Pediatric Cancer Clinical Trial
Official title:
The Impact of Nursing Interventions Based on Uncertainty In Illness Theory on Uncertainty, Hopelessness, Coping And Adaptation for Care Givers Of Children With Cancer
The aim of this Randomised Controlled study was to determine the effect of nursing interventions based on Mishel's Uncertainty in Illness Theory on uncertainty, hopelessness, coping and compliance for care givers' of children with cancer. Sample was 46 (experimental group:23; control group: 23) cara givers of children. Experimental group received nursing interventions (6 modules, 200 minutes nursing education) based on Mishel's Uncertainty in Illness Theory while control group received routine hospital care. Data were collected 3 times: pre test, post test (2 weeks after intervention for experimental group or two weeks after from pretest for control group), and follow up (2 weeks after post tests).
Cancer defines a group of diseases that arise from the uncontrolled proliferation and spread
of abnormal cells. The prevalence of cancer before the age of 15 years is 110-150 million.
Every year, more than 150,000 people in the World are newly diagnosed, and over 10,000
children in America are diagnosed with cancer for the first time. It is reported that
2500-3000 new cases of childhood cancer are expected to be seen in our country, Turkey,
annually.
Childhood cancer is a major stressor for family. They are at risk for developing psychosocial
problems during the course of disease and its long and stressful treatment. And uncertainty
is one of these problems which they live. Uncertainty arises when "the decision maker can not
give a definite value to a certain event or situation" or "can not predict the accuracy of
the results". Uncertainty refers to the inability to identify, interpret and predict the
disease-related condition/event. Uncertainty can have positive or negative affects to child
and family according the meaning and coping of uncertainty.
Mishel is the first nurse theorist who mentioned uncertainty in illness in the aspect of
nursing as a theory. In her theory, nursing interventions can help care giver to cope with or
adapt the uncertainty. Nursing interventions should contain the main domains of such as
communication, education, supporting, being reliable health care professional for parents.
In this study, 46 care givers of children with cancer from two different university hospitals
in Turkey. They were assigned group by using closed envelops that contain the letter of
E(experimental) or C(control). Prior to study, sample size for each group calculated
according to effect size (d=0,20), power (.80), alfa error (.05) and it was found 42 for all
group. To avoid possible sample problems can be seen during to study (such as do not want to
continue the stud etc), sample was improved %10 and sample number were decided 46 care giver
in total. During the study while 18 care giver (9 from experimental, 9 from control group)
finished the study, we calculated real effect size of our study and it was foun 0.24 and
according to it we calculated sample size again and it was 30 in total. So we decided to
continiue our study with 46 participants.
Experimental group received nursing intervention according to protocol. It contained 6
modules (total 10 personal education session) that were developed based on Theory and
literature. The aim of this intervention was to control/solve the antecedents of uncertainty
and to affect appraisal of uncertainty in a positive way so care givers could improve the
coping and adaptation of uncertainty. Control group received routine nursing intervention
that was given normally for hospitals to avoid bias and ethical problems.
Data was collected using information form (information about participant, parents and
children), three scales (Turkish Version of Parents' Perception Uncertainty in Illness Scale:
Parent/Child Form, Beck's Hopelessness Scale, Coping and Adaptation Process Scale). Scales
validation and reliability studies were made for Turkish population.
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