Online Exclusive Article

Preoperative Uncertainty and Anxiety Among Chinese Patients With Gynecologic Cancer

Zarina Ismail

Winnie K. W. So

Polly Wai-chi Li

preoperative anxiety, anxiety, cancer-related anxiety, gynecologic cancer, uncertainty
ONF 2010, 37(1), E67-E74. DOI: 10.1188/10.ONF.E67-E74

Purpose/Objectives: To determine the levels of preoperative anxiety and uncertainty in Hong Kong Chinese women with gynecologic cancer, the demographic factors that may affect the intensity of anxiety, and the effects of uncertainty on the anxiety levels of these women.

Design: Cross-sectional.

Setting: The gynecologic oncology unit of a public hospital in Hong Kong.

Sample: 170 Chinese women with diagnosed (or suspected) gynecologic cancer who were scheduled for surgery and able to read Chinese.

Methods: A self-administered questionnaire consisting of the Chinese version of Mishel's Uncertainty in Illness Scale (MUIS-C), the State-Trait Anxiety Inventory, the Medical Outcomes Study Social Support Survey, and demographic data.

Main Research Variables: Gynecologic cancer, anxiety, and uncertainty.

Findings: The mean scores of state anxiety and on the MUIS-C were 48.3 (SD = 11.58) and 92.27 (SD = 13.49), respectively. A higher level of anxiety was significantly associated with inadequate social support (r = -0.189, p = 0.014) and a higher level of uncertainty (r = 0.405, p < 0.001).

Conclusions: Women perceiving a higher level of uncertainty are more likely to report a higher level of anxiety, although adequate social support may reduce this.

Implications for Nursing: Nurses should increase their awareness of the adverse effects of uncertainty on their patients' mental health. They can help to relieve anxiety by minimizing uncertainty levels of their patients through offering emotional support and providing information on the disease, treatment plans, and rehabilitation. Adequate social support should be provided to patients before surgery, which might help to reduce their anxiety.

Jump to a section

    References

    Barbour, R.S. (1999). The case for combining qualitative and quantitative approaches in health services research. Journal of Health Services Research and Policy, 4, 39-43.
    Bennett, S.J. (1993). Relationships among selected antecedent variables and coping effectiveness in postmyocardial infarction patients. Research in Nursing and Health, 16, 131-139.
    Bond, M.H. (1991). Beyond the Chinese face: Insights from psychology. Hong Kong: Oxford University Press.
    Carr, E., Brockbank, K., Allen, S., & Strike, P. (2006). Patterns and frequency of anxiety in women undergoing gynaecologic surgery. Journal of Clinical Nursing, 15, 341-352. doi: 10.1111/j.1365-2702.2006.01285.x
    Caumo, W., Schmidt, A.P., Schneider, C.N., Bergmann, J., Iwamoto, C.W., Bandeira, D., & Ferreira, M.B. (2001). Risk factors for preoperative anxiety in adults. Acta Anaesthesiologica Scandinavica, 45, 298-307.
    Centers for Disease Control and Prevention. (2008). Basic information about gynecologic cancer. Retrieved from http://www.cdc.gov/cancer/gynecologic/gyn_overview.htm
    Cheung, L.H., Callaghan, P., & Chang, A.M. (2003). A controlled trial of psycho-educational interventions in preparing Chinese women for elective hysterectomy. International Journal of Nursing Studies, 40, 207-216.
    Deane, K.A., & Degner, L.F. (1998). Information needs, uncertainty, and anxiety in women who had a breast biopsy with benign outcome. Cancer Nursing, 21, 117-126.
    Dirksen, S.R., & Erickson, J.R. (2002). Well-being in Hispanic and non-Hispanic white survivors of breast cancer. Oncology Nursing Forum, 29, 820-826. doi: 10.1188/02.ONF.820-826
    Dorigo, O., & Baker, V.V. (2003). Premalignant and malignant disorders of the ovaries and oviducts. In A.H. DeCherney & L. Nathan (Eds.), Current obstetric and gynecologic diagnosis and treatment (9th ed., pp. 933-946). New York, NY: McGraw-Hill.
    Dropkin, M.J. (2001). Anxiety, coping strategies, and coping behaviors in patients undergoing head and neck cancer surgery. Cancer Nursingr 24, 143-148.
    Hawthorne, M.H., & Hixon, M.E. (1994). Functional status, mood disturbance and quality of life in patients with heart failure. Progress in Cardiovascular Nursing, 9(1), 22-32.
    Hilton, B.A. (1994). The Uncertainty Stress Scale: Its development and psychometric properties. Canadian Journal of Nursing Research, 26(3), 15-30.
    Hong Kong Cancer Registry. (n.d.). Fast stats for cancer 2005. Retrieved from http://www3.ha.org.hk/cancereg/eng/stat.asp
    Hughes, S. (2002). The effects of giving patients pre-operative information. Nursing Standard, 16(28), 33-37.
    Kain, Z.N., Sevarino, F., Alexander, G.M., Pincus, S., & Mayes, L.C. (2000). Preoperative anxiety and postoperative pain in women undergoing hysterectomy. A repeated-measures design. Journal of Psychosomatic Research, 49, 417-422.
    Karanci, A.N., & Dirik, G. (2003). Predictors of pre- and postoperative anxiety in emergency surgery patients. Journal of Psychosomatic Research, 55, 363-369. doi: 10.1016/S0022-3999(02)00631-1
    Koivula, M., Paunonen-Ilmonen, M., Tarkka, M.T., Tarkka, M., & Laippala, P. (2001). Fear and anxiety in patients awaiting coronary artery bypass grafting. Heart and Lung, 30, 302-311. doi: 10.1067/mhl.2001.116134
    Koivula, M., Paunonen-Ilmonen, M., Tarkka, M.T., Tarkka, M., & Laippala, P. (2002). Social support and its relation to fear and anxiety in patients awaiting coronary artery bypass grafting. Journal of Clinical Nursing, 11, 622-633. doi: 10.1046/j.1365-2702.2002.00653.x
    Mast, M.E. (1998). Correlates of fatigue in survivors of breast cancer. Cancer Nursing, 21, 136-142.
    Mishel, M.H. (1981). The measurement of uncertainty in illness. Nursing Research, 30, 258-263.
    Mishel, M.H. (1984). Perceived uncertainty and stress in illness. Research in Nursing and Health, 7, 163-171.
    Mishel, M.H. (1997). Uncertainty in Illness Scales manual. Chapel Hill, NC: University of North Carolina.
    Mishel, M.H., & Braden, C.J. (1988). Finding meaning: Antecedents of uncertainty in illness. Nursing Research, 37, 98-103.
    Mitchell, M. (2003). Patient anxiety and modern elective surgery: A literature review. Journal of Clinical Nursing, 12, 806-815. doi: 10.1046/j.1365-2702.2003.00812.x
    Munafo, M.R., & Stevenson, J. (2001). Anxiety and surgical recovery: Reinterpreting the literature. Journal of Psychosomatic Research, 51, 589-596.
    Sammarco, A. (2001). Perceived social support, uncertainty, and quality of life of younger breast cancer survivors. Cancer Nursing, 24, 212-219.
    Shek, D.T.L. (1988). Reliability and factorial structure of the Chinese version of the State-Trait Anxiety Inventory. Journal of Psychopathology and Behavioural Assessment, 10, 303-317. doi: 10.1007/BF00960624
    Shek, D.T.L. (1991). The factorial structure of the Chinese version of the State-Trait Anxiety Inventory: A confirmatory factor analysis. Educational Psychology and Measurement, 51, 985-997. doi: 10.1177/001316449105100418
    Sherbourne, C.D., & Stewart, A.L. (1991). The MOS Social Support Survey. Social Science and Medicine, 32, 705-714.
    Spielberger, C.D. (1983). State-Trait Anxiety Inventory for adults. Sampler set: Manual, test, scoring key. Palo Alto, CA: Mind Garden.
    Sukegawa, A., Miyagi, E., Asai-Sato, M., Saji, H., Sugiura, K., Matsumura, T., … Hirahara, F. (2008). Anxiety and prevalence of psychiatric disorders among patients awaiting surgery for suspected ovarian cancer. Journal of Obstetrics and Gynecology Research, 34, 543-551. doi: 10.1111/j.1447-0756.2008.00738.x
    Taylor-Piliae, R., & Molassiotis, A. (2000). Psychometric evaluation of the Chinese version of Mishel's Uncertainty in Illness Scale. Hong Kong Nursing Journal, 36(4), 14-21.
    Taylor-Piliae, R., & Molassiotis, A. (2001). An exploration of the relationships between uncertainty, psychological distress and type of coping strategy among Chinese men after cardiac catheterization. Journal of Advanced Nursing, 33, 79-88.
    Twinn, S. (2006). Balancing uncertainty and acceptance: Understanding Chinese women's responses to an abnormal cervical smear result. Journal of Clinical Nursing, 15, 1140-1148. doi: 10.1111/j.1365-2702.2006.01497.x
    Visser, M.R.M., Van Lanschot, J.B.V., Van Der Velden, J., Kloek, J.J., Gouma, D.J., & Sprangers, M.A.G. (2006). Quality of life in newly diagnosed cancer patients waiting for surgery is seriously impaired. Journal of Surgical Oncology, 93, 571-577. doi: 10.1002/jso.20552
    Walker, L.G. (1990). The measurement of anxiety. Postgraduate Medical Journal, 66(Suppl. 2), S11-S17.
    Welsh, J. (2000). Reducing patient stress in theatre. British Journal of Perioperative Nursing, 10, 321-327.
    Yu, D.S., Lee, D.T., & Woo, J. (2004). Health-related quality of life in elderly Chinese patients with heart failure. Research in Nursing and Health, 27, 332-344. doi: 10.1002/nur.20030