Geraldine Padilla

Defining the content domain of quality of life for cancer patients with pain.

This study identified attributes that define the content domain of quality of life in a sample of 41 cancer patients with chronic pain. Patients were asked four open-ended questions about the meaning of quality of life, what contributes to a good or poor quality of life, and how pain influences quality of life. Content analysis of responses revealed three categories of attributes that embrace the quality-of-life content domain. The first category is physical well-being. It includes general functioning and disease/treatment-specific attributes. The second is psychological well-being. It includes affective-cognitive attributes, coping ability, meaning of pain and cancer, and accomplishment attributes of quality of life. The third is interpersonal well-being. It incorporates social support and social/role functioning attributes. Replications of the current study in other groups of patients may yield data to support a two-part, multidimensional quality-of-life instrument. A norm-referenced measure can be used to evaluate quality of life in terms of attributes that are salient regardless of the disease or treatment. A domain-referenced measure may be used to evaluate attributes whose salience is dependent on specific disease, treatment, or life events.

Quality of Life of Long-Term Survivors of Non–Small-Cell Lung Cancer

PURPOSE To describe the quality of life (QOL) among survivors of non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS One hundred forty-two 5-year minimum self-reported disease-free survivors of NSCLC completed QOL instruments (QOL-Survivor and Medical Outcomes Study 36-Item Short Form [SF-36]) and assessments of emotional distress (Center for Epidemiologic Studies Depression Scale [CES-D]), comorbid disease, and tobacco use. Pulmonary function was assessed with a hand-held spirometer. Multivariate regression methods were used on total QOL-Survivor scores and physical (PC) and mental (MC) component scores of the SF-36. RESULTS The majority (71%) of survivors described themselves as hopeful, and 50% viewed the cancer experience as contributing to positive life changes (QOL-Survivor). Comorbidity was common (60% >or= one condition); 22% had distressed mood (CES-D >or= 16). Most were former smokers (76%); 13% continued to smoke. Half had moderate/severe pulmonary distress (forced expired volume in 1 second [FEV1] < 70% of predicted). Regression models including the set of variables (age, sex, living alone, education, smoking status, pulmonary function category, distressed mood, time since diagnosis, and comorbidity) accounted for 37%, 48%, and 29% in the QOL-total, MC, and PC scores, respectively. Primary predictors of lower QOL scores were white ethnicity and distressed mood (CES-D >or= 16) (34% of the variance explained). The primary predictor of lower MC scores was distressed mood (R(2) = 0.45). Lower PC scores were associated with older age, living alone, FEV1 less than 70% of predicted, distressed mood, time since diagnosis, and more comorbid diseases (R(2) = 0.28). CONCLUSION These findings provide the first description of the QOL of long-term survivors of lung cancer. Risk factors for poorer QOL are strongly linked to distressed mood, which is a potential target for intervention.

Quality of life as a cancer nursing outcome variable

A reliable and valid multidimensional instrument for measuring quality of life in cancer patients has been developed. Furthermore, a model has been offered that describes how quality of life works as an outcome variable. Using this model, predictions were made of how nursing interventions may directly or indirectly impact on quality of life. Initial testing of the model using data from 135 colostomy patients showed how satisfaction with nursing care and personal control act as cognitive mediators of self-worth, which then impacts on dimensions of quality of life.

Sleep and delirium in ICU patients: a review of mechanisms and manifestations

Sleep deprivation and delirium are conditions commonly encountered in intensive care unit patients. Sleep in these patients is characterized by sleep fragmentation, an increase in light sleep, and a decrease of both slow wave sleep and rapid eye movement sleep. The most common types of delirium in this population are hypoactive and mixed-type. Knowledge about the mechanisms of sleep and delirium has evolved over time, but these phenomena are not yet well understood. What is known, however, is that different areas in the brainstem transmit information to the thalamus and cortex necessary for sleep–wake regulation. Delirium is related to an imbalance in the synthesis, release, and inactivation of some neurotransmitters, particularly acetylcholine and dopamine. The relationship between sleep deprivation and delirium has been studied for many years and has been viewed as reciprocal. The link between them may be ascribed to shared mechanisms. An imbalance in neurotransmitters as well as alteration of melatonin production may contribute to the pathogenesis of both phenomena. A better understanding of the mechanisms and factors that contribute to sleep deprivation and delirium can guide the development of new methods and models for prevention and treatment of these problems and consequently improve patient outcomes.

Uncertainty in illness theory: a replication of the mediating effects of mastery and coping.

The purpose of this investigation was to replicate a test of the mediating functions of mastery and coping and to determine whether the relationships found in the initial test of the model would hold with a sample more heterogenous than the original sample. One hundred women receiving treatment for gynecological cancer participated in the investigation. Of the 14 relationships in the model, only 5 replicated significant paths and had overlapping confidence intervals. Two moderators were proposed to explain the differences between the initial and replication tests of the model and to improve the specificity of the theory.

Breast cancer survivorship in a multiethnic sample: Challenges in Recruitment and measurement

The inclusion of ethnic minorities in cancer‐related studies continues to be an important concern for researchers. In this article, the authors present 1) a brief discussion of recruitment and measurement challenges in conducting multiethnic survivorship research, and 2) recruitment outcomes and sample characteristics for a health‐related quality‐of‐life study with a multiethnic sample of breast cancer survivors (BCS).

Uncertainty, appraisal and quality of life

This study evaluates the influence of different factors in the adaptation process activated by uncertainty in illness on health-related quality of life. The sample included 100 women (mean age = 52.1 years) receiving treatment for newly diagnosed (M=52.1 months) gynaecological cancer (38 cervical, 26 ovarian, 24 endometrial, 7 uterine, 4 vulvar, and 1 vaginal). Stepwise regression analyses identified mood states, ambiguity about illness-wellness state, dangerfocused appraisal and mastery as key predictors of four health-related quality of life scores. The variance accounted for by those variables is reflected in cumulative multipleR2 of 0.56 for total quality of life score, 0.57 for psychosocial well-being, 0.235 for physical well-being and 0.25 for disease/symptom distress. These variances do not reflect the contribution of age, time since diagnosis, metastasis and stage of cancer which were forced to enter the regression equation first. The latter set of variables accounted for a smaller portion of the variance in health-related quality of life (R2=0.03–0.195). Coping strategy did not predict health-related quality of life. These findings provide beginning support for conceptualizing health-related quality of life as the outcome of an adaptation process explained by the uncertainty in illness theory. However, uncertainty in illness theory may not be sufficient to predict quality of life outcomes. Future research should consider the addition of discrepancy theory to guide the selection or development of a health-related quality of life measure, to account for the perceived discrepancy between actual experience and expected well-being.

Assessment of quality of life with a single instrument

A number of single measures of quality of life have been developed over the last few years. Some of these instruments have been used more frequently than others. Psychometric properties are reported in many of these instruments, and continued psychometric development is needed. Instruments differ in the content tested, and users are encouraged to have specific objectives in mind when selecting an instrument. The continued research interest and activity in the field of single measures has provided beginning tools for both research and clinical evaluations. Quality of life measures add to the depth of evaluation of the impact on cancer and cancer treatment, and provide a measurement dimension that augments that of the historic evaluation via morbidity and mortality statistics. Continued work on single measures for quality of life will provide both researchers and clinicians with valuable tools.

Quality of life and meaning of illness of women with lung cancer.

PURPOSE/OBJECTIVES To describe the quality of life (QOL) of women with non-small cell lung cancer (NSCLC) and examine relationships of demographic, clinical, health status, and meaning of illness (MOI) characteristics to QOL. DESIGN Descriptive, cross-sectional survey. SETTING In-person interviews in homes or research offices. SAMPLE 217 women with NSCLC (greater than 6 months and less than 5 years since diagnosis, mean = 2 years); 19% of the women had advanced disease. The mean age was 65 years. METHODS Assessments of QOL with cancer-specific (QOL Scale-Patient Version) and generic (Short Form-36) self-reports, health status (i.e., number and type of comorbid conditions, presence of depressed mood using the Center for Epidemiologic Studies Depression Scale, smoking status), and MOI (positive and negative perceptions). MAIN RESEARCH VARIABLES QOL, health status, MOI, and demographic and clinical characteristics. FINDINGS Serious disruptions in psychological and social aspects of QOL were common. Depressed mood, negative conceptualizations of MOI, and younger age explained 37% of the variance of global QOL and were correlated with poorer physical, psychological, and social dimensions of QOL. Thirty-six percent reported negative ascriptions of MOI; 35% experienced depressed mood; more than 75% reported distress with their diagnosis, family distress, and impact of sexual function as lowering their QOL; and 67% reported comorbid conditions, the most common being chronic obstructive pulmonary disease (31%). CONCLUSIONS Women with lung cancer experience a range of disruptions in QOL, and more than a third associate lung cancer with negative meaning. Younger age, depressed mood, and number of comorbid diseases are risk factors for negative QOL. IMPLICATIONS FOR NURSING These findings support the importance of assessing the QOL, MOI, and health status of women with lung cancer even after treatment is completed. Younger women may be at higher risk for disruptions.

Challenges of Recruitment and Retention in Multisite Clinical Research

This article reviews recruitment and retention issues in a multisite, multistate (California, New York, Connecticut, Georgia, Alabama) 6-month prospective cross-sectional study focused on quality of life among 230 women with lung cancer. Recruitment of women into clinical trials and their retention are important, yet understudied. To date, few articles have described the challenges associated with recruiting women with lung cancer to participate in clinical research. Data from this trial were used to investigate the most effective strategies for recruitment across sites, to identify the most common reasons for refusal and attrition, and to identify challenges and potential solutions to recruitment and retention issues associated with multisite clinical research studies. Strategies for recruitment included letters from physicians, posters, announcements in community support groups, and newspaper and radio advertisements. Three sites allowed the researchers to contact potential participants directly, whereas 2 sites required the potential participants to contact the researchers for further information. Enrollment included 63% of the women eligible for the study (n = 230). The most common reasons for refusal were health limitations (n = 60), lack of interest (n = 46), and inconvenience (n = 16). The most common reasons for attrition (24% of the sample) were death (n = 21) and severity of illness (n = 13). Challenges related to recruitment and retention varied by geographic location.