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Jung JY, Yun YH. Self-Management Strategy Clustering, Quality of Life, and Health Status in Cancer Patients Considering Cancer Stages. Int J Behav Med 2023; 30:769-776. [PMID: 36169885 DOI: 10.1007/s12529-022-10128-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND In the cancer-care continuum, self-management can help cancer patients regardless of their treatment plan or cancer stage. However, research examining self-management strategy clusters considering cancer stages is lacking. Thus, we examined self-management strategy clusters considering cancer stages and the effects of self-management strategy clusters on quality of life (QoL) and overall health status. METHOD A total of 256 patients who completed both baseline and second surveys for a 6-month period ultimately participated in this prospective cohort study. To identify the interrelationship between self-management strategies measured by the Smart management strategies for health assessment tool (SAT), we conducted cluster analysis using a principal component analysis in varimax rotation and the k-mean clustering method. We also performed multivariate-adjusted analyses in QoL and overall health status comparisons by dividing the cancer stage into early (I, II) and advanced (III, IV). RESULTS All patients experienced two domains of self-management strategies concurrently. However, self-management strategy clusters differed by cancer stage, and the effect of self-management strategy clusters on quality of life and overall health status also differed. Self-management strategy clusters effectively improved the quality of life and overall health status of the entire cohort of patients, even in patients with advanced-stage cancer. CONCLUSION This study revealed that the pattern of using self-management strategies might differ by cancer stage. The strategy cluster positively affected QoL and overall health status in cancer patients. Identifying the self-management clusters of cancer patients with different cancer stages may have clinical implications for supporting their health management.
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Affiliation(s)
- Ju Youn Jung
- Department of Biomedical Science, Seoul National University College of Medicine and Hospital, Seoul, South Korea
| | - Young Ho Yun
- Department of Family Medicine, Seoul National University College of Medicine and Hospital, 103 Daehak-ro, Jongno-gu, Seoul, 110-799, South Korea.
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Yun YH, Kim KN, Sim JA, Yoo SH, Kim M, Kim YA, Kang BD, Shim HJ, Song EK, Kang JH, Kwon JH, Lee JL, Nam EM, Maeng CH, Kang EJ, Do YR, Choi YS, Jung KH. Comparison of attitudes towards five end-of-life care interventions (active pain control, withdrawal of futile life-sustaining treatment, passive euthanasia, active euthanasia and physician-assisted suicide): a multicentred cross-sectional survey of Korean patients with cancer, their family caregivers, physicians and the general Korean population. BMJ Open 2018; 8:e020519. [PMID: 30206075 PMCID: PMC6144336 DOI: 10.1136/bmjopen-2017-020519] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES This study determined attitudes of four groups-Korean patients with cancer, their family caregivers, physicians and the general Korean population-towards five critical end-of-life (EOL) interventions-active pain control, withdrawal of futile life-sustaining treatment (LST), passive euthanasia, active euthanasia and physician-assisted suicide. DESIGN AND SETTING We enrolled 1001 patients with cancer and 1006 caregivers from 12 large hospitals in Korea, 1241 members of the general population and 928 physicians from each of the 12 hospitals and the Korean Medical Association. We analysed the associations of demographic factors, attitudes towards death and the important components of a 'good death' with critical interventions at EoL care. RESULTS All participant groups strongly favoured active pain control and withdrawal of futile LST but differed in attitudes towards the other four EoL interventions. Physicians (98.9%) favoured passive euthanasia more than the other three groups. Lower proportions of the four groups favoured active euthanasia or PAS. Multiple logistic regression showed that education (adjusted OR (aOR) 1.77, 95% CI 1.33 to 2.36), caregiver role (aOR 1.67, 95% CI 1.34 to 2.08) and considering death as the ending of life (aOR 1.66, 95% CI 1.05 to 1.61) were associated with preference for active pain control. Attitudes towards death, including belief in being remembered (aOR 2.03, 95% CI 1.48 to 2.79) and feeling 'life was meaningful' (aOR 2.56, 95% CI 1.58 to 4.15) were both strong correlates of withdrawal of LST with the level of monthly income (aOR 2.56, 95% CI 1.58 to 4.15). Believing 'freedom from pain' negatively predicted preference for passive euthanasia (aOR 0.69, 95% CI 0.55 to 0.85). In addition, 'not being a burden to the family' was positively related to preferences for active euthanasia (aOR 1.62, 95% CI 1.39 to 1.90) and PAS (aOR 1.61, 95% CI 1.37 to 1.89). CONCLUSION Groups differed in their attitudes towards the five EoL interventions, and those attitudes were significantly associated with various attitudes towards death.
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Affiliation(s)
- Young Ho Yun
- Department of Biomedical Science, College of Medicine, Seoul National University, Seoul, Korea
- Department of Biomedical Informatics, College of Medicine, Seoul National University, Seoul, Korea
| | - Kyoung-Nam Kim
- Public Health Medical Service, Seoul National University Hospital, Seoul, Korea
| | - Jin-Ah Sim
- Department of Biomedical Science, College of Medicine, Seoul National University, Seoul, Korea
| | - Shin Hye Yoo
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Miso Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Young Ae Kim
- Cancer Survivorship Branch, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Beo Deul Kang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyun-Jeong Shim
- Division of Hematology and Medical Oncology, Department of Internal Medicine, School of Medicine, Chonbuk National University, Jeonju, Korea
| | - Eun-Kee Song
- Division of Hematology/Oncology, Chonbuk National University Medical School, Jeonju, Korea
| | - Jung Hun Kang
- Department of Internal Medicine, Postgraduate Medical School, Gyeongsang National University, Jinju, Korea
| | - Jung Hye Kwon
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Jung Lim Lee
- Department of Hemato-oncology, Daegu Fatima Hospital, Daegu, Korea
| | - Eun Mi Nam
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Chi Hoon Maeng
- Department of Medical Oncology and Hematology, Kyung Hee University Hospital, Seoul, Korea
| | - Eun Joo Kang
- Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Young Rok Do
- Department of Internal Medicine, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Yoon Seok Choi
- Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Kyung Hae Jung
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Yoo SH, Kim M, Yun YH, Keam B, Kim YA, Kim YJ, Shim HJ, Song EK, Kang JH, Kwon JH, Lee JL, Lee SN, Kim SY, Kang EJ, Do YR, Choi YS, Jung KH. Attitudes toward early palliative care in cancer patients and caregivers: a Korean nationwide survey. Cancer Med 2018; 7:1784-1793. [PMID: 29577624 PMCID: PMC5943547 DOI: 10.1002/cam4.1441] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 02/16/2018] [Accepted: 02/19/2018] [Indexed: 11/15/2022] Open
Abstract
Integrated early palliative care (EPC) improves quality of life and reduces psychological distress in adult patients with cancer and caregivers, but attitudes toward EPC have been poorly studied. We aimed to investigate attitudes toward EPC in a nationwide survey of patients with cancer and caregivers. From July to October 2016, we administered nationwide questionnaires examining attitudes toward EPC in patients with cancer (n = 1001) and their families (n = 1006) from 12 Korean hospitals. When an individual considered EPC unnecessary, the reasons were collected and analyzed. Factors associated with perception of EPC were examined. A majority of patients (84.5%) and caregivers (89.5%) had positive attitudes toward EPC. The most common reasons for deeming EPC unnecessary were that EPC may be an obstacle to cancer treatment (patients: 37%; caregivers: 23%; respectively) or that they were not sure if EPC is beneficial (patients: 21%; caregivers: 24%; respectively). Financial burden as a reason was more evident in caregivers (23%) than in patients (17%). Male gender, age <50, early stage, intensive care unit admission, and not believing that dying people should prepare to practice charity were associated with patients’ negative attitudes. In caregivers, opposition to EPC was associated with not thinking death should be feared, not thinking people should be remembered, and lower educational level. Our findings showed that significant numbers of patients with advanced cancer and family caregivers showed positive attitudes toward EPC. However, more than 10% of participants did not consider EPC necessary. Physicians’ communication with patients and caregivers and financial support could help overcome the barriers of EPC.
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Affiliation(s)
- Shin Hye Yoo
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Miso Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Young Ho Yun
- Department of Family Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Bhumsuk Keam
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Young Ae Kim
- Cancer Survivorship Branch, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Yu Jung Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Hyun-Jeong Shim
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Chonnam National University School of Medicine, Hwasun, Korea
| | - Eun-Kee Song
- Division of Hematology/Oncology, Chonbuk National University Medical School, Jeonju, Korea
| | - Jung Hun Kang
- Department of Internal Medicine, Postgraduate Medical School, Gyeongsang National University, Jinju, Korea
| | - Jung Hye Kwon
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University, Seoul, Korea
| | - Jung Lim Lee
- Department of Hemato-oncology, Daegu Fatima Hospital, Daegu, Korea
| | - Soon Nam Lee
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Si-Young Kim
- Departments of Medical Oncology and Hematology, Kyung Hee University Hospital, Seoul, Korea
| | - Eun Joo Kang
- Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Young Rok Do
- Departments of Internal Medicine, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Yoon Seok Choi
- Departments of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Kyung Hae Jung
- Departments of Internal Medicine, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
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