| BackgroundBenign prostatic hyperplasia (BPH) is a common chronic disease in elderly population, for its incidence is high. According to the epidemiological statistics, 90% of men over the age of 80 suffer from the disorder. At present, researches on the quality of life of BPH patients have chiefly focused on its role in evaluating the outcomes of clinic treatments, covered limited fields but not all the fields of the quality of life, and varied in understanding of the basic concept of quality of life and in the instruments used in researches. Moreover, the medical literature review revealed no such researches on the quality of life of BPH patients from the point of view of modern nursing.Objective and SignificanceThis study is to conduct an overall assessment of the quality of life of BPH patients from the point of view of holistic nursing by using multiple genericinstruments. In order to have a more accurate and more complete understanding of the quality of life of BPH patients and the physical, psychological, social and environmental factors that have an impact on their quality of life, this study is to make a transverse comparison of quality of life between BPH patients and healthy people and patients with other diseases so that the results of this study can provide positive evidence for scientific and effective nursing measures for elderly BPH patients.Since a series of generic instruments developed by WHOQOL Group with uniform criteria are adopted in this study, the findings of this study will acquire certain comparability between different districts, different cultures and different populations. The findings will also serve as comparable data for researches on the quality of life and its influencing factors of BPH patients in other areas and of patients with other diseases. This study is also a preliminary attempt to foster international cooperation in researches on the quality of life of patients with chronic diseases in different countries.Subjects:In the study group, the 139 subjects were chosen during March to October 2004 from the BPH patients in three Grade Three hospitals in Guangzhou. In the control group, 155 elderly men were chosen in a community in Guangzhou who did not suffer from BPH or other serious diseases.Methods:I. This study is a transverse field investigation which adopts Chinese versions ofsix instruments, WHOQOL-BREF, WHOQOL OLD module, Experiences and Altitudes of Aging Questionnaire (WHO EAAQ), The Geriatric Depression Scale, International Prostate Symptom Score (IPSS) and WHO General Social andDemographic Data Questionnaire. WHOQOL-BREF, WHOQOL OLD, and WHO EAAQ are a series of generic instruments that were developed by the WHOQOL Group according to the WHO definition of the basic concept of quality of life and intended to be used in different districts, cultures and populations. IPSS is a BPH specific instrument used for BPH patient screening in this study.II. The investigation was carried out by asking subjects to fill in questionnaires and complete scales to acquire needed data concerning the BPH group and the control group. The differences in quality of life were assessed by comparing the scores of WHOQOL-BREF and WHOQOL OLD between the two groups of men. Psychological impacts on the quality of life of the two groups of men were analyzed with results of WHO EAAQ and GDS. Social impacts on the quality of life of the two groups of men were analyzed with results of WHO General Social and Demographic Data Questionnaire. The BPH symptoms were assessed according to the scores of IPSS that was used to distinguish BPH men and healthy men in this study.III. All the data obtained in the field investigation were statistically analyzed by computer with the software package SPSS 10.0 for Windows.Results:In the BPH group, 169 sets of questionnaires were handed out and 160 men responded. The valid sets received were 139, with the validity rate being 86.9%. In the healthy men group, 180 sets of questionnaires were handed out and 178 men responded. The valid sets received were 155, with the validity rate being 87.1%.The investigation results show that WHOQOL OLD (Cronbach's a 0.74) and WHOQOL EAAQ (Cronbach's a 0.839) have fine internal consistency, reliability, and structural validity. Compared with the results of WHOQOL-BREF, WHOQOL-OLD proves to be more specific to the elderly people in assessment of their quality of life.In comparison of scores of quality of life between the two groups of men with WHOQOL OLD, the differences in the fields Autonomy and Intimacy were statistically insignificant (Z=-1.396, P=0.163 and Z=-0.993, P=0.321 respectively), but statistically significant (P <0.05) in the four fields Sensory Abilities, Past, Present and Future Activities, Social Participation, and Death & Dying, with scores of BPH patients lower than those of healthy men. In comparison of scores of quality of life between the two groups of men with WHOQOL-BREF, however, it was found that the differences in the Total Score and all the fields but Physical Field were statistically insignificant.In comparison of scores of WHOQOL-EAAQ between the two groups of men, it was found that the differences in the fields Psychological Response to Ageing (Z= -0.119, P=0.906) and Roles and Values (Z=-1.936, P=0.053) were statistically insignificant, but statistically significant in Physical Functioning Field, Social and Interpersonal Field Economic and Occupational Field, with scores of BPH patients lower than those of healthy men. It was also found that the BPH group was more pessimistic towards aging than the control group.In comparison of scores of GDS between the two groups of men, it was found that the differences in the severity of depression (Z=-5.570, P=0.000) were statistically significant, and the severity of depression in the BPH group (mean rank = 174.13) was higher than that in the control group (mean rank—119.47).Stepwise canonical discriminant analysis found that three items, IPSS2, IPSS7 and IPSS Total Score, in IPSS, Death & Dying Field in WHOQOL-OLD, and Physical and Economic Fields in WHOQOL-EAAQ were six variables of the greatest importance that could make a difference between BPH men and healthy men, with a discriminant rate of 100%. This indicates that the six variables have a good potential of forecasting.The social factors that have an impact on the quality of life of BPH patients were screened with multiple stepwise regression. It was found that the most significant factors in sequence of importance were spouse relationship, satisfaction of sexual life, grandchildren relationship, self-evaluation of health and financial status.In comparison of total scores of WHOQOL-BREF between this study and a relative German study, it was found that the difference between the Chinese healthy group (total score 67.8±7.4) and German healthy group (total score 71.4±13.8) was statistically insignificant, while the differences between the Chinese BPH group (total score 55.6±9.2) and the German cancer group (total score 38.5±17.8) and the German respiratory diseases group (total score 41.7±21.4) were statistically significant.Conclusions:I. The series of WHOQOL instruments are suitable for assessment of the quality of life of Chinese BPH patients. This study proves that WHOQOL OLD and WHOQOL EAAQ have fine reliability of internal consistency and structural validity.II. The quality of life of BPH patients is inferior to that of common healthy men, but superior to that of patients with other more serious chronic diseases, such as caner, and respiratory diseases.HI. The chief variables that have a significant impact on the quality of life of BPH patients are symptoms of the disorder and negative psychological responses resulted from the symptoms. Psychologically speaking, the severity of depression and mental state during the process of aging that are displayed by BPH patients areobviously inferior to those of healthy men.IV. The sociological factors that affect the quality of life of BPH patients are: spouse relationship, satisfaction of sexual life, grandchildren relationship, financial status and self-evaluation of health.V. Since a series of generic instruments developed by WHOQOL Group withuniform criteria are adopted in this study, the results can be compared with those of other equivalent researches conducted in different districts, different cultures and different populations. When findings of researches on the quality of life and its influencing factors of patients with BPH and other diseases can be compared with the same criteria, it will be possible and feasible to conduct international cooperation in researches on the quality of life of patients with chronic diseases in different countries.
|
PDF Full Text Request