Health-related quality of life and the predictive role of sense of coherence, spirituality and religious coping in a sample of Iranian women with breast cancer: a prospective study with comparative design

The mediating role of cognitive emotion regulation in the relationship between self-concealment and quality of life among breast cancer chemotherapy patients

PURPOSE

This study aimed to explore whether self-concealment (SC) affects the quality of life (QOL), and whether cognitive emotion regulation (CER) mediates the relationship between SC and QOL among breast cancer chemotherapy patients.

METHODS

This cross-sectional study was conducted among 228 breast cancer chemotherapy patients from November 2021 to March 2022 in Anhui Province, China. Data were collected using the Self-Concealment Scale, Cognitive Emotion Regulation Questionnaire, and Short Form 36 Questionnaire. Descriptive statistics, independent-sample t test, one-way analysis of variance, and structural equation modeling were used to explore associations among SC, CER, and QOL.

RESULTS

QOL levels differed significantly by participant age, monthly per capita household income and home location. SC was negatively correlated with QOL. SSC was negatively correlated with adaptive-CER strategies and positively correlated with maladaptive-CER strategies. Adaptive-CER strategies were positively correlated with QOL. Maladaptive-CER strategies were negatively correlated with QOL. CER fully mediated the association between SC and QOL in breast cancer chemotherapy patients.

CONCLUSION

Nursing staff should help breast cancer chemotherapy patients reduce the use of maladaptive-CER strategies in the care of patients in the future. Helping patients reduce SC is more conductive to improving the QOL of breast cancer chemotherapy patients.

Self at Risk: Self-Esteem and Quality of Life in Cancer Patients Undergoing Surgical Treatment and Experiencing Bodily Deformities

Self-esteem is an important factor determining QoL after surgical procedures leading to bodily deformities associated with cancer treatment. However, there are few data on which components of self-esteem are most closely related to QoL. The article presents two studies that aim to fill this gap. Study 1 concerns changes in global self-esteem and QoL in patients treated surgically for oral cancer (n = 35); Study 2 concerns changes in explicit and implicit self-esteem and QoL in women with breast cancer undergoing mastectomy (n = 96). The study was longitudinal with two measurements: before and after surgery. Both studies used the EORTC QLQ-C30 and Rosenberg's SES questionnaires. In Study 2, the Implicit Association Test (IAT) was additionally performed. The patients' global QoL and self-esteem deteriorated after surgery. In Study 1, patients with higher initial self-esteem showed a greater range of decreased self-esteem and QoL than patients with initially low self-esteem. In Study 2, the largest decreases in various dimensions of QoL and explicit self-esteem were observed in women with fragile self-esteem. A group of women with high explicit and implicit self-esteem showed the best QoL after mastectomy. Cancer patients with high, fragile self-esteem are at risk of the greatest deterioration in QoL and self-image after cancer surgery. These people should be given special psycho-oncological care.

Estimation of a Structural Equation Modeling of Quality of Life Mediated by Difficulty in Daily Life in Survivors of Breast Cancer

BACKGROUND

The purpose of this study was to clarify the structural relationship of quality of life (QOL) in survivors of breast cancer, including difficulty in daily life and negative experiences in daily activities, as health-related indicators.

METHODS

Participants were survivors of breast cancer for more than 2 years after primary breast cancer surgery and belonged to self-help groups. The assessment used FACT-B (QOL), HADS (anxiety and depression), SOC (sense of coherence), WHODAS 2.0 (difficulties in daily life), and CAOD (negative experiences in daily activities). Bayesian structural equation modeling (BSEM) was performed to analyze the hypothesized model. If the causal model was significant, multiplication of the path coefficient from emotional distress (anxiety and depression) to QOL, and from SOC to emotional distress, was considered a direct effect on QOL, and from SOC to difficulty in daily life, from difficulty in daily life to negative experiences in daily activities, and from negative experiences in daily activities to anxiety and depression were considered indirect effects on QOL.

RESULTS

The participants comprised 73 survivors of breast cancer. The goodness of fit of the model in the BSEM was satisfactory. The direct effect was 0.274, and the indirect effect was 0.164.

CONCLUSIONS

An additional finding of this study is that coping with difficulty in daily life and negative experiences in daily activities related to QOL may improve QOL.

Sense of coherence or self-efficacy as predictors of health-related quality of life in sickle cell disease patients

Patients with sickle cell disease (SCD) suffer from impaired health-related quality of life (HRQoL). This study aimed to determine the level of HRQoL, sense of coherence (SOC), and self-efficacy (SE) in a sample of SCD patients, and to explore predictors of their physical and mental HRQoL. A cross-sectional descriptive study was conducted on 83 SCD patients of one university hospital. The data of the study was collected through Persian versions of the Short-Form Health Survey SF-36 (RAND 36-item), the Sense of Coherence Scale (SOC-13), and the Sickle Cell Self-Efficacy Scale (SCSES). The mean age of the patients was 26.34 ± 8.19 years old. Patients' mean scores for the Physical Component Summary (PCS), Mental Component Summary (MCS), SOC, and SCSES were 40.57 ± 17.18 (range: 0-100), 50.44 ± 17.95 (range: 0-100), 52.40 ± 15.35 (range: 13-91), 26.40 ± 6.96 (range: 9-45), respectively. Regression models showed that the level of the patients' SOC, was the main predictor of the MCS (β = 0.37, p < 0.001). However, the level of the patients' SE was the main predictor of the PCS (β = 0.30, p = 0.004). Also, "blood transfusion history" in patients was a common predictor for both the PCS (β =  - 0.28, p = 0.008) and the MCS (β =  - 0.29, p = 0.003). These results can assist nurses and clinicians to plan clinical interventions for SCD patients by focusing on increasing the level of the SOC and SE and improving SCD patients' HRQoL. Furthermore, measuring the level of the SOC and self-efficacy as screening tests are useful to find patients with a greater risk of impaired HRQoL.

Climacteric symptoms, age, and sense of coherence are associated with sexual function scores in women after menopause

BACKGROUND

Postmenopausal sexual function presupposes the integration of hormonal, neural, and vascular interactions and is subject to optimal crosstalk among psychological, interpersonal, cultural, and environmental factors. Sense of coherence (SOC) reflects a person's ability to cope with stressors and may influence the occurrence of menopausal symptoms and sexual dysfunction.

AIM

To investigate the association of severity of climacteric symptoms, cardiometabolic risk factors, and SOC with sexual function in postmenopausal women.

METHODS

Overall 281 sexually active postmenopausal women without significant psychopathology or cardiovascular disease attending the Menopause Unit of Aretaieion Hospital were evaluated by the Female Sexual Function Index (FSFI), Greene Climacteric Scale, Beck Depression Scale, and Sense of Coherence Scale. Hormonal and biochemical parameters and cardiometabolic risk factors were evaluated. FSFI scores <26.5 were considered pathologic.

OUTCOMES

Total and subdomain scores of sexual response were determined.

RESULTS

Pathologic FSFI scores were found in 79.7% of the sample. Linear models of multivariable regression analysis showed that FSFI scores were associated with (1) Beck scores (b  = -0.200; 95% CI, -0.472 to -0.073, P = .001), vasomotor symptom severity (b = -0.324; 95% CI, -0.985 to 0.051; P < .001), and age and (2) SOC (b = 0.150, 95% CI, 0.036-0.331; P = .008), vasomotor symptom severity (b = -0.361; 95% CI, -0.743 to 0.245; P < .001), and age. Both models were adjusted for menopausal age, diabetes mellitus, hypertension, type of menopause, and menopausal hormone therapy intake. SOC was associated with Beck depression scores (β = -0.487, P < .001; Greene Climacteric Scale total scores, β = -0.199, P < .001). FSFI score <26.5 vs >26.5 was associated with SOC (odds ratio, 0.982; 95% CI, 0.563 to 1.947; P = .006) and moderate to severe vasomotor symptom severity (odds ratio, 2.476; 95% CI, 1.478 to 3.120; P = .009) independent of age, diabetes mellitus, hypertension, menopausal hormone therapy intake, type of menopause, or Beck depression classification.

CLINICAL IMPLICATIONS

The results indicate the importance of psychometric assessment of postmenopausal women when presenting with scores of low sexual function. The severity of vasomotor symptoms should also be addressed in any case.

STRENGTHS AND LIMITATIONS

This is the first study investigating the relationship between SOC and sexuality in menopause in a carefully selected homogenous population. Limitations included the cross-sectional design and the fact that sexual distress was not assessed.

CONCLUSIONS

Pathologic FSFI scores were highly prevalent in this sample of postmenopausal women. FSFI is associated positively with age and severity of vasomotor symptoms and negatively with SOC.

Psychometric Evaluation of the Spiritual Perspective Scale in Palliative Care Nurses in China

This study aimed to translate the Spiritual Perspectives Scale (SPS) into a Mandarin Chinese version (C-SPS) and evaluate its psychometric properties among 154 palliative care nurses from twelve community healthcare centres in Shanghai, China. Exploratory factor analysis suggested two factors (spiritually related activities and spiritual beliefs), accounting for 67.49% of the total variance. The Cronbach's α of the total C-SPS score was 0.89, and its split-half coefficient (Spearman-Brown reliability coefficient) was 0.72. The C-SPS showed consistently acceptable psychometric properties of reliability and validity. It can be used to evaluate the level of spiritual perspectives of nurses in China.

Sense of Coherence and Health-Related Quality of Life in Patients with Multiple Sclerosis: The Role of Physical and Neurological Disability

Multiple sclerosis is a progressive demyelinating disease of the central nervous system that can lead to permanent disability and significantly impact the quality of life. The present study explores the relationship between neurological disability and disease symptoms, quality of life, and the level of sense of coherence, which is an important resource for coping with the disease. EDSS, GNDS, SOC-29, and MSIS-29 were used in the presented study. The study group consisted of 137 people diagnosed with multiple sclerosis. The study showed the correlation between most of the analyzed variables. Mood disability and fatigue were significant predictors of the sense of coherence and explained 34% of its variance. Physical disability and fatigue served as significant predictors of the physical aspect of quality of life, explaining 49% of its variance. Fatigue and sense of coherence were significant predictors of the psychological aspect of quality of life, explaining 47% of the variance. In studies on a group of people with multiple sclerosis, it is worth considering, in addition to the level of disability, also invisible symptoms, such as fatigue or mood disability, which are important for the quality of life and the level of resources. As this study suggests, a sense of coherence is a resource essential for the quality of life of people with disabilities.

Stigma and Quality of Life in Women With Breast Cancer: Mediation and Moderation Model of Social Support, Sense of Coherence, and Coping Strategies

Objectives

The breast cancer stigma affects Health-related quality of life (HRQoL), while general resilience resources (GRRs), namely, sense of coherence (SOC), social support, and coping skills, are thought to alleviate this effect. The study aimed to explore the mediating/moderation role of GRRs in the relationship between stigma and HRQoL and its dimensions in Iranian patients with breast cancer.

Methods

In this cross-sectional study, Stigma Scale for Chronic Illness 8-item version (SSCI-8), SOC-13, Medical Outcome Survey- Social Support Scale (MOS-SSS), Brief COPE, and Functional Assessment of Cancer Therapy-Breast (FACT-B) were investigated in a convenience sample of Iranian women with confirmed non-metastatic breast cancer. Following the establishment of correlations using Pearson's correlation, single and parallel mediation analysis and moderation analysis were conducted to determine the extent to which each GRR might be impacted by stigma or decrease the adverse impact of stigma on HRQoL.

Results

An analysis of 221 women (response rate of 87.5%) with the mean age of 47.14 (9.13) showed that stigma was negatively correlated to all HRQoL's dimensions (r = -0.27∼0.51, p < 0.05), SOC (r = -0.26∼0.35, p < 0.01), social support (r = -0.23∼0.30, p < 0.01), and the bulk of coping skills. In the single mediation analysis, stigma affected all facets of SOC, all subscales of social support, and positive reframing, which partially reduced breast cancer HRQoL. Stigma affects general HRQoL through damaging meaningfulness, social support (except for tangible), and positive reframing. Meaningfulness was marked as the most impacted GRR in terms of all domains of HRQoL. In parallel mediation, reduced meaningfulness, total social support, and positive reframing were highlighted as the pathways of diminished breast cancer HRQoL. Moderation analysis indicated the higher levels of humor, behavioral disengagement, and use of instrumental support behaviors to be functional in protecting different dimensions of HRQoL, while the results were mixed for venting, especially in patients with mastectomy surgery.

Conclusion

While GRRs may be impacted by stigma, they exert a relatively small protective effect against the impact of stigma on HRQoL. This study provides some novel findings, but longitudinal studies are needed to further verify these before any causal conclusion or recommendations for health policy can be drawn.

Health-related quality of life in patients with breast cancer: A systematic review and meta-analysis

BACKGROUND

Breast cancer is the most common type of cancer of women across the world, which can affect the quality of life in patients due to complications caused by the disease and related treatments. Various treatments have been designed for these patients to improve their life quality. This study aimed to estimate the mean score of health-related quality of life patients with breast cancer in Iran.

METHODS

In this study, we searched the national and international databases of SID, MagIran, Google Scholar, ISI/Web of Science, PubMed and Scopus with no time limits using the keywords of "health-related quality of life", "health related quality of life", "quality of life", "breast neoplasm", "breast cancer", and "breast tumors". Data analysis was performed in STATA version 14 based on the heterogeneity state using random effects model.

RESULTS

In this study, 15 articles with a sample size of 1883 were evaluated, and the mean global quality of life in patients was reported at 72.48 (95% CI: 64.94-79.82). In addition, the worst performance and symptoms were related to emotional functioning (56.70) (95% CI: 49.84-63.55) and financial difficulties (43.57) (95% CI: 31.47-55.67).

CONCLUSION

According to the results of the present study, the Iranian patients with breast cancer had a moderate quality of life in most dimensions.

Expanding the purview of wellness indicators: validating a new measure that includes attitudes, behaviors, and perspectives

Objective

The present study validated the DeltaQuest Wellness Measure (DQ Wellness), a new 15-item measure of wellness that spans relevant attitudes, behaviors, and perspectives.

Design

This cross-sectional web-based study recruited chronically-ill patients and/or caregivers (n = 3,961) and a nationally representative comparison group (n = 855).

Main Outcome Measures

The DQ Wellness assesses: a way of being in the world that involves seeing and embracing the good and expressing kindness toward others; engagement in one's activities and self-care; downplaying negative thoughts that reduce one's energy; and an ability to feel joy. Six widely used measures of physical and mental health, cognition, and psychological well-being enabled construct-validity comparisons. Item-response theory (IRT) methods evaluated reliability, factor structure, and differential item functioning (DIF) by gender.

Results

The DQ Wellness showed strong cross-sectional reliability (marginal reliability = 0.89) and fit a bifactor model (RMSEA = 0.063, CFI = 0.982, TLI = 0.983). The DQ Wellness general score demonstrated construct validity, convergent and divergent validity, unique variance, and known-groups validity, and minimal gender DIF. The study is limited to addressing cross-sectional reliability and validity, and response rates are not known due to the recruitment source.

Conclusion

The DQ Wellness is a relatively brief measure, taps novel content, and could be useful for observational or interventional studies.

Fear of COVID-19 and Life Satisfaction: The Role of the Health-Related Hardiness and Sense of Coherence

Introduction: The COVID-19 pandemic is contributing to increased fear and anxiety throughout society, which may affect life satisfaction. Health-related hardiness and sense of coherence (SOC) are personal resources that help people adapt to difficult circumstances. The purpose of this study was to investigate the relationship between fear of COVID-19, SOC, health-related hardiness, and life satisfaction. Methods: A total of 907 Polish people (522 women and 385 men) participated in this study. The Fear of COVID-19 Scale (FOC-6), the Health-Related Hardiness Scale, the Sense of Coherence Scale (SOC-29), and the Satisfaction with Life Scale were used. Results: Correlation showed that fear of COVID-19 was negatively related to health-related hardiness, SOC, and life satisfaction. Health-related hardiness and SOC were positively related to life satisfaction. Both SOC and hardiness were mediators between fear of COVID-19 and life satisfaction during the current pandemic. Conclusion: SOC and health-related hardiness are personal resources that are important for dealing with the effects of the COVID-19 pandemic. According to our study, SOC and hardiness can mediate between fear of COVID-19 and life satisfaction. Presented cross-sectional results have to be verified in future longitudinal studies in order to strengthen the conclusions presented in this manuscript. This study verified the role of only two personal resources, so more research is needed on the role of other personal resources during COVID-19 pandemic.

Evaluation of Religious Coping in Tunisian Muslim Women with Newly Diagnosed Breast Cancer

Studies evaluating religious coping in Arab-Muslim populations are few. We aimed to evaluate religiosity and religious coping in a sample of breast cancer women, and to analyze the association between religiosity, religious coping, depression, anxiety, cancer clinical data, and sociodemographic data in our patients. A cross-sectional and descriptive study was conducted over a 4-month period in 61 newly diagnosed breast cancer women. We used the following scales: The Depression Anxiety Stress Scales (DASS-21), the Arabic-Brief Religious Coping Scale (A-BRCS) and the Arabic Religiosity Scale. The majority of participants (98.4%) had a moderate to high level of religiosity. A weak correlation was found between religious coping scores and stress, depression, and anxiety scores. Our patients had high scores of positive religious coping, with a mean score of 26.13 out of 28 and used more positive coping than negative coping to cope with the cancerous disease. High levels of affective religiosity were the main predictive factor of positive religious coping. Therapies should reinforce the positive religious coping patterns of breast cancer patients, and detect a possible resort to negative religious coping that may negatively affect the patients' quality of life.

How does stress affect life satisfaction during the COVID-19 pandemic? Moderated mediation analysis of sense of coherence and fear of coronavirus

The aim of the present study was to determine the relationship between fear of COVID-19, stress, sense of coherence, and life satisfaction during the coronavirus pandemic. Participants were 907 Polish people (522 women and 385 men). We used the Perceived Stress Scale (PSS-10), Fear of COVID-19 Scale (FOC-6), Sense of Coherence Scale (SOC-29) and the Satisfaction with Life Scale. The relationship between stress and life satisfaction was mediated by the sense of coherence, and the relationship between stress and sense of coherence was moderated by fear of COVID-19. The fear of COVID-19 acted as a buffer in the relationship between stress and sense of coherence weakening the impact of stress on the sense of coherence. This study is the first to verify the proposed model of moderated mediation during the COVID-19 pandemic and was undertaken in a very large sample. This manuscript highlights the important role of the fear of COVID-19 and sense of coherence in our well-being. An individual's sense of coherence can affect their subjective well-being and help them to effectively manage stress and reduce anxiety.

A path analysis model of spiritual well-being and quality of life in Iranian cancer patients: a mediating role of hope

PURPOSE

Maintenance of quality of life (QOL) is vital for adaptation to life-threatening and chronic illnesses such as cancer. Therefore, the evaluation and strengthening of personal psychological resources that support QOL for patients with cancer is paramount. This study investigated the potential mediating role of hope in the relationship between spiritual well-being and QOL in Iranian cancer patients.

METHODS

A correlational predictive design was used with 200 patients with varying types and stage of cancer. Demographic and health characteristic surveys, spiritual well-being (SWB), adult hope, and EORTC QLQ-c30 scales were used for measuring the study constructs. Path analysis modeling was used to determine mediation relationships.

RESULTS

Patients' QOL was affected by SWB and hope. Religious (β = 0.205, p = 0.002) and existential (β = 0.286, p < 0.001) SWB dimensions and hope (β = 0.263, p < 0.001) improved QOL scores. The presence of hope partially mediated the relationship between SWB and QOL.

CONCLUSION

Quality of life was directly affected by SWB and was further improved by the presence of hope. The study suggests that maintenance of hope is essential to QOL in Iranian patients with cancer.

Spiritual and Emotional Experience With a Diagnosis of Breast Cancer: A Scoping Review

BACKGROUND

The breast cancer diagnosis causes a high level of suffering and distress in patients who experience difficulties in coping. There is a need to improve knowledge of emotional and spiritual coping in response to the stressful situation of women who must face this diagnosis.

OBJECTIVES

The aims of this study were to map women's spiritual and emotional coping experiences reported after a breast cancer diagnosis and examine the proposed interventions and suggestions for clinical practice.

METHODS

A scoping review was performed by searching the Scientific Electronic Library Online, Scopus, Cumulative Index to Nursing and Allied Health Literature, Latin American & Caribbean Health Sciences Literature, Medical Literature Analyses and Retrieval System Online, Spanish Bibliographic Index of Health Sciences, PSYCINFO, and Google Scholar databases using Medical Subject Headings terms. Additional pertinent studies were identified by reviewing the bibliographies of the included studies. Twenty articles were included according to the recommendations for scoping reviews.

RESULTS

Study findings regarding emotional and spiritual coping with the diagnosis and proposed interventions were synthesized. A thematic list of interventions and recommendations for clinical practice is also provided.

CONCLUSIONS

The studies demonstrated that women with breast cancer are challenged by their emotions and experiences. The review highlights the importance of spiritual coping for redefining women's meaning in life. In clinical practice, caring for women's inherent needs when they are coping with a diagnosis is important to establish integral care.

IMPLICATIONS FOR PRACTICE

Nurses can evaluate coping strategies, offer support for adaptation to the disease, provide qualified listening, help women in their search for significance while coping with cancer, and help them identify ways to overcome this stressful situation. Similarly, they can encourage patients to find spiritual comfort and emotional support.

Sense of coherence and coping strategies: How they influence quality of life in Iranian women with breast cancer

Aim

To investigate the mediation/moderation effect between Coping Behaviors (CBs) and Sense of Coherence (SOC) in the prediction of health‐related quality of life (HRQoL) in breast cancer patients.

Design

Cross‐sectional.

Methods

A total of 221 patients were included in this study. The 13‐item Orientation to Life Questionnaire, Brief COPE and Functional Assessment of Cancer Therapy—Breast were investigated. Pearson's correlation coefficient and mediation/moderation analysis were performed.

Results

Significant correlations were observed for SOC, active coping, acceptance, positive reframing (PR), planning, use of emotional support (UES), use of instrumental support, behaviour disengagement and self‐blame with HRQoL. Except for planning and acceptance, SOC partially mediated the CBs' effect on HRQoL. The UES and PR's effects on HRQoL were significant at lower SOC levels and diminished at higher SOC levels.

Conclusion

Practitioners can incorporate SOC and adaptive CBs, including PR and UES, into the rehabilitation programmes to improve HRQoL in patients.

The Role of Family Caregiver's Sense of Coherence and Family Adaptation Determinants in Predicting Distress and Caregiver Burden in Families of Cancer Patients

Background:

Most cancer patients' families suffer from maladaptation which increases family distress and caregiving burden. This study was conducted to explore the relationship between these maladaptation indicators, and the sense of coherence (SOC) of family caregivers alongside other family resilience determines among family caregivers of cancer patients.

Methods:

A total of 104 family caregivers of cancer patients were included in this cross-sectional study. They answered three questionnaires to assess family resilience factors: Family Inventory of Resources for Management (FIRM), Family Crisis Oriented Personal Evaluation Scales (F-COPES), and SOC scale. In addition, family maladaptation factors were determined by two instruments, including Family Distress Index (FDI) and Caregiver Burden Inventory (CBI).

Results:

The results of this study showed that the FIRM and the SOC together were responsible for 35% and 43% of the variances in FDI and CBI scores, respectively (P < 0.001). “Reframing”, the subscale of the F-COPES, significantly predicted the variances of FDI (β = −0.26, P = 0.01) and CBI scores (β = −0.21, P = 0.04). Moreover, “Mastery and health”, the subscale of the FIRM, significantly predicted the variances of FDI (β = −0.38, P < 0.01) and CBI scores (β = −0.21, P = 0.02).

Conclusions:

Family caregiver's SOC alongside other family resilience determinants plays a significant role in alleviating family distress and caregiver burden. It is suggested that palliative care providers consider family caregivers' SOC in developing a psychological intervention plan to improve family resilience in families of cancer patients.

Analysis of quality of life in breast cancer survivors using structural equation modelling: the role of spirituality, social support and psychological well-being

BACKGROUND

To explore and characterize the inter-relationship between psychological well-being, spirituality, social support, comorbidity, demographic and lifestyle factors and quality of life (QoL).

METHODS

This cross-sectional study was conducted with 305 breast cancer survivors in northern Iran in 2017. The demographic and socio-economic data and physical activity were measured with a standard questionnaire. The standard European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 QoL scale, a system-of-belief inventory questionnaire, the social support scale, the short form of the Hospital Anxiety and Depression Scale and the fatigue severity scale (FSS) were used in data collection. In structural equation modelling analysis, we used the maximum likelihood procedure to estimate the direct and indirect effects of relevant factors on QoL.

RESULTS

The median age (quartile 1 [Q1], quartile 3 [Q3]) of patients was 50 y (43, 55). The psychological factors designated by anxiety, depression and FSS had a negative significant direct effect on QoL (β=-0.62). Spirituality has a positive direct effect (β=0.089) but a negligible indirect effect (β=0.020) on QoL, while the direct association of social support was almost negligible.

CONCLUSIONS

The findings emphasized the unifying structure of the determinants of QoL and the mediating negative association of psychological factors with QoL. Thus the supportive education efforts should focus on improving psychological well-being along with standard treatment in breast cancer survivors.

Sense of coherence and its relationship to participation, cancer-related fatigue, symptom burden, and quality of life in women with breast cancer participating in the OptiTrain exercise trial

PURPOSE

This study examined the Sense of Coherence (SOC) of patients participating in the randomized controlled 'Optimal Training for Women with Breast Cancer' (OptiTrain) study and assessed how patient characteristics were associated with SOC. Secondary aims were to assess the association between SOC and patients' participation in this study and to determine whether SOC moderates the effect of the 16-week exercise intervention on fatigue, quality of life (QoL), and symptom burden in women with breast cancer undergoing chemotherapy.

METHODS

Modified Poisson regression analyses were conducted to determine the relative risk of weak-normal SOC versus strong SOC in terms of exercise session attendance, study and intervention dropout, and long absence rates. Analyses of covariance were performed to assess whether SOC moderated the effect of the exercise intervention (pinteraction ≤ 0.10).

RESULTS

Two hundred and forty women with early breast cancer (mean age 53 ± 10) participated in the OptiTrain study. Women with strong SOC reported less fatigue, lower symptom burden, and higher QoL. Women with weak-normal SOC were significantly more likely to drop out from the OptiTrain study and tended to have slightly poorer exercise session attendance. Women with breast cancer and weaker SOC benefitted as much from the exercise intervention, in terms of fatigue and QoL, as those with stronger SOC (pinteraction > 0.10).

CONCLUSIONS

Strong SOC appears to be associated with a more positive subjective state of health. Women with weak-normal SOC may need additional support to encourage participation and adherence in exercise trials. Assessing SOC may assist clinicians to identify and provide extra support for participants with weak SOC, who may be less inclined to participate in exercise programs.

Exploring the relationship between sexual function, sense of coherence, and well-being in a sample of Iranian breast cancer survivors

PURPOSE

This study was aimed at exploring the type and role of relationships between sexual function, sense of coherence (SOC), and well-being in a sample of Iranian breast cancer survivors.

METHODS

In this cross-sectional study with correlational design, data were collected from 181 survivors by consecutive sampling. They answered demographic and clinical information sheet, the SOC scale, the Female Sexual Function Index (FSFI), and the Health Index (HI). The data were analyzed using SPSS version 20.

RESULTS

The mean age of survivors was 47.04 ± 9.05 years. Most survivors were menopausal (51.9%) and underwent mastectomy (69.1%), and 12 months or more had passed since their treatment ended (71.2%). Sexual function was positively correlated with the level of SOC (r = 0.20) and the HI (r = 0.33). Also, there was a positive correlation between the level of SOC and the HI (r = 0.51). The results of logistic regression analyses showed the protective role of the SOC (OR: 0.95; 95% CI: 0.92-0.97) and the HI (OR: 0.87; 95% CI: 0.79-0.96) for women's sexual function. According to these results, the mediating role of the SOC was assessed between the variables of the HI and the FSFI. The SOC revealed a complete mediating effect in this relationship.

CONCLUSIONS

The mediator role of the SOC between survivors' well-being and their sexual function helps nurses and clinicians to understand how the SOC can be used as a screening test to detect survivors who are at risk of sexual problems and to plan for salutogenic interventions.

A salutogenic model predicting the need for psycho-oncological care and its utilisation-The role of generalised resistance resources and sense of coherence

OBJECTIVE

Although many cancer patients experience psychological distress, not all affected patients utilise psycho-oncological care. We aim to examine the role of generalised resistance resources (GRRs) and sense of coherence (SOC) in predicting cancer patient needs for psycho-oncological care and its utilisation. A salutogenic prediction model was conceptualised and statistically tested.

METHODS

Survey data (response rate 88.94%) from 2270 breast cancer patients one year after treatment in one of 88 certified hospitals in North Rhine-Westphalia, Germany, were analysed. Structural Equation Modelling analysis was performed.

RESULTS

21.6% of patients (n = 485; N = 2249) felt they currently needed psycho-oncological care, of which 61.6% currently utilised it (n = 299, N = 485). 42.2% (n = 953, N = 2259) had the need for psycho-oncological care in the previous 12 months, of which 58.0% (n = 553, N = 953) utilised it. Several GRRs directly predict the need for psycho-oncological care and SOC, as well as indirectly predict the utilisation of psycho-oncological care. Past utilisation significantly affects current need and utilisation. The model shows good model fit.

CONCLUSIONS

Generalised resistance resources and SOC affect the utilisation of psycho-oncological care. Therefore, measuring key GRRs and SOC during cancer treatment should be integrated into patient care as a salutogenic approach, to identify resources and vulnerabilities on an individual level.

Relación entre sentido de coherencia y diabetes mellitus: una revisión sistemática

Resumen El objetivo fue sintetizar las mejores evidencias científicas sobre el efecto del sentido de coherencia en el desarrollo de la enfermedad, tratamiento e indicadores biomédicos de control metabólico y desarrollo de complicaciones de personas en riesgo de desarrollar diabetes y en diabéticos. El método utilizado fue la revisión sistemática. Búsqueda y selección por dos revisores independientes en las bases de datos Scopus, Web of Science, PubMed, Ebsco, Science Direct y manuales, disponibles hasta 2017, en español e inglés, en población con edad superior a 18 años. De un total de 154 estudios, 20 artículos fueron incluidos en la revisión sistemática. Más de la mitad de los estudios utilizaron la versión SOC-13 para la verificación del sentido de coherencia y el indicador de control metabólico más frecuente fue la hemoglobina glucosilada. Además, 14, de los 20 estudios, encontraron una relación estadísticamente significativa entre el sentido de coherencia y la diabetes. Se concluye que el sentido de coherencia tiene una fuerte correlación con la diabetes en las diferentes fases de la enfermedad y está relacionado con la reducción del riesgo para el desarrollo de la enfermedad, la reducción de los valores de hemoglobina glucosilada y la aparición de complicaciones de la diabetes mellitus.

Religious Coping in Cancer: A Quantitative Analysis of Expressive Writing Samples From Patients With Renal Cell Carcinoma

CONTEXT

Past religiosity/spirituality (R/S) research has mainly relied on self-report instruments, which may result in self-presentation and defensive biases.

OBJECTIVES

To address these limitations, we reviewed the writing samples that were generated as part of an expressive writing (EW) trial, coded the samples for R/S content, and examined cross-sectional and prospective associations between R/S content and symptom and psychosocial outcomes.

METHODS

Participants diagnosed with renal cell carcinoma who were randomized to the EW arm completed a standard writing protocol. Before randomization, they completed validated measures of R/S, depressive symptoms, social support, fatigue, and sleep disturbances and one, four, and 10 months after completing the intervention. Writing samples were coded for positive and negative religious coping (RC), and personal (e.g., private prayer) and collective (e.g., church attendance) religious engagement (RE).

RESULTS

Of the 138 patients, 117 provided at least one writing sample, and 89% of participants made at least one R/S reference with 70% including at least one positive RC statement, and 45.3% revealed personal and 42.3% collective RE. Negative RC was rare (8%). Although positive RC and RE were significantly associated with the R/S Index (P < 0.01), negative RC was not. In prospective analyses, RE was associated with reduced cancer-related symptoms over time (P = 0.04), and negative RC was associated with increased psychological distress over time (P = 0.004).

CONCLUSION

Behavioral coding of EW samples supported the literature suggesting that positive RC is common among patients with cancer. Although negative RC may be relatively rare, it may be associated with psychological distress.

Sense of Coherence and Health-Related Quality of Life in Patients With Brain Metastases

With improvements in treatments for primary tumor and brain metastases (BM), the life expectancy of patients with advanced cancers is increasing; thus, helping patients with BM maintain quality of life is becoming increasingly important. Sense of coherence (SOC) has been found to be closely related to health-related quality of life (HRQoL) in patients with chronic diseases, however, this relationship has not been validated in patients with BM. This study first examined the relationship between SOC and HRQoL in patients with BM, and further identified factors associated with SOC in these patients. Patients with BM reported lower scores for most of the functioning subscales and for the general rating of quality of life, and higher scores for most of the symptom subscales, compared with a normative sample. SOC was significantly correlated with most aspects of HRQoL in patients with BM. Further, SOC in the patients was associated with awareness of the disease, possession of religious belief, and type of primary cancer. These results validate the close relationship between SOC and HRQoL in patients with BM, and indicate that SOC is associated with awareness of illness and religious belief.

Nutrition Indicators, Physical Function, and Health-Related Quality of Life in Breast Cancer Patients

OBJECTIVE

This study aimed to investigate how nutrition indicators and physical function may influence Health-related Quality of Life (HRQoL) of breast cancer patients undergoing treatment.

METHODS

This was a cross sectional study among a total of 163 breast cancer patients. Series of measurements including anthropometry, biochemical, and dietary were employed to assess patients' nutritional status while physical function was assessed by handgrip strength. HRQoL of patients was determined using European Organization for Research and Treatment of Cancer quality of life questionnaire Core 30 (EORTC-QLQ-C30) version 3.0. Multiple linear regression was used to identify factors associated with HRQoL.

RESULTS

Breast cancer patients perceived moderately their overall quality of life (QoL), with the mean global health status (GHS) score of 69.12. Emotional functioning was the poorest functional scale while fatigue was the most distressing symptom presented by the patients. Approximately 20% of patients had low corrected arm muscle area while more than half had low hemoglobin level. More than 90% of patients did not meet the overall dietary recommendation and had poor handgrip strength. Mid-upper arm circumference (MUAC) was associated with GHS (β: 0.906; 95% CI: 0.22, 1.56) and cognitive functioning (β: -1.543; 95% CI: -3.07, -0.01). Handgrip strength was positively associated with most of HRQoL outcomes.

CONCLUSIONS

Breast cancer patients reported overall good nutritional status and moderate QoL during treatment. Being well-nourished improved HRQoL and handgrip strength could be a potential proxy for functional outcomes as well as overall QoL.

Spirituality and quality of life in women with breast cancer: The role of hope and educational attainment

OBJECTIVE

This study investigated relationships among spirituality, hope, and overall quality of life in Muslim women with breast cancer in Malaysia.

METHOD

A cross-sectional descriptive design with a convenience sample of 145 Malay patients was used. The mediating role of hope in the relationship between spirituality and quality of life as well as the moderating effect of education level on the spirituality hope link were examined.

RESULTS

Participants with higher self-reported spirituality reported more hope (b = 6.345, p < 0.001) and higher levels of quality of life (b = 1.065, p < 0.001). Higher educational attainment weakened relationships between spirituality and hope (b = -1.460, p < 0.001).

SIGNIFICANCE OF RESULTS

The role of advanced education in contributing to lessened hope in relation to spirituality emphasizes the importance of skilled and personalized spiritual counseling in the respective socio-cultural religious context.

Factors Associated with Health-Related Quality of Life in Women with Breast Cancer in the Middle East: A Systematic Review

Objectives: The aim of the present systematic review was to identify the factors that potentially influence health-related quality of life (HRQoL) in women with breast cancer (BC) in the Middle East. Methods: A systematic search of the PubMed, Ovid Medline, Cochrane, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, and Ebscohost databases was conducted to identify all relevant articles published in peer-reviewed journals up to April 2018. The keywords were “Health related quality of life”, “Breast Cancer”, and “Middle East countries”. The Newcastle–Ottawa (NOS) scale was used to evaluate the methodological quality of the included studies. Due to the methodological heterogeneity of the identified studies, no statistical pooling of the individual effect estimates was carried out; instead, the results were summarized descriptively. Results: A total of 5668 articles were screened and 33 studies were retained. The vast majority of these studies were cross-sectional and only two were longitudinal prospective studies. Concerning the methodological quality, only 39% were of high quality. Our comprehensive literature review identified several modifiable and non-modifiable risk factors associated with HRQoL, including sociodemographic, clinical, and treatment-related factors as well as behavioral and psychosocial factors. Conclusion: This study has many implications for clinical practice and may provide a framework for establishing policy interventions to improve HRQoL among women with BC. Healthcare systems in the Middle East are encouraged to develop interventional programs targeting modifiable factors, particularly socio-demographic, behavioral, and psychosocial factors.

Identifying variables in relation to health-related quality of life among married women of reproductive age in Sivas Turkey

A cross-sectional study was performed to identify the factors associated with health-related quality of life (HRQoL) among 1,236 married Turkish women aged 15-49 years, in the urban area of Sivas, between January and July 2017. Multiple logistic regression analyzes showed that being unemployed [adjusted odds ratio (AOR) = 1.73, 95% confidence interval (CI) = 1.18-2.25], and having an unsatisfying sexual life (AOR = 1.54, 95% CI = 1.17-2.03), a chronic illness (AOR = 1.66, 95% CI = 1.27-2.17), more than three children (AOR = 1.38, 95% CI = 1.03-1.86), and experienced domestic violence (AOR = 2.15, 95% CI = 1.55-2.98) were associated with worse mental HRQoL. Having less than a high school education (AOR = 2.00, 95% CI = 1.33-3.02), a chronic illness (AOR = 2.49, 95% CI = 1.88-3.30), a history of abortion (AOR = 1.59, CI = 1.09-2.31), and experienced domestic violence (AOR = 1.71, 95% CI = 1.21-2.40) were associated with worse physical HRQoL. These findings suggest that health care providers or policy makers should pay special attention to unemployed women who are less educated, have more than three children and those having unsatisfied sexual lives, chronic illness, domestic violence experience and abortion history to enhance their HRQoL.

Decreased symptom burden following surgery due to support from an interactive app for symptom management for patients with pancreatic and periampullary cancer

Background: Patients with pancreatic and periampullary cancer have poor prognoses, experience multiple symptoms following surgery and sometimes lack knowledge of self-care activities. Consequently, it is vital to develop systems that support self-management, improvement of health-related quality of life and reduction of symptoms. Therefore, the aim was to evaluate the impact on health-related quality of life and self-care activity when using the Interaktor app following pancreaticoduodenectomy due to cancer. Material and Methods: Patients in the intervention group used Interaktor up to six months after surgery. They reported symptoms daily at home and received support for self-management by continuous access to written self-care advice and to their healthcare professionals. Descriptive data from the app were collected. Health-related quality of life and self-care activity were collected before surgery, and six weeks and six months after surgery. Comparisons between the intervention group (n = 26) and a historical control group (n = 33) were made. Decline/dropout rate was 37% in the intervention group and 10% in the control group. Results: Six weeks after surgery the intervention group rated significantly higher emotional functioning and less nausea/vomiting, pain, appetite loss, constipation, pancreatic pain, flatulence and worry about low weight. Twenty-five subscales/items showed non-statistical differences. Six months after surgery the intervention group rated significantly fewer hepatic symptoms, less worry about low weight, and higher self-care activity level. Thirty subscales/items showed non-statistical differences. The first four weeks, patients reported symptoms in a median 95% of the intended days, and for the rest of the period in median 83%. Conclusion: The use of an app for management of patient-reported outcomes reduces symptom burdens six weeks after pancreaticoduodenectomy due to cancer. Interaktor is well accepted for patients choosing to participate and appears to facilitate supportive care needs and timely symptom management for this patient group. Future studies should also include cost-benefits and objective measures.

Health-related quality of life of breast cancer patients in the Eastern Mediterranean region: a systematic review and meta-analysis

PURPOSE

Breast cancer is the most common type of cancer in women around the world, and this applies to the Middle East as well. The goal of all medical care and treatment is to improve the quality of life (QoL) of patients. Accordingly, the present study aimed at evaluating the QoL of patients with breast cancer in the Middle East region.

METHODS

In this meta-analysis, three electronic databases (PubMed, Web of Science, and Scopus) were searched from inception until August 2018. The hoy et tool was used to evaluate the quality of the articles included in the meta-analysis. The search, screening, quality evaluation, and data extraction were carried out by two of the researchers.

RESULTS

Thirty-six studies conducted on 8347 Middle Eastern women with breast cancer entered the final stage. QoL was assessed by the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire in 20 studies, with 6034 patients. The mean of the reported QoL was between 31.1 and 75.6. Based on the results of the random effect method, the overall mean of the QoL was 60.5 (95% confidence interval 56.0, 65.0; I2 = 99.0%). In six studies performed on 1053 individuals, QoL was classified as good, moderate, or poor. Less than one-third of patients (21%) had a good QoL.

CONCLUSIONS

Since less than one-third of patients had a good QoL, it seems necessary to design and implement an integrated and multidimensional educational program to improve QoL of patients with breast cancer.

Type C Personality and Depression Among Newly Diagnosed Breast Cancer Patients: The Mediating Role of Sense of Coherence

PURPOSE

This study aims to explore the mediating role of sense of coherence in the relationship of type C personality and depression among newly diagnosed breast cancer patients.

METHODS

A descriptive and correlational survey was conducted in 600 breast cancer patients aged ≥18 years from September 2018 to March 2019 in Zhengzhou, China. The demographic questionnaire, Cancer Behavior Scale, Sense of Coherence Scale and Hamilton Depression Scale were included in this study. Data analysis was performed by correlation analysis, multiple linear regression analysis, and structural equation modeling.

RESULTS

The valid questionnaires were 575 (effective response rate: 95.8%). The score of sense of coherence was negatively correlated with type C personality and depression (r = -0.41, P < 0.01; r = -0.58, P < 0.01); the score of type C personality and depression were positively correlated (r = 0.51, P < 0.01). The results of multiple linear regression analysis revealed that the effect of type C personality on depression was partly mediated by sense of coherence, which was confirmed by structural equation modeling. The mediation effect accounts for 45.2% (0.269/0.594) of the total effect.

CONCLUSION

The results of this study revealed that sense of coherence as a partial mediating role is essential for reducing the influence of type C personality on depression. Early and targeted psychological interventions on sense of coherence are needed to alleviate the symptom of depression in newly diagnosed breast cancer patients.

Correlation between religiosity, spirituality and quality of life in adolescents with and without cleft lip and palate

OBJECTIVE

to correlate spirituality and religiosity with quality of life of adolescents with and without cleft lip and palate.

METHODS

cross-sectional and correlational study involving two groups: case group (n = 40) and comparison group (n = 40). The Duke University Religion Index (DUREL) and the World Health Organization Quality of Life Bref were used for data collection. The Mann-Whitney, Chi-Square, Student's t-test and Pearson's correlation tests were used in the statistical analyses, with a significance level of 5% (p ≤ 0.05).

RESULTS

organizational religiosity and overall quality of life were significantly higher in the case group (p = 0.031 and p = 0.012, respectively). As for quality of life, the Environment Domain was significantly higher in the case group (p < 0.001). In the correlation between religiosity and spirituality, non-organizational religiosity had a strong correlation (r = 0.62) with organizational religiosity (p < 0.001). In the correlation of religiosity and spirituality with quality of life, only a moderate correlation between spirituality and overall quality of life was identified (r = -0.35, p = 0.026).

CONCLUSION

there was no relationship of religiosity and spirituality with quality of life among adolescents with cleft lip and palate for most aspects evaluated.

The Relationship between Resilience with Self- Compassion, Social Support and Sense of Belonging in Women with Breast Cancer

Background: The purpose of this study was to investigate the associations among Resilience, self- compassion, social support and Sense of belonging in Iranian women with breast cancer. Materials and methods: This study was a descriptive-analytical cross-sectional study .The data of 150 patients with breast cancer were collected by convenience sampling using Demographic characteristics questionnaire, Connor-Davidson resilience scale, self-compassion scale and the multidimensional scale of perceived social support in Urmia, Iran in 2016. Results: The most age of the patients were in the range of 41-49 years, and most of them were married. The self- compassion, social support and Sense of belonging (r = all correlated significantly with resilience). Significant positive correlation was identified among self-compassion, social support, sense of belonging and resilience (P < 0.01). Conclusions: The results of this study clarified the self-compassion, social support and Sense of belonging are effective on the resilience among Iranian women with breast cancer. It is recommended to design some interventional programs to increase the aspect of resilience in these patients.

Family Intervention Based on the FOCUS Program Effects on Cancer Coping in Iranian Breast Cancer Patients: a Randomized Control Trial

Background:

Breast cancer affects patients’ lives. Many breast cancer patients have problems with coping and they need support from their families. Family involvement based on the FOCUS program is designed to support breast cancer survivors within their families. The aim of this study was to investigate the effect of family involvement based on the FOCUS program on coping in breast cancer patients undergoing chemotherapy in academic centers in Urmia in 2016.

Methods:

In this randomized controlled trial study, sixty breast cancer survivors were randomly assigned into intervention (N=30) and control (N=30) groups. The FOCUS program family-based intervention featured six sessions covering subject areas of family involvement, optimism, cancer coping, uncertainty reduction and symptom management. The instruments used were demographic and cancer coping questionnaires. Data were analyzed with SPSS 20 software.

Result:

The findings revealed a significant improvement in total cancer coping scores (t= -12/39, p<0.001), in all subscales including individual (t= -11/52, p<0.001), positive focus (t= -7/03, p<0.001), coping (t= -7/28, p<0.001), diversion (t= -11/76, p<0.001), planning (t=-4/91, p<0.001) and in interpersonal (t=-11/14, p<0.001). No significant changes were observed for the control group.

conclusion:

The results showed that family involvement based on the FOCUS program increases the ability to cope in breast cancer survivors.

Relational spirituality and quality of life 2007 to 2017: an integrative research review

BACKGROUND

Despite the increasing number of evidence-based research on relational spirituality (RS) and quality of life (QoL) in medical-health research, little is known about the links between RS and QoL outcomes and the mechanisms by which RS aspects are functionally tied to QoL.

OBJECTIVE

To determine how RS is perceived/positioned in relation to QoL, we (a) examined recent available data that identify and appraise the links between RS and QoL; (b) identified themes emerging from the association between RS and QoL, and (c) discussed the implications of the effects of RS on QoL outcomes.

METHODS

We conducted an integrative research review of English-language peer-reviewed articles published between 2007 to March 2017 which examined an association between RS and QoL, as identified from a search of three databases: PubMed, PsycINFO, and ScienceDirect.

RESULTS

A total of 20 studies were analysed. Of these, twelve (60%) reported positive association between RS and QoL, three (15%) studies reported inverse associations, whereas five (25%) studies showed evidence of lack of association (with two out of the five studies showing an indirect association). Physical health and psychological functioning were the most researched domains of QoL, and some studies suggest an attachment-based model of RS in the last 10 years of RS and QoL research. Studies conducted with participants with serious illnesses ranging from dementia, cardiac arrest, and breast cancer reported no association between RS and physical health. Our review shows evidence of both the direct and/or indirect effects of RS on QoL as a possible spiritual coping model for complementary alternative health therapy, albeit occurring through several religious-related psychosocial conduits.

CONCLUSION AND IMPLICATION

RS appears to be associated with health benefits as indicated across QoL domains. General medical practitioners and other healthcare agencies could benefit from the understanding that a spiritual coping model could aid their patients, and therefore their clinical practices, in the healing process.

Effect of Community-Based Occupational Therapy on Health-Related Quality of Life and Engagement in Meaningful Activities of Women with Breast Cancer

We aimed to evaluate the short-term effects of community-based occupational therapy on health-related quality of life and engagement in meaningful activities among women with breast cancer. An open label randomized controlled trial study design was applied. The participants were members of various societies of women with cancer. In total, 22 women have participated in the study. Participants of the experimental group (n = 11) participated in a 6-week community-based occupational therapy program and the usual activities of various societies, whereas the control group (n = 11) women participated in the usual activities of the societies only. 1 of the participants withdrew during the course; therefore 21 completed the study successfully. Participants of both groups were assessed for health-related quality of life and the participants of the experimental group were assessed for engagement in meaningful activities. The evaluation was carried out during the nonacute period of the disease-at the beginning of the study and after 6 weeks. Women of the experimental group demonstrated statistically significantly better scores in the global quality of life, role functions, physical, emotional, cognitive, and social functions, fatigue, insomnia, financial impact, systemic therapy side effects, and breast symptoms scales compared to the control group participants (p < 0.05) after the 6 weeks, as measured by the EORTC QLQ-C30 questionnaire and its breast cancer module QLQ-BR23. Furthermore, women of the experimental group demonstrated significant greater engagement in meaningful activities when applying community-based occupational therapy (p < 0.05), as measured by using the Engagement in Meaningful Activities Survey (EMAS). The evaluation of the associations between the women's engagement in meaningful activities and changes in health-related quality of life showed that greater engagement in meaningful activities was associated with better emotional functions and a lower level of insomnia (p < 0.05). Based on the results of our study, we recommend applying occupational therapy in the field of community healthcare in order to maintain or improve breast cancer patients' health-related quality of life and suggest involving women into meaningful activities during community-based occupational therapy after clarifying which activities are important to them.

A Survey on the Relationship between Religiosity and Quality of Life in Patients with Breast Cancer: A Study in Iranian Muslims

OBJECTIVE

This study aimed to assess the relationship between religiosity and quality of life (QoL) in patients with breast cancer in a Muslim population.

METHODS

This descriptive-correlational study was conducted in 84 Muslim patients with breast cancer who were admitted to Ahvaz Shafa Hospital, Iran, during 2015. QoL and religiosity were measured with the Short Form-36 questionnaire and Muslim Religiosity questionnaire based on the Glock and Stark model, respectively. Data were analyzed using a software program for descriptive statistics, the Chi-square test, Pearson's correlation, and an independent sample t-test.

RESULTS

Most patients had high religiosity (69%) and moderate QoL (46.5%) scores. Total scores and all subscales scores for QoL were significantly higher in patients with high religiosity than patients with moderate religiosity (P < 0.0001). Moreover, a direct correlation was found between religiosity (total and all subscales) and QoL (total and all subscales) (P < 0.0001).

CONCLUSIONS

A significant relationship was found between religiosity and QoL in patients with breast cancer. Accordingly, care team members, especially midwifery and nursing staff, should pay more attention to religious beliefs among these patients to improve their QoL.

Self-Confidence and Quality of Life in Women Undergoing Treatment for Breast Cancer

Introduction: Quality of life is an important topic in the study of chronic diseases, especially cancer which can have a major effect on patient self-confidence. This study was conducted to determine quality of life and its relationship with self-confidence in women undergoing treatment for breast cancer. Methods: This cross-sectional, descriptive, analytical study was conducted in 2016 on 166 women with breast cancer undergoing treatment at Ghazi, Al-Zahra, International and/or Shams hospitals in Tabriz. The subjects were selected through convenience sampling. A personal-demographic questionnaire, the Cancer Quality of Life Questionnaire (QLQ-C30), and the Rosenberg Self-Esteem Scale (RSES) were completed for each patient. The data obtained were analyzed using independent t-tests, one-way ANOVA, multivariate linear regression and Pearson’s correlation coefficients. Findings: The mean total score of quality of life was 59.1±17.4, ranging from 0 to 100. The highest mean score was obtained in the cognitive subscale (74.9±23.8) and the lowest in the emotional subscale (51.4±21.1). The mean score for self-confidence was 0.3 with a standard deviation of 0.1, ranging from -1 to +1. There was a significant positive relationship between self-confidence and quality of life, except in three symptom subscales for diarrhea, constipation and loss of appetite (P<0.05). Self-confidence, disease duration, lifestyle, marital satisfaction and caregiver status were among the predictors of quality of life. Discussion: Given the significant relationship between quality of life and self-confidence, health care providers may need to pay special attention to women undergoing treatment for breast cancer and perform timely measures to maintain their belief in themselves.

Health-related quality of life of Iranian breast cancer patients: a meta-analysis and systematic review

PURPOSE

Quality of life is the most important psychological factor affecting breast cancer patients. This study aimed to examine the health related quality of life of breast cancer patients in Iran.

METHODS

International (PubMed, Web of science, Scopus and Google scholar) and national (SID, Magiran) databases were searched for related studies to September 2017. The quality of the articles was evaluated using the Hoy tool.

RESULTS

Out of 232 initial studies, 18 studies performed on 2263 people were included in the final stage of the study. Based on the EORTC-QLQ-C30 and random effect method, the pooled mean score of quality of life in 1073 people was 57.88 (95% CI 48.26-67.41, I² = 97.90%) and the pooled mean score of quality of life based on WHOQOL-BREF in 357 people was 66.79 (95% CI 45.96-87.62, I² = 99.50%).

CONCLUSION

According to the results of the study, a moderate level of quality of life in women with breast cancer was indicated. Therefore, the use of multidimensional approaches can improve their quality of life.

The comparison of spiritual health and self-esteem in women with and without sexual violence

Background and aim

Sexual violence is a serious public health problem which is common around the world. The aim of this study was to evaluate spiritual health and self-esteem in sexual violence victims.

Methods

This cross-sectional study was performed on 66 subjects in the group of sexual violence women and 147 subjects in the group of women with no experience of sexual violence who referred to Tehran Forensic Medical Center and the health centers of Shahid Beheshti University of Medical Sciences respectively, in 2015, in Tehran, Iran. Sexual violence was considered as vaginal or anal penetration. Paloutzian & Ellison spiritual health questionnaire and Rosenberg self-esteem scale were used for data collecting. Data were analyzed using IBM-SPSS version 21. The Kolmogorov Simonov test was used for normality distribution of variables. Descriptive and the Mann-Whitney tests were used to analyze the data. Statistical significance was set to p<0.05.

Results

Sexual activity in both groups was started at 20 years old. Most of the abused subjects were single (48.8%), with education level below diploma (55.2%), unemployed (67%) and with an average annual income of 200 million Rials ($7,000). Familiarity with the offender was mostly as friendship (42.4%), and the offence had occurred through deception (37.8%). No significant difference was found between the total mean scores of self-esteem in the two groups (M1: 21.89, M2: 21.02; p=0.76) while a significant difference was seen between the mean scores of spiritual health, which indicates a lower level of spiritual health in women with sexual violence (M1: 74.59 (2.03), M2: 86.39 (3.12); p<0.001).

Conclusion

The results of the present study highlight the importance of spirituality in sexual violence so policies to promote spiritual health are recommended to protect women.

Perceived social support and the sense of coherence in patient-caregiver dyad versus acceptance of illness in cancer patients

BACKGROUND

Acceptance of illness is a significant determinant of further coping with a disease. Development of illness acceptance may be associated with the sense of coherence and perception of social support. Cancer is an example of a crisis situation, which affects both the patient and his/her close relatives. Consequently, acceptance of illness may be influenced by factors originating from both sides of caregiver-patient dyad. The aim of this study was to analyse direct and indirect interrelationships between perceived support and the sense of coherence in patient-caregiver dyad, and acceptance of illness in cancer patients.

DESIGN

Cross-sectional study.

METHODS

The study included 80 dyads composed of cancer patients and their caregivers. Only cancer patients undergoing oncological treatment at the time of the study, for at least 3 months but no longer than 12 months, were enrolled. All subjects completed perceived support subscale included in the Berlin Social Support Scales, sense of coherence-29 questionnaire to determine the sense of coherence and Acceptance of Illness Scale.

RESULTS

Compared to cancer patients, their caregivers presented with significantly lower levels of perceived social support and weaker sense of coherence. The sense of coherence in caregivers and patients was determined by their perceived support levels. The sense of coherence in caregivers turned out to be a key resource influencing acceptance of illness in cancer patients, both directly and indirectly, via their perceived social support and their sense of coherence.

CONCLUSIONS

The sense of coherence, an intrinsic psychological factor determined by social support, is an important determinant of illness acceptance. Functioning of cancer patients is also modulated by psychosocial characteristics of their caregivers.

RELEVANCE TO CLINICAL PRACTICE

Greater support offered to caregivers may substantially strengthen the sense of coherence in caregivers and cancer patients and, therefore, may improve the functioning of patient-caregiver dyad in a situation of neoplastic disease.

Effect of specialist palliative care services on quality of life in adults with advanced incurable illness in hospital, hospice, or community settings: systematic review and meta-analysis

Objective To assess the effect of specialist palliative care on quality of life and additional outcomes relevant to patients in those with advanced illness.Design Systematic review with meta-analysis.Data sources Medline, Embase, Cochrane Central Register of Controlled Trials, PsycINFO, and trial registers searched up to July 2016.Eligibility criteria for selecting studies Randomised controlled trials with adult inpatients or outpatients treated in hospital, hospice, or community settings with any advanced illness. Minimum requirements for specialist palliative care included the multiprofessional team approach. Two reviewers independently screened and extracted data, assessed the risk of bias (Cochrane risk of bias tool), and evaluated the quality of evidence (GRADE tool).Data synthesis Primary outcome was quality of life with Hedges' g as standardised mean difference (SMD) and random effects model in meta-analysis. In addition, the pooled SMDs of the analyses of quality of life were re-expressed on the global health/QoL scale (item 29 and 30, respectively) of the European Organization for Research and Treatment of Cancer QLQ-C30 (0-100, high values=good quality of life, minimal clinically important difference 8.1).Results Of 3967 publications, 12 were included (10 randomised controlled trials with 2454 patients randomised, of whom 72% (n=1766) had cancer). In no trial was integration of specialist palliative care triggered according to patients' needs as identified by screening. Overall, there was a small effect in favour of specialist palliative care (SMD 0.16, 95% confidence interval 0.01 to 0.31; QLQ-C30 global health/QoL 4.1, 0.3 to 8.2; n=1218, six trials). Sensitivity analysis showed an SMD of 0.57 (-0.02 to 1.15; global health/QoL 14.6, -0.5 to 29.4; n=1385, seven trials). The effect was marginally larger for patients with cancer (0.20, 0.01 to 0.38; global health/QoL 5.1, 0.3 to 9.7; n=828, five trials) and especially for those who received specialist palliative care early (0.33, 0.05 to 0.61, global health/QoL 8.5, 1.3 to 15.6; n=388, two trials). The results for pain and other secondary outcomes were inconclusive. Some methodological problems (such as lack of blinding) reduced the strength of the evidence.Conclusions Specialist palliative care was associated with a small effect on QoL and might have most pronounced effects for patients with cancer who received such care early. It could be most effective if it is provided early and if it identifies though screening those patients with unmet needs.Systematic review registration PROSPERO CRD42015020674.

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.