化疗期乳腺癌患者疾病不确定感水平及其影响因素的研究
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摘要
研究目的
1、评估化疗期乳腺癌患者在不同化疗周期的疾病不确定感的水平。
2、明确不同化疗周期乳腺癌患者疾病不确定感的影响因素。
研究方法
采取目的抽样的方法,选取2009年1月-2009年10月中国医科大学乳腺外科需要进行乳腺癌术后6个周期的化疗患者,于第一次化疗前、第三次化疗前及第六次化疗前应用疾病不确定感量表对其疾病不确定感水平进行测评。采用自行设计的一般状况调查表收集患者的社会人口学资料和疾病相关资料；应用SPSS16.0进行数据处理,采用均数、标准差、百分比等来描述患者的一般资料；用方差分析来比较患者三个化疗期间不同时间点的疾病不确定感水平,进一步用LSD检验法进行多样本均数的多重比较；用多元逐步回归分析来探讨乳腺癌患者疾病不确定感的影响因素。
结果
1、本研究有60例研究对象,全部完成了调查问卷的填写。结果显示,化疗期乳腺癌患者疾病不确定感水平处于中等水平,在化疗周期三个不同时间点的的得分差异均有统计学意义(P<0.05)。进一步分析显示,患者的疾病不确定感的不明确和不可预测在第一次化疗前与第六次化疗前均有差异。
2、疾病不确定感影响因素分析显示,化疗副反应种类、学历、年龄、家庭人均月收入和医疗费用支付方式是影响疾病不确定感重要的因素,分别在化疗期三个不同的时间点对疾病不确定感总分及其四个维度产生不同的影响。
结论
1、化疗期乳腺癌患者三个不同时间点存在中等程度的疾病不确定感。
2、在化疗期三个不同的时间点,患者的疾病不确定感主要来源于疾病不确定感的不明确和不可预测。
3、化疗期乳腺癌患者三个不同时间点的影响因素也不同。
Objective
1、To investigate the levels of uncertainty in breast cancer patients with chemotherapy at different times.
2、To evaluate the effecting factors of uncertainty in illness.
Methods
By purpose of sampling,60 breast cancer patients in breast cancer surgical department of the first affiliated hospital of china medical university were recruited in the study. The levels of uncertainty in breast cancer patients undergoing total six chemotherapy cycles were assessed with Chinese version MUIS-A(Mishel Uncertainty in illness Scale-Adult) before the first, third and sixth chemotherapy. Individual characteristics and related data of illness were collected with self-designed questionnaire.The data were caculated by SPSS 16.0. Individual characteristics of patients were described by mean±SD or percentage. The levels of uncertainty prior to three chemotherapy were evaluated by ANOVA(analysis of variance), and mean multiple comparision among groups further caculated by LSD. The effecting factors of uncertainty in illness were explored with stedwise hierarchical multiple regression.
Results
1、The 60 participants who were recruited into the study, all that completed the questionnaire. The results show that the level of illness uncertainty of breast cancer women undergoing chemotherapy was middle at different time points. The scores of the three time points showed significant difference(P<0.05). Further analysis showed that patients with uncertainty in illness, the uncertainty arose mainly from unpredictability and ambiguity at the first and sixth chemotherapy.
2、Uncertainty factors analysis showed that type of chemotherapy side effects, education, age, family income and payment of medical expenses affect the uncertainty of disease in the chemotherapy at three different time points. Uncertainty of disease score and its four dimensions have different impacts.
Conclusions
1、Chemotherapy in patients with breast cancer in three different points in time there is
moderate uncertainty in illness.
2、During the three time points during chemotherapy, the uncertainty arose mainly from unpredictability and ambiguity.
3、Chemotherapy in breast cancer patients have different factors at different time points.
1、评估化疗期乳腺癌患者在不同化疗周期的疾病不确定感的水平。
2、明确不同化疗周期乳腺癌患者疾病不确定感的影响因素。
研究方法
采取目的抽样的方法,选取2009年1月-2009年10月中国医科大学乳腺外科需要进行乳腺癌术后6个周期的化疗患者,于第一次化疗前、第三次化疗前及第六次化疗前应用疾病不确定感量表对其疾病不确定感水平进行测评。采用自行设计的一般状况调查表收集患者的社会人口学资料和疾病相关资料；应用SPSS16.0进行数据处理,采用均数、标准差、百分比等来描述患者的一般资料；用方差分析来比较患者三个化疗期间不同时间点的疾病不确定感水平,进一步用LSD检验法进行多样本均数的多重比较；用多元逐步回归分析来探讨乳腺癌患者疾病不确定感的影响因素。
结果
1、本研究有60例研究对象,全部完成了调查问卷的填写。结果显示,化疗期乳腺癌患者疾病不确定感水平处于中等水平,在化疗周期三个不同时间点的的得分差异均有统计学意义(P<0.05)。进一步分析显示,患者的疾病不确定感的不明确和不可预测在第一次化疗前与第六次化疗前均有差异。
2、疾病不确定感影响因素分析显示,化疗副反应种类、学历、年龄、家庭人均月收入和医疗费用支付方式是影响疾病不确定感重要的因素,分别在化疗期三个不同的时间点对疾病不确定感总分及其四个维度产生不同的影响。
结论
1、化疗期乳腺癌患者三个不同时间点存在中等程度的疾病不确定感。
2、在化疗期三个不同的时间点,患者的疾病不确定感主要来源于疾病不确定感的不明确和不可预测。
3、化疗期乳腺癌患者三个不同时间点的影响因素也不同。
Objective
1、To investigate the levels of uncertainty in breast cancer patients with chemotherapy at different times.
2、To evaluate the effecting factors of uncertainty in illness.
Methods
By purpose of sampling,60 breast cancer patients in breast cancer surgical department of the first affiliated hospital of china medical university were recruited in the study. The levels of uncertainty in breast cancer patients undergoing total six chemotherapy cycles were assessed with Chinese version MUIS-A(Mishel Uncertainty in illness Scale-Adult) before the first, third and sixth chemotherapy. Individual characteristics and related data of illness were collected with self-designed questionnaire.The data were caculated by SPSS 16.0. Individual characteristics of patients were described by mean±SD or percentage. The levels of uncertainty prior to three chemotherapy were evaluated by ANOVA(analysis of variance), and mean multiple comparision among groups further caculated by LSD. The effecting factors of uncertainty in illness were explored with stedwise hierarchical multiple regression.
Results
1、The 60 participants who were recruited into the study, all that completed the questionnaire. The results show that the level of illness uncertainty of breast cancer women undergoing chemotherapy was middle at different time points. The scores of the three time points showed significant difference(P<0.05). Further analysis showed that patients with uncertainty in illness, the uncertainty arose mainly from unpredictability and ambiguity at the first and sixth chemotherapy.
2、Uncertainty factors analysis showed that type of chemotherapy side effects, education, age, family income and payment of medical expenses affect the uncertainty of disease in the chemotherapy at three different time points. Uncertainty of disease score and its four dimensions have different impacts.
Conclusions
1、Chemotherapy in patients with breast cancer in three different points in time there is
moderate uncertainty in illness.
2、During the three time points during chemotherapy, the uncertainty arose mainly from unpredictability and ambiguity.
3、Chemotherapy in breast cancer patients have different factors at different time points.
引文
1 Radina ME, Amer JM, Culbertson, et al. Post-breast cancer lymphedema understanding woman's knowledge of their condition. Oncol Nurs Forum.2004;31:97-104.
2 张总清,李广灿,叶召.乳腺癌当前流行趋势分析.中国肿瘤.2000；9：454-455.
3 Mishel MH. Uncertainty in illness. IMAGE:Journal of Nursing Scholarship.1988;20:225-231.
4 李美云,萧正光,许淑莲,等.乳癌患者不确定感及影响因素之探讨.慈济护理杂志.2002：1：57-65.
5 Sammarco A. Quality of life among older survivors of breast cancer. Cancer Nurs.2003;26: 431-438.
6 Sammarco A, Konecny LM. Quality of life, social support, and uncertainty among Latina breast cancer survivors. Oncol Nurs Forum.2008;35:844-849.
7 Clayton MF, Mishel MH, Belyea M. Testing a model of symptoms, communication, uncertainty, and well-being, in older breast cancer survivors. Res Nurs Health.2006;29:18-39.
8 Sammarco A. Perceived social support, uncertainty and quality of life of younger breast cancer survivors. Cancer Nurs.2001;24:212-219.
9 McCormick, KM. A concept analysis of uncertainty in illness. Journal of Nursing Scholarship. 2002;34:127-131.
10 Nelson, JP. Struggling to gain meaning:Living with the uncertainty of breast cancer. ANS Adv Nurs Sci.1996;18:59-76.
11 Knobf, MT. Carrying on:The experience of premature in women with early stage breast cancer. Nurs Res.2002;51:9-17
12 Fielding R. The evolving experience of illness for Chinese women with breast cancer:a qualitative study.Psychooncology.2003; 12:127-40.
13汪向东.心理卫生量表评定手册(增订版).广东：中国心理卫生杂志社.1999：131-133.
14吴航洲,李峥,金维佳.乳腺癌患者的疾病不确定感及其与社会支持的相关性研究.中华护理杂志.2006：41：101-104.
15 Wonghongkul T, Dechaprom N, Phumivichuvate L, et al. Uncertainty appraisal,coping and quality of life in breast cancer survivors. Cancer Nurs.2006;29:250-257.
16 Nelson, JP. Struggling to gain meaning:Living with the uncertainty of breast cancer. ANS Adv Nurs Sci.1996; 18:59-76.
17 Liao MN, Chen MF, Chen SC, et al. Uncertainty and anxiety during the diagnostic period for women with suspected breast cancer. Cancer Nursing.2008;31:274-283.
18 Mishel MH, Germino BB, Belyea M, et al.Moderators of an uncertainty management intervention:for men with localized prostate cancer. Nurs Res.2003;52:89-97.
19 Sammarco A.Quality of life among older survivors of breast cancer. Cancer Nurs.2003;26: 431-438.
20 Neville KL.Uncertainty in illness. An integrative review. Orthopaedic Nursing.2003;22:206-214.
21 Shaha M, Cox CL, Talman K, et al. Uncertainty in breast, prostate, and colorectal cancer: implications for supportive care. Journal of nursing scholarship.2008;40:60-67.
22 Dirksen SR, Eriekson JR, Well-being in Hispanic and non-Hispanic white survivors of breast cancer. Oncol Nurs Forum.2002;29:820-826.
23 Lauver DR, Connolly-Nelson K, Vang P. Stressors and coping strategies among female cancer survivors after treatments. Cancer Nurs.2007;30:101-1 11.
24 Gil KM, Mishel MH, Belyea M, et al. Benefits of the uncertainty management intervention for African American and White older breast cancer survivors:20-month outcomes. Int J Behav Med.2006; 13:286-294.
25 May-Yun Lee, Cheng-Kuang Shaw. A study of breast cancer patients' uncertainty and impact factors. Tzu Chi Nursing Journal.2002; 1:57-65.
26 Liu LN, Li CY, Tang ST, et al. Role of continuing supportive cares in increasing social support and reducing perceived uncertainty among women with newly diagnosed breast cancer in Taiwan. Cancer Nurs.2006;29:273-282.
1 张总清,李广灿,叶召.乳腺癌当前流行趋势分析.中国肿瘤.2000；9：454-455.
2 Neville KL. Uncertainty in illness. An integrative review. Orthopaedic Nursing.2003;22:206-214.
3 Northouse L, Kershaw T, Mood D, et al. Effects of a family intervention on the quality of life of women with recurrent breast cancer and their family caregivers.Psychooncology.2005; 14:478-491.
4 Mishel MH. Uncertainty in illness. IMAGE:Journal of Nursing Scholarship.1988;20:225-231.
5 Mishel MH, Braden C. Finding meaning:Antecedents of uncertainty in illness. Nurs Res.1988; 37:98-103.
6 Shaha M, Cox CL, Talman K, et al. Uncertainty in breast, prostate, and colorectal cancer: implications for supportive care. Journal of nursing scholarship.2008;40:60-67.
7 Harrow A, Wells A, Barbour RS, et al. Ambiguity and uncertainty:The ongoing concerns of male partners of women treated for breast cancer. European Journal of Oncology Nursing.2008; 12:349-356.
8 沈南平.白血病患儿家长焦虑、疾病不确定感及其需求调查分析.护理学杂志.2006：21：17-19.
9 Hilton BA. The uncertainty stress scale:Its development and psychometric properties. Canadia Journal of Nursing Research.1994;26:15-30.
10 Heu S, Hwang SL. Validation of Chinese version of Mishel's uncertainty in illness scale. Nursing Research(China).1996;4:59-68.
11 Ferrell BR, Grant MM, Funk BM, et al. Quality of life in breast cancer survivors:Implications for developing support services. Oncology Nursing Forum.1998;25:887-895.
12 Sammarco A. Quality of life among older survivors of breast cancer. Cancer Nurs.2003;26:431-438.
13 Mast ME. Correlates of fatigue in survivors of breast cancer. Caneer Nurs.1998;21:136-142.
14 Clayton MF, Mishel MH, Belyea M. Testing a model of symptoms, communication, uncertainty, and well-being, in older breast cancer survivors. Res Nurs Health.2006;29:18-39.
15 May-Yun Lee, Cheng-Kuang Shaw. A study of breast cancer patients'uncertainty and impact factors. Tzu Chi Nursing Journal.2002; 1:57-65.
16 Germino B, Mishel MH, BelyeaM, et al. Uncertainty in prostate cancer.Ethnic and family patterns. Cancer Pract.1998;6:107-113.
17 Sammarco A, Konecny LM. Quality of life, social support, and uncertainty among Latina breast cancer survivors. Oncol Nurs Forum.2008;35:844-849.
18 Dirksen SR, Eriekson JR.Well-being in Hispanic and non-Hispanic white survivors of breast cancer. Oncol Nurs Forum.2002;29:820-826.
19 Wonghongkul T, Dechaprom N, Phumivichuvate L, et al. Uncertainty appraisal,coping and quality of life in breast cancer survivors. Cancer Nurs.2006;29:250-257.
20 Lauver DR, Connolly-Nelson K, Vang P. Stressors and coping strategies among female cancer survivors after treatments. Cancer Nurs.2007;30:101-111.
21 Hilton BA. The uncertainty stress scale:Its development and psychometric properties. Canadia Journal of Nursing Research.1994;26:15-30.
22 Murphy AE.Dealing with the uncertainty of developing a cancer. Eur J Cancer Care.1999; 8:233-237.
23 Gill KM, Mishel M, Belyea M, et al. Triggers of uncertainty about recurrence and long-term treatment side effects in older African American and Caucasian breast cancer survivors. Oncol Nurs Forum.2004;1:633-639.
24 Nelson, JP. Struggling to gain meaning:Living with the uncertainty of breast cancer. ANS Adv Nurs Sci.1996;18:59-76.
25 Knobf, MT. Carrying on:The experience of premature in women with early stage breast cancer. Nurs Res.2002;51:9-17.
26 Lam WW, Fielding R. The evolving experience of illness for Chinese women with breast cancer:a qualitative study.Psychooncology.2003;12:127-140.
27 Liu LN, Li CY, Tang ST, et al. Role of continuing supportive cares in increasing social support and reducing perceived uncertainty among women with newly diagnosed breast cancer in Taiwan. Cancer Nurs.2006;29:273-282.
28 Sammarco A. Perceived social support, uncertainty and quality of life of younger breast cancer survivors. Cancer Nurs.2001;24:212-219.
29吴航洲,李峥,金维佳.乳腺癌患者的疾病不确定感及其与社会支持的相关性研究.中华护理杂志.2006；41：101-104.
30 Harrison-Woermke DE, Graydon JE. Perceived informational needs of breast cancer patients receiving radiation therapy after excisional biopsy and axillary node dissection. Cancer Nurs. 1993; 16:449-455.
31孙红,郭红.信息支持对乳腺癌根治术患者疾病不确定感的影响.中华护理杂志.2004；39：244-246.
32 Liao MN, Chen MF, Chen SC, et al. Uncertainty and anxiety during the diagnostic period for women with suspected breast cancer. Cancer Nursing.2008;31:274-283.
33王艳华,阎成美.乳腺癌患者术后疾病不确定感与焦虑抑郁及应对方式相关研究.护理管理杂志.2007；7：2-6.
34 Shaha M, Cox CL, Talman K, et al. Uncertainty in breast, prostate, and colorectal cancer: implications for supportive care. Journal of nursing scholarship.2008;40:60-67.
35邓露,李乐之.癌症患者疾病不确定感的研究进展及护理对策.现代护理.2007；13：371-372.
36 Coward DD. The lived experience of self-transcendence in women with advanced breast cancer. Nurs Sci Q.1990;3:162-169.
37罗惠敏,徐南丽,萧正光.比较疼痛及非疼痛癌症病患不确定感、症状困扰、社会支持与生活品质关系.慈济护理杂志.2003；2：70-76.
38王艳华,阎成美,黄丽婷,等.乳腺癌化疗患者的疾病不确定感对希望及应对方式的影响.中国行为医学科学.2007；16：113-114.
39赵鑫.乳腺癌化疗患者疾病不确定感及其与应对方式的相关性研究[硕士学位论文].2007.
40 Mishel MH, Germino BB, Belyea M, et al. Moderators of an uncertainty management intervention:for men with localized prostate cancer. Nurs Res.2003;52:89-97.
41 Gil KM, Mishel MH, Belyea M, et al. Benefits of the uncertainty management intervention for African American and White older breast cancer survivors:20-month outcomes. Int J Behav Med.2006；13:286-294.
42张卫红,闫晓东,肖向莉,等.护理干预对癌症患者疾病不确定感及社会支持的影响.现代护理.2007：13：3306-3308.
2 张总清,李广灿,叶召.乳腺癌当前流行趋势分析.中国肿瘤.2000；9：454-455.
3 Mishel MH. Uncertainty in illness. IMAGE:Journal of Nursing Scholarship.1988;20:225-231.
4 李美云,萧正光,许淑莲,等.乳癌患者不确定感及影响因素之探讨.慈济护理杂志.2002：1：57-65.
5 Sammarco A. Quality of life among older survivors of breast cancer. Cancer Nurs.2003;26: 431-438.
6 Sammarco A, Konecny LM. Quality of life, social support, and uncertainty among Latina breast cancer survivors. Oncol Nurs Forum.2008;35:844-849.
7 Clayton MF, Mishel MH, Belyea M. Testing a model of symptoms, communication, uncertainty, and well-being, in older breast cancer survivors. Res Nurs Health.2006;29:18-39.
8 Sammarco A. Perceived social support, uncertainty and quality of life of younger breast cancer survivors. Cancer Nurs.2001;24:212-219.
9 McCormick, KM. A concept analysis of uncertainty in illness. Journal of Nursing Scholarship. 2002;34:127-131.
10 Nelson, JP. Struggling to gain meaning:Living with the uncertainty of breast cancer. ANS Adv Nurs Sci.1996;18:59-76.
11 Knobf, MT. Carrying on:The experience of premature in women with early stage breast cancer. Nurs Res.2002;51:9-17
12 Fielding R. The evolving experience of illness for Chinese women with breast cancer:a qualitative study.Psychooncology.2003; 12:127-40.
13汪向东.心理卫生量表评定手册(增订版).广东：中国心理卫生杂志社.1999：131-133.
14吴航洲,李峥,金维佳.乳腺癌患者的疾病不确定感及其与社会支持的相关性研究.中华护理杂志.2006：41：101-104.
15 Wonghongkul T, Dechaprom N, Phumivichuvate L, et al. Uncertainty appraisal,coping and quality of life in breast cancer survivors. Cancer Nurs.2006;29:250-257.
16 Nelson, JP. Struggling to gain meaning:Living with the uncertainty of breast cancer. ANS Adv Nurs Sci.1996; 18:59-76.
17 Liao MN, Chen MF, Chen SC, et al. Uncertainty and anxiety during the diagnostic period for women with suspected breast cancer. Cancer Nursing.2008;31:274-283.
18 Mishel MH, Germino BB, Belyea M, et al.Moderators of an uncertainty management intervention:for men with localized prostate cancer. Nurs Res.2003;52:89-97.
19 Sammarco A.Quality of life among older survivors of breast cancer. Cancer Nurs.2003;26: 431-438.
20 Neville KL.Uncertainty in illness. An integrative review. Orthopaedic Nursing.2003;22:206-214.
21 Shaha M, Cox CL, Talman K, et al. Uncertainty in breast, prostate, and colorectal cancer: implications for supportive care. Journal of nursing scholarship.2008;40:60-67.
22 Dirksen SR, Eriekson JR, Well-being in Hispanic and non-Hispanic white survivors of breast cancer. Oncol Nurs Forum.2002;29:820-826.
23 Lauver DR, Connolly-Nelson K, Vang P. Stressors and coping strategies among female cancer survivors after treatments. Cancer Nurs.2007;30:101-1 11.
24 Gil KM, Mishel MH, Belyea M, et al. Benefits of the uncertainty management intervention for African American and White older breast cancer survivors:20-month outcomes. Int J Behav Med.2006; 13:286-294.
25 May-Yun Lee, Cheng-Kuang Shaw. A study of breast cancer patients' uncertainty and impact factors. Tzu Chi Nursing Journal.2002; 1:57-65.
26 Liu LN, Li CY, Tang ST, et al. Role of continuing supportive cares in increasing social support and reducing perceived uncertainty among women with newly diagnosed breast cancer in Taiwan. Cancer Nurs.2006;29:273-282.
1 张总清,李广灿,叶召.乳腺癌当前流行趋势分析.中国肿瘤.2000；9：454-455.
2 Neville KL. Uncertainty in illness. An integrative review. Orthopaedic Nursing.2003;22:206-214.
3 Northouse L, Kershaw T, Mood D, et al. Effects of a family intervention on the quality of life of women with recurrent breast cancer and their family caregivers.Psychooncology.2005; 14:478-491.
4 Mishel MH. Uncertainty in illness. IMAGE:Journal of Nursing Scholarship.1988;20:225-231.
5 Mishel MH, Braden C. Finding meaning:Antecedents of uncertainty in illness. Nurs Res.1988; 37:98-103.
6 Shaha M, Cox CL, Talman K, et al. Uncertainty in breast, prostate, and colorectal cancer: implications for supportive care. Journal of nursing scholarship.2008;40:60-67.
7 Harrow A, Wells A, Barbour RS, et al. Ambiguity and uncertainty:The ongoing concerns of male partners of women treated for breast cancer. European Journal of Oncology Nursing.2008; 12:349-356.
8 沈南平.白血病患儿家长焦虑、疾病不确定感及其需求调查分析.护理学杂志.2006：21：17-19.
9 Hilton BA. The uncertainty stress scale:Its development and psychometric properties. Canadia Journal of Nursing Research.1994;26:15-30.
10 Heu S, Hwang SL. Validation of Chinese version of Mishel's uncertainty in illness scale. Nursing Research(China).1996;4:59-68.
11 Ferrell BR, Grant MM, Funk BM, et al. Quality of life in breast cancer survivors:Implications for developing support services. Oncology Nursing Forum.1998;25:887-895.
12 Sammarco A. Quality of life among older survivors of breast cancer. Cancer Nurs.2003;26:431-438.
13 Mast ME. Correlates of fatigue in survivors of breast cancer. Caneer Nurs.1998;21:136-142.
14 Clayton MF, Mishel MH, Belyea M. Testing a model of symptoms, communication, uncertainty, and well-being, in older breast cancer survivors. Res Nurs Health.2006;29:18-39.
15 May-Yun Lee, Cheng-Kuang Shaw. A study of breast cancer patients'uncertainty and impact factors. Tzu Chi Nursing Journal.2002; 1:57-65.
16 Germino B, Mishel MH, BelyeaM, et al. Uncertainty in prostate cancer.Ethnic and family patterns. Cancer Pract.1998;6:107-113.
17 Sammarco A, Konecny LM. Quality of life, social support, and uncertainty among Latina breast cancer survivors. Oncol Nurs Forum.2008;35:844-849.
18 Dirksen SR, Eriekson JR.Well-being in Hispanic and non-Hispanic white survivors of breast cancer. Oncol Nurs Forum.2002;29:820-826.
19 Wonghongkul T, Dechaprom N, Phumivichuvate L, et al. Uncertainty appraisal,coping and quality of life in breast cancer survivors. Cancer Nurs.2006;29:250-257.
20 Lauver DR, Connolly-Nelson K, Vang P. Stressors and coping strategies among female cancer survivors after treatments. Cancer Nurs.2007;30:101-111.
21 Hilton BA. The uncertainty stress scale:Its development and psychometric properties. Canadia Journal of Nursing Research.1994;26:15-30.
22 Murphy AE.Dealing with the uncertainty of developing a cancer. Eur J Cancer Care.1999; 8:233-237.
23 Gill KM, Mishel M, Belyea M, et al. Triggers of uncertainty about recurrence and long-term treatment side effects in older African American and Caucasian breast cancer survivors. Oncol Nurs Forum.2004;1:633-639.
24 Nelson, JP. Struggling to gain meaning:Living with the uncertainty of breast cancer. ANS Adv Nurs Sci.1996;18:59-76.
25 Knobf, MT. Carrying on:The experience of premature in women with early stage breast cancer. Nurs Res.2002;51:9-17.
26 Lam WW, Fielding R. The evolving experience of illness for Chinese women with breast cancer:a qualitative study.Psychooncology.2003;12:127-140.
27 Liu LN, Li CY, Tang ST, et al. Role of continuing supportive cares in increasing social support and reducing perceived uncertainty among women with newly diagnosed breast cancer in Taiwan. Cancer Nurs.2006;29:273-282.
28 Sammarco A. Perceived social support, uncertainty and quality of life of younger breast cancer survivors. Cancer Nurs.2001;24:212-219.
29吴航洲,李峥,金维佳.乳腺癌患者的疾病不确定感及其与社会支持的相关性研究.中华护理杂志.2006；41：101-104.
30 Harrison-Woermke DE, Graydon JE. Perceived informational needs of breast cancer patients receiving radiation therapy after excisional biopsy and axillary node dissection. Cancer Nurs. 1993; 16:449-455.
31孙红,郭红.信息支持对乳腺癌根治术患者疾病不确定感的影响.中华护理杂志.2004；39：244-246.
32 Liao MN, Chen MF, Chen SC, et al. Uncertainty and anxiety during the diagnostic period for women with suspected breast cancer. Cancer Nursing.2008;31:274-283.
33王艳华,阎成美.乳腺癌患者术后疾病不确定感与焦虑抑郁及应对方式相关研究.护理管理杂志.2007；7：2-6.
34 Shaha M, Cox CL, Talman K, et al. Uncertainty in breast, prostate, and colorectal cancer: implications for supportive care. Journal of nursing scholarship.2008;40:60-67.
35邓露,李乐之.癌症患者疾病不确定感的研究进展及护理对策.现代护理.2007；13：371-372.
36 Coward DD. The lived experience of self-transcendence in women with advanced breast cancer. Nurs Sci Q.1990;3:162-169.
37罗惠敏,徐南丽,萧正光.比较疼痛及非疼痛癌症病患不确定感、症状困扰、社会支持与生活品质关系.慈济护理杂志.2003；2：70-76.
38王艳华,阎成美,黄丽婷,等.乳腺癌化疗患者的疾病不确定感对希望及应对方式的影响.中国行为医学科学.2007；16：113-114.
39赵鑫.乳腺癌化疗患者疾病不确定感及其与应对方式的相关性研究[硕士学位论文].2007.
40 Mishel MH, Germino BB, Belyea M, et al. Moderators of an uncertainty management intervention:for men with localized prostate cancer. Nurs Res.2003;52:89-97.
41 Gil KM, Mishel MH, Belyea M, et al. Benefits of the uncertainty management intervention for African American and White older breast cancer survivors:20-month outcomes. Int J Behav Med.2006；13:286-294.
42张卫红,闫晓东,肖向莉,等.护理干预对癌症患者疾病不确定感及社会支持的影响.现代护理.2007：13：3306-3308.