Academic journal article Journal of Evidence-Based Psychotherapies

Ranking of Quality of Life Determinants by Structural Equation Modeling in a Population of Women at Childbearing Age, Treated for Premalignant and Malignant Pathology of the Uterine Cervix

Academic journal article Journal of Evidence-Based Psychotherapies

Ranking of Quality of Life Determinants by Structural Equation Modeling in a Population of Women at Childbearing Age, Treated for Premalignant and Malignant Pathology of the Uterine Cervix

Article excerpt

Abstract

To date, there is no multivariate analysis in literature on the relationships between quality of life (QOL), female sexual functioning, symptomatology, distress and irrational beliefs among women with premalignant and malignant pathology of the cervix, namely aggravator dysplasia and microinvasive carcinoma with conservative surgery - cervix conization. This study investigated the relationships among the five variables using structural equation modelling. One hundred and two women with premalignant and malignant pathology of the cervix were included in the study and filled in a set of measures during the first year after surgery. The following instruments were used: Female Sexual Function Index (FSFI), the European Organisation for Research and Treatment of Cancer Quality of Life C30 (EORTC QOL-C30), the Attitudes and Beliefs Scale, Short Version (ABS-SV) and a distress visual analogue scale. Goodness-of-fit indices were obtained for the final structural model by MLR estimation : χ2/df ratio=1.54, TLI = 0.87, CFI = 0.88, RMSEA = 0.07 (90% CI: 0.065-0.084) SRMR = 0.08 and bootstrapping: χ2/df ratio = 1.30, TLI = 0.89, CFI = 0.90, RMSEA = 0.05 (90% CI : 0.043-0.064 ), SRMR = 0.086. No direct effect of sexual functioning and irrational beliefs on quality of life was found, but there is a tendency of dependence between distress and QOL. There is a positive correlation between irrational beliefs and symptomatology (?=0.40), so that symptoms are more serious, in persons who have more irrational beliefs. Also, there is a correlation between distress and symptomatology (?=0.37), and distress and irrational beliefs (?=0.41). The model explained 98% of the total variance of QOL. In conclusion, the structural model provides a valid assessment model of QOL, a ranking of levels of QOL by regression weights and the inter-relationships between the specified constructs.

Keywords: quality of life, premalignant and malignant pathology, childbearing age and pregnancy, structural equation modelling, psycho-oncology

Introduction

A diagnosis of cancer is accompanied by a wide range of medical and psychosocial challenges. The first six months post-diagnosis can be overwhelming for patients who must manage their emotional responses to the diagnosis, treatment plan, and side effects of treatment. Declines in physical functioning, fears surrounding the uncertainty of the prognosis and treatment, and doubts as to whether the illness will be overcome, may all compromise functional, social, emotional, and psychological well-being (Hack, Pickles, Ruether, et al., 2010)

Over the last decade, increasing attention has been given to the issues of emotional distress and quality of life (QOL) in women with gynecological cancer (Chase, Watanabe, & Monk, 2010; Mantegna, Petrillo, Fuoco, et al., 2013; Vistad, Fossa, & Dahl, 2006).

Distress can be simply defined as the experience of significant emotional upset, arising from various psychological and psychiatric conditions (Bidstrup, Johabsen, & Mitchell, 2011; Carlson, Clifford, Groff, Maciejewski, & Bultz, 2010). It is a common, but manageable side effect of the experience of cancer, and it can appear at any stage of the illness (Bidstrup et al., 2011; Fallowfi, Ratcliffe, Jenkins, & Saul, 2001). According to the National Comprehensive Cancer Network, distress should be recognized and monitored through a screening process and treated promptly at all stages of illness (Holland, Breitbart, Dudley, et al., 2010). Heightened psychological distress has been linked to several negative outcomes, including increased non-adherence to treatment recommendations (Kennard, Smith, Olvera et al., 2004) and poorer quality of life (Skarstein, Aass, Fossa, Skovlund, & Dahl, 2000).

Sources of distress include the common experience of aversive side effects such as fatigue and nausea (Faul1, Jim, Williams, Loftus & Jacobsen, 2010; Roscoe, Morrow, & Hickok, 2000). …

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