Physical and psychosocial functioning in patients undergoing autologous bone marrow transplantation--a prospective study.

The main purpose of this study was to evaluate prospectively physical and psychosocial functioning in patients with malignant blood disorders undergoing autologous bone marrow transplantation (ABMT), and relate the findings to the patients' coping capacity. Twenty patients participated in the study before ABMT, 14 survivors at the 2-6 month follow-up and 12 at the 8-12 month follow-up. Three standardized questionnaires were used: the EORTC QLQ-C30, the Hospital Anxiety and Depression (HAD) scale and the Sense of Coherence scale. No significant changes over time were found in the scores of the QLQ-C30 and HAD. Impaired social function, fatigue, dyspnea, financial problems and emotional distress were the most frequently reported deficits. Functional limitations were related to less successful coping. The results indicate that the patients in this study perceive their physical and psychosocial functioning as rather good before, as well as up to 1 year after the ABMT, as measured with the instruments used.

Patients' subjective evaluations of quality of life related to disease-specific symptoms, sense of coherence, and treatment in Ménière's disease.

OBJECTIVE: To evaluate the self-rated quality of life associated with vertigo, hearing loss, and tinnitus in Ménière's patients, and to identify potential relationships between these findings, treatment regimens, and sense of coherence in comparison to the classification of the American Academy of Otolaryngology-Head and Neck Surgery (AAO/HNS). STUDY DESIGN: Cross-sectional. SETTING: Tertiary referral hospital centers. PATIENTS: 112 patients with Méniére's disease, who had undergone endolymphatic sac surgery or intratympanic gentamicin injections, or were surgically untreated. MAIN OUTCOME MEASURE: Questionnaires concerning quality of life aspects and symptom-specific instruments: the Vertigo Symptom Scale (VSS), the Hearing Disability Handicap scale (HDHS), the Tinnitus Severity Questionnaire (TSQ), the AAO/HNS criteria for reporting results of treatment of Ménière's disease, and the Sense of Coherence Scale. RESULTS: A majority of the patients reported their quality of life in general as very good or good. There was no difference in general quality of life, present hearing loss, or tinnitus between the three treatment groups, but the gentamicin-treated patients had less vertigo than did the other groups. Sense of coherence showed a strong correlation to reported quality of life in all measurements. CONCLUSIONS: Even though the gentamicin-treated patients had less vertigo, no difference in overall quality of life was found between the surgically treated and untreated patients. The sense of coherence seems to be an important factor in the patient's experience of quality of life. Quality of life instruments can measure both specific symptoms and related aspects on quality of life and may give complementary information to the AAO/HNS classification in evaluating the treatment of patients with Ménière's disease.

Oral- and pharyngeal-cancer patients' perceived symptoms and health.

The purpose of this study was to describe the perceived eating problems, general symptoms, and general health of a group of oral- and pharyngeal- cancer patients before surgery in order to facilitate nursing care planning. A total of 29 patients (20 men and nine women) participated. Two groups were formed: in group 1, 13 patients participated before and, in group 2, 16 patients participated after the presurgical radiotherapy. Questionnaires were used to collect data. Eating disabilities were evident in both groups. The patients who had had their radiation therapy experienced problems such as bad taste function, mouth dryness, difficulties in chewing, and mouth pain more frequently than those who had not been treated. Only five patients in group 2 ate solid food, compared with 10 in group 1. Shoulder and back pain and feelings of worry and anxiety were perceived as the most frequent general symptoms. Most of the patients perceived their general health as being rather good, but some indicated poor health, several symptoms, poor appetite, and/or severe eating problems. Patients with oral and pharyngeal cancer should be carefully assessed before surgery because of their disparity of symptoms and disabilities so as to identify those who need specific nursing interventions.

[Salutogenic model and utilization of the KASAM form (Sense of Coherence) in nursing research--a methodological report]. / Den salutogena modellen och användning av KASAM-formuläret i omvårdnadsforskningen metodredovisning.

This paper presents psychometrical properties of the Swedish version of the Sense of Coherence (SOC) scale. The concept sense of coherence is proposed to explain successful coping with stressors and as being a stable trait of the individual. The stronger the SOC, the more successful coping and the more likely one is to have better health and quality of life. The data in this study has been obtained from five groups of healthy individuals and eight patient groups. The scores of the SOC scale did not change over time when studied after two, 12 and 18 months respectively. Weaker sense coherence was correlated to more self-rated anxiety, functional limitations especially those of a psychosocial character, and severe perception of symptoms, and to worse self-rated general health, and less motivation. It is suggested that the SOC scale could be of clinical use in assessing the need for nursing care.

Coping ability and functional status in a Swedish population sample.

The paper presents reference values of the questionnaires Sense of Coherence scale (SOC), measuring self-rated prerequisite for coping ability, and Sickness Impact Profile (SIP), measuring self-rated functional status. The sample used is randomly selected from a Swedish urban population consisting of 145 individuals (75 women, 70 men), divided into three age groups, 26-40, 41-55 and 56-70 years. The mean SOC score was 151 (SD 18) and was not related to gender or age. The total SIP score was low (median 0) as expected in a general population. However, again as expected, the results revealed the functional status being worse in the older group of individuals than in the younger ones. The results might give further validity to the test. The SOC scores were significantly correlated to the overall SIP scores and to the subscales of mental and social character and not to those of a physical nature. Thus, the weaker the SOC the worse the functional status. These findings are suggested to give the Sense of Coherence scale a discriminating validity. A single item concerning general health was also rated by the individuals showing the better the general health the stronger the SOC and the less the dysfunction.

The applicability of the Antonovsky Sense of Coherence Scale to a group of Pentecostalists.

A methodological issue concerning the Antonovsky of Sense of Coherence (SOC) scale was raised in an earlier study questioning the applicability of the scale in different populations, and among these the Pentecostalists. The question was raised when a group of Pentecostalists had had difficulties in filling in another scale intended to measure the SOC. Therefore, the aim of this study was to test the applicability of the 29-item Antonovsky SOC scale in a group of people (n = 37) belonging to a church of the Pentecostal Movement and to compare the results with those of a randomized group (n = 145) from a general population. The Pentecostalists filled in the scale with no obvious difficulties. No significant differences were found between the Pentecostal group and the group of a general population regarding the total SOC scale scores (mean 152, SD 16 and mean 151, SD 18, respectively). The applicability difficulties found in the earlier study, however using an other SOC scale, could not be confirmed in the present study. To conclude, the Antonovsky SOC scale has so far not shown to have applicability weakness.

The sense of coherence concept and its relation to personality traits in Swedish samples.

The paper proposes that Antonovsky's salutogenic orientation and his sense of coherence (SOC) concept provide a sound theoretical basis for the study and strengthening of the caring component in clinical practice. In order to study the operational utility of the concept, the 29-item SOC questionnaire (in two formats) was administered to five Swedish samples (3 groups of nurses, patients in a hospital emergency department, and a general population sample). Psychometric data are provided which test the internal and test-retest reliability of the SOC scale. A Self-Motivation Inventory (SMI) and the Karolinska Scales of Personality (KSP) were used to test the relation between the SOC concept and personality traits. The results revealed that those with strong SOC also scored as having more general motivation and less Somatic and Psychic Anxiety as well as less Hostility. In addition the data, though in some part modest in sample size, consistently supported the view that the SOC scale is a robust instrument. Particular note is taken of its crosscultural character and of its potential utility in clinical work.

Well-being and coping in oral and pharyngeal cancer patients.

Patients with oral and pharyngeal cancer often suffer serious functional impairments. To achieve a broader understanding of the patients' situation it is important to include their appraisal of present functioning. There may also be other factors of importance in the evaluation of well-being such as personality and coping. 42 patients with oral and pharyngeal cancer answered the Oral and Pharyngeal Nursing Care Questionnaires 12 months after treatment. The questionnaires contain 25 conditions (grouped as Therapy- or Psychosocial-related Conditions) from three perspectives: perceived severity, received support and received information. Other questionnaires included in the study were the Sense of Coherence Scale, Somatic Anxiety Scale (from the Karolinska Scale of Personality) and Health Index. The patients were classified with regard to the extensiveness of their surgery. Severe disturbances related to therapy were significantly correlated to weaker sense of coherence (r = -0.34), more anxiety (r = 0.31) and to worse feelings about general health (r = -0.37). The corresponding data with regard to severe disturbances related to psychosocial situation were r = -0.44, 0.52 and -0.65, respectively. There was no significant correlation between perceived severity and surgical extensiveness. The support and information concerning Psychosocial-related Conditions were evaluated as less than those concerning Therapy-related Conditions. The level of support and information was not significantly correlated to sense of coherence, anxiety, general health or surgical procedure. The patient's subjective appraisal of the seriousness of the circumstances connected with oral and pharyngeal cancer and its treatment is an important parameter in the care of these patients.

Dizziness symptom severity and impact on daily living as perceived by patients suffering from peripheral vestibular disorder.

The purpose of this study was to describe quality-of-life aspects in a group of patients (n = 99) suffering from peripheral vestibular disorder, using three different self-rated instruments, the Vertigo Symptom Scale (VSS), the Vertigo Handicap Questionnaire (VHQ) and the Sickness Impact Profile (SIP). The results showed that the type of dizziness that most influenced the quality-of-life aspects were: frequent short- or long-term dizziness, nausea, and the feeling that the ground was distant or as though the patient were walking on clouds. However, several of the impairments in daily life were neither related to the disease itself nor the demographic data. This verifies the necessity of investigating other factors such as personality and coping capacity. The results of this study also demonstrate the patients' need of psychosocial support. A comprehensive assessment and evaluation is important in order to identify each patient's needs.

The sense of coherence: a tool for evaluating patients with peripheral vestibular disorders.

Peripheral vestibular disorders may result in physical as well as psychosocial dysfunction. Such a situation demands a capacity to cope which lately has been discussed as an important factor in the health outcome. Antonovsky has described the concept of sense of coherence (SOC) as such a trait and has developed a questionnaire (the SOC Scale) to measure it. The aim of this study was to describe the patients' self-rated degree of SOC and to set this in relation to their perception of the self-rated quality of life. The results showed that patients with a strong SOC scored statistically less self-rated handicap, less emotional distress, less impact on working capacity and sleep and rest and less psychosocial dysfunction than those with weak SOC scores. It is suggested that the SOC Scale may serve as a tool to identify patients who are at risk of poorer quality of life and in need of supportive care.

Treatment decision-making and its relation to the sense of coherence and the meaning of the disease in a group of patients with colorectal cancer.

UNLABELLED: The aims of the present study were to describe the preferred and the actual participating roles in treatment decision-making in relation to patients with newly diagnosed, colorectal cancer and to relate this result to the sociodemographic data, the Sense of Coherence Scale (SOC) and the patients' meaning of the disease. Eighty-six patients were studied. The following instruments were used: the Control Preferences Scale (CPS); the eight Lipowski categories of the meaning of the disease (LCMD); and the SOC. The results showed that 62% of the patients preferred a collaborative role and 28% a passive role in treatment decision-making. Agreement between the preferred and the actual participating roles was achieved by 44% of the patients. Seventy-one per cent of the patients showed an optimistic understanding of their disease. The mean SOC score was 150. There was no statistically significant difference between the CPS groups as regarded the sociodemographic data, the SOC and the LCMD. CONCLUSION: Sociodemographic data, the perceived meaning of the disease as well as the patients' sense of coherence were not related to the decision-making preferences in the investigated group of patients. Therefore, further investigations are needed to get an understanding of influencing factors of the decision-making preferences.

Functional status and coping in patients with oral and pharyngeal cancer before and after surgery.

BACKGROUND: Few studies, prospective or retrospective, exist that describe the quality of life of patients with oral or pharyngeal cancer. This study describes functional status, measured by the sickness impact profile (SIP), and coping, measured by the sense of coherence (SOC) scale, in a group of patients treated by surgery for oral or pharyngeal cancer. METHODS: Forty-two patients, divided into two groups, participated in the study. Twenty-seven patients completed SIP and SOC scale 12 months after treatment (the 12-month follow-up group), and 15 patients completed SIP and SOC scale before surgery and SIP 2-4 months and 12 months after treatment (the prospective group). The patients were also classified according to the extensiveness of their surgery: minor, moderate, or major. RESULTS: The psychosocial and physical functioning as well as the functions of recreation/pastimes, sleep/rest, home management, work, and eating were rated as being impaired 2-4 months and also 12 months after treatment. However, the obtained values were spread over a wide range, with large individual differences. Functional limitations were related to more extensive surgery and also to less successful coping. CONCLUSION: This study reveals the need of individualized rehabilitation for these patients, and that the SIP and the SOC scale may serve as evaluation tools in a rehabilitation program.

Two models of care as evaluated by a group of women operated on for breast cancer with regard to their perceived well-being.

The main aim of this study was to evaluate two different models of care for breast cancer patients with regard to the patients' perceived well-being. Twenty-nine patients were treated in an established care model and 115 patients were treated at a surgical breast clinic with an increased personnel continuity and a short hospital stay. Two questionnaires were used. The Sense of Coherence (SOC) Scale and a study-specific questionnaire concerning perceptions of the hospital stay, information received, body image, social support, pain, health and psycho-sociological well-being. Regression analyses were used to study the effects of the care models and the SOC on the patients' perceived well-being. The results showed that the care model with high personnel continuity had a significant positive effect on the patients' emotional state, mental well-being and perception of postoperative pain evaluated 1 year after surgery. The strongest predictors of the patients' well-being postoperatively were their perceived well-being before surgery. Furthermore, the stronger the SOC the more positive were the patients' emotional perceptions, perceived general health and mental well-being after surgery. The duration of the hospital stay did not show any effect on the patients' well-being. It is concluded that an early preoperative psycho-social assessment of the patients is of importance in planning the care, to help patients cope with the disease and its treatment. It is suggested that a care model with high personnel continuity for breast cancer patients could facilitate that assessment.

Post-traumatic stress symptoms in patients undergoing autologous stem cell transplantation.

The aim of this explorative study was prospectively to evaluate the presence of post-traumatic stress symptoms (PTSS) in patients with hematological malignant disorders undergoing autologous stem cell transplantation (ASCT). The findings were related to sense of coherence and quality of life aspects. Twenty patients were evaluated with four standardized instruments before undergoing ASCT and then at two follow-ups. The patients participating in the study reported PTSS levels high enough to merit attention. Although PTSS declined over time, the levels were still high compared with other studied populations of cancer patients. Intrusive and avoidant symptoms correlated significantly to anxiety and depression but not to sense of coherence and physical dimensions. The high levels of PTSS and their relation to emotional distress emphasize the importance of psychosocial care for this group of patients.

Indicators of changes in weight and eating behaviour in severely obese patients treated in a nursing behavioural program.

To assess some possible reasons for the changes of weight and eating behaviour at a one year follow up in 33 severely obese subjects (mean BMI, 39.9 s.d. 5.2) treated in a nursing behavioural-treatment program, three instruments were used; the Self Motivation Inventory (SMI), the Sense of Coherence Scale (SOC) and the Karolinska Scales of Personality (KSP). The Three Factor Eating Questionnaire (EI) measuring restrained eating, disinhibition and hunger, was used to register the change of eating behaviour. The weight lost at the one year follow-up was significantly (P < .01) correlated to the restrained eating score at the time for the follow-up as well as to the difference value (P < .01) of the restraint score before and one year after treatment and to the number of participated booster sessions (P < .05). The SMI score, as measured before treatment, correlated significantly to all the EI subscales scores at the one-year follow-up (P < .05, P < .01, P < .01). Thus, the greater the self motivation, the more restraint and the less disinhibition and hunger. In turn, the SOC score correlated significantly (P < .01) to the SMI score. Thus, the stronger the sense of coherence, the more perceived self-motivation. Finally, there was a significant negative correlation between the KSP subscales Somatic Anxiety (P < .01), Muscular Tension (P < .05), Psychic Anxiety (P < .001), Psychasthenia (P < .01), Hostility (P < .001), and Inhibition of Aggression (P < .001) and a positive correlation between Socialization (P < .05) and the SOC score.(ABSTRACT TRUNCATED AT 250 WORDS)