The Nurse's Relationship-Based Perceptions of Patient Quality of Life
Purpose/Objectives: To explore patients' quality of life (QOL) as defined by RNs in adult and pediatric oncology settings and to examine, from the perspectives of clinical nurses, the knowledge that is needed to apply QOL research outcomes in clinical practice.
Design: Qualitative research design using a focus group technique to explore the research questions.
Setting: Three sites (i.e., a pediatric research center in western Tennessee and oncology nurses from a chapter of the Oncology Nursing Society (ONS) in Central Florida and another in upstate New York).
Sample: 24 oncology nurses working with adult or pediatric patients or both.
Methods: Oncology nurses were approached at work or through their local ONS chapters for a focus group discussion.
Findings: 47 unique themes were reported by all five focus groups in response to three questions. The most frequently reported themes were (a) Using the Patient's Standard, (b) Nursing Strategies, (c) Differences Decrease QOL Care, (d) Maintaining Social Interests, (e) Insightful Relations With Patient, and (f) Nurse-Patient Communication.
Conclusions: Nurses' assessments of QOL primarily are based on their established relationships with their patients. From these relationships, nurses derive perceptions of patients' QOL and clinical direction for interventions to positively influence QOL. Based on these findings, the investigators developed a conceptual model of the nurses' relationship-based perceptions of patients' QOL.
Implications for Nursing: The current QOL measures have minimal importance to nurse clinicians. Because nurse clinicians rely on their relationships with patients to assess QOL, available tools should be made more clinically useful. Further research should be conducted using the new conceptual model, specifically to learn more about how nurses complete a QOL assessment within the context of the nurse-patient relationship.
Aaronson, N.K. (1986). Methodological issues in psychosocial oncology with special reference to clinical trials. In V. Ventafridda, F. van Dam, R. Yancik, & M. Tamburini (Eds.), <i>Assessment of quality of life and cancer treatment</i> (pp. 29-41). Amsterdam: Excerpta Medica.
Carr, A.J., & Higginson, I.J. (2001). Are quality of life measures patient centered? <i>BMJ</i>, 322, 1357-1360.
Cella, D.F., & Cherin, E.A. (1987). Measuring quality of life in patients with cancer. In <i>Proceedings of the American Cancer Society fifth national conference on human values and cancer</i> (pp. 23-31). Atlanta, GA: American Cancer Society.
Cella, D.F., & Tulsky, D.S. (1990). Measuring quality of life today: Methodological aspects. <i>Oncology</i>, 4(5), 29-38.
Churchill, D.N., Torrance, G.W., Taylor, D.W., Barnes, C.C., Ludwin, D., Shimizu, A., et al. (1987). Measurement of quality of life in end-stage renal disease: The time trade-off approach. <i>Clinical Investigative Medicine</i>, 10, 14-20.
Dow, K.H., Ferrell, B.R., Haberman, M.R., & Eaton, L. (1999). The meaning of quality of life in cancer survivorship. <i>Oncology Nursing Forum</i>, 26, 519-528.
Ferrans, C., & Powers, M. (1985). Quality of life index: Development and psychometric properties. <i>Advances in Nursing Science</i>, 8(1), 15-24.
Ferrans, C.E. (2000). Quality of life as an outcome of cancer care. In C.H. Yarbro, M. Goodman, M.H. Frogge, & S.L. Groenwald (Eds.), <i>Cancer nursing: Principles and practice</i> (5th ed., pp. 243-258). Boston: Jones and Bartlett.
Ferrell, B.R., & Dow, K.H. (1996). Portraits of cancer survivorship: A glimpse through the lens of survivors' eyes. <i>Cancer Practice</i>, 4, 76-80.
Ferrell, B.R., Dow, K.H., Leigh, S., Ly, J., & Gulasekaram, P. (1995). Quality of life in long-term cancer survivors. <i>Oncology Nursing Forum</i>, 22, 915-922.
Fitch, M.I. (1998). Quality of life in oncology: Nurses' perceptions, values and behaviors. <i>Canadian Oncology Nursing</i>, 8(1), 24-39.
Hinds, P.S. (1990). Quality of life in children and adolescents with cancer. <i>Seminars in Oncology Nursing</i>, 6, 285-291.
Keith, K., & Schalock, R. (1994). The measurement of quality of life in adolescence: The quality of student life questionnaire. <i>American Journal of Family Therapy</i>, 22(1), 83-87.
King, C.R., Ferrell, B.R., Grant, M., & Sakurai, C. (1995). Nurses' perceptions of the meaning of quality of life for bone marrow transplant survivors. <i>Cancer Nursing</i>, 18, 118-129.
King, C.R., Haberman, M., Berry, D.L., Bush, N., Butler, L., Dow, K.H., et al. (1997). Quality of life and the cancer experience: The state-of-the-knowledge. <i>Oncology Nursing Forum</i>, 24, 27-41.
King, C.R., & Hinds, P.S. (1998). <i>Quality of life: From nursing and patient perspectives: Theory, research, practice.</i> Boston: Jones and Bartlett.
Krueger, R.A. (1994). <i>Focus groups: A practical guide for applied research</i> (2nd ed.). Thousand Oaks, CA: Sage.
Lindley, C.M., & Hirsch, J.D. (1994). Oncology nurses' attitudes, perceptions, and knowledge of quality-of-life assessments in patients with cancer. <i>Oncology Nursing Forum</i>, 21, 103-108.
Newell, S., Sanson-Fisher, R.W., Girgis, A., & Bonaventura, A. (1998). How well do medical oncologists' perceptions reflect their patients' reported physical and psychological problems? <i>Cancer</i>, 83, 1640-1651.
Osoba, D. (1994). Lessons learned from measuring health-related quality of life in oncology. <i>Journal of Clinical Oncology</i>, 12, 608-616.
Schipper, H., & Levitt, M. (1985). Measuring quality of life: Risks and benefits. <i>Cancer Treatment</i>, 69, 1115-1123.
Slevin, M.L., Plant, H., Lynch, D., Drinkwater, J., & Gregory, W.M. (1988). Who should measure quality of life, the doctor or the patient? <i>British Journal of Cancer</i>, 57, 109-112.
Sprangers, M.A., & Aaronson, N.K. (1992). The role of health care providers and significant others in evaluating the quality of life of patients with chronic disease: A review. <i>Journal of Clinical Epidemiology</i>, 45, 743-760.
Sprangers, M.A.G., & Sneeuw, K.C.A. (2000). Are healthcare providers adequate raters of patients' quality of life perhaps more than we think? <i>Acta Oncologica</i>, 39(1), 5-8.
Stewart, D., & Shandasani, P. (1990). <i>Focus groups: Theory and practice.</i> Beverly Hills, CA: Sage.
Varricchio, C.G. (1990). Relevance of quality of life to clinical practice. <i>Seminars in Oncology Nursing</i>, 6, 255-259.
Vivier, P.M., Bernier, J.A., & Starfield, B. (1994). Current approaches to measuring health outcomes in pediatric research. <i>Current Opinions in Pediatrics</i>, 6, 530-537.
Wilson, K.A., Dowling, A.J., Abdolell, M., & Tannock, I.F. (2000). Perception of quality of life by patients, partners and treating physicians. <i>Quality of Life Research</i>, 9, 1041-1052.