Impact of cancer patients’ quality of life on that of spouse caregivers

Goals of work This study aimed to examine the correlation between quality of life (QOL) in cancer patients and that of their spouse caregivers and to identify factors that influence this correlation.Patients and methods This cross-sectional study collected data from 121 cancer patient/spouse caregiver dyads. The Functional Assessment of Cancer Therapy Scale-General (FACT-G) was used to measure patients QOL, and the Caregiver Quality of Life Index (CQLI) was used to measure spouse caregivers QOL. Correlation coefficients between patients and caregivers QOL were computed for four dimensions of QOL, as well as a total score for QOL. Correlations between patients and caregivers total QOL scores were furthered analyzed by three groups of factors: disease-/treatment-related, caregiving-related, and relationship-related variables.Main results Only the social/family and functional dimensions of patient QOL and total score for patient QOL were associated with each dimension of their caregivers QOL and with the total score (r=0.27–0.44). Physical and emotional dimensions of patients QOL did not significantly influence spouse caregivers QOL for any dimension nor for the total score. Factors influencing the association between patients and caregivers overall QOL included cancer diagnosis, length of hospitalization, caregiving intensity and duration, marital satisfaction, and caregiving self-esteem.Conclusions Social and functional aspects of patients QOL play a significant role in determining the QOL of their spouse caregivers. The strength of association between patients and spouse caregivers overall QOL can be moderated by some factors.     

The effect of the patient–physician relationship on health-related quality of life after cardiac rehabilitation

Purpose The patient–physician relationship has effects on adherence and health outcomes in chronic diseases. This prospective study investigates the effect of the patient–physician relationship on patients’ health-related quality of life (HRQOL) in the context of cardiac rehabilitation. Methods Three hundred and thirty-eight German patients filled out questionnaires at the start and end of rehabilitation and at 6 months follow-up. Patient–physician relationship variables surveyed were patient involvement (perceived involvement in care scales), trust in the physician, patient satisfaction (PHYSAT) and physician’s communicative behaviour (KOVA). After adjusting for multiple confounders, hierarchical regression analyses were conducted to predict the influence of the patient–physician relationship on HRQOL after rehabilitation. We further examined clinical relevance using minimal clinically important differences (MCID). Results In the hierarchical regression analyses, 42.8–54.9% of the variance at the end of rehabilitation and 22.4–40.5% at follow-up were explained. The patient–physician variables patient satisfaction, physician’s emotionally supportive communication and effective and open communication accounted for 1.4–2.6% of the variance and proved statistically and clinically significant for HRQOL change. Further predictors for better HRQOL were higher income and less trait anger. Conclusion Aspects of the patient–physician relationship are significant predictors for patients’ HRQOL after rehabilitation. Rehabilitation physicians should emotionally support the patients and communicate in an effective and open manner to enhance HRQOL.

• Implications for rehabilitation

• Aspects of the patient–physician relationship have effects on adherence and clinical outcomes in chronic diseases.

• In this cardiac sample, the patient–physician relationship had an influence on patients’ health-related quality of life (HRQOL) after inpatient rehabilitation.

• Rehabilitation physicians should emotionally support and encourage the patients and communicate with them in an effective and open manner to enhance patients’ HRQOL.

     

CuidaCare: effectiveness of a nursing intervention on the quality of life’s caregiver: cluster-randomized clinical trial

Background

In Spain, family is the main source of care for dependent people. Numerous studies suggest that providing informal (unpaid) care during a prolonged period of time results in a morbidity-generating burden. Caregivers constitute a high-risk group that experiences elevated stress levels, which reduce their quality of life. Different strategies have been proposed to improve management of this phenomenon in order to minimize its impact, but definitive conclusions regarding their effectiveness are lacking.

Methods/Design

A community clinical trial is proposed, with a 1-year follow-up period, that is multicentric, controlled, parallel, and with randomized allocation of clusters in 20 health care centers within the Community of Madrid. The study's objective is to evaluate the effectiveness of a standard care intervention in primary health care (intervention CuidaCare) to improve the quality of life of the caregivers, measured at 0, 6, and 12 months after the intervention. One hundred and forty two subjects (71 from each group) ≥65 years, identified by the nurse as the main caregivers, and who provide consent to participate in the study will be included. The main outcome variable will be perceived quality of life as measured by the Visual Analogue Scale (VAS) of EuroQol-5D (EQ-5D). The secondary outcome variables will be EQ-5D Dimensions, EQ-5D Index, nursing diagnosis, and Zarit's test. Prognostic variables will be recorded for the dependent patient and the caregiver. The principle analysis will be done by comparing the average change in EQ-5D VAS value before and after intervention between the two groups. All statistical tests will be performed as intention-to-treat. Prognostic factors' estimates will be adjusted by mixed-effects regression models. Possible confounding or effect-modifying factors will be taken into account.

Discussion

Assistance for the caregiver should be integrated into primary care services. In order to do so, incorporating standard, effective interventions with relevant outcome variables such as quality of life is necessary. Community care nurses are at a privileged position to develop interventions like the proposed one.

Trial registration

This trial has been registered in ClinicalTrials.gov under code number NCT01478295.     

Impact of caregivers’ unmet needs for supportive care on quality of terminal cancer care delivered and caregiver’s workforce performance

Goals of work

Family caregivers play an important role in caring for cancer patients, but the impact of caregivers’ unmet needs on the quality of end-of-life (EOL) care they deliver and on their workplace performance are less understood.

Patients and methods

We identified 1,662 family caregivers of cancer patients who had died at any of 17 hospitals in Korea during 2004. The caregivers answered a telephone questionnaire about needs that were not met when they delivered terminal cancer care and how those unmet their needs affected their workplace performance; they also answered the Quality Care Questionnaire-End of Life (QCQ-EOL).

Results

Compared with caregivers who did not have unmet needs, caregivers who had unmet needs for symptom management, financial support, or community support showed poorer QCQ-EOL scores (P?<?0.01). Caregivers who had unmet needs for financial support (adjusted odds ratio (aOR)?=?7.55; 95% confidential interval (CI) 3.80–15.00), psychosocial support (aOR?=?6.24; 95% CI 2.95–13.05), symptom management (aOR?=?3.21; 95% CI 2.26–4.54), community support (aOR?=?3.82; 95% CI 2.38–6.11), or religious support (aOR?=?4.55; 95% CI 1.84–11.26) were more likely to experience work limitations. Caregivers of patients receiving conventional hospital care were more likely to have unmet needs for symptom management (aOR?=?1.21; 95% CI 1.00–1.47), psychosocial support (aOR?=?1.99; 95% CI 1.37–2.88), and religious support (aOR?=?1.73; 95% CI 1.08–2.78) than those of patients receiving palliative hospice care.

Conclusions

Caregivers’ unmet needs negatively affected both the quality of EOL care they delivered and their workplace performance. More investment in caregiver support and public policies that meet caregiver needs are needed, and hospice use should be encouraged.     

The effect of SSP therapy on elderly nursing home residents’ chronic constipation

[Purpose] The aim of the present study is to examine the effects of silver spike point therapy on elderly persons’ chronic constipation. [Subjects and Methods] The subjects of the present study were 30 elderly chronic-constipation sufferers who resided in a nursing home and had other physical conditions that necessitated wheelchair ambulation. There were three test groups in the present study: an silver spike point group, an acupuncture group, and a control group; 10 subjects were assigned to each group. The silver spike point group and the acupuncture group received their respective interventions, which were applied to both sides of the Tiensu for 20 minutes per day, five days per week, over a four week period. Weekly bowel movement frequency was recorded, and the Constipation Assessment Scale and Bowel Function Assessment Form were used as data-gathering instruments. [Results] Following treatment, the silver spike point and acupuncture groups showed significant improvement, based on the Constipation Assessment Scale and the Bowel Function Assessment Form, compared with the control group. [Conclusion] Based on the above results, silver spike point therapy can be administered to alleviate chronic constipation in elderly nursing home residents who cannot walk independently due to declining physical functions.Key words: Constipation, Elder, Silver spike point therapy     

Long-term impact of stroke on patients’ health-related quality of life

Purpose: This international study aims to examine the size and determinants of the impact of stroke on five-year survivors’ health-related quality of life (HRQoL) in four different European countries.

Method: Patients were recruited consecutively in four European rehabilitation centers. Five years after stroke, the EuroQol-visual analog scale (EQ-VAS) was administered in 226 first-ever stroke patients. Impact of stroke was determined by calculating EQ-VAS z-norm scores (= deviation – expressed in SD – of patients’ EQ-VAS level relative to their age-and gender-matched national population norms). Determinants of EQ-VAS z-norm scores were identified using multivariate linear regression analysis.

Results: Five years post-stroke, patients’ mean EQ-VAS was 63.74 (SD?=?19.33). Mean EQ-VAS z-norm score was ?0.57 [95%CI: (?0.70)–(?0.42)]. Forty percent of the patients had an EQ-VAS z-norm score SD; 52% had an EQ-VAS z-norm score between ?0.75 and?+0.75 SD, only 8% scored >+0.75 SD. Higher patients’ levels of depression, anxiety and disability were associated with increasingly negative EQ-VAS z-norm scores (adjusted R^2?=^?0.392).

Conclusions: Five years after stroke, mean HRQoL of stroke survivors showed large variability and was more than ½ SD below population norm. Forty percent had a HRQoL level below, 52% on, and 8% above population norm. The variability could only partially be explained by the variables considered in this study. Longitudinal studies are needed to increase our understanding of the size and determinants of the impact of stroke on the HRQoL of long-term stroke survivors.

• Implications for rehabilitation

• The current European concept of stroke rehabilitation is focused on the acute and sub-acute rehabilitation phase, i.e., in the first months after stroke. The results of this study show that at five years after stroke, the mean level of HRQoL of stroke survivors remains below the healthy population level. This finding shows the need for continuation of rehabilitation in the chronic phase.

• At five years after stroke, higher patients’ levels of depression, anxiety and disability were associated with lower scores for HRQoL. This finding implicates that chronic rehabilitation programs should be multi-faceted in order to increase long-term survivors’ psychosocial outcomes.

     

The effects of cognitive exercise therapy on chronic stroke patients’ upper limb functions,activities of daily living and quality of life

This study aimed to examine the effects of task-oriented exercise therapy and cognitive exercise therapy on the recovery of hand function and the quality of life in chronic stroke patients. [Subjects and Methods] A total of 16 patients with chronic stroke were selected and divided into two groups. Group I (n = 8) received task-oriented exercise therapy and Group II (n = 8) received cognitive exercise therapy. This study was conducted for eight weeks. Upper limb function was assessed using the Fugl-Meyer assessment (FMA) and manual function test (MFT); activities of daily living were assessed using the motor activity log (MAL); and the quality of life was assessed using the stroke impact scale (SIS). The pre- and post-intervention results of these tests were analyzed. [Results] There were significant differences in all areas of upper limb function, activities of daily living, and quality of life between the two groups. There were significant differences between the two groups in the post-intervention upper limb function and quality of life. [Conclusion] Application of cognitive exercise therapy was found to effect functional recovery in stroke patients. Future research should focus on application of cognitive exercise therapy in diverse populations, and assess its clinical utilization.Key words: Stroke, Cognitive exercise therapy, Quality of life     

The effect of a community-based spiritual life review program on Indonesian elders’ resilience

Objective

This quasi-experimental, pre-/post-test study aimed to examine the effect of a community-based spiritual life review program on the resilience of elders residing in a disaster-prone area.

Reprint of Recovery programme for ICU survivors has no effect on relatives’ quality of life: Secondary analysis of the RAPIT-study

BackgroundRelatives of intensive care patients are at risk of developing symptoms of anxiety, depression and posttraumatic stress resulting in reduced health-related quality of life. Recovery programmes for patients have been implemented, but their effect on relatives is uncertain.AimTo determine whether relatives benefit from a recovery programme intended for intensive care survivors.Research designA randomised controlled trial of 181 adult relatives: intervention group (n = 87), control group (n = 94).SettingTen intensive care units in Denmark.Main outcome measuresPrimary outcome: health-related quality of life (HRQOL). Secondary outcomes: Sense of coherence (SOC), and symptoms of anxiety, depression and posttraumatic stress, compared to standard care at 12 months after intensive care discharge.ResultsNo difference in HRQOL between groups was observed at 12 months (mean difference in mental component summary score, 1.35 [CI 95%: −3.13; 5.82], p = 0.55; and physical component summery score, 1.86 [CI 95%: −1.88; 5.59], p = 0.33). No differences were found in secondary outcomes.ConclusionThe recovery programme intended for intensive care survivors did not have an effect on the relatives. Future recovery programmes should be targeted to help both patient and family, and future research should be conducted on a larger scale to make conclusions with higher probability.     

The relationship between comorbidities in dementia patients and burden on adult–child primary caregivers: Does having a secondary caregiver matter?

Primary family caregivers of patients with dementia often experience high caregiver burden and significant decline in a range of health outcomes. The current study examined the relationship between medical comorbidities of inpatients with dementia and caregiver burden in adult–child primary caregivers, and the buffering effect of having a secondary caregiver on the relationship between patients’ comorbidities and caregiver burden. The study is a secondary analysis of data from a cross‐sectional observational study design. The sample comprised 477 dyads of inpatients with dementia and adult–child primary caregivers attending the neurological department of two grade A hospitals. All the inpatients were assessed with the Charlson Comorbidity Index (CCI) and the Mini‐Mental State Examination (MMSE). All the adult–child primary caregivers were assessed with the Zarit Burden Interview (ZBI) and completed the questionnaires on socio‐demographic data, caring hours, presence of secondary caregiver, and the level of impairment of the patient. Higher burden was associated with higher scores on the CCI and having a spouse of the patient as the secondary caregiver. A significant interaction occurred between the CCI and caregiver burden when having a spouse as the secondary caregiver, indicating the negative effect of the CCI on caregiver burden was greater when the spouse of the patient served as the secondary caregiver. In summary, the negative impact of patients’ comorbidities on caregiver burden in adult–child primary caregivers was heightened when the secondary caregiver role was undertaken by the spouse of the patient with dementia. These results may inform programmes targeted to improve care arrangements for people with dementia and their caregivers.     

The relationship between stroke patients’ socio-economic conditions and their quality of life: the 2010 Korean community health survey

[Purpose] The relationship between stroke patients’ socio-economic conditions and quality of life (QOL) using the 2010 Korean Community Health Survey (KCHS) statistics was examined. [Subjects and Methods] A total of 4,604 stroke patients were analyzed. Socio-economic conditions were sex, age, educational level, monthly household income, occupation, residential area, and living with family. [Results] The results show a statistically significant lower QOL for men than for women, for those aged 75 years or over compared to individuals between 19 years and 64 years, and for elementary (or lower) or middle school graduates compared to higher education graduates. QOL was also significant lower among patients whose household income was KRW4 million (US$3,746.72) or less a month. Finally, QOL was significantly lower for patients without an occupation compared to those with an occupation, for patients in rural areas compared to urban areas, and for patients who did not live with family compared to those who lived with family. [Conclusion] We showed the importance of the relationships between socio-economic conditions and QOL of stroke patient.Key words: Stroke, Quality of life, Korean Community Healthy Survey     

The impact of a high-grade glioma on everyday life: A systematic review from the patient’s and caregiver’s perspective

BackgroundWith poor prognosis and disabling symptomatology high-grade gliomas affect not only the patient but also the family.PurposeThe aim of this systematic review is to explore the experiences and needs of patients with a high-grade glioma and their family caregivers.MethodBased on literature search in six databases, sixteen qualitative studies, published between 2000 and 2010 and with mixed methodological quality, were included.ResultsFor both patients and their caregivers the diagnosis is marked by shock and recognition of death. For patients, coping with restriction seems to be most difficult to deal with. Especially loss of autonomy is hard. For caregivers, neurocognitive symptoms and personality changes irreversibly change the relationship with the patient leading to caregivers expressing a sense of total responsibility. The experience of being a caregiver is described by positive as well as negative feelings. Both patients and caregivers describe the need for hope, support and information.ConclusionThe review provides some relevant insight in the experiences and needs of patients with a high-grade glioma and their caregivers. The methodological limitations of the included studies, however, urge for more research to refine our understanding of patients’ and caregivers’ experiences and needs to better tune care to their needs.     

The effect of a quality improvement initiative on the quality of other aspects of health care: the law of unintended consequences?

PROBLEM: Policymakers and clinicians are concerned that initiatives to improve the quality of care for some conditions may have unintended negative consequences for quality in other conditions. OBJECTIVE: We sought to determine whether a practice redesign intervention that improved care for falls, incontinence, and cognitive impairment by an absolute 15% change also affected quality of care for masked conditions (conditions not targeted by the intervention). DESIGN, SETTING, AND PARTICIPANTS: Controlled trial in 2 community medical groups, with 357 intervention and 287 control patients age 75 years or older who had difficulty with falls, incontinence, or cognitive impairment. INTERVENTION: Both intervention and control practices implemented case-finding for target conditions, but only intervention practices received a multicomponent practice-change intervention. Quality of care in the intervention practices improved for 2 of the target conditions (falls and incontinence). MAIN OUTCOME MEASURES: Percent of quality indicators satisfied for a set of 9 masked conditions measured by abstraction of medical records. RESULTS: Before the intervention, the overall percent of masked indicators satisfied was 69% in the intervention group and 67% in the control group. During the intervention period, these percentages did not change, and there was no difference between intervention and control groups for the change in quality between the 2 periods (P=0.86). The intervention minus control difference-in-change for the percent of masked indicators satisfied was 0.2% (bootstrapped 95% confidence interval, -2.7% to 2.9%). Subgroup analyses by clinical condition and by type of care process performed by the clinician did not show consistent results favoring either the intervention or the control group. CONCLUSION: A practice-based intervention that improved quality of care for targeted conditions by an absolute 15% change did not affect measurable aspects of care on a broad set of masked quality measures encompassing 9 other conditions.     

Do the self-concept and quality of life decrease in CP patients? Focussing on the predictors of self-concept and quality of life

Purpose.?To find out if the quality of life (QOL) and self-concept of the children with cerebral palsy (CP) was different from that of children without disability, to investigate predictive variables that could affect self-concept and QOL.

Methods.?A total of 40 children with CP and 46 age-matched peers were included. The baseline characteristics including sex, type of CP, the level of disability according to Gross Motor Function Classification System (GMFCS) were recorded. Education levels of both children and parents, demographic features of parents, features of living area, usage of devices and associated impairments were filled out. Self-concept was measured using Piers–Harris Self-concept (PH) Scale. Quality of life was measured by Pediatric Quality of Life Inventory 4.0 (PedsQL). The physical and psychosocial health subscale scores of PedsQL (P-PedsQL and PS-PedsQL) were recorded.

Results.?Significant differences in mean scores favouring the control group were found for PH scale, PedsQL scale (p?<?0.001). P-PedsQL and PS-PedsQL of the CP group were lower than the control group (p?<?0.001). PS-PedsQL report was significant predictor of self-concept. The presence of incontinence and GMFCS level were significant predictors of PedsQL and PPedsQL, respectively.

Conclusion.?Self-concept and QOL of the CP children were lower than the children without CP. Presence of incontinence, self-concept rating and GMFCS level were important to predict domains of QOL.     

Impact of skin conditions of infants on their mothers’ quality of life

Many parents worry about their infants' skin conditions, which can greatly impact their quality of life (QOL). This is applicable even to skin problems that are not severe enough to require medical intervention. This study aimed to explore the impact of infants' skin problems on their mothers' QOL depending on the type of the problems. Mothers' QOL was measured using the Dermatitis Family Impact questionnaire (DFI), and a DFI score of 2 or higher was defined as impacting mothers' QOL. A total of 143 mothers believed their infants had skin problems and completed the DFI. Twenty-eight mothers (19.6%) of infants with eczema had an impacted QOL. Diaper dermatitis and facial skin problems significantly affected mothers' QOL (p = 0.042 and 0.031, respectively). In conclusion, diaper dermatitis and facial skin problems in infants can affect mothers’ QOL. Pediatric and perinatal health professionals should consider such impacts and provide support and reassurance to parents.     

The impact of occupational stress on nurses’ caring behaviors and their health related quality of life

Background

Nursing is perceived as a strenuous job. Although past research has documented that stress influences nurses’ health in association with quality of life, the relation between stress and caring behaviors remains relatively unexamined, especially in the Greek working environment, where it is the first time that this specific issue is being studied. The aim was to investigate and explore the correlation amidst occupational stress, caring behaviors and their quality of life in association to health.

Methods

A correlational study of nurses (N?=?246) who worked at public and private units was conducted in 2013 in Greece. The variables were operationalized using three research instruments: (1) the Expanded Nursing Stress Scale (ENSS), (2) the Health Survey SF-12 and (3) the Caring Behaviors Inventory (CBI). Univariate and multivariate analyses were performed.

Results

Contact with death, patients and their families, conflicts with supervisors and uncertainty about the therapeutic effect caused significantly higher stress among participants. A significant negative correlation was observed amidst total stress and the four dimensions of CBI. Certain stress factors were significant and independent predictors of each CBI dimension. Conflicts with co-workers was revealed as an independent predicting factor for affirmation of human presence, professional knowledge and skills and patient respectfulness dimensions, conflicts with doctors for respect for patient, while conflicts with supervisors and uncertainty concerning treatment dimensions were an independent predictor for positive connectedness. Finally, discrimination stress factor was revealed as an independent predictor of quality of life related to physical health, while stress resulting from conflicts with supervisors was independently associated with mental health.

Conclusion

Occupational stress affects nurses’ health-related quality of life negatively, while it can also be considered as an influence on patient outcomes.

     

The effect of literature medicine on ameliorating quality of life of patients with middle or late non-small cell lung cancer

Background：Literaturemedicineistopreventandtreatdiseaseswiththeeffectofliteratureandart，tocreategoodphysiologicaldis－position，culturehealthyhabitsandoptimisticspiritbyliteratureandrecoverthestabilizationofsocialpsychology．Intheexperiment，westudytheeffectofliteraturemedicineonqualityofpatient＇slifeinthetherapyofmiddleorlatenon－smallcelllungcancer．Objective：Toexploretheeffectofliteraturemedicineoname－lioratingqualityoflifeofpatientswithmiddleorlatenon－smallcelllungcancer．Unit：Depa…     

The life-sustaining treatments among cancer patients at end of life and the caregiver’s experience and perspectives

Goals of work

The goal of this study was to investigate the utilization of and attitudes toward life-sustaining treatments (LSTs) at the end of life.

Materials and methods

We identified 4,042 families of cancer patients who had died at any of 17 hospitals in Korea during 2004. Among those, we analyzed the interviews provided by 1,592 (39.4%) primary caregivers. Only women who provided information in baseline and follow-up point could be included for internal comparison.

Main results

Most caregivers did not discuss with their patient the option of utilizing the intensive care unit (ICU; 92.7%) or cardiopulmonary resuscitation (CPR; 93.7%) to prolong an ending life. Logistic regressions indicated that the ICU was more likely to be utilized when patients experienced an unexpected medical problem before dying, discussed the ICU with the family caregiver, or were low-educated. CPR was more likely to be used if the patient died within 6 months of diagnosis or the family caregiver was <65 years old. Family caregivers more likely to use the ICU if placed in the same situation again were those whose patients had a higher monthly income or died within 6 months of diagnosis, low-educated, or had utilized the ICU.

Conclusions

Our findings underscore the importance of discussing LST with terminally ill patients based on adequate information.