Quality of life and its predictors among women with gynaecological cancers

BackgroundSurvival rates among gynaecological cancer patients have increased over time; however, patients must now cope with long-term treatment-related issues affecting their quality of life (QOL). Little is known about the factors influencing QOL in patients with gynaecological cancers in the Chinese population.AimTo identify QOL predictors among patients with gynaecological cancers, and examine the relationship between QOL and demographics, stress, coping strategies, and social support. Methods: A cross-sectional survey was conducted with 111 patients who were recruited from the gynaecological oncology outpatient department of a hospital in Taiwan.FindingsPatients’ QOL was positively correlated with marriage, emotion-focused coping, problem-focused coping, and social support. QOL was negatively correlated with malfunctioning coping strategies and stress. Regression models accounted for 19%–30% of the variance across the four domains of QOL. Stress was a significant predictor of all QOL domains. Social support was the main predictor of the social relationships and environment QOL domains. The lowest QOL score was for sexual life.DiscussionPatients with gynaecological cancers reported lower levels of satisfaction with the social relationships and psychological health domain of QOL. Diagnosis and treatment for a gynaecological cancer may impact how women perceive their femininity and relationship with their husband.ConclusionsThis study provides a comprehensive picture for nurses to understand the factors associated with QOL among patients with gynaecological cancers in the Chinese cultural context. Screening for stress is important since stress was the main predictor for all domains of QOL among patients. Providing support, especially familial and emotional support, to patients with Chinese cultural backgrounds is critical because of their family values. Offering a private space to discuss the patients’ concern and carefully observing their non-verbal language are essential because these patients often do not talk about their cancer and sexual life openly and publicly.     

慢性心力衰竭患者生活质量与社会支持的相关性研究

目的探讨慢性心力衰竭患者生活质量和社会支持的相关性。方法采用心功能不全生活质量量表和社会支持评定量表对111例慢性心力衰竭患者进行调查。结果慢性心力衰竭患者的生存质量得分（62．13±16．27）分,社会支持总分（24．17±7．64）分,两者呈显著正相关（P〈0．01）。结论慢性心力衰竭患者的生存质量受社会支持程度的影响,通过实施综合的护理于预措施予以支持,以提高患者的生存质量：     

慢性稳定性心力衰竭患者睡眠状况与生活质量的相关性

目的探讨慢性稳定性心力衰竭患者睡眠状况与其生活质量的关系。方法应用瑞典心力衰竭患者睡眠调查表(uppsala sleep inventory-chronie heart failure,USI-CHF)和健康调查简表(the MOSitemshort from health survey,SF-36),对120例慢性稳定性心力衰竭患者(慢性心力衰竭组)的睡眠状况、生活质量进行评估。同期选择60例与心力衰竭患者在年龄、性别、文化层次和社会地位方面相匹配的健康成人作对照(健康对照组)。结果与健康对照组相比,慢性心力衰竭组患者存在明显的睡眠障碍(P<0.05),主要表现为入睡困难和睡眠维持困难;其生活质量在SF-36量表的所有8个项目中评分均明显降低(P<0.01),尤以生理功能和躯体角色方面最为显著。结论慢性稳定性心力衰竭患者睡眠障碍发生率高,生活质量明显下降,应引起医护人员重视,予以积极干预。     

Social and structural determinants and their associations with patient experience in the emergency department

BackgroundImproving patient experience and satisfaction in the emergency department (ED) is challenging but beneficial. Previous studies have shown an association between social and structural factors and patient satisfaction. This study examined the structural and social factors related to the ED patient experience among Jewish and Arab patients in a Jerusalem hospital.MethodsA cross-sectional study was conducted among ED patients in a Jerusalem hospital. Data were collected via questionnaires. The sample included 257 Jewish patients and 170 Arab patients. The outcome variable was a positive or negative ED experience.ResultsJewish and Arab patients had different factors related to ED experience. Cultural differences, including a language barrier and access to information, were associated with a negative experience among Arab patients. Among Jewish patients, frequent use of community health services was associated with a negative ED patient experience.ConclusionThis study shows an association between social and structural factors and patient experience, illustrating gaps for and vulnerability of different ethnic groups that affect their experience with healthcare services. Understanding these issues and implementing solutions formulated at the institutional and national levels can promote equity by providing structurally competent care.     

Relationships between coping, coping resources and quality of life in patients with chronic illness: a pilot study

Scand J Caring Sci; 2011; 25; 476–483
Relationships between coping, coping resources and quality of life in patients with chronic illness: a pilot study Background: In Sweden there are approximately about 3500 end‐stage renal disease (ESRD) and 250 000 chronic heart failure (CHF) patients. Objectives: The original purpose of the study was to determine differences between two groups of patients with chronic illness (ESRD and CHF) regarding the following study variables: coping, sense of coherence (SOC), self‐efficacy and quality of life (QOL). Following this, the aim was to explore the relationships between demographic variables (sex, age, educational level and living area) and QOL as well as between coping, SOC, self‐efficacy and QOL for the combined sample of patients with ESRD and CHF. Methods: A comparative and correlative design was used with a sample of 100 patients (n = 41 ESRD, n = 59 CHF). The data were collected during 2004, using four standardized questionnaires and regression analyses were conducted. Results: No significant differences were found between the two groups. Positive correlations were identified between SOC, general self‐efficacy and QOL, whereas negative correlations emerge between emotion‐focused coping, SOC, general self‐efficacy and QOL. SOC, general self‐efficacy and emotion‐focused coping explained 40% of the variance in QOL. Those with low SOC and general self‐efficacy showed negative correlations between emotion‐focused coping and QOL, whereas no such correlations were shown for those with high values on SOC and general self‐efficacy. Conclusions: The present results on coping and QOL correspond with previous research regarding how other groups with chronic illness handled their daily life. Preliminary results indicate that how individuals tackle their present situation is more important than which chronic illness they have. Women used more emotion‐focused coping than men, which constitute an important finding for further research.     

Symptom clusters and quality of life in Chinese patients with heart failure

BackgroundEffective symptom assessment and management can improve quality of life in patients with heart failure. However, how psychological symptom cluster, physical symptom cluster and heart failure symptom cluster influence the quality of life of patients with heart failure remains unknown.Aims(a) To describe the symptom clusters among Chinese patients with heart failure (HF), (b) explore the relationship between symptom clusters and quality of life (QOL), and (c) detect if physical and psychological symptoms are mediators of the association between heart failure symptom and QOL.MethodsThree hundred and one patients with heart failure completed measures of symptom (MSAS), QOL and demographic and clinical characteristics. Multiple regression analysis was used to analyse the data.FindingsThe mean age of participants was 72.19 years (range 31–96 years). Each patient was approximately accompanied by an average of 11.19 symptoms (range 0–31), and the top six most common symptoms of Chinese HF patients were shortness of breath, difficulty sleeping, difficulty breathing when lying flat, lack of energy, lack of appetite and cough. Both physical symptom cluster and psychological symptom cluster were the mediators of the relationship between heart failure symptom cluster and QOL.ConclusionsThere were mediating effects of physical symptom cluster and psychological symptom cluster between heart failure symptom cluster and QOL in Chinese patients with HF. Operative assessment, management and alleviation of physical symptoms and psychological symptoms should be prioritised in symptom management strategies for the clinical caregivers.     

社会支持对肝癌患者生活质量的影响

目的:探讨肝癌患者的社会支持情况及其对生活质量(QOL)的影响,寻找提高其生活质量的方法。方法:对102例住院肝癌患者所获得的社会支持、生活质量进行问卷调查,并与正常人(对照组)进行比较,分析癌症患者的社会支持与其生活质量的相关性。结果:肝癌患者的生活质量低于对照组,肝癌患者的社会支持高于国内常模(P<0.01),社会支持与生活质量呈正性相关关系。结论:与正常人相比肝癌患者的生活质量低,获得的社会支持高,重视和利用家庭、邻居、同事、病友及护士等社会支持来源可改善护理效果、提高肝癌患者的生活质量。     

程序康复对急性心肌梗死患者生活质量的影响

目的 :观察 2周程序康复能否改善急性心梗 (AMI)患者的生活质量 (QOL)。方法 :通过多种QOL问卷(QOLQ)对顺利完成早期康复计划的 2 1例AMI患者进行QOL评估。结果 :对完成程序康复的AMI患者 (平均住院时间为 15 .4 1± 3 .76天 )通过WHOQOL等量表进行QOLQ的测试 ,主观感受积分较对照组高 (P <0 .0 0 1) ,在生理、心理及环境领域的得分亦高于对照组 (P <0 .0 0 0 1)。结论 :AMI患者早期程序康复可改善患者的生活质量     

The Reliability,Validity and Practical Utility of Measuring Supports using the I‐CAN Instrument: Part II

Background There is an urgent need for developing reliable, valid and practical instruments that assess and classify the support needed by persons with disability to function in their chosen living, working and social environments. I‐CAN is an instrument that addresses the frequency and level of support needed (not individual skills or deficits) for each individual with a disability. Method Studies were conducted to assess the test–retest reliability and inter‐rater reliability. Concurrent validity was investigated by exploring the relationship between the I‐CAN domain scales and the Inventory for Client and Agency Planning (ICAP) ( Bruininks et al. 1986 ) and the Quality of Life Questionnaire (QOL‐Q) ( Schalock & Keith 1993 ). Predictive validity studies were undertaken using day‐ and night‐time support hours. Regression analyses were run using these measures with I‐CAN domain scales. Two independent studies were also conducted to ascertain the practical utility of the instrument. Results The I‐CAN instrument demonstrated excellent inter‐rater and test–retest reliability in the Activities and Participation domains. Low‐to‐moderate test–retest results in Physical Health, Mental Emotional Health and Behaviour domains were tracked to actual change in support needs in these areas. Validity proved acceptable. The relationships between I‐CAN domain scales and adaptive behaviour were mixed but in the expected direction. Low‐to‐moderate correlation coefficients were evident between the I‐CAN scales and the QOL‐Q Total, but greater support needed in certain domains was associated with less empowerment and independence, and less community integration and social belonging. Attempts to explain current support hours against the I‐CAN scales were disappointing and suggest that a number of other factors apart from individual support need to play a significant role. There was general satisfaction with the assessment process from stakeholders and participant groups. Conclusions I‐CAN is a reliable, valid and user‐friendly instrument for assessing the support needs of people with disabilities. It uses a process that involves the persons with disability, their family and friends and staff as appropriate. It is also apparent that the current provision of paid support hours by agencies is a complex phenomenon that is not based solely on individual support needs. Further research is warranted on the influence of the environment and the perceptions of need for support based on negotiable and non‐negotiable support needs.     

Translating and testing the Liver Disease Symptom Index 2.0 for administration to people with liver cirrhosis in Egypt

The Liver Disease Symptom Index (LDSI) 2.0 is a simple, short and specific liver disease questionnaire in English, but an Arabic version does not exist, therefore we translated the LDSI‐2.0 into Arabic and tested its psychometric properties in a pilot cross‐sectional study. A convenience sample of 38 patients with liver cirrhosis from one hospital in Cairo, Egypt, were interviewed for approximately 45 min. Patients completed a background data sheet, the translated LDSI‐2.0 and the Short Form (SF)‐36v₂. Construct convergent validity was examined by correlating LDSI‐2.0 items with the SF‐36v₂ eight domains. Reliability was estimated using measures of internal consistency, test–retest reliability and internal consistency reliability. Median completion time was 10 min. The correlation between the translated LDSI‐2.0 items and the SF‐36 domains confirmed that there was moderate to high overlapping between the two measures, suggesting convergent validity of the LDSI‐2.0. The LDSI‐2.0 showed good to very good retest reliability (kappa value 0.62–0.94). Chronbach's alpha coefficient for the multi‐item scales ranged from 0.73 to 0.96. The Arabic LDSI‐2.0 therefore has satisfactory validity, retest reliability and internal consistency.     

Study of unmet needs in symptomatic veterans with advanced cancer: incidence, independent predictors and unmet needs outcome model

Veteran patients possess distinctive characteristics such as a higher mortality rate, lower socioeconomic status and poorer health status. We report the prevalence and predictors of unmet needs and examine the association between unmet needs and quality of life (QOL). Two hundred ninety-six male cancer patients who presented with distressing symptom(s) completed the following instruments: a 14-item multidimensional unmet needs questionnaire, Functional Assessment of Cancer Therapy (FACT-G), Memorial Symptom Assessment Scale-Short Form (MSAS-SF) and other validated measurements of function, depression, health and social support. Multiple linear regression models were used to identify independent predictors of each unmet needs domain and of total unmet needs. The relationships between total unmet needs, QOL and multidimensional variables were also explored. The median number of total unmet needs was three, and the most frequently reported unmet needs areas were physical (80.0%), activities of daily living (53.3%), nutrition (46.1%) and emotional (32.5%). Different predictors of each unmet needs domain were identified. Younger age was associated with a higher risk of unmet needs in physical, economic and medical domains. Higher psychological symptom distress was associated with more unmet needs in the emotional/social, economic and medical domains. Physical symptom distress, extent of disease and health measure were only significant in the physical unmet needs domain. The depression, psychological and physical symptom distress scores, confident and affective social support scores, total unmet needs and age independently predicted FACT-G total QOL score (R(2)=63%, P < 0.00001). Patients with higher psychological, physical symptom distress and depression scores, younger age, lower functional status and metastatic disease were more likely to report more unmet needs. The total number of unmet needs was predictive of QOL. The unmet needs and QOL outcomes model was developed but needs further validation.     

Quality of life of adults with spinal cord injury: a study using the WHOQOL-bref

The objective of this study was to evaluate the quality of life (QOL) of adults with spinal cord injury and to identify the domains that may influence QOL. Data was collected using the WHOQOL-bref and a questionnaire with sociodemographic variables. Participants were 47 subjects, with a mean age of 42.95 years, 91.5% males and 8.5% females. The domains obtained the following scores: physical (58.59), psychological (63.82), social (68.79), and environmental (55.20). Through multiple linear regression, it was verified the correlation between domain scores and the perception of QOL: physical (p <0.187), psychological (p <0.399), social (p <0.000), and environmental (p <0.008). In conclusion, most participants (55.3%) are unsatisfied with their QOL, and the social and environmental domains showed a higher correlation with QOL.     

Perceptions of persons with Parkinson's disease,family and professionals on quality of life: an international focus group study

Purpose.?Parkinson's disease (PD) is a progressive neurodegenerative disorder. Motor and non-motor symptoms have an impact on persons' lives. To what extent this is effecting persons' quality of life (QOL) is not clear. Therefore, the aim of this qualitative study was to identify factors that persons perceive as eminently important for QOL.

Method.?Focus groups were employed with persons with PD, caregivers and health professionals.

Results.?The results, obtained through thematic and conceptual qualitative analysis, largely support the framework of domains and facets of the World Health Organization Quality of Life (WHOQOL) assessment instrument. Three new themes were identified, reflecting (i) practical adaptations to PD, (ii) personal adaptations to PD and (iii) the ability to communicate and the availability of communication supports.

Conclusion.?This study demonstrated that focus groups are a valid and reliable way of eliciting views on QOL from persons with PD, caregivers and professionals. The focus group method confirmed the original WHOQOL parameters and also provided some new QOL themes. In addition, the results of this study pointed out that the impact of PD on QOL goes beyond the physical, social and emotional domains of health-related QOL (HRQOL).     

Living with cardiac resynchronization therapy: Challenges for people with heart failure

The number of people with heart failure requiring implantation of a cardiac resynchronization device is increasing in Iran. Although this intervention is an effective life‐saving treatment, several challenges are associated with patients’ lifestyle after insertion. This study identified the challenges and coping mechanisms of Iranians with heart failure living with cardiac resynchronization therapy. A qualitative approach using conventional content analysis was adopted. Seventeen people with heart failure and three nurses were recruited between December 2014 and November 2015 from a teaching hospital and a private clinic in Rasht, Iran. Participants were interviewed using semi‐structured interviews lasting 30–60 min. Five themes emerged: (i) fear of implantation, (ii) the panic of receiving a shock from the device, (iii) lack of control over life, (iv) inadequacies of the healthcare system, and (v) psychosocial coping. A heightened understanding of these challenges and coping strategies could prepare healthcare professionals to provide better routine care, education, and support to the recipients of cardiac resynchronization therapy prior to implantation, during the recovery period, and for long‐term management.     

The Quality of Life of Family Caregivers of Adults with Intellectual Disabilities in Taiwan

Background Taiwanese family carers of people with intellectual disabilities not only suffer from long‐term stress but also need to cope with social difficulties. The aim of this study is to evaluate the quality of life (QOL) among family carers of people with intellectual disabilities. Materials and methods A census interview survey was conducted in Hsin‐Chu City in Taiwan and included the primary family caregivers of 792 adults with intellectual disability who were living with their families. The survey packet contained the WHOQOL‐BREF Taiwan‐version scale with four core domains and the activities of daily life/instrumental activities of daily life (ADL/IADL) scales. Results The mean score for ‘physical’ was highest and that for ‘environment’ was lowest. The strongest predictors of caregivers QOL were the caregiver's health status, their family income and the level of severity of the intellectual disability of the adult. Conclusions The results of the study support the need to expand services and individualize support to families of adults with intellectual disability living in family homes.     

Cross-cultural adaptation,reliability and validity of the Arabic version of the reduced Western Ontario and McMaster Universities Osteoarthritis index in patients with knee osteoarthritis

Purpose: We adapted the reduced Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index for the Arabic language and tested its metric properties in patients with knee osteoarthritis (OA). Methods: One hundred and twenty-one consecutive patients who were referred for physiotherapy to the outpatient department were asked to answer the Arabic version of the reduced WOMAC index (ArWOMAC). After the completion of the ArWOMAC, the intensity of knee pain and general health status were assessed using the visual analog scale (VAS) and the 12-item short form health survey (SF-12), respectively. A second assessment was performed at least 48?h after the first session to assess test–retest reliability. The test–retest reliability was quantified using the intra-class correlation coefficient (ICC), and Cronbach’s alpha was calculated to assess the internal consistency of the Arabic questionnaire. The construct validity was assessed using Spearman rank correlation coefficients. Results: The total ArWOMAC scale and pain and function subscales were internally consistent with Cronbach’s coefficient alpha of 0.91, 0.89 and 0.90, respectively. Test–retest reliability was good to excellent with ICC of 0.91, 0.89 and 0.90, respectively. SF-12 and VAS score significantly correlated with ArWOMAC index (p?Conclusions: The ArWOMAC index is a reliable and valid instrument for evaluating the severity of knee OA, with metric properties in agreement with the original version.

• Implications for Rehabilitation

• Although, the reduced WOMAC index has been clinically utilized within the Saudi population, the Arabic version of this instrument is not validated for an Arab population to measure lower limb functional disability caused by OA.

• The Arabic version of reduced WOMAC (ArWOMAC) index is a reliable and valid scale to measure lower limb functional disability in patients with knee OA.

• The ArWOMAC index could be suitable in Saudi Arabia and other Arab countries where the language, culture and the life style are similar.