A new assessment of quality of life (QOL) for cancer patients

A new assessment of quality of life (QOL) was made for cancer patients. The QOL assessment consists of 12 items: pain; nausea; constipation; general fatigue; sleep; eating; activity; a daily life pattern; conversation; treatment acceptability; satisfaction at the present status and family exhaustion. Ranges of scores are one (best) to five (worst). For visual expression of QOL, the author made an original method called "QOL diagram", drawn with a circle which has 12 diverging lines marked five points indicating the score for each item. QOL changes after cancer pain control with either oral or intravenous morphine were examined in 22 adult cancer patients by the QOL assessment. Laxatives and anti-nausea drugs were mostly prescribed at the same time in order to avoid side effects of morphine. QOL was evaluated and recorded by the author through an individual interview with each patient. It was observed that the psychological factors were improved along with pain relief. Although items such as general fatigue, nausea, constipation, sleep and eating did not change considerably at first, they improved well with time in the oral morphine group. On the other hand, there was no marked time-dependent change in the intravenous morphine group. Items such as activity, a daily life pattern and conversation were rather negative than positive. These items seem to be more important to improve QOL of the cancer patients, in particular, whose general status is relatively good. In conclusion, the QOL diagram helped us to follow subtle changes of status and needs of cancer patients. And it enables us to easily assess risks and benefits of the treatment plans including palliative care and home supportive programs. It is designed for both patients and medical staffs to use easily and repeatedly. However, the further evaluation and refinement will be needed to verify validity and reliability of the QOL diagram before a routine clinical application.     

Hispanic cultural health beliefs and folk remedies

Cultural awareness of health care practices and beliefs is increasing, but knowledge regarding Hispanic folk remedies and health care practices and beliefs is limited. This study used a focus group interview format for an open discussion of folk remedies and the health and illness practices of the participants. Eleven Hispanic women participated in a group interview that addressed the question, How do Hispanic health beliefs affect health care practices? Specifically, what actions are taken to treat symptoms of illness or injury? Qualitative data analysis of the 75 symptom and treatment statements was completed, and data were grouped according to symptom and complexity of treatments. This resulted in a rich compilation of remedies that Hispanics use in home treatments, with the emergence of a pattern comparable to the nursing process. This information adds to the current knowledge base of cultural health practices and provides a basis for continued research.     

Nodal trajectories of spin observables and kaon photoproduction dynamics

The purpose of this comparative cross-cultural study was to describe the cultural/religious perception of the childbirth experiences of selected childbearing women. Finnish Lutheran women's beliefs and perceptions of childbirth were compared with those of Canadian Orthodox Jewish and American Mormon women. Methodological triangulation was achieved through semistructured, open-ended interviews and use of the Utah Test for the childbearing Year (UTCY). Canadian Orthodox Jewish women showed a significantly higher level of reliance on authority figures to ensure positive outcomes and significantly less active participation in childbirth care decisions. The Finnish Lutheran women showed less valuing of childbearing and childrearing, which may be related to a less active religious belief system and the view by Finnish women that motherhood is only one of a multiplicity of roles viewed as important. There is a need to understand and appreciate the cultural beliefs and values of childbearing women to facilitate more culturally sensitive and holistic nursing care.     

Quality of life in advanced prostate cancer: results of a randomized therapeutic trial

BACKGROUND: For patients with metastatic prostate cancer, treatment is primarily palliative, relying mainly on the suppression of systemic androgen hormone levels. To help document the achievement of palliation and to characterize positive and negative effects of treatment, we evaluated quality-of-life (QOL) parameters in patients with metastatic prostate cancer who were randomly assigned to two methods of androgen deprivation. METHODS: Patients (n = 739) with stage M1 (bone or soft tissue metastasis) prostate cancer were enrolled in a QOL protocol that was a companion to Southwest Oncology Group INT-0105, a randomized double-blind trial comparing treatment with bilateral orchiectomy (surgical castration) plus either flutamide or placebo. Patients completed a comprehensive battery of QOL questionnaires at random assignment to treatment and at 1, 3, and 6 months later. Data were collected on three treatment-specific symptoms (diarrhea, gas pain, and body image), on physical functioning, and on emotional functioning. All P values are two-sided. RESULTS: Questionnaire return rates for this study never dropped below 80%; only 2% of the patients did not submit baseline QOL assessments. Cross-sectional analyses (corrected for multiple testing) identified statistically significant differences that favored orchiectomy plus placebo for two of the five primary QOL parameters as follows: patients receiving flutamide reported more diarrhea at 3 months (P = .001) and worse emotional functioning at 3 and 6 months (both P<.003). Longitudinal analyses replicated these findings. Other analyzed QOL parameters favored the group receiving placebo but were not statistically significant after adjustment for multiple testing. CONCLUSIONS: We found a consistent pattern of better QOL outcomes at each follow-up assessment during the first 6 months of treatment for orchiectomized patients with metastatic prostate cancer who received placebo versus flutamide. Improvement over time was evident in both treatment groups but more so for patients receiving placebo.     

Quality of life for individuals with traumatic brain injury: comparison with others living in the community

OBJECTIVES: To provide a conceptual overview of approaches to quality of life (QOL) measurement and an extensive review of research relating to QOL after TBI; to document subjective QOL of individuals with traumatic brain injury (TBI); to explore how subjective QOL differs for people with TBI in comparison to individuals with no disability (ND) and those with spinal cord injury (SCI); and to document the perceptions of unmet important needs and the relationship between such perceptions and subjective QOL. DESIGN: Interview-based data focusing on current perceptions of QOL and unmet important needs, obtained from individuals with TBI, SCI, or ND. Covariance and partial regression analyses were used to explore group differences and to document relationships between variables. SETTING: Individuals drawn from diverse communities across New York State. PARTICIPANTS: TBI group: 430 individuals who identified themselves as having TBI; SCI group: 101 individuals with spinal cord injury; ND group: 187 people who identified themselves as having no disability. Participants were recruited through recruitment ads in general circulation newspapers and newsletters and through contacting a wide variety of community agencies. MAIN OUTCOME MEASURES: Two summary QOL indicators: a Global QOL Measure based on two items tapping the individual's emotion-based view of QOL, and a summary score adapted from Flanagan"s Scale of Needs, reflecting the individual's perceptions of total unmet important needs. RESULTS: Both summary QOL indicators were correlated with demographic characteristics. Unmet important needs were stronger in the TBI group than in the SCI and ND groups. Most areas of unmet important need were moderately correlated with the summary QOL indicators. Analyses of covariance showed that severity of injury was a more powerful modulator of post-TBI QOL judgments than the mere fact of TBI. For example, those with the most severe injury (ie, loss of consciousness [LOC] >1 month) rated their QOL similar to that in the ND group, whereas individuals who had experienced only a brief LOC (<20 minutes) viewed their QOL as significantly lower than that in the ND and SCI groups and lower than other TBI severity subgroups. CONCLUSIONS: This exploration of subjective QOL strengthens the argument that after TBI, the insider"s reaction to injury varies greatly within the population. Thus, severity of injury strongly affects perceptions of QOL. The use of a multimethod approach for exploring the reactions and perceptions of QOL has proven useful in this study.     

Mitochondrial transmembrane potential and free radical production in excitotoxic neurodegeneration

OBJECTIVE: To evaluate quality-of-life (QOL) parameters in patients undergoing esophagectomy, curative or palliative, for carcinoma. DESIGN: Nonconsecutive case series. PATIENTS: Eighty-eight patients who underwent esophagectomy for cancer (curative, n=49 [56%]; palliative, n=39 [44%]) provided QOL assessments over an 18-month period. SETTING: Procedures for referral care were performed by a single team of clinicians in a tertiary referral center. Evaluations of QOL were made by 1 independent trained investigator. OUTCOME MEASURES: Data were documented by questionnaire at interview and parameters evaluated included an esophageal module for the type and quantity of food intake, severity of related symptoms on eating, Eastern Cooperative Oncology Groups (ECOG) performance status, sleep, pain, leisure activity, working capacity, outlook on life, general well-being, and support from family and friends. A summation of selected parameters was used to calculate a total score. RESULTS: Significant improvements were recorded in both the curative and palliative groups for at least 1 year following surgery in the type (P<.03) and quantity (P<.03) of food intake and severity of diet-related symptoms (P<.02), when compared with preoperative considerations. Findings were comparable between the groups with regard to dietary intake. Pain status and total scores were worse in the palliative group at 9 months postoperatively but no significant differences between the groups were evident at any time for sleep, leisure activity, and ECOG performance status. CONCLUSIONS: To our knowledge, there are no previous data regarding a comparison of QOL considerations in patients who have undergone either potentially curative or palliative esophagectomy for malignant disease. Data analysis revealed that palliative esophagectomy provided enhanced QOL with marked symptomatic benefits and enjoyment of daily living comparable to that observed following curative resection.     

Grieving and death rituals of Latinos

PURPOSE/OBJECTIVES: To describe the grieving behaviors and selected death beliefs and rituals for two Latino groups: island Puerto Ricans and Mexican immigrants. DATA SOURCES: Published articles, book chapters, books, government documents, and clinical experience. DATA SYNTHESIS: Limited scientific research exists on the grieving process and beliefs about death of Latinos. Death is seen as an extension of life in some Latino cultures, a belief that seems to assist positively in the grieving process. Rituals and ceremonies to honor the dead still are practiced in many Latino cultures and are rooted partly in their cultural heritage. CONCLUSIONS: Nurses caring for Latinos with cancer can provide better care with an understanding of grieving behaviors observed early in the disease process and at the time of imminent death. IMPLICATIONS FOR NURSING PRACTICE: Culturally competent care can be given when beliefs and values about death are understood. Allowing Latino clients to grieve and honor the dead in a culturally appropriate way will enhance the nurse/client/family relationship.     

Culture care of Iranian immigrants in New South Wales, Australia: sharing transcultural nursing knowledge

Discovery and analysis of care meanings, expressions, and practices of Iranian Immigrants in New South Wales, Australia was the focus of this ethnonursing qualitative research. The purpose of the study was to systematically discover, describe and analyse the values, beliefs, and practices of Iranian immigrants in New South Wales, Australia. The aim of the investigation was to discover transcultural nursing knowledge to guide nurses and health professionals to provide culturally congruent nursing and health care to Iranians. Leininger's theory of Culture Care Diversity and Universality (Leininger, 1991) was used as the conceptual framework for the study. It was predicted that care meanings and expressions of Iranian immigrants would be influenced by their worldview, social structure features, language, and cultural values rooted in their long ethnohistorical past and reflected in their lifeways in Australia. Using the ethnonursing qualitative research method, key and general informants were purposefully selected among Iranian immigrants residing in New South Wales. Three care themes supported by a number of universal and some diverse patterns were identified for Iranian immigrants. The three themes were: (1) Care meant family and kinship ties (hambastegie) as expressed in daily lifeways and interactions with family, friends, and community; (2) Care as expressed in carrying out traditional urban gender roles (role-zan-o-mard) (Azadie zan) as well as in fulfilling emerging new role responsibilities related to equality for female Iranian immigrants; and (3) Care as preservation of Iranian identity (inhamoni, hamonandi) as expressed in traditional cultural events and health care practices. Leininger's (1991) three modes of actions and decisions were used to develop appropriate and culturally meaningful nursing care actions and decisions which were in harmony with the cultural beliefs of Iranian immigrants.     

Family physicians' involvement with dying patients and their families. Attitudes, difficulties, and strategies

OBJECTIVE: To determine family physicians' perceptions of the difficulty in caring for dying patients and how prepared they are to provide such care relative to strategies used with difficulties encountered, personal need for support and development, and cooperation with other caregivers. DESIGN: Exploratory. SETTING: Physicians' offices. SUBJECTS: Thirty-five randomly selected family physicians (doctors of medicine and doctors of osteopathy) representative of family physicians practicing in Franklin County, Ohio. INTERVENTIONS: None. MAJOR OUTCOME MEASURES: A semistructured interview guide corresponding to a three-dimensional theoretical model developed prior to the study was used to determine family physicians' perceptions regarding care of dying patients and their families. The three dimensions include family physicians' involvement with dying patients and their families, their personal needs and development, and their cooperation with other caregivers. RESULTS: Participants agreed that the care of dying patients and their families is an important and special component of practicing family medicine. Generally seeing themselves as adequately prepared, they still found such care difficult and desired more education and training to increase comfort of their patients and of themselves. Their perceptions regarding the care of dying patients and their families could be categorized in terms of communication as part of the care process, family issues, legal and ethical issues, coordination of care, physicians' feelings, and physicians' influence and support. CONCLUSIONS: Family physicians require formal training in death issues and need to find a way to maximize learning through personal experiences. Discussion of cases in a support group may be beneficial.     

The emerging Hispanic population: a foundation for cancer prevention and control

Although making up only 9% of the U.S. population and concentrated in urban areas of a few states, Hispanics are found throughout the country and represent a mix of historical and cultural backgrounds. This diverse group cuts across racial and ethnic lines, with origins in various countries of Europe and North, Central, and South America. The Hispanic population has several distinguishing demographic characteristics, including its rapid growth rate, relative youth, and low educational and socioeconomic levels. However, considerable differences exist among Hispanic groups, particularly in median age, household size, education, and family income. The majority of Hispanics face barriers to health care access, including a lack of health insurance coverage, underrepresentation in health care fields, and cultural and language differences. These distinct demographic characteristics and barriers have a direct impact on the risk of cancer in Hispanics and on the development of prevention and control strategies. The purpose of this review is to examine the demographic and socioeconomic characteristics of Hispanics and issues of access to health care among this population within the context of cancer prevention and control.     

Quality-of-life changes in patients with thyroid cancer after withdrawal of thyroid hormone therapy

Quality of life (QOL) is an important consideration as patients survive longer with cancer and is an area of increasing interest in patients with thyroid cancer who undergo long-term cancer surveillance. However, there are few disease-specific QOL tools available to evaluate QOL in patients with thyroid cancer. The purposes of this longitudinal, repeated-measures study were to: (1) test a new instrument, the QOL-Thyroid Scale, during thyroid hormone withdrawal; and (2) to evaluate the impact of thyroid hormone withdrawal on patients' perceived changes in quality of life. The sample included 34 subjects (mean age 40 years) undergoing thyroid hormone withdrawal in preparation for scanning procedures. Subjects completed three instruments (demographic data tool, the QOL-Thyroid, and the FACT-G) at four specific time points in relationship to scanning. The results demonstrated that the QOL-Thyroid tool is a reliable and valid measure of QOL. Cronbach's alpha coefficient of r = .78 between QOL-Thyroid and FACT-G indicated good concurrent validity. Second, the impact of thyroid hormone withdrawal on QOL showed significant changes in physical, psychological, and social well-being across the four testing points. The greatest changes occurred between peak hormone withdrawal and thyroxine (T4) therapy. While it is generally known that patients suffer troublesome physical symptoms relating to thyroid hormone withdrawal, the negative psychological, family, and work sequelae are less apparent. In conclusion, the QOL-Thyroid is a reliable and valid measure for use in evaluating patients undergoing scanning procedures and may be used to identify and target teaching and support for high-risk areas in patients lives that are negatively affected by hormone withdrawal.     

Maintaining perceptions of control: Finding perceived control in low-control circumstances.

Three questions about the role of perceived control in coping with a major life stressor were addressed in a sample of 71 cancer patients. As expected, those with greater perceptions of control were less depressed, even when physical functioning, marital satisfaction, and negative affectivity were controlled for. Consistent with a compensatory model of control, it was more important for patients to believe that they could control daily emotional reactions and physical symptoms than the course of the disease. Patients who endorsed irrational beliefs had lower overall perceptions of control. The results indicated that even patients who were physically or psychosocially worse off were better adjusted if they had higher perceptions of control. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Transcultural nursing practice described by registered nurses and baccalaureate nursing students

Using Leininger's Theory of Culture Care Diversity and Universality as a framework, this research examined transcultural practices of nurses and students. A survey was administered to a convenience sample of registered nurses and senior baccalaureate students with 767 usable questionnaires returned. Neither group expressed confidence in their ability to care for culturally-diverse patients. Registered nurses (RNs) reported assessing cultural factors and modifying practices more frequently than did students. Respondents reported their beliefs about transcultural nursing were influenced by being with people of other cultures, their own personal values, and education. Analysis of the open-ended questions revealed two major themes. First, both nurses and students perceive an overwhelming need for transcultural nursing. Second, nurses and students respond to cultural challenges by modifying their care. Modifications are based on language and communication, pain perception and relief, religious and spiritual dimensions, gender and family roles, and other values. Results suggest that nurses and students are aware of culture, recognize that culture influences the care they provide, and modify their health teaching and nursing care based on culture. The use of a conceptual framework to help make modifications in care was not mentioned.     

Efficacy beliefs in geriatric rehabilitation

Motivation is an important variable in older adults' ability to recover from any disabling event. The theory of self-efficacy states that efficacy beliefs affect behavior, motivational level, thought patterns, and emotional reactions in response to any situation. This study explored the impact of efficacy beliefs on older adults in a rehabilitation program and tested interventions to strengthen efficacy beliefs related to participation in rehabilitation and functional performance. An experimental pretest-posttest design was used. Participants were randomly assigned to: the usual care control group or the treatment group. The study was completed on an inpatient geriatric rehabilitation unit. The sample consisted of 77 participants, 55 women and 22 men with a mean age of 78 +/- 7.2. Individuals in the treatment group received three efficacy enhancing interventions: role modeling, verbal persuasion, and physiological feedback. Baseline data were collected within 48 hours of admission and included four investigator-developed efficacy measures: Functional Inventory Measure, Participation Index, Numeric Rating Scale for pain, amount of analgesic used for pain, and Health Status. With the exception of Health Status, these measures were again completed within 48 hours of discharge. Admission performance was the only statistically significant predictor of efficacy beliefs. All efficacy beliefs increased over time and were significantly correlated with performance behaviors and length of stay. The treatment group had stronger efficacy beliefs regarding participation, higher participation at discharge, and less pain than the control group. Efficacy beliefs, both self-efficacy and outcome expectations, are related to participation, functional performance, and length of stay. Interventions to strengthen these beliefs improved participation in rehabilitation and decreased pain. Consideration of motivation can facilitate rehabilitation and help older adults obtain and maintain their highest functional level.     

Biculturalism and perceived competence of Latino immigrant adolescents

The present study investigated acculturation to the Hispanic and American cultures and self-perceptions of competence among 123 Latino immigrant adolescents. The study tested a contextual model of biculturalism by examining whether different acculturation styles predicted perceived competence in life spheres with different cultural demands. Perceived competence was assessed using Harter's (1988). Self-Perceptions of Competence Profile for Adolescents for the life spheres of school, peers (both Latino and non-Latino), and global self-worth. In addition, an analogous scale to assess perceptions of competence in the family was constructed for that sphere. The study found some support for a contextual model of acculturation. Acculturation to American culture predicted positive self-perceptions of competence with American peers, while acculturation to Hispanic culture predicted positive self-perceptions of competence with Latino peers. Perceived family competence, however, was predicted by acculturation to American rather than Hispanic culture. Results with respect to biculturalism are tentative, with a trend relating biculturalism to positive self-perceptions of global self-worth. However, because many of the conditions stipulated by the model were not met, results with respect to biculturalism raise questions about current approaches to operationalizing the construct.     

Calls on reproductive and developmental toxicants to a regional poison center

OBJECTIVES/HYPOTHESIS: Rehabilitation following head and neck cancer surgery has steadily moved into the outpatient realm and become dependent on caregivers with no formal medical background (lay caregivers.) Satisfactory rehabilitation and quality of life (QOL) depend on successful relationships between patients and the lay caregivers. This study evaluates the QOL assessments of patients by themselves and their primary lay caregivers before head and neck surgery. STUDY DESIGN: Institutional Review Board-approved study using validated QOL assessment instrument. MATERIALS AND METHODS: The preoperative QOL status in 50 patients undergoing extensive head and neck surgery was evaluated using the self-administered Medical Outcomes Survey Short Form 36 (SF-36). The patient's primary lay caregiver (spouse, child, or friend) completed a similar questionnaire evaluating the patient's status. RESULTS: Thirty-three (66%) questionnaires were returned. Twenty-five (50%) questionnaire sets were successfully completed by both parties and employable for comparison. Sixty percent of the caregivers were within the 90% confidence interval of the patient's assessment for six or more of the eight parameters evaluated by the SF-36. Likewise, caregiver assessments for specific parameters were consistently congruent with patient evaluation, except for the parameters of bodily pain and general health, for which caregivers demonstrated a trend for overrating pain and underestimating general health. Caregivers of the same generation as the patient demonstrated significantly higher congruence (P = .007). Similarly, a trend for higher congruence was noted in patients with recurrent disease. CONCLUSIONS: The importance of the lay caregiver has increased in the era of greater outpatient rehabilitation. This pilot study indicates that QOL assessment by lay caregivers may be examined with existing instruments and highlights QOL parameters critical to both the head and neck surgery patient and his or her primary lay caregiver.     

A brief spiritual beliefs inventory for use in quality of life research in life-threatening illness

This paper reports on the initial efforts to validate a brief self-report inventory, the Systems of Belief Inventory(SBI-15R), for use in quality of life (QOL) and psychosocial research studying adjustment to illness. The SBI-15R was designed to measure religious and spiritual beliefs and practices, and the social support derived from a community sharing those beliefs. The authors proposed this scale to address the need for greater exploration of spiritual and religious beliefs in QOL, stress and coping research. Phase I: Item generation. The research team identified four domains comprised of 35 items that make up spiritual and religious beliefs and practices. The instrument was piloted in a structured interview format on 12 hospitalized patients with varying sites of cancer. Phase II: Formation of SBI-54. After these initial efforts, the research team increased the number of items to 54 and adopted a self-report format. To assess patients reactions to the questionnaire, the new version was piloted on 50 outpatients with malignant melanoma. Phase III: Initial validation. To begin establishing validation, 301 healthy individuals with no history of cancer or serious illness in the prior year were asked to complete the SBI-54 and several other instruments. A principal components analysis with varimax rotation of the SBI-54 identified two factors, in contrast to the four which were hypothesized, one measuring spiritual beliefs and practices, the other measuring social support related to the respondent's religious community. Phase IV: Item reduction of the SBI-54. A shortened version of the SBI-54 with 15 items, five from the items identifying factor I and ten from those identifying factor II, was developed to lessen patient burden. The new SBI-15 correlated highly with the SBI-54, and demonstrated convergent, divergent, and discriminant validity. Revision of SBI-15. The investigators rephrased one statement in order to broaden the applicability of the SBI-15 to patients other than those with a diagnosis of cancer, and to healthy individuals. DISCUSSION. The SBI-15R met tests of internal consistency, test-retest reliability, and convergent, divergent, and discriminant validity in both physically healthy and physically ill individuals. The SBI-15R may have value in measuring religious and spiritual beliefs as a potentially mediating variable in coping with life-threatening illness, and in the measurement of QOL.