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Uncertainty in Patients With Unruptured Intracranial Aneurysms Undergoing Endovascular Surgery: A Qualitative and Inductive Study

Masuda, Mitsumi; Oishi, Hidenori; Yamamoto, Munetaka

doi: 10.1097/NNR.0000000000000050

Background Advances in diagnostic imaging technology have increased opportunities to discover unruptured intracranial aneurysms (UIA), and prior research has shown that UIA patients experience uncertainty both when making choices regarding treatment and after surgery.

Objectives The purpose of this study was to clarify the nature of the uncertainty experienced by UIA patients who elect to undergo endovascular surgery.

Methods Data from interviews with 31 subjects were synthesized with findings from previous research and then analyzed qualitatively and inductively.

Results Six categories were derived from the analysis to describe the uncertainty experienced by UIA patients who undergo intravascular surgery: Nature of the Disease, Treatment Characteristics, Information, Decision-making, Course of the Future, and Living with UIA.

Discussion The Treatment Characteristics and Decision-making categories reflect new aspects of uncertainty arising from advances in diagnostic imaging and appeared specific to patients with UIA. This suggests a need to select appropriate nursing methods adapted to the situation of each patient that can both reduce and manage their uncertainty. Developing an uncertainty scale for UIA patients based on the structural concepts clarified in this study and investigating reliability and validity of scores are topics for future research.

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Mitsumi Masuda, PhD, RN, is Lecturer, Nursing Science, School of Nursing, Adult Nursing and Critical Care Nursing, Tokyo Women’s Medical University, Japan.

Hidenori Oishi, PhD, MD, is Professor, Medical Science, Graduate School of Medicine, Neurosurgery and Neuroendovascular Therapy, Juntendo University, Tokyo, Japan.

Munetaka Yamamoto, PhD, MD, is Associate Professor, Medical Science, School of Medicine, Neurosurgery, Juntendo University, Tokyo, Japan.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s web site (

Accepted for publication May 20, 2014.

The authors acknowledge that this study received funding assistance from JSPS KAKENHI Grant Number 24890253.

The authors are grateful to the subjects of this study who provided us with invaluable information. They would also like to thank Head Nurse Director Noriko Teruanuma of service department for their understanding and cooperation as well as the outpatient nurses, senior staff, doctors, and nurses of the hospital ward.

The authors have no conflicts of interest to report.

Corresponding author: Mitsumi Masuda, PhD, RN, Tokyo Women’s Medical University, 8-1, Kawata-cho, Shinjuku-ku, Tokyo, 161-8666, Japan (e-mail:

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins.