A Causal Model of Health-Related Quality of Life in Thai Children with Cancer

Abstract

The path analytic study aims to develop and test a hypothesized causal model of health-related quality of life in Thai children with cancer. The revised Wilson and Clary conceptual model of HRQOL by Ferrans et al. (2005) and previous evidences were used to develop the model. Seven independent variables including family functioning, coping, symptom distress, trait anxiety, state anxiety, functional status, and self-care behavior were examined in the model. Data were collected using a set of questionnaires. Back translation technique was performed with two instruments developed in English. The reliability of instruments was tested and the results showed that all instruments had an acceptable value of reliability between .82 and .93. Purposive sampling was used to recruit 199 children with cancer and caregivers from eight tertiary hospitals in three parts of Thailand. Children were 9-18 years old, received chemotherapy at least one cycle, had good consciousness, and had no serious conditions. Data were analyzed using path analysis. The results showed that: 1) The goodness of fit measures of the hypothesized model was not met. 2) The goodness of fit measures of the modified model was met. 3) The modified model revealed that six independent variables including coping, symptom distress, trait anxiety, state anxiety, and functional status significantly accounted for 33% of variance in HRQOL. Trait anxiety had both a significant direct negative effect (ẞ = -.35, p < .001) and indirect negative effect on HRQOL (ẞ = -.08, p < .05) via state anxiety and functional status. It had a significant total effect on HRQOL (B = -.43, p < .05). Functional status had a significant positive effect on HRQOL (B = .34, p < .001). However, coping, symptom distress, and state anxiety had no direct effect on HRQOL. Coping had a significant indirect effect on HRQOL via state anxiety and functional status (B = .03, p < .05). Symptom distress had a significant indirect effect on HRQOL via functional status (B-.05, p < .05). Trait anxiety had a significant positive direct effect on state anxiety (B =.44, p < .001). Symptom distress and state anxiety had a significant negative direct effect on functional status (ẞ = -.16, p < .05; B = -.28, p < .001, respectively). Coping had a significant negative direct effect on state anxiety (B = -22, p < .001), whereas it had no direct effect on trait anxiety (B = -.11, p > .05). Besides, coping significantly and negatively correlated with symptom distress (r = -.19, p < .01). These findings provide the empirical evidences regarding the magnitude and directional effects of the factors influencing HRQOL in Thai children with cancer. This provides useful information for nurses to develop effective interventions to enhance HRQOL in Thai children with cancer.