Doctoral Dissertations

Date of Award

12-1998

Degree Type

Dissertation

Degree Name

Doctor of Philosophy

Major

Nursing

Major Professor

Martha R. Alligood

Committee Members

Sandra Thomas, Debra Wallace, Pamela Hinds, Carol Tenopir

Abstract

The purpose of this study was to test an explanatory theory of decision making derived from King's (1981) systems framework in women eligible for a cancer clinical trial. Specifically, the three-stage theory proposed that the systems concepts of uncertainty, role functioning, and social support are related to emotional health (hope and mood state), which in turn is related to the treatment decision of women eligible for a cancer clinical trial. A correlational study design was applied to test the proposed theory.

The convenience sample consisted of 40 women from four cancer care centers in the South and Southeast. Data were collected within 28 days of the women's treatment decision to either participate or not participate in a clinical trial. The data were collected using the Mishel Uncertainty in Illness Scale - Community Form (Mishel, 1997), the Inventory of Functional Status - Cancer (Tulman, Fawcett, & McEvoy, 1991), the Medical Outcomes Study - Social Support Survey (Sherbourne & Stewart, 1991), the Herth Hope Index (Herth, 1992), the Profile of Mood States - Short Form (McNair, Lorr, & Droppleman, 1992), and a demographic data form. Reliability was assessed using tests of instrument homogeneity. Reliability was high for each of the instruments. Statistical analyses performed on the data included the Kolmogorov-Smimov Lilliefors statistic, the Cronbach's alpha coefficient, the Spearman rank-order correlation coefficient, and the Mann-Whitney U test.

Uncertainty, role functioning, and social support were all significantly correlated to hope (p < .01). Uncertainty and role functioning were also significantly correlated to mood state (p < .01), although social support was not. The indicators of emotional health. hope and mood state, were also significantly correlated (p < .01). However, there was no significant difference in the level of hope (z = -.102, p = .919) or mood state (z = -.766, p = .444) among women who entered a clinical trial and those who did not.

The study findings provided empirical evidence for the theory component which proposed the relationships between the variable of emotional health and several systems concepts: (1) the woman's uncertainty about the illness situation, (2) her ability to function in her roles, and (3) her social support. The findings did not support a relationship between emotional health and the decision whether or not to enter a clinical trial. While the overall findings provided adequate empirical evidence to advance the credibility of King's systems framework, future research should focus on theory revision and additional theory testing. The need remains to theoretically explicate the critical factors in a woman's decision to participate or not participate in a cancer clinical trial.

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