Testing a theory for health-related quality of life in cancer patients: a structural equation approach

Pathways to psychological wellbeing for patients with bladder cancer and their partners-in-care

PURPOSE

The goal of the current analyses was to describe pathways through which Psychological Wellbeing might be better understood for clinical participants with bladder cancer and their partners. This was achieved by applying Roy's Adaptation Model that provides a framework with which to understand responses to challenging circumstances that has proved useful in the study of a range of chronic conditions.

METHODS

The sample comprised 119 patients with a diagnosis of bladder cancer, and 103 supportive partners. Participants completed a self-report questionnaire comprising the Bladder Cancer Index, Mini-Mental Adjustment to Cancer Scale, Psychosocial Adjustment to Illness Scale, and sociodemographic details. For each sample, structural equation modelling was used to determine goodness of fit, guided by Roy's Adaptation Model.

RESULTS

For patients, increasing age and disease duration, the negative appraisal of health care, perceived poor functioning and elevated burden of disease provided pathways to Psychological Wellbeing. For partners, increasing age, being male, a negative health care experience, and perceived burden of disease were significant. However, for both groups a positive evaluation of family and social support was the key indicator of lower Psychological Wellbeing.

CONCLUSIONS

The models presented describe a suite of issues that could inform a nursing model of care to enhance the experience of living with bladder cancer for both patients and their supportive partners.

Patterns of Symptom Distress in Adults Receiving Treatment for Lung Cancer

Knowledge of the patterns of symptom distress in adults receiving treatment for lung cancer is an important first step in developing interventions that can potentially lessen symptom distress. The purposes of this secondary analysis were to describe the changes in patterns of symptom distress over time in adults receiving treatment for lung cancer, and to examine the relationship of selected demographic and clinical characteristics to symptom distress. Complete data were available for 117 patients. The patterns of symptom distress in adults receiving treatment for lung cancer varied between treatment groups and over time. Symptom distress scores were moderate to high on entry into the study, indicating that symptom management in newly diagnosed lung cancer patients is essential and should begin early in the course of illness. Moreover, clinical interventions should be tailored to the type of treatment. Various demographic and clinical variables were weak and inconsistent predictors of symptom distress, underscoring the importance of examining the role of psychosocial factors in mediating symptom distress.

Factors That Influence Parental Uncertainty and Health-Related Quality of Life in Children With Cancer: A Framework

The purpose of this paper is to present a conceptual-theoretical-empirical model addressing factors that influence the relation between parental uncertainty and health-related quality of life in children with cancer. The basic concepts identified and defined in the model include parental uncertainty, health-related quality of life, parental trait anxiety, parental depression, and perceived parental social support. The proposed relationships between the concepts are explained with explicit linkages to their empirical indicators. There is limited research in childhood cancer regarding the relation between parental uncertainty and health-related quality of life; therefore, the proposed model will help to better understand this relationship.

Nursing, Healthcare, and Culture: A View of the Year 2050 From Germany and the United Kingdom

This column presents a dialogue with German nurse scholar Gerd Bekel and United Kingdom nurse scholars, Francis C. Biley and Kirstin Fragemann, who share their respective visions and understanding of each country's vision of nursing, healthcare, and quality of life in the year 2050.

Quality of Life in Hospice Patients with Terminal Illness

To better understand quality of life (QOL) and its important correlates among patients with terminal illness, a cross-sectional correlational design was used in a study based on Stewart, Teno, Patrick, and Lynn’s conceptual model of factors affecting QOL of dying patients and their families. Sixty participants were recruited from two local hospice programs in the midwestern region of the United States. Data were collected at the participants’ homes. The participants had an above average QOL. Living with the caregiver, spirituality, pain intensity, physical performance status, and social support as a set explained 38% of the variance in their QOL. Among these five predictors, living with the caregiver, spirituality, and social support statistically were significant predictors of the QOL of these participants. Participants who did not live with their caregivers experienced less pain intensity, perceived higher spirituality, had more social support, and had a significantly better QOL. Important contributions of these findings are discussed.

Aplikacija adaptacijskega modela Calliste Roy pri pacientu z rakom in s kronično bolečino

Uvod: Prilagajanje je ključni dejavnik za uspešno soočenje posameznika s spremembami v svojem notranjem in zunanjem okolju. Z aktivnostmi zdravstvene nege medicinske sestre pomagajo zagotoviti potrebne vire za uspešnejši proces prilagajanja. Avtorji v prispevku razpravljajo, ali bi teoretični model prilagoditve Calliste Roy ustrezal pri obravnavi in zdravstveni negi v enoti za zdravljenje bolečine.Metode: Uporabljena je triangulacija metod pregleda literature in kvalitativne metode z raziskovalno tehniko kritičnega dogodka. Pregled literature je bil narejen v vzajemni bibliografsko-kataložni bazi COBIB.SI in Cumulative Index to Nursing and Allied Health Literature (CINAHL). Pridobljenih je bilo 165 zadetkov in uporabljenih 34 znanstvenih člankov ter 7 monografij. Kriteriji izbora so bili primarni viri Calliste Roy, dostopnost, relevantnost, kritična ponazoritev teoretičnega modela. Tehnika kritičnega dogodka v treh fazah opiše incident, ga analizira ter poda možne izide. Rezultati: Adaptacijski model Calliste Roy je aplikativen, uporaben in v sedanji situaciji se dobro dopolnjuje s štirinajstimi temeljnimi življenjskimi aktivnostmi po Virginie Henderson. Model daje možnost ocene tako fizičnega kot psihosocialnega stanja. Najpomembnejše prepoznane intervencije medicinske sestre, ki pripomorejo k prilagoditvenemu procesu pacienta, so psihosocialna podpora, učenje in svetovanje. Diskusija in zaključek: Prednost obravnave pacienta z rakom in bolečino po izbranem modelu zdravstvene nege je v možnosti ocene stanja po vseh štirih ravneh prilagajanja in v prikazu načrta zdravstvene nege. Pokazalo se je kot pozitivno, da medicinska sestra lahko s psihosocialno podporo in informiranjem vpliva na kakovost življenja pacienta. Pacient in družina se soočata s kronično boleznijo, načinom življenja in pomenom poznavanja ter nadzorovanja bolečine. 

Health-related quality of life after treatment of Hodgkin lymphoma in young adults

PURPOSE/OBJECTIVES

To describe changes in health-related quality of life (HRQOL) and to identify supportive care services used after treatment for Hodgkin lymphoma (HL) in young adults.

DESIGN

A longitudinal, repeated-measures study design was used to test the feasibility of data collection at the conclusion of treatment for HL and at one, three, and six months post-treatment.

SETTING

Participants were identified from two large comprehensive cancer centers in New England.

SAMPLE

40 young adults with newly diagnosed HL were enrolled in the study prior to the completion of chemotherapy or radiation.

METHODS

Data were collected by interviews, standardized questionnaires, and medical record reviews.

MAIN RESEARCH VARIABLES

HRQOL variables defined as symptom distress, functional status, emotional distress, and intimate relationships; use of specific supportive care services; and baseline demographic and disease-related information.

FINDINGS

Results indicate that symptom distress improved at one month post-treatment and remained low at three and six months. Similarly, functional status improved at one month post-treatment. Only 13% of the sample had significant emotional distress at baseline, and this decreased to 8% over time. Patients placed high value on their intimate relationships (i.e., family and friends or sexual partners). A variety of supportive care services were used after treatment, the most common of which were related to economic issues. However, by six months post-treatment, services shifted toward enhancing nutrition and fitness.

CONCLUSIONS

The results from this study suggest that HRQOL in young adults with HL improved one-month post-treatment and that interest in using supportive care services was high.

IMPLICATIONS FOR NURSING

Facilitating the use of supportive care services at the end of cancer treatment appears to be an important part of helping young adults transition to survivorship.

KNOWLEDGE TRANSLATION

Supportive care services appear to be a vital component of the transition to survivorship and often change over time from an emphasis on economic issues to enhancing wellness through nutrition and fitness programs.

The geriatric cancer experience at the end of life: testing an adapted model

PURPOSE/OBJECTIVES

To test an adapted end-of-life conceptual model of the geriatric cancer experience and provide evidence for the validity and reliability of the model for use in practice and research.

DESIGN

Nonexperimental and cross-sectional using baseline data collected within 24-72 hours of admission to hospice.

SETTING

Two hospices in the southeastern United States.

SAMPLE

403 hospice homecare patients; 56% were men and 97% were Caucasian with a mean age of 77.7 years.

METHODS

Confirmatory factor analyses using structural equation modeling with AMOS statistical software.

MAIN RESEARCH VARIABLES

Clinical status; physiologic, psychological, and spiritual variables; and quality of life (QOL).

FINDINGS

A three-factor model with QOL as an outcome variable showed that 67% of the variability in QOL is explained by the patient's symptom and spiritual experiences.

CONCLUSIONS

As symptoms and associated severity and distress increase, the patient's QOL decreases. As the spiritual experience increases (the expressed need for inspiration, spiritual activities, and religion), QOL also increases.

IMPLICATIONS FOR NURSING

The model supports caring for the physical and metaphysical dimensions of the patient's life. It also highlights a need for holistic care inclusive of physical, emotional, and spiritual domains.

Development of the Comprehensive Inventory of Functioning-Cancer

The Comprehensive Inventory of Functioning-Cancer (CIF-CA) was developed to measure actual and desired functional status in women with cancer. CIF-CA items were taken from the Inventory of Functional Status-Cancer, which measures only actual performance of usual activities. Six CIF-CA subscales measure the extent to which women perform usual personal care, family care, household, social, community, and occupational activities following diagnosis of cancer (actual functional status) and the level at which they wish to perform those activities (desired functional status). Reliability and construct validity estimates were obtained using a sample of 190 women with breast, lung, or colon cancer. Internal consistency reliability using average correlations for subscale item to subscale total scores ranged from 0.68 to 0.93 for actual functional status and from 0.61 to 0.85 for desired functional status. Internal consistency reliability coefficients for subscale to total CIF-CA scores ranged from 0.46 to 0.86 for actual functional status and from 0.62 to 0.83 for desired functional status. Initial construct validity coefficients, using subscale to subscale scores, ranged from 0.10 to 0.61 for actual functional status and from 0.33 to 0.62 for desired functional status. The data support continued development of the CIF-CA.

A middle range theory for generative quality of life for the elderly

Decades of quality of life (QOL) research has failed to produce widely recognized QOL definitions or measurements. The inconsistency may be due to an ontological error in the perspective of researchers. Most researchers portray QOL as a given or inherent condition that declines in the face of challenges. We believe QOL is a cumulative process that results from a series of connections and disconnections that elders experience in their daily lives. The Register theory of Generative Quality of Life for the Elderly offers an alternative ontological perspective by placing elder QOL in a generative context.

Model test of the relationship between self-help-promoting nursing interventions and self-care and health status outcomes

In this study of a nursing intervention outcomes model was tested. Path analysis techniques were used to examine predicted relationships between self-help-promoting interventions and patient outcomes of self-care practice and client morbidity at three times. A sample of 307 women receiving medical treatment for breast cancer provided data for the study. The average participant was White, middle-aged, married, educated, and in stage I or stage II disease. Findings support the hypothesized model linking these nursing interventions directly to self-care outcomes and self-care to client morbidity outcomes. Client factors of age, social network size, disease stage, receipt of chemotherapy, resourcefulness, and uncertainty significantly influenced predicted relationships. Examination of specific patterns of relationships for the sample revealed delayed behavioral responses to the interventions, variability in predictors of each outcome at the three measurement times and a more strongly predictive model when patient outcomes were considered within the context of client factors.

Research and commentary: Change in exercise tolerance, activity and sleep patterns, and quality of life in patients with cancer participating in a structured exercise program

PURPOSE/OBJECTIVES

To investigate the feasibility of an exercise program patterned after a phase II cardiac rehabilitation program to improve selected physiologic and psychological parameters of health in patients with cancer.

DESIGN

Prospective, repeated measures study.

SETTING

Two major military medical centers in the southwestern United States.

SAMPLE

62 patients diagnosed with cancer within the previous two years. Ages ranged from 24-83 (meanX = 59). Half of the participants were male and half were female. Minorities made up 29% of the sample. Participants had a wide range of cancer diagnoses and all stages of cancer. Fifteen subjects were undergoing treatment when they enrolled in the study. More than half of the subjects exercised prior to their cancer diagnoses, but fewer than half were able to resume an exercise routine following their cancer diagnoses.

METHODS

Subjects met two days each week for 12 weeks for exercise and education.

MAIN RESEARCH VARIABLES

Exercise tolerance as measured with a graded exercise test, activity and sleep patterns as measured with a wrist actigraph, and quality of life (QOL) as measured with the Cancer Rehabilitation Evaluation System-Short Form.

FINDINGS

Significant improvements were observed over time in exercise tolerance, selected activity and sleep patterns, and QOL among the 46 (74%) subjects who completed the program.

CONCLUSIONS

Patients with various types and stages of cancer can safely exercise using a cardiac rehabilitation model and can realize significant improvements in exercise tolerance, selected activity and sleep patterns, and QOL.

IMPLICATIONS FOR NURSING

Most people are aware that regular exercise is part of a healthy lifestyle. After cancer diagnosis and treatment, patients experience uncertainty regarding how to resume exercise or how to begin an exercise program as part of their rehabilitation. Participation in a structured exercise program can provide patients with a safe environment within which to exercise at an intensity appropriate to their individual needs.

A conceptual model-based programme of nursing research: retrospective and prospective applications

BACKGROUND

A conceptual model implicitly or explicitly guides research. Some researchers identify the conceptual model prior to conducting their studies. Other researchers may eventually come upon a conceptual model that provides a context for the research already completed and direction for future studies.

AIM

The purpose of this article is to explain how one researcher, working with a theoretician, found a conceptual model that has provided a frame of reference for her past, present, and future studies and has allowed her to view her heretofore somewhat disparate studies as a more coherent programme of research.

CONCLUSION

Finding an explicit conceptual model provided a meaningful frame of reference for interpreting previous research. Finding an explicit model also had the benefit of uncovering of new possibilities for research. In particular, as the findings from previous research were brought together within the context of the conceptual model, unanticipated areas of future study were identified.

Health-related quality of life in pediatric patients with cancer. A structural equation approach with the Roy Adaptation Model

The purpose of this study was to test the Roy Adaptation Model-based theory of health-related quality of life in Taiwanese children with cancer. The environmental stimuli included severity of illness, age, gender, communication with others, and understanding of the illness. The severity of the illness was considered as a latent variable construct, including the stage of illness, laboratory values, and number of hospitalizations. Biopsychosocial responses, that is health-related quality of life, was hypothesized as a latent variable that consisted of (1) physical function, (2) psychologic function, (3) peer/school func tion, (4) treatment/disease symptoms, and (5) cognition functions. In total, 102 children with cancer participated in the study. Structural equation modeling was used to examine 2 Roy Adaptation Model-based theory propositions. The findings showed that the construct of severity of illness demonstrated excellent fit with the stage of illness, laboratory values, and total number of hospitalizations. Second, the health-related quality of life also demonstrated good construct validity with 5 domains. Third, this study supported the Roy Adaptation Model-based theory proposition that environmental stimuli influenced biopsychosocial responses.

Symptoms in adults with lung cancer. A systematic research review

Health care providers play a key role in providing adequate symptom management and promoting quality of life during chronic illness. Several studies have noted that adults with lung cancer experience more symptom distress than patients with other types of cancer. Therefore, symptom management in this group of patients is particularly important. An understanding of the research conducted in this area is important for further knowledge development and for potentially improving symptom management. This paper presents a systematic review of empirical studies examining symptoms in adults with lung cancer. The results of this systematic review revealed that although major strides have been made in understanding symptoms associated with lung cancer, further progress is needed to decrease the morbidity associated with uncontrolled symptoms. Theoretical, conceptual, and/or methodological issues identified through this review must be addressed in future research. In particular, the researcher should provide information about the theoretical or empirical framework guiding the study, give an explicit definition about the dimensions of the symptom experience being studied, report refusal rates and attrition, and use instruments that are reliable and valid.