Quality of life: verification and use of a self-assessment scale in two patient populations

Internet-based cognitive-behavioral therapy for premenstrual syndrome: a randomized controlled trial

Background

Premenstrual syndrome (PMS) is a common problem of women of reproductive age, affecting various aspects of their lives. However, limited studies have investigated the effect of internet-based cognitive-behavioral therapy (ICBT) on PMS. Therefore, we aimed to assess whether ICBT can reduce symptom severity of women with PMS and improve their quality of life during the perimenstrual and late follicular phases of menstrual cycle.

Methods

The study included 92 university students aged 18–35 years who had moderate to severe PMS. The participants were allocated into two groups of 46 using block randomization. The intervention group underwent ICBT for two menstrual cycles, while the control group received no intervention. Before and after the intervention, all participants filled the Daily Record of Severity of Problems (DRSP) for two menstrual cycles and the Quality of Life Enjoyment and Satisfaction Questionnaire—Short Form (Q-LES-Q-SF) on days 1–2 and 11–13 of the menstrual cycle. Data were analyzed using univariate general linear models.

Results

Four students in the intervention group were lost to follow-up. Following the intervention, the mean score of total PMS symptoms was significantly lower in the intervention group than in the control group (10.4 vs. 20.2, adjusted difference: − 9.9 [95% CI − 13.3 to − 6.6]), and the score of perimenstrual quality of life was significantly higher (64.2 vs. 50.3, 14.1 [8.5 to 19.8]). However, there was no significant intergroup difference in the late follicular quality of life (68.3 vs. 67.3, 1.9 [− 4.4 to 8.1]).

Conclusions

The ICBT could reduce the symptom severity of women suffering from PMS while improving their perimenstrual quality of life. However, it had no significant effect on the late follicular quality of life. Therefore, this intervention can be used for women with PMS.

Trial registration The Iranian Registry of Clinical Trials, Identifier: IRCT20100414003706N34, Registered prospectively on 19 June 2019, https://www.irct.ir/trial/38394.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12905-021-01589-7.

Developing and testing an instrument for the measurement of individual care

This paper describes a preliminary study in which an instrument was developed for the measurement of individual care in adult patients and in which the reliability and validity of the instrument were evaluated. Individual care was defined in terms of how patient individuality was taken into account and how patient participation in decision-making was facilitated. The purpose here is to describe the process by which the individual care instrument (IC) was developed, the preliminary testing of the instrument and psychometric evaluation of the instrument in a sample of adult patients discharged from a Finnish general Hospital (n=203). Item analyses showed an acceptable level of internal consistency reliability and homogeneity in each scale of the IC, and Cronbach alpha values were high in every measurement. Exploratory factor analysis supported a three-factor solution. The psychometric evaluations suggested that the instrument is worthy of further development.

Individualized care in a Finnish healthcare organization

This paper reports the findings of a study exploring the provision of individualized care in a regional hospital in Finland. Individualized care was defined in terms of how patient individuality was taken into account and how patient participation in decision-making was facilitated. The data were collected from hospitalized patients (n = 203) using a questionnaire specially developed for this study. The response rate was 89%. A strong support to facilitate patient participation in decision-making was reported. Most shortcomings concerning the provision of individualized care related to consideration of the patient's cultural background and the involvement of the patient's family in the planning of care. Patients' age and the type of ward were associated with the provision of individualized care: patients aged 65 or over were more satisfied than younger age groups with the way in which their personal life situation had been taken into account. Patients from the gynaecological ward thought, more than patients from the surgical ward, that their situation had been taken into account during hospitalization.

Inflammatory bowel disease. 3: importance of partnership in care

In the preceding articles (Vol 8(13): 858-62; Vol 8(14): 926-30), the pathogenesis and aetiology of inflammatory bowel disease (IBD) and its medical and surgical treatment options were considered. In this final part of the series, the concept of an alliance between the patient with IBD and healthcare professionals in terms of healthcare choices is examined. The article explores the role of the clinical nurse specialist in IBD in relation to education, psychological support and compliance with treatment regimens. There is also a discussion of the social and psychological impact of IBD on the patient, and an exploration of the positive effects such a participatory relationship may have on health and quality of life.

Individuals' perception of their quality of life following a liver transplant: an exploratory study

This study explores individuals' perceptions of the effect of a liver transplant on their quality of life, focusing on the progression from dependence to independence physically, socially and psychologically. A phenomenological design using taped semi-structured interviews was used. The sample consisted of five patients attending the out-patients clinic at least 1 year following a liver transplant for chronic liver disease. The data were analysed using cluster analysis of transcribed interviews. Categories were identified as physical, social and psychological factors affecting their progression from dependence to independence pre- and post-transplant and specific factors were identified as significant in overcoming the stressors affecting this progression. The findings reflected Maslow's Hierarchy of Needs. Pre-transplant their physical problems prevented them fulfilling personal goals and addressing psychological issues, e.g. dying. Post-transplant any physical problems identified were insignificant to the participant. They were keen to socially integrate and be treated as normal; however, family and friends restricted their independence by continuing to 'wrap them in cotton wool' as they had before their transplant. Personality, incentives and Unit support were identified as imperative in their progression from dependence to independence. The findings demonstrate a need to impress on family and friends of patients following a liver transplant, their role in assisting the patient's progression from dependence to independence.

Symptom distress in adult patients with cancer

Symptom distress in the adult population with cancer is of concern to clinicians who care for these patients. Increased research has been directed toward the development and refinement of symptom distress scales, the identification of determinants of symptom distress, the investigation of symptom distress as a predictor, and the examination of the relationship between quality of life and symptom distress. Findings from this research have increased our understanding of symptom distress in adult patients with cancer. However, a major limitation of work to date has been a lack of consensus related to the definition and measurement of the symptom distress construct. The purpose of this article is to address existing conceptual and methodological challenges inherent in the study of symptom distress, and to make recommendations for further research in this area.

Advances in supportive care

A range of distressing symptoms, such as nausea and vomiting, dyspnoea and pain, which invariably impair quality of life, may develop in cancer patients as a result of their disease and treatment. The side-effects of cancer treatments place additional burdens on the patient. Patients indicate that they find nausea and vomiting and fatigue to be the most distressing symptoms. The burden of distressing symptoms and the side-effects of cancer treatments may be so great for some patients that they make a decision not to continue with treatment. Developing better methods of managing these complaints is critical for improving both quality of life and treatment outcome. Over the past two decades there have been dramatic advances in supportive care. The most significant advances have occurred in the general approach to symptom management and in the development of new pharmacological agents. Advances have also occurred in non-pharmacological approaches to supportive care and it is now acknowledged that interventions such as patient education and complementary therapies have an important role to play in ameliorating distressing symptoms.

A right to die?

Often nurses within the critical care setting face moral dilemmas when confronted with issues surrounding resuscitation and withdrawal of treatment. In this article the nurses' role and the patients' rights regarding resuscitative measures and withdrawal of basic and advanced forms of life support are discussed. Cases that have improved decision-making have been used to illustrate the dilemmas involved. It is hoped that critical care nurses will become more aware of their vital role when these decisions are being made.

Assessment of the Impact of Cancer on Work, Recreation, Home Management and Sleep Using a General Health Status Measure

A general health status measure (the UK Sickness Impact Profile) was used to assess health-related quality of life in 212 cancer patients [143 women, mean (SD - standard deviation) age 55.3 (11.7) years] compared to 105 age-sex matched control subjects [71 women, mean (SD) age 54.7 (12.2) years]. The four main areas of impairment in the cancer patient group were work, recreation and pastimes, home management and sleep and rest. The majority of patients were unable to work or working shorter hours due to their disease. A diagnosis of cancer was likewise found to have a major impact on active leisure pursuits and led to reduced participation in social and community activities. Patients had particular problems in carrying out household chores and maintenance or repair work in the house. Many patients had difficulty sleeping at night and tended to sleep during the day or rest for much of the day.

The majority of studies of quality of life in oncology patients concentrate upon alterations in symptoms, such measures would fail to detect impairment in the aspects described above. Greater attention should be directed towards addressing issues such as changes in employment status and the need for help in the home to improve the overall care of cancer patients.

QALYs (Quality Adjusted Life Years): a nurse's view

Examines the political and ideological significance of measures of quality of life, specifically Quality Adjusted Life Years (QALYs). Briefly reviews recent developments in the debate surrounding the economic and political functions of quality of life measures. The dialectic between conceptions of the quality of life and the implicit realpolitik of socio-economic pressures, ecological conditions, political ethos and cultural norms and expectations, is conceived as a powerful means for the critique of our aspirations concerning health. Argues that existing approaches to assessing quality of life, in denying this dialectic, have jeopardized their potential contribution to the planning, implementation and evaluation of health are policy. Resource allocation challenges us to develop openly ideological strategies and measures.

Quality of life as quality of being: an alternative to the subject-object dichotomy

The opening section of this paper is concerned with certain questions concerning the concept 'quality of life'. Is it possible for one person to make judgements about the quality of life of another? If it is possible, then is it morally acceptable? Given that quality of life is a concept and therefore not amenable to direct observation, which visible phenomena will be chosen as its indicators, and how can their choice be justified? Do the components of a life of quality vary from person to person, or can features be identified which are common to all? Next, it is argued that instruments which have been developed to measure quality of life give clues to the ontological beliefs of their authors; those which address fragments of the human experience, or accept the artificial limits of the subjective/objective dichotomy, are expressive of a fractured and reductionist view of what it means to be a human being. Finally, it is suggested that the adoption of insights drawn from Heidegger's work would enable us to develop a rather more unified view of quality of life as quality of being, and that this theoretical principle might constitute a common link between nurses of varying professional backgrounds.