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The Influence of Symptoms, Social Support, Uncertainty, and Coping on Health-Related Quality of Life Among Cholangiocarcinoma Patients in Northeast Thailand

Somjaivong, Busaba RN, PhD(c); Thanasilp, Sureeporn DNS, RN, CNS; Preechawong, Sunida PhD, RN; Sloan, Rebecca PhD, RN

doi: 10.1097/NCC.0b013e31820d0c3f

Background: Health-related quality of life (HRQOL) is an important outcome for evaluating the effectiveness of cancer care. Cholangiocarcinoma (CCA) is a major public health problem in northeast Thailand. There is little information regarding factors influencing HRQOL in CCA patients. Understanding the factors affecting HRQOL in CCA patients is necessary to develop nursing interventions to improve the HRQOL.

Objective: The purpose of this study was to develop and test a model that explained the influence of symptoms, social support, uncertainty, and coping on the HRQOL in CCA patients.

Methods: Using a cross-sectional descriptive design, a convenience sample of 260 CCA patients were consecutively recruited from a regional hospital and a university hospital in northeast Thailand. All participants responded to a set of 6 questionnaires in structured interview format. A linear structural relationship was used to test the hypothesized model.

Results: Findings revealed the hypothesized model fit the empirical data and explained 69.4% of the variance of HRQOL. Symptoms were the most influential factor affecting HRQOL directly and indirectly through uncertainty. Social support had a direct effect on HRQOL and an indirect effect on HRQOL through uncertainty. Uncertainty had a direct effect on coping and HRQOL. Coping had a nonsignificant direct effect on HRQOL.

Conclusion: Symptoms, social support, and uncertainty were important factors influencing HRQOL in CCA patients.

Implications for Practice: Cholangiocarcinoma is a unique yet understudied condition. Further work in developing CCA-specific HRQOL interventions is warranted.

Author Affiliations: Faculty of Nursing, Chulalongkorn University, Bangkok, Thailand (Ms Somjaivong, Drs Thanaslip and Preechawong); and Indiana University School of Nursing, Indianapolis (Dr Sloan).

This study was funded by the 90th Anniversary of Chulalongkorn University Fund (Ratchadaphiseksomphot Endowment Fund) and Thailand Nursing Council.

The authors have no conflicts of interest to disclose.

Correspondence: Sureeporn Thanasilp, DNS, RN, CNS, Faculty of Nursing, Chulalongkorn University, Boromarajonani Srisatapat Building, Rama 1 Rd, Patumwan Bangkok 10330, Thailand (

Accepted for publication December 22, 2010.

© 2011 Lippincott Williams & Wilkins, Inc.