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Relationships Among Functional Health RELATIONSHIPS AMONG DEPRESSIVE SYMPTOMS, SPIRITUAL WELL-BEING, AND QUALITY OF LIFE IN PRIMARY LIVER CANCER PATIENTS IN KOREA by EUNSUK LEE Submitted in partial fulfillment of the requirements For the degree of Doctor of Philosophy Dissertation Adviser: Dr. Joyce J. Fitzpatrick, PhD, MBA, RN, FAAN Frances Payne Bolton School of Nursing CASE WESTERN RESERVE UNIVERSITY May, 2012 i CASE WESTERN RESERVE UNIVERSITY SCHOOL OF GRADUATE STUDIES We hereby approve the dissertation of EUNSUK LEE . candidate for the Doctor of Philosophy degree *. (signed) Dr. Joyce J. Fitzpatrick . (chair of the committee) Dr. Mary T. QuinnGriffin . Dr. Elizabeth A. Madigan . Dr. Smitha S. Krishnamurthi . Dr. Haeok Lee . (date) March 21, 2012 . *We also certify that written approval has been obtained for any proprietary material contained therein. ii Dedication This dissertation is dedicated to: My late grandparents, Hansun Maria Lee and Bockyee Lee, who taught me the importance of education and caring, the virtue of patience, and the value of lifelong learning. My parents, Younsik Lee and Chungui Jang, who taught me morals and values, for their love and commitment to my education in making this dream come true in reality. My sister, Eunkyung Agnes Lee, who paved the way and cleared the path before me so that I could move forward; for her prayers, devotion, and setting a good example of courageous footprints for my life journey. And My advisor, Dr. Joyce J. Fitzpatrick, for mentoring, encouraging, and inspiring me to pursue my doctoral study through her Life Perspective Rhythm Model. iii TABLE OF CONTENTS Page Title Page ······························································································· i Committee Approval Sheet ········································································· ii Dedication Page ····················································································· iii Table of Contents·····················································································iv List of Tables ························································································ vii List of Figures ······················································································ viii List of Appendices ···················································································ix Acknowledgements ·················································································· x Abstract ······························································································ xiii CHAPTER 1: INTRODUCTION ·································································· 1 Introduction ······················································································· 1 Background and Significance ··································································· 2 Statement of the Problem ········································································ 7 Purpose ···························································································· 11 Conceptual Framework ········································································· 12 Assumptions ······················································································ 18 Research Questions ············································································· 18 Nursing Implications ············································································ 19 CHAPTER 2: REVIEW OF LITERATURE ···················································· 23 Introduction ······················································································ 23 Depressive Symptoms ·········································································· 23 Spiritual Well-Being ············································································ 29 Quality of Life ··················································································· 36 Relationships among Examined Variables··················································· 43 Depressive Symptoms and Quality of Life in Cancer Patients ························ 43 Spiritual Well-Being and Quality of Life in Cancer Patients ························· 47 Depressive Symptoms and Spiritual Well-Being in Cancer Patients ················ 50 CHAPTER 3: METHOD ··········································································· 54 Research Design ················································································ 54 Sampling ························································································· 54 Sample Selection ············································································ 54 Setting ························································································ 54 iv Inclusion and Exclusion Criteria ·························································· 55 Sample Size Determination ································································ 56 Definitions of the Study Variables ··························································· 59 Depressive Symptoms ······································································ 59 Spiritual Well-Being ········································································ 60 Quality of Life ··············································································· 61 Instruments ······················································································ 61 Demographic Data Collection Sheet ····················································· 61 The Center for Epidemiologic Studies Depression Scale (CES-D Scale) ·········· 62 Spiritual Well-Being Scale (SWBS) ····················································· 64 The 12-item Medical Outcomes Study Short Form Health Survey (SF-12v2) ···· 68 Data Collection ·················································································· 75 Methods ······················································································· 75 Procedure ····················································································· 75 Data Analysis ···················································································· 77 Quantitative Data Analysis ································································· 77 Qualitative Data Analysis ·································································· 79 Protection of Human Subjects ································································ 80 CHAPTER 4: RESULT ············································································ 81 Screening of the Data ·········································································· 81 Preliminary Data Examination ································································ 81 Regression Diagnostics ···································································· 81 Demographic Characteristics ································································· 86 Description of the Sample ································································· 86 Personal Profile ············································································· 87 Socioeconomic Profile ····································································· 88 Medical Profile ·············································································· 89 Summary of the Instrument Results by Demographic Characteristics ·············· 91 Predictor Variables ·············································································· 92 Depressive Symptoms ······································································ 92 Spiritual Well-being ········································································· 93 Dependent Variable ············································································· 94 Reliability of the SF-12v2 ·································································· 95 QOL-PCS ····················································································· 95 QOL-MCS ···················································································· 95 Research Question #1 ··········································································· 96 Relationship between Depressive Symptoms and Spiritual Well-Being ············ 96 Relationship between Depressive Symptoms and Quality of Life ··················· 97 Relationship between Spiritual Well-Being and Quality of Life ····················· 97 Research Question #2 ··········································································· 98 Research Question #2a ······································································ 98 Research Question #2b ···································································· 100 Research Question #3 ········································································· 102 Negative Themes ·········································································· 103 Positive Themes ············································································ 104 v Summary ························································································ 104 CHAPTER 5: DISCUSSION ···································································· 107 Sample Characteristics ······································································· 109 Testing the Study Model ····································································· 112 Depressive Symptoms ········································································ 115 Spiritual Well-Being
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