| 1. |
- Hagelin, Carina Lundh, et al.
(författare)
-
Nurses' experiences of clinical use of a quality of life instrument in palliative care
- 2007
-
Ingår i: Contemporary Nurse. - : Informa UK Limited. - 1037-6178 .- 1839-3535. ; 27:1, s. 29-38
-
Tidskriftsartikel (refereegranskat)abstract
- This pilot study explored how nursing staff experienced clinical use of a quality of life (QoL) instrument as complement to their standard assessment interview. Twenty-six of 36 Registered Nurses working in one palliative care service responded in writing to six open questions. We found that nurses described Positive features in using the QoL instrument related to how it supported their professional role, eased therapeutic contact with patients, and in terms of the outcomes of its use. Others noted difficulties incorporating the tool into the framework of their traditional nursing assessment, noting instrument and situation-specific limitations, with attitudes and comfort with the questionnaire affecting its use. Clinical use of QoL tools may be facilitated by emphasizing their role as a first screening assessment, and acknowledging and supporting the importance of clinical expertise and the patient-nurse relationship in further more focussed assessments and nursing care.
|
|
| 2. |
- Hagelin, Carina Lundh, et al.
(författare)
-
The psychometric properties of the Swedish multidimensional fatigue inventory MFI-20 in four different populations
- 2007
-
Ingår i: Acta Oncologica. - : Informa UK Limited. - 0284-186X .- 1651-226X. ; 46:1, s. 97-104
-
Tidskriftsartikel (refereegranskat)abstract
- The Multidimensional Fatigue Inventory (MFI-20) scale is widely used for measuring fatigue in cancer care. This questionnaire has been translated into Swedish and used in Swedish cancer populations, and the aim of this study was to test the validity and reliability of the Swedish version in four populations, with a total of 584 patients. The participants were classified into four groups: palliative cancer patients, cancer patients receiving radiation therapy, non-cancer outpatients, and a group of hospital staff. The MFI-20 consists of five subscales of fatigue: General Fatigue (GF), Physical Fatigue (PF), Reduced Motivation (RM), Reduced Activity (RA) and Mental Fatigue (MF). We have tested the convergent validity of the MFI-20 using the Category Ratio instrument (CR-10). The validity and the reliability of MFI-20 were acceptable. All subscales of the MFI-20 were correlated, and all were also correlated with the CR-10 score (p <= 0.001). General Fatigue was highly correlated with Physical Fatigue for the three patient groups, but this was not the fact for healthy staff. Deleting some items increased Cronbach's alpha of the subscale to which these items belonged (where alpha measures the reliability of the results). The level of non-response was low (less than 1.2%) and there was no pattern to the items omitted. We conclude that the MFI-20 is a valid and reliable instrument for measuring fatigue in patients and in healthy individuals. The results support, to some extent, earlier findings and one item can be removed from the Swedish version of the MFI-20.
|
|
| 3. |
- Lundh Hagelin, Carina, et al.
(författare)
-
Fatigue dimensions in patients with advanced cancer in relation to time of survival and quality of life
- 2009
-
Ingår i: Palliative Medicine. - : SAGE Publications. - 0269-2163 .- 1477-030X. ; 23:2, s. 171-178
-
Tidskriftsartikel (refereegranskat)abstract
- To understand the relation between fatigue and patients emotional situation at the end of life, this cross-sectional study aimed to explore the association between multidimensional aspects of fatigue, emotional functioning and quality of life (QoL) in patients with advanced cancer at the end of life. Patients with advanced cancer answered fatigue related measurements (Borg Category Ratio-10 scale, Multidimensional Fatigue Inventory-20, Swedish Occupational Fatigue Inventory and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30), when admitted for specialised palliative care. A total of 228 patients with a median length of survival of 63 days were included. In relation to time of survival, fatigue increased closer to death, in both global and multidimensional aspects, as well as the patient's experience of being sleepy. Marital status was found to affect the experience of fatigue in both global and multidimensional ratings of fatigue. The association between the experience of fatigue and feelings of being tense, worried, irritable or depressed and rated QoL decreased and was not evident closer to death. Fatigue in all dimensions increased, as patients got closer to death. The association between fatigue and both QoL and negative emotions faded away during the last days and weeks of life. Palliative Medicine (2009); 23: 171-178
|
|
| 4. |
- Lundh Hagelin, Carina
(författare)
-
Fatigue in patients with advanced cancer : aspects of assessment and measurements
- 2008
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Symptoms are very common in patients with advanced cancer, with weakness, fatigue, anorexia, pain, and depression reported as the most common and distressing ones. A core issue in palliative care is to provide relief of symptoms, and to be able to do this satisfactory there is still much to be known about symptom aetiology, prevalence, character and measurement. In this thesis, focus is on fatigue in patients with advanced cancer. Although fatigue is recognised to affect patients during the whole cancer trajectory, few studies have included and compared individuals at different stages of cancer from early treatment to the end of life. The primary aim was to advance knowledge of fatigue in patients with advanced cancer, by exploring to what extent and in what ways these patients experience fatigue, and to investigate aspects of assessment and measurement of fatigue. Both quantitative and qualitative methods have been used. Patients with advanced cancer (paper I-IV), patients receiving curative radiotherapy (Paper II, III), patients visiting a medical outpatient clinic (Paper II), healthy individuals (health care staff, Paper II) and registered nurses at a specialized palliative care facility (Paper V), participated in the different studies. In all studies the participants responded to different self-reporting questionnaires, the quantitative data were analysed with descriptive and parametric statistical methods, the qualitative data was explorative using an interpretive descriptive analysis. The results indicate that patient with advanced cancer experienced fatigue more intensively than did patients earlier in the cancer trajectory, receiving curative cancer therapy. Our results confirm the multidimensionality of fatigue in patients with cancer. At different stages fatigue was most often experienced as a bodily sensation: as an overall feeling of tiredness, tiring easily, not feeling fit or rested, and lack of energy. Mental aspects of fatigue including ability to concentrate, making plans and do things had less of an impact. Being married or cohabiting was found to be related to higher levels of reported fatigue, which contradicts earlier findings. Forty-four percent of the patients with advanced cancer could be classified as depressed, as compared to about 17% of the patients receiving radiotherapy. There is a common agreement that fatigue negatively influences quality of life. It was shown that the relationship between fatigue and emotional functioning, and with quality of life, varies during the palliative care trajectory, and that the relation decreases in the last month of life. This may reflect that other symptoms and aspects of life become more important when patients are getting closer to death. These correlations were strongest for the group of patients who lived between 61 to 120 days. These findings may be interpreted that the fatigue experience may change at the end of life. We have shown clinical difficulties in making an assessment of quality of life and fatigue with a standardised measurement. This reflects the difficulties to perform these procedures both clinically and for research purposes in palliative care. However, this thesis also demonstrates that fatigue specific instruments are helpful in assessment of fatigue and that patients were able to answer different instruments even very close to death. Future research about fatigue is needed in this group of frail patients comprising physical, psychological, social and existential aspects of fatigue, as well as changes and meaning of fatigue over time.
|
|
| 5. |
- Lundh Hagelin, Carina, et al.
(författare)
-
Patterns of fatigue related to advanced disease and radiotherapy in patients with cancer : a comparative cross-sectional study of fatigue intensity and characteristics
- 2009
-
Ingår i: Supportive Care in Cancer. - : Springer Science and Business Media LLC. - 0941-4355 .- 1433-7339. ; 17:5, s. 519-526
-
Tidskriftsartikel (refereegranskat)abstract
- This cross-sectional comparative study was designed to explore and describe the prevalence and patterns of cancer-related fatigue in patients with advanced cancer as well as patients undergoing curative radiotherapy. Another aim was to explore the association of anxiety and depression with fatigue. Patients with an advanced stage of disease (n = 228) and patients receiving radiotherapy (n = 81) completed the Borg Category Ratio Scale, the Multidimensional Fatigue Inventory and the Hospital Anxiety and Depression Scale. Patients with advanced disease had an increased probability of experiencing all aspects of fatigue except for mental fatigue as compared to patients undergoing radiation, e.g., odds ratio 11.5 (CI 5.8-22.7) for physical fatigue. Higher scores for depression than for anxiety were reported when patients had high levels of fatigue, with 23% of the patients classified as anxious and 39% depressed. The present study was carried out in order to address a gap in research by comparing the multidimensional aspects of fatigue in different groups of cancer patients. It is the intensity of fatigue that seems to be related to the underlying exposure to radiation or to the level of disease burden rather than the different fatigue profiles, such as the relation between physical and mental aspects.
|
|
| 6. |
- Lundh Hagelin, Carina, et al.
(författare)
-
Quality of life in terminal care--with special reference to age, gender and marital status.
- 2006
-
Ingår i: Supportive Care in Cancer. - : Springer Science and Business Media LLC. - 0941-4355 .- 1433-7339. ; 14:4, s. 320-8
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: This study was conducted to explore symptoms, other quality of life (QoL) aspects and impact of age, gender, marital status, cancer diagnosis and time of survival in patients with advanced cancer admitted to palliative care.PATIENTS AND METHODS: A cross-sectional study of 278 cancer patients completing the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 at referral to palliative care.MAIN RESULTS: Gynaecological and gastro-intestinal tract cancers were the most common. Mean age was 67 years; 62% were female. Median survival was 43 days and 39% lived less than 30 days. Patients reported impaired general QoL and high occurrence of symptoms (44 and 100% for diarrhoea and fatigue, respectively). Fatigue, appetite loss and dyspnoea were reported as most severe (mean values of 80, 59 and 51, respectively, 0-100 scales). Married/cohabiting patients and younger patients reported lower functional abilities and more symptoms. No impact of diagnoses on QoL parameters was found. Patients closest to death did not differ significantly from those with longer time to live in social functioning.CONCLUSION: Young and married patients may be at higher risk for perceived low quality of life at the end of life. EORTC QLQ-C30 could be used as a clinical tool for screening of symptoms and reduced functioning in palliative care, but may not be appropriate for use in the most severely ill patients. Limitations of the instrument and the need for robust measurements of patient mix are discussed. Proxy ratings of physical symptoms and nurse responsibility to include QoL assessment in daily practice would increase attrition and decrease selection bias.
|
|
