Quality of life reporting in the management of posterior fossa tumours: A systematic review

Introduction

Survival amongst posterior fossa tumour (PFT) patients is improving. Clinical endpoints such as overall survival fail to depict QoL. There is yet to be a review of current QoL instruments used for adult PFTs. Aim of this review is to outline the QoL reporting in the management of PFTs and measure participation level.

Methods

This systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis. A search strategy to identify adult patients with PFTs who took part in QoL metrics was conducted. Observational and experimental studies published from 1990 to date were included. Studies with a sample size less than 10 and performance measures such as Karnofsky Performance Status were not considered.

Results

A total of 116 studies were included in the final analysis. Vestibular schwannomas were the most common tumour pathology (n = 23,886, 92.6%) followed by pilocytic astrocytomas (n = 657, 2.5%) and meningiomas (n = 437, 1.7%) Twenty-five different QoL measures were used in the study pool. SF-36 was the most common (n = 55, 17 47.4%) QoL metric in the whole study pool, followed by the Penn Acoustic Neuroma QoL scale (n = 24, 20.7%) and Dizziness Handicap Inventory (n = 16, 13.8%). Seventy-two studies reported less-than 100% participation in QoL evaluation. The commonest reason for non-participation was a lack of response (n = 1,718, 60.8%), incomplete questionnaires (n = 268, 9.4%) and cognitive dysfunction (n = 258, 9.1%).

Conclusion

Informed clinical decision-making in PFT patients requires the development of specific QoL outcomes. Core outcome sets, and minimal clinically important differences (MCID) are essential for these metrics to show clinically significant improvements in patient QoL.

What determines quality of life in patients with vestibular schwannoma?

Objectives

Patients with a vestibular schwannoma (VS) experience a reduced quality of life (QoL). The main objective of this study was to determine the strongest predictors reducing physical and mental QoL from the disease‐specific Penn Acoustic Neuroma Quality of Life (PANQOL) questionnaire in patients with VS.

Design

Observational study.

Setting

Radboudumc Skull Base Centre, Nijmegen.

Participants

Patients newly diagnosed with VS between 2014 and 2017 managed with either observation, stereotactic radiosurgery or microsurgery.

Main outcome measures

Quality of life was assessed using the disease‐specific PANQOL and general Short‐Form (36) Health Survey (SF‐36). Multiple linear regression models with PANQOL domains as predictors were used to determine the strongest predictors for SF‐36 QoL physical and mental health scores. Standardised beta coefficients (β) were used for ranking.

Results

A total of 174 patients (50% females, mean age 58.9 years) returned the questionnaires, providing a 69% response rate. Fifteen patients (9%) were treated with microsurgery, 29 (17%) with stereotactic radiosurgery and 130 patients (75%) were observed in a wait and scan strategy. A lack of energy (β = .28; P ≤ .001), lower general health (β = .22; P ≤ .001), headache (β = .16; P ≤ .001), anxiety (β = .15; P ≤ .001) and balance problems (β = .10; P ≤ .001) are the strongest predictors affecting physical health, while mental health is most affected by anxiety (β = .37; P ≤ .001), a lack of energy (β = .34; P ≤ .001), facial nerve dysfunction (β = .07; P ≤ .001), balance problems (β = .04; P ≤ .001) and headaches (β = .04; P ≤ .001).

Conclusion

A lack of energy, anxiety, headache and balance problems are the strongest predictors of both SF‐36 physical and mental QoL in patients with VS. More awareness and supportive care regarding energy, anxiety, headache and balance in informing, evaluating and treating patients with VS could improve QoL.

Spinal Stenosis Patients' Visual and Verbal Description of the Comprehension of Their Surgery

BACKGROUND

Spine surgery patients have difficulty comprehending the patient education aimed at preparing for surgery.

PURPOSE

To assess the effect of a specific preoperative education approach (Knowledge Test Feedback Intervention, KTFI) on patients' verbal and visual understanding of their surgery.

METHODS

In this randomized controlled trial, the intervention group (n = 50) went through the KTFI and routine education, whereas the control group (n = 50) received only routine patient education. Written description of the surgical procedure and drawing of incision were used as outcome measures at baseline, at hospitalization, at discharge, and 3 and 6 months after surgery.

RESULTS

At baseline, half of the participants showed verbal and visual understanding of their surgery. During follow-up, understanding improved significantly with no statistically significant differences between the groups.

CONCLUSION

Spinal stenosis patients' understanding of their surgical procedure is imperfect. Patient educators need to ensure patient learning by evaluating comprehension outcomes.

Start making sense: Art informing health psychology

Growing evidence suggests that the arts may be useful in health care and in the training of health care professionals. Four art genres - novels, films, paintings and music - are examined for their potential contribution to enhancing patient health and/or making better health care providers. Based on a narrative literature review, we examine the effects of passive (e.g. reading, watching, viewing and listening) and active (e.g. writing, producing, painting and performing) exposure to the four art genres, by both patients and health care providers. Overall, an emerging body of empirical evidence indicates positive effects on psychological and physiological outcome measures in patients and some benefits to medical training. Expressive writing/emotional disclosure, psychoneuroimmunology, Theory of Mind and the Common Sense Model of Self-Regulation are considered as possible theoretical frameworks to help incorporate art genres as sources of inspiration for the further development of health psychology research and clinical applications.

Drawing asthma: An exploration of patients' perceptions and experiences

OBJECTIVE

As an art form, drawings can facilitate the tangible expression of patients' inner images and feelings in a range of health conditions. However, there are currently no published studies investigating adults' perspectives of asthma using drawings. This study aimed to explore how adults' drawings illustrate their perceptions and experiences of asthma.

METHODS

Adults with asthma participated in a one-on-one drawing activity. Analysis was grounded in the participants' accounts of their drawing, which were examined alongside the relevant image. A coding approach was used to cluster thematic material and map the data according to the Common-Sense Model of Self-Regulation (CSM).

RESULTS

Eighteen participants took part. Three themes emerged: (1) asthma is constrictive and restrictive, (2) feeling alone, feeling different, and (3) the life journey of asthma. The drawings aligned with several domains of the CSM, in particular consequences. The images drawn by the participants and their subsequent discussions highlighted the prominence of the emotional burden of asthma.

CONCLUSIONS

The drawings provided powerful and evocative communication of the experience of asthma. Future research using drawings can further both healthcare professionals' and patients' understanding of the physical, social and emotional demands of living with asthma, and support the development of asthma self-management practices.

Using drawings to explore patients' perceptions of their illness: a scoping review

Background

An emerging approach for investigating patient perspectives of their illness is the use of drawings.

Objective

This scoping review consolidates findings from current literature regarding the use of drawings to explore patients’ perceptions and experiences of their illness and treatment.

Methods

Electronic databases (Medline, PubMed, Embase, PsychINFO, Cinahl, Art Index and Scopus) and reference lists were searched to identify published English language studies using participant-generated drawings to explore adults’ perceptions and experiences of their illness and treatment. Using the scoping methodological framework, data were analyzed with respect to each study’s design, key findings and implications.

Results

Thirty-two studies were identified and these reflected diversities in both health conditions and methods of data collection and analysis. Participants’ drawings revealed new, insightful knowledge about patients’ perceptions, beliefs and experiences of their condition and were associated with clinical and psychological markers of health. Drawing was a powerful adjunct to traditional data collection approaches, and demonstrated potential benefits for participants. This review provides detailed insights and guidance on the use of drawings in research and clinical practice.

Conclusion

Drawing is a novel and potentially valuable technique for exploring patients’ perceptions and experiences about their illness and treatment. Advancing the methodology and applicability of drawings in this area will assist in the future development of this technique, with benefits for the patient, researcher and health care professional alike.

Kinematic measures of brain drawings are associated with illness perceptions in people with stroke

BACKGROUND

Previous research has shown that measuring the size and content of patients' drawings of their illness can reveal their perceptions and predict recovery. This study aimed to assess the usefulness of analyzing kinematic features of drawings.

METHODS

A pilot observational study was conducted with 15 patients who had been hospitalized with a stroke 8 to 11 months previously. They were asked to draw a picture of what they thought had happened to their brain and describe the drawing using an electronic inking pen and digitizing tablet. Analysis of kinematic data (time to draw/write, drawing/writing speed, and pen pressure) was conducted using MovAlyzeR® software. Evaluations of physical functioning, quality of life, illness perceptions, and emotional well-being were administered, and correlations with kinematic measures assessed.

RESULTS

Stronger pen pressure was associated with perceptions of greater control over the stroke. Faster drawing was correlated with greater worry about a recurrent stroke and the perception that the effects of the stroke would last longer. Needing more time to write was associated with perceptions of fewer consequences of the stroke. No associations between kinematic measures and indicators of stroke severity, physical, or emotional well-being were shown.

CONCLUSIONS

Kinematic measures of stroke patients' drawings of their brain and comments were associated with illness perceptions and not measures of physical or emotional health status. The addition of kinematic analysis may add further utility to the assessment of patients' drawings of their illness. More studies need to be performed with larger sample sizes and other patient groups.

Drawings of Blood Cells Reveal People's Perception of Their Blood Disorder: A Pilot Study

CONTEXT

Sickle cell disease (SCD) and thalassemia are rare but chronic blood disorders. Recent literature showed impaired quality of life (QOL) in people with these blood disorders. Assessing one of the determinants of QOL (i.e. illness perceptions) therefore, is an important next research area.

OBJECTIVE

We aimed to explore illness perceptions of people with a blood disorder with drawings in addition to the Brief Illness Perception Questionnaire (Brief IPQ). Drawings are a novel method to assess illness perceptions and the free-range answers drawings offer can add additional insight into how people perceive their illness.

METHOD

We conducted a cross-sectional study including 17 participants with a blood disorder. Participants' illness perceptions were assessed by the Brief IPQ and drawings. Brief IPQ scores were compared with reference groups from the literature (i.e. people with asthma or lupus erythematosus).

RESULTS

Participants with SCD or thalassemia perceived their blood disorder as being more chronic and reported more severe symptoms than people with either asthma or lupus erythematosus. In the drawings of these participants with a blood disorder, a greater number of blood cells drawn was negatively correlated with perceived personal control (P<0.05), indicating that a greater quantity in the drawing is associated with more negative or distressing beliefs.

CONCLUSION

Participants with a blood disorder perceive their disease as fairly threatening compared with people with other chronic illnesses. Drawings can add additional insight into how people perceive their illness by offering free-range answers.

Participatory medicine: model based tools for engaging and empowering the individual

The long-term goal of the Virtual Physiological Human and Digital Patient projects is to run 'simulations' of health and disease processes on the virtual or 'digital' patient, and use the results to make predictions about real health and determine the best treatment specifically for an individual. This is termed 'personalized medicine', and is intended to be the future of healthcare. How will people interact and engage with their virtual selves, and how can virtual models be used to motivate people to actively participate in their own healthcare? We discuss these questions, and describe our current efforts to integrate and realistically embody psychobiological models of face-to-face interaction to enliven and increase engagement of virtual humans in healthcare. Overall, this paper highlights the need for attention to the design of human-machine interfaces to address patient engagement in healthcare.

Views on clinically suspect arthralgia: a focus group study

The rheumatology field is moving towards identifying individuals with an increased risk for rheumatoid arthritis (RA) at a stage when arthritis is still absent but persons having clinically suspect arthralgia (CSA). Incorporating patients’ views in rheumatologic care is pivotal; however, the views of persons with CSA on their condition are unknown. We aimed to help fill this gap by exploring illness perceptions of persons with CSA and their views on hypothetical prognoses for developing RA. Persons with CSA were invited to participate in a semi-structured focus group discussion. Illness perceptions according to the Common Sense Model (CSM) and four a priori formulated themes were explored in detail during the group discussion. The discussion was audio-taped and transcribed verbatim. Transcripts were analysed in an interpretative phenomenological approach manner, on the basis of the dimensions of the CSM by three researchers independently. The views of four participants with CSA were explored during one focus group discussion. Four dimensions of the CSM were mainly observed: Identity, Consequences, Personal Control and Concern. None of the patients identified themselves as being a patient. They did experience pain and impairments in daily functioning and were concerned that their symptoms would progress. In the absence of physician-initiated treatment, some patients changed lifestyle in order to reduce pain and to promote health. Patients unanimously said that they could not interpret prognostic information on RA development expressed in hypothetical chances. Persons with CSA do not consider themselves patients. Prognostic information related to the development of RA based on risk percentages was considered as not useful by persons with CSA. Understanding of the illness perceptions of persons with CSA by health care professionals might improve medical management and facilitate shared decision-making.

Illness Perceptions in Women with Breast Cancer-a Systematic Literature Review

Women with breast cancer respond to the illness and its medical management in their own personal way. Their coping behavior and self-management are determined by their views (cognitions) and feelings (emotions) about symptoms and illness: their illness perceptions. This paper reports the results of a systematic literature review of illness perceptions and breast cancer. In the 12 studies identified, published between 2012 and 2015, illness perceptions were found to be important concomitants of medical and behavioral outcomes: fear of recurrence, distress, quality of life, satisfaction with medical care, use of traditional healers, and risk perception. Intervention studies are called for where the effects are examined of replacing unhelpful illness perceptions by more constructive ones. Health care providers do well by incorporating illness perceptions in their care for women with breast cancer, as this is instrumental in improving patients’ quality of life.