结构方程模型在癌症患者家属生活质量评价中的应用

目的:评价癌症患者家属的护理负担和生活质量,并对其影响因素进行研究.方法:采用中文版Zarit护理负担量表、癌症患者家属生活质量调查表和患者日常生活能力量表进行问卷调查.结果:结构方程模型拟合参数GFI=0.936,AGFI=0.860,CFI=0.959,模型拟合较好.护理负担显著影响护理者生活质量(P＜0.01),患者日常生活能力和护理者特征可通过影响护理负担,对护理者生活质量产生间接影响.结论:未来的干预措施应围绕改善患者日常生活能力和加强协助照顾来帮助护理者减轻负担,最终达到提高护理者生活质量的目的.     

癌症患者生活质量评价的现状及展望

全文对生活质量的概念、特征及评定量表作一简单介绍，并着重指出生活质量评价在癌症患者治疗中的应用。     

癌症患者的生活质量研究

本文综述了生活质量概念的提出、研究历史及其定义，阐述了ＱＯＬ研究的必要性、重要性及其在癌症临床研究中的作用及地位，提出了ＱＯＬ研究目前所存在的一些问题并预测其发展趋势。     

临终关怀护理对癌症晚期患者临终期生存质量的影响

目的探讨临终关怀护理对癌症晚期患者临终期生存质量的影响,为临终关怀护理在临床上进一步普及提供依据。方法选取2011年1月至2013年12月收治住院的临终癌症晚期患者73例。按照患者及家属意愿将73例患者分为对照组(选择继续治疗,24例)和观察组(放弃治疗,进行临终关怀,49例)。采用生存质量核心问卷(QLQ-C30)量表评价患者的生存质量,并调查患者对护理工作的满意度。对照组实施常规护理,观察组实施临终关怀护理。比较两组患者的生活质量及对护理人员的满意率。结果两组患者临终关怀前生活质量评价比较,差异无统计学意义(P>0.05)。临终关怀1个月后,观察组患者的躯体功能、情绪功能、认知功能及整体生活质量评分均明显优于对照组(均P<0.05);观察组患者对护理工作满意度为71.4%,明显高于对照组(33.3%,P>0.05)。结论临终关怀护理能提高癌症晚期患者临终期生存质量,值得临床推广。     

应重视癌症患者的生活质量

近年来，生活质量(Quality of Life)研究日益受到人们的广泛关注。Quality of Life，国内译法及解释颇多，可译为生活质量、生存质量或生命质量等，本质无多大区别，故简称为QOL。     

中医药维护癌症患者生存质量的作用

目前 ,癌症患者中约 70 %～ 80 %是中晚期患者 ,大多数失去早期手术根治的机会 ,多以放疗或化疗为主 ,虽有一定近期疗效 ,但常因伴有明显的毒副反应和副作用 ,且缓解期短 ,生存质量差 ,不能明显延长患者生存期。近 2 0年来 ,我国许多医院开展了中西医结合治疗肿瘤的临床研究 ,根据患者的全身及局部具体情况 ,把中医扶正祛邪的方法 ,与西医的手术、放疗、化疗等方法进行有机结合 ,综合治疗 ,取长补短 ,在延长患者生存时间和维护、改善癌症患者的生存质量方面都取得较大进展 ,显示了中医药在肿瘤治疗中的特色与优势。一、中医扶正培本法能改善…     

癌症患者生活质量调查对护理工作的启示

为了解癌症患者生活质量,改进护理工作,2002年6月我们随机对100例住院癌症患者进行问卷调查,现报告如下.     

癌症患者生活质量评估量表QLQ-52的设计及质量评价

目的:设计一套适合中国文化背景的癌症患者生活质量评估量表QLQ52。方法:通过对133名癌症患者的测评,以考核所设计的QLQ52的信度、效度、反应度以及可行性。结果:QLQ52由52项指标构成,反映了癌症患者生理、心理、独立性、社会关系及环境、精神支柱和满意度6个方面;QLQ52的被测者信度Pearson相关系数为0.334(P<0.01),分半信度为0.9242,α系数0.9404,内容效度94.00%,结构效度系数0.87,准则关联效度Pearson相关分析系数0.574(P<0.01);反应度:治疗前、中的癌症患者的生活质量与治疗后比较差异有显著性(P<0.05);可行性:完整率93.66%,填表完成时间的均数为14.30分钟,中位数为12分钟。结论:QLQ52量表具有较好的信度、效度、反应度和临床应用可行性,可试用于评价我国癌症患者的生活质量。     

Underestimated caregiver burden by cancer patients and its association with quality of life,depression and anxiety among caregivers

This study examined how patients with cancer estimate caregiver burden (CB) and the association between their underestimation of CB and their caregivers' self‐ratings of their quality of life (CQOLC‐K; Korean version of the Caregiver Quality of Life Index‐Cancer), depression and anxiety (Korean version of the Hospital Anxiety and Depression Scale). Participants consisted of 990 patient‐caregiver dyads recruited from a nationwide cross‐sectional survey conducted in South Korea. Medical baseline data were retrieved from the hospital information systems of the participating centres. The patients with cancer who underestimated CB ranged from 18.62% (for physical CB) to 23.33% (for social CB). They had less advanced cancer, a lower income, were the caregiver's spouse, reported higher levels of family avoidance of communication about cancer, and had female caregivers. The patients' underestimation of CB was significantly related to lower CQoL and higher levels of caregiver depression and anxiety. The current study provides empirical evidence for the link between the underestimation of CB by patients with cancer and compromised caregiving experiences of cancer caregivers. Open family communication about cancer was discussed as one of several practical strategies for decreasing patients' underestimation of CB.     

Burden,emotional distress and quality of life among informal caregivers of lung cancer patients: An exploratory study

This study was conducted to explore the interrelationships among caregiver burden, emotional status and quality of life (QoL) in caregivers of lung cancer patients, and to identify whether caregiver burden and health status are associated with patient emotional status and QoL. Forty‐three dyads of lung cancer patients and their caregivers were included for analysis. Caregiver‐reported outcomes were measured by Caregiver Burden Scale (CBS), Caregivers Quality of Life Index‐Cancer (CQOLC) and Hospital Anxiety and Depression Scale (HADS), while patient‐reported outcomes were collected by HADS and Lung Cancer Symptom Scale (LCSS). The majority of the CBS and CQOLC scores were significantly higher in anxious and depressed caregivers than non‐anxious and non‐depressed caregivers (p < .01 or .05). Caregivers of depressed patients experienced significantly greater emotional distress than those of non‐depressed patients (p < .01). Significantly positive associations were identified among most of the CBS, CQOLC and caregiver HADS scores. Patient LCSS scores were positively correlated with the CBS and caregiver HADS scores, and patient HADS scores were also positively related to caregiver HADS scores. The close interrelationships between caregiver and patient health outcomes provide evidence that lung cancer patients and their caregivers should be viewed as a unit in future supportive service models.     

Parents of children with cancer: which factors explain differences in health-related quality of life

Research with parents of children with cancer has identified factors related to their adjustment and coping, but it is not fully understood why some parents do well and others do not. Guided by a stress process model, we examined the interrelationships among a comprehensive set of factors to identify the most important determinants of health-related quality of life (HRQoL) in parents of children in active treatment for cancer. A cross-sectional survey of 411 parents (80% response rate) of children receiving cancer treatment in Canada was conducted between November 2004 and February 2007. The following constructs were measured: background and context factors, child characteristics, family-centered service delivery, caregiver strain, intrapsychic factors, coping/supportive factors and parental HRQoL. The model was evaluated using structural equation modeling. Analysis was stratified by time since diagnosis (i.e., <12 months and ≥12 months). For those within 12 months of their child's diagnosis, family-centred service provision, caregiver strain, and self-perception accounted for 58% of the variation in psychosocial health, whereas caregiver strain and social support explained 50% of the variation in physical health. For parents in the >12 month group, caregiving strain was the only factor with a direct relationship with parental psychosocial and physical health, accounting for 66% and 55% of the variance in these constructs, respectively. Our findings reinforce the need for health professionals to be particularly attuned to family caregivers in the early stages of treatment and identify potential areas for interventions to promote parental health.     

Quality of sleep and quality of life in caregivers of breast cancer patient

BACKGROUND: Sleep is an important issue for cancer patients and caregivers and poor sleep quality may have deleterious effects on health. This study will examine the correlation between sleep quality and quality of life of breast cancer caregivers. METHOD: A cross-sectional and correlational design was used to explore the relationship between sleep quality and the quality of life of caregivers. Sixty-one participants were identified by invasive early breast cancer patients, who were diagnosed within the period of 18-month period, as their primary caregivers. The World Health Organization Questionnaire on Quality of Life: BREF-Taiwan version (WHOQOL-BREF-TAIWAN) and the Chinese Pittsburgh Sleep Quality Index (CPSQI) were used to measure the quality of life and sleep quality of caregivers, respectively. RESULT: Eighty-nine percent of caregivers from this study reported possible sleep difficulties. The scores of CPSQI scores were negatively correlated with the score of every domain of the WHOQOL-BREF-TAIWAN. DISCUSSION: The results suggest that sleep quality may have an impact on several aspects of the quality of life of caregivers. Understanding the correlation between sleep quality and the quality of life of caregivers may assist health professionals in enhancing the sleep quality of caregivers and their ability to care for patients and themselves.     

晚期乳腺癌患者年龄和生存质量对其家庭照顾者生存质量的影响

目的：探讨晚期乳腺癌患者年龄及生存质量对其家庭照顾者的生存质量的影响。方法选取130例晚期乳腺癌患者及其130名家庭照顾者为研究对象,家庭照顾者完成照顾者生活质量指数-癌症表（CQOLC）问卷调查,所有的患者和家庭照顾者完成线性模拟自评量表（LASA）调查评估生活质量（QOL）,心境量表（POMS）评估心理状态。结果年龄≥65岁的晚期乳腺癌患者其照顾者心理健康、情感健康、精神健康、社会支持、总POMS分和总CQOLC分均高于年龄﹤65岁的患者照顾者,差异均具有统计学意义（P﹤0.05）。患者LASA中总的QOL评分﹥50分的晚期乳腺癌患者照顾者总QOL分、心理健康、身体健康、情感健康、精神健康、总POMS分和总CQOLC分均高于LASA中总的QOL评分≤50分的患者照顾者,差异均具有统计学意义（P﹤0.05）。结论晚期乳腺癌患者年龄≥65岁、生存质量高,其相应的家庭照顾者生存质量亦高。     

Quality of life in a heterogeneous sample of caregivers of cancer patients: an in‐depth interview study

MANCINI J., BAUMSTARCK‐BARRAU K., SIMEONI M.‐C., GROB J.‐J., MICHEL G., TARPIN C., LOUNDOU A.‐D., LAMBERT A., CLÉMENT A. & AUQUIER P. (2010) European Journal of Cancer Care
Quality of life in a heterogeneous sample of caregivers of cancer patients: an in‐depth interview study To establish the best approach to develop a quality of life (QoL) questionnaire for cancer‐patient caregivers, this study attempts to identify primary domains of QoL in terms of their impact on a purposive sample of caregivers. Seventy‐seven informal adult caregivers of cancer patients (breast cancer, paediatric haematological malignancies or melanoma) with different relationships with the patients (parents, children, spouses, siblings, and friends) were recruited at three specialised French centres and extensively interviewed. Caregivers' lives were altered in several domains: psychological well‐being, leisure and everyday activities, relationships with institutional caregivers, occupation and finances, relationships with family and friends, physical well‐being, and relationship with the patient. The relative importance of these domains varied mainly in association with the caregiver‐patient relationship. Multiple correspondence analysis identified two isolated clusters: children, and, most significantly, friends and siblings. The latter groups emphasised the repercussions on their psychological well‐being and their relationship with the patient, but were less willing to discuss the impact on their relationship with caregivers and on occupation, finances, leisure, and everyday activities. This study focuses on the caregiver's perspective and advocates the development of a short QoL core questionnaire. Additional modules should be cancer‐specific or dedicated to specifics of the caregiver‐patient relationship.     

Response shift effects of quality of life assessments in breast cancer survivors

Measurements of quality of life (QoL) can be distorted by respondents adapting to new situations between measurement points and consequently having a changed frame of reference. To investigate this bias in breast cancer survivors, we compare their QoL with that of the general population and use two complementary methods for detecting this bias. Breast cancer survivors (n = 308, response rate: 91%) were tested with the QoL questionnaire European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30. Response shift was examined with the thentest (retrospective judgements) and with the structural equation modelling (SEM) approach. Compared with the general population, breast cancer survivors showed impaired QoL in all functioning scales (Hedges’ g: ?0.56 to ?0.93) and symptom scales (Hedges’ g: 0.28–0.74).The thentest method indicated recalibration effects in several dimensions including social functioning. The SEM method detected a non‐uniform recalibration effect for social functioning from pretest to posttest and from pretest to thentest, but no effect between thentest and posttest. Breast cancer survivors’ QoL is clearly diminished. Comparing the two approaches for detecting response shift showed that it is also useful to apply SEM to retrospective judgements and that this can reveal response shift effects that would otherwise be overlooked.     

盐城地区食管癌化疗患者近期生命质量评价

目的：通过对盐城地区中晚期食管癌化疗患者近期生命质量（QOL）进行评价,指导临床化疗方案的选择及提高患者生命质量。方法：收集2013-2014年49例原发性食管癌新发病例在化疗前1 d、化疗后1周、化疗后4周的人口学资料、疾病与治疗情况、生命质量测量量表,运用癌症患者生命质量核心量表（EORTC QLQ-C30）按5个功能领域、3个症状领域、6个单项测量条目及1个总体健康状况领域将生命质量测量分值进行标准化换算。对人口学资料及疾病特征、患者化疗前后QOL的变化、影响化疗患者QOL的因素采用SPSS 17.0软件进行统计描述和分析。结果：化疗后1周较化疗前1 d功能领域有所改善,但恶心呕吐、疼痛、失眠、腹泻症状及经济困难加重（P < 0.05）;化疗后4周较化疗前1 d除社会支持功能外,功能领域得分变高,躯体症状加重（P < 0.05）;化疗后4周较化疗后1周躯体、角色、总体功能改善（P < 0.05）,但恶心呕吐、食欲丧失、腹泻仍有加重现象（P < 0.05）。QOL与年龄、文化程度、居住地、临床分期、不同淋巴转移结局有关。结论：化疗患者生命质量受化疗时间、年龄和文化程度等相关因素的影响,需通过选择个性化方案、采取综合措施来提高。