Bridging Disciplinary Boundaries (January 11 - 14, 2007)

Purpose: The purpose of this research study was to determine the relationship of uncertainty, social support, and symptom distress to quality of life in newly diagnosed adolescents with cancer.

Methods: Healthcare providers including physicians, nurses, psychologists, and social workers, have long recognized the importance of quality of life during the cancer experience. Using data from a study of resilience in adolescents with cancer, a secondary data analysis was performed to determine the association of variables selected from the literature on quality of life for cancer survivors. These included uncertainty, social support and symptom distress. The data was collected from a convenience sample of 74 newly diagnosed adolescents ages 11-19 years, with a mean age of 15 years (SD=2.0) recruited from four pediatric oncology centers in the US. The adolescents completed a booklet of self-administered measures and a demographic section. Uncertainty was measured using Mishel's Uncertainty in Illness Scale (á=.91); Social support was measured with three scales: Procidano's Perceived Social Support-Family (á= .89); Procidano's Perceived Social Support-Friends (á=.93)(Procidano & Heller, 1983) and; Haase's Perceived Social Support Healthcare Providers (á=.93) (adapted from Procidano's scales); symptom distress was measured using the McCorkle Symptom Distress scale (SDS) (á= .83)and; quality of life using the Index of Well-being (á= .93). Based on a preliminary correlational analysis, Perceived Social Support-Friends and Perceived Social Support-Healthcare Providers were eliminated. Multiple regression was performed using the retained variables.

Results: Using step-wise multiple regression analysis, uncertainty entered the regression equation on the first step (F(1,71)=17.25, p=.000). The adjusted R2 indicated that 18.4% of the variance in well-being was explained by uncertainty. Social support-Family entered the equation at step 2 (F(2,70)=13.45, p=.000), explaining an additional 8% of the variance in well-being. Symptom distress was entered into the equation at step 3 (F(3,69)=10.94, p=.000), explaining an additional 5% of the variance. The three variables, uncertainty, social support from family, and symptom distress, significantly explained 29.3% of the variance of quality of life.

Implications for practice: The findings demonstrated a significant relationship between uncertainty, social support from family and symptom distress with quality of life for this sample of adolescents with cancer. In this analysis, uncertainty demonstrated the strongest association with quality of life. These adolescents are faced with the uncertainty involved with understanding complex treatments, potential side-effects, and the roles of multiple healthcare providers. The cancer experience also includes uncertainty about the immediate and long-term impact of the diagnosis and treatment of cancer on their physical and psychosocial well-being, changes in their life schedule and the potential for recurrence or a secondary malignancy. While the outcome for individuals remains unpredictable, it is important to provide accurate information and reassurance whenever possible. Most adolescents diagnosed with cancer are thrust into a situation unlike any they have faced previously and will require assistance from the medical team as well as their parents in navigating and adjusting to this new environment.