Screening Recommendations for Baby Boomers With Chronic Hepatitis C and the Uncertainties That Surround Them

Background:Globally approximately 130 to 184 million individuals are living with hepatitis C, which translates to one in every 12 individuals affected by viral hepatitis worldwide (Institute of Medicine [IOM], 2010). It is projected that anywhere from 3.5 to 5.3 million Americans living with viral hepatitis do not know they are infected (U.S. Department of Health and Human Services [HHS], 2011). Viral hepatitis infections are three to five times more frequent than HIV infections in the U.S. (IOM, 2010). Baby boomers, those individuals born during 1945 and 1965 comprise an estimated 27% of the U.S. population and account for approximately three-fourths of all hepatitis C infections (CDC, 2012). Uncertainty regarding the duration of an illness or its outcome has been reported as the greatest single psychological stressor for individuals with a life-threatening illness (Mishel, 1999). The majority of the time the diagnosis of hepatitis C is made when the individual is in the chronic stage of the condition and asymptomatic. The newly diagnosed chronic hepatitis C individual has to cope with the paradox of a new diagnosis of a chronic, sometimes advanced, condition. Chronic illness, in addition to chronic uncertainty as a psychological constant can have detrimental effects on an individual

Problem:The Institute of Medicine, the U.S. Department of Health and Human Services, the Centers for Disease Control and Prevention, and the U.S. Preventative Services Task Force have called attention to the silent epidemic of viral hepatitis. These scientific institutions have created action plans on prevention, screening, and treatment of individuals with viral hepatitis. New screening practices that target the baby boomer population are sure to identify numerous cases of chronic hepatitis C. There is a gap in the literature that fails to link the uncertainties faced by individuals diagnosed with hepatitis C and the factors attributing to those uncertainties.

Purpose: The purpose of this study was to explore new hepatitis C screening recommendations and to investigate the influence a set of predictor variables prescribed by Mishel’s Uncertainty in Illness Theory had on baby boomers’ perception of uncertainty.

Methods: A multiple regression analysis was used to determine if the independent variables (i.e., level of education, credible authority, social support, length of diagnosis, familiarity of events, and cognitive capacity) were predictors of the participants’ level of uncertainty. Multiple regression analysis allows the researcher to predict one variable from several variables (Norman & Streiner, 2008). Data were collected by the researcher using a 53-item questionnaire. This questionnaire encompassed three standardized instruments, Mishel’s Uncertainty in Illness Scale – Community Form (MUIS-C), Duke Social Support Index – Abbreviated (DSSI), the Health Care Orientation subscale of the Psychosocial Adjustment to Illness Scale – Self Report (PAIS-SR), and a researcher-designed demographic questionnaire. Data were analyzed using the Statistical Program for the Social Sciences (SPSS) 22.0 software.

Setting:The main recruitment procedures gather data from baby boomers that self identified as hepatitis C positive via virtual settings through the use of SurveyMonkey.

Results: Data were collected over an 8-week period from a convenience sample of baby boomers that self-identify as having hepatitis C (N = 146). Baby boomers aged 49 to 69 provided data for this study with an average participant age of 58 years old. The linear combination of the predictors revealed a significant regression model, F (5,115) = 27.091, p < .001, with a R²value of 0.54. Two of five predictors, credible authority (β = .625) and social support (β = -.169), were significant predictors of perceived level of uncertainty.

Conclusion: The majority of the time, the diagnosis of hepatitis C is made when the individual is in the chronic stage of the condition. The newly diagnosed hepatitis C individual has to cope with the paradox and uncertainties of a new diagnosis of a chronic and sometimes advanced condition. Uncertainty, or the inability to structure meaning, can develop if the individual does not form a cognitive schema for illness events. A cognitive schema is the individual’s subjective interpretation of illness, treatment, and hospitalization. By providing anticipatory guidance, healthcare providers are seen as credible sources of information and have the greatest influence on the individual’s perception of uncertainty (β = .625). Social support shared an inverse relationship with uncertainty (β = -.169). Therefore, as social support increases, perceived levels of uncertainty decrease.

Implications:Study results contribute to the understanding of baby boomers diagnosed with hepatitis C and the uncertainties surrounding illness events. Viral hepatitis has been deemed the silent epidemic. Silence and uncertainty are a deadly combination. It is the responsibility of nurses to not only educate themselves, as credible sources of information but also to educate the general public and policymakers to break the silence and reduce uncertainty for those affected by hepatitis C. It is imperative for nurses and nurse practitioners to maintain current on practice guidelines and comprehend the role they play as liaisons of the healthcare delivery system. As liaisons, connecting individuals diagnosed with hepatitis C to treatment and resources in the community, nurses might further assist in navigating illness events and ultimately decrease uncertainty. Early identification and treatment of hepatitis C, as recommended by the scientific community, may reduce prevalence and complications of this condition.