Review of the literature on the effects of caring for a patient with cancer

Burden and well-being among a diverse sample of cancer, congestive heart failure, and chronic obstructive pulmonary disease caregivers

CONTEXT

Three important causes of death in the U.S. (cancer, congestive heart failure, and chronic obstructive pulmonary disease) are preceded by long periods of declining health; often, family members provide most care for individuals who are living with serious illnesses and are at risk for impaired well-being.

OBJECTIVES

To expand understanding of caregiver burden and psychosocial-spiritual outcomes among understudied groups of caregivers-cancer, congestive heart failure, and chronic obstructive pulmonary disease caregivers-by including differences by disease in a diverse population.

METHODS

The present study included 139 caregiver/patient dyads. Independent variables included patient diagnosis and function; and caregiver demographics, and social and coping resources. Cross-sectional analyses examined distributions of these independent variables between diagnoses, and logistic regression examined correlates of caregiver burden, anxiety, depressive symptoms, and spiritual well-being.

RESULTS

There were significant differences in patient functioning and caregiver demographics and socioeconomic status between diagnosis groups but few differences in caregiver burden or psychosocial-spiritual outcomes by diagnosis. The most robust social resources indicator of caregiver burden was desire for more help from friends and family. Anxious preoccupation coping style was robustly associated with caregiver psychosocial-spiritual outcomes.

CONCLUSION

Caregiver resources, not patient diagnosis or illness severity, are the primary correlates associated with caregiver burden. Additionally, caregiver burden is not disease specific to those examined here, but it is rather a relatively universal experience that may be buffered by social resources and successful coping styles.

The extra burdens patients in denial impose on their family caregivers

Objective:

The purpose of this study was to explore the impact of advanced cancer patients' denial on their family caregivers and how they cope, in order to enable clinicians to better support them and their caregiving.

Method:

As the objective was to obtain clinically useful findings, an interpretive descriptive design was used. Data consisted of prospective semi-structured interviews with 16 family caregivers of advanced cancer patients in denial, field notes, reflexive journals, and memos during the analysis.

Results:

Caregivers experienced extra burdens with the patient's denial. Feeling bound to preserve the denial, which they perceived as immutable, they were prevented from seeking information to manage the patient's care. Additionally, those caring for noncompliant patients felt disenfranchised from their role, resulting in feelings of powerlessness and guilt, and felt burdened by managing medical situations that arose from noncompliance. Caregivers described the ambivalence of feeling frustrated and burdened by the denial while recognizing it as a long-standing coping pattern for the patient. The denial prevented them from acknowledging their own needs to the patients or seeking informal support. They therefore developed solitary coping strategies, sought professional psychosocial support, and/or employed denial themselves.

Significance of results:

Caregivers of patients in denial experience added burdens, which they must bear without most of the usual sources of support. The burden is accentuated when patients are noncompliant with care, placing themselves in dangerous situations. Healthcare providers should identify patients in denial and support their caregivers in meeting both their caregiving and their own needs. Evidence-based strategies to accomplish this should be developed and implemented.

Patient and family caregiver decision making in the context of advanced cancer

BACKGROUND

A basic tenet of palliative care is to maintain an individual's control over the dying process. However, when decline occurs quickly, as may be the case in advanced cancer, transition of responsibility for illness management to a family caregiver may become necessary when care takes place in the home.

OBJECTIVE

The aim of this study was to understand the decision-making process that occurs between a dying individual and his or her family caregiver.

METHODS

Participants in this grounded theory study were selected by purposive and theoretical sampling methods. Data were collected and analyzed using a constant comparison approach.

RESULTS

The core category covering captured the inordinate efforts taken by informal caregivers to ensure that their family member would be able to die in the manner of his or her choosing. The basic social process, dancing on the stairs, chronicled the families' decision-making process as they navigated through this delicate and precarious end stage of life.

CONCLUSIONS

Dancing on the stairs required a close relationship between 2 people who were willing to remain engaged with each other, despite the difficulties they faced. This decision-making process may be applicable to other health care transitions in people's lives that need to be managed with another person.

IMPLICATIONS FOR PRACTICE

Palliative care education for nurses in all care health settings may ease transitions for end-stage patients. Health promotion initiatives designed to educate the lay public about advance directives and end-stage illness management in a home setting may help to prepare family caregivers for their future responsibilities.

Desire for formal psychological support among caregivers of patients with cancer: prevalence and implications for screening their needs

OBJECTIVE

To investigate the prevalence of desire for formal psychological support of primary caregivers of patients with cancer and to identify caregivers' and patients' socio-demographic and psychological characteristics as well as patients' disease-related characteristics associated with this desire.

METHODS

This is a multicenter, cross-sectional study assessing desire for formal psychological support among consecutive primary caregivers of patients with cancer. Patients and caregivers completed the Hospital Anxiety and Depression Scale and reported their desire for formal psychological support.

RESULTS

Two-hundred and eighty-two patient-caregiver dyads were assessed. Forty percent of patients had breast cancer, 16% had a hematologic cancer, 12% had a gastrointestinal cancer, and 32% had another solid tumor. Nineteen percent of caregivers reported desiring formal support, and 54% experienced moderate to high levels of distress. Regression analysis showed that caregivers' desire for formal support was negatively associated with caregivers' age (Exp(B) = 0.95; p < 0.001) and education levels (Exp(B) = 0.35; p = 0.032) and positively with caregivers' level of distress (Exp(B) = 1.08; p < 0.001) and with patients' desire for formal psychological support (Exp(B) = 2.54; p = 0.008). These variables only predicted 25% of caregivers who desire formal support.

CONCLUSIONS

One out of five caregivers desires formal psychological support although one out of two caregivers experiences significant levels of distress. The weak association between caregivers' desire for formal support and distress emphasizes the need to implement systematic screenings of both their distress and their desire for formal psychological support in oncology.

Health-related quality of life in family members of patients with an advanced cancer diagnosis: a one-year prospective study

Background

Receiving a cancer diagnosis affects family members as well as the person diagnosed. Family members often provide support for the sick person in daily life out of duty and love, and may not always think of their own vulnerability to illness. To individualise support for them, family members who are most at risk for becoming ill must be identified.

The aim of this study was to investigate health-related quality of life (HRQOL) in family members of patients with advanced lung or gastrointestinal cancer 3 to 15 months after diagnosis.

Methods

Data on mental and physical dimensions of HRQOL were collected from family members of these patients in this prospective quantitative study. Five assessments using the Short Form 36 Health Survey (SF-36) and EuroQol (EQ-5D) were conducted during a 1-year period starting 3 months after diagnosis. Thirty-six family members completed the study, i.e. participated in all five data collections.

Results

No statistically significant changes in physical or mental HRQOL within the study group appeared over the 1-year follow-up. Compared with norm-based scores, family members had significantly poorer mental HRQOL scores throughout the year as measured by the SF-36. Family members also scored statistically significantly worse on the EQ-5D VAS in all five assessments compared to the norm-based score. Findings showed that older family members and partners were at higher risk for decreased physical HRQOL throughout the 1-year period, and younger family members were at higher risk for poorer mental HRQOL.

Conclusions

It is well known that ill health is associated with poor HRQOL. By identifying family members with poor HRQOL, those at risk of ill health can be identified and supported. Future large-scale research that verifies our findings is needed before making recommendations for individualised support and creating interventions best tailored to family members at risk for illness.

"Not all my friends need to know": a qualitative study of teenage patients, privacy, and social media

Background

The literature describes teenagers as active users of social media, who seem to care about privacy, but who also reveal a considerable amount of personal information. There have been no studies of how they manage personal health information on social media.

Objective

To understand how chronically ill teenage patients manage their privacy on social media sites.

Design

A qualitative study based on a content analysis of semistructured interviews with 20 hospital patients (12–18 years).

Results

Most teenage patients do not disclose their personal health information on social media, even though the study found a pervasive use of Facebook. Facebook is a place to be a “regular”, rather than a sick teenager. It is a place where teenage patients stay up-to-date about their social life—it is not seen as a place to discuss their diagnosis and treatment. The majority of teenage patients don't use social media to come into contact with others with similar conditions and they don't use the internet to find health information about their diagnosis.

Conclusions

Social media play an important role in the social life of teenage patients. They enable young patients to be “regular” teenagers. Teenage patients' online privacy behavior is an expression of their need for self-definition and self-protection.

A systematic review of psychosocial interventions to improve cancer caregiver quality of life

OBJECTIVE

To evaluate and estimate the effect of psychosocial interventions on improving the quality of life (QoL) of adult cancer caregivers.

METHODS

We conducted a systematic review of randomized controlled trials among adult cancer caregivers published from 1947 to 2011. Rigorous inclusion criteria included randomization of caregivers, use of control groups, and at least one active psychosocial intervention where caregiver QoL was measured. A pair of raters independently reviewed all abstracts, and studies were assessed for quality using an 11-item PEDro coding scale. Data were extracted, examined, and synthesized using a narrative approach.

RESULTS

Six randomized controlled trials met inclusion criteria out of 1066 identified abstracts. Studies were rejected because of methodological flaws and failure to report a measure of caregiver QoL. A total of 1115 caregivers were included at baseline measurements. Estimated effect sizes for included studies were nil to small ranging from 0.048 to 0.271. Studies with larger effect sizes targeted caregivers' problem-solving and communication skills.

CONCLUSIONS

Interventions targeting problem-solving and communication skills may ease the burdens related to patient care and role changes associated with care while improving caregiver's overall QoL. Further research is needed to establish efficacy of interventions across all stages of the 2cancer caregiving experience, especially focusing on issues of caregiver retention, caregiver relationships to the cancer patient, and individual differences in caregiver experiences with different types of cancer.

Long-term follow-up of informal caregivers after allo-SCT: a systematic review

Currently, more than 40000 patients undergo allogeneic hematopoietic SCT (HSCT) annually throughout the world, and the numbers are increasing rapidly. Long-term survival after allogeneic-HSCT (allo-HSCT) has also improved significantly since its inception over 40 years ago due to improved supportive care and early recognition of long-term complications. In long-term follow-up after transplantation, the focus of care moves beyond cure of the original disease to late effects and quality of life. Nearly one-fourth of the long-term survivors are likely to have chronic consequences of HSCT, which require frequent help by caregivers, particularly informal caregivers such as spouses, partners or children. The physical and psychosocial consequences for patients undergoing HSCT have been extensively reported. There has, however, been far less investigation into the long-term follow-up of caregivers of HSCT recipients. This article provides an overview on addressing caregiver issues after HSCT. The rapidly growing population of long-term HSCT survivors creates an obligation not only to educate patients and physicians about the late complications observed in patients but also to follow up caregivers for their psychosocial support needs.

Coping and its effects on cancer caregiving

PURPOSE

Various studies have documented the emotional distress family members of persons with cancer experience, and descriptive research has identified those psychosocial factors that protect cancer caregivers from a range of negative outcomes. The objective of this study was to determine how different coping strategies were associated with multiple domains of stress and negative health outcomes among cancer family caregivers.

METHODS

A cross-sectional, correlational study design was used. One hundred forty-eight family caregivers of persons with cancer from the University of Minnesota Masonic Cancer Center and the University of Maryland Greenebaum Cancer Center were included.

RESULTS

Multiple regression models found that negative expectation coping strategies (worrying, expecting the worst, and getting nervous) and cancer caregivers' perceptions of not coping well were most significantly associated with emotional distress and negative psychological outcomes.

CONCLUSION

Coping strategies, and in particular negative coping styles, have a consistent and exacerbating influence on various stressors and negative psychological outcomes for cancer caregivers. Given their pervasive effects across multiple stress process domains, the alleviation or redirection of negative expectation coping strategies may enhance the delivery of clinical interventions to result in stronger, long-lasting benefits.

Walking a mile in their shoes: anxiety and depression among partners and caregivers of cancer survivors at 6 and 12 months post-diagnosis

PURPOSE

This study aims to examine the prevalence of psychosocial variables associated with anxiety and depression among partners and caregivers of cancer survivors, compare prevalence with community norms and report differences across cancer diagnosis.

METHODS

A prospective survey of partners and caregivers was undertaken to assess anxiety and depression and potential psychosocial variables associated with these outcomes at 6 and 12 months post-survivor diagnosis (N = 436).

RESULTS

Although the proportion of anxious participants decreased over time (p = 0.01), the percentage of those depressed remained stable (p = 0.68). Most participants who were depressed were also anxious. To a certain extent, the prevalence of anxiety and depression exceeded community norms and varied across cancer types. Partners and caregivers particularly vulnerable included those of lung, haematological or head and neck survivors. High use of avoidant coping and interference in regular activities were associated with both anxiety and depression across time points. Of the different types of support measured, only lower emotional/informational support was associated with anxiety and depression at 6 months, whereas lower positive social interaction was associated with depression at 12 months. Additional variables associated with anxiety and depression at 12 months included higher unmet needs and involvement in personal and medical tasks, respectively.

CONCLUSIONS

Even at 12 months post-survivor diagnosis, almost a third of participants reported anxiety, a result partially predicted by high use of avoidant coping and interference in regular activities. Understanding variables associated with partners' and caregivers' anxiety and depression can lead to optimal referral to supportive care services and inform the tailoring of interventions to address those variables contributing to anxiety and depression at particular time points.

The impact of lung cancer on patients and carers

This article aims to provide a brief review of the literature with regard to the impact of lung cancer on patients and their informal carers. Compared to other types of cancer, the distress associated with lung cancer has been found to be the most intense. Rather than focusing on symptoms in isolation recent emphasis regarding the symptom experience has been on symptoms clusters, as understanding these clusters may improve the management of ongoing and unrelieved symptoms. However, the disparities in methodology are significant barriers to producing comparable results, although recent efforts have been made to address these. Whilst research into symptoms has enormous potential for the management of symptom clusters, it needs to move away from the essentially reductionist stance which currently dominates and broaden its scope to one that acknowledges the complexity of the experience of symptom clusters from the perspective of the patient and their informal carer. Poor management of symptoms complicates patient care and potentially contributes to the heavy burden which often falls on family caregivers, especially as the disease progresses. The majority of studies focus on the experiences of primary care providers, most often the partner/spouse. Such studies have shown that spouses of patients with lung cancer exhibit significant distress and lower levels of quality of life than the general population. Research also indicates that significant others go through a transition process due to changes brought about by the diagnosis of lung cancer and struggle to endure and overcome difficulties and distress. Significant others were seen to suffer during this process of transition and experienced altered relationships. Clinicians working with patients suffering from lung cancer and their carers should intervene to enhance their quality of life from diagnosis, during the disease trajectory and during bereavement. Interventions need to be developed to support both patients and carers.

The role of informal caregivers during cancer patients' recovery from chemotherapy

AIMS

(i) To investigate the availability, perceived importance and roles of informal caregivers in the recovery of patients treated at day oncology centres and (ii) identify differences between patients with and without informal caregivers in the extent to which they experienced symptoms, and the level of bother symptoms caused.

METHOD

Patients from three Australian hospitals (n = 122) were recruited during cycles 1 or 2 of adjuvant chemotherapy. Participants completed a modified version of the Rotterdam Symptom Checklist (RSCL) each day for 5 days after chemotherapy. A telephone interview conducted 10 days post-treatment explored the availability, importance and roles of caregivers. During the interview, participants also completed the modified RSCL in which they were asked about the extent to which they experienced, and were bothered by, each symptom over the prior 5 days combined.

RESULTS

Overall, 71% of participants had an informal caregiver in the 5 days postchemotherapy, commonly a partner. More women (71%) than men (48%) had a caregiver (p < 0.05). Caregivers were perceived to be highly important; they were more important for women than men (U = 213.50, p < 0.01). The most common assistance caregivers provided was meal preparation and emotional support and companionship. On days 6-10 postchemotherapy, the extent to which overall physical symptoms were experienced was higher for patients with a caregiver than without (U = 987.50, p < 0.05); similarly their symptoms caused more bother (U = 966.00, p < 0.01).

CONCLUSIONS

These findings highlighted the importance of informal caregivers to patients postchemotherapy. It is imperative that patients are informed of the importance of this support so a caregiver can be arranged, if possible. Understanding the needs of patients following chemotherapy would enable health professionals to advise patients, with or without caregivers, how to best prepare for and manage their recovery at home.

Psychosocial characteristics associated with breast cancer survivors' intimate partners' needs for information and support after primary breast cancer treatment

This study examines which psychosocial characteristics are associated with breast cancer survivors' partners' posttreatment needs for information and support. Eighty-four partners completed measures of coping, social support, illness representations, perceived stress, self-efficacy, anxiety, depression, and marital malfunctioning. Partners in need reported higher anxiety and depression, emotional illness representations, and emotion-oriented coping than partners without needs. Moreover, partners needing information and support took a more negative view on the timeline and consequences of their spouse's posttreatment condition. Interventions aimed at enhancing partners' posttreatment adjustment should focus on partners responding emotionally as well as perceiving their spouse's condition as a chronic condition.

The relationship between hope and caregiver strain in family caregivers of patients with advanced cancer

BACKGROUND

Today, family caregivers (FCs) are involved in all aspects of patient care. Hope influences one's ability to cope with stressful situations. However, little information is available on how FCs' levels of hope influence the strain they experience in their caregiving role.

OBJECTIVES

The purposes of this study were to describe the levels of hope and caregiver strain in FCs of patients with advanced cancer and examine the relationship between hope and caregiver strain in these FCs. In addition, differences in hope and caregiver strain associated with a number of demographic characteristics are described.

METHODS

Family caregivers completed a demographic questionnaire, Herth Hope Index (HHI), and Caregiver Strain Index (CSI).

RESULTS

Of the 112 FCs, the majority were female (60%) and spouses (94%), with a mean age of 63.1 (SD, 10.7) years. Mean HHI score was 36.8 (SD, 4.0). Approximately 20% of the FCs reported a high level of caregiver strain, and these FCs were younger. The prevalence of perceived strain across subscales of the CSI was highest for emotional adjustment (70%). No relationships were found between HHI total scores and any of the CSI subscale scores. However, FCs with lower HHI scores reported significantly higher levels of caregiver strain.

CONCLUSIONS

Findings from this study suggest that younger individuals may represent a high-risk group of FCs for both lower levels of hope and higher levels of caregiver strain.

IMPLICATIONS FOR PRACTICE

Oncology nurses need to identify FCs at highest risk for increased strain and provide interventions to enhance hope and decrease perceived strain.

On-line information and support for supporters and carers of haematological cancer patients: is access an issue?

Purpose

This study aimed to assess levels of internet access, likelihood of using various sources of information or support, and sociodemographic characteristics related to high internet access among support persons of haematological cancer patients.

Methods

A cross-sectional sample of haematological cancer survivors was recruited via a state cancer registry in Australia. Participating survivors invited their support persons to complete a survey. Of the 268 survivors, 68% had a support person return a survey. Approximately 80% of support persons reported having internet access.

Results

Almost three quarters (74%) reported having ‘high’ access. Support persons reported their likelihood of using internet-based forms of information and support (59% and 26%, respectively) was lower than for other sources, including those delivered face-to-face (80% and 75%) or through print (87% and 70%). Participants who were older or had less education were less likely to report a high level of internet access or likelihood of using web-based sources.

Conclusions

The results demonstrate the need to continue to provide information and support via multiple modes. Support persons who potentially are more vulnerable due to age and lower education are the least likely to use internet-based options. Consequently, these groups may require alternatives, including face-to-face or print-based information and support.

Caregiving burden, stress, and health effects among family caregivers of adult cancer patients

Unlike professional caregivers such as physicians and nurses, informal caregivers, typically family members or friends, provide care to individuals with a variety of conditions including advanced age, dementia, and cancer. This experience is commonly perceived as a chronic stressor, and caregivers often experience negative psychological, behavioral, and physiological effects on their daily lives and health. In this report, we describe the experience of a 53-year-old woman who is the sole caregiver for her husband, who has acute myelogenous leukemia and was undergoing allogeneic hematopoietic stem cell transplantation. During his intense and unpredictable course, the caregiver's burden is complex and complicated by multiple competing priorities. Because caregivers are often faced with multiple concurrent stressful events and extended, unrelenting stress, they may experience negative health effects, mediated in part by immune and autonomic dysregulation. Physicians and their interdisciplinary teams are presented daily with individuals providing such care and have opportunity to intervene. This report describes a case that exemplifies caregiving burden and discusses the importance of identifying caregivers at risk of negative health outcomes and intervening to attenuate the stress associated with the caregiving experience.

To live close to a person with cancer--experiences of family caregivers

The purpose of this study was to obtain a deeper understanding of the experiences of Family Caregivers (FC) living close to a patient with cancer. This article reports on the findings from individual interviews with 15 FCs of patients with cancer. The interview transcripts were analyzed using qualitative hermeneutic analysis. This study revealed that living close to a cancer patient over the course of his or her illness affected many aspects of FCs lives in significant ways. Their experiences can be summarized with two major themes: (1) living in an ever changing life world and (2) balancing between conflicting interests and dilemmas. This study contributed to deeper insights into FC's experiences than previously reported in the literature.

Financial and social impact of supporting a haematological cancer survivor

Support persons of haematological cancer survivors may be faced with unique challenges due to the course of these diseases and the treatments required. This study aimed to examine the social and financial impacts associated with their role. Eight hundred adult survivors of haematological cancer within 3 years of diagnosis were invited via an Australian state population-based cancer registry to complete a survey. Survivors were mailed two questionnaire packages, one for themselves and one for their primary support person. Non-respondents were mailed reminders via the survivor after 3 weeks. One hundred and eighty-two support persons completed the questionnaire (85% response rate). Of these, 67 (46%) support persons reported having at least one personal expense and 91 (52%) experienced at least one financial impact. Male support persons and support persons of survivors in active treatment reported experiencing more personal expenses than other support persons. Older participants reported fewer financial consequences. A greater number of social impacts were reported by those born outside Australia, those who had to relocate for treatment and support persons of survivors in active treatment. Future research should focus on practical solutions to reducing these impacts on support persons.

Needs of relatives of breast cancer patients: the perspectives of families and nurses

PURPOSE

Breast cancer is not only a stressful event for those afflicted, but also for their family and friends. In Germany, attention and support from professional nurses is almost exclusively given to the patient. But even relatives require information and support in order to keep their anxiety levels low and strength up. The aim of this study is to survey those needs and the current level of satisfaction, as well as to ascertain which needs are perceived by nurses.

METHOD

Data were collected in a German-wide descriptive cross-sectional study surveying 242 relatives and 356 nurses from 150 randomly chosen certified breast care centers between August 2008 and February 2009. Two questionnaires developed for this study were used.

RESULTS

The findings indicate that relatives need above all a) security and trust, followed by b) partnership of care and c) emotional support. Regarding satisfaction, relatives consider the need for "security and trust" to be most satisfied. Least fulfilled were those for "partnership of care" and "emotional support". The nurses regarded the importance of most of the relatives' needs to be higher than the relatives themselves. Even the fulfillment of needs was over-estimated.

CONCLUSIONS

The targeted and professional involvement of relatives in the care of breast cancer patients is still not common practice. An initial step toward better family nursing is viewing families as an integral part of the patient and intentionally planning contact.

Creating a bond between caregivers online: effect on caregivers' coping strategies

Numerous studies have investigated the effect of Interactive Cancer Communication Systems (ICCSs) on system users' improvements in psychosocial status. Research in this area, however, has focused mostly on cancer patients, rather than on caregivers, and on the direct effects of ICCSs on improved outcomes, rather than on the psychological mechanisms of ICCS effects. To understand the underlying mechanisms, this study examines the mediating role of perceived caregiver bonding in the relation between one ICCS (the Comprehensive Health Enhancement Support System [CHESS]) use and caregivers' coping strategies. To test the hypotheses, a secondary analysis of data was conducted on 246 caregivers of lung cancer patients. These caregivers were randomly assigned to (a) the Internet, with links to high-quality lung cancer websites, or (b) access to CHESS, which integrated information, communication, and interactive coaching tools. Findings suggest that perceived bonding has positive effects on caregivers' appraisal and problem-focused coping strategies, and it mediates the effect of ICCS on the coping strategies 6 months after the intervention has begun.

Work productivity and health of informal caregivers of persons with advanced cancer

The purpose of this study was to describe health promotion behaviors and work productivity loss in informal caregivers of individuals with advanced stage cancer. Using a cross-sectional, correlational design, 70 caregivers completed measures of health behaviors, mood, social support, and burden. Absenteeism and presenteeism were evaluated in employed caregivers (n = 40). Caregivers reported low levels of physical activity. The mean percentage of work productivity loss due to caregiving was 22.9%. Greater work productivity loss was associated with greater number of caregiving hours, higher cancer stage, married status, and greater anxiety, depression, and burden related to financial problems, disrupted schedule, and health. Nurses should assess caregivers and provide health promotion interventions, which may ultimately reduce the economic impact of caregiving.

How do informal caregivers of patients with cancer cope: A descriptive study of the coping strategies employed

PURPOSE

A trend exists towards moving from the hospital and caring for the patients with cancer at home, which has directed the burden of caring to the family. As a result the numbers of informal caregivers, who assumed the care of their loved ones, has increased rapidly. The aim of the study is to explore the ways that families use to cope with the stressors and hardships of caregiving and expand the knowledge about coping.

METHODS

This is a descriptive research design, with the use of a convenience sample of 130 dyads. Consenting patients identified their primary family caregiver who was asked to participate in the study.

KEY RESULTS

The majority of the caregivers employed emotionally focused ways of coping with the caregiving burden such as: "I was hoping for a miracle" (mean 2.19), "I was hoping that time would change things and simply waited" (mean 2.14) and "I found consolidation in my faith to God" (mean 2.05). Assertive ways of coping such as "I expressed my anger to the patient" (mean 0.78) and "I dared to do something risky" (mean 0.98) were less likely to be used by the caregivers.

CONCLUSIONS

Findings are consistent with those of previous research that informal caregivers experience substantial psychological morbidity in the form of depression in addition to caregiver burden when they assume the role of the informal caregiver. Caregivers employ various strategies in order to cope with the strains associated with the complex physical and emotional demands involved in caring.

Descriptive study of partners' experiences of living with severe heart failure

PURPOSE

This qualitative study sought to describe the experiences of living with severe heart failure (HF) from the perspective of the partner.

METHODS

In-depth, semistructured interviews were conducted with 14 partners of individuals diagnosed with severe HF. Content analysis was performed to derive the main themes and subthemes of responses.

RESULTS

Three main themes were derived from the data: (1) My Experience of HF in My Loved One, (2) Experience With Healthcare Providers, and the (3) Patient's Experience of HF as Perceived by the Partner.

CONCLUSION

The severity of the patient's disease limited the partner's lifestyle, resulting in social isolation and difficulties in planning for the future for both the patient and the partner. The partners were unprepared to manage the disease burden at home without consistent information and assistance by healthcare providers. Moreover, end-of-life planning was neither encouraged by healthcare providers nor embraced by patients or partners.

Comparative Effectiveness Research: Using Systematic Reviews and Meta-Analyses to Synthesize Empirical Evidence

The increased demand for evidence-based health care practices calls for comparative effectiveness research (CER), namely the generation and synthesis of research evidence to compare the benefits and harms of alternative methods of care. A significant contribution of CER is the systematic identification and synthesis of available research studies on a specific topic. The purpose of this article is to provide an overview of methodological issues pertaining to systematic reviews and meta-analyses to be used by investigators with the purpose of conducting CER. A systematic review or meta-analysis is guided by a research protocol, which includes (a) the research question, (b) inclusion and exclusion criteria with respect to the target population and studies, © guidelines for obtaining relevant studies, (d) methods for data extraction and coding, (e) methods for data synthesis, and (f ) guidelines for reporting results and assessing for bias. This article presents an algorithm for generating evidence-based knowledge by systematically identifying, retrieving, and synthesizing large bodies of research studies. Recommendations for evaluating the strength of evidence, interpreting findings, and discussing clinical applicability are offered.

The complexity of cancer in multiple family members: dynamics of social work collaboration

This article presents a case study of one family affected by a cancer diagnosis in both the father and the daughter, who were diagnosed within the same time interval and who underwent treatment at the same time. The article examines the relationship between the caregivers and the oncology patient as well as with one another when the stress of diagnosis is compounded by multiple, simultaneous, and similar diagnoses in a highly condensed period of time. A thorough examination of the literature reveals that there are significant gaps regarding how multiple cancer diagnoses in one family affect the family dynamic, individual and collective coping styles, and caregiver burden. The diagnoses can also dramatically exacerbate economic stressors in a family. The coordination of psychosocial care from the perspectives of the adult and pediatric oncology social workers at an urban academic medical center will be discussed. The social work role, importance of collaboration, and family centered care perspective will be discussed as a method of easing the treatment experience for families in psychosocial distress.

Interventions with family caregivers of cancer patients: meta-analysis of randomized trials

Family caregivers of cancer patients receive little preparation, information, or support to perform their caregiving role. However, their psychosocial needs must be addressed so they can maintain their own health and provide the best possible care to the patient. The purpose of this article is to analyze the types of interventions offered to family caregivers of cancer patients, and to determine the effect of these interventions on various caregiver outcomes. Meta-analysis was used to analyze data obtained from 29 randomized clinical trials published from 1983 through March 2009. Three types of interventions were offered to caregivers: psychoeducational, skills training, and therapeutic counseling. Most interventions were delivered jointly to patients and caregivers, but they varied considerably with regard to dose and duration. The majority of caregivers were female (64%) and Caucasian (84%), and ranged in age from 18 to 92 years (mean age, 55 years). Meta-analysis indicated that although these interventions had small to medium effects, they significantly reduced caregiver burden, improved caregivers' ability to cope, increased their self-efficacy, and improved aspects of their quality of life. Various intervention characteristics were also examined as potential moderators. Clinicians need to deliver research-tested interventions to help caregivers and patients cope effectively and maintain their quality of life.

Cuidado de pacientes oncológicos: una revisión sobre el impacto de la situación de estrés crónico y su relación con la personalidad del cuidador y otras variables moduladoras

Objetivo: La incidencia y prevalencia de enfermedades de larga duración como el cáncer se ha incrementado en los últimos años. En este contexto, nuestro principal objetivo será el análisis de las principales consecuencias que la exposición a una situación de estrés crónico, como es el cuidado de un paciente oncológico, tiene sobre la salud psicosocial y la función cognitiva del cuidador informal y su relación con variables moduladoras. Método: Se realizó una revisión bibliográfica en las bases de datos PubMed y PsychINFO sobre las consecuencias de la situación de cuidado en pacientes crónicos. Resultados: Diversos estudios sugieren que la condición de cuidador de un paciente oncológico puede considerarse una situación estresante que conlleva consecuencias tanto a nivel de salud física como psicosocial del cuidador además de un deterioro en su funcionamiento cognitivo que pueden estar modulados por diferentes variables. Conclusión: Estos datos sugieren la importancia de implementar programas de intervención que amortigüen las consecuencias deletéreas de la labor de cuidado.