The Mediating Effect of Uncertainty in Illness on Cancer Coping in Patients With Primary Malignant Brain Tumors.

ABSTRACT

BACKGROUND: Patients with primary malignant brain tumors (PMBTs) experience uncertainty in illness (UI) because of the high recurrence rate and symptoms that occur during treatment. OBJECTIVE: To develop and test a model based on the Uncertainty in Illness Theory to predict the UI and cancer coping experienced by PMBT patients. METHODS: This was a cross-sectional study using path analysis. The participants were adults diagnosed with PMBT who completed a questionnaire about demographic and disease-related characteristics, UI, cancer coping, brain tumor symptoms, and social support. Clinical data (eg, the diagnosis, tumor location, and grade) were obtained from electronic health records. Data were analyzed using SPSS 26.0 and the MVN , psych , and lavaan packages in R 4.1.0. RESULTS: This study included 203 PMBT patients. The hypothesized model satisfied all statistical criteria (comparative fit index = 0.998, root mean square error of approximation = 0.044, standardized root mean square residual = 0.016). The indirect and direct associations of UI in the path from social support to cancer coping were all significant with a 95% bootstrapping confidence interval. Although the indirect and direct associations of UI in the path of brain tumor symptoms and cancer coping did not have direct or total effects, the indirect effect was statistically significant. CONCLUSIONS: Uncertainty in illness mediated brain tumor symptoms and social support to predict cancer coping. IMPLICATIONS FOR PRACTICE A nurse-led intervention for cancer coping among PMBT patients can be developed by considering symptoms and social support and UI as a mediator.