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Poco LC, Andres EB, Balasubramanian I, Chaudhry I, Malhotra C. Prognostic understanding among advanced heart failure patients and their caregivers: A longitudinal dyadic study. PATIENT EDUCATION AND COUNSELING 2024; 127:108359. [PMID: 38905752 DOI: 10.1016/j.pec.2024.108359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 05/02/2024] [Accepted: 06/15/2024] [Indexed: 06/23/2024]
Abstract
OBJECTIVES To examine heart failure patients' and caregivers' prognostic understanding (PU) over time, and patient and caregiver factors associated with their own and each other's PU. METHODS We used longitudinal dyadic data from Singapore, involving surveys with 95 heart failure patient-caregiver dyads every 4 months for up to 4 years. We assessed the association of PU with patient health status, caregiver psychological distress and caregiving hours using random effects multinomial logistic models, controlling for patient and caregiver characteristics. RESULTS At baseline, half of patients and caregivers reported correct PU. Patient and caregiver variables were associated with their own and each other's PU. Patients with poorer functional well-being were less likely to report correct PU [Average Marginal Effects (95 % CI) 0.008 (0.002, 0.015)] versus incorrect PU. Greater caregiver psychological distress was associated with a lower likelihood of caregivers reporting a correct PU [- 0.008 (-0.014, -0.002)]. Higher caregiving hours reduced the likelihood of patients reporting correct [- 0.002 (-0.003, -0.001)] and increased the likelihood of patients reporting uncertain [0.001 (0, 0.002)] PU. CONCLUSIONS We found PU among patients and caregivers was influenced by their own and each other's experience. Our findings highlight the importance of ongoing communication to enhance PU of patients and caregivers.
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Affiliation(s)
| | | | | | - Isha Chaudhry
- Lien Centre for Palliative Care, Duke-NUS Medical School,169857, Singapore
| | - Chetna Malhotra
- Lien Centre for Palliative Care, Duke-NUS Medical School,169857, Singapore; Health Services and Systems Research, Duke-NUS Medical School, 169857, Singapore.
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Rosario-Ramos L, Torres-Marrero S, Rivera T, Navedo ME, Burgos R, Garriga M, del Carmen Pacheco M, Lopez B, Torres Y, Torres-Blasco N. Preparing for Cancer: A Qualitative Study of Hispanic Patient and Caregiver Needs. Healthcare (Basel) 2024; 12:1117. [PMID: 38891192 PMCID: PMC11172160 DOI: 10.3390/healthcare12111117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 05/26/2024] [Accepted: 05/28/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Cancer disproportionately affects Hispanic populations, yet the preparedness of Hispanic caregiver-patient dyads facing cancer remains understudied. This study aims to identify essential components of preparedness needs and inform future psychosocial interventions for this demographic. METHODS Secondary analyses were conducted utilizing focus groups to develop a communication intervention for Hispanic patients and caregivers. Transcripts were qualitatively analyzed using NVivo v12 (2020). RESULTS Analysis revealed symptom management and treatment comprehension as pivotal aspects of preparation. Additionally, preparedness among our sample emerged by addressing the multifaceted dimensions of preparedness, including psychological, emotional, educational, familial, practical, financial, and spiritual aspects. CONCLUSIONS Tailoring interventions encompassing diverse dimensions of preparedness can foster inclusivity and maximize their impact on supportive measures. This underscores the necessity for culturally sensitive approaches when delivering interventions supporting Hispanic individuals navigating the challenges of cancer.
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Affiliation(s)
- Lianel Rosario-Ramos
- School of Behavioral and Brain Sciences, Ponce Health Sciences University, Ponce 00716, Puerto Rico; (L.R.-R.); (S.T.-M.); (T.R.); (R.B.); (M.G.); (M.d.C.P.); (B.L.); (Y.T.)
| | - Stephanie Torres-Marrero
- School of Behavioral and Brain Sciences, Ponce Health Sciences University, Ponce 00716, Puerto Rico; (L.R.-R.); (S.T.-M.); (T.R.); (R.B.); (M.G.); (M.d.C.P.); (B.L.); (Y.T.)
| | - Tiffany Rivera
- School of Behavioral and Brain Sciences, Ponce Health Sciences University, Ponce 00716, Puerto Rico; (L.R.-R.); (S.T.-M.); (T.R.); (R.B.); (M.G.); (M.d.C.P.); (B.L.); (Y.T.)
| | - Maria Elena Navedo
- Department of Medicine, University of Connecticut, Storrs, CT 06269, USA;
| | - Rosael Burgos
- School of Behavioral and Brain Sciences, Ponce Health Sciences University, Ponce 00716, Puerto Rico; (L.R.-R.); (S.T.-M.); (T.R.); (R.B.); (M.G.); (M.d.C.P.); (B.L.); (Y.T.)
| | - Mayra Garriga
- School of Behavioral and Brain Sciences, Ponce Health Sciences University, Ponce 00716, Puerto Rico; (L.R.-R.); (S.T.-M.); (T.R.); (R.B.); (M.G.); (M.d.C.P.); (B.L.); (Y.T.)
| | - Maria del Carmen Pacheco
- School of Behavioral and Brain Sciences, Ponce Health Sciences University, Ponce 00716, Puerto Rico; (L.R.-R.); (S.T.-M.); (T.R.); (R.B.); (M.G.); (M.d.C.P.); (B.L.); (Y.T.)
| | - Betsy Lopez
- School of Behavioral and Brain Sciences, Ponce Health Sciences University, Ponce 00716, Puerto Rico; (L.R.-R.); (S.T.-M.); (T.R.); (R.B.); (M.G.); (M.d.C.P.); (B.L.); (Y.T.)
| | - Yamilet Torres
- School of Behavioral and Brain Sciences, Ponce Health Sciences University, Ponce 00716, Puerto Rico; (L.R.-R.); (S.T.-M.); (T.R.); (R.B.); (M.G.); (M.d.C.P.); (B.L.); (Y.T.)
| | - Normarie Torres-Blasco
- School of Behavioral and Brain Sciences, Ponce Health Sciences University, Ponce 00716, Puerto Rico; (L.R.-R.); (S.T.-M.); (T.R.); (R.B.); (M.G.); (M.d.C.P.); (B.L.); (Y.T.)
- Ponce Research Institute, Ponce 00716, Puerto Rico
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Wen FH, Hou MM, Su PJ, Shen WC, Chou WC, Chen JS, Chang WC, Tang ST. Factors of preparedness for loss from cancer among Taiwanese family caregivers. DEATH STUDIES 2024; 48:630-639. [PMID: 38236991 DOI: 10.1080/07481187.2024.2305340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
This cohort study investigated factors associated with 336 Taiwanese family caregivers' emotional and cognitive preparedness for death of a loved one with terminal cancer. Caregivers' death-preparedness states (no-death-preparedness [as reference], cognitive-death-preparedness-only, emotional-death-preparedness-only, and sufficient-death-preparedness states) were previously identified. Associations of factors with these states were determined by a hierarchical generalized linear model. Financial hardship decreased caregivers' likelihood for the emotional-death-preparedness-only and sufficient-death-preparedness states. Physician prognostic disclosure increased membership in the cognitive-death-preparedness-only and sufficient-death-preparedness states. The better the quality of the patient-caregiver relationship, the higher the odds for the emotional-death-preparedness-only and sufficient-death-preparedness states, whereas the greater the tendency for caregivers to communicate end-of-life issues with their loved one, the lower the odds for emotional-death-preparedness-only state membership. Stronger coping capacity increased membership in the emotional-death-preparedness-only state, but perceived social support was not associated with state membership. Providing effective interventions tailored to at-risk family caregivers' specific needs may facilitate their death preparedness.
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Affiliation(s)
- Fur-Hsing Wen
- Department of International Business, Soochow University, Taipei, Taiwan, ROC
| | - Ming-Mo Hou
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, ROC
| | - Po-Jung Su
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, ROC
| | - Wen-Chi Shen
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, ROC
| | - Wen-Chi Chou
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, ROC
- College of Medicine, Chang Gung University, Tao-Yuan, Taiwan, ROC
| | - Jen-Shi Chen
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, ROC
- College of Medicine, Chang Gung University, Tao-Yuan, Taiwan, ROC
| | - Wen-Cheng Chang
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, ROC
- College of Medicine, Chang Gung University, Tao-Yuan, Taiwan, ROC
| | - Siew Tzuh Tang
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, ROC
- School of Nursing, Chang Gung University, Tao-Yuan, Taiwan, ROC
- Department of Nursing, Chang Gung Memorial Hospital at Kaohsiung, Taiwan, ROC
- Department of Nursing, Chang Gung University of Science and Technology, Tao-Yuan, Taiwan, ROC
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Perspectives of Indonesian Muslim patients with advanced lung cancer on good death: A qualitative study. Eur J Oncol Nurs 2023; 62:102251. [PMID: 36603494 DOI: 10.1016/j.ejon.2022.102251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 11/26/2022] [Accepted: 12/02/2022] [Indexed: 12/11/2022]
Abstract
PURPOSE Lung cancer is the leading cause of cancer-related death. Patients with advanced lung cancer may experience burdensome distress at the end of life. The concept of good death has been shown to be complex, and continues to be expanded by gaining a better understanding of the cultural views of different populations. This study aimed to explore the perspective of Indonesian Muslims patients with advanced cancer on the concept of good death. METHOD A qualitative design comprising in-depth interviews was employed. Seven male and 3 female Muslim patients between ages 36 and 68 and diagnosed with advanced lung cancer were recruited from a teaching hospital in Central Java, Indonesia. RESULTS Content analysis of the interviews revealed five themes: dying without physical discomfort, dying in religious ways and in a desirable place, dying without emotional discomfort, receiving help and support, and having a good relationship with medical staff. CONCLUSIONS Indonesian Muslim patient with advanced lung cancer have unique perspectives on good death, especially based on the themes of religious ways of dying and support from family. Health care providers should be aware that good death is not an individual concern and should thus adopt highly sensitive observation skills to assess the physical and emotional state of patients. These providers must also understand their patients' preferences and respect their needs, regardless of their own beliefs.
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van der Velden NCA, Smets EMA, Hagedoorn M, Applebaum AJ, Onwuteaka-Philipsen BD, van Laarhoven HWM, Henselmans I. Patient-Caregiver Dyads' Prognostic Information Preferences and Perceptions in Advanced Cancer. J Pain Symptom Manage 2023; 65:442-455.e2. [PMID: 36731806 DOI: 10.1016/j.jpainsymman.2023.01.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 01/12/2023] [Accepted: 01/18/2023] [Indexed: 02/04/2023]
Abstract
CONTEXT Prognostic information is considered important for advanced cancer patients and primary informal caregivers to prepare for the end of life. Little is known about discordance in patients' and caregivers' prognostic information preferences and prognostic perceptions, while such discordance complicates adaptive dyadic coping, clinical interactions and care plans. OBJECTIVES To investigate the extent of patient-caregiver discordance in prognostic information preferences and perceptions, and the factors associated with discordant prognostic perceptions. METHODS We conducted secondary analyses of a cross-sectional study (PROSPECT, 2019-2021). Advanced cancer patients (median overall survival ≤12 months) from seven Dutch hospitals and caregivers completed structured surveys (n = 412 dyads). RESULTS Seven percent of patient-caregiver dyads had discordant information preferences regarding the likelihood of cure; 24%-25% had discordant information preferences regarding mortality risk (5/2/1 year). Seventeen percent of dyads had discordant perceptions of the likelihood of cure; 12%-25% had discordant perceptions of mortality risk (5/2/1 year). Dyads with discordant prognostic information preferences (P < 0.05) and dyads in which patients reported better physical functioning (P < 0.01) were significantly more likely to perceive the one-year mortality risk discordantly. CONCLUSION Physicians should be sensitive to discordant prognostic information preferences and prognostic perceptions among patient-caregiver dyads in advanced cancer care.
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Affiliation(s)
- Naomi C A van der Velden
- Department of Medical Psychology, Amsterdam UMC Location University of Amsterdam (N.C.A.V., E.M.A.S, I.H.), Amsterdam, The Netherlands; Quality of Care, Amsterdam Public Health (N.C.A.V, E.M.A.S, B.D.O-P, I.H.), Amsterdam, The Netherlands; Cancer Treatment and Quality of Life, Cancer Center Amsterdam (N.C.A.V., E.M.A.S, H.W.M.L, I.H.), Amsterdam, The Netherlands.
| | - Ellen M A Smets
- Department of Medical Psychology, Amsterdam UMC Location University of Amsterdam (N.C.A.V., E.M.A.S, I.H.), Amsterdam, The Netherlands; Quality of Care, Amsterdam Public Health (N.C.A.V, E.M.A.S, B.D.O-P, I.H.), Amsterdam, The Netherlands; Cancer Treatment and Quality of Life, Cancer Center Amsterdam (N.C.A.V., E.M.A.S, H.W.M.L, I.H.), Amsterdam, The Netherlands
| | - Mariët Hagedoorn
- Department of Health Psychology, University Medical Center Groningen, University of Groningen (M.H), The Netherlands
| | - Allison J Applebaum
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center (A.J.A), New York, New York, USA
| | - Bregje D Onwuteaka-Philipsen
- Quality of Care, Amsterdam Public Health (N.C.A.V, E.M.A.S, B.D.O-P, I.H.), Amsterdam, The Netherlands; Department of Public and Occupational Health, Expertise Center for Palliative Care, Amsterdam UMC location Vrije Universiteit Amsterdam (B.D.O-P, I.H.), Amsterdam, The Netherlands
| | - Hanneke W M van Laarhoven
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam (N.C.A.V., E.M.A.S, H.W.M.L, I.H.), Amsterdam, The Netherlands; Department of Medical Oncology, Amsterdam UMC location University of Amsterdam (H.W.M.L), Amsterdam, The Netherlands
| | - Inge Henselmans
- Department of Medical Psychology, Amsterdam UMC Location University of Amsterdam (N.C.A.V., E.M.A.S, I.H.), Amsterdam, The Netherlands; Quality of Care, Amsterdam Public Health (N.C.A.V, E.M.A.S, B.D.O-P, I.H.), Amsterdam, The Netherlands; Cancer Treatment and Quality of Life, Cancer Center Amsterdam (N.C.A.V., E.M.A.S, H.W.M.L, I.H.), Amsterdam, The Netherlands
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Wen FH, Chou WC, Chen JS, Chang WC, Hsu MH, Tang ST. Sufficient Death Preparedness Correlates to Better Mental Health, Quality of Life, and EOL Care. J Pain Symptom Manage 2022; 63:988-996. [PMID: 35192878 DOI: 10.1016/j.jpainsymman.2022.02.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/14/2022] [Accepted: 02/16/2022] [Indexed: 10/19/2022]
Abstract
CONTEXT Patients can prepare for end of life and their forthcoming death to enhance the quality of dying. OBJECTIVES We aimed to longitudinally evaluate the never-before-examined associations of cancer patients' death-preparedness states by conjoint cognitive prognostic awareness and emotional preparedness for death with psychological distress, quality of life (QOL), and end-of-life care received. METHODS In this cohort study, we simultaneously evaluated associations of four previously identified death-preparedness states (no-death-preparedness, cognitive-death-preparedness-only, emotional-death-preparedness-only, and sufficient-death-preparedness states) with anxiety symptoms, depressive symptoms, and QOL over 383 cancer patients' last six months and end-of-life care received in the last month using multivariate hierarchical linear modeling and logistic regression modeling, respectively. Minimal clinically important differences (MCIDs) have been established for anxiety- (1.3-1.8) and depressive- (1.5-1.7) symptom subscales (0-21 Likert scales). RESULTS Patients in the no-death-preparedness and cognitive-death-preparedness-only states reported increases in anxiety symptoms and depressive symptoms that exceed the MCIDs, and a decline in QOL from those in the sufficient-death-preparedness state. Patients in the emotional-death-preparedness-only state were more (OR [95% CI]=2.38 [1.14, 4.97]) and less (OR [95% CI]=0.38 [0.15, 0.94]) likely to receive chemotherapy/immunotherapy and hospice care, respectively, than those in the sufficient-death-preparedness state. Death-preparedness states were not associated with life-sustaining treatments received in the last month. CONCLUSION Conjoint cognitive and emotional preparedness for death is associated with cancer patients' lower psychological distress, better QOL, reduced anti-cancer therapy, and increased hospice-care utilization. Facilitating accurate prognostic awareness and emotional preparedness for death is justified when consistent with patient circumstances and preferences.
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Affiliation(s)
- Fur-Hsing Wen
- Department of International Business, Soochow University, Taiwan, China
| | - Wen-Chi Chou
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Taiwan, China; Chang Gung University College of Medicine, Taiwan, China
| | - Jen-Shi Chen
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Taiwan, China; Chang Gung University College of Medicine, Taiwan, China
| | - Wen-Cheng Chang
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Taiwan, China; Chang Gung University College of Medicine, Taiwan, China
| | - Mei Huang Hsu
- School of Nursing, Chang Gung University, Taiwan, China
| | - Siew Tzuh Tang
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Taiwan, China; School of Nursing, Chang Gung University, Taiwan, China; Department of Nursing, Chang Gung Memorial Hospital at Kaohsiung, Taiwan, China.
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Chang LF, Wu LF, Lin CK, Ho CL, Hung YC, Pan HH. Inpatient Hospice Palliative Care Unit and Palliative Consultation Service Enhance Comprehensive Quality of Life Outcomes in Terminally Ill Cancer Patients: A Prospective Longitudinal Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18178992. [PMID: 34501599 PMCID: PMC8431183 DOI: 10.3390/ijerph18178992] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/22/2021] [Accepted: 08/22/2021] [Indexed: 12/24/2022]
Abstract
This study aimed to explore the effectiveness of an inpatient hospice palliative care unit (PCU) and palliative consultation service (PCS) on comprehensive quality of life outcome (CoQoLo) among terminally ill cancer patients. This was a prospective longitudinal study. Terminally ill cancer patients who met the inclusion criteria and received PCU or PCS in a northern Taiwanese medical center were recruited. The CoQoLo Inventory was used to measure CoQoLo level pre- and seven days following hospice care between August 2018 and October 2019. A total of 90 patients completed the study. No significant differences were found in CoQoLo levels between the PCU and PCS groups pre- and seven days following care. However, the CoQoLo level of patients significantly improved seven days following care in both PCU and PCS groups, compared with pre-hospice care. Patients' age, religious belief, marital status, closeness with family, palliative prognostic index (PPI), and symptom severity were significant concerning CoQoLo levels after adjusting for patients' baseline characteristics. PCU and PCS showed no difference in CoQoLo levels, but both of them can improve CoQoLo among terminally ill cancer patients. These patients could receive PCU or PCS to achieve a good CoQoLo at the end-of-life stage.
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Affiliation(s)
- Li-Fang Chang
- Department of Nursing, Tri-Service General Hospital, Taipei City 11490, Taiwan; (L.-F.C.); (L.-F.W.)
- Graduate Institute of Medical Sciences, School of Nursing, National Defense Medical Center, Taipei City 11490, Taiwan
| | - Li-Fen Wu
- Department of Nursing, Tri-Service General Hospital, Taipei City 11490, Taiwan; (L.-F.C.); (L.-F.W.)
- Graduate Institute of Medical Sciences, School of Nursing, National Defense Medical Center, Taipei City 11490, Taiwan
| | - Chi-Kang Lin
- Department of Gynecology and Obstetrics, Tri-Service General Hospital, National Defense Medical Center, Taipei City 11490, Taiwan;
| | - Ching-Liang Ho
- Division of Hematology and Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei City 11490, Taiwan;
| | - Yu-Chun Hung
- Department of Nursing, Tri-Service General Hospital, Taipei City 11490, Taiwan; (L.-F.C.); (L.-F.W.)
- Nursing Department, University of Kang Ning, Taipei City 11405, Taiwan
- Correspondence: (Y.-C.H.); (H.-H.P.); Tel.: +886-2-8792-3311 (ext. 12841) (H.-H.P.)
| | - Hsueh-Hsing Pan
- Department of Nursing, Tri-Service General Hospital, Taipei City 11490, Taiwan; (L.-F.C.); (L.-F.W.)
- Department of Nursing, Tri-Service General Hospital, School of Nursing, National Defense Medical Center, Taipei City 11490, Taiwan
- Correspondence: (Y.-C.H.); (H.-H.P.); Tel.: +886-2-8792-3311 (ext. 12841) (H.-H.P.)
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Mental Adjustment as a Predictor of Comprehensive Quality of Life Outcome among Patients with Terminal Cancer. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094926. [PMID: 34063167 PMCID: PMC8125235 DOI: 10.3390/ijerph18094926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 04/24/2021] [Accepted: 05/04/2021] [Indexed: 11/18/2022]
Abstract
Using path modeling, this study aimed to explore whether mental adjustment was directly or indirectly related to comprehensive quality of life outcome (CoQoLO) among patients with terminal cancer. We conducted a cross-sectional designed study among patients with terminal cancer who underwent convenience sampling at our northern Taiwan clinic from August 2019 to August 2020. Patient characteristics data were collected via structured questionnaires, namely, the Mini-Mental Adjustment to Cancer Scale and the Comprehensive Quality of Life Outcome Inventory. Descriptive statistics and regression analyses were used to examine the relationship between mental adjustment and CoQoLO. Path analysis described the dependencies among variables. For the 117 enrolled patients analyzed, MAC (β = 1.2, 95% confidence interval (CI) = 0.8–1.6, p < 0.001) and living with others (β = 19.9, 95% CI = 4.1–35.7, p = 0.015) were significant predictors and correlated positively with a CoQoLO score. Path modeling showed that the patients’ mental adjustment, economic status, perceived disease severity, palliative prognostic index, and symptom severity directly affected their CoQoLO. Our results indicate that the higher the mental adjustment, the better the CoQoLO among patients with terminal cancer. Thus, nurses need to assess mental adjustment levels when patients are hospitalized and accordingly develop interventions to improve the terminally ill patients’ mental adjustment to the final stages of cancer, thereby helping them to achieve good CoQoLO.
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Wen FH, Chou WC, Hsieh CH, Chen JS, Chang WC, Tang ST. Conjoint cognitive and emotional death-preparedness states and their changes within cancer patients' last 6 months. Psychooncology 2021; 30:691-698. [PMID: 33345399 DOI: 10.1002/pon.5614] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 12/15/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND/OBJECTIVE Cognitive prognostic awareness (PA) and emotional preparedness for death are distinct but related concepts that have rarely been investigated conjointly and without considering the dynamic nature of death preparedness. To fill this gap, this secondary-analysis study identified distinct patterns/states of death preparedness and their changes within cancer patients' last 6 months. METHODS Distinct death-preparedness states, determined by conjoint cognitive PA and emotional preparedness for death, as well as their changes between consecutive times were identified and estimated, respectively, by latent transition modeling with hidden Markov modeling among 383 cancer patients within their last 6 months. RESULTS Four death-preparedness states (prevalence) were initially identified: no death preparedness (17.1%), cognitive death preparedness only (23.3%), emotional death preparedness only (39.9%), and sufficient death preparedness (19.7%). Patients in the no-death-preparedness state had neither accurate PA nor adequate emotional preparedness for death. The sufficient-death-preparedness state was characterized by both accurate PA and adequate emotional preparedness for death. In the cognitive- and emotional-death-preparedness-only states, patients were accurately aware of their prognosis and adequately emotionally prepared for their forthcoming death only, respectively. As death approached, state prevalence fluctuated within a narrow range for the no- and sufficient-death-preparedness states, whereas prevalence of cognitive- and emotional-death-preparedness-only states increased and decreased substantially, respectively. CONCLUSION Cancer patients heterogeneously experienced conjoint cognitive PA and emotional preparedness for death, and prevalence of death-preparedness states changed substantially as death approached. Effective interventions are warranted to cultivate cognitive PA and facilitate emotional death-preparedness to improve end-of-life-care quality, thereby helping patients achieve a good death.
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Affiliation(s)
- Fur-Hsing Wen
- Department of International Business, Soochow University, Suzhou, Taiwan, ROC
| | - Wen-Chi Chou
- Department of Internal Medicine, Division of Hematology-Oncology, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan, ROC.,School of Medicine, Chang Gung University College of Medicine, Tao-Yuan, Taiwan, ROC
| | - Chia-Hsun Hsieh
- Department of Internal Medicine, Division of Hematology-Oncology, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan, ROC.,School of Medicine, Chang Gung University College of Medicine, Tao-Yuan, Taiwan, ROC
| | - Jen-Shi Chen
- Department of Internal Medicine, Division of Hematology-Oncology, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan, ROC.,School of Medicine, Chang Gung University College of Medicine, Tao-Yuan, Taiwan, ROC
| | - Wen-Cheng Chang
- Department of Internal Medicine, Division of Hematology-Oncology, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan, ROC.,School of Medicine, Chang Gung University College of Medicine, Tao-Yuan, Taiwan, ROC
| | - Siew Tzuh Tang
- Department of Internal Medicine, Division of Hematology-Oncology, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan, ROC.,Chang Gung University, School of Nursing, Tao-Yuan, Taiwan, ROC.,Department of Nursing, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan, ROC
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