Thesis (doctoral)--Göteborgs universitet, 2003. / Extra t.p. with thesis statement and English abstract inserted. Includes bibliographical references (p. 303-319).

published_or_final_version / Nursing Studies / Master / Master of Nursing

The number of patients with colorectal cancer had increased dramatically in recent years (Hong Kong cancer registry, 2012), and surgical resection is the first line treatment of colorectal. To enhance patients’recovery process, there is a need to develop a comprehensive and user-friendly, with most important, an evidence-based guideline for promoting patients’ recovery process. Traditional post-operative management is associated with different postoperative complications, delayed recovery, and lengthened hospital stay. Recent research documented that using a specific rehabilitation programme focused on education; early mobilization and early diet regime could enhance patients’ recovery. Therefore, this transitional research aims to evaluate the current evidence on the effect of adopting a specific rehabilitation programme, to formulate an evidence-based guideline, assess its implementation potential, and to develop an implementation and evaluation plan. Ten related literature were retrieved from four electronic bibliographical databases. Critical appraisal had been done to ensure the quality and validity of the selected evidences. A clinical guideline is developed based upon the information from the identified high level of literature. The implementation potential is assessed based on the similarity and the readiness of the target setting to the proposed environment. It was found that the transferability of the protocol was high and it was feasible to be implemented into the target site. Little expenditure and input was expected, as the protocol was a systematic reformation of practice, rather that developing a set of totally new practice to current clinical setting. An implementation plan was then planned, which included the communication plan with all the stakeholders. After reaching a consensus among the stakeholders, a two-month pilot study will be carried out for examining the readiness before the full-scale implementation of the program. The evaluation plan of the effectiveness of the proposed program is developed. Result will be used to provide recommendation for further adjustment on the protocol to yield a better outcome. The implementation of this nurse-led rehabilitation program is suggested to be worthy of adoption in the clinical setting for bringing benefits to patients, the hospital and staffs. / published_or_final_version / Nursing Studies / Master / Master of Nursing

Substantial studies have investigated homogeneity of psychological distress level among cancer patients by using cross-sectional and longitudinal study design. Nonetheless, as proposed by Bonnano (2004), heterogeneity characteristics of psychological distress following stressful event could not be neglected and he further suggested that the majority of individuals were resilient in response to stressful events. To test this postulation, recent studies employed growth mixture modelling method to examine the heterogeneity characteristics of psychological distress trajectory among cancer patients. Furthermore, identifying relevant factors differentiate the psychological distress trajectories is an integral part for developing effective interventions for cancer patients in dealing with illness demands. However, only a few studies have examined these issues among Chinese colorectal cancer patients, a second most common cancer in Hong Kong. Therefore, it is of important need to address this knowledge gap. This study had two major aims: 1) to explore the patterns of psychological distress among Chinese patients with colorectal cancer from shortly after diagnosis but before surgery (i.e. 1-day prior operation) to 1-year post-surgery and to testify Bonnano’s theory on resilience; 2) to identify the effects of cancer-related intrusive thoughts, physical symptom intrusiveness and dispositional optimism on differentiating psychological distress trajectories. A total of 246 Chinese patients with colorectal cancer were recruited for the current study. Altogether, 5 consecutive face-to-face interviews were conducted on one day prior to surgery (baseline), 1-, 4-, 8- and 12-month post-surgery (T2-T5). Patients’ psychological distress (i.e. anxiety and depression), physical symptom intrusiveness, cancer-related intrusive thoughts, dispositional optimism, demographic and medical information were assessed by a standardised questionnaire with valid and reliable psychometric instruments. Growth mixture modelling was used to estimate and specify the psychological distress trajectories. Multinomial logistic regression was adopted to assess the proposed factors in relation to differentiate the trajectory patterns. Growth mixture modelling suggested three distinct trajectories were identified for both anxiety and depression model. The majority of patients with colorectal cancer were identified as resilient (i.e. maintaining low and stable distress level across time) for both models (anxiety: 82.3%, depression: 82.7%). Additionally, for anxiety trajectory model, the remaining 12.3% and 5.4% of patients were classified as moderately-low anxiety group (i.e. maintaining moderate to low distress level) and increasing anxiety group (i.e. increased from moderate level of distress at initial to subsequently high distress level) respectively. For depression trajectory model, the remaining 12.6% and 4.7% of the patients were grouped as delayed depression (i.e. delayed level of distress over time) and recovery depression (i.e. recovered from high distress level to low across time). Multinomial logistic regression showed that cancer-related negative intrusive thoughts, physical symptom intrusiveness and dispositional optimism were significant factors to differentiate anxiety and depression trajectories respectively. This study highlighted the heterogeneous feature of psychological distress among Chinese patients with colorectal cancer. Physical symptom intrusiveness, cancer-related negative intrusive thoughts and dispositional optimism played important role on predicting cancer patient’s psychological distress respectively. Nonetheless, further investigations are much needed to clarify the underlying mechanism. / published_or_final_version / Public Health / Master / Master of Philosophy

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published_or_final_version / abstract / toc / Clinical Psychology / Master / Master of Social Sciences

This study examined the relationship between social support and self-care agency in post myocardial infarction (MI) patients. Hypothesis I stated that total social support and it's three subscales are positively related to total self-care agency and it's six subscales. Hypothesis II stated that the three subscales of social support will predict total selfcare agency in post MI patients. A convenience sample of 28 post myocardial infarction patients from a large midwestern metropolitan hospital participated in the study. The Norbeck Social Support Questionnaire (NSSQ) was used to measure the social support variable. The Denyes Self-Care Agency Instrument (DSCAI) was utilized to measure the self-care agency variable. The study supported a positive and significant relationship between social support and self-care agency. The study further supported significant relationships between the subscales of social support and four of the subscales of self-care agency. Affect (a subscale of social support), contributed to 27% of the variance in selfcare agency. The results demonstrated congruent findings with previous studies, reflecting a positive and significant relationship between social support and self-care agency. The study findings have implications for improving nursing practice for myocardial infarction patients and for further nursing research among this population. / School of Nursing

The purpose of this research study was to examine the nature and scope of nutrition counseling and/or education available to cardiac patients and the role of the Registered Dietitian (RD) in Cardiac Rehab Phase II Programs. One hundred and fifty programs were surveyed in regards to their program and the programs elements in regards to nutrition topics. To our knowledge, this is the first study to systematically examine the nature and scope of nutrition counseling and/or education and the role of the Registered Dietitian in Cardiac Rehab Phase II Programs.The results indicated that almost 75% of the programs surveyed offered nutrition counseling and/or education, regardless of the region examined. Also the majority of the programs were identified to have a Registered Dietitian on staff, but less than half reported a Registered Dietitian employment as full-time. There were also significant differences in regards to nutrition education topics among the regions. The results also uncovered a discrepancy between the perceived importance of having a Registered Dietitian on staff and their role as the primary provider of nutrition counseling and/or education. / Department of Family and Consumer Sciences

Physical activity (PA) is related to prevention and rehabilitation (rehab) of oncology patients, however little is known about PA habits of patients with cancer. Purpose. The purpose of this study was to assess and characterize PA habits, fatigue, and mood states of cancer survivors from before participation in an exercise rehab program to the final week of a 16 session exercise rehab program. Methods. Eleven subjects (9 women, 2 men, with an average age 60.9±1 0.1 years) wore an Actigraph GT1M accelerometer and New Lifestyle series pedometer a week before beginning an exercise rehab program (baseline), the first week (week 1) and the final week of exercise rehab (week 8). Intensity counts/minute and steps were measured by the GT1M and steps were calculated by the pedometer. Results. Ten subjects were classified under the sedentary step index, walking <5,500 steps/day and further grouped under the subcategory for chronic diseased individuals proposed by Tudor-Locke and Myers of 3,500-5,500 steps/day. One subject was recorded by the accelerometer to meet the Surgeon General, American College of Sports Medicine/Center for Disease Control and Prevention, the American Cancer Society, and 10,000 step/day PA guidelines throughout the study. The accelerometer underestimated rehab activity of 4 subjects who exercised on the Nu-step during rehab. PA habits of steps and intensity varied at baseline, week 1, and week 8 and on rehab and non-rehab days. There were no patterns seen determined by diagnosis, treatment, or staging of cancer. Five subjects increased their 6 minute walk distance, 6 subjects decreased in total mood disturbance, and 4 subjects lowered their perception of fatigue. Conclusion. The intervention, exercise, with 11 cancer survivors maintained PA habits, functional ability, fatigue, and mood states over time and on rehab and non-rehab days. / School of Physical Education, Sport, and Exercise Science

As the efficacy of cancer treatments has improved and the life span for cancer patients has extended, interest in patients' quality of life has increased. Assessing patients' quality of life continues to gain importance as it impacts numerous facets of oncology. Similarly, interest in spirituality and religiosity have increased as they become recognized as resources for healing in health care. This study examined spirituality and religiosity and their relationship with quality of life in cancer patients. Additional variables such as age, gender, and stage of cancer were also examined for their relationship to quality of life in cancer patients. A stepwise multiple regression analysis was performed to determine if spirituality, religiosity, age, gender, and stage of cancer are predictors of cancer patients' quality of life. The analysis indicated that patients with higher levels of spirituality tend to experience better quality of life, and patients with more advanced stages of cancer tend to experience lower quality of life. Religiosity, age, and gender were not predictors of cancer patients' quality of life. / Department of Counseling Psychology and Guidance Services