Benefits of the uncertainty management intervention for African American and white older breast cancer survivors: 20-Month Outcomes

  • Karen M. Gil
  • Merle H. Mishel
  • Michael Belyea
  • Barbara Germino
  • Laura S. Porter
  • Margaret Clayton


In a 2 x 2 randomized block repeated measure design, this study evaluated the follow-up efficacy of the uncertainty management intervention at 20 months. The sample included 483 recurrence-free women (342 White, 141 African American women; mean age = 64 years) who were 5-9 years posttreatment for breast cancer. Women were randomly assigned to either the intervention or usual care control condition. The intervention was delivered during 4 weekly telephone sessions in which survivors were guided in the use of audiotaped cognitive-behavioral strategies and a self-help manual. Repeated measures MANOVAs evaluating treatment group, ethnic group, and treatment by ethnic interaction effects at 20 months indicated that training in uncertainty management resulted in improvements in cognitive reframing, cancer knowledge, and a variety of coping skills. Importantly, the 20-month outcomes also demonstrated benefits for women in the intervention condition in terms of declines in illness uncertainty and stable effects in personal growth over time.

Key words

breast cancer cancer survivorship uncertainty management personal growth 


  1. Andersen, B. L. (2002). Biobehavioral outcomes following psychological interventions for cancer patients. Journal of Consulting and Clinical Psychology, 70(3), 590–610.PubMedCrossRefGoogle Scholar
  2. Andersen, M. R., & Urban, N. (1999). Involvement in decision-making and breast cancer survivor quality of life. Annals of Behavioral Medicine, 21(3), 201–209.PubMedCrossRefGoogle Scholar
  3. Antoni, M. H., Lehman, J. M., Kilbourn, K. M., Boyers, A. E., Culver, J. L., Alferi, S. M., et al. (2001). Cognitive-behavioral stress management intervention decreases the prevalence of depression and enhances benefit finding among women under treatment for early-stage breast cancer. Health Psychology, 20(1), 20–32.PubMedCrossRefGoogle Scholar
  4. Ashing-Giwa, K., & Ganz, P. A. (2000). Effect of timed incentives on subject participation in a study of long-term breast cancer survivors: Are there ethnic differences? Journal of the National Medical Association, 92(11), 528–532.PubMedGoogle Scholar
  5. Bailey, D. E. J., Mishel, M. H., Belyea, M., Stewart, J. L., & Mohler, J. (2004). Uncertainty intervention for watchful waiting inprostate cancer. Cancer Nursing, 27(5), 339–346.PubMedCrossRefGoogle Scholar
  6. Carver, C. S., & Antoni, M. H. (2004). Finding benefit in breast cancer during the year after diagnosis predicts better adjustment 5 to 8 years after diagnosis. Health Psychology, 23(6), 595–598.PubMedCrossRefGoogle Scholar
  7. Cordova, M. J., Cunningham, L. L., Carlson, C. R., & Andrykowski, M. A. (2001). Social constraints, cognitive processing, and adjustment to breast cancer. Journal of Consulting and Clinical Psychology, 69(4), 706–711.PubMedCrossRefGoogle Scholar
  8. Culver, J. L., Arena, P. L., Antoni, M. H., & Carver, C. S. (2002). Coping and distress among women under treatment for early stage breast cancer: Comparing African Americans, Hispanics and non-Hispanic whites. Psycho-oncology, 11(6), 495–504.PubMedCrossRefGoogle Scholar
  9. Cunningham, A. J., Edmonds, C. V., Jenkins, G. P., Pollack, H., Lockwood, G. A., & Warr, D. (1998) A randomized controlled trial of the effects ofgroup psychological therapy on survivalin women with metastatic breast cancer. Psycho-oncology, 7, 508–517.PubMedCrossRefGoogle Scholar
  10. Cunningham, A. J., Edmonds, C. V., & Williams, D. (1999). Delivering a very brief psychoeducational program to cancer patients and family members in a large group format. Psycho-oncology, 8(2), 177–182.PubMedCrossRefGoogle Scholar
  11. Curran, S. L., Andrykowski, M. A., & Studts, J. L. (1995). Short form of the profile of mood states (POMS-SF): Psychometric information. Psychological Assessment, 7(1), 80–83.CrossRefGoogle Scholar
  12. Edelman, S., Bell, D. R., & Kidman, A. D. (1999). A group cognitive behaviour therapy programme with metastatic breast cancer patients. Psycho-oncology, 8(4), 295–305.PubMedCrossRefGoogle Scholar
  13. Gil, K. M., Mishel, M. H., Belyea, M., Germino, B., Porter, L. S., Carlton-LeNay, I., et al. (2004). Triggers of uncertainty about recurrence and long term treatment side effects in older African American and Caucasian breast cancer survivors. Oncology Nursing Forum, 31, 633–639.CrossRefGoogle Scholar
  14. Gil, K. M., Mishel, M. H., Germino, B., Porter, L. S., Carlton-LaNey, I., & Belyea, M. (2005). Uncertainty management intervention for older African American and Caucasian long-term breast cancer survivors. Journal of Psychosocial Oncology, 23, 3–21.PubMedCrossRefGoogle Scholar
  15. Graves, K. D. (2003). Social cognitive theory and cancer patients’ quality of life: A meta-analysis of psychosocial intervention components. Health Psychology, 22(2), 210–219.PubMedCrossRefGoogle Scholar
  16. Helgeson, V. S., Cohen, S., Schulz, R., & Yasko, J. (2001). Long-term effects of educational and peer discussion group interventions on adjustment to breast cancer. Health Psychology, 20(5), 387–392.PubMedCrossRefGoogle Scholar
  17. Helgeson, V. S., & Tomich, P. L. (2005). Surviving cancer: A comparison of 5-year disease-free breast cancer survivors with healthy women. Psycho-oncology, 14, 307–317.PubMedCrossRefGoogle Scholar
  18. Henderson, P. D., Gore, S. V., Davis, B. L., & Condon, E. H. (2003). African American women coping with breast cancer: A qualitative analysis. Oncology Nursing Forum, 30(4), 641–647.PubMedCrossRefGoogle Scholar
  19. Hull, M. M. (2000). Lymphedema in women treated for breast cancer. Seminars in Oncology Nursing, 16(3), 226–237.PubMedCrossRefGoogle Scholar
  20. Lickley, H. L. (1997). Primary breast cancer in the elderly. Canadian Journal of Surgery, 40(5), 341–351.Google Scholar
  21. Mast, M. E. (1998). Survivors of breast cancer: Illness uncertainty, positive reappraisal, and emotional distress. Oncology Nursing Forum, 25(3), 555–562.PubMedGoogle Scholar
  22. McKinley, E. D. (2000). Under toad days: Surviving the uncertainty of cancer recurrence. Annals of Internal Medicine, 133(6), 479–480.PubMedGoogle Scholar
  23. Mishel, M. H. (1981). The measurement of uncertainty in illness. Nursing Research, 30(5), 258–263.PubMedCrossRefGoogle Scholar
  24. Mishel, M. H. (1988). Uncertainty in illness. Image: Journal of Nursing Scholarship, 20(4), 225–232.CrossRefGoogle Scholar
  25. Mishel, M. H. (1997). Uncertainty in acute illness. Annual Review of Nursing Research, 15, 57–80.PubMedGoogle Scholar
  26. Mishel, M. H., Germino, B. B., Gil, K. M., Belyea, M., Carlton-LeNay, I., Stewart, J., et al. (2005). Benefits from an uncertainty management intervention for older long term breast cancer survivors. Psycho-oncology, 14, 962–978.PubMedCrossRefGoogle Scholar
  27. Morris, K. T., Johnson, N., Homer, L., & Walts, D. (2000). A comparison of complementary therapy use between breast cancer patients and other primary tumor sites. American Journal of Surgery, 179(5), 407–411.PubMedCrossRefGoogle Scholar
  28. Northouse, L. L., Caffey, M., Deichelbohrer, L., Schmidt, L., Guziatek-Trojniak, L., West, S., et al. (1999). The quality of life of African American women with breast cancer. Research in Nursing & Health, 22(6), 435–448.CrossRefGoogle Scholar
  29. Rosenbaum, M., & Jaffe, Y. (1983). Learned helplessness: The role of individual differences in learned resourcefulness. British Journal of Social Psychology, 22(Pt 3), 215–225.PubMedGoogle Scholar
  30. Rosenstiel, A. K., & Keefe, F. J. (1983). The use of coping strategies in chronic low back pain patients: Relationship to patient characteristics and current adjustment. Pain, 17(1), 33–44.PubMedCrossRefGoogle Scholar
  31. Sarason, I. G., Levine, H. M., Basham, R. B., & Sarason, B. R. (1983). Assessing social support: The social support questionnaire. Journal of Personality and Social Psychology, 44, 127–139.CrossRefGoogle Scholar
  32. Shacham, S. (1983). A shortened version of the profile of mood states. Journal of Personality Assessments, 47(3), 305–306.CrossRefGoogle Scholar
  33. Tomich, P. L., & Helgeson, V. S. (2002). Five years later: A cross-sectional comparison of breast cancer survivors with healthy women. Psycho-oncology, 11(2), 154–169.PubMedCrossRefGoogle Scholar

Copyright information

© International Society of Behavioral Medicine 2006

Authors and Affiliations

  • Karen M. Gil
    • 1
  • Merle H. Mishel
    • 2
  • Michael Belyea
    • 2
  • Barbara Germino
    • 2
  • Laura S. Porter
    • 3
  • Margaret Clayton
    • 2
  1. 1.Department of PsychologyUniversity of North Carolina at Chapel HillChapel Hill
  2. 2.School of NursingUniversity of North Carolina at Chapel HillChapel Hill
  3. 3.Department of Psychiatry and Behavioral SciencesDuke University Medical CenterDurham

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