Effects of a nursing intervention program on disabled patients and their caregivers.

This study evaluated a continuous home-visiting program designed for disabled patients. An intervention program was also designed for caregivers that included education and disabled care skills training, and emotional support over a 22-week period. The criteria for the disabled patients were as follows: (1) aged 18 years or older, (2) Barthel activity of daily living (ADL) score of <80 on the first visit, and (3) onset of disability prior to study was less than 2 years. A total of 126 participants were transferred from several hospitals to the community to be cared for by caregivers. Patients were divided into two groups: control group (n=56), and intervention group (n=70). In the control group, caregivers were not provided with any special training and patients were just evaluated at the beginning and end of the program. In the intervention group, caregivers were given intensive training in care for the disabled and completed eight home-visits. The outcomes were measured before and after program using Barthel ADL index, life satisfaction scale (LSS) and caregiver's burnout scale (CBS). The results showed that improvements in ADL, LSS and CBS were significantly greater in the intervention group, compared to the control group. Multiple linear regression models showed that improvements in ADL were higher among patients with early-stage (onset of disability was less than 6 months before the start of the program) disability, patients whose caregivers had good health status, patients in the intervention group and patients who received more daily care hours. For LSS, there was a negative correlation with change in CBS and financial burden. In conclusion, the intervention program significantly improved disabled patients' ADL scores, as well as caregivers' LSS and CBS scores. It is necessary to coordinate medical and public health resources in the community to provide disabled patients and their caregivers with specific training and caregiving skills.

Patient and clinical variables account for changes in health- related quality of life and symptom burden as treatment outcomes in colorectal cancer: a longitudinal study.

OBJECTIVE: The aim of the current study was to evaluate changes in treatment outcomes in terms of health- related quality of life (HRQoL) and symptom burden at zero, one, three, and six months after an initial diagnosis of colorectal cancer. The demographic and clinical characteristics that account for outcome changes in patients were investigated using a repeated measures framework. METHODS AND MATERIALS: A cohort study was performed of 134 colorectal cancer patients followed from diagnosis to 6 months post-treatment in Central Taiwan. HRQoL and symptoms were assessed at diagnosis and one, three, and six months thereafter. The Functional Assessment of Cancer Therapy-Colon (FACT-C) questionnaire, VAS pain, and the Memorial Symptom Assessment Scale (MSAS) were used for data collection. A generalized estimating equation (GEE) was applied for statistical analysis. RESULTS: The majority of the patients were male (55%) and married (91.5%). The mean age was 60.4 years (SD = 11.71). Most were diagnosed stage III and IV colorectal cancer (54.5%). All underwent surgery; some also received chemotherapy (CT) or concurrent chemoradiation therapy (CCRT). The results of the GEE showed that overall, the HRQoL, pain, and symptoms of the patients significantly improved over the treatment period. Patients with stage IV disease who had received surgery and CCRT showed the worst HRQoL. Females, patients with comorbidity, and stage IV patients had higher pain scores over time. Female and stage IV patients had more severe physical symptoms, whereas stage II and IV patients had worse psychological symptoms over time. CONCLUSION: The patients' HRQoL, pain, and symptoms significantly improved over the 6-month treatment period. Certain patient and clinical variables accounted for changes in treatment outcomes regarding HRQoL and symptom burden in colorectal cancer patients.