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Tait MA, Costa DS, Campbell R, Norman R, Warne LN, Schug S, Rutherford C. Health-related quality of life in patients accessing medicinal cannabis in Australia: The QUEST initiative results of a 3-month follow-up observational study. PLoS One 2023; 18:e0290549. [PMID: 37672515 PMCID: PMC10482296 DOI: 10.1371/journal.pone.0290549] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 08/09/2023] [Indexed: 09/08/2023] Open
Abstract
AIMS Patients with chronic health conditions not responding to conventional treatment can access medicinal cannabis (MC) prescriptions from clinicians in Australia. We aimed to assess overall health-related quality of life (HRQL), pain, fatigue, sleep, anxiety, and depression in a large real-world sample of patients accessing prescribed medicinal cannabis. We hypothesized that all patient-reported outcomes (PROs) would improve from baseline to 3-months. METHODS The QUEST Initiative is a large prospective multicenter study of patients with any chronic health condition newly prescribed medicinal cannabis between November 2020 and December 2021. Eligible patients were identified by 120 clinicians at medical centers across six Australian states. Consenting participants completed the EuroQol Group EQ-5D-5L health status questionnaire; European Organization for Research & Treatment of Cancer Quality of Life questionnaire (QLQ-C30); Patient-Reported Outcomes Measurement Information System (PROMIS) Short Forms in Fatigue and Sleep Disturbance, and the Depression Anxiety Stress Scale (DASS-21) before starting therapy, at 2-weeks titration, then monthly for 3-months. RESULTS Of the 2762 consenting participants, 2327 completed baseline and at least one follow-up questionnaire. Ages ranged between 18-97 years (mean 51y; SD = 15.4), 62.8% were female. The most commonly treated conditions were chronic pain (n = 1598/2327; 68.7%), insomnia (n = 534/2327; 22.9%), generalized anxiety (n = 508/2327; 21.5%), and mixed anxiety and depression (n = 259/2327; 11%). Across the whole cohort both EQ-5D-5L utility scores and QLQ-C30 summary scores showed clinically meaningful improvement in HRQL from baseline to mean follow-up with d = 0.54 (95%CI:0.47 to 0.59) and d = 0.64 (95%CI:0.58 to 0.70) respectively; and clinically meaningful improvement in fatigue (d = 0.54; 95%CI:0.48 to 0.59). There was clinically meaningful reduction of pain for those with chronic pain (d = 0.65; 95%CI:0.57 to 0.72); significant improvements for those with moderate to extremely severe anxiety (X2 = 383; df = 4; p<0.001) and depression (X2 = 395; df = 4; p<0.001); and no changes in sleep disturbance. CONCLUSIONS We observed statistically significant, clinically meaningful improvements in overall HRQL and fatigue over the first 3-months in patients with chronic health conditions accessing prescribed medical cannabis. Anxiety, depression, and pain also improved over time, particularly for those with corresponding health conditions. The study continues to follow-up patients until 12-months to determine whether improvements in PROs are maintained long-term. TRAIL REGISTRATION Study registration - Australian New Zealand Clinical Trials Registry: ACTRN12621000063819. https://www.australianclinicaltrials.gov.au/anzctr/trial/ACTRN12621000063819.
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Affiliation(s)
- Margaret-Ann Tait
- Faculty of Science, School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, Sydney Nursing School, The University of Sydney, Sydney, New South Wales, Australia
| | - Daniel S.J. Costa
- Faculty of Science, School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
| | - Rachel Campbell
- Faculty of Science, School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
| | - Richard Norman
- School of Population Health, Curtin University, Perth, Australia
| | - Leon N. Warne
- Little Green Pharma, West Perth, Western Australia, Australia
- College of Science, Health, Engineering and Education, Murdoch University, Perth, Western Australia, Australia
- School of Pharmacy and Biomedical Sciences, Curtin Health Innovation Research Institute, Curtin University, Perth, Western Australia, Australia
| | - Stephan Schug
- School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
| | - Claudia Rutherford
- Faculty of Medicine and Health, Sydney Nursing School, The University of Sydney, Sydney, New South Wales, Australia
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Schulz AA, Wirtz MA. Midwives' empathy and shared decision making from women's perspective - sensitivity of an assessment to compare quality of care in prenatal and obstetric care. BMC Pregnancy Childbirth 2022; 22:717. [PMID: 36127645 PMCID: PMC9487070 DOI: 10.1186/s12884-022-05041-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 09/06/2022] [Indexed: 11/18/2022] Open
Abstract
Background For quality-oriented evaluation of prenatal and obstetric care, it is important to systematically consider the perspective of the women receiving care in order to comprehensively assess and optimize quality in a woman-centered manner. Empathy and Shared Decision Making (SDM) are essential components of woman-centered midwifery care. The aim of the study was to analyze measurement invariance of the items of the Consultation and Relational Empathy (CARE) and Shared Decision Making-Questionnaire (SDM-Q-9) scales depending on the prenatal versus obstetric care setting. Methods One hundred fifty women retrospectively assessed aspects of woman-centered midwifery care in both prenatal and obstetric care setting. The birth of the child was a maximum of 12 months ago. A structural equation modelling approach was adopted to separate true effects from response shift (RS) effects depending on care setting. The latter were analyzed in terms of recalibration (changing women’s internal measurement standards), Reprioritization (changing associations of items and construct) as well as Reconceptualization (redefining the target construct). Results A response shift model was identified for both assessments (pregnancy/birth: CFI = .96/.96; SRMR = .046/.051). At birth, both scales indicated lower quality of care compared with prenatal care (SDM-Q-9-M/CARE-8-M:|d| = 0.190/0.392). Although no reconceptualization is required for the items of both scales, RS effects are evident for individual items. Due to recalibration and reprioritization effects, the true differences in the items are partly underestimated (SDM-Q-9-M/CARE-8-M: 3/2 items) or overestimated (4/2 items). Conclusion The structure of the constructs SDM and Empathy, indicating woman-centered midwifery care, are moderated by the care settings. To validly assess midwives’ empathy and shared decision making from women’s perspective, setting-dependent response shift effects have to be considered. The proven item-specific response effects contribute to a better understanding of construct characteristics in woman-centered care by midwives during pregnancy and childbirth. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-05041-y.
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Affiliation(s)
- Anja Alexandra Schulz
- Department of Research Methods in the Health Sciences, University of Education Freiburg, Kunzenweg 21, 79117, Freiburg, Germany. .,Department of Research Methods, University of Education Freiburg, Kunzenweg 21, 79117, Freiburg, Germany.
| | - Markus Antonius Wirtz
- Department of Research Methods in the Health Sciences, University of Education Freiburg, Kunzenweg 21, 79117, Freiburg, Germany.,Department of Research Methods, University of Education Freiburg, Kunzenweg 21, 79117, Freiburg, Germany
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Tait MA, Costa DSJ, Campbell R, Norman R, Schug S, Rutherford C. A Quality-of-Life Evaluation Study Assessing Health-Related Quality of Life in Patients Receiving Medicinal Cannabis (the QUEST Initiative): Protocol for a Longitudinal Observational Study. JMIR Res Protoc 2021; 10:e32327. [PMID: 34821570 PMCID: PMC8663597 DOI: 10.2196/32327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/25/2021] [Accepted: 09/26/2021] [Indexed: 11/14/2022] Open
Abstract
Background Evidence supports several countries introducing legislation to allow cannabis-based medicine as an adjunctive treatment for the symptomatic relief of chronic pain, chemotherapy-induced nausea, spasticity in multiple sclerosis (MS), epileptic seizures, depression, and anxiety. However, clinical trial participants do not represent the entire spectrum of disease and health status seen in patients currently accessing medicinal cannabis in practice. Objective This study aims to collect real-world data to evaluate health-related quality of life in patients prescribed medicinal cannabis oil and describe any differences over time, from before starting therapy to after 3 and 12 months of therapy. Methods Adult patients newly prescribed medicinal cannabis oil by authorized prescribers and under the Special Access Schemes across Australia will be screened for eligibility and invited to participate. A sample size of 2142 is required, with a 3-month follow-up. All participants will complete the EuroQol 5-Dimension; European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-30; Depression, Anxiety, and Stress Scale-21; Patients’ Global Impression of Change; Patient-Reported Outcomes Measurement Information System (PROMIS) Short Form (SF) version 1.0: Sleep Disturbance 8b; and PROMIS SF Fatigue 13a questionnaires. Patients with chronic pain conditions will also complete the PROMIS SF version 1.0: Pain Intensity 3a and PROMIS SF version 1.0: Pain Interference 8a. Patients with movement disorders will also complete Quality of Life in Neurological Disorders (Neuro-QoL) SF version 1.0: Upper Extremity Function (Fine Motor and Activities of Daily Living) and if chorea is indicated, the Neuro-QoL SF version 2.0: Huntington’s Disease health-related Quality of LIFE-Chorea 6a. All questionnaires will be administered at baseline, 2 weeks (titration), monthly up to 3 months, and then every 2 months up to 1 year. Results Recruitment commenced in November 2020. By June 2021, 1095 patients were screened for the study by 69 physicians in centers across 6 Australian states: Australian Capital Territory, New South Wales, Queensland, South Australia, Victoria, and Western Australia. Of the patients screened, 833 (39% of the target sample size) provided consent and completed baseline questionnaires. Results are expected to be published in 2022. Results of this study will show whether patient-reported outcomes improve in patients accessing prescribed medicinal cannabis from baseline to 3 months and whether any changes are maintained over a 12-month period. This study will also identify differences in improvements in patient-reported outcomes among patients with different chronic conditions (eg, chronic pain, MS, epilepsy, Parkinson disease, or cancer). Conclusions This protocol contains detailed methods that will be used across multiple sites in Australia. The findings from this study have the potential to be integral to treatment assessment and recommendations for patients with chronic pain and other health indicators for accessing medicinal cannabis. Trial Registration Australian New Zealand Clinical Trials Registry: ANZCTRN12621000063819; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380807&isReview=true International Registered Report Identifier (IRRID) DERR1-10.2196/32327
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Affiliation(s)
- Margaret-Ann Tait
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, Australia
| | - Daniel S J Costa
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, Australia
| | - Rachel Campbell
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, Australia
| | - Richard Norman
- School of Population Health, Curtin University, Perth, Australia
| | - Stephan Schug
- Medical School, University of Western Australia, Perth, Australia
| | - Claudia Rutherford
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, Australia
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Nielsen LK, Larsen RF, Jarlbaek L, Möller S, Jespersen E. Health-related quality of life in patients with multiple myeloma participating in a multidisciplinary rehabilitation program. Ann Hematol 2021; 100:2311-2323. [PMID: 33409622 DOI: 10.1007/s00277-020-04356-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 11/18/2020] [Indexed: 10/22/2022]
Abstract
Patients with multiple myeloma (MM) report high symptom burden and functional disabilities resulting in impaired health-related quality of life (HRQoL). Effective evidence-based rehabilitation guidelines are needed for patients with MM to improve HRQoL. The primary aim of this study was to investigate HRQoL in patients with rehabilitation needs living their everyday life. Patients with MM in remission attended a 12-week multidisciplinary rehabilitation program including a 5-day residential course, home-based exercise and a 2-day follow-up course. The patients were referred by the treating haematologist and completed a booklet of validated HRQoL questionnaires at baseline and before arriving for the 2-day follow-up course. The proportion of participants with moderate to severe symptoms and functional problems were assessed at the two time points and multivariate logistic regression was used to investigate explaining factors of impaired HRQoL at baseline. Ninety-two patients participated with a follow-up compliance rate of 90%. Median age was 67 years and median time since diagnosis was 26 months (ranged 5 months to 15.6 years). The most frequently reported symptoms were global quality of life, role functioning, fatigue, pain, peripheral neuropathy and physical functioning. Pain and fatigue were both highly coherent with impairment in physical functioning and those two symptoms explained most HRQoL impairments. Overall, the participants reported no change in HRQoL after the 12-week rehabilitation program. The study supports the need for an evidence-based guideline for rehabilitation and palliative care to patients with MM in remission living their everyday life.
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Affiliation(s)
- Lene Kongsgaard Nielsen
- Quality of Life Research Center, Department of Haematology, Odense University Hospital, Kløvervænget 10, 12. floor, 5000, Odense C, Denmark.
- Department of Internal Medicine and Cardiology, Regional Hospital Viborg, Viborg, Denmark.
| | - Rikke Faebo Larsen
- Department of Occupational Therapy and Physiotherapy, Zealand University Hospital, Koge, Denmark
- Department of Haematology, Odense University Hospital, Odense, Denmark
| | - Lene Jarlbaek
- REHPA - The Danish Knowlegde Centre for Rehabilitation and Palliative Care, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Sören Möller
- OPEN - Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Eva Jespersen
- REHPA - The Danish Knowlegde Centre for Rehabilitation and Palliative Care, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Rehabilitation, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
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Hinz A, Zenger M, Leuteritz K, Mehnert-Theuerkauf A, Petrowski K. Do patients suffering from chronic diseases retrospectively overestimate how healthy they were before they fell ill? Int J Clin Health Psychol 2021; 21:100230. [PMID: 33995538 PMCID: PMC8091885 DOI: 10.1016/j.ijchp.2021.100230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 03/08/2021] [Indexed: 11/29/2022] Open
Abstract
Background/Objective: To examine the impact of a disease on a person's subjective health state, patients are often asked to assess their current health state and to retrospectively assess how healthy they were before they fell ill. The objective of this study was to test whether patients generally overestimated the quality of their pre-disease health. Method: Six samples of patients with chronic diseases (cancer patients, cardiovascular patients, and patients diagnosed with sarcoidosis, N between 197 and 1,197) were analyzed. The patients assessed their current health states and their health states at the time before diagnosis. The retrospective scores were compared with matched data from general population studies. Results: In three of the six studies, the retrospective health ratings of the patients were significantly higher than the general population norms (effect sizes between 0.24 and 0.46), two studies yielded nonsignificant effects, and in one study there was an opposite trend. The general overestimation of pre-disease health was more pronounced in older patients as compared with younger ones, and it was more pronounced when global health/quality of life was to be assessed. Conclusions: Retrospective assessments of pre-disease health states are not appropriate for assessing disease-related changes in a person's health state.
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Affiliation(s)
- Andreas Hinz
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Germany
| | - Markus Zenger
- Department of Applied Human Studies, University of Applied Sciences Magdeburg-Stendal, Germany.,Integrated Research and Treatment Center Adiposity Diseases, University of Leipzig, Germany
| | - Katja Leuteritz
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Germany
| | | | - Katja Petrowski
- Medical Psychology and Medical Sociology, Department of Psychosomatic Medicine and Psychotherapy, University of Mainz, Germany
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Hinz A, Schulte T, Finck C, Gómez Y, Brähler E, Zenger M, Körner A, Tibubos AN. Psychometric evaluations of the Life Orientation Test-Revised (LOT-R), based on nine samples. Psychol Health 2021; 37:767-779. [PMID: 33754894 DOI: 10.1080/08870446.2021.1892111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE The aim of this study was to examine psychometric properties of the Life Orientation Test-Revised (LOT-R). DESIGN AND MAIN OUTCOME MEASURES The LOT-R was administered in five clinical samples, three samples of the adult general population, and one sample of adolescents. Seven of the studies were performed in Germany and two in Colombia. All of the sample sizes were above 300. RESULTS Cronbach's alpha coefficients were between .57 and .75 for the eight adult samples, the correlations between the scales optimism and pessimism ranged from -.05 to -.37, and the coefficients of temporal stability (test-retest correlations) of the scales ranged from .43 to .69. There were no systematic age and gender effects observed in the nine studies. While the one-factor model of confirmatory factor analyses showed clearly insufficient fit indices among all of the samples, the two-factor model fit was markedly better. CONCLUSIONS The LOT-R proved to be a suitable instrument for measuring dispositional optimism in patients and in the general population, though the sum score should be viewed with caution. Studies comparing the LOT-R mean scores of different samples need not take age and gender distributions into account.
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Affiliation(s)
- Andreas Hinz
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Thomas Schulte
- Rehabilitation Clinic Bad Oexen, Bad Oeynhausen, Germany
| | - Carolyn Finck
- Department of Psychology, Universidad de los Andes, Bogotá, Colombia
| | - Yvonne Gómez
- Department of Psychology, Universidad de los Andes, Bogotá, Colombia
| | - Elmar Brähler
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany.,Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Markus Zenger
- Department of Applied Human Studies, University of Applied Sciences Magdeburg-Stendal, Stendal, Germany.,Integrated Research and Treatment Center Adiposity Diseases, University of Leipzig, Leipzig, Germany
| | - Annett Körner
- Department of Educational and Counselling Psychology, McGill University, Montréal, Canada
| | - Ana-Nanette Tibubos
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
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Sulaiman SK, Aldersey HM, DePaul VG, Kaka B. Selection of a quality of life instrument for polio survivors in Northwest Nigeria. Health Qual Life Outcomes 2020; 18:309. [PMID: 32958050 PMCID: PMC7507732 DOI: 10.1186/s12955-020-01552-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 09/01/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND To generate high-quality evidence, contextually relevant outcome measurement instruments are required. Quality of life evaluation among polio survivors typically involves the use of generic instruments, which are developed and validated among a different groups of people. There is no clear evidence whether these instruments are appropriate for the measurement of quality of life among polio survivors in northwest Nigeria. The purpose of this review is to identify and select a pre-existing instrument that is best suited for the measurement of quality of life among polio survivors in northwest Nigeria. METHODS Using the findings of a previous scoping review of the literature and qualitative descriptive study, we screened 11 quality of life instruments that are used in polio literature. We identified and selected the most appropriate instrument, which reflected the perspectives of polio survivors in northwest Nigeria and at the same time exhibited good measurement properties. RESULTS The Quality of Life Index, World Health Organization Quality of Life Brief, and Comprehensive Quality of Life Scale are consistent with the perspectives of polio survivors in northwest Nigeria and have satisfactory measurement properties. Among these instruments, the Quality of Life Index satisfied most of the screening criteria we employed and is suitable for cross-cultural adaptation in northwest Nigeria. CONCLUSION Most instruments that are employed to evaluate the quality of life of polio survivors were not primarily designed as a measure of quality of life. To select the appropriate instrument, there is a need to consider and reflect the perspectives of the individuals, to improve the validity of the measurement.
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Affiliation(s)
- Surajo Kamilu Sulaiman
- School of Rehabilitation Therapy, Queen’s University, Louise D. Acton Building, 31 George Street, Kingston, Ontario K7L 3N6 Canada
- Department of Physiotherapy, Faculty of Allied Health Sciences, College of Health Sciences, Bayero University, Kano, PMB 3011 Nigeria
| | - Heather Michelle Aldersey
- School of Rehabilitation Therapy, Queen’s University, Louise D. Acton Building, 31 George Street, Kingston, Ontario K7L 3N6 Canada
| | - Vincent G. DePaul
- School of Rehabilitation Therapy, Queen’s University, Louise D. Acton Building, 31 George Street, Kingston, Ontario K7L 3N6 Canada
| | - Bashir Kaka
- Department of Physiotherapy, Faculty of Allied Health Sciences, College of Health Sciences, Bayero University, Kano, PMB 3011 Nigeria
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