A CAUSAL MODEL OF HEALTH-RELATED QUALITY OF LIFE IN THAI CHILDREN WITH CANCER

The path analytic study aims to test a causal model of health-related quality of life (HRQOL) 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 questionnaires developed in English. Testing of the reliability of instruments showed that all instruments had an acceptable value of reliability between 0.82 and 0.93. Purposive sampling was used to recruit 199 children with cancer and 199 caregivers from eight tertiary hospitals in three parts of Thailand. Data were analyzed using path analysis. The modified model revealed that five 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 significant direct and indirect negative effects on HRQOL via state anxiety and functional status. Functional status had a significant positive direct effect on HRQOL. Coping, symptom distress, and state anxiety had no significant direct effects on HRQOL. However, coping had an indirect effect on HRQOL through state anxiety and functional status. Both symptom distress and state anxiety had negative indirect effects on HRQOL via functional status. The findings provide useful information for nurses to develop effective interventions to enhance HRQOL in Thai children with cancer.