valued and pursued prognostic information as a means of coping with this awareness, suggesting that prognostic uncertainty causes FCR. However, most participants acknowledged fundamental limits to both the certainty and value of prognostic information, and engaged in various strategies aimed not at reducing but constructing and maintaining prognostic uncertainty as a means of sustaining hope in the possibility of a good outcome. Participants’ comments suggested that prognostic uncertainty, fear, and hope are connected by complex, bi-directional causal pathways mediated by processes that allow patients to cope with, construct, and maintain their uncertainty. A provisional dual-process theoretical model was developed to capture these pathways. Among patients with OC, prognostic uncertainty is both a cause and an effect of FCR—a fear-inducing stimulus and a hope-sustaining response constructed and maintained through various strategies. More work is needed to elucidate the relationships between prognostic uncertainty, fear, and hope, to validate and refine our theoretical model, and to develop interventions to help patients with OC and other serious illnesses to achieve an optimal balance between these states.
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