Development and evaluation of a life review program for Chinese advanced cancer patients

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Development and evaluation of a life review program for Chinese advanced cancer patients

 

Author: Xiao, Huimin
Title: Development and evaluation of a life review program for Chinese advanced cancer patients
Degree: Ph.D.
Year: 2011
Subject: Cancer -- Patients -- Care.
Cancer -- Patients -- China -- Fuzhou Region (Fujian Sheng)
Cancer -- Palliative treatment.
Reminiscing.
Hong Kong Polytechnic University -- Dissertations
Department: School of Nursing
Pages: xix, 231, [25] p. : ill. ; 30 cm.
InnoPac Record: http://library.polyu.edu.hk/record=b2456249
URI: http://theses.lib.polyu.edu.hk/handle/200/6173
Abstract: Background: Empirical data have supported that a life review is an effective psycho-spiritual intervention, particularly with the elderly. However, no life review programs have been specifically designed for Chinese patients with advanced cancer and their views on the life review therefore remain unknown. Aim: This study aimed to develop a life review program for Chinese advanced cancer patients and test its effects on a sample of advanced cancer patients in Fuzhou, China. Method: There were two phases in this study. Phase one was the development of a life review program for Chinese advanced cancer patients. Based on Erikson's eight stages of psychosocial development, Confucian thoughts on human development, a previous study of this research team, and the literature, the program was designed, including reviewing a life and formulating a life review booklet. Phase two was the evaluation of this program with a randomized controlled trial design. Subjects were recruited from April 2009 to January 2010 in the Fujian Hospice. Eighty subjects were randomly assigned to the control and experimental groups. The subjects in the experimental group received the program, which was performed once a week for three weeks by the student researcher at the subjects' own homes. The QOL data measured by the Single Item Scale and the quality of life concerns in the end of life questionnaire, and assessed before the commencement of the program, immediately after , and three weeks after the completion of the program. The data about patients' perceptions of the program were collected through semi-structured interviews immediately after the program.
Results: In the ITT sample, the patients in the experimental group demonstrated: (1) a significant improvement in the within-group, between-group, and interaction effects on overall QOL (F=32.881, P=0.000; F=52.615, P=0.000; F=40.555, P=0.000, respectively), negative emotions (F=9.987, P=0.000; F=8.683, P=0.000; F=20.033, P=0.000, respectively), existential distress (F=21.243, P=0.000; F=14.301, P=0.000; F=17.447, P=0.000, respectively), and value of life (F=9.344, P=0.000; F=68.218, P=0.000; F=117.227, P=0.000, respectively); (2) a significant increase in support in the interaction effects (F=6.330, P=0.003); (3) a significant improvement in healthcare concerns in the within-group (F=5.561, P=0.005) and between-group effect (F=4.766, P=0.032); and (4) a significant decline in sense of alienation in the between-group (F=9.191, P=0.003) and interaction effects (F=9.118, P=0.000). The patients in the improved group perceived that the life review program helped them accept one's unique life, have feelings of emotional relief, achieve a sense of meaning in life, leave a personal legacy, and make future orientations. The perceptions of patients in the unchanged group were of struggling between accomplished tasks and unresolved conflicts; enhancing mood, leaving a generativity booklet, and feeling difficulty in reviewing a life due to uncontrolled physical discomfort. The perceptions of patients in the decreased group involved being overwhelmed with negative feelings of encountering a painful life, and failing to freely share life experiences due to the presence of family members during the interviews. Conclusion: This study is a pioneer research project to develop a life review program for Chinese advanced cancer patients and test its effects in the context of China with a randomized controlled trial. The program not only provides Chinese nurses with a new approach to meeting the unique needs of patients approaching death, but also poses a challenge to customary beliefs about death. The program can be either used or modified as routine care for Chinese advanced cancer patients to enhance their QOL, particularly psycho-spiritual well-being. However, nurses should realize that physical discomfort, painful life experiences, and the presence of family members may interfere with the impact of the life review program.

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