Li-Chueh Weng

Predicting Survival with the Palliative Performance Scale in a Minority-Serving Hospice and Palliative Care Program

Palliative Performance Scale (PPS) scores have shown potential for prognosticating survival in Caucasian samples, but have not been studied for prognostic value in cancer patients from minority groups. Using data obtained from a retrospective chart audit of 492 cancer patients admitted over an 18-month period to a minority-serving home-based hospice and palliative care program, we examined the relationship between PPS scores and length of survival (survival days). Patients with PPS scores of 10% to 30% had fewer survival days than those with scores of 40% and those with scores of 50% to 100% (median=6, 19, and 34 days, respectively; F=25.02, P<0.001). A PPS score of 40% serves as a reliable inclusion criterion for a study requiring two weeks for completion, whereas 50% to 100% is required for a three-week study. Findings from a predominantly minority sample are similar to those from predominantly Caucasian samples.

Effects of self-efficacy, self-care behaviours on depressive symptom of Taiwanese kidney transplant recipients

AIMS The aim of this study was to examine the effect of self-efficacy on depression and to consider the mediating effect of self-care behaviour. BACKGROUND Depression is a problem for kidney transplant recipients and can compromise their quality of life. From other studies on chronic illnesses, self-efficacy and self-care behaviour have been considered to be potential determinants for depressive symptoms. However, none of these previous studies have investigated the relationships among these variables in kidney transplantation recipients. DESIGN A cross-sectional survey employing correlation design and purposive sampling was used. METHODS One hundred and seventy-seven persons who had received a kidney transplant participated. A self-administrated questionnaire and a medical record audit were used to collect data. The data were analysed using correlation and hierarchical linear regression methods. RESULTS The average score of depressive symptoms was 8.61 SD 7.64. Among the participants in the study, 32.8% had scores of depressive symptoms higher than 11 (indicating mild to severe symptoms of depression). Self-efficacy and self-care behaviour had direct negative effects on depressive symptoms. Self-care behaviour had partial mediating effect on the relationship between self-efficacy and depression. Total variance explained was 23%. CONCLUSION Depressive symptoms are still a problem that need to be addressed among kidney transplantation patients. Patients who have higher self-efficacy and higher self-care behaviour will have lower depressive symptoms. Our results support that self-efficacy is the significant predictor of depressive symptoms. RELEVANCE TO CLINICAL PRACTICE Self-efficacy is a powerful and modifiable determinant of depressive symptoms. We should design interventions that focus not only on the skill aspects of self-care behaviour but also on those that have a strong connection with self-efficacy. We could incorporate the self-efficacy-enhanced strategies as proposed by social cognitive theory into the kidney transplantation care programme.

Primary caregiver stress in caring for a living‐related liver transplantation recipient during the postoperative stage

AIM The aim of this study was to explore the stress experienced by the primary family caregiver of the living-related liver transplantation patient during the postoperative stage. BACKGROUND Living-related liver transplantation is a treatment choice for end-stage liver disease patients who face a shortage of available donated livers. Research suggests that the caregiver of the liver transplant recipient experiences tremendous stress because a family member is on the waiting list. Nevertheless, there are limited studies that investigate the caregiver experience of stress during this surgery. METHOD This qualitative study used face-to-face semi-structured interviews to understand the subjective experiences of study participants. The study participants were drawn from a tertiary medical centre in northern Taiwan. During the data collection period (October 2007 to May 2008), 6 of the 12 caregivers agreed to participate in this study (N = 6), all of whom were female and, except for one participant, were the wives of the recipients. RESULTS Participant stress was caused by the gap between expectations and primary caregiving experiences. In particular, the five themes that were identified: (a) unstable sentiment towards liver transplantation; (b) entanglement of burden; (c) non-synchronized family interaction; (d) distance from the healthcare professional; and (e) concern about the protector role function. CONCLUSIONS The stress of primary caregivers of living-related liver transplantation is related to the gap between expectations and primary caregiving experiences. The immediate postoperative stage is a critical one for health professionals to provide intervention and management.

The effect of self-efficacy, depression and symptom distress on employment status and leisure activities of liver transplant recipients

AIM To examine the effect of self-efficacy, subjective work ability, depression and symptom distress on and to provide a description of, the employment and leisure activities of liver transplant recipients. BACKGROUND Return to work and leisure activities have become an important aspect of life for liver transplant recipients worldwide. An investigation of the factors that influence the employment status and leisure activities has been recommended as a means to help transplant recipients restore their productivity. DESIGN This was a cross-sectional, descriptive and correlational study in 2010. METHODS A convenience sampling method was used. Data were collected using a set of questionnaires that were administered retrospectively. A total of 106 liver transplant patients were included in this study. RESULTS The post-transplantation employment rate was 45.2%. The positive predictors of employment were higher subjective work ability and higher symptom distress. Gender (female), monthly family income (<US

The coping experience of Taiwanese male donors in living donor liver transplantation.

2,000), depression and unemployment pre-transplantation were negatively associated with employment status. Of the 106 patients, 62 (58.5%) were in the low-diversity group (score of less than 3) of leisure activities. Monthly family income of <US

Association Between Use of FK506 and Prevalence of Post-transplantation Diabetes Mellitus in Kidney Transplant Patients

2,000 was associated with a low diversity of participation in leisure activities. CONCLUSION Subjective work ability and symptom distress were positive predictors of employment, while depression was a negative predictor. Nurses in the transplant team should focus on increasing a sense of confidence, decreasing depressive symptoms and monitoring the severity of symptoms to improve the employment status of liver transplant recipients.

End-of-Life Care Discussion for Residents With Dementia in Long-Term Care Facilities

Background:Living donor liver transplantation is an option for effective treatment for patients with liver disease or a liver tumor. One disadvantage, however, is the risk of complications or death in a healthy donor. Thus, promoting the donor’s safety and well-being is a major goal of transplantation care. In this regard, more research on physical and psychological complications and adjustment among donors is needed. Objectives:The aim of this study was to describe the experiences of living liver donors, focusing on their perceptions of living liver transplantation and corresponding coping strategies. Methods:The data were analyzed using content analysis in this qualitative design. Results:Seven of 12 donors, all men, agreed to participate in the study. The core theme that emerged in regard to adjustment was “maintaining peace of mind.” In addition, there were 4 subthemes: (a) removing themselves from information, (b) viewing the surgery as common, (c) having overall confidence, and (d) assigning value to their decision. Discussion:Living donor liver transplantation is a treatment option that requires acceptance by both the donor and his or her family. The process is enormously stressful, and the living liver donor needs adjustment strategies to maintain his or her peace of mind throughout the process.

Self-management behaviours for patients with chronic obstructive pulmonary disease: a qualitative study.

BACKGROUND Tacrolimus (FK506) use has been suggested as a risk factor for post-transplantation diabetes mellitus (PTDM) because it can impair insulin secretion. This association warrants further investigation. This study aimed to examine the prevalence of PTDM and its association with FK506 use in kidney transplant recipients. The study also aimed to examine the relationship of FK506 use and diabetes-related biologic markers. METHODS A retrospective chart review was used to collect data at a medical center in northern Taiwan from September 2003 to February 2012. PTDM was defined with the use of the criteria of the American Diabetes Association. RESULTS Among 166 patients included in the analysis, PTDM was reported in 49 patients (29.5%). A total of 93 patients used the FK506 regimen, of whom 34 (36.6%) were PTDM cases. Logistic regression showed that FK506 use (odds ratio [OR], 2.71; 95% confidence interval [CI], 1.20-6.11; P = .016) and older age (OR,1.08; 95% CI, 1.03-1.13; P = .001) were significant risk factors for PTDM. In addition, FK506 use in PTDM cases was associated with a significantly higher hemoglobin A1c level (7.55 vs 5.81; P = .01) and a borderline significantly higher insulin resistance index (3.24 vs 1.92; P = .053) than was FK506 use without the presence of PTDM. CONCLUSIONS Older age and an FK506 regimen were important predictors of the prevalence of PTDM. Greater early detection and prevention efforts for PTDM are needed for older transplant recipients. PTDM patients with an FK506 regimen had higher hemoglobin A1c levels and insulin resistance index than did patients who did not use FK506. The association of serum indicators with FK506 use in the prevalence of PTDM warrants further investigation.

Self-efficacy, self-care behaviours and quality of life of kidney transplant recipients.

Background: Healthcare professionals play an important role in end-of-life care decisions. Although the factors affecting end-of-life care in long-term care facilities have been well studied in Western contexts, few studies have examined factors affecting end-of-life care discussions for residents with dementia among multidisciplinary professionals in Asian or Taiwanese contexts. Purpose: The aim of this study was to explore the factors related to the end-of-life care discussions of registered nurses, social workers, and physicians with residents with dementia and their families. Methods: This is a cross-sectional and correlational study. A stratified random sampling was conducted, and self-administered questionnaires were mailed to physicians, registered nurses, and social workers who work in long-term care facilities with accreditation ranks ≥ Grade A in Taiwan. Results: Questionnaires were returned by 478 participants (response rate = 94.1%). Fewer than 10% of the participants reported often discussing end-of-life care with residents with dementia and their families. Physicians were significantly more likely to discuss life-sustaining treatment than nurses and social workers. The frequency of professionals discussing advance directives and life-sustaining treatment for residents with dementia was predicted by higher confidence in end-of-life care skills and greater perceived facility support. Conclusions/Implications for Practice: Most professionals did not frequently discuss end-of-life care with residents with dementia and their caregivers. Discussions of end-of-life care in long-term care facilities should be promoted by enhancing the confidence of these professionals in providing end-of-life care and creating a supportive environment for end-of-life discussions and care.