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Abstract
BACKGROUND Competing theories of adaptation and wear-and-tear describe psychological distress patterns among family caregivers. PURPOSE This study seeks to characterize psychological distress patterns in family caregivers and identify predictors. METHODS One hundred three caregivers of care recipients with primary malignant brain tumors were interviewed within 1, 4, 8, and 12 months post-diagnosis regarding psychological distress; care recipients were interviewed regarding clinical/functional characteristics. Group-based trajectory modeling identified longitudinal distress patterns, and weighted logistic/multinomial regression models identified predictors of distress trajectories. RESULTS Group-based trajectory modeling identified high-decreasing (51.1 % of caregivers) and consistently low (48.9 %) depressive symptom trajectories, high-decreasing (75.5 %) and low-decreasing (24.5 %) anxiety trajectories, and high (37.5 %), moderate (40.9 %), and low-decreasing (21.6 %) caregiver burden trajectories. High depressive symptoms were associated with high trajectories for both anxiety and burden, lower caregivers age, income, and social support, and lower care recipient functioning. CONCLUSIONS Our data support the adaptation hypothesis; interventions should target those at risk for persistent distress.
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Aziz NM, Miller JL, Curtis JR. Palliative and end-of-life care research: embracing new opportunities. Nurs Outlook 2012; 60:384-90. [PMID: 23141198 PMCID: PMC3499046 DOI: 10.1016/j.outlook.2012.08.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2012] [Revised: 08/09/2012] [Accepted: 08/16/2012] [Indexed: 12/25/2022]
Abstract
The past two decades have witnessed dramatic advances in palliative and end-of-life care research with increased understanding of the burden of life-limiting diseases on patients, families, clinicians, and our healthcare system; and researchers have documented palliative care interventions that improve patient and family outcomes and reduce the costs of care (Detering, Hancock, Reade, & Silvester, 2010). These advances have led to a new era of palliative and end-of-life care research and practice with widespread recognition of its accomplishments and successes. Consequently, we now have an important opportunity to reassess our recent successes and challenges and to identify the goals and benchmarks that will ensure ongoing robust advances in this now-recognized and critical scientific area. High-quality palliative and end-of-life care will be best informed by methodologically strong research efforts that generate a body of evidence with the capacity to support and direct care and effect changes in practice. It is in this context that the National Institute of Nursing Research conceptualized and led a Summit titled The Science of Compassion: Future Directions in End-of-Life and Palliative Care Research in August, 2011. In this summary article, we present brief overviews of the six articles chosen for this Special Issue of Nursing Outlook, examine their key conclusions, articulate gaps and needs, and discuss next steps in palliative and end-of-life care research through the lens of these six topics.
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Affiliation(s)
- Noreen M Aziz
- National Institute of Nursing Research, National Institutes of Health, Office of Extramural Programs, Division of Extramural Activities, Bethesda, MD 20892, USA.
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Ferrell B, Hanson J, Grant M. An overview and evaluation of the oncology family caregiver project: improving quality of life and quality of care for oncology family caregivers. Psychooncology 2012; 22:1645-52. [PMID: 23065694 DOI: 10.1002/pon.3198] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Revised: 08/24/2012] [Accepted: 09/08/2012] [Indexed: 11/08/2022]
Abstract
OBJECTIVE With changes in health care, oncology family caregivers (FCs) provide the vast majority of patient care. Yet, FCs assume their role with little or no training and with limited resources within the cancer setting to support them. The purpose of this project is to develop and implement a curriculum to improve the quality of life and quality of care for FCs by strengthening cancer care settings in this area. METHODS A National Cancer Institute (NCI) R25 grant funded the development of an FC curriculum for professional healthcare providers. The curriculum, based on the City of Hope Quality-of-Life Model, is presented to professionals from cancer centers in national training courses. The project brings together the most current evidence-based knowledge and multiple resources to help improve FC support. Participants develop goals related to implementation and dissemination of the course content and resources in their home institution. Goal evaluation follows at 6, 12, and 18 months. RESULTS To date, three courses have been presented to 154 teams (322 individuals) representing 39 states. Course evaluations were positive, and participants have initiated institutional FC support goals. Although the goals are diverse, the broad categories include support groups, staff/FC/community education, resource development, assessment tools, and institutional change. CONCLUSIONS There is a critical need to improve support for cancer FCs. This FC training course for professionals is a first step in addressing this need.
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Affiliation(s)
- Betty Ferrell
- City of Hope National Medical Center, Duarte, CA 91010, USA
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Abstract
OBJECTIVE Informal caregivers (ICs) are relatives, friends, and partners who have a significant relationship with and provide assistance (i.e., physical, emotional) to a patient with a life- threatening, incurable illness. The multidimensional burden that results from providing care to a patient with cancer is well documented, and as a result, a growing number of psychosocial interventions have been developed specifically to address this burden. The purpose of the present study was to characterize the state of the science of psychosocial interventions for informal cancer caregivers. METHOD A comprehensive systematic review of interventions for cancer caregivers was conducted via an electronic literature search of publications between 1980 and January 13, 2011. A final sample of 49 interventions was reviewed in detail. RESULTS The interventions, which varied in terms of modality and patient population, fell into the following eight categories: psychoeducation, problem-solving/skills building interventions, supportive therapy, family/couples therapy, cognitive-behavioral therapy, interpersonal therapy, complementary and alternative medicine interventions, and existential therapy. Benefits and disadvantages of each of the categories are discussed, with special attention given to studies that produced null findings. SIGNIFICANCE OF RESULTS Beyond specific techniques, structured, goal-oriented, and time-limited interventions that are integrative appear to be the most feasible and offer the greatest benefits for ICs of cancer patients. Future studies are needed to examine the specific benefits and challenges of delivering interventions in alternative modalities (Internet, Skype) so that the needs of a greater number of ICs may be addressed.
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Abstract
This study investigated the experiences of caregivers of loved ones with cancer in Lomé, Togo. The authors developed a framework that captures the experiences of 17 caregivers. The framework explains the exploratory factors that influenced the lives of caregivers from the caregivers' own perspectives. Findings showed that even though the caregivers experienced significant challenges that affected their lives and the lives of their families, because of cultural norms and expectations, they tried their best to overcome the challenges. Although some reported positive impacts on their family functioning, others reported negative impacts such as fragmentation of the family unit. Implications for practice and policy are discussed.
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Affiliation(s)
- Yawo Bessa
- University of North Texas, Department of Sociology, 1155 Union Circle # 311157, Denton, TX 76203, USA.
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Gaugler JE, Eppinger A, King J, Sandberg T, Regine WF. Coping and its effects on cancer caregiving. Support Care Cancer 2012; 21:385-95. [PMID: 22717917 DOI: 10.1007/s00520-012-1525-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Accepted: 06/04/2012] [Indexed: 01/10/2023]
Abstract
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.
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Affiliation(s)
- Joseph E Gaugler
- School of Nursing, Masonic Cancer Center, The University of Minnesota, 6-153 Weaver-Densford Hall 1331, Minneapolis, MN 55455, USA.
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Longacre ML, Ridge JA, Burtness BA, Galloway TJ, Fang CY. Psychological functioning of caregivers for head and neck cancer patients. Oral Oncol 2011; 48:18-25. [PMID: 22154127 DOI: 10.1016/j.oraloncology.2011.11.012] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Revised: 11/11/2011] [Accepted: 11/15/2011] [Indexed: 12/30/2022]
Abstract
Patients with head and neck squamous cell carcinoma (HNSCC) often require assistance from family caregivers during the treatment and post-treatment period. This review article sought to summarize current findings regarding the psychological health of HNSCC caregivers, including factors that may be associated with poorer psychological health. Online databases (PUBMED, MEDLINE and PSYCINFO) were searched for papers published in English through September 2010 reporting on the psychological health of caregivers of HNSCC patients. Eleven papers were identified. Caregivers experience poorer psychological health, including higher levels of anxious symptoms, compared to patients and to the general population. Fear of patient cancer recurrence is evident among caregivers and is associated with poorer psychological health outcomes. The 6-month interval following diagnosis is a significant time of stress for caregivers. Greater perceived social support may yield positive benefits for the psychological health of caregivers. To date, there have been relatively few reports on the psychological health of caregivers of HNSCC patients. Well designed, prospective, longitudinal studies are needed to enhance our understanding of how caregiver psychological health may vary over the cancer trajectory and to identify strategies for improving caregiver outcomes.
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Fletcher BS, Miaskowski C, Given B, Schumacher K. The cancer family caregiving experience: an updated and expanded conceptual model. Eur J Oncol Nurs 2011; 16:387-98. [PMID: 22000812 DOI: 10.1016/j.ejon.2011.09.001] [Citation(s) in RCA: 198] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2010] [Revised: 08/30/2011] [Accepted: 09/05/2011] [Indexed: 02/01/2023]
Abstract
OBJECTIVE The decade from 2000 to 2010 was an era of tremendous growth in family caregiving research specific to the cancer population. This research has implications for how cancer family caregiving is conceptualized, yet the most recent comprehensive model of cancer family caregiving was published ten years ago. Our objective was to develop an updated and expanded comprehensive model of the cancer family caregiving experience, derived from concepts and variables used in research during the past ten years. METHODS A conceptual model was developed based on cancer family caregiving research published from 2000 to 2010. RESULTS Our updated and expanded model has three main elements: 1) the stress process, 2) contextual factors, and 3) the cancer trajectory. Emerging ways of conceptualizing the relationships between and within model elements are addressed, as well as an emerging focus on caregiver-patient dyads as the unit of analysis. CONCLUSIONS Cancer family caregiving research has grown dramatically since 2000 resulting in a greatly expanded conceptual landscape. This updated and expanded model of the cancer family caregiving experience synthesizes the conceptual implications of an international body of work and demonstrates tremendous progress in how cancer family caregiving research is conceptualized.
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Affiliation(s)
- Barbara Swore Fletcher
- College of Nursing, University of Nebraska Medical Center, 985330 Nebraska Medical Center, Omaha, NE 68198-5330, USA.
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Given BA, Sherwood P, Given CW. Support for Caregivers of Cancer Patients: Transition After Active Treatment. Cancer Epidemiol Biomarkers Prev 2011; 20:2015-21. [DOI: 10.1158/1055-9965.epi-11-0611] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Hricik A, Donovan H, Bradley SE, Given BA, Bender CM, Newberry A, Hamilton R, Given CW, Sherwood P. Changes in caregiver perceptions over time in response to providing care for a loved one with a primary malignant brain tumor. Oncol Nurs Forum 2011; 38:149-55. [PMID: 21356653 DOI: 10.1188/11.onf.149-155] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To examine how family members of patients with a primary malignant brain tumor transition into the caregiver role and how their perceptions of this transition change over time. RESEARCH APPROACH Descriptive, qualitative. SETTING Neurosurgery and neuro-oncology clinics of a regional medical center. PARTICIPANTS 10 family caregivers of patients with a primary malignant brain tumor. METHODOLOGIC APPROACH A series of 11 open-ended questions addressing various aspects of the care situation were administered to each caregiver. The same questions were asked at baseline (within one month of the patient's diagnosis) and four months later. Content analysis was performed to identify themes among interviews. MAIN RESEARCH VARIABLES Patient changes, caregiver adjustments, and accessing support. FINDINGS Caregivers described difficulties stemming from the patient's tumor-related dysfunction and changes in their familial, occupational, and social roles. Support from family and friends was vital to caregivers' emotional health, but shock and fear were evident in all interviews. Becoming subsumed in the care situation was described as enmeshment. Caregivers reported difficulty in communicating with healthcare providers. When looking at change over time, three major themes emerged: Patient Changes: The New Normal; Caregiver Adjustments; and Accessing Support. CONCLUSIONS Caregivers require support in handling neurologic and physical sequelae, transitioning into new roles, and avoiding becoming enmeshed in the care situation. INTERPRETATION This study underlines the importance of continuing research in this area to provide the necessary interventions that will assist caregivers and provide support throughout their loved one's disease trajectory.
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Affiliation(s)
- Allison Hricik
- School of Nursing, University of Pittsburgh, Pennsylvania, USA
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Palos GR, Mendoza TR, Liao KP, Anderson KO, Garcia-Gonzalez A, Hahn K, Nazario A, Ramondetta LM, Valero V, Lynch GR, Jibaja-Weiss ML, Cleeland CS. Caregiver symptom burden: the risk of caring for an underserved patient with advanced cancer. Cancer 2011; 117:1070-9. [PMID: 20960510 PMCID: PMC3065823 DOI: 10.1002/cncr.25695] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2010] [Revised: 08/30/2010] [Accepted: 09/01/2010] [Indexed: 11/12/2022]
Abstract
BACKGROUND The growing diversity of the population of the United States and the high burden of cancer-related symptoms reflect the need for caregiver research within underserved groups. In this longitudinal study, the authors assessed changes in symptom severity in caregivers and underserved minority patients diagnosed with advanced solid tumors who were being treated at public hospitals. METHODS A total of 85 matched patient-caregiver dyads completed the M. D. Anderson Symptom Inventory 3 times during 20 weeks of chemotherapy. At each time point, symptom severity and interference with daily activities were assessed. Group-based trajectory modeling was used to classify caregivers into high-symptom or low-symptom burden groups. RESULTS Sadness and distress were more prevalent among caregivers (P = .005). Symptom burden remained stable among caregivers in the high-symptom group (40%), whereas the low-symptom group (60%) demonstrated a statistically significant decrease over time. Multivariate analysis found being a family-member caregiver (adjusted odds ratio [ADJ-OR], 4.1; 95% confidence interval [95% CI], 1.4-11.6) and caring for a highly symptomatic patient (ADJ-OR, 8.0; 95% CI, 1.5-41.4), rather than race, ethnicity, or sociodemographic characteristics, were significant predictors of the caregiver's membership in the high-symptom burden group. CONCLUSIONS Approximately 40% of the caregivers in the current study were found to be at an increased risk for moderate to severe sadness and distress, which remained severe throughout the patient's treatment course at public hospitals. To the authors' knowledge, this study marks the first time that the concept of symptom burden has been used to measure caregiver burden, and the first time that symptom burden has been measured and documented in dyads of caregivers and underserved minority patients. Cancer 2011. © 2010 American Cancer Society.
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Affiliation(s)
- Guadalupe R Palos
- Department of Symptom Research, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
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Northfield S, Nebauer M. The Caregiving Journey for Family Members of Relatives With Cancer. Clin J Oncol Nurs 2010; 14:567-77. [DOI: 10.1188/10.cjon.567-577] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Measures of Psychological Stress and Physical Health in Family Caregivers of Stroke Survivors. J Neurosci Nurs 2010; 42:128-38. [DOI: 10.1097/jnn.0b013e3181d4a3ee] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Bradley SE, Sherwood PR, Kuo J, Kammerer CM, Gettig EA, Ren D, Rohrer WM, Donovan HS, Hricik A, Newberry A, Given B. Perceptions of economic hardship and emotional health in a pilot sample of family caregivers. J Neurooncol 2009; 93:333-42. [PMID: 19159080 PMCID: PMC2735729 DOI: 10.1007/s11060-008-9778-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2008] [Accepted: 12/30/2008] [Indexed: 11/30/2022]
Abstract
Although several studies have quantified costs of cancer care; none to date have examined how cancer costs impact family caregivers' emotional health. This study was designed to evaluate how perceptions of economic hardship influence burden, depressive symptoms, and anxiety in family caregivers of persons with a primary malignant brain tumor. Caregiver (CG)/patient dyads (n = 33) were recruited at the time of diagnosis; data were collected at diagnosis and 4 months, and linear regression determined the impact of economic hardship on caregivers' emotional health. Economic hardship did not predict CG burden-schedule at diagnosis or 4 months. Economic hardship predicted burden-abandonment at diagnosis (P < 0.01), but not 4 months. There was a trend for economic hardship to predict CG depressive symptoms at 4 months (P = 0.09), but not at diagnosis. Economic hardship predicted CG anxiety at 4 months (P = 0.06), but not diagnosis. Results suggest caregivers' economic hardship is an important and dynamic aspect of the emotional health of neuro-oncology family caregivers.
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Affiliation(s)
- Sarah E. Bradley
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, USA
| | - Paula R. Sherwood
- School of Nursing, University of Pittsburgh, 336 Victoria Building, 3500 Victoria Street, Pittsburgh, PA 15261, USA,
- Department of Neurosurgery, School of Medicine, University of Pittsburgh, Pittsburgh, USA
| | - Jean Kuo
- School of Nursing, University of Pittsburgh, 336 Victoria Building, 3500 Victoria Street, Pittsburgh, PA 15261, USA
| | | | | | - Dianxu Ren
- School of Nursing, University of Pittsburgh, 336 Victoria Building, 3500 Victoria Street, Pittsburgh, PA 15261, USA
| | - Wesley M. Rohrer
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, USA
- School of Health & Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, USA
| | - Heidi S. Donovan
- School of Nursing, University of Pittsburgh, 336 Victoria Building, 3500 Victoria Street, Pittsburgh, PA 15261, USA
| | - Allison Hricik
- School of Nursing, University of Pittsburgh, 336 Victoria Building, 3500 Victoria Street, Pittsburgh, PA 15261, USA
| | - Alyssa Newberry
- School of Nursing, University of Pittsburgh, 336 Victoria Building, 3500 Victoria Street, Pittsburgh, PA 15261, USA
| | - Barbara Given
- College of Nursing, Michigan State University, East Lansing, USA
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Evaluation of anxiety, depression and urinary protein excretion among the family caregivers of advanced cancer patients. Biol Psychol 2008; 79:234-8. [DOI: 10.1016/j.biopsycho.2008.06.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2007] [Revised: 05/15/2008] [Accepted: 06/02/2008] [Indexed: 11/20/2022]
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