Kanaungnit Pongthavornkamol

Comparing the Meanings of Fatigue in Individuals With Cancer in Thailand and Canada

Background: Illness is experienced in social contexts; its meaning is rooted in local beliefs and values as well as one’s personal and family situation. Health professionals are steeped in knowledge of disease but know much less about illness. Objectives: The objective of the study was to learn more about the social construction of illness by comparing the meanings of fatigue in Thai and Canadian individuals with cancer. Methods: Using an ethnoscience design, 10 Thai adults receiving chemotherapy for advanced lung cancer or colorectal cancer were interviewed twice. They were asked to sort words and phrases about fatigue from their first interview using Q-sort, triadic, and dyadic approaches; to name each pile; and to describe the similarities and differences between the piles. The card sorts were used to understand the relationships among key ideas in each interview. A table summarizing the card sorts was constructed, and patterns in the data were identified. Results: Two segregates in the Thai data were identified: essential/constant and intermittent, with essential/constant including 2 segregates (feeble and altered cognition), and intermittent including 2 segregates (loss of mental strength and difficulty sleeping). The primary meanings of fatigue in the Thai data were related to temporality, whereas the primary meanings of fatigue in the Canadian data were related to the location of the fatigue (mind/body). Conclusion: These findings help us understand the social construction of fatigue, a common symptom in cancer. Implications for Practice: Further research in relation to links between fatigue and other related-symptoms is needed with the goal of developing cross-cultural interventions for managing fatigue in the future.

Mapping unmet supportive care needs, quality-of-life perceptions and current symptoms in cancer survivors across the Asia-Pacific region: results from the International STEP Study

Background To assess the supportive care needs, quality of life (QoL) and symptoms of patients with cancer after the end of first-line treatments and into survivorship in Asian countries using Australian data as benchmark. Patients and methods A cross-sectional survey was carried out in Australia and eight high-income (HICs) and low-/middle-income (LMICs) Asian countries (China, Japan, Hong Kong SAR, South Korea, Myanmar, Thailand, India, Philippines) using validated scales (Cancer Survivors Unmet Needs scale), physical-symptom concerns (Cancer Survivors Survey of Needs subscale) and a single-item measure of global QoL perception. Results Data were collected from 1748 patients from nine countries. QoL was highest in Australia and all other countries had significantly lower QoL than Australia (all P < 0.001). One-quarter of the patients reported low QoL (scores 1-3/10). The most frequently reported symptoms were fatigue (66.6%), loss of strength (61.8%), pain (61.6%), sleep disturbance (60.1%), and weight changes (57.7%), with no difference in symptom experience between Australian data and all other countries, or between HICs and LMICs. Unmet needs of moderate/strong level were particularly high in all aspects assessed, particularly in the area of existential survivorship (psychosocial care) and receiving comprehensive cancer care. Australia and HICs were similar in terms of unmet needs (all low), but LMICs had a significantly higher number of needs both compared with Australia and HICs (all P < 0.001). Conclusion Health care systems in Asian countries need to re-think and prioritize survivorship cancer care and put action plans in place to overcome some of the challenges surrounding the delivery of optimal supportive cancer care, use available resource-stratified guidelines for supportive care and test efficient and cost-effective models of survivorship care.

Understanding the meaning of fatigue at the end of life: An ethnoscience approach

PURPOSE Fatigue is a devastating state of body and mind associated with distress at the end of life. We report the results of the third in a series of papers outlining a novel approach we have developed for understanding the meaning of fatigue by exploring how this meaning is shaped by beliefs and values. The aims of the study were to examine the perception and experiences of fatigue held by patients attending a hospice in England; identify the behavioural patterns that distinguish fatigue from tiredness and exhaustion; provide conceptual definitions of tiredness, fatigue and exhaustion. METHOD An Ethnoscience design was selected. The sample comprised nine people who attended a hospice between May and December 2009. Inclusion criteria included: at least 18 years of age, experiencing fatigue, able to provide informed consent and resident in the selected city in northern England for 10 years. Data were collected from two consecutive semi-structured interviews for each participant. RESULTS We found that tiredness, fatigue and exhaustion are markers of progressive functional decline. Fatigue had two dimensions: 1) Mental Challenge, which included: emotional effects, cognitive realisation of decline and mental tenacity and 2) Physical Challenge, which included: limitations in leisure activities, limitations in functional roles and re-patterning routines. CONCLUSIONS This study provides evidence that symptom experience is socially constructed, which has potential implications for the development of effective interventions.

Benefits of a self-help group for rural Thai elders with Type-2 Diabetes

บทคดยอ วตถประสงคของการวจยเชงปฏบตการแบบมสวนรวมในผสงอายไทยในชนบททเปนโรค เบาหวานชนดท 2 นเพอ: (1) ศกษาการรบรเกยวกบประสบการณการมสวนรวมในกลมชวยเหลอ ตนเองวาสงผลตอความสามารถดแลตนเองและคณภาพชวตอยางไรและ (2) เปรยบเทยบคะแนนความ สามารถดแลตนเอง คณภาพชวตและระดบนำตาลในเลอดกอนและหลงการมสวนรวมในกลมชวยเหลอ ตนเอง การวจยนไดแนวคดจากแผนพฒนาระบบสขภาพแหงชาต พ.ศ. 2550-2554 ทสงเสรมใหม การสำรวจความตองการและพฒนากลมชวยเหลอตนเองสำหรบผสงอายในชนบท ประกอบกบการท ผสงอายไทยในชนบททเปนโรคเบาหวานชนดท 2 ไดประสบกบภาวะแทรกซอนของโรคและอปสรรค หลายประการในการดแลตนเองอนกอใหเกดผลเสยตอสขภาพและคณภาพชวต ไดมการนำทฤษฎ วพากษสงคม (Critical Social Theory) มาเปนกรอบแนวคดสำหรบการทำวจย เกบขอมลจากการม สวนรวมในกลมชวยเหลอตนเองและแบบสอบถาม ผรวมวจย 20 คนถกคดเลอกจากรายชอผปวยท เปนโรคเบาหวานชนดท 2 ทขนทะเบยนผปวยไวทสถานอนามยของหมบานหนงในจงหวดหนงของภาคกลาง ผรวมวจยไดเขารวมกลมชวยเหลอตนเองทกสองสปดาหเปนเวลา 6 เดอน ขอมลเชงคณภาพจาก การประชมกลมและการสงเกตถกนำมาวเคราะหเชงเนอหา ขอมลเชงปรมาณอนประกอบดวยระดบ นำตาลในเลอด แบบสอบถามเกยวกบความสามารถดแลตนเองและคณภาพชวตทงกอนและหลงเขา รวมกลมชวยเหลอตนเองไดนำมาวเคราะหหาคาความแตกตางดวยสถต paired-samples t test จากการเขากลมชวยเหลอตนเองพบประโยชนทผรวมวจยไดรบ 4 ดานคอ ความรทสอดคลอง กบวฒนธรรมทองถน (culturally-sensitive knowledge) การชวยเหลอทางสงคม ความมพลงอำนาจ และการรบรความสามารถตนเอง (self-efficacy) ผลการวจยแสดงใหเหนวาการรบรความสามารถตนเอง ไดสงเสรมใหผรวมวจยมกจกรรมการดแลตนเองเมอเปนโรคเบาหวานชนดท 2 มากขน นอกจากนพบ วาการเขากลมชวยเหลอตนเองทำใหผรวมวจยมคะแนนความสามารถดแลตนเองและคณภาพชวตเพม ขนและมระดบนำตาลในเลอดกอนรบประทานอาหารเชาลดลง กลมชวยเหลอตนเองนบวาเปนประโยชน อยางยงสำหรบการสงเสรมสขภาพผสงอายไทยในชนบททเปนโรคเบาหวานชนดทสอง คำสำคญ : โรคเบาหวานชนดท 2, คณภาพชวต, ความสามารถดแลตนเอง, กลมชวยเหลอตนเอง, ระดบนำตาลในเลอด Abstract The objectives of this participatory action research, with rural Thai elders with type-2 diabetes, were to: (a) explore perspectives of the elders with respect to how taking part in a self-help group on diabetes affected their self-care ability and quality of life; and, (b) compare self-efficacy and quality of life scores, and blood glucose levels, of the elders, before and after participation in a self-help group on diabetes. The research was undertaken in light of the fact that: Thailand’s 2007-2011 national health plan promotes identification of needs for, and development of, community self-help groups for rural elders; and, rural Thai elders, with type-2 diabetes, face multiple self-care barriers and complications, which put them at risk for poor health and decreased quality of life. Critical Social Theory was used as the guiding framework for the study. Data were gathered through use of a self-help group and questionnaires. Twenty participants were selected, from a database of elders with type-2 diabetes, who were registered at the community health care center of a rural village, in central Thailand. Participants took part in the self-help group, every other week, for 6 months. Qualitative data, from the self-help group meetings and observations, were analyzed via content analysis. Quantitative data, including fasting blood sugar levels and data from questionnaires assessing the elders’ self-efficacy and quality of life, obtained prior to and after completion of the self-help group, were analyzed through use of paired-samples t-test. Upon completion of the self-help group, four themes emerged from the qualitative data. The themes included: obtained culturally-sensitive knowledge; perceived social support; perceived sense of empowerment; and, perceived self-efficacy. The results revealed positive self-efficacy enabled participants to improve their self-care activities. In addition, the quantitative data suggested participants, after completion of the self-help group, had higher self-efficacy and quality of life scores, as well as lower fasting blood sugar levels. Thus, the use of a community-based self-help group appeared to be an effective health promotion strategy for rural Thai elders with type-2 diabetes. Keywords : Type-2 Diabetes, Quality of life, Self-efficacy, Self-help group, Blood glucose levels

Treatment-Related Quality of Life in Nepalese Women with Breast Cancer

Objective: To identify the level of quality of life and its predictors in Nepalese women with breast cancer while receiving chemotherapy. Methods: This cross-sectional study with a predictive design was conducted for a conveniently selected sample of 85 Nepalese women with primary breast cancer receiving chemotherapy at outpatient clinics of three cancer hospitals of Kathmandu, Nepal. Data were collected during December 2016 and February 2017 using demographic sheets, the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire and the modified Medical Outcomes Study Social Support Survey. Descriptive and inferential statistics were employed for data analysis. Results: The mean age of the sample was 50.2 years (SD = 11.50). Study participants reported moderate to poor quality of life (M = 33.5, SD = 23.5). Multiple regression analysis showed that age, years of education, stage, past breast surgery, overall symptom severity, and social support significantly explained 56.8% of the variance in quality of life (R2 = .568, F (8,76) = 12.469, p = .000). However, overall symptom severity (β = -.477, p= .000) and social support (β = .183, p = .050) were the most important predictors. Conclusions: As Nepalese women reported decreased quality of life, nurses should provide preventive and supportive services to improve the quality of life of their patients during chemotherapy.