Understanding domains of health-related quality of life concerns of Singapore Chinese patients with advanced cancer: a qualitative analysis.
OBJECTIVE
Quality of life concerns in patients with advanced diseases might be different from other patients and are shaped by sociocultural context. The objective of this qualitative study was to identify domains and themes of health-related quality of life (HRQoL) that Chinese patients with advanced cancer in Singapore considered relevant and important.


METHODS
English- and Chinese-speaking patients with advanced solid cancer were recruited from a tertiary cancer center and a community-based hospice for in-depth interview or focused group discussion. Thematic analysis was used to identify subthemes, themes, and domains from the transcripts.


RESULTS
Forty-six ethnic Chinese (aged 26-86, 48% male) participated in the study. Six domains of HRQoL concerns were identified: pain and suffering, physical health, social health, mental health, financial well-being, and spiritual health. Pain and suffering are not limited to the physical domain, reflecting the multidimensional nature of this concept. Pain and suffering must also be understood within the cultural context. Healthcare relations (i.e., social health), existential well-being and religious well-being (i.e., spiritual health), and suffering (i.e., pain and suffering) are not fully captured in the existing HRQoL instruments. In addition, financial issues and the practice of secrecy in interpersonal relationships emerged as unique features possibly arising from our sociocultural context and healthcare financing landscape.


CONCLUSIONS
Socioculturally specific issues not measured by the existing HRQoL instruments for use in patients with advanced cancers or terminal diseases were found in our study. These are non-physical pain and suffering, meaning of illness, meaning of death, financial issues, and practice of secrecy in interpersonal relationships.
Department of Social Work, Faculty of Arts and Social Sciences, National University of Singapore, Block AS3, Level 4, 3 Arts Link, Singapore, 117570, Singapore. swklgl@nus.edu.sg.
G L
GL
Lee
Department of Palliative Medicine, National Cancer Centre Singapore, Singapore, Singapore.
G S Y
GS
Pang
HCA Hospice Care, Singapore, Singapore.
R
R
Akhileswaran
Centre for Quantitative Medicine, Duke-NUS, Singapore, Singapore.
M Y L
MY
Ow
Department of Psychosocial Oncology, National Cancer Centre Singapore, Singapore, Singapore.
G K T
GK
Fan
Centre for Quantitative Medicine, Duke-NUS, Singapore, Singapore.
C C F
CC
Wong
Department of Pharmacy, National University of Singapore, Singapore, Singapore.
H L
HL
Wee
Centre for Quantitative Medicine, Duke-NUS, Singapore, Singapore.
Y B
YB
Cheung
D000328:Adult; D000368:Aged; D002681:China; D005006:Ethnicity; D005260:Female; D017051:Hospice Care; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology*; D036301:Qualitative Research; D011788:Quality of Life / Q000523:psychology*; D012846:Singapore
Advanced cancer; Chinese; Psycho-oncology; Qualitative research; Quality of life