Chronic obstructive pulmonary disease (COPD) is an irreversible and progressive lung disorder, so there is no cure and mortality rates attributed to COPD are high. The best outlook is slowing COPD progression by medical treatments and lifestyle changes. However, the inevitability of the disease progression and frequent exacerbations can cause high levels of uncertainty in patients, which results in anxiety, depression, and reduced quality of life (QOL). This paper will examine a study that aimed to investigate how uncertainty interventions impact anxiety, depression, and QOL in COPD patients.
Study Purpose
Authors’ Main Problem
According to Jiang and He (2012), uncertainty is a common state of being in chronic progressive disorders, such as COPD, and uncertainty has been positively linked to anxiety, depression, and reduced QOL. There have been no studies on uncertainty in COPD patients, so the researchers wanted to learn whether uncertainty management can affect the QOL, anxiety, and depression in COPD patients. This is a significant study for nursing because it can contribute to planning effective nursing interventions when assessing COPD patients.
Hypothesis
It is explicitly stated that it is hypothesized that an uncertainty management intervention will reduce uncertainty and consequently improve anxiety, depression, and QOL in COPD patients. The hypothesis lists anxiety, depression, and QOL dependent variables that will be monitored, and the uncertainty intervention as an independent variable.
Literature Review
The literature review is relevant and accurate. The sources cited are mainly published in 2009 or later, and they are both primary sources and highly relevant to the topic explored in the study. Some studies used in the review were published in 2005, 2001, 1995, but they are relevant to the study’s conceptual framework, and because the human physiology did not change significantly, their findings are still valid.
Conceptual Framework
It is clearly stated that the researchers expect and intervention (i.e. uncertainty management) to improve anxiety, depression, and QOL in patients with a chronic disorder. That means the researchers are using a formal hypothesis framework to determine how an intervention predicts several outcomes. In the context of nursing, they are using a chronic care framework because the intervention is designed to manage a chronic health problem.
Methodology
Protection of Human Research Participants
The Ethics Committee of Xiangya Hospital approved the study, and informed written consent was required from the patients to enter the study. In order to ensure all participants are protected from adverse events potentially caused by the intervention, substance abuse history, comorbid psychiatric or oncologic disorders, and inability to communicate or give informed consent were listed as exclusion criteria.
Research Design
The research was a randomized controlled trial, which means participants were divided into the intervention and the control group. That is an appropriate design because it allows the researchers to measure whether the intervention is responsible for the improved outcomes. A randomized controlled trial also minimizes threats to internal and external validity, but the research by Jiang and He (2012) has one notable weakness. The participants were exposed to the intervention in a non-experimental setting, which is an external validity threat.
However, the intervention was clearly described and the staff followed a clear standardized protocol. The patients received their materials for uncertainty management at the beginning of the study. The intervention nurses were instructed to deliver four phone calls in which the patients were instructed on how and when to use cognitive coping skills.
Sample and Settings
The participants were COPD outpatients with moderate or severe instances of COPD diagnosed within the last two years and at least one instance of an acute exacerbation that lasted three days or more. Block randomization was used to randomly assign the participants to different groups. The sample size was estimated by a two-tailed test with the following parameters: α = .05, power = .80, and effect size = 0.65. The minimal sample size of 39 per group was determined, so 50 patients were assigned to each group taking in account a 25 percent dropout rate, but because 49 and 47 participants completed the study, it is possible to conclude that the sample size was adequate.
Data Collection and Measurement
Validated instruments were used to measure all variables, so all variables were operationalized based on the subjects’ responses. Uncertainty levels were measured with Mishel’s Uncertainty in Illness Scale-Adult version (Cronbach's alpha = .86). Coping strategies were measured with the cognitive coping strategies questionnaire (Cronbach's alpha = .81). Anxiety was measured with the State-Trait Anxiety Inventory (Cronbach's alpha = .83 and .87). Depression was measured with the Hospital Anxiety and Depression Scale (Cronbach's alpha = .90). QOL was measured with SF-36 scale (Cronbach's alpha = .82). In all instances Cronbach's alpha was higher than .80, which means the items on questionnaires have high inter-correlation and therefore measure the same construct, so the results obtained can be considered reliable.
Results
Discussion
Currently, there are no implications for nurses from the findings in this study. Although it was confirmed that uncertainty interventions can improve depression, anxiety, and QOL scores, the authors reported three limitations. First, the population consisted only of people with moderate and severe instances of COPD. Second, the study was only 10 months long, which could impact the findings given the fact that time proved to be a significant independent variable. Third, an attention control group was not included in the study design. Finally, this was the first study on uncertainty interventions in COPD outpatients, so future research needs to replicate and confirm the findings before they can be considered in clinical practice.
References
Jiang, X., & He, G. (2012). Effects of an uncertainty management intervention on uncertainty, anxiety, depression, and quality of life of chronic obstructive pulmonary disease outpatients. Research in Nursing & Health, 35(4), 409-418.
