title: Evaluation of a conceptual model based on Mishel's theories of uncertainty in illness in a sample of Taiwanese parents of children with cancer: a cross-sectional questionnaire survey.
abstract: BACKGROUND
  The prognoses of childhood cancers have improved over the last few decades. Nevertheless, parental uncertainty about the absolute cure and possible relapse pervades the entire illness trajectory. Despite illness-related uncertainty is significantly related to psychological distress, continual uncertainty may serve as a catalyst for positive psychological change and personal growth in the context of surviving cancer.
  
  
  OBJECTIVE
  The purpose of this study was to examine a conceptual model that depicts coping and growth in Taiwanese parents living with the continual uncertainty about their child's cancer. The conceptual model was guided by Mishel's theories of Uncertainty in Illness. The impact of the child's health status, parents' education level and perceived social support on parental uncertainty was analyzed. The mediating effect of coping as well as the influence of parental uncertainty and parents' perceived social support on growth through uncertainty was incorporated in the model testing.
  
  
  METHODS
  This study involved a sample of 205 mothers and 96 fathers of 226 children enrolled in a longitudinal cancer study in Taiwan. This study only analyzed the data collected at baseline. A cross-sectional design was utilized to examine the relationships among proposed variables. Parental uncertainty and growth through uncertainty were measured by the translated questionnaires originally developed by Mishel. Parents' perceived social support and coping were measured by culturally sensitive instruments developed in Taiwan.
  
  
  RESULTS
  The full research model and its alternative models fit adequately to the data via structural equation modeling tests. Parental uncertainty and parents' perceived social support were associated with growth through uncertainty which was mediated by coping. Child's health status and parents' perceived social support would significantly predict parental uncertainty.
  
  
  CONCLUSIONS
  This study suggests that parental uncertainty has negative impact on coping strategies such as interacting with family members while these coping strategies may help Taiwanese parents gain growth through uncertainty. Coping strategies of searching for spiritual meaning and increasing religious activities were not significantly influenced by parental uncertainty in this study. The two coping strategies may be relevant to growth through uncertainty due to Taiwanese cultural belief. Moreover, the availability of social support promotes growth through uncertainty by its impact on lowering parental uncertainty and encouraging more coping. The findings indicate that Taiwanese parents may gain growth through uncertainty while experiencing their child's cancer. The research model provides possible guidelines for oncology nurses to deliver more culturally competent health care for Taiwanese parents of children with cancer.
authors.affiliation: The University of Texas Health Science Center at Houston, School of Nursing, Department of Integrative Nursing Care, 6901 Bertner Ave., Room 788, Houston, TX 77030, United States. Lin.Lin@uth.tmc.edu
authors.forename: Lin
authors.initials: L
authors.lastname: Lin
authors.forename: Chao-Hsing
authors.initials: CH
authors.lastname: Yeh
authors.forename: Merle H
authors.initials: MH
authors.lastname: Mishel
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D002648:Child; D003430:Cross-Sectional Studies; D004522:Educational Status; D005220:Fathers / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D009035:Mothers / Q000523:psychology; D009369:Neoplasms; D010287:Parent-Child Relations; D010290:Parents / Q000523:psychology*; D012944:Social Support; D011795:Surveys and Questionnaires; D035501:Uncertainty