A Summary of Current Findings on Quality of Life Domains and a Proposal for Their Inclusion in Clinical Interventions

Patient-Reported Outcomes and PTSD Symptoms in Emergency General Surgery

INTRODUCTION

Patient-reported outcomes (PRO) are increasingly recognized as a measure of surgical quality and long-term outcomes. There are few PRO data for patients undergoing emergency general surgery (EGS) procedures. Sudden illness and injury are associated with worse health-related quality of life, symptoms of depression, post-traumatic stress. This study aimed to evaluate PRO and post-traumatic stress disorder (PTSD) symptoms in an EGS population.

METHODS

Patients who underwent an EGS operation and had quality improvement data available from Jan 2020 to Jan 2021 were eligible for inclusion. Participants completed a survey of demographics, socio-economic status, PROMIS PRO measures for general life satisfaction (GLS), general self-efficacy (GSE), and physical function (PF), and the PCL-5 PTSD symptom screening tool.

RESULTS

One hundred forty-one patients were eligible for inclusion, 40 (28%) completed the study. Mean PRO scores were 52.5 ± 9.3 for GLS, 48.6 ± 8.0 for GSE, and 48.7 ± 9.6 for PF. 12.5% of patients had a low or very low GLS and GSE score, while 32.5% had mild, moderate, or severe PF scores. Seven patients (17.5%) scored >31 on PCL-5 indicating a positive PTSD screen. Regression analysis found American society of anesthesiology score, emergency case, and lower income associated with lower GLS scores. Age, body mass index, and lower income were associated with lower PF scores.

CONCLUSIONS

We found that following EGS most patients have average PRO. This limited study did also identify that there are patients potentially at risk for worse functional and mental health outcomes. We plan to use this data to prospectively evaluate the role that EGS plays in these outcomes and how they can be improved on.

Impact of care-recipient relationship type on quality of life in caregivers of older adults with dementia over time

BACKGROUND

Dementia caregiving is a dynamic and multidimensional process. To gain a comprehensive understanding of informal caregiving for people living with dementia (PLWD), it is pivotal to assess the quality of life (QoL) of informal caregivers.

OBJECTIVE

To evaluate whether the care-recipient relationship type predicts changes in the QoL of informal caregivers of PLWD over a two-year period.

METHODS

This was a secondary analysis of longitudinal data. The data were drawn from two waves of linked data from the National Health and Aging Trends Study (NHATS) and the National Study of Caregiving (NSOC) (2015: NHATS R5 & NSOC II; 2017: NHATS R7 & NSOC III). Caregivers were categorized into spousal, adult-child, "other" caregiver and "multiple" caregivers. QoL was assessed through negative emotional burden (NEB), positive emotional benefits and social strain (SS). Generalized estimating equation modelling was used to examine changes in caregivers' QoL outcomes across types of relationship over time.

RESULTS

About, 882 caregivers were included who linked to 601 PLWD. After adjusting caregivers' socio-demographics, "other" caregivers had lower risk of NEB and SS than spousal caregivers (OR = 0.34, P = 0.003, 95%CI [0.17, 0.70]; OR = 0.37, P = 0.019, 95%CI 0.16, 0.85], respectively), and PLWD's dementia status would not change these significance (OR = 0.33, P = 0.003, 95%CI [0.16, 0.68]; OR = 0.31, P = 0.005, 95%CI [0.14, 0.71], respectively).

CONCLUSIONS

The study demonstrates that spousal caregivers face a higher risk of NEB and SS over time, underscoring the pressing need to offer accessible and effective support for informal caregivers of PLWD, especially those caring for their spouses.

Patients' subjective well-being: Determinants and its usage as a metric of healthcare service quality

It is commonly suggested that patients' subjective well-being (SWB) can be affected by pre-treatment conditions and treatment experiences, and hence SWB can be used to measure and improve healthcare quality. With data collected in a hospital in the UK (N = 446), we investigated the determinants of patients' SWB and evaluated its use in healthcare research. Our findings showed strong relationships between pre-treatment conditions and patients' SWB: anxiety and depression negatively predicted SWB across all three domains, mobility positively predicted the life satisfaction and happiness domains, while the ability to self care and pain and discomfort also predicted SWB in some domains. In contrast, patients' satisfaction with the treatment only played minor roles in determining SWB, much less so the characteristics of their nurses. The general lack of associations between treatment experiences and patient's SWB highlighted the challenges of using SWB to measure healthcare quality and inform policy making.

Quality of Life in Cancer Patients: The Modern Psycho-Oncologic Approach for Romania-A Review

Quality of life (QOL) is an important indicator of human satisfaction and well-being. QOL is significantly and persistently affected for patients after a cancer diagnosis. Despite some evidence suggesting that psycho-oncologic interventions can provide lasting benefits, the inclusion of such interventions in cancer therapy is not universal. This article provides an overview of the known approaches to the evaluation of QOL in cancer patients and various interventions for improving patients' outcomes, with a focus on the eastern European regional and specific Romanian context. With a mortality rate above and cancer care performance below the EU average and unequally distributed, Romania urgently needs a national coordination program, which is discussed in our review, highlighting the main psychological tools needed for the assessment and the challenges involved in implementing the program. In the end, we suggest some directions for the future development of the psycho-oncologic approach in the context of social considerations, policy, and the unexpected financial challenges the nation provides.

The construction of a new Clinical Quality of Life Scale (CLINQOL)

Whilst the variables in quality of life and well-being can be separated into objective and subjective domains, there remains a dearth of multiple utility instruments that assess their impact upon quality of life. To address this, ten domains were identified in a preliminary exploratory literature search, and an exploratory review generated enough facets to represent each domain, with items developed to form a composite scale. A principal components analysis run on data collected from 210 participants produced seven factors: relationships, work, money, health, leisure, and life management, with the remaining four domains subsuming into a seventh composite subjective factor (mental state). Final items were collated into the new Clinical Quality of Life Scale (CLINQOL) and were tested against the Assessment of Quality of Life Instrument, the Personal Wellbeing Index-Adult, Positive and Negative Affect Scale, the Satisfaction with Life scale, and the Mindfulness Attention Awareness Scale. The CLINQOL demonstrated suitable reliability, with items within each category forming internally consistent subscales. The full scale score demonstrated satisfactory test-retest reliability and concurrent validity, correlating with all measures. Findings suggest that the CLINQOL captures critical clinical factors, and may be an acceptable instrument to assess quality of life and well-being.