Mapping illness uncertainty in adolescents with cancer: A cross-sectional network analysis

Illness uncertainty, as conceptualised in Mishel's theory, is an important psychosocial issue in paediatric oncology. This study aimed to describe illness uncertainty from adolescents' perspective, examine its item-level network structure and identify central concerns and key co-occurring pathways.

Illness uncertainty was assessed using the Chinese version of the Uncertainty Scale for Kids, which includes the unpredictability (UP), complexity (CP) and uncertainty (UC) dimensions, with a total score ranging from 0 to 80. An item-level partial correlation network was estimated, and the node strength centrality and edge weights were examined.

The mean total illness uncertainty score was 42.94 ± 11.46, indicating a moderate level of illness uncertainty. Items UC11 (expected illness course; strength = 1.292), UP15 (changes in condition; strength = 1.068), UP4 (illness outcome; strength = 1.039) demonstrated the highest strength centrality. The strongest edges formed four co-occurring pathways: disease trajectory judgment, including UP3-UP4 (weight = 0.324), UC9-UP20 (weight = 0.279), UP3-UP5 (weight = 0.249) and UP15-UC16 (weight = 0.242); symptom attribution, represented by CP18-UC19 (weight = 0.354); treatment-related risk, including UC12-CP14 (weight = 0.389) and CP8-UP13 (weight = 0.258); and information interpretation, represented by CP7-UC11 (weight = 0.251).

The findings underscore the importance of assessing illness uncertainty from the perspective of adolescent patients. Given the cross-sectional design, use of convenience sampling and absence of subgroup network analyses in this study, future longitudinal and multicentre studies are recommended to validate the above findings.