title: [Effectiveness of nursing instruction in reducing uncertainty, anxiety and self-care in breast cancer women undergoing initial chemotherapy].
abstract: BACKGROUND
  Level of uncertainty and anxiety may increase when breast cancer women experience unexpected side effects during chemotherapy.
  
  
  OBJECTIVE
  This longitudinal study explored the effectiveness of nursing instruction in reducing uncertainty, anxiety and self-care in breast cancer women undergoing initial chemotherapy.
  
  
  METHODS
  This study used a quasi-experimental design. Convenience sampling was used to recruit 75 women with breast cancer at a medical centre in northern Taiwan between January 2008 and September 2008. Participants were divided into either the control (n=37) or experimental (n=38) group. Control group patients received usual care. Experimental group patients were provided with nursing instructions that followed the evidence-based guidelines prescribed in the "Chemotherapy Self-Care for Breast Cancer" handbook and individualized education. Both groups received repeated questionnaires in the first, third and sixth chemotherapy cycles. Demographic data, Mishel's Uncertainty Illness Scale, Hospital Anxiety and Depression Scale and the Self-Care Scale were used for data collection and analysis.
  
  
  RESULTS
  There were no significant differences in demographic data between the two groups. There were moderate to high levels of uncertainty and low levels of anxiety in both groups prior to the first chemotherapy cycle. There was a significant decrease in uncertainty and an elevation in self-care level (p<.05*) in both groups at the sixth chemotherapy cycle. However, the experimental group showed less uncertainty and higher levels of self-care in comparison with the control group. There was a significant decrease in complexity uncertainty in the experimental group (p=.02*) and no significant decrease in the control group.
  
  
  CONCLUSIONS
  Study results indicate that nursing instruction can decrease uncertainty and elevate self-care levels. We suggest that nurses provide structured nursing instructions based on evidence-based guidelines to breast cancer women undergoing initial chemotherapy in order to promote self-care level and patient degree of control over their disease and treatment. This intervention may ameliorate patient and family uncertainties with regard to disease and chemotherapy complexity.
authors.affiliation: Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
authors.forename: Chin-Yen
authors.initials: CY
authors.lastname: Lien
authors.forename: Shu-Hui
authors.initials: SH
authors.lastname: Chen
authors.forename: Pei-Pin
authors.initials: PP
authors.lastname: Tsai
authors.forename: Kang-Min
authors.initials: KM
authors.lastname: Chen
authors.forename: Ya-I
authors.initials: YI
authors.lastname: Hsieh
authors.forename: Ying
authors.initials: Y
authors.lastname: Liang
mesh_terms: D000328:Adult; D000368:Aged; D001007:Anxiety / Q000517:prevention & control*; D001943:Breast Neoplasms / Q000188:drug therapy / Q000451:nursing* / Q000523:psychology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D012648:Self Care; D035501:Uncertainty