“Uncertainty in patients with primary brain tumors”“Uncertainty, Mood States, and symptoms in patients with primary brain tumors”
Presenter: Lin Lin, PhD, RN
Department of Family Health
UTHealth School of Nursing
The University of Texas Health Science Center at Houston,
School of Nursing
 
School of Nursing
Develop an Uncertainty Management Intervention for Patients with Primary Brain Tumors (PI: Lin Lin) (2011-2012)
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Uncertainty in Illness
Uncertainty is defined as the inability to determine the meaning of illness-related events.
Uncertainty is a cognitive state created when the individual cannot adequately structure or categorize an illness event because of insufficient cues.
Uncertainty exists in illness situations that are ambiguous, complex, unpredictable, and when information is unavailable or inconsistent.
(Mishel, 1988; Mishel & Clayton, 2008)
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Mishel (1988)
Primary Brain Tumors (PBTs)
Tumors that begin in brain tissue are known as primary tumors of the brain.
The most common primary brain tumors are gliomas. A grade IV astrocytoma is usually called a glioblastoma multiforme (GBM).
Overall, the chance that a person will develop a malignant tumor of the brain or spinal cord in his or her lifetime is less than 1% (about 1 in 150 for a man and 1 in 185 for a woman).
(ACS, 2012)
91%
85%
84%
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Treatment
The treatment options for brain and spinal cord tumors depend on several factors, including the type and location of the tumor and how far it has grown or spread. Surgery is often the first treatment when it can be done.
Some tumors (e.g.,  glioblastomas) are not curable by surgery. After maximal safe surgical resection, chemotherapy wafers may be placed in or near any remaining tumor at this time. Radiation therapy is then given, usually along with or followed by chemotherapy if the person's health allows.
Temozolomide is the chemotherapy drug most commonly used to treat these tumors. It is often given along with radiation therapy, as it appears to make it more effective. It is then continued after the radiation is completed. 
(ACS, 2012)
Effects of the tumor and its treatment
31 (17%)
13 (7%)
34 (18%)
33-item
4-factors
Uncertainty was significantly correlated with symptom severity (p<.01) and symptom interference (p<.01).
Uncertainty was significantly correlated with symptom subscales of affective (p<.01), cognitive (p<.01), focal neurological deficit (p<.01), constitutional, generalized, and GI-related symptoms (all with p<.01).
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SRMR=Standardized Root Mean Square Residual
RMSEA= Root Mean Square Error of Approximation
90% CI= 90 Percent Confidence Interval
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SEM-Tension
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SEM-Anger
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SEM-Depression
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SEM-Fatigue
SEM-Confusion
Mark R. Gilbert, MD;
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