Αυτοαξιολόγηση της ποιότητας ζωής ογκολογικών ασθενών στο σπίτι και σύγκρισή της με τη νοσηλευτική αξιολόγηση

Abstract

Introduction. Home health care is a new structure, which is not very common in Greece. It is intended for patients suffering from chronic illnesses, giving them the opportunity to stay at home. Cancer is a chronic illness. The main aim of home health care and oncology nursing is the achievement of a bearable level of quality of life for both the patients and their families. The subjectivity and multi-dimensional meaning of health related quality of life constitutes a challenge for nursing assessment and providing care. The aim of the study. The aim of this study is to examine the agreement of the assessment of cancer patients quality of life at home and their nurses who took care of them. In order to achieve this purpose they were examined: (a) the agreement of the assessment of quality of life with the different dimensions of multidimensional meaning of quality of life, (b) if the difference of the assessment about the patients quality of life ,between patients and nurses, is related to the demographic characteristics of the patients and their nurses and the clinical characteristics of the patients. Sample and Method. The heterogeneous sample consisted of 150 oncology patients (61 males and 89 females) and their mean age was 71.5+ 12.5 years. All patients received home health care nursing by the two public anticancer hospitals in Attica, which can afford home health care units in their services. The nurses’ sample consists of 5 female nurses, who had made home health care visits during the period of the study. Patients and nurses filled the two questionnaires themselves. The first questionnaire is the EORTC QLQ C-30 (version 3.0), which assesses the patients’ quality of life. The second consists of an amount of questions related to care. All the questions in the nurses’ questionnaires were in the third person, in order to assess the patients’ situation. Results. The main findings of this study are the following four: First, it has been found that there is an almost excellent agreement (ICC=0, 87) between the patients’ and nurses’ assessments of the total score of patients’ quality of life, while the agreement on the other dimensions of quality of life varies from moderate to excellent. It was also found that the agreement of the total score of quality of life depends positively and statistically significant on the communicationexchange of information, the nurses’ training and negatively on the frequency of visits. Second, data shows a general tendency of nurses to underestimate, to a small extent, the patients’ functions and symptoms, in eleven out of fifteen dimensions of quality of life, which have been assessed by the EORTC QLQ-C30 questionnaire. The underestimation of the total score of the patients’ quality of life by their nurses has been found to correlate statistically with the patients’ physical functioning, namely if a patient is confined to bed or is active. Third, the total score of the patients’ quality of life was found to be statistically influenced, only by the patients’ characteristics. Specifically the complete disability, the person who is involved in their care, the previous experience of the illness the positive attitude to life, the frequency of visits and the exchange of information between patient and nurse. Fourth, the analysis of the questions related to care showed that the taking of opioids and by extension pain, increase the rate of disagreement between patients and nurses regarding relief of insomnia suffering, emotional communication with the family, as well as satisfaction of home health care services. The presence of children increases the rates of agreement between patients and nurses, regarding how well the patient characterizes his state. Conclusions. Home health care nurses seem to assess the quality of life of cancer patients cared at home with relevant accuracy. The results of this study indicate the ways through which nurses interventions could improve the patients’ quality of life. The improvement of communication, the encouragement for self-sufficiency, the cultivation of a positive way of thinking and the presence of a supporting family environment can improve patients’ well-being and satisfaction.