Profile of diabetes patients' chronic illness care in India and its role in their adherence.

BACKGROUND AND AIMS: Negligence of illness care in terms of non-adherence may give rise to serious health outcomes in patients with type 2 diabetes mellitus. Considering the importance of both chronic illness care and adherence, the primary purpose of the study is to explore the profile of diabetic patients' chronic illness care and examine its role in their clinical adherence. In addition to this, we have also investigated the major confounding variables in understanding the chronic illness care of diabetic patients. METHODS: We have conducted this study using a simple retrospective design with one group involving the patients primarily diagnosed with type 2 diabetes (N = 200) in India. RESULTS: The cluster analysis (k-Means) has yielded three clusters on the basis of five domains of chronic illness care-patient activation, delivery system design, goal setting, problem solving, and follow-up/coordination. The findings further reveal that the profile of chronic illness care plays a significant role in deciding the clinical adherence of patients with type 2 diabetes. The three clusters of diabetes patients, however, are confounded by health risk behaviour. CONCLUSIONS: These initial findings are suggestive of an association between chronic illness care, clinical adherence, and health risk behaviour of patients with type 2 diabetes. More research on this topic, however, needs to be undertaken involving other important dimensions of health care system like patient-provider relationship and quality of life during hospitalisation. The implications and shortcomings are discussed.

Stress and Quality of Life in Cancer Patients: Medical and Psychological Intervention.

BACKGROUND: Cancer pervades many dimensions of an individual's life - demanding a holistic treatment approach. However, studies with combined medical and psychological interventions (MPIs) are sparse. High-level stress and poor quality of life (QoL) can hinder patients' prognosis. The study thus aimed to analyze the impact of combined medical and psychological (psychoeducation, relaxation technique-guided imagery, and cognitive therapy) interventions on stress and QoL of cancer patients - head and neck, breast, and lung cancers. METHODS: The study was conducted in cancer hospitals employing one-group pretest-posttest-preexperimental design. Descriptive statistics, paired t-test, Cohen's d, and bar graphs were used to analyze the data. RESULTS: Findings showed high impact of the combined MPIs in reducing both the overall stress as well as the various components of the stress scale-fear, psychosomatic complaints, information deficit, and everyday life restrictions. Significant changes were also seen in QoL and its domains - global health status, besides functional and symptom scales. Results showed a significant improvement in physical, role and emotional functioning scale, while decrement in fatigue, pain, insomnia, appetite loss, diarrhea, and constipation of symptoms scales. CONCLUSIONS: It can be concluded that combined MPI has a positive impact - decreasing stress and improving QoL in cancer patients, which can further enhance their prognosis.

Development and Preliminary Testing of the Biopsychosocial Prognosis Scale for Coronary Artery Bypass Grafting.

BACKGROUND: The present study attempted to develop a self-report scale called Biopsychosocial Prognosis Scale for Coronary Artery Bypass grafting (BIPROSCAB) that measured patients' prognosis in an integrated manner, a month after they had undergone coronary artery bypass grafting (CABG). METHOD: The development and preliminary testing of the psychometric properties of BIPROSCAB followed five phases involving 450 patients in total. RESULTS: Findings gave rise to a 25-item scale which was subjected to an exploratory factor analysis using principal component analysis with varimax rotation. A 9-factor structure emerged, and the factors were named post-CABG affect state, post-CABG anxiety, post-CABG physical pain, discomfort in surgical sites, worry about return to normalcy, discomfort in the leg, CABG bio-social by-products, constraints in socializing, and infection and interference to routine life. The reliability, validity, and usability of BIPROSCAB were also analyzed. CONCLUSION: BIPROSCAB is a reliable, valid, and useful multidimensional self-report scale for measuring and evaluating the impact of medical treatment and psychosocial intervention in patients after CABG.

Enhancing Hospital Well-being and Minimizing Intensive Care Unit Trauma: Cushioning Effects of Psychosocial Care.

CONTEXT: Hospitalization has the potential to induce hospital anxiety, while admission in the Intensive Care Unit (ICU) is found to surpass the anxiety and result in what is termed as "ICU Trauma." AIMS: This study aimed to determine the impact of psychosocial care and quality of ICU on ICU trauma and hospital well-being in patients who underwent coronary artery bypass grafting (CABG). SETTINGS AND DESIGN: This correlational study involved 250 CABG patients, who were recruited from five major corporate hospitals. PARTICIPANTS AND METHODS: The ICU Psychosocial Care Scale, Hospital Wellbeing Scale, and ICU Trauma Scale were used. Each of the participants was assessed individually. The ICU Practices Checklist was used to assess the environment of the ICU in the hospital. STATISTICAL ANALYSIS USED: Descriptive statistics, correlation, and simple and multiple linear regression analyses were done. RESULTS: The results revealed the significant contribution of psychosocial care in ICU in enhancing hospital well-being as well as minimizing ICU trauma of patients who underwent CABG. The results of multiple regressions clearly indicated that psychosocial care was a powerful predictor of hospital well-being and ICU trauma. CONCLUSIONS: Although psychosocial care was not a component of hospital well-being and had a negative correlation with ICU trauma, it contributed significantly with a cushioning effect to minimize trauma and helped enhance the feelings and experiences of well-being among patients in ICU.

Quality of Life of Patients with Cancer: A Determinant of the Quality of Life of Their Family Caregivers.

Cancer disrupts the quality of life of both the patients and their family caregivers. This study attempted to explore the relationship between the quality of life of cancer patients and their family caregivers and to examine whether the quality of life, age, and gender of the patients contributed to the quality of life of their family caregivers. This correlational study involved 206 pairs of participants consisting of cancer patients and their corresponding family caregivers. The European Organization for the Treatment and Research of Quality of Life Questionnaire C-30 (version 3) was administered on the patients and the Caregiver Quality of Life-Cancer was administered on their family caregivers. The result revealed that social functioning, appetite loss, physical functioning, and gender of the patients contributed significantly to the quality of life of their family caregivers. Implications, shortcomings, and future directions were discussed.

Care givers' depression, anxiety, distress, and somatization as predictors of identical symptoms in cancer patients.

CONTEXT: The critical condition of the cancer patient and the stringent medical procedures do not often warrant the accessibility of the patient for psychological evaluation. Therefore, the study is conceptualized to assess the psychological problems of caregivers, which in turn have their impact upon cancer patients. AIMS: The objective of the study was to explore the relationships between depression, anxiety, distress, and somatization in cancer patients and their caregivers along with age, gender, and relationship; and to measure whether these psychological problems of caregivers were predictors of the identical symptoms of the cancer patients. MATERIALS AND METHODS: Four-Dimensional Symptom Questionnaire was used to measure depression, anxiety, distress, and somatization of cancer patients and their caregivers. The sample had 200 participants, with 100 patients (male = 47 and female = 53) and 100 caregivers. (male = 36 and female = 64) selected by purposive sampling method. STATISTICAL ANALYSIS USED: The data were analyzed by using descriptive statistics, product.moment correlations, simple and multiple linear regression analyses. RESULTS: Significant correlations were found between cancer patients' depression and anxiety, and caregivers' depression, anxiety, distress, and somatization; patients' distress and somatization, and caregivers' anxiety and age, respectively. It was also found that anxiety was a significant predictor of distress in patients, and that caregivers' depression, anxiety, distress, and somatization significantly predicted depression and anxiety in cancer patients. CONCLUSIONS: The association between depression, anxiety, distress, and somatization of caregivers and patients indicates the need for psychological interventions to manage these problems of caregivers, which would in turn help managing the identical symptoms in patients.

The intensive care unit psychosocial care scale: Development and initial validation.

The main objective of the current study was to construct a new self-report scale - ICU-PC Scale - to measure the psychosocial care (PC) of patients in Intensive Care Unit (ICU) and examine different psychometric issues in the development and initial validation of this scale. The findings indicate that the ICU-PC Scale has established high internal consistency. A three-factor structure - protection of human dignity and rights, transparency for decision making and care continuity and sustained patient, family orientation - has been identified with a substantial number of subjects (N=250) in hospital settings. The three oblique factor solutions are found to be interrelated and interdependent with good indices of internal consistency and content validity. This new instrument is the first of its kind to measure the psychosocial care to be provided to patients in the ICU. The present findings indicate that the ICU-PC scale, with additional factor analytic research, could become an established and clinical tool.

Impact of medical intervention on stress and quality of life in patients with cancer.

CONTEXT: Many studies have explored stress and quality of life in (QOL) patients with cancer, under several phases of disease and treatment. However, the impact of medical intervention on psychological parameters, such as stress and quality of life focusing on psychological intervention has been sparsely studied. AIMS: The main aim of the study was to examine the impact of medical intervention on the level of stress and quality of life of patients with lung, breast, and head and neck cancers. SETTINGS AND DESIGN: The study was carried out in hospital settings by following a one-group pre-test-post-test pre-experimental design. STATISTICAL ANALYSIS USED: The quantitative data were analysed by means of descriptive statistics, paired t-tests, Cohen's d, and bar graphs accordingly. RESULTS: The effect of medical intervention was medium in case of reduction of overall stress in participants. So far as the components are concerned, the effect was high in case of psychosomatic complaints, medium in case of fear and information deficit, and low in case of everyday life restrictions. The effect of medical intervention in respect of the quality of life was found to be high in case of symptom scale (pain) and additional symptoms (constipation); medium in case of functional scale (emotional functioning, cognitive functioning) and symptoms scale (nausea, vomiting). In additional symptoms scale the effect of medical intervention was found to be medium in dyspnoea and appetite loss. CONCLUSIONS: The findings revealed that though the medical intervention reduced stress and improved the quality of life, it was not instrumental in bringing down the stress to minimal level and enhancing the quality of life to optimum level. Therefore, the findings point to the need of inclusion of psychological intervention along with the medical intervention for minimizing stress and optimizing the quality of life of patients with cancer.

Role of psychosocial care on ICU trauma.

CONTEXT: Patients treated in intensive care units (ICU) though receive the best medical attention are found to suffer from trauma typically attributed to the ICU environment. Biopsychosocial approach in ICUs is found to minimize ICU trauma. AIMS: This study investigates the role of psychosocial care on patients in ICU after coronary artery bypass graft (CABG). SETTINGS AND DESIGN: The study included 250 post-operative CABG patients from five corporate hospitals. The combination of between subject and correlation design was used. MATERIALS AND METHODS: The ICU psychosocial care scale (ICUPCS) and ICU trauma scale (ICUTS) were used to measure the psychosocial care and trauma. STATISTICAL ANALYSIS: ANOVA and simple and multiple regression were applied. RESULTS: Hospitals significantly differed in psychosocial care provided in ICUs. Higher the psychosocial care in ICU, lower was the ICU trauma experienced and vice versa. Psychosocial care was a significant major predictor of ICU trauma. CONCLUSIONS: The study suggests emphasis on psychosocial aspects in ICU care for optimizing prognosis.