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So WKW, Au DWH, Chan DNS, Ng MSN, Choi KC, Xing W, Chan M, Mak SSS, Ho PS, Tong M, Au C, Ling WM, Chan M, Chan RJ. Financial well-being as a mediator of the relationship between multimorbidity and health-related quality of life in people with cancer. Cancer Med 2023; 12:15579-15587. [PMID: 37283252 PMCID: PMC10417171 DOI: 10.1002/cam4.6204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 05/10/2023] [Accepted: 05/23/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND It is unknown whether financial well-being mediates the impact of multimorbidity on the health-related quality of life (HRQoL) of cancer patients. METHODS Participants were recruited from three outpatient oncology clinics of Hong Kong public hospitals. Multimorbidity was assessed using the Charlson Comorbidity Index. Financial well-being, the mediator of the association between multimorbidity and HRQoL outcomes, was assessed using the Comprehensive Score for Financial Toxicity Functional Assessment of Chronic Illness Therapy. The HRQoL outcomes were assessed using the Functional Assessment of Cancer Therapy - General (FACT-G) and its four sub-dimensions. Mediation analyses were conducted using SPSS PROCESS v4.1. RESULTS Six-hundred and forty cancer patients participated in the study. Multimorbidity had a direct effect on FACT-G scores independent of financial well-being (β for path c' = -0.752, p < 0.001). In addition, multimorbidity had an indirect effect on FACT-G scores through its effect on financial well-being (β for path a = -0.517, p < 0.05; β for path b = 0.785, p < 0.001). Even after adjustments were made for the covariates, the indirect effect of multimorbidity on FACT-G via financial well-being remained significant, accounting for 38.0% of the overall effect, indicating partial mediation. Although there were no statistically significant associations between multimorbidity, social well-being, and emotional well-being, the indirect effects of multimorbidity on physical and functional well-being through financial well-being remained significant. CONCLUSIONS Poor financial well-being attributable to multimorbidity partially mediates the direct impact of chronic conditions on HRQoL in Chinese cancer patients, particularly their physical and functional well-being.
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Affiliation(s)
- Winnie K. W. So
- The Nethersole School of Nursing, Faculty of MedicineThe Chinese University of Hong KongHong KongChina
| | - Doreen W. H. Au
- The Nethersole School of Nursing, Faculty of MedicineThe Chinese University of Hong KongHong KongChina
- School of Nursing and Health StudiesHong Kong Metropolitan UniversityHong KongChina
| | - Dorothy N. S. Chan
- The Nethersole School of Nursing, Faculty of MedicineThe Chinese University of Hong KongHong KongChina
| | - Marques S. N. Ng
- The Nethersole School of Nursing, Faculty of MedicineThe Chinese University of Hong KongHong KongChina
| | - Kai Chow Choi
- The Nethersole School of Nursing, Faculty of MedicineThe Chinese University of Hong KongHong KongChina
| | - Weijie Xing
- School of NursingFudan UniversityShanghaiChina
| | - Mandy Chan
- Department of Clinical OncologyPrince of Wales HospitalHong KongChina
| | - Suzanne S. S. Mak
- Department of Clinical OncologyPrince of Wales HospitalHong KongChina
| | - Pui Shan Ho
- Department of Clinical OncologyTuen Mun HospitalHong KongChina
| | - Man Tong
- Department of Clinical OncologyTuen Mun HospitalHong KongChina
| | - Cecilia Au
- Department of Clinical OncologyPamela Youde Nethersole Eastern HospitalHong KongChina
| | - Wai Man Ling
- Department of Clinical OncologyPamela Youde Nethersole Eastern HospitalHong KongChina
| | | | - Raymond J. Chan
- Caring Futures Institute, College of Nursing and Health SciencesFlinders UniversityAdelaideAustralia
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Shepard V, Al Snih S, Burke R, Downer B, Kuo YF, Malagaris I, Raji M. Characteristics Associated With Mexican-American Hospice Use: Retrospective Cohort Study Using the Hispanic Established Population for the Epidemiologic Study of the Elderly (H-EPESE). Am J Hosp Palliat Care 2023; 40:480-491. [PMID: 35731552 PMCID: PMC9772355 DOI: 10.1177/10499091221110125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Hospice use is lower among ethnic/racial minorities in the United States, though little is known about trends, associated factors and duration of hospice use by Mexican-Americans. AIM The purpose of this study is to examine Mexican-American characteristics associated with hospice stay, both ≤ and > 7 days. DESIGN This retrospective cohort study used data from the Hispanic Established Population for the Epidemiological Study of the Elderly (H-EPESE) and the Centers for Medicare and Medicaid Services. Multivariate logistic regression models were used to estimate the ORs and 95% CIs for hospice stay among Mexican-Americans, both ≤ and > 7 days. SETTING AND PARTICIPANTS The first cohort (N = 970) includes H-EPESE participants who died between 2004 and 2016 who had Medicare parts A and B. The second cohort (N = 403) includes participants who completed the H-EPESE survey within the last 2 years of life. RESULTS Although hospice use increased among Mexican-Americans between 2004 and 2016 (OR 1.88, 95% CI 1.19-2.97), 38% of participants died within the first week of hospice care. Mexican-Americans in New Mexico and Arizona were 2-4 times more likely to use hospice than those in Texas and Colorado. Dementia was associated with hospice use (OR 1.47, 95% CI 1.11-1.94). Characteristics, like church attendance and living alone, were not associated with hospice use. CONCLUSIONS The substantial proportion of Mexican-Americans with 7 days or less of hospice use underscores the need for early palliative/hospice intervention to mitigate variation in use.
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Affiliation(s)
- Victoria Shepard
- Department of Population Health, University of Texas Dell Medical School, Austin, TX, USA
| | - Soham Al Snih
- Division of Geriatrics and Palliative Care, University of Texas Medical Branch, Galveston, TX, USA
- Department of Nutrition, Metabolism & Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX, USA
- Department of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX, USA
| | - Rebecca Burke
- Division of Geriatrics and Palliative Care, University of Texas Medical Branch, Galveston, TX, USA
- Department of Family Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Brian Downer
- Department of Nutrition, Metabolism & Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX, USA
| | - Yong-Fang Kuo
- Division of Geriatrics and Palliative Care, University of Texas Medical Branch, Galveston, TX, USA
- Office of Biostatistics, University of Texas Medical Branch, Galveston, TX, USA
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, USA
| | - Ioannis Malagaris
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, USA
| | - Mukaila Raji
- Division of Geriatrics and Palliative Care, University of Texas Medical Branch, Galveston, TX, USA
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Jiang D, Yan Y, Zhou H, Wang Q. The association between personal social capital and health-related quality of life among Chinese older people: A cross-sectional study. Front Nutr 2022; 9:995729. [PMID: 36570148 PMCID: PMC9773083 DOI: 10.3389/fnut.2022.995729] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 11/22/2022] [Indexed: 12/13/2022] Open
Abstract
Background Lower health-related quality of life (HRQoL) can result in adverse effects on the health of older people. This study aims to explore the relationship between personal social capital (PSC) and HRQoL among Chinese elderly people from rural-and-urban perspective. Materials and methods 4,802 samples were included from China's health-related quality of life Survey for Older Adults 2018 (CHRQLS-OA 2018). The PSC, including bonding and bridging social capital (BOC and BRC), was measured by the Chinese version of the Personal Social Capital Scale (PSCS-16). The HRQoL was evaluated by the European Five Dimensions Questionnaire (EQ-5D-3L). Linear and Tobit regression models were conducted to examine the relationship between PSC and HRQoL. Results The BOC and BRC of rural older people were significantly lower than those of urban older people. Pain/discomfort and anxiety/depression were the most significant health problems affecting the older samples. In the five dimensions, the proportion of rural older people with problems was higher than that of urban older people. Among rural older people, BOC was significantly related to self-rated health and EQ-5D utility index (p < 0.05); while BRC was insignificantly associated with self-rated health (p > 0.05) but related to EQ-5D utility index (p < 0.05). Both BOC and BRC were significantly correlated with self-rated health and EQ-5D utility index (p < 0.05) among urban older people. Conclusion Our study reveals older people's worrying PSC and HRQoL status. The relationship between PSC and HRQoL suggested that more social support and care of intimates should be encouraged to increase the PSC of older people, especially rural older people.
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Affiliation(s)
- Dongdong Jiang
- Global Health Institute, School of Public Health, Wuhan University, Wuhan, China,School of Public Health, Zhejiang University, Hangzhou, China
| | - Yajie Yan
- Global Health Institute, School of Public Health, Wuhan University, Wuhan, China
| | - Han Zhou
- Nanjing Lishui District Hospital of Traditional Chinese Medicine, Nanjing, China
| | - Quan Wang
- Global Health Institute, School of Public Health, Wuhan University, Wuhan, China,*Correspondence: Quan Wang,
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Espinoza Suarez NR, LaVecchia CM, Morrow AS, Fischer KM, Kamath C, Boehmer KR, Brito JP. ABLE to support patient financial capacity: A qualitative analysis of cost conversations in clinical encounters. PATIENT EDUCATION AND COUNSELING 2022; 105:3249-3258. [PMID: 35918230 DOI: 10.1016/j.pec.2022.07.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 07/20/2022] [Accepted: 07/23/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To explore how costs of care are discussed in real clinical encounters and what humanistic elements support them. METHODS A qualitative thematic analysis of 41 purposively selected transcripts of video-recorded clinical encounters from trials run between 2007 and 2015. Videos were obtained from a corpus of 220 randomly selected videos from 8 practice-based randomized trials and 1 pre-post prospective study comparing care with and without shared decision making (SDM) tools. RESULTS Our qualitative analysis identified two major themes: the first, Space Needed for Cost Conversations, describes patients' needs regarding their financial capacity. The second, Caring Responses, describes humanistic elements that patients and clinicians can bring to clinical encounters to include good quality cost conversations. CONCLUSION Our findings suggest that strengthening patient-clinician human connections, focusing on imbalances between patient resources and burdens, and providing space to allow potentially unexpected cost discussions to emerge may best support high quality cost conversations and tailored care plans. PRACTICE IMPLICATIONS We recommend clinicians consider 4 aspects of communication, represented by the mnemonic ABLE: Ask questions, Be kind and acknowledge emotions, Listen for indirect signals and (discuss with) Every patient. Future research should evaluate the practicality of these recommendations, along with system-level improvements to support implementation of our recommendations.
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Affiliation(s)
- Nataly R Espinoza Suarez
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA; VITAM - Centre for Sustainable Health Research, Laval University, Quebec, QC, Canada
| | | | - Allison S Morrow
- Evidence-Based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA; Milken Institute School of Public Health, The George Washington University, Washington DC, USA
| | - Karen M Fischer
- Division of Biomedical Statistics and Informatics, Mayo Clinic, MN, USA
| | - Celia Kamath
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA; Evidence-Based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Kasey R Boehmer
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA; Evidence-Based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.
| | - Juan P Brito
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA; Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, MN, USA.
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Haier J, Schaefers J. Economic Perspective of Cancer Care and Its Consequences for Vulnerable Groups. Cancers (Basel) 2022; 14:cancers14133158. [PMID: 35804928 PMCID: PMC9265013 DOI: 10.3390/cancers14133158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 05/04/2022] [Accepted: 06/15/2022] [Indexed: 12/02/2022] Open
Abstract
Simple Summary For cancer patients, many different reasons can cause financial burdens and economic threads. Sociodemographic factors, rural/remote location and income are known determinants for these vulnerable groups. This economic vulnerability is related to the reduced utilization of cancer care and the impact on outcome. Financial burden has been reported in many countries throughout the world and needs to be addressed as part of the sufficient quality of cancer care. Abstract Within healthcare systems in all countries, vulnerable groups of patients can be identified and are characterized by the reduced utilization of available healthcare. Many different reasons can be attributed to this observation, summarized as implementation barriers involving acceptance, accessibility, affordability, acceptability and quality of care. For many patients, cancer care is specifically associated with the occurrence of vulnerability due to the complex disease, very different target groups and delivery situations (from prevention to palliative care) as well as cost-intensive care. Sociodemographic factors, such as educational level, rural/remote location and income, are known determinants for these vulnerable groups. However, different forms of financial burdens likely influence this vulnerability in cancer care delivery in a distinct manner. In a narrative review, these socioeconomic challenges are summarized regarding their occurrence and consequences to current cancer care. Overall, besides direct costs such as for treatment, many facets of indirect costs including survivorship costs for the cancer patients and their social environment need to be considered regarding the impact on vulnerability, treatment compliance and abundance. In addition, individual cancer-related financial burden might also affect the society due to the loss of productivity and workforce availability. Healthcare providers are requested to address this vulnerability during the treatment of cancer patients.
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Xu RH, Wang LL, Zhou LM, Wong ELY, Wang D. Urban-rural differences in financial toxicity and its effect on cancer survivors' health-related quality of life and emotional status: a latent class analysis. Support Care Cancer 2022; 30:4219-4229. [PMID: 35083540 DOI: 10.1007/s00520-021-06762-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 12/14/2021] [Indexed: 01/16/2023]
Abstract
OBJECTIVE This study aimed to investigate the urban-rural differences in associations between financial toxicity (FT), physical health-related quality of life (HRQoL), negative emotional status, and the effect of patients' socioeconomic status and clinical and cost-related characteristics on the levels of FT in a sample of Chinese cancer survivors. METHODS Data were obtained from a cross-sectional survey conducted by the oncology department at two tertiary level hospitals in China. The COmprehensive Score for financial Toxicity, Euroqol five-level instrument (EQ-5D), and Depression Anxiety Stress Scale - 21 (DASS-21) were used to measure patients' FT, physical HRQoL, and negative emotional status. A latent class analysis was used to identify patient subgroups with distinct symptom experiences based on self-reported data on symptom occurrence using the EQ-5D and DASS-21. RESULTS Four distinct latent classes were identified: all low (47.6%); high physical and low psych (18.6%); low physical and high psych (17.1%); and all high (17.1%). Rural patients younger than 50 years showed a statistically significantly higher FT than urban patients. Rural patients who were male, highly educated, insured, first hospitalization, new cases, received surgery or immunotherapy, and had low cancer-related costs in all low classes showed a higher FT than urban patients. CONCLUSIONS Rural patients with cancer suffered from higher FT than their urban counterparts, and the negative impact of psychological distress on FT was higher than that of physical HRQoL.
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Affiliation(s)
- Richard Huan Xu
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China.
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China.
| | - Ling-Ling Wang
- Department of Blood Transfusion Medicine, School of Medicine, Jinling Hospital, Nanjing University, Nanjing, China
| | - Ling-Ming Zhou
- Department of Human Resource, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Eliza Lai-Yi Wong
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Dong Wang
- School of Health Management, Southern Medical University, Guangzhou, China.
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Xu L, Wang X, Cui Y, Tian Y, Zhou N, Zhang J, Ji H, Cheng X, Zhang Q, Li Q, Hu P, Zhang L. Illness perception characteristics and influencing factors in adult patients with myasthenia gravis in China. Brain Behav 2022; 12:e2451. [PMID: 34898040 PMCID: PMC8785644 DOI: 10.1002/brb3.2451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 10/01/2021] [Accepted: 11/06/2021] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE We aimed to examine the illness perception characteristics of patients with myasthenia gravis and analyze the associated factors. METHODS A general information questionnaire, Illness Perception Questionnaire, and Simplified Coping Style Questionnaire were used to survey 90 patients with myasthenia gravis. One-way analysis of variance and multivariate linear regression were used for statistical analysis. RESULTS The timeline (acute/chronic), consequence, and emotional representation scores of patients with myasthenia gravis were 18.31 ± 4.47, 18.58 ± 3.57, and 20.80 ± 4.56, respectively. Multivariate stepwise linear regression analysis showed that marital status, disease duration, educational level, disease type, and coping style are factors associated with illness perception in patients with myasthenia gravis. CONCLUSION Patients who have myasthenia gravis have a negative illness perception. Medical professionals should provide targeted intervention measures based on the factors associated with illness perception.
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Affiliation(s)
- Le Xu
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China
| | - Xia Wang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China
| | - Yafeng Cui
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China
| | - Yanghua Tian
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China
| | - Nong Zhou
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China
| | - Juanjuan Zhang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China
| | - Hiaxia Ji
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China
| | - Xiumei Cheng
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China
| | - Qin Zhang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China
| | - Qingfeng Li
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China
| | - Panpan Hu
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China
| | - Long Zhang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China
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