The influence of symptoms, social support, uncertainty, and coping on healthe-related quality of life among cholangiocarcinoma patients

Abstract

The purpose of this cross-sectional, descriptive correlation study was to develop and test a model that explains the influence of symptoms, social support, uncertainty, and coping on the health-related quality of life (HRQOL) in cholangiocarcinoma (CCA) patients. The conceptual framework was the uncertainty in illness theory. A consecutive sample of 260 CCA patients was recruited from the outpatient surgery department at a regional hospital and a university hospital in the northeast of Thailand. All participants responded to a set of six questionnaires in a structured interview format. Data collection instruments included the Demographic Characteristics Questionnaire, the Modified Memorial Symptoms Assessment Scale, the Social Support Questionnaire, Mishel’s Uncertainty in Illness Scale: Community Form, the Jalowiec Coping Scale, and the Functional Assessment of Cancer Therapy General Scale. A linear structural relationship (LISREL) 8.72 was used to test the hypothesized path model. The study findings revealed that the hypothesized model fit the empirical data and explained 70% of the variance of HRQOL (X² = 0.10, df = 1, p = 0.75, X²/df = 0.10, RMSEA = 0.00, GFI = 1.00, AGFI = 1.00). Symptoms were the most influential factor affecting HRQOL directly (-.65, p < .001) and indirectly (-.13, p < .001) through uncertainty and emotive coping. In addition, social support had a positive direct effect (.12, p < .01) on HRQOL and an indirect effect (.13, p < .01) on HRQOL through uncertainty. However, social support had a non-significant indirect effect (-.12, p > .05) on HRQOL through symptoms, while uncertainty had a negative direct effect (-.18, p < .001) on HRQOL and non-significant indirect effect (-.01, p > .05) on HRQOL through emotive coping. Finally, emotive coping had a negative direct effect (-.10, p < .05) on HRQOL. These findings demonstrated that symptoms, social support, uncertainty, and emotive coping were important factors influencing HRQOL in CCA patients. Therefore, further nursing interventions should take managing symptoms, motivating social support, reducing uncertainty, and promoting effective coping into account so as to maintain or improve HRQOL in CCA patients.