Il existe une forte prévalence d'incontinence urinaire (IU) chez les femmes ayant été traitées pour un cancer de l'endomètre (CE). Les connaissances actuelles sur les effets d'un programme de réadaptation pour réduire la sévérité de l'IU pour cette population sont rares. L'objectif principal de cette thèse était de vérifier les effets d'un programme de réadaptation à distance, comprenant l'utilisation d'une technologie mobile, pour réduire la sévérité de l'IU chez des survivantes d'un CE. Les objectifs secondaires visés par les travaux de cette thèse étaient de 1) décrire l'étendue des connaissances actuelles concernant l'utilisation des technologies mobiles pour le traitement de l'IU, 2) faire une synthèse des évidences sur les indices de sensibilité au changement des questionnaires auto-administrés qui mesurent l'impact de l'IU sur la qualité de vie lors d'une intervention conservatrice, et 3) déterminer la fidélité intra et inter-évaluateurs des mesures échographiques pour des mesures morphologiques et fonctionnelles de la vessie, de l'urètre et des muscles du plancher pelvien (MPPs) chez des femmes ayant été traitées avec de la radiothérapie pelvienne. Quatre études ont été réalisées pour rencontrer ces objectifs. La première étude était un examen systématique de la portée des connaissances sur l'utilisation des technologies mobiles pour le traitement conservateur de l'IU. Les résultats ont permis de démontrer que les technologies mobiles étudiées pour le traitement de l'IU présentent plusieurs fonctionnalités et paramètres recommandés pour les soins de santé. Également, les évidences recensées indiquent que l'utilisation des technologies mobiles peut être bénéfique en matière de réduction de la sévérité de l'IU, de satisfaction, de l'adhérence au traitement et des coûts. La deuxième étude était une revue systématique dans laquelle ont été recensées les évidences sur les indices de sensibilité au changement des questionnaires auto-administrés qui mesurent l'impact de l'IU sur la qualité de vie dans un contexte d'intervention conservatrice. Les résultats ont permis de mettre en lumière que le questionnaire bref International Consultation on Incontinence pour l'IU (ICIQ-UI SF) présente la sensibilité interne au changement la plus élevée dans un contexte d'intervention conservatrice. Les résultats indiquent également que l'étude avec la plus haute qualité méthodologique démontrait que c'est le questionnaire PRAFAB qui avait l'indice de sensibilité au changement externe le plus élevé. La troisième étude réalisée a permis de déterminer la fidélité des mesures échographiques transpérinéales de morphologie et de fonction des muscles du plancher pelvien auprès de femmes ayant eu de la radiothérapie pour traiter un cancer pelvien. Les résultats démontrent qu'il existe une très bonne fidélité intra-évaluateur pour mesurer la longueur de la plaque des releveurs au repos (LP-R), lors d'une contraction maximale des MPPs (LP-MVC) et lors d'une manœuvre maximale de Valsalva (LP-MVM), ainsi que pour la longueur de l'urètre (UL). La fidélité inter-évaluateurs est jugée très bonne pour LP-R, et bonne pour LP-MVC, LP-MVM et UL. Cependant, la fidélité intra- et inter-évaluateurs est jugée pauvre pour la mesure de l'épaisseur du mur de la vessie (BWT). Enfin, la quatrième étude était une étude d'intervention qui a été réalisée à l'aide d'un devis expérimental à cas unique avec réplications. Le programme de réadaptation comprenait des exercices des MPPs effectués avec la technologie mobile Elvie, une rééducation vésicale et de l'éducation sur les habitudes de vie favorisant la continence urinaire. Le programme s'est déroulé à distance et était supervisé téléphoniquement par une physiothérapeute. Les résultats indiquent que 7 femmes sur 8 ont amélioré la sévérité de leur IU à la suite du programme de réadaptation selon la mesure principale, le Pad Test d'une heure. De plus, les résultats découlant de l'analyse de groupe démontrent une réduction significative du nombre de fuites urinaires et d'urgences urinaires au journal urinaire de trois jours, ainsi que du score au ICIQ-UI SF. Ainsi, les résultats présentés dans cette thèse soutiennent qu'une approche de réadaptation à domicile, comprenant l'utilisation d'une technologie mobile et une supervision à distance par une physiothérapeute, peut réduire l'IU chez les survivantes d'un CE. / There is a high prevalence of urinary incontinence (UI) in women who have been treated for endometrial cancer (CE). Current knowledge on the effects of a rehabilitation program to reduce the severity of UI for this population is scarce. The main objective of this thesis was to verify the effects of an in-home rehabilitation program, including the use of a mobile technology, in reducing the severity of UI in CE survivors. The secondary objectives of the works of this thesis were to 1) describe the extent of current knowledge on the use of mobile technologies for the treatment of UI, 2) to synthesize the evidence on the responsiveness of patient-reported outcome measures (PROMs) questionnaires that measure the impact of UI on quality of life in the context of a conservative intervention, and 3) to determine the intra and inter-rater reliability of ultrasound measurements for morphological and functional measurements of the bladder, urethra, and pelvic floor muscles (PFMs) in women who have been treated with pelvic radiotherapy. Four studies were carried out to meet these objectives. The first study was a systematic scoping review on the use of mobile technologies for the conservative management of UI. The results demonstrated that the mobile technologies studied for the treatment of UI have several important features that are recommended for healthcare. Evidence also indicates that the use of mobile technologies can be beneficial in reducing UI severity, for satisfaction, for treatment adherence and for treatment-related costs. The second study was a systematic review that synthesized the responsiveness indices from recommended PROMs questionnaires that measure the impact of UI on quality of life in the context of conservative intervention. The results established that the International Consultation on Incontinence for UI (ICIQ-UI SF) questionnaire presented the highest internal responsiveness index in a conservative intervention setting. In addition, the results established that the study with the highest methodological quality indicated that the PRAFAB-Q questionnaire was the one with the highest external responsiveness index. The third study carried out made it possible to determine the reliability of transperineal ultrasound measurements of the morphology and function of the pelvic floor muscles in women who have been treated with pelvic radiotherapy. The results demonstrate that there is very good intra-rater reliability for measuring the length of the levator plate at rest (LP-R), during maximal contraction of the PFMs (LP-MVC) during a maximal Valsalva maneuver (LP-MVM), as well as for the length of the urethra (UL). Results established that inter-rater reliability is very good for LP-R, and good for LP-MVC, LP-MVM and UL. However, intra- and inter-rater reliability are considered poor for the measurement of bladder wall thickness (BWT). Finally, the fourth study was an interventional study which was carried out using a single-case experimental design with replications. The rehabilitation program included PFM exercises performed with the Elvie mobile technology, bladder training and education on lifestyle to favor urinary continence. The program was conducted remotely (in-home) and was supervised by a physiotherapist through telephone follow-ups. The results indicate that 7 out of 8 women improved the severity of their UI measured by the main outcome, the one-hour Pad Test, after the rehabilitation program. In addition, the results from the group analysis demonstrate a significant reduction in the number of urine leaks and urinary urgency episodes on a three day bladder diary, as well as in the ICIQ-UI SF score, were found after the rehabilitation program. Thus, the results presented in this thesis support that an in-home rehabilitation program, including the use of a mobile technology and remote supervision by a physiotherapist, can reduce UI in CE survivors.

published_or_final_version / Social Work and Social Administration / Master / Master of Philosophy

The present thesis consists of three thematic parts in relation to breast cancer: (a) practice of breast self - examination (BSE), (b) screening mammography attendance and (c) adjustment to breast cancer surgery / mastectomy. The aims of the respective studies are (a) to examine attitudes, beliefs and practices regarding BSE in younger (30 years old or under) and older women (over 30 years old), (b) to explore attitudes and beliefs regarding mammography and identify factors associated with screening mammography attendance and (c) to explore factors associated with adjustment to breast cancer surgery. The above aims are explored in two different cultural contexts, by comparing samples from Scotland and Greece. Samples consisted (a) of 205 younger and 258 older women, university staff and students in Scotland and 85 younger women, university students in Greece, (b) 283 women who attended and 72 women who did not attend the National Breast Screening in Scotland, and 72 women undergoing mammography in Greece and (c) 19 women in Scotland and 27 women in Greece, who have undergone surgery for breast cancer. All participants were assessed on a variety of measures. These included demographics, health history, health beliefs and health - related personality variables. Results indicated that: 1. BSE was predicted by different variables across age and cultural groups. 2. In particular, practice of BSE in younger women was predicted by knowledge about breast cancer, perceived barriers, health motivation and cues for action, whereas practice in older women was predicted by knowledge about BSE, perceived barriers and cues for action. 3. BSE rates in both countries were higher than previously reported but did not differ between women in Scotland and Greece. However, the two groups differed in knowledge and attitudes, regarding BSE, and in personality. Women in Scotland appeared more knowledgeable regarding BSE, felt less susceptible to breast cancer and were less active in coping with health issues than women in Greece. Women in Greece valued their health more and scored higher in chance health locus of control beliefs than women in Scotland. 4. The best predictor of breast screening mammography attendance in Scotland was knowledge about mammography. Attenders appeared to have more knowledge about breast cancer and about mammography and to focus more on emotional coping, in order to deal with health stresses. 5. The two cultural groups differed in health-related decision making and health - related coping styles. Attenders in Scotland were more knowledgeable about risk factors related to breast cancer and about mammograms and perceived significantly more pain/discomfort associated with the procedure, than attenders in Greece. Attenders in Greece resorted more to acceptance and denial and were more likely to seek emotional support, in order to cope with health stressors than attenders in Scotland. 6. Health beliefs of breast cancer patients, in relation to their condition, and their style of coping with threatening information, concerning their breast problem, are highlighted as important factors to their adjustment in both cultures. However, adjustment to breast cancer surgery appears culture-specific, as different factors seem to determine it in different cultural contexts. 7. Patients in Scotland and Greece did not differ in their overall adjustment. However, Greek patients were significantly less well adjusted sexually postoperatively than patients in Scotland. Findings are discussed in relation to theoretical and practical implications.

It is estimated that nearly 14.5 million Americans are living with cancer today. A commonly overlooked component to quality cancer care, as defined by the Institute of Medicine, is the role of psychological and social support. Better known as psychosocial support, these needs reflect a broad spectrum of obstacles or assets in an individual’s personal life that may help or hinder their healing experience. Some psychosocial examples include coping skills, transportation to medical appointments, or appropriate knowledge to mitigate the physical impacts of the cancer process. Research has shown that by addressing these potential needs, a better health outcome may be achieved for cancer patients. Through participant observation at local psychosocial service establishments and through semi-structured interviews with service providers and adults diagnosed with cancer living in the Dallas-Fort Worth region, this thesis research seeks to explore how local cancer patients are learning of psychosocial services available to them, what barriers may exist in accessing these services, and what individuals may be doing to address their psychosocial needs, both formally or informally. Results yielded recommendations for local psychosocial providers to adjust their marketing of services and kinds of services offered as well as yielded recommendations for future academic research.

This study tested the relationship between Social Support, Psychological Distress, and Illness Stress in individuals who report cancer as a health condition. This study was based on archival data obtained from the Wave 1 of the Health and Retirement Study (HRS). The HRS provides a nationally representative sample of individuals aged 51 to 61 in 1992 and their spouses. The study sample was limited to cancer patients with a spouse or partner (n = 503). A structural equation modeling analysis procedure was used to test the theoretical models. Measures of social support were limited to variables assessing the participant's satisfaction with social support. Evidence was found for the Stress Prevention and the Support Deterioration models. This is congruent with previous research using measures of social support perception. Both the Stress Prevention and the Support Deterioration models predict a negative relationship between Illness Stress and Social Support. In addition, a univariate analysis of variance was used to test the stress buffering model. Similarly to other studies measuring the individual's degree of integration, or its perception, in the social network, the present research supported the only the Main Effect model and not the Stress Buffering model.

陳津利. / "2000年7月" / 論文 (哲學碩士)--香港中文大學, 2000. / 參考文獻 (leaves 138-151) / 附中英文摘要. / "2000 nian 7 yue" / Chen Jinli. / Lun wen (zhe xue shuo shi)--Xianggang Zhong wen da xue, 2000. / Can kao wen xian (leaves 138-151) / Fu Zhong Ying wen zhai yao. / Chapter 第一章 --- 緒論 --- p.1 / Chapter 第一節 --- 中國的乳腺癌患者 --- p.1 / Chapter 第二節 --- 中國內地的癌症自助團體 --- p.3 / Chapter 第三節 --- 硏究意義和主題 --- p.5 / Chapter 一、 --- 硏究意義 --- p.5 / Chapter 二、 --- 硏究主題 --- p.8 / Chapter 第二章 --- 文獻回顧 --- p.9 / Chapter 第一節 --- 乳腺癌和乳腺癌患者 --- p.9 / Chapter 一、 --- 乳腺癌和乳腺癌患者的定義 --- p.9 / Chapter 二、 --- 患者瀕死的心理反應 --- p.10 / Chapter 三、 --- 患者面臨的實際問題和情感需求 --- p.15 / Chapter 第二節 --- 支持的槪念和取向 --- p.21 / Chapter 一、 --- 社會支持的槪念 --- p.21 / Chapter 二、 --- 支持的類型 --- p.23 / Chapter 三、 --- 社會支持的功能 --- p.27 / Chapter 四、 --- 社會支持的測量和指標 --- p.31 / Chapter 第三節 --- 自助團體的定義及功能 --- p.36 / Chapter 一、 --- 自助團體的定義 --- p.36 / Chapter 二、 --- 自助團體作爲社會支持系統的組成部分 --- p.37 / Chapter 第三章 --- 硏究架構 --- p.46 / Chapter 第一節 --- 基本假設 --- p.46 / Chapter 第二節 --- 研究變量名詞的操作性定義 --- p.48 / Chapter 一、 --- 自助團體行爲認知 --- p.48 / Chapter 二、 --- 感受的情感支持 --- p.50 / Chapter 三、 --- 個人特徵 --- p.50 / Chapter 第四章 --- 硏究方法 --- p.51 / Chapter 第一節 --- 研究法的選擇 --- p.51 / Chapter 一、 --- 應用三角測量的思考 --- p.51 / Chapter 二、 --- 量化爲主、質性爲輔的主輔設計 --- p.51 / Chapter 三、 --- 同步三角測量法的采用 --- p.53 / Chapter 第二節 --- 問卷調查硏究設計 --- p.54 / Chapter 一、 --- 樣本策略_ --- p.54 / Chapter 二、 --- 測量工具 --- p.56 / Chapter 三、 --- 資料搜集方法 --- p.59 / Chapter 四、 --- 效度和信度 --- p.59 / Chapter 五、 --- 問卷調查的資料處理及數据分析 --- p.62 / Chapter 第三節 --- 質性硏究方案 --- p.63 / Chapter 一、 --- 硏究樣本及資料收集 --- p.63 / Chapter 二、 --- 資料分析 --- p.63 / Chapter 第四節 --- 硏究局限 --- p.65 / Chapter 第五章 --- 硏究結果 --- p.66 / Chapter 第一節 --- 中國乳腺癌患者的基本特徵 --- p.66 / Chapter 一、 --- 背景結構 --- p.66 / Chapter 二、 --- 身心狀況 --- p.72 / Chapter 三、 --- 病患情感特徵 --- p.77 / Chapter 第二節 --- 患者自助團體行爲認知 --- p.85 / Chapter 一、 --- 患者的自助團體活動參與程度(A1 ) --- p.85 / Chapter 二、 --- 患者的自助團體活動認知程度(A2 ) --- p.90 / Chapter 三、 --- 患者對自助團體的主觀認同(A3) --- p.91 / Chapter 四、 --- 個人基本特徵的作用 --- p.96 / Chapter 第三節 --- 患者自助團體中的情感支持感受(B) --- p.100 / Chapter 一、 --- 患者在自助團體中的情感支持感受 --- p.100 / Chapter 二、 --- 個人特徵對情感支持感受影響 --- p.108 / Chapter 第四節 --- 假設驗証：自助團體行爲認知與情感支持感受的 相關關係 --- p.114 / Chapter 一、 --- 活動參與程度(A1)與情感支持感受的相關關係 --- p.115 / Chapter 二、 --- 活動認知程度(A2)與情感支持感受的相關關係 --- p.119 / Chapter 三、 --- 主觀認同(A3)與情感支持感受的相關關係 --- p.120 / Chapter 四、 --- 個人基本特徵對行爲認知(A)與情感支持感受 關係的影響 --- p.122 / Chapter 五、 --- 小結 --- p.122 / Chapter 第六章 --- 結論、檢討及建議 --- p.123 / Chapter 第一節 --- 硏究結果討論 --- p.123 / Chapter 一、 --- 自助團體情感支持硏究結果與西方 研究的异同及討論 --- p.123 / Chapter 二、 --- 社會支持理論和槪念的适用性討論 --- p.127 / Chapter 第二節 --- 待5幵究或澄淸的議題 --- p.129 / Chapter 一、 --- 患者的情感問題： 乳腺癌是否破坏了患者的婚姻質量？ --- p.129 / Chapter 二、 --- 家庭的支持功能問題： 什么是對患者的“愛´ح ？ --- p.131 / Chapter 三、 --- 來自“大鍋飯´ح的資源： 制度安排帶給乳腺癌患者什么？ --- p.131 / Chapter 四、 --- 未接受乳房再造術： 經濟的？醫療的？制度的？觀念的？ --- p.132 / Chapter 五、 --- 關於自助團體的几點發現 --- p.132 / Chapter 第三節 --- 建議 --- p.134 / Chapter 一、 --- 政府部門與自助團體建立伙伴關係 --- p.134 / Chapter 二、 --- 加強對患者家庭的輔導，引進境外社會工 作理念和實務，開展針對性情感治療 --- p.134 / Chapter 三、 --- 營造新女性文化，關注自身生存質量 --- p.135 / Chapter 四、 --- 未來的硏究 --- p.136 / 參考書目 --- p.138 / 附錄 / 附錄一統計結果列表 --- p.152 / 附錄二 量表信度列表 --- p.173 / 附錄三調查問卷 --- p.177 / 附錄四訪談指引 --- p.185

published_or_final_version / Medicine / Master / Master of Medical Sciences

Colorectal cancer has been a major health issue worldwide. Not only it affects the patients but it also carries physical and psychological influences to their caregivers. Despite the concerns of the psychological needs of caregivers of colorectal cancer patients, there has been a lack of a good understanding of their needs, and how to intervene in order to alleviate their psychological problems and burdens. Therefore, this thesis aimed at designing and evaluating a nurse-led telephone based psychosocial education program for improving the psychological conditions and quality of life among Chinese caregivers of patients with colorectal cancer. The nurse-led telephone based psycho-educational program was designed based on the transactional model of stress and copying. It was piloted on 6 caregivers and refined. Its efficacy over the patients discharged under the ‘usual routine hospital standard discharge care procedure’ was assessed in a randomized controlled trial on 140 Chinese caregivers of colorectal cancer patients. Caregivers in the intervention group received three telephone calls from an experienced Nurse Interventionist at 1, 3 and 5 weeks after the patients’ discharge. Each call addressed any unmet needs of the caregivers with the provision of education and psychological support. At baseline, 2 weeks, 4 weeks and 8 weeks, all caregivers were assessed for the primary outcome of depression measured by the Depression Anxiety Stress Scale (DASS), and for the secondary outcomes of anxiety, stress, burden of care and quality of life. The mixed effects model, which takes into account the extra-covariance among repeated measurements, and which is consistent with the intention-to-treat principle, was used in the efficacy analysis. Of the 140 caregivers recruited in the randomized controlled study, 5 dropped out before the end of the study. However, all the caregivers were included in the analysis. There was no significant baseline difference between the intervention and ‘usual care’ groups. The psycho-education program reduced depression more than the ‘usual care’ group by2.7 (95% CI = 0.6 to 4.8, p=0.013) units in DASS at 2 weeks, and even more by 3.5 (95% CI = 1.7 to 5.24, p<0.001) at 4 weeks. However, the ‘usual care’ group caught up at 8 weeks, and no significant effect of the psycho-education program was found (p=0.144). Moreover, the program also reduced anxiety and stress more than the ‘usual care’ group by1.83 (95% CI = 0.61 to 3.50, p=0.004) and 3.50 (95% CI = 1.74 to 5.25, p<0.001) respectively at follow-up. In addition, the burden of care and quality of life were also generally improved more in the psycho-education program group. Furthermore, strong positive associations among depression, stress, anxiety, and burden of care were found. Caregivers perceived to have a high burden of care would be associated with more depression, stress or anxiety(r = 0.53, p<0.001). Moreover, depression, anxiety, and stress had a strong negative association with the physical, psychological, social relationship and environmental well-being but not with social relationships(r = -0.16, p = 0.550). In conclusion, this thesis has developed the first nurse-led telephone based psycho-education program for caregivers of colorectal cancer patients. The program can effectively help caregivers in reducing their feelings of stress from depression, anxiety, stress and the burden of care, as well as improving their quality of life. It paves the way for a new direction for a comprehensive colorectal cancer care service in addressing the caregivers’ needs. / published_or_final_version / Nursing Studies / Doctoral / Doctor of Nursing

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Self-help groups have emerged as a system of care for groups of people sharing a common problem or condition. Most of the interest in research came from professionals in mental health and social services. Educators have traditionally viewed self-help groups as outside their domain. The focus of this study is the phenomenon of personal change within self-help groups. This is viewed as “learning with peers.” The subject of the study was HOPE Cancer Health Centre, a non-profit community based self-help organization in Vancouver, B.C. Appropriate to the study of phenomena in their natural surroundings, data collection methods were qualitative in nature. Fourteen in-depth interviews were carried out with members and leaders of the self-help group. Two introductory workshops were attended for participant observation and several pertinent documents were reviewed. A full description of HOPE Cancer Health Centre as a self-help group and as a context for adult learning was developed. To clarify the description of HOPE, a framework of characteristics of self-help groups was developed. It was used to organize data collection and analysis. Compilation and analysis of the findings created a description of HOPE that adds to the understanding of self-help groups as organizations in a larger system of care provision. It also adds to the understanding of HOPE as an organization with the purpose to assist cancer patients who are interested in actively participating in their cancer treatment and recovery. In order to enhance understanding of adult learning in the context of a selfhelp group, three perspectives from the literature on adult learning were selected for their potential to organize and explain the resulting data. Four important themes emerged from the data on the learning experiences of the members of HOPE. First, the ideology of HOPE, “self as participant in healing,” is the framework of learning and within that frame there are four forms of learning, the forms of transformative learning being the most significant. Second, for the learners of HOPE, the basis of knowledge is their personal experience; therefore, processes of experiential learning are important as well as those of perspective transformation. Third, the affective dimension of the experiential learning process was found to be integral in the process of learning. The fourth theme is “learning with peers,” the innate characteristic of self-help groups. All members interviewed placed high value on their experiences of learning with peers and of learning at HOPE. Meaningful interpretation of the data resulted from application of concepts and theoretical propositions from three perspectives on adult learning: experiential learning, transformative learning and situated learning.