UNCERTAINTY IN PROSTATE-CANCER - ETHNIC AND FAMILY PATTERNS

PURPOSE: Prostate cancer occurs 37% more often in African-American men than in white men. Patients and their family care providers (FCPs) ma y have different experiences of cancer and its treatment. This report addresses two questions: 1) What is the relationship of uncertainty to family coping, psychological adjustment to illness, and spiritual fac tors? and 2) Are these patterns of relationship similar for patients a nd their family care givers and for whites and African-American? DESCR IPTION OF STUDY: A sample of white and African-American men and their family care givers (N = 403) was drawn from an ongoing study, testing the efficacy of an uncertainty management intervention with men with s tage B prostate cancer. Data mere collected at study entry, either 1 m eek after postsurgical catheter removal or at the beginning of primary radiation treatment. Measures of uncertainty, adult role behavior, pr oblem solving, serial support, importance of God in one's life, family coping, psychological adjustment to illness, and perceptions of healt h and illness met standard criteria for internal consistency. Analyses of baseline data using Pearson's product moment correlations were con ducted to examine the relationships of person, disease, and contextual factors to uncertainty. RESULTS: For family coping, uncertainty was s ignificantly and positively related to two domains in white family car e providers only. In African-American and white family care providers, the more uncertainty experienced, the less positive they felt about t reatment. Uncertainty for all care givers was related inversely to pos itive feelings about the patient recovering from the illness. For all patients and for white family members, uncertainty was related inverse ly to the qualify of the domestic environment. For everyone, uncertain ty was related inversely to psychological distress. Higher levels of u ncertainty were related to a poorer social environment for African-Ame rican patients and for white family members. For white patients and th eir family members, higher levels of uncertainly were related to lower scores on adult role behavior (shopping, running errands). for white family members, higher levels of uncertainty were related to less acti ve problem solving and less perceived social support. Finally, higher levels of uncertainty were related to the importance of God for white patients and family care providers. CLINICAL IMPLICATIONS: The dearest finding of the present study is that there are ethnic differences in die relationship of uncertainty to a number of quality-of-life and cop ing variables. This has immediate implications for the assessment of p sychosocial responses to cancer and cancer treatment. Much of what is in curricula is based on clinical and research experience primarily wi th white individuals. The experience of uncertainty related to cancer and its treatment is influenced by the cultural perspectives of patien ts and their families. To assist patients and families with the inevit able uncertainties of the cancer experience, healthcare providers need to reconsider their ethnocentric assumptions and develop more skill i n assessing patient and family beliefs, values, cultural perspectives, and the influence of these on patient and family uncertainties.