|
Study of life satisfaction
and quality of life of patients receiving home oxygen therapy
Toshiko Tada1), Fumiko Hashimoto1),Yasuko
Matsushita1), Yoshiyasu Terashima2), Tetsuya Tanioka1),
and Isao Nagamine1)
|
1)Major in Nursing,
School of Health Sciences, The University of Tokushima, Tokushima,
Japan, and 2)Department of Digestive and Pediatric
Surgery, Member of Palliative Care Team, The University of
Tokushima School of Medicine, Tokushima, Japan
Abstract: Backgrounds and Aims:There is no commonly accepted
view concerning changes in gastric metaplasia after the eradication
of Helicobacter pylori. The aim of this study was to evaluate
the long-term course of gastric metaplasia after the eradication
of this bacterium.
Methods:An investigation was conducted by mail using a questionnaire
regarding the life satisfaction and quality of life (QOL)
of patients receiving home oxygen therapy (HOT) to evaluate
their support. QOL was evaluated according to 4 scales:(1)
activities, (2) state of health and quality of living, (3)
physical symptoms, and (4) economic state. The answers of
90 patients (recovery rate:60%) who responded to the investigation
were analyzed, and the following points were clarified.
1. Most of the subjects visited the hospital regularly, and
about half the subjects (50.6%) had been treated by hospitalization
during the 3 years prior to the investigation.
2. A large majority of the subjects (77.4%) answered they
were satisfied with life.
3. Life satisfaction was closely related to the patients'
roles and hobbies, and their activities in their communities
and families.
4. The quality of living and the state of health were closely
related to mental activity.
5. The economic state was closely related to all items of
life satisfaction, quality of living, and state of health.
From these results, expansion of the range of activities of
patients receiving HOT and providing an economic basis for
their living as well as preventing exacerbation of the disease
are considered to be important for improving their life satisfaction.
J. Med. Invest. 50:55-63, 2003
Keywords:home nursing care, home oxygen therapy (HOT), life
satisfaction, quality of life (QOL).
INTRODUCTION
Recently, the disease structure of developed
nations has changed markedly, and the importance of life management
has increased. The place of care has rapidly shifted to the
home during the past few years, particularly in diseases with
a chronic course. Improving the quality of life (QOL) is an
important task of nursing services for home-cared patients.
Concerning the QOL of patients receiving home oxygen therapy,
there are reports that even meals, which are one of the few
enjoyments in their life, are affected by the disease (1),
and that home oxygen therapy does not necessarily contribute
to improvement in the QOL (2). In these circumstances, research
on care for patients using home oxygen therapy and their families
(3) may reveal implications about the support of home-cared
patients, who are highly dependent on medical support and
are expected to increase in the future. A goal of care for
patients using home oxygen therapy is considered to be “to
continue safe, prolonged, and more consistent home care,"
as proposed by Fukanogi (3). There have been studies from
the viewpoint of the patients' living (4-7), and QOL is an
important factor of home care (8).
We, therefore, studied the state of QOL and evaluated the
relationship between life satisfaction and the QOL in patients
receiving home oxygen therapy, in whom long-term treatment
is needed and activities are markedly restricted due to dyspnea.
The objective was to obtain basic date for evaluation of their
support. In this study, life satisfaction was defined as something
that spiritually supports the patient's life and an object
or matter that the patient considered important, and the QOL
was defined as the adequacy of the environment in which the
patient lives, consisting of 4 scales:(1) activities, (2)
state of health and quality of living, (3) physical symptoms
and (4) economic state (9). The QOL was understood as a comprehensive
concept that encompasses the “quality of living"
contained in one of the scales.
METHODS
1. Subjects and methods
The investigation was carried out in August 1999. The subjects
were members of an association of patients with reduced pulmonary
function (mean age;71 years) living in a prefecture with a
high percentage of elderly. A questionnaire was sent to the
151 members of the association with a stamped return envelope
enclosed, and responses were received from 90 members (recovery
rate:60%).
2. Ethical considerations
The investigation was carried out with the agreement that
it benefits the association by increasing its understanding
of the state of its members and that the authors would publish
the results as a scientific report. The contents of the investigation
were determined by conferences between the authors and representatives
of the association according to the principle that answering
the questionnaire would not be an excessive burden to the
elderly subjects. The questionnaire was anonymous, and items
that might lead to identification of the responders were excluded.
It was mailed to each subject, and return of the questionnaire
by the subjects was regarded as their consent to the investigation.
3. Contents of investigation
The purpose of the investigation was to clarify the levels
of self-management, life satisfaction and QOL of each patient.
As for self-management, the experience of hospitalization,
regular visits to the hospital, management of water intake,
exercise and going out were investigated. The QOL was measured
using the Japanese version of the European Organization for
Research and Treatment of Cancer (EORTC) scoring manual. The
EORTC questionnaire, the validity and reliability of which
as a scale of QOL have been established, can be completed
in about 10 minutes, does not markedly burden the respondents,
and is reported to yield consistent results whether it is
carried out by self-completion or by interview (10, 11). Permission
to use the EORTC was obtained from Karen West (manager of
the original version) and Dr. Shimozuma (creator of the Japanese
version) on the basis of the International Association Under
Belgian Law (August, 1999). The questionnaire consisted of
30 questions, divided into 4 major scales:(1) activities,
(2) 2 items of comprehensive QOL (state of health, quality
of living), (3) 12 items of physical symptoms and (4) economic
state. The comprehensive scale of QOL was represented by the
question, “How good or bad was the quality of the
general contents of your living and the state of your health
during the past week?" and answers were given by checking
on a scale from 1 (“very bad") to 7 (“very
good"). The other questions, which concerned the state
during the past week, were answered using a 4-point scale
from “never" (1 point) to “very often"
(4 points). Patients indicate the extent to which they have
experienced specific symptoms or functional limitations during
the past week.
4. Analytical methods
Answers were regarded as valid even when the subject did not
answer all the questions, and they were totaled item-wise.
Cases were counted concerning the answers to items related
to self-management and life satisfaction. As for the relationship
between life satisfaction and the QOL, the difference in the
mean value of each scale was compared between those who felt
satisfied and those who did not, and multiple regression analysis
was carried out using life satisfaction as the criterion variable
and various scales of the EORTC as explanatory variables.
Also, the “quality of living" and “state
of health," as scales of comprehensive QOL, were used
as criterion variables to evaluate their relationships with
other scales. Moreover, to examine which symptoms affected
the “state of health," multiple regression
analysis was carried out using the “state of health"
as the reference variable and the 12 items reflecting symptoms
as explanatory variables.
Statistical analyses were performed using the software Excel
2000 Ver. 5.
RESULTS
Table 1 outlines the subjects' profile. Answers concerning
the sex were absent in 20 of the 90 subjects. Of the 70 who
gave their sex, 50 (71.4%) were males and 20 (28.6%) were
females. The mean age of the males was 71.2±14.6
years, while that of the females was 71.2±13.9
years. The patients gave the name of their disease, and they
included emphysema, old tuberculosis, bronchial asthma, etc.
The percentages of those who had a history of hospitalization
during the 3 years prior to the investigation and those who
did not were nearly equal. Most subjects (88.5%) regularly
visited the hospital, and only 11.5% did not. Regarding the
water intake, 77.5% were careful, but 22.5% were indifferent.
Concerning exercise, 58.4% exercised, but 41.6% did not. With
regard to going out, the most frequent answer, given by 51.1%,
was “sometimes," 33.3%answered "every
day," and 15.6% answered “seldom or never."
1. Relationship between life satisfaction and QOL scales
Table 2 shows the contents of life satisfaction in the 65
subjects who answered that they were satisfied with life.
Two or more items, including enjoying contact with family
and friends and hobbies, were raised by many of them. “Family"
was included as a content of life satisfaction in 56.9% of
them, and “friends" were included in 70.7%.
Enjoying contact with family or friends was mentioned in varying
combinations by 90.8%.
Table 3 compares the mean values of various scales of EORTC
according to whether the subjects were satisfied with life
or not. Significant differences were observed between those
who were satisfied and those who were not in role activities,
social activities, and economic state. When role activities
were compared separately according to work and hobbies, significant
differences were observed according to both work (p<0.05)
and hobbies (p<0.01). As for social activities, significant
differences (p<0.05) were observed in both community activities
and family activities. For all scales, the mean value was
lower, indicating a higher QOL, in those who were satisfied.
Table 4 shows the results of multiple regression analyses
using life satisfaction as the criterion variable. “Social
activities" and “role activities" were
extracted as significant (p<0.01) with a multiple correlation
coefficient (after correction for the degree of freedom) of
0.33. The standardized partial correlation coefficient was
0.21 for both items.
2. Relationships among scales of QOL
Table 5 shows the relationships of “quality of living"
and “state of health" with the other scales
of QOL. The multiple correlation coefficients (after correction
for the degree of freedom) for the “state of health"
and “quality of living" were 0.65 and 0.60,
respectively, and they were significantly related (p<0.001)
to the explanatory variables. Both the “state of
health" and “quality of living" showed
significant partial correlation coefficients with “mental
activities" (p<0.05) and “economic state"
(p<0.01).
Table 6 shows the results of multiple regression analysis
using the “state of health" as the criterion
variable and the 12 items of symptoms as explanatory variables
performed to identify symptoms that affect the “state
of health." The multiple correlation coefficient was
0.71 (p<0.001), and “shortness of breath,"
“fatigue," “sleep," “pain"
and “restriction of activities due to pain"
were extracted. Among them, the standardized partial regression
coefficient was significant for “shortness of breath"
(p<0.01) and “sleep" (p<0.05).
DISCUSSION
Because the quality of care for patients receiving home oxygen
therapy is evaluated according to the QOL in some reports
(12), the QOL is an important element of support for home-cared
patients. However, evaluation of the QOL has not been widely
conducted (13, 14). Tsuji et al. (5), who studied the QOL
in patients receiving home oxygen therapy, evaluated it from
physical, social, mental and psychological aspects, and Fukanogi
(3, 7) used the PGC scale. Kobayashi et al. (10) mentioned
the physical health, psychological wholesomeness and proper
social responses and psychosocial activities as elements of
the QOL. Fukuhara (15) also mentioned “physical
functions" as one of the basic elements of QOL along
with “mental health," “functions
of social living" and “functions of everyday
roles." Self-respect was included as an element of the
QOL in another study (16). In our study, the EORTC, a scale
that is reliable and places no great burden on the subjects,
was selected in consideration of the nature of this study
carried out using a mailed questionnaire in elderly patients
receiving home oxygen therapy. The EORTC is a scoring manual
that is widely used to assess the status of cancer patients
(10, 11, 17). The EORTC was selected for use in the present
study for comparison with the QOL of cancer patients and because
it uses a QOL scale that includes items relating to evaluation
of the economic state of the patient. In patients with chronic
diseases, it is important to have a stable of their lives,
and the economic state is considered to be a key factor therein.
However, in earlier studies carried out in patients with respiratory
diseases, the SF-36 scale has been widely used (18-22). Among
those reports, Grimmer et al. (21) even used the SF-36 scale
to evaluate the QOL of caregivers. In addition, the CRDQ (Chronic
Respiratory Disease Questionnaire), SGRQ (St. George's Respiratory
Questionnaire), etc., are used as QOL assessment scales specifically
designed for patients with respiratory diseases (19, 23).
Chang et al. (19) and Yamada et al. (20) reported using the
SF-36 and SGRO scales especially for the evaluation of patients
with chronic respiratory diseases. For asthma patients, the
AQLQ (Asthma Quality of Life Questionnaire) allows assessment
of the psychological state as well, and it has been reported
to be useful for the diagnosis of outpatients (24).
First, the relationship between the QOL and life satisfaction
was evaluated. The higher mean values of role activities,
social activities and economic state in those who answered
they were satisfied with life indicated their better QOL.
Particularly, role activities and social activities were shown
by multiple regression analysis to be closely related to life
satisfaction. Therefore, individuals who were satisfied may
be in a stable economic state, have roles and maintain ties
with people (society). This was reflected by the result that
a majority of subjects who were satisfied mentioned contact
with friends and families as key contents of their life. These
were in agreement with the characteristics of individuals
with high levels of life satisfaction observed by Fukanogi
(3):(1) continuation of work and (2) clear roles in the family.
Therefore, supporting patients to develop their roles and
to increase occasions of social contact that promote their
activities is necessary for improving their QOL. Having a
role may lead to retention of the sense of self-respect and
a feeling of having something to live for.
Next, concerning the relationships of the quality of living
and the state of health with the other scales, both were found
to be closely related to mental activities and the economic
state. This is in agreement with the report by Tsuji et al.
(4) that the mental QOL was better, and the psychological
and social QOL tended to be better, in those with a higher
home-care rate among patients receiving home oxygen therapy.
Moreover, the economic state, which was reported to be an
important element of the QOL of elderly individuals (16, 25),
was also suggested to be important by the results of this
study. This result is similar to the finding of Ritva et al.
(26), in their study of asthma patients, that the patients'
QOL was influenced by their economic state. Thus, maintenance
of a high level of mental QOL and provision of an adequate
economic basis were suggested to be important for the quality
of living and state of health of patients receiving home oxygen
therapy. Appropriate use of social systems in cooperation
with other health-worker and welfare professions is needed
to provide economic support.
Concerning the relationship between the state of health and
the symptoms, the standardized partial regression coefficient
was highest for “shortness of breath" among
the 5 items extracted from the 12 items, probably because
the subjects had respiratory disorders. Dyspnea and symptoms
that affect sleep markedly influenced the patients' evaluation
of their state of health. Therefore, it is important to prevent
exacerbation or improve respiratory functions by measures
such as the introduction of pulmonary rehabilitation proposed
by Tsuji et al. as well as to teach the patients about activities
that do not cause dyspnea (5). The fact that about half (49.4%)
of the subjects experienced hospitalization during the 3 years
prior to the investigation suggests that their self-management
was not adequate. The need for improvement is especially high
in relation to exercise and going out compared with regular
hospital visits or control of water intake. Exercise has been
reported to be effective for improving the QOL in elderly
individuals because it leads to enhancement of the sense of
self-respect(27). The report that internal motivation is necessary
for elderly individuals to exercise (28) also applies to patients
receiving home oxygen therapy. Salvany et al. (18) reported
that the prognosis was poor in patients with a low QOL, but
we did not investigate the relationship between the QOL and
the prognosis. However, acceptance of the proposition that
there is a correlation between the QOL and the prognosis results
in greater awareness of the importance of intervention to
improve the QOL.
On the other hand, a limitation of the present study was that
evaluation was restricted to life satisfaction and QOL scales,
without adequate evaluation of their relationships with the
basic profile of patients or the state of self-management
of theirlives. Also, since the recovery rate of the questionnaire
was 60%, and the subjects were limited to those who were judged
able to participate in the investigation, the findings in
this study may not be applied directly to all patients receiving
home oxygen therapy.
A major conclusion of our study was that having roles related
to work or a hobby and being involved in activities in the
community or the family were important for life satisfaction
of HOT patients. Also, the quality of living and the state
of health were closely related to mental activities. Furthermore,
the economic state was closely related to all items of the
life satisfaction, quality of living and state of health.
Therefore, expansion of the range of activities of patients
receiving HOT and providing an economic basis for their living
as well as preventing exacerbation of the disease are considered
to be important for their life satisfaction. Thus, a stable
economic basis, a sense of life satisfaction and roles in
the family or the community were confirmed to be important
for the spiritual well-being of patients receiving HOT. We
confirmed the importance of the viewpoint of home-cared individuals
in evaluation of their care rather than paying attention exclusively
to the disease that has made them dependent on home oxygen
therapy. Patients receiving HOT require support so that the
improvement in their respiratory function brought about by
the oxygen treatment will translate into a greater range of
activities and increased joy of life and feeling of satisfaction
with their lives. Such intervention can be thought to include
devising ways to expand the patient's ADL, enable them to
carve out a meaningful role and increase their opportunities
for social interactions. Accordingly, after starting HOT,
the patient's actual quality of living and change in the QOL
should be continuously assessed, and it is necessary to devise
methods for periodic or continuous intervention at the time
of outpatient visits to the hospital or in cooperation with
the local public health nurse. It can be surmised that this
approach will further elevate the significance of home oxygen
treatment.
As a future problem, the selection of the QOL assessment scale
represents a problem in QOL research. The authors hope to
carry out follow-up surveys to elucidate whether the EORTC
scale is truly suitable for the assessment of the QOL in patients
undergoing home oxygen treatment.
ACKNOWLEDGMENTS
The authors express their sincere gratitude to the members
of the Association of Patients who cooperated in this study.
An abstract of this paper was presented at the 6th Conference
of the Japan Society of Nursing and Welfare (Kyoto, Japan;July,
2000).
REFERENCES
1.Ohkubo I, Konishi M, Asahara K:Evaluation of the state of
meals and factors related to the pleasure of eating in patients
receiving home oxygen therapy. Quality Nursing (in Japanese)
6:959-967, 2000
2.Takahashi J, Iwabuchi M, Hachiya M, Itabashi S:QOL of patients
receiving home oxygen therapy:Gap between patients and medical
staff. Clinical Nursing (in Japanese) 26:1578-1582, 2000
3.Fukanogi T, Murashima S, Iida S:Analyses of factors affecting
home oxygen therapy (HOT) patients' quality of life-focusing
on their life satisfaction-. J Jpn Acad Nurs Sci (in Japanese)
11:9-21, 1991
4.Tsuji K, Ishimoto Y, Kita M, Sakamoto K, Murai H, Tabira
K, Sekigawa N, Kuraoka T:Factors increasing the rate of home
care using home oxygen therapy - from the standpoint of patient
background and QOL -. Kyousai Ihou (in Japanese) 48:214-218,
1998
5.Tsuji K, Ishimoto Y, Kita M, Sakamoto K:Effect of pulmonary
rehabilitation on quality of life in patients receiving home
oxygen therapy. Kyousai Ihou (in Japanese) 49:361-365, 1999
6.Aoyama K:Quality of nursing care for patients undergoing
home oxygen therapy:Analysis of nursing intervention using
an assessment tool. J Juntendo Medical College of Nursing
(in Japanese) 11:1-11, 2000
7.Fukanogi T:Understanding the state of living of patients
with chronic respiratory insufficiency receiving home oxygen
therapy and the development of an index of home respiratory
management (DIHOT-F):For the establishment and improvement
of home nursing. Progress in Clinical Nursing Research (in
Japanese) 7:44-64, 1995
8.Watson J:Holistic nursing and caring:A value-based approach.
J Jpn Acad Nurs Sci 22:69-74, 2002
9.Shimizu T:Basic theories of QOL reevaluated. Palliative
Medicine (in Japanese) 2:3-8, 2000
10.Kobayashi K, Takeda H:Japanese version of EORTC QLQ-C30.
Guideline for investigation and evaluation of QOL:Actual investigation
and analytical procedures and the use of the results in bedside
care (editorial supervision by Urushibara I). First Edition.
Gan to Kagakuryoho Sha, Tokyo, 1955, pp.11-15 (in Japanese)
11.Fayers P, Aaronson N, Bjordal K, Curran D, et al.:EROTC
QLQ-C30 scoring manual. Second edition, Quality of Life Unit,
EORTC Data Center, Brussels, 1999, pp.1-15
12.Kamei T, Uchida Y:Development and evaluation of a standard
framework of the contents and frequency of home-visit nursing
using the pass method in patients receiving home oxygen therapy:Outcomes
in the users and a case-control study by analysis of the cost-efficiency.
J Japan Academy of Community Health Nursing (in Japanese)
5:43-49, 2002
13.Mitsuya Y tr. (Birren J E & Dieckmann L):Diversity
of the concept of QOL and difficulty in its measurement (Mitsuya
Y. et al. tr.:The concept and measurement of quality of life
in the frail elderly). Ishiyaku Shuppan, Tokyo, First edition,
1998, pp.439 (in Japanese)
14.Takahashi R:Methods for evaluation of mental functions:Methods
for evaluation of motivation, morale, and QOL. A guidebook
for evaluation of functions necessary for living of the elderly
(Ozawa T, Etoh F, Takahashi R, edit.), First edition, Ishiyaku
Shuppan, Tokyo, 1999, pp.51-56 (in Japanese)
15.Fukuhara S:Why QOL now?:Its definition as a patient-oriented
measure of outcome. Handbook for clinical assessment of QOL
(Ikegami N, Fukuhara S, Shimozuma K, Ikeda S, edit.), First
edition, Igakushoin, Tokyo, 2001, pp. 2-7:(in Japanese)
16.Hatsutani Y tr. (Standard, E.,P.):Effects of family support
and economic status (Mitsuya Y et al. tr.:The concept and
measurement of quality of life in the frail elderly). Ishiyaku
Shuppan (Tokyo), First edition, 1998, pp. 247 (in Japanese)
17.Wilson K A, Dowling AJ, Abdolell M, Tannock IF:Perception
of quality of life by patients, partners and treating physicians.
Quality of Life Research 9:1041-1052, 2000
18.Salvany AD, Lamarca R, Ferr M, Aymerich GJ, Alonso J, Felez
M, Khalaf A, Marrades RM, Monso E, Batlles JS, Anto JM:Health-related
quality of life and mortality in male patients with chronic
obstructive pulmonary disease. Am J Respir Critl Care Med
166:680-685, 2002
19.Chang JA, Curtis R, Patrick DL, Raghu G:Assessment of health-related
quality of life in patients with interstitial lung disease.
Chest 116:1175-1182, 1999
20.Yamada K:Assessment of QOL, ADL and dyspnea in chronic
obstructive pulmonary disease. Kango-Gijutu (in Japanese)
48:23-28, 2002
21.Grimmer KA, Moss JR, Gill TK:Discharge planning quality
from the care perspective. Quality of Life Research 9:1005-1013,
2000
22.Aoki K:Quality of life and related factors of home oxygen
therapy patients. Jpn J Health Hum Ecol (in Japanese) 67:277-290,
2001
23.Osman LM, Godden JA, Friend JAR, Legge JS, Douglas JG:Quality
of life and hospital re-admission in patients with chronic
obstructive pulmonary disease. Thorax 52 : 67-71, 1997
24.Muntner P, Sugre P, Perneger T V:Comparison of the psychometric
properties of the Asthma Quality of Life Questionnaire (AQLQ)
among 115 asthmatic adults assessed during acute hospitalization
and as outpatients. Quality of Life Research 9:987-995, 2000
25.Kaneyasu H:Life quality of the elderly in Northern Europe
and environmental factors, The Japanese Red Cross. Hiroshima
Coll Nurs (in Japanese) 1:101-104, 2000
26.Ritva K, Pekka R, Harri S:Agreement between a generic and
disease-specific quality-of-life instrument:The 15D and the
SGRQ in asthmatic patients. Quality of Life Research 9:997-1003,
2000
27.Ellingson T, Conn VS:Exercise and quality of life in elderly
individuals. J Gerontological Nursing 26:17-25, 2000
28.Resnick B & Spellbring AM:Understanding what motivates
older adults to exercise. J Gerontological Nursing 26:34-42,
2000
Received for publication November 12,
2002;accepted December 24, 2002.
Address correspondence and reprint requests to Prof. Toshiko
Tada, Major in Nursing, School of Health Sciences, The University
of Tokushima, Kuramoto-cho, Tokushima, 770-8503, Japan and
Fax:+81-886-33-9033. |
| |
