Publications

CONTEXT

Patients with life-threatening or chronic illness report an experience of increased positive psychological, social, and/or spiritual change during diagnosis and/or treatment of their illness, even in the face of unfavorable prognosis. This transformation begins through the ability to make their life meaningful by forming meaningful connections that emerge through self-introspection and relationships with a divine entity, nature, and other people. The Healing Experience in All Life Stressors (HEALS) assessment provides a way to identify distress-causing changes that may interfere with the development of meaning and psycho-social-spiritual homeostasis.

OBJECTIVE

Preliminary examination of responses to items on the HEALS and examination of the factor structure.

METHOD

The 48-item HEALS questionnaire was developed using a multistep process: literature review for concept development, item generation from qualitative data, and face and content validity by expert panel. In the current study, HEALS was completed by 100 patients diagnosed with life-limiting disease and seen by the palliative care team at a large research institution in the US. Exploratory factor analysis techniques were used to determine scale structure of the instrument.

RESULTS

Outcome testing of sample adequacy using Kaiser-Meyer-Olkin statistic was 0.75, which exceeds the recommended value of 0.60. The HEALS show very good internal consistency with a Cronbach's of 0.94. Overall results of the exploratory factor analysis established a four-factor questionnaire: 1) religion; 2) spirituality, demonstrated by a) interaction with a religious community and b) belief in higher power; 3) intrapersonal; and 4) interpersonal relationships expressed through psychological changes resulting in enhanced outlook and improvement in relationships with family and friends.

CONCLUSION

This study involved the initial step to commence the process of scale validation, with promising outcomes identifying subscales as an effective way to assess the construct of healing. These findings support further examination using cognitive appraisal and confirmatory factor analysis.

OBJECTIVE

To investigate the impact of hearing aid (HA) and cochlear implant (CI) use on loneliness in adults.

STUDY DESIGN

Prospective observational cohort study.

METHODS

One hundred and thirteen adults, aged ≥ 50 years, with postlingual hearing loss and receiving routine clinical care at a tertiary academic medical center, were evaluated with the University of California at Los Angeles Loneliness Scale before and 6 and 12 months after intervention with HAs or CIs. Change in score was assessed using linear mixed effect models adjusted for age; gender; education; and history of hypertension, diabetes, and smoking.

RESULTS

Significant improvements in loneliness scores were observed in CI users from baseline to 6 months (-3.79 [95% confidence interval): -5.73, -1.85], P <.001) and baseline to 12 months (-3.26 [95% confidence interval: -5.66, -0.87], P =.007). We did not observe a significant improvement in loneliness scores in HA users from baseline to 6 months (-0.83 [95% confidence interval: -2.68, 1.02], P =.381) or baseline to 12 months (-0.34 [95% confidence interval: -2.77, -2.10], P = .007). The most substantial increases were observed in individuals with the lowest baseline scores.

CONCLUSION

Treatment of hearing loss with CIs results in a significant reduction in loneliness symptoms. This improvement was not observed with HAs. We observed differential effects of treatment depending on the baseline loneliness score, with the greatest improvements observed in individuals with the most loneliness symptoms at baseline.

LEVEL OF EVIDENCE

2b. Laryngoscope, 127:1885-1889, 2017.