Uncertainty Intervention for Watchful Waiting in Prostate Cancer

Abstract

Watchful waiting is a reasonable alternative to treatment for some older men with localized prostate cancer, but it inevitably brings uncertainty. This study tested the effectiveness of the watchful waiting intervention (WWI) in helping men cognitively reframe and manage the uncertainty of watchful waiting. Based on Mishel's Reconceptualized Uncertainty in Illness Theory (Image. 1990; 256-262), the WWI was tested with a convenience sample of 41 men. Experimental subjects received 5 weekly intervention calls from a nurse. Control subjects received usual care. Outcomes were new view of life, mood state, quality of life, and cognitive reframing. Repeated measures of analysis of variance were used to test the effectiveness of the WWI. The sample was 86% Caucasian and 14% African American, with an average age of 75.4 years. Intervention subjects were significantly more likely than controls to view their lives in a new light (P = .02) and experience a decrease in confusion (P = .04) following the intervention. Additionally, intervention subjects reported greater improvement in their quality of life than did controls (P = .01) and believed their quality of life in the future would be better than did controls (P = .01). This study's findings document the benefits of the WWI for patients living with uncertainty.

Transitoriness in cancer patients: a cross-sectional survey of lung and gastrointestinal cancer patients

“…These aspects may explain the levels of uncertainty in the study participants. Uncertainty has been found among patients with prostate cancer who are undergoing watchful waiting [34,35] or among survivors of breast cancer [15]. Among the latter group, the uncertainty levels (mean = 57.08, SD=10.14) were lower than the ones of our study participants [15].…”

Active surveillance for the management of prostate cancer in a contemporary cohort

“…A small, prospective, randomized trial of 41 patients on a watchful-waiting protocol demonstrated that patients on the experimental (intervention) arm, who received 5 weekly calls from a nurse, had both an increase in quality of life (P 5 .01) and decreased confusion (P 5 .04) as measured on multiple validated questionnaires. 29 There are several limitations to the current study. There may be a self-selection bias on the part of these patients who are presenting to a referral center.…”

Supportive care needs of men living with prostate cancer in England: a survey

“…Recognition of the contribution of uncertainty to psychological distress in men with prostate cancer is not new. It is acknowledged to be particularly associated with watchful wait or active monitoring protocols (Wallace, 2003;Bailey et al, 2004) and reported to be present in survivors of the disease (Talcott, 2006).…”

“…Across all domains measured, men with psychological distress had greater unmet supportive care needs. Nurse-led interventions for uncertainty have been developed and evaluated (Mishel et al, 2002;Bailey et al, 2004), as have those for depression (McCorkle et al, 2007). Arguably, a clinical nurse specialist could deliver such interventions following the requisite training.…”