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American Journal of Critical Care. 2008;17: 232-242
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CE Article

Uncertainty and Health-Related Quality of Life 1 Year After Coronary Angiography

By Jo-Ann Eastwood, RN, PhD, CCNS, Lynn Doering, RN, DNSc, Janice Roper, RN, PhD and Ron D. Hays, PhD. Jo-Ann Eastwood is an assistant professor and Lynn Doeringis a professor and chair of acute care in the School of Nursing, and Ron D. Haysis a professor, Department of Medicine, Division of General Internal Medicine and Health Services Research, at the University of California, Los Angeles. Janice Roperis assistant chief, nurse research and education, Greater West Los Angeles Veterans Administration Healthcare.

Corresponding author: Jo-Ann Eastwood, RN, PhD, CCNS, UCLA School of Nursing, 700 Tiverton Ave, Box 951702, Los Angeles, CA 90095-1702 (e-mail: eastwood{at}ucla.edu).

Background Little is known about illness-related uncertainty and decreased health-related quality of life in patients undergoing initial coronary angiography or about the long-term effects of uncertainty.

Objectives To compare patients with and without high levels of uncertainty before angiography and to examine the influence of uncertainty on health-related quality of life 1 year after angiography.

Methods In a prospective, longitudinal study, measurements of perceived control, uncertainty, affective distress, and health-related quality of life were collected from 93 patients before angiography (baseline) and 1 year later. At baseline, patients were classified into high- and low-uncertainty groups by median split. At 1 year, analysis of variance was used to compare health-related quality of life and psychological outcomes in the 2 groups, and multiple linear regression with stepwise entry was used to identify independent determinants of health-related quality of life.

Results Compared with patients with low baseline uncertainty, patients with high baseline uncertainty had higher levels of anxiety and depression and lower levels of perceived control and health-related quality of life 1 year after angiography. Baseline health-related quality of life, uncertainty, and life stress accounted for 54% of the variance in health-related quality of life, even when angiographic outcome was controlled for (P < .001). Baseline uncertainty was independently associated with health-related quality of life (β = –0.25; 95% confidence interval, –9.40 to –0.05; P = .02).

Conclusions At initial angiography, high levels of uncertainty about illness portend negative health-related quality of life outcomes up to 1 year later.

Notice to CE enrollees:
A closed-book, multiple-choice examination following this article tests your understanding of the following objectives:
  1. Describe health-related quality of life (HRQOL) and its relationship to disease trajectory
  2. Recognize the factors that have been correlated with lower HRQOL
  3. Understand the relationship of the perceived threat of coronary artery disease and the patient’s HRQOL
To read this article and take the CE test online, visit www.ajcconline.org and click "CE Articles in This Issue." No CE test fee for AACN members.


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Ruth Kleinpell
AJCC 2008 17: 244-245. [Full Text]  





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