The Self-Perception and Relationships Tool (S-PRT): a novel approach to the measurement of subjective health-related quality of life

What Matters in Cancer Survivorship Research? A Suite of Stakeholder-Relevant Outcomes

The outcomes assessed in cancer survivorship research do not always match the outcomes that survivors and health system stakeholders identify as most important in the post-treatment follow-up period. This study sought to identify stakeholder-relevant outcomes pertinent to post-treatment follow-up care interventions. We conducted a descriptive qualitative study using semi-structured telephone interviews with stakeholders (survivors, family/friend caregivers, oncology providers, primary care providers, and cancer system decision-/policy-makers) across Canada. Data analysis involved coding, grouping, detailing, and comparing the data by using the techniques commonly employed in descriptive qualitative research. Forty-four participants took part in this study: 11 survivors, seven family/friend caregivers, 18 health care providers, and eight decision-makers. Thirteen stakeholder-relevant outcomes were identified across participants and categorized into five outcome domains: psychosocial, physical, economic, informational, and patterns and quality of care. In the psychosocial domain, one’s reintegration after cancer treatment was described by all stakeholder groups as one of the most important challenges faced by survivors and identified as a priority outcome to address in future research. The outcomes identified in this study provide a succinct suite of stakeholder-relevant outcomes, common across cancer types and populations, that should be used in future research on cancer survivorship care.

Plant-Dominant Low-Protein Diet for Conservative Management of Chronic Kidney Disease

Chronic kidney disease (CKD) affects >10% of the adult population. Each year, approximately 120,000 Americans develop end-stage kidney disease and initiate dialysis, which is costly and associated with functional impairments, worse health-related quality of life, and high early-mortality rates, exceeding 20% in the first year. Recent declarations by the World Kidney Day and the U.S. Government Executive Order seek to implement strategies that reduce the burden of kidney failure by slowing CKD progression and controlling uremia without dialysis. Pragmatic dietary interventions may have a role in improving CKD outcomes and preventing or delaying dialysis initiation. Evidence suggests that a patient-centered plant-dominant low-protein diet (PLADO) of 0.6–0.8 g/kg/day composed of >50% plant-based sources, administered by dietitians trained in non-dialysis CKD care, is promising and consistent with the precision nutrition. The scientific premise of the PLADO stems from the observations that high protein diets with high meat intake not only result in higher cardiovascular disease risk but also higher CKD incidence and faster CKD progression due to increased intraglomerular pressure and glomerular hyperfiltration. Meat intake increases production of nitrogenous end-products, worsens uremia, and may increase the risk of constipation with resulting hyperkalemia from the typical low fiber intake. A plant-dominant, fiber-rich, low-protein diet may lead to favorable alterations in the gut microbiome, which can modulate uremic toxin generation and slow CKD progression, along with reducing cardiovascular risk. PLADO is a heart-healthy, safe, flexible, and feasible diet that could be the centerpiece of a conservative and preservative CKD-management strategy that challenges the prevailing dialysis-centered paradigm.

Reintegration for Post-treatment Cancer Survivors: A Concept Analysis

Background: Cancer survivors who have completed active treatments experience challenges in the survivorship phase of cancer care. Survivors transitioning through an illness experience negotiate former roles and relationships and reevaluate their self-identity. Reintegration of post-treatment cancer survivors has not been analyzed; however, nurses with a clear understanding of reintegration influence holistic care. Purpose: The goal of this artricle is to provide a theoretical definition of the concept of reintegration for cancer survivors post-treatment. The definition is derived and supported from a multidisciplinary literature review. Method: The discussion was organized using the Walker and Avant approach to concept analysis. Findings: This concept analysis defined reintegration as a dynamic process involving the reorganization of former performance roles concurrent with the reevaluation of personal abilities. Survivors are involved in creating a new normal and post-treatment cancer survivor identity. Reintegration is characterized by transitional phases that may be cyclical and evolve with time. Finally, desired outcomes are based on perceived subjective and objective criteria of importance and are strengthened through multidimensional supportive networks. Conclusion: Incorporating the physical, social, emotional, spiritual, and community/environmental aspects of the cancer survivorship experience enhances reintegration.

Quality-of-life and spirituality

Spirituality has been identified as an important dimension of quality-of-life. The objective of this study was to review the literature on quality-of-life and spirituality, their association, and assessment tools. A search was conducted of the keyterms 'quality-of-life' and 'spirituality' in abstract or title in the databases PsycINFO and PubMed/Medline between 1979-2005, complemented by a new search at PUBMED from 2006-2016. Quality-of-life is a new concept, which encompasses and transcends the concept of health, being composed of multiple domains: physical, psychological, environmental, among others. The missing measure in health has been defined as the individual's perception of their position in life in the context of culture and value system in which they live and in relation to their goals, expectations, standards, and concerns. There is consistent evidence of an association between quality-of-life and religiosity/spirituality (R/S), through studies with reasonable methodological rigour, using several variables to assess R/S (e.g. religious affiliation, religious coping, and prayer/spirituality). There are also several valid and reliable instruments to evaluate quality-of-life and spirituality. Further studies are needed, however, especially in Brazil. Such studies will provide empirical data to be used in planning health interventions based on spirituality, seeking a better quality-of-life. In the last 10 years, research is consistently growing about quality-of-life and spirituality in many countries, and also in many areas of health research.

Ayurveda: between religion, spirituality, and medicine

Ayurveda is playing a growing part in Europe. Questions regarding the role of religion and spirituality within Ayurveda are discussed widely. Yet, there is little data on the influence of religious and spiritual aspects on its European diffusion. Methods. A survey was conducted with a new questionnaire. It was analysed by calculating frequency variables and testing differences in distributions with the χ (2)-Test. Principal Component Analyses with Varimax Rotation were performed. Results. 140 questionnaires were analysed. Researchers found that individual religious and spiritual backgrounds influence attitudes and expectations towards Ayurveda. Statistical relationships were found between religious/spiritual backgrounds and decisions to offer/access Ayurveda. Accessing Ayurveda did not exclude the simultaneous use of modern medicine and CAM. From the majority's perspective Ayurveda is simultaneously a science, medicine, and a spiritual approach. Conclusion. Ayurveda seems to be able to satisfy the individual needs of therapists and patients, despite worldview differences. Ayurvedic concepts are based on anthropologic assumptions including different levels of existence in healing approaches. Thereby, Ayurveda can be seen in accordance with the prerequisites for a Whole Medical System. As a result of this, intimate and individual therapist-patient relationships can emerge. Larger surveys involving bigger participant numbers with fully validated questionnaires are warranted to support these results.

[Health-related quality of life in patients with chronic rhinosinusitis]

INTRODUCTION

The need for assessing the quality of life in chronic rhinosinusitis is emphasised by the medical, social and economic importance of this pathological condition. Questionnaires have been employed in majority of studies while there are no available data that Q method has been used for quality of life research in chronic rhinosinusitis up to the present.

OBJECTIVE

The aim of this study was to identify, group and analyse subjective perception of the impact of the disease on health-related quality of life in patients with chronic rhinosinusitis.

METHODS

The study involved 36 consecutive patients of both sexes, older than 10 years of age, diagnosed with chronic rhinosinusitis in the tertiary health clinic in three successive weeks. They were selected for medicamentous treatment. Health-related quality of life was assessed by Q method. Through 34 representative statements, which were sorted by the examinees related to subjective priorities, 10 key quality of life domains were examined. The data were processed by factor analysis employing specialised software package PQMethod.

RESULTS

Analysing individual opinions of the examinees, five different opinion-types (factors) on the impact of chronic rhinosinusitis on quality of life were demonstrated. They were marked numerically and descriptively according to dominant characteristics of the group: Factor 1--stable group (47.2% of individuals), Factor 2--symptomatic group (11.1% of individuals), Factor 3--mental group (5.6% of individuals), Factor 4--physical group (11.1% of individuals) and Factor 5--optimistic group (25.0% of individuals). Each group was systematically analysed.

CONCLUSION

Majority of patients with chronic rhinosinusits (72.2%) were found to be satisfied with the quality of life, while just a small number (5.6%) heavily bore the illness which especially jeopardised their mental health. This study demonstrates the strength of Q method in analysing and categorizing subjectivity and offers quality practical information which enables a more comprehensive approach and more adequate intervention in patients with chronic rhinosinusitis.

Barriers to adherence and hypertension control in a racially diverse representative sample of elderly primary care patients

PURPOSE

To examine the effect of antihypertensive adherence on blood pressure and barriers to adherence in racially diverse elderly patients.

METHODS

Telephone survey of a representative sample of 300 of all 3416 hypertensive patients aged >70 from four urban primary care practices. From electronic records, we calculated subjects' annual mean systolic blood pressure. We asked about the last missed antihypertensive dose in six time intervals. Based on association with blood pressure control, non-adherence was defined as missing any dose in the past 3 months. Subjects were also asked about six domains of adherence barriers: health, personal support, drug coverage, medication filling and use, doctor-patient interaction and knowledge. All models adjust for demographics, treatment regimen and sampling weights.

RESULTS

The 202 subjects (67% response rate) were: female (65.9%), black (64.8%), mean age 77.4 years (5.49) and on mean 2.4 (SD 1.3) antihypertensive drugs. Mean annual systolic pressure for non-adherent subjects (22% of the cohort) was higher than adherent subjects (137.7 vs.133.4 mmHg, p = 0.065). After adjustment, the association between adherence and blood pressure was stronger in black than white patients (p = 0.007). In an initial model, being unaware of Medicare Part D had a lower adjusted odds ratio (AOR) of adherence (p < 0.05). In the final model, adherence barriers were: medication filling/use (run out of pills [AOR 0.25, CI 0.09-0.66] and 28% reduction per each of eight barriers); doctor-patient interaction (less important to discuss hypertension [AOR 0.32, CI 0.12-0.84]); and knowledge (38% lower AOR per incorrect answer about diseases unrelated to hypertension).

CONCLUSION

Self-reported adherence was associated with a higher blood pressure, especially in elderly black patients. To promote adherence, our data suggest targeting: filling prescriptions, prioritizing hypertension care and educating about effects of hypertension.

Relationships between psychosocial-spiritual well-being and end-of-life preferences and values in African American dialysis patients

The objective of the study was to examine whether psychosocial and spiritual well-being is associated with African American dialysis patients' end-of-life treatment preferences and acceptance of potential outcomes of life-sustaining treatment. Fifty-one African Americans with end-stage renal disease (ESRD) completed a sociodemographic questionnaire and interview with measures of symptom distress, health-related quality of life, psychosocial and spiritual well-being, and preferences and values related to life-sustaining treatment choices. The subjects were stratified by end-of-life treatment preferences and by acceptance of life-sustaining treatment outcomes, and compared for psychosocial and spiritual well-being, as well as sociodemographic and clinical characteristics. Individuals who desired continued use of life-sustaining treatment in terminal illness or advanced dementia had significantly lower spiritual well-being (P=0.012). Individuals who valued four potential outcomes of life-sustaining treatment as unacceptable showed a more positive, adaptive well-being score in the spiritual dimension compared with the group that valued at least one outcome as acceptable (P=0.028). Religious involvement and importance of spirituality were not associated with end-of-life treatment preferences and acceptance of treatment outcomes. African Americans with ESRD expressed varied levels of psychosocial and spiritual well-being, and this characteristic was associated with life-sustaining treatment preferences. In future research, the assessment of spirituality should not be limited to its intensity or degree but extended to other dimensions.

Randomized controlled trial of SPIRIT: an effective approach to preparing African-American dialysis patients and families for end of life

This randomized controlled trial tested an intervention, Sharing Patients' Illness Representations to Increase Trust (SPIRIT), designed to enhance communication regarding end-of-life care between African Americans with end-stage renal disease (ESRD) and their chosen surrogate decision makers (N = 58 dyads). We used surveys and semi-structured interviews to determine the feasibility, acceptability, and preliminary effects of SPIRIT on patient and surrogate outcomes at 1 week and 3 months post-intervention. We also evaluated patients' deaths and surrogates' end-of-life decision making to assess surrogates' perceptions of benefits and limitations of the SPIRIT while facing end-of-life decisions. We found that SPIRIT promoted communication between patients and their surrogates and was effective and well received by the participants.

[The relationship between optimistic bias about health crisis and health behavior]

PURPOSE

This study was performed to identify the relationship between optimistic bias about health crisis and health behavior of Korean adults in a crisis of health, and to prepare baseline data for developing a health education and promotion program.

METHODS

Study subjects were 595 adults aged from 19 to 64 who live in Korea. Data were collected through questionnaires administered by one interviewer. Descriptive statistics and Pearson's correlation coefficient were calculated using the SPSS program.

RESULTS

The average score for optimistic bias about health crisis was 2.69, and that for health behavior was 107.05. The optimistic bias about health crisis showed a significantly positive correlation with health behavior (r=.187, p=.000).

CONCLUSION

To make our results more useful, it is necessary to identity the causal relationship between health attitudes as an explanatory variable and optimistic bias as an outcome variable. In addition, a relatively low score in optimistic bias from this research compared to other studies must be explained through further studies considering unique Korean cultural background. Moreover, research of the relationship between optimistic bias about health crisis and health behavior looking at people who don't have good health behaviors is needed.

Extending basic principles of measurement models to the design and validation of Patient Reported Outcomes

A recently published article by the Scientific Advisory Committee of the Medical Outcomes Trust presents guidelines for selecting and evaluating health status and health-related quality of life measures used in health outcomes research. In their article, they propose a number of validation and performance criteria with which to evaluate such self-report measures. We provide an alternate, yet complementary, perspective by extending the types of measurement models which are available to the instrument designer. During psychometric development or selection of a Patient Reported Outcome measure it is necessary to determine which, of the five types of measurement models, the measure is based on; 1) a Multiple Effect Indicator model, 2) a Multiple Cause Indicator model, 3) a Single Item Effect Indicator model, 4) a Single Item Cause Indicator model, or 5) a Mixed Multiple Indicator model. Specification of the measurement model has a major influence on decisions about item and scale design, the appropriate application of statistical validation methods, and the suitability of the resulting measure for a particular use in clinical and population-based outcomes research activities.

Role of religion and spirituality in medical patients: confirmatory results with the SpREUK questionnaire

BACKGROUND

Spirituality has become a subject of interest in health care as it is was recognized to have the potential to prevent, heal or cope with illness. There is less doubt that values and goals are important contributors to life satisfaction, physical and psychological health, and that goals are what gives meaning and purpose to people's lives. However, there is as yet but limited understanding of how patients themselves view the impact of spirituality on their health and well-being, and whether they are convinced that their illness may have "meaning" to them. To raise these questions and to more precisely survey the basic attitudes of patients with severe diseases towards spirituality/religiosity (SpR) and their adjustment to their illness, we developed the SpREUK questionnaire.

METHODS

In order to re-validate our previously described SpREUK instrument, reliability and factor analysis of the new inventory (Version 1.1) were performed according to the standard procedures. The test sample contained 257 German subjects (53.3 +/- 13.4 years) with cancer (51%), multiple sclerosis (24%), other chronic diseases (16%) and patients with acute diseases (7%).

RESULTS

As some items of the SpREUK construct require a positive attitude towards SpR, these items (item pool 2) were separated from the others (item pool 1). The reliability of the 15-item the construct derived from the item pool 1 respectively the 14-item construct which refers to the item pool 2 both had a good quality (Cronbach's alpha = 0.9065 resp. 0.9525). Factor analysis of item pool 1 resulted in a 3-factor solution (i.e. the 6-item sub-scale 1: "Search for meaningful support"; the 6-item sub-scale 2: "Positive interpretation of disease"; and the 3-item sub-scale 3: "Trust in external guidance") which explains 53.8% of variance. Factor analysis of item pool 2 pointed to a 2-factor solution (i.e. the 10-item sub-scale 4: "Support in relations with the External life through SpR" and the 4-item sub-scale 5: "Support of the Internality through SpR") which explains 58.8% of variance. Generally, women had significantly higher SpREUK scores than male patients. Univariate variance analyses revealed significant associations between the sub-scales and SpR attitude and the educational level.

CONCLUSIONS

The current re-evaluation of the SpREUK 1.1 questionnaire indicates that it is a reliable, valid measure of distinct topics of SpR that may be especially useful of assessing the role of SpR in health related research. The instrument appears to be a good choice for assessing a patients interest in spiritual concerns which is not biased for or against a particular religious commitment. Moreover it addresses the topic of "positive reinterpretation of disease" which seems to be of outstanding importance for patients with life-changing diseases.