Biomedical subjects
G V Padilla
Publications and source records attributed to G V Padilla.
Health quality of life and colorectal cancer.
BACKGROUND: Quality of life associated with cancer and radiation treatment includes the dimensions of psychologic and physical well-being, nutrition concerns/side effects, and radiation treatment-related anxiety/adjustment. An understanding of the impact of colorectal cancer and radiation treatment on these aspects of health quality of life can be reached by comparing this diagnostic group to others undergoing similar treatment. METHODS: Thirty-six patients with colorectal cancers, 41 with uterocervical cancers, 43 with genitourinary tumors, 13 with leukemia or bone metastasis, and 129 with head and neck cancers undergoing radiation therapy provided complete health quality of life index (QLI-RT) data during weeks 1 and 3 of treatment and at the first follow-up visit after treatment completion. The QLI-RT was found to be reliable and valid. RESULTS: Those with colorectal cancer had similar QLI-RT summary scores as the other groups at the beginning of treatment and during the follow-up period. QLI-RT scores tended to range from 62 to 84 for the summary score and individual-item scores; this was a narrow span considering the QLI-RT uses a 0-100-mm linear analog-response scale. The exceptions were strength, which elicited scores in the 46-68 range and a couple of responses to worrying about radiation therapy. The largest change in QLI-RT score in relation to the treatment trajectory was 11 mm. CONCLUSIONS: These findings tend to support the notion that patients with cancer try to maintain health quality of life at an acceptable level despite the occurrence of stressful negative events. Future research should explore the stable versus dynamic attributes of health quality of life to learn more about the factors that contribute to the adaptive process that maintains such quality of life at an acceptable level.
Nursing research into quality of life.
This report describes the scope of nursing research in the area of quality of life. The strategy used to identify research reports relied heavily on nursing publications included in the Cumulative Index for Nursing and Allied Health Literature (CINAHL) from 1983 (when the database first included the subject, quality of life) to December, 1991. During this period, over 1,000 references concerning quality of life can be identified through a key-word search of the data set. Nursing investigators defined quality of life in terms of psychological, physical, social/interpersonal, and financial/material well-being. Nursing instruments have been developed to measure one or more of these dimensions of the concept. Nursing journals like Advances in Nursing Science (1985), Seminars in Oncology Nursing (1990), and Progress in Cardiovascular Nursing (1992) dedicated whole issues to the topic. Major nursing associations have supported conferences/talks (American Heart Association Council on Cardiovascular Nursing, Santa Fe, NM, 1991; Oncology Nursing Society, Fall Institute, Annual Quality of Life Lectureship) and provided awards on the subject (Oncology Nursing Society Annual Quality of Life Research Award). The National Center for Nursing Research is launching an intramural programme to address quality of life questions.
Uncertainty, appraisal and quality of life.
This study evaluates the influence of different factors in the adaptation process activated by uncertainty in illness on health-related quality of life. The sample included 100 women (mean age = 52.1 years) receiving treatment for newly diagnosed (M = 5.1 months) gynaecological cancer (38 cervical, 26 ovarian, 24 endometrial, 7 uterine, 4 vulvar, and 1 vaginal). Stepwise regression analyses identified mood states, ambiguity about illness-wellness state, danger-focused appraisal and mastery as key predictors of four health-related quality of life scores. The variance accounted for by those variables is reflected in cumulative multiple R2 of 0.56 for total quality of life score, 0.57 for psychosocial well-being, 0.235 for physical well-being and 0.25 for disease/symptom distress. These variances do not reflect the contribution of age, time since diagnosis, metastasis and stage of cancer which were forced to enter the regression equation first. The latter set of variables accounted for a smaller portion of the variance in health-related quality of life (R2 = 0.03-0.195). Coping strategy did not predict health-related quality of life. These findings provide beginning support for conceptualizing health-related quality of life as the outcome of an adaptation process explained by the uncertainty in illness theory. However, uncertainty in illness theory may not be sufficient to predict quality of life outcomes. Future research should consider the addition of discrepancy theory to guide the selection or development of a health-related quality of life measure, to account for the perceived discrepancy between actual experience and expected well-being.
Home care: maintaining quality of life for patient and family.
Cancer affects the family as well as the patient. The home is a primary site of care, which often must be intensive and complex. Attention to home care of the cancer patient is therefore a major concern in maintaining quality of life for both patient and family. The authors explore the major burdens of home care that affect both patient and family and describe four specific interventions that the health care team can initiate to optimize quality of life in these difficult situations.
Theories used in patient/health education.
Patient and health education programs may need to use a multitheory approach to promote health behaviors such as cancer prevention and early detection practices and decrease negative responses such as anxiety, distress, pain, and use of damaging alternative treatments. Multiple intrapersonal, interpersonal, organizational, and community approaches are required. For example, a strategy for breast cancer education should be characterized by an understanding of the target population's attitudes and beliefs about breast cancer, communication of information, education regarding specific facts about breast health and breast cancer, social influence strategies to promote acceptance of the target behaviors, and organizational and community-based interventions to reach the widest audience. Nurses should design education programs that carefully integrate theories to obtain predicted result for the largest number of people for whom the results are desirable. Intervention strategies designed to alter the identified influential factors will have the most successful impact and optimal chance of attaining program goals.
Assessment of quality of life with a single instrument.
A number of single measures of quality of life have been developed over the last few years. Some of these instruments have been used more frequently than others. Psychometric properties are reported in many of these instruments, and continued psychometric development is needed. Instruments differ in the content tested, and users are encouraged to have specific objectives in mind when selecting an instrument. The continued research interest and activity in the field of single measures has provided beginning tools for both research and clinical evaluations. Quality of life measures add to the depth of evaluation of the impact on cancer and cancer treatment, and provide a measurement dimension that augments that of the historic evaluation via morbidity and mortality statistics. Continued work on single measures for quality of life will provide both researchers and clinicians with valuable tools.
Defining the content domain of quality of life for cancer patients with pain.
This study identified attributes that define the content domain of quality of life in a sample of 41 cancer patients with chronic pain. Patients were asked four open-ended questions about the meaning of quality of life, what contributes to a good or poor quality of life, and how pain influences quality of life. Content analysis of responses revealed three categories of attributes that embrace the quality-of-life content domain. The first category is physical well-being. It includes general functioning and disease/treatment-specific attributes. The second is psychological well-being. It includes affective-cognitive attributes, coping ability, meaning of pain and cancer, and accomplishment attributes of quality of life. The third is interpersonal well-being. It incorporates social support and social/role functioning attributes. Replications of the current study in other groups of patients may yield data to support a two-part, multidimensional quality-of-life instrument. A norm-referenced measure can be used to evaluate quality of life in terms of attributes that are salient regardless of the disease or treatment. A domain-referenced measure may be used to evaluate attributes whose salience is dependent on specific disease, treatment, or life events.
Nutritional management in the head and neck cancer patient.
Explore the source record for details and available documents.
Quality of life as a cancer nursing outcome variable.
Explore the source record for details and available documents.
Psychological aspects of nutrition and cancer.
Cancer and the various treatments employed to combat this disease have an impact on food intake that is psychologic in nature. These psychologic consequences include behavioral responses such as learned food aversions, changes in food preferences, and anticipatory nausea and vomiting. In a second cluster of psychologic consequences are the emotional responses of anxiety and depression. A third type of psychologic consequence is perceptual in nature and is most commonly represented by changes in palatability of foods. A fourth psychologic aspect of food intake and cancer includes attitudinal responses, wherein social, religious, cultural, and other values related to food may change as a consequence of the disease. Studies are needed in this area. Approaches to nutritional care that address the psychologic impact of cancer are described. As a means of maintaining adequate nutritional status, artificial feeding routes may create psychologic problems. In general, cancer and its treatment can exert a negative impact on quality of life. Finally, the ethics of feeding are discussed in terms of care giving versus alimentation.
Psychosocial aspects of artificial feeding.
Artificial feeding can have an impact on the patient's quality of life. The psychosocial problems commonly reported in relation to parenteral nutrition are distress from loss of normal eating ability, depression, body image changes, fear of problems with apparatus, and decreased sexual activity. The psychosocial problems most commonly reported in relation to enteral nutrition include gustatory distress , some physical distress , and tube-related distress . Results of teaching approaches to reduce patient discomfort during tube feeding indicate that sensory rather than coping behavior information is more likely to be associated with higher levels of perceived control over enteral feeding, and that perceived control rather than perceived coping ability is more likely to be associated with willingness to repeat the experience. In general, the studies reviewed suggest that enteral feeding may be less stressful and produce fewer psychosocial problems than parenteral nutrition.
Quality of life as a cancer nursing outcome variable.
A reliable and valid multidimensional instrument for measuring quality of life in cancer patients has been developed. Furthermore, a model has been offered that describes how quality of life works as an outcome variable. Using this model, predictions were made of how nursing interventions may directly or indirectly impact on quality of life. Initial testing of the model using data from 135 colostomy patients showed how satisfaction with nursing care and personal control act as cognitive mediators of self-worth, which then impacts on dimensions of quality of life.
Technical notes: reliability and validity of the independent variable.
Explore the source record for details and available documents.
Quality of life index for patients with cancer.
The purpose of this study was to develop an instrument for measuring the quality of life of cancer patients. Quality of life was measured with 14 linear analogue scale items concerning general physical condition, normal activities, and personal attitudes on general quality of life. The tool was tested with four subject groups: oncology outpatients receiving chemotherapy (43) or radiation therapy (39), oncology inpatients receiving chemotherapy (48), and nonpatient volunteers (48). Test-retest reliability coefficients for these samples ranged from r = .11 to .97, with 52 of the 56 possible r's greater than .60, p less than .01; internal consistency was .88, p less than .01. Construct and discriminant validity were indicated, while concurrent validity between quality of life scores and physician estimates of Karnofsky ratings, prognosis, and quality of life were poor.
An overview of cancer nursing research.
Explore the source record for details and available documents.
Quality assurance programme for nursing.
This article describes a conceptual and methodological framework for evaluating nursing care quality. The conceptual framework is based on Orem's theory of self-care which emphasizes the importance of decisions in the selection of nursing process based on patient status and problems. The primary outcome criteria is self-care. The methodological framework is based on Greenfield's criteria maps methodology for linking patient status (problems or diagnoses) to decisions about nursing interventions and linking these specific nursing intervention criteria to desired outcomes for self-care. The article further describes a multiagency quality assurance programme for nursing. The programme includes: a definition of criteria and standards across agencies; nursing care management protocols that define standards of care; continuing education courses for nursing based on management protocols; the maps method of auditing actual and recorded nursing process and patient outcomes as defined in the management protocol.
Distress reduction and the effects of preparatory teaching films and patient control.
Fifty patients undergoing nasogastric intubation for gastric analysis participated in an experiment comparing the distress-reducing effects of four different types of information about an unpleasant procedure. Filmstrips depicted the procedure only; the procedure with common distressful sensations; the procedure with coping behaviors; and the procedure with coping behaviors to relieve common distressful sensations. Patients were also tested on their preference for control. Distress was measured by self-ratings on a 10-item Nasogastric Intubation Checklist. Pain, discomfort, and anxiety pre-, during, and postmanipulation- intubation were measured on a visual scale. Willingness to repeat the procedure was measured on a four-point scale. The study showed that: (a) Procedure with sensory and coping behavior information was effective in decreasing discomfort, pain, and anxiety for control and no-control preference subjects during and after the procedure, but was most effective in reducing intubation distress for subjects preferring no control. (b) Sensory information led to greater willingness to repeat the procedure. (c) Perceived control had little effect on distress reduction.