研究背景：婦科癌症的診斷及各種相關的治療，對性功能、生活質素及心理健康都有負面的影響。文獻指出心理教育對婦科癌症病人這方面的影響有正面的效果，但是效用的証據並不一致。 / 系統化綜述: 本研究首先進行系統化綜述，並根據喬安娜．布里格斯的方法進行，目的在於確定心理教育對婦科癌症病人的性功能、生活質素及心理健康的功效，以及辨認一套有效的心理教育課程給予婦科癌症病人。總共有十一份隨機控制實驗的文獻，包括九百七十五位婦科癌症病人，被納入本綜述，其中四份可比較的文獻進行了薈萃分析。根據兩份評估心理教育對抑鬱功效的文獻薈萃結果顯示，心理教育對改善抑鬱徵狀有顯著的改善。另外兩份文獻評估心理教育對生活質素的功效，薈萃結果顯示心理教育對身理方面的生活質素未有明顯的改善，相反地，提供資訊性的教育對婦科癌症病人心理方面的生活質素有明顯的功效。關於心理教育對性功能的功效，似乎對性生活有所改善，但是並未能在性功能的評估工具反映出來。關於心理教育對心理健康的功效，除了抑鬱以外，似乎未有足夠的証據顯示有顯著的功效。系統化綜述建議心理教育予婦科癌症病人應包括三種元素：資訊提供、行為治療及心理支持；形式可以是個人、個人及伴侶共同參予、或小組；應由護士提供；於癌症治療開始前進行，直至出院後；包括四堂課程，每堂三十分鐘至一小時完成。 / 試驗性研究目的：試驗性研究目的是測試提供一套根據系統化綜述結果設計的心理教育予香港婦科癌症病人的可行性，以及評估該課程對改善香港婦科癌症病人的性功能、生活質素、及心理健康的功效。 / 試驗性研究方法：試驗性研究採用隨機控制實驗的方法，把二十六位婦科癌症病人分配到兩個不同的組別。實驗組的參加者，接受一套心理教育；對照組的參加者於實驗組的同一時段收到研究員的訪問。不論哪個組別的參加者，都會進行指標評估，包括性功能、生活質素、不明朗、社交支持、焦慮及抑鬱的狀況。研究指標分別在手術前(T0)、手術後及住院期間(T1)，和手術後8星期(T2)。實驗組的參加者及於臨床工作的護士更會被邀請進行了簡單的傾談，從而了解她們對此心理教育的意見及感受。非參數統計推斷方法用以檢驗組內和組間於上述各指標的差異。實驗組的參加者及護士參予的面談，會進行錄音及內容分析。 / 研究結果：於兩組之間的比較，實驗組的參加者對疾病資料的不一致，有顯著的改善。但是，兩組之間的性功能、生活質素、不明朗、社交支持、焦慮及抑鬱均未有顯著的分別。參加者於面談中指出，心理教育可減低婦科癌症病人的壓力，對她們來說有著實際的用途。 / 研究結論：系統化綜述顯示心理教育對婦科癌症病人有正面的功效。雖然試驗性研究的定量資料結果指出心理教育對香港的婦科癌症病人，除了對疾病資料的不一致有所改善外，在其他各方面的評估，均未有顯著的功效，但是，品質數據的結果顯示婦科癌症病人確實需要心理教育，而此教育於臨床環境實行是可行的。 / Background: A diagnosis and treatment of gynecological cancer (GC) has adverse effects on the sexual functioning, quality of life and psychological outcomes of patients. Psychoeducational interventions (PEIs) are recommended for GC patients to improve their outcomes, but evidence for their effectiveness is far from conclusive. / Systematic review: A systematic review was first carried out according to the Joanna Briggs Institute (JBI) approach to identify the best available evidence relating to the effectiveness of PEIs for GC patients in sexual functioning, quality of life and psychological outcomes. A total of 11 randomized controlled trials (RCTs) involving 975 GC patients were included in the systematic review, but only four comparable studies were appropriate for meta-analysis. PEIs significantly improved depressive symptoms, standardized mean difference (SMD) = -0.80, 95% CI [-1.05 to -0.54], p = < .00001, among the patients. However, there was no significant benefit to the physical aspect of quality of life, SMD = -0.12, 95% CI [-0.45 to 0.20], p = .46. Conversely, information-only therapy demonstrated significant effects on the mental aspects of quality of life, SMD = -0.41, 95% CI [-0.74 to -0.08], p = .01. In addition, from qualitative data, PEIs appeared to be helpful in improving sexual life, but changes in sexual functioning scores were not statistically significant. The interventions appeared to have only limited beneficial effect on anxiety, distress, adjustment to illness and uncertainty, and had no significant effect in improving mood, self-esteem or ability to cope. The review also suggested that PEIs for GC patients would incorporate information provision, behavior therapy and psychological support. The format might be individual, with or without a partner’s participation, or in a group. A nurse was found to be the ideal provider. The interventions could be arranged at the start of cancer treatment and then be continued after discharge, and the number of sessions might be four, each lasting between 30 minutes and one hour. / Aim of pilot study: A program of PEIs was designed based on the systematic review, and piloted on Hong Kong GC patients to test the feasibility and effectiveness of implementing the interventions in Hong Kong. / Pilot research plan: The pilot study was a single-blinded RCT and mix-method design. Twenty-six subjects were randomly assigned to either the intervention or attention control group. The intervention group received the program of PEIs, while the attention control group received attention from the researcher over the same period. Data collection was carried out at baseline (T0), after the operation and during the in-hospital period (T1) and eight weeks after the operation (T2). Qualitative data was collected from the intervention group and nurses working in the clinical setting at T2. Non-parametric tests were used to compare the baseline and various outcome variables within and between groups. Audio-tapes of semi-structured interviews were transcribed verbatim, and content analysis was performed to identify significant themes. / Key findings of pilot study: Participants in the intervention group had statistically significantly less inconsistent information on illness than the attention control group, but there were no statistically significant differences in all other outcome variables including sexual functioning, quality of life, uncertainty, social support, anxiety and depression. Qualitative data from the participants indicated the program of PEIs reduced their stress level and was useful. / Conclusion: The systematic review demonstrated evidence of the positive effects of PEIs on GC patients. Although there were no significant effects appearing in most quantitative results of the intervention program in the pilot study, the qualitative results indicated that the interventions were found desirable by Hong Kong GC patients. Nurses identified implementing the program as feasible in clinical settings. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Chow, Ka Ming. / Thesis (D.Nurs.)--Chinese University of Hong Kong, 2013. / Includes bibliographical references (leaves 185-204). / Abstracts also in Chinese; appendixes includes Chinese. / Chapter CHAPTER 1 --- INTRODUCTION / Chapter 1.1 --- Introduction --- p.1 / Chapter 1.2 --- Aims and significance of the study --- p.4 / Chapter 1.3 --- Overview of the thesis --- p.4 / Chapter CHAPTER 2 --- LITERATURE REVIEW / Chapter 2.1 --- Introduction --- p.6 / Chapter 2.2 --- Impact of GC on sexual functioning --- p.6 / Chapter 2.2.1 --- Mixed types of GC --- p.7 / Chapter 2.2.2 --- Ovarian cancer --- p.10 / Chapter 2.2.3 --- Cervical cancer --- p.11 / Chapter 2.2.4 --- Impact of GC on sexual functioning in Chinese culture --- p.15 / Chapter 2.3 --- Impact of GC on quality of life --- p.18 / Chapter 2.3.1 --- Mixed types of GC --- p.19 / Chapter 2.3.2 --- Cervical cancer --- p.21 / Chapter 2.3.3 --- Impact of GC on quality of life in Chinese culture --- p.24 / Chapter 2.4 --- Impact of GC on psychological well-being --- p.25 / Chapter 2.4.1 --- Mixed types of GC --- p.26 / Chapter 2.4.2 --- Cervical cancer --- p.29 / Chapter 2.4.3 --- Impact of GC on psychological well-being in Chinese culture --- p.30 / Chapter 2.5 --- Current nursing practice on sexuality with GC patients --- p.30 / Chapter 2.5.1 --- Attitudes of health-care professionals towards sexuality --- p.31 / Chapter 2.5.2 --- Information needs of GC patients --- p.33 / Chapter 2.5.3 --- Sexuality assessment --- p.35 / Chapter 2.5.4 --- Sexuality interventions --- p.37 / Chapter 2.6 --- Psychoeducational interventions (PEIs) --- p.38 / Chapter 2.6.1 --- Theoretical background --- p.38 / Chapter 2.6.2 --- Effects of PEIs on cancer patients --- p.40 / Chapter 2.6.3 --- Effects of PEIs on GC patients --- p.42 / Chapter 2.7 --- Summary --- p.44 / Chapter CHAPTER 3 --- SYSTEMATIC REVIEW (PHASE I) / Chapter 3.1 --- Introduction --- p.46 / Chapter 3.2 --- Review objectives and questions --- p.46 / Chapter 3.3 --- Inclusion criteria --- p.48 / Chapter 3.3.1 --- Types of studies --- p.48 / Chapter 3.3.2 --- Types of participants --- p.48 / Chapter 3.3.3 --- Types of interventions --- p.48 / Chapter 3.3.4 --- Types of outcome measures --- p.49 / Chapter 3.4 --- Search strategy --- p.50 / Chapter 3.5 --- Methods of the review --- p.52 / Chapter 3.5.1 --- Assessment of methodological quality --- p.52 / Chapter 3.5.2 --- Data extraction --- p.52 / Chapter 3.5.3 --- Data synthesis --- p.53 / Chapter 3.6 --- Systematic review results --- p.54 / Chapter 3.6.1 --- Description of studies’ retrieval and selection --- p.54 / Chapter 3.6.2 --- Methodological quality of the included studies --- p.57 / Chapter 3.6.2.1 --- Randomization --- p.57 / Chapter 3.6.2.2 --- Blinding --- p.57 / Chapter 3.6.2.3 --- Consent and completion rates --- p.58 / Chapter 3.6.2.4 --- Power estimation --- p.58 / Chapter 3.6.2.5 --- Result data --- p.58 / Chapter 3.6.3 --- Details of the included studies --- p.59 / Chapter 3.6.3.1 --- Country of origin --- p.59 / Chapter 3.6.3.2 --- Samples --- p.59 / Chapter 3.6.3.3 --- Components of PEIs --- p.59 / Chapter 3.6.3.4 --- Comparison group --- p.61 / Chapter 3.6.3.5 --- Format of PEIs --- p.62 / Chapter 3.6.3.6 --- Provider of PEIs --- p.62 / Chapter 3.6.3.7 --- Provision time frame of PEIs --- p.63 / Chapter 3.6.3.8 --- Duration of PEIs --- p.63 / Chapter 3.6.3.9 --- Outcome measurements --- p.64 / Chapter 3.6.4 --- Effects of PEIs on outcomes --- p.64 / Chapter 3.6.4.1 --- Sexual functioning --- p.65 / Chapter 3.6.4.2 --- Quality of life --- p.65 / Chapter 3.6.4.3 --- Psychological outcomes --- p.68 / Chapter 3.6.4.3.1 --- Anxiety and depression --- p.68 / Chapter 3.6.4.3.2 --- Distress --- p.70 / Chapter 3.6.4.3.3 --- Adjustment to illness --- p.71 / Chapter 3.6.4.3.4 --- Mood --- p.71 / Chapter 3.6.4.3.5 --- Self-esteem --- p.72 / Chapter 3.6.4.3.6 --- Uncertainty --- p.72 / Chapter 3.6.4.3.7 --- Coping --- p.72 / Chapter 3.6.4.4 --- Brief summary --- p.72 / Chapter 3.6.5 --- Design of PEIs --- p.73 / Chapter 3.6.5.1 --- Effective components --- p.73 / Chapter 3.6.5.2 --- Effective format --- p.75 / Chapter 3.6.5.3 --- Effective provider --- p.76 / Chapter 3.6.5.4 --- Effective provision time frame --- p.76 / Chapter 3.6.5.5 --- Effective duration --- p.77 / Chapter 3.7 --- Discussion --- p.78 / Chapter 3.7.1 --- Effects of PEIs on sexual functioning --- p.80 / Chapter 3.7.2 --- Effects of PEIs on quality of life --- p.82 / Chapter 3.7.3 --- Effects of PEIs on psychological outcomes --- p.84 / Chapter 3.7.3.1 --- Anxiety and depression --- p.84 / Chapter 3.7.3.2 --- Distress --- p.86 / Chapter 3.7.3.3 --- Adjustment to illness --- p.87 / Chapter 3.7.3.4 --- Mood --- p.87 / Chapter 3.7.3.5 --- Self-esteem --- p.88 / Chapter 3.7.3.6 --- Uncertainty --- p.88 / Chapter 3.7.3.7 --- Coping --- p.89 / Chapter 3.7.4 --- Design of PEIs --- p.89 / Chapter 3.7.4.1 --- Effective components and theories --- p.89 / Chapter 3.7.4.2 --- Effective format --- p.92 / Chapter 3.7.4.3 --- Effective provider --- p.93 / Chapter 3.7.4.4 --- Effective provision time frame --- p.93 / Chapter 3.7.4.5 --- Effective duration --- p.94 / Chapter 3.8 --- Summary of systematic review --- p.95 / Chapter 3.8.1 --- Implications for practice --- p.95 / Chapter 3.8.2 --- Implications for research --- p.97 / Chapter 3.9 --- Summary --- p.100 / Chapter CHAPTER 4 --- METHODOLOGY OF PILOT STUDY (PHASE II) / Chapter 4.1 --- Introduction --- p.102 / Chapter 4.2 --- Rationale for conducting a pilot study --- p.102 / Chapter 4.3 --- Aims and objectives --- p.103 / Chapter 4.4 --- Operational definition --- p.104 / Chapter 4.4.1 --- Psychoeducational interventions (PEIs) --- p.104 / Chapter 4.4.2 --- Sexual functioning --- p.105 / Chapter 4.4.3 --- Quality of life --- p.105 / Chapter 4.4.4 --- Uncertainty --- p.105 / Chapter 4.4.5 --- Anxiety --- p.106 / Chapter 4.4.6 --- Depression --- p.106 / Chapter 4.4.7 --- Social support --- p.106 / Chapter 4.5 --- Interventions --- p.107 / Chapter 4.5.1 --- Program of PEIs --- p.107 / Chapter 4.5.1.1 --- Theoretical framework underpinning the interventions --- p.107 / Chapter 4.5.1.2 --- Components of the program of PEIs --- p.113 / Chapter 4.5.1.2.1 --- Information provision --- p.113 / Chapter 4.5.1.2.2 --- Behavioral therapy --- p.113 / Chapter 4.5.1.2.3 --- Psychological support --- p.114 / Chapter 4.5.1.3 --- Design of the program of PEIs --- p.115 / Chapter 4.5.2 --- Attention control --- p.121 / Chapter 4.5.3 --- Usual care --- p.122 / Chapter 4.6 --- Methodology --- p.123 / Chapter 4.6.1 --- Study design --- p.123 / Chapter 4.6.2 --- Study setting --- p.125 / Chapter 4.6.3 --- Sample --- p.126 / Chapter 4.6.3.1 --- Sampling method --- p.126 / Chapter 4.6.3.2 --- Sample size determination --- p.127 / Chapter 4.6.3.3 --- Recruitment process --- p.128 / Chapter 4.7 --- Data collection --- p.129 / Chapter 4.7.1 --- Measures --- p.129 / Chapter 4.7.2 --- Study instruments --- p.130 / Chapter 4.7.2.1 --- Demographic data sheet --- p.130 / Chapter 4.7.2.2 --- Sexual functioning --- p.131 / Chapter 4.7.2.2.1 --- Justification for choosing the instrument --- p.134 / Chapter 4.7.2.3 --- Quality of life --- p.134 / Chapter 4.7.2.3.1 --- Justification for choosing the instrument --- p.136 / Chapter 4.7.2.4 --- Uncertainty --- p.136 / Chapter 4.7.2.4.1 --- Justification for choosing the instrument --- p.138 / Chapter 4.7.2.5 --- Social support --- p.139 / Chapter 4.7.2.5.1 --- Justification for choosing the instrument --- p.141 / Chapter 4.7.2.6 --- Anxiety and depression --- p.141 / Chapter 4.7.2.6.1 --- Justification for choosing the instrument --- p.143 / Chapter 4.7.2.7 --- Semi-structure interview --- p.144 / Chapter 4.7.2.7.1 --- Intervention recipients --- p.144 / Chapter 4.7.2.7.2 --- Health-care providers --- p.144 / Chapter 4.7.3 --- Data collection procedure --- p.145 / Chapter 4.8 --- Data analysis --- p.149 / Chapter 4.8.1 --- Quantitative data --- p.149 / Chapter 4.8.1.1 --- Comparison of baseline data --- p.151 / Chapter 4.8.1.2 --- Comparison of outcome variables --- p.151 / Chapter 4.8.2 --- Qualitative data --- p.153 / Chapter 4.9 --- Ethical considerations --- p.154 / Chapter 4.1 --- Summary --- p.155 / Chapter CHAPTER 5 --- RESULTS OF THE PILOT STUDY / Chapter 5.1 --- Introduction --- p.156 / Chapter 5.2 --- Recruitment of participants --- p.157 / Chapter 5.3 --- Characteristics of all participants --- p.159 / Chapter 5.3.1 --- Demographic and clinical characteristics --- p.159 / Chapter 5.3.2 --- Homogeneity of the participants --- p.161 / Chapter 5.4 --- Baseline outcome variables --- p.164 / Chapter 5.4.1 --- Baseline outcome variables of all participants --- p.164 / Chapter 5.4.2 --- Comparison of baseline outcome variables between intervention and attention control groups --- p.166 / Chapter 5.5 --- Outcome variables within-group changes --- p.168 / Chapter 5.5.1 --- Quality of life --- p.168 / Chapter 5.5.2 --- Uncertainty --- p.170 / Chapter 5.5.3 --- Social support --- p.174 / Chapter 5.5.4 --- Anxiety and depression --- p.179 / Chapter 5.6 --- Outcome variables between-group changes --- p.181 / Chapter 5.6.1 --- Sexual functioning --- p.181 / Chapter 5.6.2 --- Quality of life --- p.184 / Chapter 5.6.3 --- Uncertainty --- p.185 / Chapter 5.6.4 --- Social support --- p.187 / Chapter 5.6.5 --- Anxiety and depression --- p.190 / Chapter 5.7 --- Feasibility of implementing the PEI program in Hong Kong clinical settings --- p.191 / Chapter 5.7.1 --- Intervention recipients’ perspective --- p.191 / Chapter 5.7.1.1 --- Emotional support --- p.192 / Chapter 5.7.1.1.1 --- Offering psychology support --- p.192 / Chapter 5.7.1.1.2 --- Removing worries about sexual life --- p.192 / Chapter 5.7.1.2 --- Informational support --- p.193 / Chapter 5.7.1.2.1 --- Acquiring knowledge on illness --- p.193 / Chapter 5.7.1.2.2 --- Behavioral therapy helpful in post-operative care --- p.193 / Chapter 5.7.1.2.3 --- Resources available in the community --- p.194 / Chapter 5.7.1.3 --- Elements of the program --- p.194 / Chapter 5.7.1.3.1 --- Appropriate design of the interventions --- p.194 / Chapter 5.7.1.3.2 --- Content of information provided --- p.195 / Chapter 5.7.1.4 --- Feelings towards the program --- p.195 / Chapter 5.7.1.4.1 --- Appreciation of the interventions --- p.195 / Chapter 5.7.1.4.2 --- Lack of GC health education --- p.196 / Chapter 5.7.2 --- Health-care providers perspective --- p.196 / Chapter 5.7.2.1 --- Opinions regarding the program --- p.197 / Chapter 5.7.2.1.1 --- Quality of information provided --- p.197 / Chapter 5.7.2.1.2 --- Usefulness of the interventions --- p.197 / Chapter 5.7.2.2 --- Suggestions for improvement --- p.198 / Chapter 5.7.2.2.1 --- Content of information provided --- p.198 / Chapter 5.7.2.2.2 --- Format of the interventions --- p.199 / Chapter 5.7.2.2.3 --- Coverage of the patient population --- p.199 / Chapter 5.7.2.3 --- Feasibility of implementing the program in Hong Kong --- p.200 / Chapter 5.7.2.3.1 --- Anticipated barriers --- p.200 / Chapter 5.7.2.3.2 --- Solutions to the barriers --- p.201 / Chapter 5.8 --- Summary --- p.201 / Chapter CHAPTER 6 --- DISCUSSION OF THE PILOT STUDY / Chapter 6.1 --- Introduction --- p.205 / Chapter 6.2 --- Baseline characteristics of the participants --- p.205 / Chapter 6.2.1 --- Demographic and clinical characteristics --- p.206 / Chapter 6.2.2 --- Baseline outcome variables --- p.208 / Chapter 6.3 --- Effectiveness of the PEI program --- p.211 / Chapter 6.3.1 --- Quality of life --- p.211 / Chapter 6.3.2 --- Uncertainty --- p.214 / Chapter 6.3.3 --- Social support --- p.216 / Chapter 6.3.4 --- Anxiety and depression --- p.218 / Chapter 6.3.5 --- Sexual functioning --- p.221 / Chapter 6.4 --- Feasibility of implementing the PEI program in Hong Kong --- p.223 / Chapter 6.4.1 --- Intervention recipients’ perspective --- p.223 / Chapter 6.4.2 --- Health-care providers’ perspective --- p.226 / Chapter 6.5 --- Limitations of the pilot study --- p.229 / Chapter 6.5.1 --- Four types of validity threats --- p.229 / Chapter 6.5.2 --- Limitations in attention placebo, intervention format and integrity --- p.232 / Chapter 6.6 --- Summary --- p.234 / Chapter CHAPTER 7 --- CONCLUSION / Chapter 7.1 --- Introduction --- p.235 / Chapter 7.2 --- Implications for nursing practice --- p.235 / Chapter 7.3 --- Implications for future research --- p.236 / Chapter 7.4 --- Conclusion --- p.239 / REFERENCES --- p.241 / APPENDICES --- p.267

Conclusion. The missing data is a common problem in clinical trial. The methodology development is urgently needed to detect the difference of two treatments drug in patient quality of life. The modified pattern mixture model incorporating generalized estimating equation method or multiple imputation method provides a solution to tackle the non-ignorable missing data problem. Different clinical trials with various treatment schedules, missing data patterns will be formed. Further studies are needed to study the optimal choice of patterns under the methods. / Introduction. Health-related Quality of Life (HRQoL) has now been included as a major endpoint in many cancer clinical trials in addition to the traditional endpoints such as tumor response and survival. It refers to how illness or its treatment affects patients' ability to function and whether it induces symptoms. Toxicity, progression and death are common outcome affecting patient's QOL in cancer trial. Since this type of missing data are not occurred at random and are called non-ignorable missing data, conventional methods of analyses are not appropriate. It is important to develop general methods to deal with this problem so that treatment effectiveness for improving patient's QOL or those with serious side effect that is detrimental to patient's QOL can be identified. / Methods. The generalized estimating equation based on modified pattern mixture model is constructed to deal with non-ignorable missing data problem. We conducted a simulation study to examine performance of the model for different types of data. Two scenarios were examined. The first case assumes that two groups have quadratic trend but with different rates of change. The second case assumes that one group has linear trend with time while the other group has quadratic trend with time. Moreover, the second methodology is the multiple imputation based on modified pattern mixture model. The main idea is to resample the data within each pattern to create the full data set and use the standard method to analyze the data. Comparison between two methods was carried out in this study. / Recently, joint models for the QOL outcomes and the indicators of drop-outs are used in longitudinal studies to correct for non-ignorable missing. Two broad classes of joint models, selection model and pattern mixture model, were used. Most of the methodology has been developed in the selection model while the pattern mixture model has attracted less attention due to the identifiability problem. Although pattern mixture model has its own limitation, a modified version of this model incorporating Generalized Estimating Equation can be used in practice. / Result. The power of generalized estimating equation alone is higher than pattern mixture model when the missing data is missing at random. Moreover, the bias of generalized estimating equation is less than that of pattern mixture model when the missing data is missing at random. However, the pattern mixture model performs well when the missing data is missing not at random. On the other hand, the modified pattern mixture model has higher power than the standard pattern mixture model if one group has quadratic trend and other group has linear trend. However, the power of modified pattern mixture model is similar or worst than the standard when the data is both quadratic trends with different rates of change. On the other hand, the results of multiple imputation based on modified pattern mixture model were similar but the power was less than the generalized estimating equation model. / Mo Kwok Fai. / "August 2006." / Adviser: Benny Zee. / Source: Dissertation Abstracts International, Volume: 68-09, Section: B, page: 6051. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2006. / Includes bibliographical references (p. 91-93). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts in English and Chinese. / School code: 1307.

Background. Subjective quality of life (SQOL) is increasingly gaining attention in psychiatric practice and research. To date, few studies have examined the SQOL in outpatients with schizophrenia in China. / Conclusions. Despite considerable differences between the two sites in terms of socio-cultural background, health care delivery and the economic conditions of the subjects, the SQOL did not differ significantly between HK and BJ. SQOL was more strongly related to the severity of depressive symptoms and had only weak association with socio-demographic factors. / Method. In the psychiatric outpatient services of two university-affiliated teaching hospitals in BJ and HK, 522 (264 in BI and 258 in HK) clinically stable outpatients diagnosed with schizophrenia (age: 18-60 years) were randomly selected according to the same inclusion and exclusion criteria. The two samples were matched according to age, sex, educational level, and length of illness. The diagnosis of schizophrenia was confirmed on the basis of a chart review followed by a diagnostic interview on both sites by the candidate. Socio-demographic data were collected and clinical characteristics including psychotic and depressive symptoms, drug-induced extrapyramidal side effects (EPS), and SQOL were assessed by the candidate. Analysis of covariance (ANCOVA) was used to compare the SQOL and its four domains between the two sites after controlling for the effect of the clinical condition of the subjects. Bi-variate correlation and multiple regression analyses were used to evaluate the relationship between SQOL and socio-demographic and clinical data. / Objectives of the study. This study compared SQOL in schizophrenia patients living with their families in Hong Kong (HK) and Beijing (BI) and explored the relationship between SQOL and socio-demographic and clinical factors. / Results. There was no significant difference in SQOL and its domains between the two cohorts after controlling for the effect of other confounding variables. Length of illness, history of suicide attempts, positive, negative, depressive and anxiety symptoms and EPS were all significantly correlated with SQOL. Multiple regression analysis revealed that depressive symptoms predicted all SQOL domains while positive symptoms predicted the psychological, the social relationship and environmental SQOL domains. Married status predicted the social relationship SQOL domain and length of illness predicted the environmental SQOL domain. / Xiang Yu-tao. / "October 2006." / Advisers: G. S. Ungvari; W. K. Tang. / Source: Dissertation Abstracts International, Volume: 68-08, Section: B, page: 5131. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2006. / Includes bibliographical references (p. 107-122). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts in English and Chinese. / School code: 1307.

Atualmente, as pesquisas sobre qualidade de vida relacionada à saúde (QVRS) de pacientes com câncer têm contribuído para o planejamento de cuidado integral ao paciente e familiar. Este estudo teve como objetivo avaliar a QVRS de pacientes oncológicos, sem possibilidades terapêuticas de cura, de acordo com as dimensões do instrumento EORTC QLQ C-30 e sua associação com os aspectos sociodemográficos e clínicos. O referencial adotado foi o de QVRS de Ashing-Giwa. Trata-se de um estudo analítico, de corte transversal, realizado em João Pessoa - PB, com amostragem por conveniência. As entrevistas foram norteadas por dois instrumentos, o de caracterização sociodemográfica e clínica e o de avaliação de qualidade de vida - EORTC QLQ C-30. O estudo acatou as observâncias éticas normatizadas para pesquisas com seres humanos. Participaram 127 pacientes, sendo 59,1% mulheres, idade média de 63 anos; 43,3% casados e 44,1% tinham de 1 a 3 filhos; 40,9% com ensino fundamental; 72,4% católicos; 81,9% não praticavam atividade física. Quanto à situação financeira, 52,8% eram aposentados; 85,8% recebiam mensalmente de 1 a 3 salários mínimos; e 98,4% não tinham plano de saúde privado. Na caracterização clínica, o câncer foi mais prevalente nas mulheres (58,3%), com localização primária do tumor mais citado no útero, ovário, mama e colorretal, e nos homens o tumor se apresentou significativamente na cabeça, pescoço, próstata e pulmão. Tempo de diagnóstico menor que seis meses foi encontrado em 48,8% da amostra; 58,3% tinham tumor com disseminação regional e distante; 52,8% com metástase; 63,0% realizaram biópsia; 57,5% e 51,2% não realizaram radioterapia nem quimioterapia, respectivamente, e 78,0% estavam há menos de um mês hospitalizados. Os sintomas mais prevalentes foram dor (89,8%), fadiga (70,9%) e anorexia (53,5%). Na avaliação pelo EORTC QLQ-C30, os resultados com pior avaliação foram para o Estado de Saúde Global e Função Desempenho de Papel; na Escala de Sintomas, dor, fadiga, insônia e perda do apetite tiveram destaque bem como na escala Dificuldade Financeira. Na associação dos domínios do EORTC QLQ-C30, com as variáveis sociodemográficas, houve associação significativa (p<0,05) da faixa etária e escolaridade com Função Cognitiva; e renda mensal com Estado Geral de Saúde. Já com as variáveis clínicas, houve extensão da doença e metástase com Função Física; radioterapia com Função Social; e tempo de hospitalização com Escala Funcional. Na associação dos itens da Escala de Sintomas houve associação significativa de fadiga com extensão da doença, metástase, quimioterapia e tempo de hospitalização; dor com quimioterapia e tempo de hospitalização; insônia com procedimento cirúrgico; e perda de apetite com quimioterapia. A associação dos escores da escala Dificuldade Financeira com variáveis sociodemográficas mostrou resultado significativo com situação laboral atual, fonte de renda, renda mensal e situação financeira. E com variáveis clínicas, foi encontrada associação com tempo de hospitalização e com diabetes. Os resultados mostraram que os aspectos sociodemográficos e clínicos da população do estudo afetaram de forma significativa sua QVRS, principalmente com relação aos domínios Função Física e Função Cognitiva. Assim, o prejuízo na capacidade funcional, pelo impacto de uma doença como o câncer, afeta a capacidade de desempenhar suas atividades de vida diária, suas relações sociais, e sobremaneira, sua situação financeira / Nowadays, the pieces of research on quality of life related to the health (HRQoL) of patients with cancer have contributed to the whole care plan devoted to the patient and family member. This study aimed at evaluating the HRQoL to the oncology patients, with no therapeutic healing possibilities, according to the dimensions of the EORTC QLQ C-30 and its association with the socio-demographic and clinical aspects. Ashing-Giwa´s HRQoL was the reference adopted. It is an analytical and cross-sectional study carried out in João Pessoa - PB, with convenience sampling. The interviews were guided by two instruments: the socio- demographic and clinical characterization and the evaluation of quality of life - EORTC QLQ C-30. The study accepted the ethical observance ruled by pieces of research with human beings. A total of 127 patients took part in the research, being 59,1% women, mean age 63 years old; 43,3% married and 44,1% had 1 to 3 children; 40,9% with elementary education level; 72,4% catholic; 81,9% did not practice physical activity. In regard to the financial situation, 52,8% were retired; 85,8% received 1 to 3 minimum wages monthly; and 98,4% had no private health plan. In the clinical characterization, cancer was more prevalent in women (58,3%), with tumor primary locus in the uterus, ovary, breast and colorectal whereas in men, the tumor was meaningfully present in the head, neck, prostate and lung. Diagnosis period less than six months was found in 48,8% of the sample; 58,3% had tumor with regional and distant dissemination; 52,8% with metastasis; 63,0% fulfilled biopsy; 57,5% and 51,2% were submitted neither to radiotherapy nor to chemotherapy, respectively, and 78,0% had been hospitalized for less than a month. The most prevalent symptoms were pain (89,8%), fatigue (70,9%) and anorexia (53,5%). With reference to the EORTC QLQ-C30 assessment, the results with the worst evaluation were for the Global Health Status and Performance Status; in the Symptoms Scale, pain, fatigue, insomnia and appetite loss were highlighted as well as in the Financial Difficulty Scale. In the association of EORTC QLQ-C30 domains with the socio-demographic variables, there was meaningful association (p<0,05) of age group and education level with Cognitive Function; and monthly income with Global Health Status. With the clinical variables, there was length of the disease and metastasis with the Physical Function; radiotherapy with the Social Function; and the hospitalization period with the Functional Scale. While associating the items of the Symptom Scale, there was meaningful association of fatigue with the length of the disease, metastasis, chemotherapy and the hospitalization period; pain with chemotherapy and period of hospitalization; insomnia with surgical procedure; and appetite loss with chemotherapy. Score association of the Financial Difficulty Scale, with socio-demographic variables, showed meaningful result with the current work condition, income source, monthly income and financial situation. Concerning the clinical variables, there was association with the hospitalization period and with diabetes. Results showed that the clinical and socio-demographic aspects of the studied population affected meaningfully their HRQoL, especially, with reference to the Physical Function and Cognitive Function domains. Therefore, the damage regarding the functional capacity, by the impact of a disease as cancer, affects the capacity of performing their daily life activities, their social relations, and overall, their financial situation

Poucos estudos têm avaliado a estrutura dimensional do Oral Health Impact Profile-14 (OHIP-14). Análise sobre a dimensionalidade e a adequação do OHIP-14 pode ajudar a melhorar a interpretação deste instrumento. Os objetivos desta tese foram avaliar a dimensionalidade e testar um modelo conceitual de qualidade de vida relacionada à saúde bucal utilizando a escala OHIP-14. A tese foi organizada em 3 manuscritos. O primeiro manuscrito "Comparison of two assessment instruments of the quality of life in older adults" teve como objetivo investigar se existe convergência entre as dimensões da versão abreviada do questionário da Organização Mundial da Saúde sobre Qualidade de vida (WHOQOL-Bref) e do questionário Perfil do Impacto de Saúde Bucal-14 (OHIP-14). Neste estudo, foram avaliados 872 idosos do sul do Brasil. As dimensões dos questionários WHOQOL-Bref e OHIP-14 foram correlacionas por afinidade. Todas as correlações analisadas apresentaram baixa magnitude. Apesar dos questionários WHOQOL-Bref and OHIP-14 apresentarem dimensões relacionadas, eles medem as relações físicas, sociais e psicológicas de maneira diferente. O segundo manuscrito "Oral Health Impact Profile-14: a Unidimensional Scale?" teve como objetivo investigar a estrutura dimensional do OHIP-14. As amostras foram provenientes de dois estudos realizados no Brasil, um no Rio de Janeiro (N=504) e o outro em Carlos Barbosa (N=872). Análises Fatoriais Confirmatória e Exploratória foram realizadas para identificar as dimensões do OHIP-14. As análises fatoriais confirmaram um fator para ambos os estudos. Nossos resultados sugerem que o OHIP-14 é uma escala unidimensional. O terceiro manuscrito "Testing the applicability of a conceptual model of oral health-related quality of life in community-dwelling older people" teve como objetivo testar o modelo conceitual de Wilson e Cleary em relação à qualidade de vida relacionada à saúde bucal. Uma amostra aleatória de 578 idosos do sul do Brasil foi avaliada.O modelo conceitual de Wilson e Cleary foi testado usando a modelagem de equações estruturais, incluindo: edentulismo, sintomas, estado funcional, percepção de saúde bucal, qualidade de vida relacionada à saúde bucal e variáveis sociodemográficas. No modelo final, o edentulismo foi correlacionado com a insatisfação da aparência dos dentes (r = -0,25). O pior estado funcional foi correlacionado com pior percepção de saúde bucal (r = 0,24). A idade teve um efeito direto no OHIP-14 (r = -0,15). Houve um efeito indireto do sexo no OHIP-14 através do estado funcional (r = 0,12).Os resultados apresentados mostram que, para idosos brasileiros, variáveis como sexo e idade desempenham um papel importante para o entendimento conceitual de qualidade de vida relacionada à saúde bucal. Nossos resultados sugerem que o OHIP-14 não avalia o impacto das condições bucais na qualidade de vida numa perspectiva multidimensional, mas em uma única dimensão. A presente tese demonstrou que há caminhos diretos e mediados entre as variáveis clínicas e não clínicas em relação à qualidade de vida relacionada à saúde bucal. / A few studies have evaluated the dimensional structure of Oral Health Impact Profile-14. Further analysis on the dimensionality and the adequacy of OHIP-14 can help improve the interpretation of this instrument. The objectives of this thesis were to assess the dimensionality and testing a conceptual model of oral health-related quality of life using the OHIP-14 scale. The thesis was organized in three manuscripts. The first manuscript "Comparison of two assessment instruments of the quality of life in older adults" aimed to investigate if there is convergent validity between the dimensions of World Health Organization Quality of Life Questionnaire-Brief Version (WHOQOL-Bref) and Oral Health Impact Profile-14 (OHIP-14) questionnaires. In this study, 872 elderly Southern-Brazilians were evaluated. The dimensions of WHOQOL-Bref and OHIP-14 questionnaires were correlated by affinity. All correlations analyzed had a low magnitude. Despite the fact that WHOQOL-Bref and OHIP-14 instruments have related dimensions, they measure physical, psychological and social relations differently. The second manuscript "Oral Health Impact Profile-14: a Unidimensional Scale?" aimed to investigate the dimensional structure of the OHIP-14. Subjects were from Rio de Janeiro (N=504) and Carlos Barbosa (N=872) Studies in Brazil. Exploratory and Confirmatory Factor Analysis were performed to identify the dimensions of OHIP-14. The factor analysis confirmed one factor in both studies. Our findings suggest that the OHIP-14 is a unidimensional scale. The third manuscript "Testing the applicability of a conceptual model of oral health-related quality of life in community-dwelling older people" aimed to test Wilson and Cleary's conceptual model in relation to oral health-related quality of life. A random sample of 578 elderly Southern-Brazilians was evaluated. Wilson and Cleary's conceptual model was tested using structural equations modeling including: edentulism, symptom status, functional health, oral health perceptions, oral health-related quality of life, and sociodemographic variables. In the final model, edentulism was negatively correlated to dissatisfaction of appearance of their dental prostheses (r= -0.25). The worse functional status was correlated with poor oral health perception (r= 0.24). Age had a direct effect on OHIP-14 (r= -0.15). There was an indirect effect of sex on OHIP-14 via functional status (r= 0.12). The results showed that for elderly Brazilians variables such as sex and age are important in the conceptual understanding of oral health-related quality of life. Our findings suggest that the OHIP-14 may not evaluate the oral impact on quality of life on a multidimensional perspective, but in a single dimension. The present thesis demonstrates that there are direct and mediated pathways between clinical and nonclinical variables in relation to oral health-related quality of life.

Until recently, long-term effects of a critical illness (CI) have received little attention from intensive care staff, who have traditionally measured outcome from an intensive care unit (ICU) by morbidity and mortality. However, it is now acknowledged that CI is a continuum that begins before ICU and continues to impact on a patient�s quality of life after they have been discharged home. Measuring health related quality of life (HRQOL) is a complex matter due to its multifaceted, subjective and dynamic nature. There has been a lack of consensus in the literature regarding the most appropriate methodological approaches and measuring instruments to use. This disparity has impeded comparison between studies. The aim of this thesis was to review the literature between January 1998 and December 2003 that focused on HRQOL for patients after a CI to identify and summarise themes and key outcomes. There were two main areas of focus - the methods used to measure the effects of the CI, and evaluation of the patient outcomes. An electronic search for relevant articles was conducted using the common clinical research databases and key words such as health related quality of life, outcomes and critical illness. Reference lists from these articles and conference proceedings were reviewed to identify further studies. There were 74 primary papers identified that reflected a number of subcategories including general ICU, Acute Respiratory Distress Syndrome (ARDS), and elderly patients. There were four categories of instruments used in the literature including those that measured acuity of illness, physical functioning, psychological functioning and HRQOL. The majority of studies used more than one measuring instrument, most of which had been previously validated. Results from the studies were diverse, but it is apparent that physical and psychological recovery from a CI may be a slow and varied process. Most studies were observational; only one randomised control study examined the benefits of a physical exercise program for patients post-hospital discharge. In general, there was no evidence of how to translate the study findings into some form of structured program to assist the patient with any identified problems. To enhance continuum of care, integration of ICU, hospital and rehabilitation services could target identified physical and psychological problems to assist patient recovery. However, strong evidence on the benefits of initiatives such as inpatient follow-up, outpatient clinics and use of ICU diaries is yet to be demonstrated.

<p>Abstract</p><p>The aim of this review was to describe how quality of life is experienced among patients with diabetes type 2. Literature search was made in Medline and the keywords used were “diabetes mellitus type 2” and “quality of life”. Twenty studies were examined and categorized into four sections: Quality of life during complications due to diabetes type 2, quality of life during various treatments, quality of life during depression and quality of life and aspects in relation to the individual as well as social aspects. The designs of the studies were of a varying kind: randomized controlled studies, comparative studies, correlative studies and descriptive studies. The studies were published between the years of 2003-2007 and most frequently occurring were questionnaires. Validity and reliability of the instruments used in the studies were examined and valued. The number of participants in the samples varied between 49-5145 persons. The results showed that diabetes type 2-complications had a negative impact on quality of life, although different treatments and self-care support had the opposite effect. Other aspects of importance to quality of life were the support of family and relatives, age, sex, education, physical function, civil status and personal background.</p>

To ensure that the resources of the health care sector are used effectively, new technologies need to be evaluated before implementation to examine if they generate health outcomes at an acceptable cost. This information can be collected by performing health economic evaluations in which the costs and health outcomes of different technologies are compared. To estimate the effect on health care budgets, there is also a need for information about the prevalence of the specific disease. Health outcomes in health economic evaluations are often measured in quality-adjusted life years (QALYs), which are calculated by multiplying the remaining life years after an intervention by a weight representing the health-related quality of life (HRQoL) during those years. This thesis aims to provide deeper knowledge of the health economic aspects of diabetic retinopathy (DR), an eye complication that affects patients with diabetes and may in the worst case lead to blindness. The focus is on three empirical and two methodological health economic research questions. The empirical research areas cover prevalence, costs, and HRQoL related to patients with DR. The methodological research questions explore the performance of different methods for estimation of QALY weights. This is of interest since it has been argued that the most common methods for estimating QALY weights may not capture all relevant vision-related aspects of quality of life. The analyses comprehend the validity of different methods for estimating QALY weights among patients with DR and if the results of one of the specific methods for estimating QALY weights, the time trade-off (TTO) exercise, are affected by patients’ subjective life expectancy (SLE). The empirical results demonstrate that DR is seen in approximately 40% and 30% of patients with type I and type II diabetes respectively, indicating that the prevalence of DR has decreased in both of these patient groups. Healthcare costs vary considerably between different severity levels of the disease, being estimated at €26, €257, €216, and €433 per patient per year for background retinopathy, proliferative diabetic retinopathy (PDR), diabetic macular oedema (DMO), and PDR combined with DMO respectively. Blindness due to DR is associated with an increased use of transportation services, caregiving services, and assistive technologies as well as productivity losses. This suggests that preventing the progression of DR may lower healthcare costs. Patients with vision impairment due to DR have lowered HRQoL in various dimensions, but the diagnosis of DR in itself has only a limited effect on HRQoL. The results on the methodological research questions show that different methods for estimating QALY weights seem to give different results. In comparison to EQ-5D, the Health Utilities Index Mark 3 (HUI-3) is the most sensitive method for detecting differences in QALY weights due to DR, and if decisions are to be made based on values from the general public, it can be recommended for use in cost-utility analyses of interventions directed at DR. Neither of the direct methods, TTO and the visual analogue scale, seems to be sensitive to differences in visual function, and more research is needed concerning the role of vision in people’s responses to the TTO exercises. In TTO exercises with time frames based on actuarial life expectancy, the patients’ SLE has an effect on their willingness to trade off years for full health. Thus, applying time frames deviating from patients’ SLE may result in biased QALY weights. Such bias may appear stronger within patient populations than within the general public. In conclusion, this thesis offers estimates for prevalence, costs, and QALY weights that can be used in economic evaluations of interventions directed at DR and as benchmarks for future DR research in order to follow up consequences of changes in diabetes care. In addition, it demonstrates that the choice of method for estimating QALY weights may have an impact on whether an intervention is considered cost-effective.

Abstract The aim of this review was to describe how quality of life is experienced among patients with diabetes type 2. Literature search was made in Medline and the keywords used were “diabetes mellitus type 2” and “quality of life”. Twenty studies were examined and categorized into four sections: Quality of life during complications due to diabetes type 2, quality of life during various treatments, quality of life during depression and quality of life and aspects in relation to the individual as well as social aspects. The designs of the studies were of a varying kind: randomized controlled studies, comparative studies, correlative studies and descriptive studies. The studies were published between the years of 2003-2007 and most frequently occurring were questionnaires. Validity and reliability of the instruments used in the studies were examined and valued. The number of participants in the samples varied between 49-5145 persons. The results showed that diabetes type 2-complications had a negative impact on quality of life, although different treatments and self-care support had the opposite effect. Other aspects of importance to quality of life were the support of family and relatives, age, sex, education, physical function, civil status and personal background.

Thesis (M.S.)--West Virginia University, 2001. / Title from document title page. Document formatted into pages; contains v, 76 p. Includes abstract. Includes bibliographical references (p. 38-42).