Validation of the Thai Version of a Work-related Quality of Life Scale in the Nursing Profession

BACKGROUND: Currently available questionnaires for evaluating the quality of worklife do not fully examine every factor related to worklife in all cultures. A tool in Thai is therefore needed for the direct evaluation of the quality of worklife. Our aim was to translate the Work-related Quality of Life Scale-2 (WRQLS-2) into Thai, to assess the validity and reliability of the Thai-translated version, and to examine the tool's accuracy vis-a-vis nursing in Thailand. METHODS: This was a descriptive correlation study. Forward and backward translations were performed to develop a Thai version of the WRQLS. Six nursing experts participated in assessing content validity and 374 registered nurses (RNs) participated in its testing. After a 2-week interval, 67 RNs were retested. Structural validity was examined using principal components analysis. The Cronbach's alpha values were calculated. The respective independent sample t test and intraclass correlation coefficient were used to analyze known-group validity and test-retest reliability. Multistate sampling was used to select 374 RNs from the In- and Outpatient Department of Srinagarind Hospital of the Khon Kaen University (Khon Kaen, Thailand). RESULTS: The content validity index of the scale was 0.97. Principal components analysis resulted in a seven-factor model, which explains 59% of the total variance. The overall Cronbach's alpha value was 0.925, whereas the subscales ranged between 0.67 and 0.82. In the assessment results, the known-group validity was established for the difference between civil servants and university employees [F (7.982, 0.005) and t (3.351; p < 0.05)]. Civil servants apparently had a better quality worklife, compared to university employees. Good test-retest reliability was observed (r = 0.892, p < 0.05). CONCLUSION: The Thai version of a WRQLS appears to be well validated and practicable for determining the quality of the work-life among nurses in Thailand.

Preliminary Psychometric Properties of the Chinese Version of the Work-Related Quality of Life Scale-2 in the Nursing Profession

OBJECTIVES: As quality of work-life (QWL) among nurses affects both patient care and institutional standards, assessment regarding QWL for the profession is important. Work-related Quality of Life Scale (WRQOLS) is a reliable QWL assessment tool for the nursing profession. To develop a Chinese version of the WRQOLS-2 and to examine its psychometric properties as an instrument to assess QWL for the nursing profession in China. METHODS: Forward and back translating procedures were used to develop the Chinese version of WRQOLS-2. Six nursing experts participated in content validity evaluation and 352 registered nurses (RNs) participated in the tests. After a two-week interval, 70 of the RNs were retested. Structural validity was examined by principal components analysis and the Cronbach's alphas calculated. The respective independent sample t-test and intra-class correlation coefficient were used to analyze known-group validity and test-retest reliability. RESULTS: One item was rephrased for adaptation to Chinese organizational cultures. The content validity index of the scale was 0.98. Principal components analysis resulted in a seven-factor model, accounting for 62% of total variance, with Cronbach's alphas for subscales ranging from 0.71 to 0.88. Known-group validity was established in the assessment results of the participants in permanent employment vs. contract employment (t = 2.895, p < 0.01). Good test-retest reliability was observed (r = 0.88, p < 0.01). CONCLUSION: The translated Chinese version of the WRQOLS-2 has sufficient validity and reliability so that it can be used to evaluate the QWL among nurses in mainland China.

Effects of Melatonin on Quality of Life of Non-resectable Cholangiocarcinoma Patients

Background and Objective: Chemotherapy and supportive care are alternative treatments in non-resectable cholangiocarcinoma patients. The adverse events from disease and treatments have been reported which affect quality of life (QOL) of the patients. The primary objective of this study was to evaluate the effect of melatonin on QOL of non-resectable cholangiocarcinoma patients.Methods: The study was a randomized, double-blind, placebo, controlled trial. Non-resectable cholangiocarcinoma patients were randomized by mixed-block randomization stratified by hospital and type of treatment. The treatment group received melatonin (20 mg/day); the control group received placebo. The patients started taking the study drug on the first day of the treatment and continued for three months. The QOL was assessed using Thai Functional Assessment of Cancer Therapy-Hepatobiliary (FACT-HEP) and adverse events were assessed using Common Toxicity Criteria Adverse Events (CTCAE).Result: There were 30 patients recruited in the study, divided into 15 patients in each group. After 1 month of treatment, QOL of patients in the melatonin group decreased but not significantly while those in the control group showed significantly worse in many domains. Melatonin group had higher percentage of improvement in FACT-Hep scores than the control in both the first (20% vs 6.7%) and the second (20% vs 6.7%) month, but not significant. The median survival was longer in the melatonin group (160 vs. 130 days), but it is not significantly different. In addition, there were fewer reports of moderate to severe adverse events (Grade 3-5) in the melatonin group than placebo at two months in terms of anorexia (1 vs. 5), fatigue (1 vs. 5), nausea/vomiting (0 vs. 1), weight loss (2 vs. 9) and weight loss was greater than 5% from baseline (1 vs. 6).Conclusion: The combination of melatonin with standard treatment did not prolong overall survival period.  The melatonin treatment, however,  decreased adverse events and maintained QOL of non-resectable cholangiocarcinoma patients. Further studies with larger samples are needed.Keywords : Melatonin, Cholangiocarcinoma, Quality of Life

Quality of Life of Cholangiocarcinoma Patients: Preliminary Study

This study was of longitudinal prospective design and sough to evaluate quality of life (QOL) of cholangiocarcinoma patients at before and one month after treatment. The incidence of adverse events and their impact on a patient’s QOL were also analyzed. The study population were new patients with cholangiocarcinoma receiving treatment at Khon Kaen or Srinagarind Hospitals. QOL was assessed using Thai Functional Assessment of Cancer Therapy-Hepatobiliary (FACT-Hep) version 4 and adverse events were assessed using Common Toxicity Criteria Adverse Event (CTCAE) version 3. The report of QOL was categorized as improved, no change and worsening based on clinical meaningful scores of the measures. The mean difference of QOL scores before and after treatment, the relation of adverse events, and their severity on QOL were analyzed using Wilcoxon Sign rank test, Mann-Whitney U test and Kruskal Wallis, respectively. Preliminary results from 16 cholangiocarcinoma patients indicate that. Most patients were male (69%), median age 59, able to work or do high activities at baseline (ECOG ≤ 1, 87%) and only 12 out of 16 patients received chemotherapy treatment (75%). After a one month period, 12 out of 16 patients reported no change or worsening QOL (75%). The most common adverse events reported were fatigue (69%), anorexia (69%), weight loss (44%) and nausea/vomiting (37%). There were more reports of grade 3 or 4 adverse events at one month after treatment in terms of fatigue (12.6% vs. 6.3%), anorexia (43.8% vs. 18.8%) and nausea/vomiting (12.5% vs. 6.3%) compared to baseline. Patients experiencing weight loss after the treatments had reported a statistically significant lower QOL than those without (p \< 0.05). The alteration of fatigue severity from worsening, no-change or better after treatment has significantly affected QOL of these patients (p=0.05).

Outcome of Chemotherapy Counseling in Oncology Patients by Pharmacist

Cancer is a disease that requires long term treatment and intensive monitoring. There are several methods to manage cancer but most cases are treated with chemotherapy. Patients who receive chemotherapy should receive advice on side effect management and proper self-care to properly cope with drug related problems and ultimately obtain the maximum benefits from the treatment. The prospective descriptive study was designed to evaluate the outcome of chemotherapy counseling utilizing standard questionnaires by a pharmacist who participated in an oncology care team during December 2004 to March 2005. The study setting was a medical oncology patient care unit (5E ward), Srinagarind Hospital, Khon Kaen University, Thailand. Ninety-one cancer patients were assessed for eligibility and 82 (90.1%) were recruited in this study. The counseling by pharmacist took place three times before and after patient received chemotherapy at each visit. The patients were evaluated in terms of knowledge, satisfaction and frequency of side effects. The results demonstrated that patients had an improved knowledge score based on disease and chemotherapy, possible side effect of chemotherapy and self care behavior after receiving chemotherapy counseling by a pharmacist following three evaluation periods (p \< 0.01). Satisfaction score also significant improved (4.8 of 5) after receiving intervention by a pharmacist (p \< 0.01). As for the adverse event evaluation, gastrointestinal (GI) side effects such as anorexia were the most common adverse event (91.5%) found in the first evaluation period however GI side effects were reported to be less in degree and frequency at the second and third follow up period post counseling. In conclusion, the pharmacist intervention based on chemotherapy counseling improved knowledge and satisfaction in oncology inpatients and reduced adverse events following chemotherapy treatment. The results of the present study should be used to encourage the establishment of oncology pharmacy practice model. By utilizing this pharmaceutical care activity, pharmacists will be able to serve as valuable health care staffs who can ultimately improve the quality of oncology care in the future.

Exploration the Results of Cancer Pain Management Following Implementation of World Health Organization (WHO) Pain Guideline

Background: Pain is among the most common symptoms encountered in cancer patients and remains the first priority of care.Methods: This cross sectional study aimed to explore a result of pain management at Srinagarind Hospital, Khon Kaen University following the implementation of World Health Organization (WHO) Pain Guideline. Cancer pain patients were categorized based on prior analgesic exposure into two groups; Naïve group, and Routine group. Treatments were defined according to WHO as 1) drug treatment relevant to pain severity, 2) analgesics being prescribed as around-the-clock and 3) analgesics used for break-through pain for patients receiving strong opioids.Results: From Dec 2005 to Jul 2006, 261 patients were enrolled, 93.1% (n=243) were in advanced stages and 88.5% (n=231) were in moderate to severe pain.In Naïve group (n=159), 32.7% (n=52) of patients were given analgesics following the WHO on both day 1 and day 3 of admissions; 3.8% (n=6) of patients followed WHO only on day 1; 23.3% (n=37) of patients followed WHO only on day 3 whereas 40.2% (n=64) of patients did not follow WHO on both days. A decreased pain score was greater (2.61, SD±1.5) in a group following the WHO both days on day 1 and a decreased pain score was much improved (3.9, SD±1.8) as continuing to follow WHO on day 3 (p \< 0.0001) compared to those not following WHO on both days.In Routine group (n=102), 31.4% (n=32) of patients were given analgesics following WHO guideline on both day 1 and day 3 of admission. 5.9% (n=6) of patients followed WHO only on day 1; 27.5% (n=28) of patients followed WHO only day 3 while 35.3% (n=36) of patients did not follow WHO on both days. A decreased pain score was statistically significant greater (2.6, SD±1.8) in a routine group following the WHO both days on day 1 (p \< 0.0001). Furthermore, a decreased pain score was even greater (3.9, SD±2.3) in the routine group continuing to follow WHO on day 3 compared to those not following WHO on both day 1 and day 3 of admission. The most common of adverse effects related to analgesics was constipation.Conclusions: The results demonstrated that patients who received pain management following the WHO guideline reported significantly lower pain intensity than those not following the WHO regardless the history of analgesics exposure.

Economic Evaluation of Disease Management Program : A Cases Study of Open Heart Surgery

This study aimed to analyze the cost effectiveness for open heart surgery in disease management program compared with usual care. This study analyzed the cost effectiveness for coronary bypass grafting (CABG) in the 60 years old patients and open heart surgery for patients with valvular heart disease in 40 years old patients. Decision Analysis Model was used to calculate life expectancy, quality-adjusted life expectancy (QALY), lifetime cost and incremental cost-effectiveness ration (ICER). The disease management program was assumed to increase the proportion of patients receiving the surgery by 30% and reduce the proportion of patients who received delayed surgery by 40% when compared with usual care. Mortality rate in the first year of the surgery was based on the clinical data of Queen Sirikit Heart Center of the Northeast, Khon Kaen University. Mortality rate in the second year after surgery and thereafter was obtained from published literatures. Cost data were abstracted from electronic databases of Maharat Nakhonratchasima Hospital and obtained from DGR system. Quality of life data were based on the study of quality of life outcome measured by EuroQol VAS among patients with open heart surgery under the disease management program. Time horizons were 20 years for CABG and 40 years for VHD surgery. Compared to usual care, CABG under the disease management program improved life expectancy and QALY, and was more costly. Life expectancy were 9.83 and 9.36 years which were equivalent to 6.29 and 5.82 QALYs for disease management program and usual care, respectively. An ICER of the disease management program as compared with usual care was 17,276 Baht per QALY. For surgery in VHD, compared with usual care, the disease management program also improved life expectancy and QALY, and was more costly. Life expectancy were 13.17 and 11.54 years which were equivalent to 11.54 and 7.35 QALYs for the disease management program and usual care, respectively. An ICER of the disease management program as compared with usual care was 5,904 Baht per QALY. A cost effectiveness acceptability curve, based on Monte Carlo simulation suggests that at a willingness to pay (WTP) threshold of more than 15,000 Baht per QALY, more than 50% of CABG in the disease management program will be cost effective. For the surgery for VHD, at a WTP threshold of more than 10,000 Baht per QALY, more than 50% of surgery for VHD under the disease management program will be cost effective. Based on the WHO cost-effectiveness threshold, open heart surgery under the disease management program is considered the cost-effectiveness management when compared to usual care.