title: Health-related quality of life in patients with serious non-specific symptoms undergoing evaluation for possible cancer and their experience during the process: a mixed methods study.
abstract: The purpose of this research was to measure changes in HRQoL during the diagnostic evaluation of patients presenting with non-specific symptoms possibly attributable to cancer, to describe their experiences of HRQoL and to merge these findings with intent to obtain a more comprehensive understanding of their HRQoL experience during this stressful life event.
  
  
  
  A convergent mixed methods (MM) design was used and involved quantitative data about HRQoL measured by the EORTC-QLQ-C30 instrument and qualitative interview data about patients' HRQoL experiences. Participants completed the EORTC-QLQ-C30 questionnaire prior to and after evaluation. The baseline questionnaire informed the purposive sampling for the qualitative interview study, and open-end questions matched to the EORTC-QLQ-C30 constructs were used in the semi-structured interviews.
  
  
  
  A total of 838 patients were enrolled in the quantitative study; 680 (81 %) also completed follow-up. Twenty-one patients participated in interviews. The MM findings are the meta-inferences drawn by looking across the matched quantitative and qualitative findings: physical function, social function, role function, emotional function, cognitive function, social function, symptoms and quality of life.
  
  
  
  The survey results illustrate that HRQoL improved over time and the qualitative findings confirmed and further expanded the survey results. The MM analysis underlines that the HRQoL experience cannot be observed independently from context. Participants adapted to their situation over time, and this may change their perceptions of HRQoL. These findings can be used to enhance evidence-based care as clinicians need to be aware of how the context influences the HRQoL experience.
authors.affiliation: Department of Pulmonary and Infectious Diseases, University Hospital of Copenhagen, Nordsjælland, Dyrehavevej 29, Building 10, 3400, Hillerød, Denmark. elar0073@regionh.dk.
authors.forename: E
authors.initials: E
authors.lastname: Moseholm
authors.affiliation: Research Unit of Clinical Nursing, Bispebjerg and Frederiksberg University Hospital, Bispebjerg Bakke 23, 20E, 2400, Copenhagen NV, Denmark.|Department of Public Health, Section for Nursing, Aarhus University, Århus, Denmark.
authors.forename: S
authors.initials: S
authors.lastname: Rydahl-Hansen
authors.affiliation: Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Kettegård Alle 30, Department 144, 2650, Hvidovre, Denmark.
authors.forename: B Ø
authors.initials: BØ
authors.lastname: Lindhardt
authors.affiliation: Department of Family Medicine, University of Michigan, 1018 Fuller St, Ann Arbor, MI, 48104, USA.
authors.forename: M D
authors.initials: MD
authors.lastname: Fetters
mesh_terms: D000368:Aged; D003627:Data Interpretation, Statistical; D003718:Denmark; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis / Q000523:psychology*; D011788:Quality of Life; D013315:Stress, Psychological; D011795:Surveys and Questionnaires
keywords: Cancer diagnosis; Health-related quality of life; Mixed methods research; Pre-diagnosis