Systematic Review and Meta-analysis of Psychosocial Uncertainty Management Interventions

Background Psychosocial uncertainty management interventions (UMIs) targeting patients and their family members might help to alleviate the negative influences of illness-related uncertainty, such as diminished quality of life and poor adjustment. Objectives The aims of this study were to evaluate the key characteristics of psychosocial UMIs and assess intervention effects on patients' and their family members' short-term and long-term illness-related uncertainty. Methods We conducted a systematic review and meta-analysis of psychosocial UMIs published through 2017. We performed a comprehensive electronic search and manual review. The outcome indicator was illness-related uncertainty experienced by patients or their family members. Results We included 29 studies in the systematic review and 14 studies in the meta-analysis. The main intervention components were information and resource provision, coping skills training, social and emotional support, communication skills, symptom management and self-care, coordination of care, and exercise. Compared to usual care, patients who received UMIs reported less uncertainty immediately after intervention delivery (g = -0.44, 95% confidence interval [CI] [-0.71, -0.16]) and at later follow-up points (g = -0.47, 95% CI [-0.91, -0.03]). Family members who received UMIs also reported less uncertainty immediately after intervention delivery (g = -0.20, 95% CI [-0.33, -0.06]) and at later follow-up points (g = -0.20, 95% CI [-0.36, -0.04]). Discussion Psychosocial UMIs had small to medium beneficial effects for both patients and their family members. Questions remain regarding what intervention components, modes of delivery, or dosages influence effect size. More rigorously designed randomized controlled trials are needed to validate intervention effects on patients' and family members' uncertainty management.