Decision-Making under Uncertainty in Pediatric Oncology (I)

Care in oncology involves with numerous forms of uncertainty due to the nature of cancer, treatment modalities and rate of remission. Specific kind of cancer such as childhood cancer can induce higher level of uncertainty because of lack of research and evidence in respect to treatment and prognosis, and as the result patients and families are more vulnerable in this context of care. Thus, ways to reduce uncertainty in the context of decision-making for children with cancer and their families are paramount for health care professionals. Uncertainty management intervention [DM-UMI] derives from the theory of uncertainty in illness (Mishel, 1988) and will be used for the study cohort of children with cancer and their primary caregivers. This study has been designed as a 3 X 2 randomized control trail (RCT) and repeated measures design with three levels of the intervention. The intervention will be given to either the treatment direct group (child-patients and their primary caregivers) or the treatment supplemented group (parents/guardians or extended family members). Recruitment will occur at the Chang-Gung Children’s Hospital. Data collection will occur at three time points – T1 = at diagnosis; T2 = 4 weeks post baseline; T3 = 3 months post baseline. Questionnaires and telephone follow-ups are the methods of data collection. Data analysis will conduct chi-square tests, Pearson correlations, ANOVA, and MANOVA. The predicted outcomes of this study are threefold: (1) An attempt is to empower child-patients and primary caregivers in the communication with health care providers towards a two-way communication culture, and as the result may reduce their level of uncertainty to childhood cancer trajectory. (2) Child-patients and their primary caregivers who received the intervention will show an increase of knowledge of cancer and indicate positive results in reducing negative emotions such as anxiety and depression. (3) Comparison of results of this study with those of Dr. Mishel will lead to an indication of similarity and difference, which can also highlight the unique culture of pediatric oncology in Taiwan. The intervention will benefit health care institution by providing a way to improve communication between care-providers and care-receivers, and thus reduce the possibility of misunderstanding and decisional regret and enhance collaboration and treatment compliance in pediatric oncology.

Project ID:PC9505-0002
External Project ID:NSC95-2314-B182-015