Relationship of Uncertainty, Perceived Threat, Stress, Positive Appraisal, and Daily Spiritual Experiences in Women with Breast Cancer: A Transitions Perspective


Sharon Kern

Defense Date


Graduation Date

Summer 1-1-2015


Immediate Access

Submission Type


Degree Name





School of Nursing

Committee Chair

Linda Goodfellow

Committee Member

Carolyn Nickerson

Committee Member

Deborah Volker


Daily Spiritual Experiences, Perceived Threat, Stress, Transitions, Uncertainty, Women with breast Cancer


The American Cancer Society (2013) has estimated that there were 230,480 new cases of breast cancer in the United States (U.S.) and 39,520 deaths from breast cancer in 2011. Breast cancer is second leading cancer etiology behind skin cancer for American women and is the second cause of cancer mortality. Uncertainty, stress, and perceived threat may impair a person’s coping with cancer while a positive appraisal may enhance coping skills. As an inner resource, daily spiritual experiences may affect appraisal and coping choices. Lazarus and Folkman’s (1984) framework on stress, appraisal and coping explicates the processes of stress and uncertainty while Meleis’ Transitions Theory (2010) focuses on the dynamic changes that occur with illness. The purposes of this study are: 1) to examine the relationships between uncertainty, stress, daily spiritual experiences, perceived threat, and positive appraisal in women with breast cancer persons with cancer, and, 2) ascertain if women with breast cancer perceive a transition within their own daily spiritual experiences while coping with breast cancer.

A multi- method design including a descriptive cross sectional design and qualitative inquiry was utilized to examine the relationships between the major variables under study and to explore perceptions of a transition of daily spiritual experiences. This study was conducted mainly online via encrypted web hosting by Snap® Surveys and also via telephone interviews. Descriptive and correlational statistics as well as qualitative analysis were used to answer the research questions. Measures of stress including stress from uncertainty and overall stress were significantly correlated (r (95) = 0.76, p < 0.001). Data from this study supported a significant low to moderate inverse relationship between daily spiritual experiences and uncertainty. Direct relationships were found between uncertainty, stress from uncertainty, overall uncertainty, overall stress, and perceived threat. Spiritual experiences were present in a majority of the participants and 68.2 % percent reported that their spiritual experiences had changed. This study added to nursing’s understanding of the relationships between uncertainty, perceived threat, stress, positive appraisal, and daily spiritual experiences during a woman’s transitions through the breast cancer illness.





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