{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,10]],"date-time":"2026-11-10T11:13:09Z","timestamp":1794309189423,"version":"4.9.0"},"reference-count":55,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2023,5,30]],"date-time":"2023-05-30T00:00:00Z","timestamp":1685404800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: The purpose of this study is to enhance the quality of life in elderly patients with lung cancer by understanding relations of uncertainty, appraisal of uncertainty, self-efficacy, and quality of life targeting elderly patients with lung cancer receiving anticancer therapy, and also analyzing the factors affecting the quality of life based on Mishel\u2019s theory. Materials and Methods: The subjects were a total of 112 lung cancer patients aged 65 or older receiving anticancer therapy. The data was collected by using self-report questionnaires targeting patients in hemato-oncology at Chungbuk National University Hospital. The data were analyzed using descriptive statistics, a t-test, an analysis of variance, Pearson\u2019s correlational coefficients, and hierarchical regression analysis. Results: In stage 1, anticancer therapy (chemotherapy) (\u03b2 = \u22120.34, p &lt; 0.001), economic condition (low) (\u03b2 = \u22120.30, p &lt; 0.001), the number of anticancer therapies (three times or more) (\u03b2 = \u22120.29, p &lt; 0.001), and education (graduation from high school or higher) (\u03b2 = 0.18, p = 0.033) were influencing factors (F = 0.52, p &lt; 0.001). In stage 2, self-efficacy (\u03b2 = 0.41, p &lt; 0.001), appraisal of uncertainty: danger (\u03b2 = \u22120.29, p &lt; 0.001), appraisal of uncertainty: opportunity (\u03b2 = 0.18, p = 0.018), the number of anticancer therapies (three times or more) (\u03b2 = \u22120.17, p = 0.006), and anticancer therapy (chemotherapy) (\u03b2 = \u22120.14, p = 0.031) were influencing factors, which showed 74.2% explanatory power (F = 26.17, p &lt; 0.001). Conclusions: In order to improve the quality of life of subjects, it would be necessary to develop interventions for raising their self-efficacy by considering their degree of education, economic condition, the types and numbers of anticancer therapies, and understanding of the appraisal of uncertainty about the disease is assessed as an opportunity factor or a danger factor.<\/jats:p>","DOI":"10.3390\/medicina59061051","type":"journal-article","created":{"date-parts":[[2023,5,31]],"date-time":"2023-05-31T02:01:15Z","timestamp":1685498475000},"page":"1051","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Effects of Uncertainty, Appraisal of Uncertainty, and Self-Efficacy on the Quality of Life of Elderly Patients with Lung Cancer Receiving Chemotherapy: Based on Mishel\u2019s Theory of Uncertainty"],"prefix":"10.3390","volume":"59","author":[{"given":"Min-Kyung","family":"Hwang","sequence":"first","affiliation":[{"name":"Department of Nursing, Graduate School, Kongju National University, Gongju 32588, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2103-4835","authenticated-orcid":false,"given":"Hee-Kyung","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Nursing, Kongju National University, Gongju 32588, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ki-Hyeong","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Medical Oncology, Chungbuk National University Hospital, Cheongju 28644, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,5,30]]},"reference":[{"key":"ref_1","unstructured":"(2023, January 21). Korean Statistical Information Service. Cancer Statistics. Available online: https:\/\/kosis.kr\/statHtml\/statHtml.do?orgId=101&tblId=DT_1BPA002&vw_cd=&list_id=&scrId=&seqNo=&lang_mode=ko&obj_var_id=&itm_id=&conn_path=K1."},{"key":"ref_2","unstructured":"National Cancer Information Center (2023, January 21). National Cancer Statistics. Available online: https:\/\/www.cancer.go.kr\/lay1\/program\/S1T211C223\/cancer\/view.do?cancer_seq=5237."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1007\/s00520-002-0388-6","article-title":"Quality of Life in Young Adult Survivors of Childhood Cancer","volume":"10","author":"Angeveld","year":"2002","journal-title":"Support Care Cancer"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"714","DOI":"10.1111\/j.1365-2354.2009.01158.x","article-title":"Quality of Life Research: Is There a Difference in Output between the Major Cancer Types?","volume":"19","author":"Sanson","year":"2010","journal-title":"Eur. J. Cancer Care"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"237","DOI":"10.5388\/jkon.2011.11.3.237","article-title":"The Relationships between Stigma, Distress, and Quality of Life in Patients with Lung Cancer","volume":"1","author":"Lee","year":"2011","journal-title":"J. Korean Oncol. Nurs."},{"key":"ref_6","unstructured":"Lee, J.L. (2013). Quality of life Non-small Cell Lung Cancer Patients: A Structural Equation Model Approach. [Doctoral Dissertation, Seoul National University]."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"614","DOI":"10.1111\/j.1365-2354.2012.01332.x","article-title":"Association between Changes in Quality of Life Scores and Survival in Non-Small Cell Lung Cancer","volume":"21","author":"Guputa","year":"2012","journal-title":"Eur. J. Cancer Care"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Yun, Y.H., Kim, Y.A., Sim, J.A., Shin, A.S., Chang, Y.J., Lee, J., and Zo, J.L. (2016). Prognostic value of quality of life score in disease-free survivors of surgically-treated lung cancer. BMC Cancer, 16.","DOI":"10.1186\/s12885-016-2504-x"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"173","DOI":"10.3747\/co.2007.145","article-title":"Symptom Clusters in Cancer Patients: A Review of the Literature","volume":"14","author":"Fan","year":"2007","journal-title":"Curr. Oncol."},{"key":"ref_10","unstructured":"Choi, S.H. (2023). Effects of Symptom Crusters and Depression on the Quality of Life in Patients with Advanced Lung Cancer. [Master\u2019s Thesis, ChungAng University]."},{"key":"ref_11","first-page":"77","article-title":"Symptom Cluster Presented by Non-Small Cell Lung Cancer Patients on Gefitinib Treatment","volume":"9","author":"Lee","year":"2009","journal-title":"Asian Oncol. Nurs."},{"key":"ref_12","first-page":"108","article-title":"Defining the Content Domain of Quality of Life for Cancer Patients with Pain","volume":"13","author":"Padila","year":"1990","journal-title":"Cancer Nurs."},{"key":"ref_13","first-page":"278","article-title":"A Cross-Sectional Study on the Quality of Life of Adult Cancer Patients-Focused on the EORTC QLQ-C30","volume":"1","author":"Choi","year":"2011","journal-title":"Korean Assoc. Intern. Med."},{"key":"ref_14","unstructured":"Jeong, J.A. (2020). The Effect of Symptom Clusters, Uncertainty and Social Support on Health-Related Quality of Life in Patient with Lung Cancer. [Master\u2019s Thesis, Kongju National University]."},{"key":"ref_15","first-page":"148","article-title":"Relationships among Uncertainty, Distress, and Quality of Life in Lung Cancer Patients: Mediating effect of Resilience","volume":"25","author":"Lee","year":"2018","journal-title":"J. Muscle Jt. Health"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"180","DOI":"10.5388\/aon.2017.17.3.180","article-title":"Influences of Uncertainty and Social Support on the Quality of Life among Elderly Cancer Patients","volume":"17","author":"Kim","year":"2017","journal-title":"Asian Oncol. Nurs."},{"key":"ref_17","unstructured":"Kim, S.H. (2011). Comparison of Factors Affecting Uncertainty between the Patients with Lung Cancer in Adult and the Elderly. [Master\u2019s Thesis, Kyunghee University]."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1097\/00006199-198803000-00009","article-title":"Finding Meaning: Antecedents of Uncertainty in Illness","volume":"37","author":"Mishel","year":"1988","journal-title":"Nurs. Res."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1111\/j.1547-5069.1988.tb00082.x","article-title":"Uncertainty in illness","volume":"20","author":"Mishel","year":"1988","journal-title":"J. Nurs. Scholarsh."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1111\/j.1547-5069.1990.tb00225.x","article-title":"Reconceptualization of the Uncertainty in Illness Theory","volume":"22","author":"Mishel","year":"1990","journal-title":"Image J. Nurs. Scholarsh."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1097\/00006199-199105000-00010","article-title":"Uncertainty in Gynecological Cancer: A Test of the Mediating Function of Mastery and Coping","volume":"40","author":"Mishel","year":"1991","journal-title":"Nurs. Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"139","DOI":"10.5388\/aon.2012.12.2.139","article-title":"Impact of Uncertainty on Resilience in Cancer Patients","volume":"12","author":"Cha","year":"2012","journal-title":"Asian Oncol. Nurs."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"45","DOI":"10.5388\/aon.2017.17.1.45","article-title":"Influence of Uncertainty and Uncertainty Appraisal on Quality of Life in Prostate Cancer Patients after Prostatectomy","volume":"17","author":"Nam","year":"2017","journal-title":"Asian Oncol. Nurs."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1037\/0033-295X.84.2.191","article-title":"Self-efficacy: Toward a Unifying Theory of Behavioral Change","volume":"84","author":"Bandura","year":"1997","journal-title":"Psychol. Rev."},{"key":"ref_25","unstructured":"Lee, E.J. (2017). Perceptions of Quality of Patient-Centered Nursing Care, Pain, Anxiety and Self-Efficacy among Cancer Patients with Surgery in Korea: A Correlational Study. [Master\u2019s Thesis, Seoul National University]."},{"key":"ref_26","first-page":"59","article-title":"The Effects of Self-Efficacy on the Depression of Lonely Frail Elders","volume":"48","author":"Kim","year":"2010","journal-title":"J. Welf. Aged"},{"key":"ref_27","unstructured":"Lee, E.J. (2020). Influencing factors of Type D Personality, Self-Efficacy, Sleep Quality on the Quality of Life in Patients with Breast Cancer Receiving Anticancer Chemotherapy. [Doctoral Dissertation, Inje University]."},{"key":"ref_28","unstructured":"Pyun, I.H. (2017). Relationships between Self-Esteem, Self-Efficacy and Nurses\u2019 Communication Styles Perceived by Elderly Cancer Patients Receiving Chemotherapy. [Master\u2019s Thesis, Korea University]."},{"key":"ref_29","unstructured":"Ko, A.R. (2015). A Model for Quality of Life in Lung Cancer Survivors Based on the Theory of Symptom Self-Management. [Master\u2019s Thesis, Chungang University]."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"58","DOI":"10.4069\/kjwhn.2005.11.1.58","article-title":"Functional status and Psychosocial Adjustment in Gynecologic Cancer Patients Receiving Chemotherapy","volume":"11","author":"Chung","year":"2005","journal-title":"Korean J. Women Health Nurs."},{"key":"ref_31","first-page":"230","article-title":"The Relationships among Uncertainty, Appraisal of Uncertainty, Depression, Anxiety and Perceived Health Status in Patients with Atrial Fibrillation","volume":"17","author":"Kang","year":"2005","journal-title":"Korean J. Adult Nurs."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1097\/NCC.0000000000000691","article-title":"Psychometric Evaluation of a Korean version of the Cancer Survivors\u2019 Self-Efficacy Scale","volume":"42","author":"Kim","year":"2019","journal-title":"Cancer Nurs."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1007\/s11764-014-0384-0","article-title":"Cancer Srvivors\u2019 Self-Efficacy to Self-Manage in the Year Following Primary Treatment","volume":"9","author":"Foster","year":"2015","journal-title":"J. Cancer Surviv."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1016\/j.hoc.2005.02.009","article-title":"Quality of Life in Lung Cancer: The Validity and Cross-Cultural Applicability of the Functional Assessment of Cancer Therapy-Lung Scale","volume":"19","author":"Butt","year":"2005","journal-title":"Hematol Oncol. Clin. N. A."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1007\/s11136-005-8752-x","article-title":"Korean Tanslation and Validation of the Functional Assessment of Cancer Therapy-Lung (FACT-L) Version 4","volume":"15","author":"Yoo","year":"2006","journal-title":"Qual. Life Res."},{"key":"ref_36","first-page":"248","article-title":"Influencing Factors on Uncertainty of Patients Undergoing Chemotherapy for Lung Neoplasms","volume":"18","author":"Mo","year":"2017","journal-title":"J. Korea Acad. Ind. Coop. Soc."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"298","DOI":"10.4040\/jkan.2019.49.3.298","article-title":"Mediation Effect of Self-Efficacy on the Relationship between Perceived Self-Management Support and Health-Related Quality of Life among Cancer Survivors","volume":"49","author":"Lee","year":"2019","journal-title":"J. Korean Acad. Nurs."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"2445","DOI":"10.1007\/s00520-015-3044-7","article-title":"A Web-Based Intervention (RESTORE) to Support Self-Management of Cancer-Related Fatigue Following Primary Cancer Treatment: A Multi-Centre Proof of Concept Randomised Controlled Trial","volume":"24","author":"Foster","year":"2015","journal-title":"Support. Care Cancer"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"241","DOI":"10.5388\/aon.2021.21.4.241","article-title":"Impact of Symptom Clusters on the Quality of Life in Lung Cancer Patients Undergoing Chemotherapy","volume":"21","author":"Kim","year":"2021","journal-title":"Asian Oncol. Nurs."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"18","DOI":"10.5388\/aon.2015.15.1.18","article-title":"Distress and Quality of Life in Cancer Patients Receiving Chemotherapy","volume":"15","author":"Seo","year":"2015","journal-title":"Asian Oncol. Nurs."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"287","DOI":"10.4069\/kjwhn.2018.24.3.287","article-title":"Impacts of Psychological Distress, Gender Role Attitude, and Housekeeping Sharing on Quality of Life of Gynecologic Cancer Survivors","volume":"24","author":"Kim","year":"2018","journal-title":"Korean J. Women Health Nurs."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"52","DOI":"10.7475\/kjan.2012.24.1.52","article-title":"Factors Influencing on Quality of Life in Gynecological Cancer Patients","volume":"24","author":"Park","year":"2012","journal-title":"Korean J. Adult Nurs."},{"key":"ref_43","unstructured":"Bae, J.H. (2015). Impact of Supportive Care Needs and Family Support on Quality of Life of Advanced Cancer Patients in Chemotherapy. [Master\u2019s Thesis, Seoul National University]."},{"key":"ref_44","unstructured":"Lee, S.H. (2017). The Relationships among Health Literacy, Self-care Performance, and Quality of Life in Elderly Patients with Lung Cancer Receiving Chemotherapy. [Master\u2019s Thesis, Chungbuk National University]."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1080\/00909882.2015.1083600","article-title":"Young Breast Cancer Survivors\u2019 Experiences of Uncertainty","volume":"43","author":"Miller","year":"2015","journal-title":"J. Appl. Commun. Res."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1007\/s11764-012-0229-7","article-title":"Sources of Uncertainty in Cancer Survivorship","volume":"2","author":"Miller","year":"2012","journal-title":"J. Cancer Surviv."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1080","DOI":"10.1016\/j.ijnurstu.2010.02.003","article-title":"Long-Term Follow-Up study of Uncertainty and Psychosocial Adjustment among Implantable Cardioverter Defibrillator Recipients","volume":"47","author":"Mauro","year":"2010","journal-title":"Int. J. Nurs. Stud."},{"key":"ref_48","first-page":"231","article-title":"The Effect of perceived social support and self-efficiency on health promoting behavior of the elderly","volume":"32","author":"Kang","year":"2009","journal-title":"Korean J. Leis. Recreat."},{"key":"ref_49","first-page":"4","article-title":"The relationship between lung cancer patient educational level and evaluation of their treatment information needs","volume":"24","author":"Schumacher","year":"2009","journal-title":"J. Cancer Educ."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"37","DOI":"10.5388\/aon.2022.22.1.37","article-title":"The influence of anxiety, uncertainty, and cancer coping on the quality of life in breast cancer patients receiving neoadjuvant chemotherapy","volume":"22","author":"Hyun","year":"2022","journal-title":"Asian Oncol. Nurs."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1097\/jnr.0000000000000252","article-title":"Effects of a Psychoeducational Intervention in Patients with Breast Cancer Undergoing Chemotherapy","volume":"26","author":"Huang","year":"2018","journal-title":"J. Nurs. Res."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"E403","DOI":"10.1188\/13.ONF.E403-E410","article-title":"Development and Psychometric Testing of a Breast Cancer Survivor Self-Efficacy Scale","volume":"40","author":"Champion","year":"2013","journal-title":"Oncol. Nurs. Forum"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1188\/17.ONF.127-136","article-title":"Patient-reported Self-Efficacy, Anxiety, and Health-Related Quality of Life during Chemotherapy: Results from a Longitudinal Study","volume":"44","author":"Papadopoulou","year":"2017","journal-title":"Oncol. Nurs. Forum"},{"key":"ref_54","unstructured":"Lee, I.S. (2005). Uncertainty, Appraisal and Quality of Life in Patients with Breast Cancer Across Treatment Phases. [Master\u2019s Thesis, Yonsei University]."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"1","DOI":"10.38083\/JKNS.25.2.202108.001","article-title":"Effects of Symptom Experience and Uncertainty on the Quality of Life in Breast Cancer Survivors","volume":"25","author":"Kim","year":"2021","journal-title":"J. Kyungpook Nurs. Sci."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/59\/6\/1051\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:45:09Z","timestamp":1760125509000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/59\/6\/1051"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5,30]]},"references-count":55,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2023,6]]}},"alternative-id":["medicina59061051"],"URL":"https:\/\/doi.org\/10.3390\/medicina59061051","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,5,30]]}}}