A substantive theory of quality of life of adults with chronic leukaemia

Adult-Child Caregivers' Family Communication Experiences after an Older Parent's Blood Cancer Diagnosis: A Survey Exploring Their Openness, Avoidance, and Social Support

Adult-child caregivers of an aging parent living with a blood cancer describe struggling to communicate with one another and within the family system. They may avoid critical care conversations, which may impede care and their ability to receive social support. We examined what approaches adult-child caregivers of a parent diagnosed with a blood cancer use to enhance their family communication, the topics they find most challenging to discuss, and the roles of openness and support. We used qualitative and quantitative approaches to analyze data from a larger online survey study. In partnership with the Leukemia & Lymphoma Society, we recruited 121 adult-child caregivers. Responses to one open-ended item were analyzed to capture strategies used to enhance communication with their parent and family. They reported utilizing digital communication modalities, prioritizing frequent communication, engaging in openness, establishing boundaries, kinkeeping, and enacting support. Within the quantitative data, we further explored two of these themes (openness and support) and their relationships to other variables using t-tests and regression analysis. Adult-child caregivers and diagnosed parents avoid talking about mortality and negative feelings. Openness in the family about cancer was linked to caregivers' perceptions of receiving social support. Findings demonstrate that cultivating openness between midlife adult children and diagnosed parents may enhance opportunities to receive support.

Understanding the Impact of COVID-19 on Chronic Lymphocytic Leukemia (CLL) Caregiving and Related Resource Needs

Chronic lymphocytic leukemia (CLL) caregivers play a central role in disease management-a role that has been heightened during the COVID-19 pandemic given the healthcare system's reliance on frontline family caregivers and CLL patients' increased risk of infection and mortality. Using a mixed-method design, we investigated the impact of the pandemic on CLL caregivers (Aim 1) and their perceived resource needs (Aim 2): 575 CLL caregivers responded to an online survey; 12 spousal CLL caregivers were interviewed. Two open-ended survey items were thematically analyzed and compared with interview findings. Aim 1 results showed that two years into the pandemic, CLL caregivers continue to struggle with coping with distress, living in isolation, and losing in-person care opportunities. Caregivers described experiencing increasing caregiving burden, realizing the vaccine may not work or didn't work for their loved one with CLL, feeling cautiously hopeful about EVUSHELD, and dealing with unsupportive/skeptical individuals. Aim 2 results indicate that CLL caregivers needed reliable, ongoing information about COVID-19 risk, information about and access to vaccination, safety/precautionary measures, and monoclonal infusions. Findings illustrate ongoing challenges facing CLL caregivers and provide an agenda to better support the caregivers of this vulnerable population during the COVID-19 pandemic.

Validation of the transactional eHealth literacy instrument with cancer caregivers

Objective

Family members are important sources of support for patients with cancer. They access, evaluate, and engage with online information and discuss it with a cancer clinician. This study validates the 4-dimensions, 18-item Transactional eHealth Literacy Instrument (TeHLI) and proposed to include Clinical eHealth Literacy as a 5th dimension.

Methods

The Leukemia & Lymphoma Society (LLS) disseminated an online survey to 121 family member caregivers between March-June 2020. We conducted confirmatory factor analyses (1) to examine model fit for the 4-factor TeHLI in the cancer caregiver population, and (2) to examine the model fit when adding the 5th factor.

Results

The 4-dimension model yielded acceptable model fit (RMSEA = 0.09; 90% CI = 0.08-0.11; CFI = 0.98; TLI = 0.98; SRMR = 0.07). The 5-dimension model also yielded acceptable model fit (RMSEA = 0.08; 90% CI = 0.07-0.10; CFI = 0.97; TLI = 0.97; SRMR = 0.08), supporting the expansion of the TeHLI within this population.

Conclusion

The five-dimension TeHLI is a valid and reliable measure of eHealth literacy among blood cancer caregiver populations.

Innovation

The TeHLI can be used as an outcome measure for communication skills training for caregivers, patients, and clinicians.

Blood cancer caregiving during COVID-19: understanding caregivers' needs

The COVID-19 pandemic likely exacerbated caregiving challenges for caregivers of parents diagnosed with a blood cancer. Providing care during a public health crisis presents a complex web of uncertainties regarding cancer care, personal health, and COVID-19 risk. Identifying caregivers’ uncertainty experiences during the COVID-19 pandemic can be a first step in learning where to direct resources or alter policies to ensure that they can not only perform their caregiver role but also cope in health-promoting ways. Using uncertainty management theory, this study explored how the pandemic has impacted adult child caregivers’ experiences caring for a parent diagnosed with a blood cancer, as well as their experiences of uncertainty and uncertainty management. As part of a larger study on blood cancer caregivers’ needs, a survey was administered from March 30 to June 1, 2020, to recruit caregivers through the Leukemia and Lymphoma Society. A qualitative and quantitative content analysis was conducted on open-ended responses from 84 caregivers. Caregivers described changes illustrating the complexity of providing care during a pandemic: (a) increased fears and uncertainty-related distress, b) reduced in-person care opportunities, (c) increased isolation, and (d) enhanced family communication. Caregivers with parents diagnosed with acute blood cancers used significantly more uncertainty management strategies and had more sources of uncertainty than caregivers with parents living with chronic blood cancer types. Findings highlight the need for supportive services to help caregivers manage uncertainty and improve their capacity to provide care in an unpredictable global health crisis. Such support may reduce poor psychosocial outcomes.

"Home wasn't really home anymore": Understanding caregivers' perspectives of the impact of blood cancer caregiving on the family system

PURPOSE

Research on the impact of family cancer caregiving is primarily dyadic in focus. How caregiving affects the larger family system is less understood, yet knowing this is vital to developing supportive resources for caregivers, patients, and their families. To better understand how blood cancer caregiving impacts the family system, we explored the experiences of adult child caregivers of diagnosed parents and parent caregivers of diagnosed children.

METHODS

We conducted semi-structured interviews with 39 midlife parent and adult child caregivers of patients with leukemia or lymphoma. Using a family systems theory lens, we conducted a thematic analysis using the constant comparative method to identify how caregiving impacts the larger family system.

RESULTS

Caregivers ranged from age 30 to 64 (M = 43). They described four ways that caregiving impacted themselves and the larger family system: (1) disruption of home life, (2) emotional (dis)connection, (3) juggling competing roles, and (4) developing resiliency and intimacy. Perspectives within each category differed based on their relational role to the patient or in the broader family.

CONCLUSIONS

Themes identify ways to provide support to both caregiver types. Support care resources could help families navigate gains and losses impacting the family system after a blood cancer diagnosis. Both caregiver types described experiencing (and/or their family experiencing) a loss in relational connection, feeling alone, and members distancing themselves. Both caregiver types also described gains in family functioning, like strengthened bonds and togetherness. Findings validate the need for family-centered support with key areas to address for healthy family functioning.

Multi-focused psychosocial residential rehabilitation interventions improve quality of life among cancer survivors: a community-based controlled trial

Background

Even though multi-focused psychosocial residence rehabilitation intervention (MPRRI) programs are widely implemented by the Shanghai Cancer Rehabilitation Club, these programs have not been rigorously evaluated. In this study, we evaluated the effects of a 21-day MPRRI program, on the quality of life (QoL) among cancer survivors.

Methods

A total of 388 cancer patients were enrolled to either receive the 21-day MPRRI (n = 129) intervention or a waiting-list comparison (WLC) intervention (n = 259). The intervention group was offered community-based 21-day MPRRI program, combining supportive-expressive group, cognitive-behavioral therapy, and Guolin Qigong. QoL was measured using the European Organization for Research and Treatment Quality of Life Version 3 Questionnaire. Multivariable linear models were used to compare changes in QoL values between the two groups.

Results

After adjustment for the QoL score and other covariates at baseline, there was no significant difference in global health status (mean = 3.8, 95% CI − 1.3–9.0, P = 0.14) between the two groups after 6 months intervention. While compared with the WLC group, the intervention group showed significant improvements in the QoL score (all P < 0.05); however, there were no clinically relevant changes in subscales including emotional functioning (ES = 0.58), cognitive functioning (ES = 0.53), pain (ES = 0.52), physical functioning (ES = 0.36), and insomnia (ES = 0.30).

Conclusions

These preliminary results suggest the MPRRI program is both feasible and acceptable intervention for cancer survivors in community settings and is effective in significant improving QoL above.

Quality of life in chronic lymphocytic leukemia: 5-year results from the multicenter randomized LRF CLL4 trial

Health-related quality of life (HRQoL) is a key issue for patients with chronic lymphocytic leukemia. The multicenter LRF CLL4 trial, in which 777 patients were randomized to receive chlorambucil or fludarabine, alone or with cyclophosphamide (FC), assessed HRQoL at baseline, months 3, 6 and 12, then annually until 5 years, using the European Organisation for Research and Treatment of Cancer quality of life questionnaire (EORTC-QLQ-C30). While on treatment, some HRQoL impairment was seen in patients receiving fludarabine, particularly FC, compared with chlorambucil. Thus at 3 months, role/social functioning and fatigue were ≥ 10 points worse than baseline in 41%/46%/56%, respectively, of patients receiving fludarabine alone and 48%/54%/60% receiving FC, compared with only 29%/31%/40% of those receiving chlorambucil. Thereafter HRQoL appeared similar between treatment groups. Sustained remissions were associated with long-term HRQoL benefit. In the primary HRQoL domains patients still in complete or partial remission at each time-point had scores close to those reported in general population studies, while patients whose disease had progressed had mean scores up to 22 points worse, in spite of subsequent treatments. These data offer support for the use of primary treatment regimens likely to achieve and sustain remission in otherwise medically fit patients of all ages, including those aged > 70 years.

Population preference values for treatment outcomes in chronic lymphocytic leukaemia: a cross-sectional utility study

Background

Given that treatments for chronic lymphocytic leukaemia (CLL) are palliative rather than curative, evaluating the patient-perceived impacts of therapy is critical. To date, no utility (preference) studies from the general public or patient perspective have been conducted in CLL. The objective of this study was to measure preferences for health states associated with CLL treatment.

Methods

This was a cross-sectional study of 89 members of the general population in the UK (England and Scotland). Using standard gamble, each participant valued four health states describing response status, six describing treatment-related toxicities based on Common Toxicity Criteria, and two describing line of treatment. The health states incorporated standardized descriptions of treatment response (symptoms have "improved," "stabilized," or "gotten worse"), swollen glands, impact on daily activities, fatigue, appetite, and night sweats. Utility estimates ranged from 0.0, reflecting dead, to 1.0, reflecting full health.

Results

Complete response (CR) was the most preferred health state (mean utility, 0.91), followed by partial response (PR), 0.84; no change (NC), 0.78; and progressive disease (PD), 0.68. Among the toxicity states, grade I/II nausea and nausea/vomiting had the smallest utility decrements (both were -0.05), and grade III/IV pneumonia had the greatest decrement (-0.20). The utility decrements obtained for toxicity states can be subtracted from utilities for CR, PR, NC, and PD, as appropriate. The utilities for second- and third-line treatments, which are attempted when symptoms worsen, were 0.71 and 0.65, respectively. No significant differences in utilities were observed by age, sex, or knowledge/experience with leukaemia.

Conclusions

This study reports UK population utilities for a universal set of CLL health states that incorporate intended treatment response and unintended toxicities. These utilities can be applied in future cost-effectiveness analyses of CLL treatment.

The choices, choosing model of quality of life: description and rationale

AIM

This introductory paper offers a critical review of current models and measures of quality of life, and describes a choices and choosing (c-c) process as a new model of quality of life.

METHOD

Criteria are proposed for judging the relative merits of models of quality of life with preference being given to explicit mechanisms, linkages to a science base, a means of identifying deficits amenable to rational restorative interventions, and with embedded values of the whole person.

RESULT

A conjectured model, based on the processes of gaining access to choices and choosing among them, matches the proposed criteria. The c-c process is an evolved adaptive mechanism dedicated to the pursuit of quality of life, driven by specific biological and psychological systems, and influenced by social and environmental forces.

CONCLUSIONS

This model strengthens the science base for the field of quality of life, unifies approaches to concept and measurement, and guides the evaluation of impairments of quality of life. Corresponding interventions can be aimed at relieving restrictions or distortions of the c-c process; thus helping people to preserve and improve their quality of life. RELATED WORK: Companion papers detail relevant aspects of the science base, present methods of identifying deficits and distortions of the c-c model so as to open opportunities for rational restorative interventions, and explore empirical analyses of the relationship between health imposed restrictions of c-c and conventional indicators of diminished quality of life. [corrected]

Coping with illness and subjective theories of illness in adult patients with haematological malignancies: systematic review

In parallel to development of individualised antineoplastic treatment, scientific interest in patients' subjective theories of illness (STOI) has emerged in the oncological community. STOI depend decisively on patients' information about their disease. Coping with illness is dependent from the individual situation and context, and it is generally modulated by patients' STOI. The purpose is fivefold: (1) to provide a thorough literature review about coping and about STOI in adult haematological patients, (2) to survey through which indicators the topics were operationalized in studies, (3) to clarify the kind of coherence between these two topics, (4) to explicate the interaction between STOI and other variables, and (5) to verify the clinical relevance of both topics. We searched 19 electronic databanks for English biomedical literature manuscripts (1995-2008) on this subject. Twenty-six studies met our criteria and varied in haematological entity, treatment concept, sample size and methodological design. We conclude that a subjective-individual regulation of patient's mental stability during a cytotoxic chemotherapy is important. Successful coping strategies develop not only based on objective, but also subjective evaluation mechanisms. We deduce consequences for doctor-patient communication and psychosocial care in haematology. The newly developed process model of subjective regulation in cancer patients, in general, views the oncological treatment process as a procedural mental evaluation.

Methodological issues related to assessing and measuring quality of life in patients with cancer: implications for patient care

Consideration of quality-of-life issues by all members of the healthcare team is essential in caring for people with cancer. In cancer research, quality of life is generally classified as health-related quality of life or individual quality of life. This paper discusses the instruments used to measure quality-of-life outcomes, and the relevance of such findings for healthcare staff in planning and providing effective and patient-centred care. Visual analogue scales (VASs) and questionnaires are commonly used to measure quality of life; however, both types of instruments are criticized because the content may not be relevant to individual patients, and do not distinguish differences between statistical and clinical significances in the findings. Using a combination of questionnaires and VASs may overcome some of these criticisms. In order to interpret the difference between statistical and clinical significance of findings and the associated implications for patient care, a mixed-methods approach to data collection is recommended in quality-of-life studies. This provides meaning and understanding to the quantitative data and individual perspectives on patients' experiences of having cancer. Information from such studies may also be more effective in helping healthcare staff identify relevant issues when planning cancer care services at individual, local and national level.

Missed opportunities: nursing insights on end-of-life care for haematology patients

There is now extensive consumer research to indicate that patients with haematological malignancies are not receiving appropriate or timely referrals to the palliative system. This paper begins to explore the issue from the professional perspective by presenting findings from haematology nurses on their experience with terminal care. The nursing insights have been gathered through open-ended interviews with a national sample of nurses with extensive experience in haematology in both public and private hospitals throughout Australia. The findings resonate with the previous consumer research in that all the acute care nurses affirmed that it is their belief, based on their professional experience, that patients from these diagnostic groups typically die in the acute ward dealing with escalating technology and invasive treatments. For some, the statements could be qualified by the satisfaction that they worked in a haematology unit, aware of the death-denying issues, trying to address the problem. Others, caught in a 'refractory' subculture (i.e. a subculture with a negative perception of palliative care), outlined the factors driving the lack of integration for their specific hospital. The focus of the discussion of findings is on the latter.

Chronic lymphocytic leukemia: economic burden and quality of life: literature review

The purpose of this review was answer 2 main questions: what is the impact of chronic lymphocytic leukemia (CLL) on the patient's quality of life and how great is the economic burden of this disease on the health care payers and providers. Patients with CLL typically do not receive any treatment soon after the initial diagnosis. Although there is no known cure for CLL yet, when treated, the patients receive aggressive and expensive therapies (eg, chemotherapy or bone marrow transplantation). A rigorous and systematic literature review was performed of English-language articles published in 1990-2002. It was supplemented with additional articles published before 1990 for completeness and additional references to fill the gaps identified in the published medical literature. The literature on the quality of life (QOL) of CLL patients is very limited. We identified only 8 articles, and none of them analyzed the QOL in untreated CLL patients. Because CLL is a disease affecting adults, especially the elderly, all 8 studies measured the QOL in the adult population. QOL difficulties include fear of death and disability, problems gaining employment or health insurance, and fatigue. No specific leukemia or CLL instruments but general QOL instruments (eg, I-HRQL) were identified and some cancer-specific ones (eg, EORTC QLQ-C30, FACT-G, FACT Anemia, FACT-Fatigue). Interestingly, a FACT-Bone Marrow Transplant instrument exists, although we found no study on CLL that used it. Even the literature on the economic burden of CLL is very limited. We identified 13 studies on the cost of CLL: Most of them were cost-identification or cost-comparison studies, and 5 dealt with the cost-effectiveness of medical interventions to treat CLL. Cost drivers identified for CLL were the chemotherapy costs, intravenous immunoglobulin costs, transplantation costs, and costs associated with the differential staining cytotoxicity assay. We identified very few articles on the QOL of CLL patients and therefore cannot draw strong conclusions about the key QOL predictors. Nevertheless, patients with anemia were found to have a better QOL if they had higher hemoglobin counts and good response to erythropoietin treatment. The articles published seem to demonstrate that the older the age of the patient was, the poorer the QOL. The main cost drivers identified for CLL were related to the treatment chosen (eg, chemotherapy, bone marrow transplantation). There are hints that higher costs often result from the delivery of non-optimal therapy that leads to adverse events, infections, and drug resistance. In summary, the impact of this disease on the health care budget of the different health care providers and payers as well as on the patient's QOL is substantially unknown, calling for appropriate economic and QOL studies.

The Meaning of Quality of Life Among Patients With Familial Hypercholesterolemia

BACKGROUND

Living with a genetic predisposition to disease may influence quality of life. The presence of premature disease can lead to an increased focus on family history and genetic predisposition.

OBJECTIVE

The purpose of this study was to describe quality of life in patients with the genetic disease, familial hypercholesterolemia, who are at an increased risk of premature coronary heart disease.

METHODS

Interviews from 12 adult patients with FH were analyzed using constant comparative analysis. The findings of this qualitative study revealed that for patients, quality of life was equated with harmony in life, the core category. Attaining harmony in life presumes satisfaction and togetherness. Cognizance of the threat of coronary heart disease and impending mortality is balanced by the support of togetherness and satisfaction that builds harmony in life.

CONCLUSION

When caring for patients with familial hypercholesterolemia, it is important to meet each patient on his or her own level, and to support balance and their choices for maintaining or regaining harmony in life.

The meaning of quality of life in patients being treated for advanced breast cancer: A qualitative study

The purpose of the present study was to investigate the meaning of advanced breast cancer patients' quality of life (QoL). A semi-structured interview was used, and the phenomenological research method chosen to analyse the data. The findings show that limitations in physical functioning translate into dependency on others, leading to decreased autonomy. Patients tended to ensure their autonomy by participating in easier activities or changing their internal standards. Changes in appearance and decreased condition affected patients' ability to carry out roles and responsibilities, which led to changes in lifestyle and also affected patients' social functioning, often resulting in isolation. The meaning of being able to sustain reciprocal relationships was emphasized. Patients maintained control of to what extent their illness was recognized in social relationships, which was crucial to their feelings of autonomy. Close families were a main source of social support, but also a major source of concern. Meaning of emotional functioning was often expressed in terms of the ability to enjoy life day-by-day and of commitment to treatment. Patients' cognitive functioning was largely intact while their difficulties in cognitive functioning were more characteristic of anxiety. Global QoL was often expressed in terms of a normal life. In addition there were 3 meta themes which emerged from the data: the patients' ability to control the illness experience, personal growth and hope.

The experience of leukaemia and bone marrow transplant: searching for meaning and agency

This qualitative study examines the experience of haematological cancer as described by ten people who have been through leukaemia or lymphoma and a bone marrow transplant. The focus is on the interaction of these participants with this challenging experience and the meaning it had for them. The descriptions of their thoughts, feelings and actions as they negotiated the period from diagnosis to treatment and survival reveal that these people brought both the present values in their life, as well as a life-long pattern of dealing with adversity, into their confrontation of a life-threatening illness. Issues of personal meaning and agency (the capacity to act and control valued aspects of one's life) were found to be paramount. These results are then discussed with a view to their implications for patient care.

Assessing the quality of life of patients in phase I and II anti-cancer drug trials: interviews versus questionnaires

This paper discusses two different approaches to assessing quality of life in the context of cancer clinical trial participation. Drawing on empirical evidence from a study of patients' experiences of phase I and II anti-cancer drug trial participation, the paper demonstrates how different methods of collecting data about an individual's quality of life (questionnaires and interviews) can lead to alternative conclusions about patients' trial experience and the impact of trial involvement on their quality of life. Data obtained from the quality of life questionnaires interestingly revealed no statistically significant differences in any of the scores over time while in-depth interviews uncovered something of the psychological, emotional and social impact of taking part in a clinical trial from the perspective of the patient. The paper concludes by reflecting on some of the methodological issues that arise when assessing the quality of life of patients with a life threatening disease in clinical trials.

Quality of life in patients with familial hypercholesterolaemia

OBJECTIVES

The primary aim of this study was to analyse quality of life in adult patients with familial hypercholesterolaemia (FH), a genetic disorder with increased risk of coronary heart disease (CHD). Secondary aims were to find explanatory factors for quality of life and anxiety.

DESIGN

A descriptive cross-sectional design was used.

SETTING

Outpatients from lipid clinics at two university hospitals in Sweden were included. Patients with heterozygous FH and a randomly selected control group participated by filling out questionnaires.

SUBJECTS

Two hundred and eighty patients with heterozygous FH above 18 years of age were asked, and 212 of whom 185 were free of overt CHD, participated. Of a control group of 2980 persons 1485 were included for comparison.

METHODS

We used Likert-type questionnaires: the Quality of Life Index (QLI) consisting of four subscales, the Hospital Anxiety and Depression Scale (HAD), the Mastery Scale measuring coping and a questionnaire on health and lipids constructed for FH patients.

RESULTS

Patients with FH were significantly more satisfied with overall quality of life 21.8 +/- 0.3 (SEM) vs. controls 21.1 +/- 0.1 and this was also the case in three of four subscales, all differences P < 0.05. Anxiety about getting CHD was expressed amongst 86% of the patients with FH.

CONCLUSIONS

Quality of life amongst patients with FH was at least as good as in controls but they were worried about getting CHD.

Reflections on nutritional issues associated with cancer therapy

PURPOSE

It is now recognized that dietitians have a significant role to play in the care of oncology patients, many of whom have problems with nutrition. However, it is increasingly understood that there are important obstacles to assisting patients with nutritional problems in the oncology setting. The purpose of this article is to discuss the incidental findings of two recent studies, highlighting the importance of and problems associated with nutritional issues in patients with a hematologic malignancy.

OVERVIEW

This article presents findings from two recent studies with a subset of patients who have hematologic malignancies. This diagnostic subgroup has specific challenges associated with nutrition and eating because of the intensive and aggressive treatments that patients endure. An explorative, descriptive, iterative, qualitative methodology was used for both studies. The focus was on exploring the lived experience of treatment in oncology/hematology for patients (prospective) and caregivers (retrospective).

CLINICAL IMPLICATIONS

The findings indicate that the issues surrounding food and eating are considered to be of great significance both to patients who are undergoing intensive treatment for a hematologic malignancy and to their caregivers. The significance of food is not seen purely in relation to its nutritional value, but as an important quality-of-life issue. Eating problems during intensive chemotherapy are perceived as highly stressful and can be, in the case of treatment-related anorexia, life threatening. Recommendations are made for interventions that could reduce the stress and nutritional difficulties for both patients and caregivers.

Quality of life of idiopathic pulmonary fibrosis patients

Little attention has been paid to quality of life (QOL) in idiopathic pulmonary fibrosis (IPF). Therefore, the aim of this study was to address this issue and study the relationship between QOL, depressive symptoms, and breathlessness in these patients. Forty-one IPF patients and 41 healthy persons matched for age and sex completed the World Health Organization Quality of Life assessment instrument-100. The IPF patients also completed the Beck Depression Inventory, the Bath Breathlessness Scale, a social support questionnaire and a question concerning perceived seriousness of illness. Compared to the control group, QOL in IPF patients was mainly impaired in the domains "physical health" and "level of independence". A number of relationships were found between pulmonary function tests and QOL. The QOL facet "negative feelings" was highly associated with scores on depression. Subjective breathlessness was related to depressive symptoms and QOL. Moreover, sex and effective/emotional breathlessness predicted overall QOL. In conclusion, the impairment of the quality of life areas "physical health" and "level of independence" are important issues in idiopathic pulmonary fibrosis. Subjective breathlessness, especially the effective/emotional scale, seems related to quality of life and depressive symptoms. Rehabilitation programmes are needed that are aimed at physiological aspects and psychosocial aspects of idiopathic pulmonary fibrosis in order to enhance the quality of life of these patients.

Sense of coherence: quality of life before and after coronary artery bypass surgery--a longitudinal study

The attention to patient outcome has nowadays extended from morbidity and mortality to an aspect of patients' benefits in terms of quality of life. One factor crucial for quality of life is coping capacity, in this study represented by the sense of coherence concept. Physical status and emotional state (often measured by comprehensive instruments not always suitable for clinical use) are also additionally used to reflect quality of life. The purpose was therefore to study sense of coherence and emotional state as indirect measures of quality of life in relation to coronary artery bypass grafting surgery. One hundred and eleven patients were studied by a developed questionnaire on five occasions in relation to the surgery: the week before the angiography, the day before surgery and then at 3, 6, and 12 months post-operatively. The main findings were: (1) The sense of coherence was changed (more than +/-10%) from before to 1 year after surgery in 41% of the patients, which is contrary to the theory of sense of coherence as a stable personality characteristic in adults. (2) Experience of depressed mood, stress, and anxiety decreased significantly from before to after surgery. (3) Beneficial outcome with regard to sense of coherence was significantly related to less experience of loneliness, depressed mood, stress and anxiety, and to less experience of chest pain 1 year after surgery. In conclusion, sense of coherence and emotional state variables, are suggested to be valuable as measurements of quality of life in relation to coronary artery bypass grafting surgery.

Findings from an educational support course for patients with leukemia

OBJECTIVES

Recent evidence indicates that patients with leukemia are a distinct subset of cancer patients with specific adjustment issues and special needs for support and follow-up. This article shares recent research findings on an Australian educational support course, appropriately named Taking Control, designed specifically for patients with leukemia and associated disorders.

MATERIALS AND METHODS

The material presented in this article represents the findings from the retrospective arm of a descriptive study designed to evaluate this course. Participants in the course during the calendar year of 1997 were surveyed with an author-designed, self-report questionnaire requesting feedback on their experience of the course.

RESULTS

Although the majority of participants were seeking information, there was strong evidence that the provision of information needs to be coupled with an understanding of the psychosocial reasons that motivated individuals to attend the course. The findings indicate that the course is perceived by participants to be an effective psychosocial intervention for assisting patients and their families cope with the serious diagnosis of leukemia.

CONCLUSIONS

Even though information seeking was an important reason for attending this educational course, there were many other significant emotional concerns that individuals brought to the experience. When exposed to the stress of leukemia and its treatment, patients and their significant others may become preoccupied with information gathering. Therefore, it is important to not only explore the issue of the informational needs of participants, but also to examine the emotional needs they associate with this information gathering. The hope and expectation about sharing the findings of this program is that it will assist with the development of similar programs elsewhere and will stimulate further research on the importance of educational support groups in oncology.

Update on psychosocial research on leukaemia for social work practitioners

This article describes an Australian initiative that has undertaken the challenge of establishing a permanent psychosocial research program on leukaemia and associated haematological disorders to inform service provision and policy development for patients and their families. The description of this initiative is set in the context of a summary of the present research that exists in this area. This research indicates that this is a group of patients with a high rate of morbidity who, along with their family and carers, are vulnerable to physical, social, emotional and spiritual distress. The discussion concludes with a description of research projects that are presently being undertaken to extend our understanding of the psychosocial issues associated with these diagnostic groups.