Assessing longitudinal quality of life in prostate cancer patients and their spouses: a multilevel modeling approach.
ABSTRACT This study aimed at examining the relationship between quality of life (QOL) in prostate cancer (PCa) patients and partners and how baseline demographics, cancer-related factors, and time-varying psychosocial and symptom covariates affect their QOL over time.
Guided by a modified Stress-Coping Model, this study used multilevel modeling to analyze longitudinal data from a randomized clinical trial that tested a family-based intervention to improve QOL in couples managing PCa. Patients and partners from the usual-care control group (N = 134 dyads) independently completed the measurements at baseline, and at 4-, 8-, and 12-month follow-ups.
Correlations of QOL between patients and partners over time were small to moderate. Patients' lower education level, partners' older age, higher family income, and localized cancer at baseline were associated with better QOL in couples. Over time, couples' QOL improved as their social support and cancer-related dyadic communication increased and as couples' uncertainty, general symptoms, and patients' prostate cancer-related sexual and hormonal symptoms decreased.
Evidence indicates that couples' QOL during cancer survivorship is affected by multiple contextual factors (e.g., baseline demographics and time-varying psychosocial factors and symptoms). Intervention research is needed to explore comprehensive strategies to improve couples' QOL during the continuum of PCa survivorship.
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ABSTRACT: Despite an increasing focus on cancer rehabilitation programs, there is limited knowledge about the experiences of residential rehabilitation focusing on both the patients and their relatives. The aim of this study was to explore the experienced benefits of the joint involvement of patients and their relatives in a 5-day residential cancer rehabilitation course, provided as part of a larger intervention study in Denmark. Ethnographic fieldwork, consisting of participant observations and informal conversations, was conducted with 20 individuals (10 patients and 10 relatives). In-depth interviews were conducted in the participants' homes 1 month after the rehabilitation course. Data were analyzed by a constant comparative method. Residential rehabilitation course was identified to serve as an "arena for sharing," underpinned by 3 dimensions of sharing: sharing cancer experiences, sharing strategies, and sharing mutual care. Sharing in residential rehabilitation is experienced as useful for cancer patients and their relatives, to validate cancer-related strategies and strengthen mutual understanding within relationships. The results can guide the development of cancer rehabilitation to involve patients and their relatives and provide opportunity for sharing and empowerment on individual as well as couple and group levels.Cancer nursing 05/2014; DOI:10.1097/NCC.0000000000000149 · 1.93 Impact Factor
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ABSTRACT: Cancer has a great impact on the well-being of affected persons and their caregivers long into survivorship. This article reviews the state of science on the survivorship experience of cancer survivors and caregivers, with a focus on symptom burden and quality of life (QOL) after treatment termination. The primary databases utilized included PubMed and CINAHL. Search results were limited to human participants, English language, and publications from 2008 to 2013. The articles retrieved included studies of prostate, breast, colorectal, and gynecologic cancers during adulthood. As many as a third of cancer survivors experienced symptoms after treatment cessation equivalent to those experienced during treatment. Fatigue, depression or mood disturbance, sleep disruption, pain, and cognitive limitation were commonly reported by survivors across various malignancies; depression, anxiety, and sleep disturbance affected some caregivers. The studies indicated residual symptoms that extend into survivorship have a great impact on QOL and are associated with disability and healthcare utilization. Younger age, lower socioeconomic status, and increased comorbidities are associated with poorer QOL and higher symptom distress in cancer survivors. Younger age and lower income are associated with greater distress and poorer QOL in caregivers. Survivors and caregivers struggle with symptom burden and diminished QOL long into survivorship. Longitudinal studies are needed to investigate the persistence and severity of symptom burden over time as well as long-term and late effects of these symptoms. Interventions designed to help alleviate symptom burden in those most affected are needed.Cancer nursing 05/2014; 38(1). DOI:10.1097/NCC.0000000000000135 · 1.93 Impact Factor
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ABSTRACT: A decrease in the quality of life among family caregivers of advanced cancer patients negatively influences the quality of care provided. Thus, evaluating caregiver quality of life and related factors is very significant because it can guide nurses to maintain health status and ability of caregivers to provide caring for their loved one. This study, based on the Stress Process Model, examined causal relationships among caregiver's age, education, income, caregiver burden, family hardiness, coping, social support, and quality of life among family caregivers of patients with advanced cancer. A sample of 275 caregivers was recruited from two tertiary hospitals in the Central Region of Thailand. Data were collected via six questionnaires including a demographic data questionnaire, the Zarit Burden Interview, the Family Hardiness Index, the Jalowiec Coping Scale, the Social Support Questionnaire, and the Ferrans and Powers Quality of Life Index Cancer Version-III and analyzed through use of descriptive statistics and path analysis. The final model of factors influencing quality of life among family caregivers of patients with advanced cancer fitted the empirical data and explained 45% of the variance in caregiver quality of life. The results also indicated caregiver age, social support and family hardiness had significant direct positive effects on caregiver quality of life; whereas, burden had a significant negative direct effect on this, and an indirect effect through social support and family hardiness. The findings suggest that nurses should develop a program focused on reducing burden, enhancing caregivers' support and family hardiness, and helping them to maintain their quality of life. However studies to evaluate this program are needed test this causal model in other populations in Thailand. Pacific Rim Int J Nurs Res 2013 ; 17(4) 304-316