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Ramazanu S, Loke AY, Chiang VCL. Couples coping in the community after the stroke of a spouse: A scoping review. Nurs Open 2020; 7:472-482. [PMID: 32089843 PMCID: PMC7024616 DOI: 10.1002/nop2.413] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 09/16/2019] [Accepted: 10/14/2019] [Indexed: 11/10/2022] Open
Abstract
Aim To summarize evidence on the poststroke coping experiences of stroke patients and spousal caregivers living at home in the community. Design A scoping review. Methods Extensive searches were conducted in credible databases. Articles published in the English language were retrieved. Data were extracted based on study location, aims, study design, sample size, time after stroke and key findings. Results Out of 53 identified articles, 17 studies were included in the review. Five key themes were as follows: (a) emotional challenges; (b) role conflicts; (c) lack of strategies in coping; (d) decreased life satisfaction of the couples; and (e) marriage relationship: at a point of change. Couples were not sufficiently prepared to cope and manage with stroke at home on discharge from the hospital. This review emphasized the need for hospitals to implement policies to address the inadequate preparation of couples in coping with stroke.
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Affiliation(s)
- Sheena Ramazanu
- The Hong Kong Polytechnic UniversityHung HomHong Kong
- Yishun Community HospitalSingaporeSingapore
| | - Alice Yuen Loke
- School of NursingThe Hong Kong Polytechnic UniversityHung HomHong Kong
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Costi S, Pellegrini M, Cavuto S, Fugazzaro S. Occupational therapy in rehabilitation of complex patients: protocol for a superiority randomized controlled trial. J Interprof Care 2020:1-8. [PMID: 32013621 DOI: 10.1080/13561820.2020.1711720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 08/08/2019] [Accepted: 01/02/2020] [Indexed: 10/25/2022]
Abstract
Patient-centered, interprofessional occupational therapy is feasible in complex patients in the early phase of rehabilitation, and it contributes to meet needs in the domains of self-care, productivity, and leisure, promoting social role. We planned this single-center single-blind two-arm parallel individual patient randomized controlled trial, to verify the superiority of interprofessional experimental occupational therapy (EOT) compared to standard rehabilitation (SR) in producing higher levels of patients' social participation assessed by the Reintegration to Normal Living Index. EOT is a patient-centered, hospital/home-based rehabilitation intervention based on the Canadian Model of Occupational Performance and Engagement. This appropriately powered study will provide evidence regarding the effectiveness of EOT on the recovery of social participation in the critical transition of complex patients from hospital to the home setting.
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Affiliation(s)
- Stefania Costi
- Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Department of Surgery, Medicine, Dentistry and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genova, Genova, Italy
| | - Martina Pellegrini
- Department of Neuromotor Physiopathology and Rehabilitation Medicine, Physical Medicine and Rehabilitation Unit-Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Silvio Cavuto
- Clinical Trials and Statistics Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Stefania Fugazzaro
- Department of Neuromotor Physiopathology and Rehabilitation Medicine, Physical Medicine and Rehabilitation Unit-Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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53
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Denham AM, Baker AL, Spratt NJ, Wynne O, Hunt SA, Bonevski B, Kumar R. YouTube as a resource for evaluating the unmet needs of caregivers of stroke survivors. Health Informatics J 2019; 26:1599-1616. [PMID: 31722610 DOI: 10.1177/1460458219873538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Content produced by caregivers of stroke survivors on the online video-sharing platform YouTube may be a good source of knowledge regarding caregivers' unmet needs. We aimed to examine the content, quantity and quality of YouTube videos that target and discuss the needs and concerns of caregivers of stroke survivors. YouTube was systematically searched using six search strings, and the first 20 videos retrieved from each search were screened against the inclusion criteria. A pre-determined coding schedule was used to report the rate of unmet needs in each video. Twenty-six videos were included in the analysis. In total, 291 unmet needs were reported by caregivers of stroke survivors, an average of 11.2 unmet needs per video. The most common unmet needs domain was 'Impact of Caregiving on Daily Activities' (44%). Most videos were developed in the United States (61.5%) and featured spouses of stroke survivors (65.47%). Content produced by caregivers of stroke survivors on YouTube may be used as a tool for caregivers to provide and receive support through online communication. YouTube videos offer insight into the unmet needs of caregivers of stroke survivors and may be used as an additional resource for stroke services to support caregivers.
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54
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Hedlund Å, Nordström T, Kristofferzon M, Nilsson A. New insights and access to resources change the perspective on life among persons with long-term illness-An interview study. Nurs Open 2019; 6:1580-1588. [PMID: 31660186 PMCID: PMC6805306 DOI: 10.1002/nop2.363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 08/05/2019] [Indexed: 11/10/2022] Open
Abstract
AIM The aim was to describe individuals' experiences of living with long-term illness. METHODS A qualitative approach with a descriptive design was used. Semi-structured interviews were conducted with 16 persons (50-80 years). They were also asked to self-rate their perceptions of their current health status and confidence in their ability to cope with everyday life. RESULTS One main theme was identified: new insights and access to resources change the perspective on life. Personal characteristics and support from others were advantageous in finding ways to deal with limitations related to the illness. Most of the persons experienced a changed approach to life, in that they now valued life more than they had before. However, some persons also experienced lost values and found it difficult to accept medications. The persons rated their current health status as slightly above average, but their confidence in their ability to cope with everyday life as high.
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Affiliation(s)
- Åsa Hedlund
- Department of Health and Caring SciencesUniversity of GävleGävleSweden
| | - Tina Nordström
- Department of Health and Caring SciencesUniversity of GävleGävleSweden
| | - Marja‐Leena Kristofferzon
- Department of Health and Caring SciencesUniversity of GävleGävleSweden
- Department of Public Health and Caring Sciences,Section of Caring SciencesUppsala UniversityUppsalaSweden
| | - Annika Nilsson
- Department of Health and Caring SciencesUniversity of GävleGävleSweden
- Department of Public Health and Caring Sciences,Section of Caring SciencesUppsala UniversityUppsalaSweden
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55
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Bright FAS, McCann CM, Kayes NM. Recalibrating hope: A longitudinal study of the experiences of people with aphasia after stroke. Scand J Caring Sci 2019; 34:428-435. [PMID: 31487069 PMCID: PMC7432176 DOI: 10.1111/scs.12745] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 08/01/2019] [Indexed: 11/29/2022]
Abstract
Background Hope is a critical resource for people with aphasia after stroke, sustaining people though times of distress and uncertainty and providing motivation. In the first months after stroke, hope is vulnerable to different influences, and people can struggle to identify and work towards hopes for the future. We have little knowledge about how people with aphasia experience hope in the longer term after stroke. Objectives To identify how people with aphasia experience hope 1 year after stroke and how hope may change in the year after stroke. Methods The study used an Interpretive Description methodology. Interviews were conducted with four people with aphasia who had been interviewed 1 year previously. These were analysed using content analysis. Results All people reported a broad sense of hope for the future. They described an active process of recalibrating their early poststroke hopes through a process of reflecting on past progress, current function and what they considered might be possible and desirable in the future. People were able to develop ‘new’ hopes that were meaningful and seemingly achievable when they had a sense of a possible, desirable future. Those who struggled to see a possible future maintained a hope that things will be good. Social supports, a sense of progress, engagement in meaningful activities and interactions appeared crucial in helping people (re)develop hopes for their future. Conclusions Hope and hopes for the future gradually changed after stroke. Hope, identity and social connectedness were closely entwined and could enable people to both dwell in the present and move towards desired futures. This research suggests clinicians should prioritise creating hope‐fostering environments which support people to develop hope for their future.
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Affiliation(s)
- Felicity A S Bright
- Centre for Person Centred Research, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Clare M McCann
- School of Psychology (Speech Science), University of Auckland, Auckland, New Zealand
| | - Nicola M Kayes
- Centre for Person Centred Research, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
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56
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Minshall C, Pascoe MC, Thompson DR, Castle DJ, McCabe M, Chau JPC, Jenkins Z, Cameron J, Ski CF. Psychosocial interventions for stroke survivors, carers and survivor-carer dyads: a systematic review and meta-analysis. Top Stroke Rehabil 2019; 26:554-564. [PMID: 31258017 DOI: 10.1080/10749357.2019.1625173] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Objective: To evaluate the effectiveness of psychosocial interventions on depressive symptoms, anxiety symptoms, quality of life, self-efficacy, coping, carer strain and carer satisfaction among stroke survivors, carers and survivor-carer dyads. Data sources: MEDLINE, CINAHL, PsycINFO, SocINDEX, Cochrane Library, Web of Science and Scopus databases and the grey literature were searched up to September 2018. Methods: A systematic review and meta-analysis of randomized controlled trials of psychosocial interventions for stroke survivors, carers and survivor-carer dyads, compared to usual care. Outcomes measured were depressive symptoms, anxiety symptoms, quality of life, coping, self-efficacy, carer strain, and carer satisfaction. Results: Thirty-one randomized controlled trials (n = 5715) were included in the systematic review which found improvements in depressive symptoms, anxiety symptoms, quality of life and coping, though the number of trials assessing each outcome varied. A meta-analysis (11 trials; n = 1280) on depressive symptoms found that in seven trials psychosocial interventions reduced depressive symptoms in stroke survivors (SMD: -0.36, 95% CI -0.73 to 0.00; p = .05) and in six trials reduced depressive symptoms in carers (SMD: -0.20, 95% CI -.40 to 0.00; p = .05). Conclusion: Psychosocial interventions reduced depressive symptoms in stroke survivors and their carers. There was limited evidence that such interventions reduced anxiety symptoms, or improved quality of life and coping for stroke survivors and carers and no evidence that they improved self-efficacy, carer strain or carer satisfaction.
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Affiliation(s)
- Catherine Minshall
- Faculty of Health Sciences, Australian Catholic University , Melbourne , Australia.,Mental Health Service, St. Vincent's Hospital , Melbourne , Australia
| | - Michaela C Pascoe
- Institute of Sport, Exercise and Active Living, Victoria University , Melbourne , Australia.,Department of Cancer Experiences, Peter MacCallum Cancer Centre , Melbourne , Australia
| | - David R Thompson
- Department of Psychiatry, University of Melbourne , Melbourne , Australia.,School of Nursing and Midwifery, Queen's University , Belfast , UK
| | - David J Castle
- Mental Health Service, St. Vincent's Hospital , Melbourne , Australia.,Department of Psychiatry, University of Melbourne , Melbourne , Australia
| | - Marita McCabe
- Faculty of Health Sciences, Swinburne University of Technology , Melbourne , Australia
| | - Janita P C Chau
- Nethersole School of Nursing, Chinese University of Hong Kong , Shatin , Hong Kong
| | - Zoe Jenkins
- Mental Health Service, St. Vincent's Hospital , Melbourne , Australia
| | - Jan Cameron
- School of Nursing and Midwifery, Monash University , Melbourne , Australia
| | - Chantal F Ski
- Department of Psychiatry, University of Melbourne , Melbourne , Australia.,School of Nursing and Midwifery, Queen's University , Belfast , UK
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57
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Denham AM, Wynne O, Baker AL, Spratt NJ, Bonevski B. The unmet needs of carers of stroke survivors: An evaluation of Google search results. Health Informatics J 2019; 26:934-944. [PMID: 31213117 DOI: 10.1177/1460458219852530] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Google is the most used search engine in the world, and likely to be used by caregivers of stroke survivors to find online forums and online communities to connect with other caregivers. This study aims to identify the types of websites accessed by caregivers of stroke survivors to connect with other caregivers, and analyse the online content produced by caregivers to identify their unmet needs. The first 20 websites from eight search strings entered into Google were systematically reviewed. Unmet needs on included websites were identified using a pre-determined coding schedule. Six websites were analysed. Most were discussion boards (n = 5, 83%) developed by organisations in the United States (n = 4, 66.6%). Overall, 2124 unmet needs appeared in 896 posts from caregivers. 'Emotional and psychological' were the most reported needs across posts (n = 765, 36%). Content produced on websites may address social isolation and provide insight into delivering and developing services to meet the needs of caregivers of stroke survivors.
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Affiliation(s)
- Alexandra Mj Denham
- The University of Newcastle, Australia; Priority Research Centre for Stroke and Brain Injury, Hunter Medical Research Institute, New Lambton Heights, Australia
| | | | | | - Neil J Spratt
- The University of Newcastle, Australia; School of Biomedical Sciences and Pharmacy, University of Newcastle, University Drive, Callaghan, Australia; Department of Neurology, Hunter New England Local Health District, John Hunter Hospital, New Lambton Heights, Australia
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58
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Chien SH, Sung PY, Liao WL, Tsai SW. A functional recovery profile for patients with stroke following post-acute rehabilitation care in Taiwan. J Formos Med Assoc 2019; 119:254-259. [PMID: 31147198 DOI: 10.1016/j.jfma.2019.05.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 04/10/2019] [Accepted: 05/14/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Functional impairment is frequently seen in patients with stroke. Although the progression of functional recovery after stroke has been proposed, the recovery profile after acute stroke is not well described. The objective of this study is to investigate functional recovery in stroke patients entering post-acute rehabilitation care. METHODS A retrospective cohort study collected the data of patients who entered the stroke Post-acute Care (PAC) programs. Ninety-five patients after stroke with a modified Ranking Scale (mRS) score of 3-4 who were referred to a post-acute care unit for intensive rehabilitation were recruited. The patients underwent functional, quality of life, and neuropsychological evaluation tests at admission and before discharge. The test scores before discharge were used as outcome variables and were compared with the test scores at admission to show functional recovery. RESULTS The average length of stay was 58.15 days. After an intensive rehabilitation intervention, significant improvements were observed in all test scores. Additionally, a significant removal rate for nasogastric tubes (p = 0.000) and Foley catheters (p = 0.003) was found at discharge. CONCLUSION This study showed that the PAC rehabilitation unit was beneficial for patients with acute stroke who had functional impairments. The study results may call for further investigation to identify and develop better models for the delivery of rehabilitation in the stroke PAC unit.
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Affiliation(s)
- Sou-Hsin Chien
- Department of Post-Acute Care Center, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung City 427, Taiwan; Department of Plastic Surgery, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung City 427, Taiwan; School of Medicine, Tzu Chi University, Hualien 970, Taiwan
| | - Pi-Yu Sung
- Department of Post-Acute Care Center, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung City 427, Taiwan; School of Medicine, Tzu Chi University, Hualien 970, Taiwan; Department of Physical Medicine and Rehabilitation, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung City 427, Taiwan
| | - Wen-Ling Liao
- Department of Physical Medicine and Rehabilitation, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung City 427, Taiwan
| | - Sen-Wei Tsai
- Department of Post-Acute Care Center, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung City 427, Taiwan; School of Medicine, Tzu Chi University, Hualien 970, Taiwan; Department of Physical Medicine and Rehabilitation, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung City 427, Taiwan.
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Mori H, Naito M, Nakane A, Tohara H. Caregivers’ Perspectives on the Slight Recovery of Oral Intake of Home-Dwelling Patients Living With a Percutaneous Endoscopic Gastrostomy Tube: A Qualitative Study Using Focus Group Interviews. Nutr Clin Pract 2019; 34:272-279. [DOI: 10.1002/ncp.10253] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Hiroko Mori
- Department of Health Informatics; Kyoto University School of Public Health; Kyoto Japan
| | - Mariko Naito
- Department of Oral Epidemiology; Graduate School of Biomedical and Health Sciences; Hiroshima University; Hiroshima Japan
| | - Ayako Nakane
- Gerodontology and Oral Rehabilitation; Department of Gerontology and Gerodontology; Graduate School of Medical and Dental Sciences; Tokyo Medical and Dental University; Tokyo Japan
| | - Haruka Tohara
- Gerodontology and Oral Rehabilitation; Department of Gerontology and Gerodontology; Graduate School of Medical and Dental Sciences; Tokyo Medical and Dental University; Tokyo Japan
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60
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Maguire R, Hanly P, Maguire P. Beyond care burden: associations between positive psychological appraisals and well-being among informal caregivers in Europe. Qual Life Res 2019; 28:2135-2146. [DOI: 10.1007/s11136-019-02122-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2019] [Indexed: 01/03/2023]
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Walter HAW, Seeber AA, Willems DL, de Visser M. The Role of Palliative Care in Chronic Progressive Neurological Diseases-A Survey Amongst Neurologists in the Netherlands. Front Neurol 2019; 9:1157. [PMID: 30692960 PMCID: PMC6340288 DOI: 10.3389/fneur.2018.01157] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Accepted: 12/14/2018] [Indexed: 12/12/2022] Open
Abstract
Background: Chronic progressive neurological diseases like high grade glioma (HGG), Parkinson's disease (PD), and multiple sclerosis (MS) are incurable, and associated with increasing disability including cognitive impairment, and reduced life expectancy. Patients with these diseases have complex care needs. Therefore, timely advance care planning (ACP) is required. Our aim was to investigate timing and content of discussions on treatment restrictions, i.e., to initiate, withhold, or withdraw treatment in patients with HGG, PD, and MS, from the neurologists' perspective. Methods: We performed a national online survey amongst consultants in neurology and residents in The Netherlands. The questionnaire focused on their daily practice concerning timing and content of discussions on treatment restrictions with patients suffering from HGG, PD or MS. We also inquired about education and training in discussing these issues. Results: A total of 125 respondents [89 neurologists (71%), 62% male, with a median age of 44 years, and 36 residents (29%), 31% male with a median age of 29 years] responded. Initial discussions on treatment restrictions were said to take place during the first year after diagnosis in 28% of patients with HGG, and commonly no earlier than in the terminal phase in patients with PD and MS. In all conditions, significant cognitive decline was the most important trigger to advance discussions, followed by physical decline, and initiation of the terminal phase. Most discussed issues included ventilation, resuscitation, and admission to the intensive care unit. More than half of the consultants in neurology and residents felt that they needed (more) education and training in having discussions on treatment restrictions. Conclusion: In patients with HGG discussions on treatment restrictions are initiated earlier than in patients with PD or MS. However, in all three diseases these discussions usually take place when significant physical and cognitive decline has become apparent and commonly mark the initiation of end-of-life care. More than half of the responding consultants in neurology and residents feel the need for improvement of their skills in performing these discussions.
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Affiliation(s)
- Hannah A W Walter
- Department of Neurology, Amsterdam University Medical Center, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Antje A Seeber
- Department of Neurology, Amsterdam University Medical Center, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Dick L Willems
- Section of Medical Ethics, Department of General Practice, Amsterdam University Medical Center, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Marianne de Visser
- Department of Neurology, Amsterdam University Medical Center, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
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62
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Jimenez G, Tan WS, Virk AK, Low CK, Car J, Ho AHY. Overview of Systematic Reviews of Advance Care Planning: Summary of Evidence and Global Lessons. J Pain Symptom Manage 2018; 56:436-459.e25. [PMID: 29807158 DOI: 10.1016/j.jpainsymman.2018.05.016] [Citation(s) in RCA: 293] [Impact Index Per Article: 48.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 05/16/2018] [Accepted: 05/18/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Advance care planning (ACP) involves important decision making about future medical needs. The high-volume and disparate nature of ACP research makes it difficult to grasp the evidence and derive clear policy lessons for policymakers and clinicians. AIM The aim of this study was to synthesize ACP research evidence and identify relevant contextual elements, program features, implementation principles, and impacted outcomes to inform policy and practice. DESIGN An overview of systematic reviews using the Cochrane Handbook of Systematic Reviews of Interventions was performed. Study quality was assessed using a modified version of the AMSTAR (A MeaSurement Tool to Assess Reviews) tool. DATA SOURCES MEDLINE, EBM Reviews, Cochrane Reviews, CINAHL, Global Health, PsycINFO, and EMBASE were searched for ACP-related research from inception of each database to April 2017. Searches were supplemented with gray literature and manual searches. Eighty systematic reviews, covering over 1660 original articles, were included in the analysis. RESULTS Legislations, institutional policies, and cultural factors influence ACP development. Positive perceptions toward ACP do not necessarily translate into more end-of-life conversations. Many factors related to patients' and providers' attitudes, and perceptions toward life and mortality influence ACP implementation, decision making, and completion. Limited, low-quality evidence points to several ACP benefits, such as improved end-of-life communication, documentation of care preferences, dying in preferred place, and health care savings. Recurring features that make ACP programs effective include repeated and interactive discussion sessions, decision aids, and interventions targeting multiple stakeholders. CONCLUSIONS Preliminary evidence highlights several elements that influence the ACP process and provides a variety of features that could support successful, effective, and sustainable ACP implementation. However, this evidence is compartmentalized and limited. Further studies evaluating ACP as a unified program and assessing the impact of ACP for different populations, settings, and contexts are needed to develop programs that are able to unleash ACP's full potential.
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Affiliation(s)
- Geronimo Jimenez
- Centre for Population Health Sciences (CePHaS), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
| | - Woan Shin Tan
- Centre for Population Health Sciences (CePHaS), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore; NTU Institute of Health Technologies (HealthTech), Interdisciplinary Graduate School, Nanyang Technological University, Singapore, Singapore; Health Services and Outcomes Research Department, National Healthcare Group, Singapore, Singapore
| | - Amrit K Virk
- Centre for Population Health Sciences (CePHaS), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Chan Kee Low
- Economics Programme, School of Social Sciences, Nanyang Technological University, Singapore, Singapore
| | - Josip Car
- Centre for Population Health Sciences (CePHaS), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore; Global eHealth Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Andy Hau Yan Ho
- Centre for Population Health Sciences (CePHaS), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore; Psychology Programme, School of Social Sciences, Nanyang Technological University, Singapore, Singapore; Palliative Care Centre for Excellence in Research and Education, Singapore, Singapore
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63
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State of advance care planning research: A descriptive overview of systematic reviews. Palliat Support Care 2018; 17:234-244. [PMID: 30058506 DOI: 10.1017/s1478951518000500] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To provide an overview of the current state of research of advance care planning (ACP), highlighting most studied topics, publication time, quality of studies and reported outcomes, and to identify gaps to improve ACP receptivity, utilization, implementation, and outcomes. METHOD Cochrane methodology for conducting overviews of systematic reviews. Study quality was assessed using a modified version of the Assessing the Methodological Quality of Systematic Reviews tool. The following databases were searched from inception to April 2017: MEDLINE, EBM Reviews, Cochrane Reviews, CINAHL, Global Health, PsycINFO, and EMBASE. Searches were supplemented with gray literature and manual searches. RESULT Eighty systematic reviews, covering 1,662 single articles, show that ACP-related research focuses on nine main topics: (1) ACP as part of end-of-life or palliative care interventions, (2) care decision-making; (3) communication strategies; (4) factors influencing ACP implementation; (5) ACP for specific patient groups, (6) ACP effectiveness; (7) ACP experiences; (8) ACP cost; and (9) ACP outcome measures. The majority of this research was published since 2014, its quality ranges from moderate to low, and reports on documentation, concordance, preferences, and resource utilization outcomes. SIGNIFICANCE OF RESULTS Despite the surge of ACP research, there are major knowledge gaps about ACP initiation, timeliness, optimal content, and impact because of the low quality and fragmentation of the available evidence. Research has mostly focused on discrete aspects within ACP instead of using a holistic evaluative approach that takes into account its intricate working mechanisms, the effects of systems and contexts, and the impacts on multilevel stakeholders. Higher quality studies and innovative interventions are needed to develop effective ACP programs and address research gaps.
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Connolly T, Mahoney E. Stroke survivors’ experiences transitioning from hospital to home. J Clin Nurs 2018; 27:3979-3987. [DOI: 10.1111/jocn.14563] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 05/02/2018] [Accepted: 06/03/2018] [Indexed: 11/29/2022]
Affiliation(s)
| | - Ellen Mahoney
- Connell School of Nursing; Boston College; Chestnut Hill Massachusetts
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65
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Denham AM, Baker AL, Spratt NJ, Wynne O, Hunt S, Sharma-Kumar R, Bonevski B. The unmet needs of caregivers of stroke survivors: A review of the content of YouTube videos (Preprint). JMIR Rehabil Assist Technol 2018. [DOI: 10.2196/11052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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66
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Béjot Y, Blanc C, Delpont B, Thouant P, Chazalon C, Daumas A, Osseby GV, Hervieu-Bègue M, Ricolfi F, Giroud M, Cordonnier C. Increasing early ambulation disability in spontaneous intracerebral hemorrhage survivors. Neurology 2018; 90:e2017-e2024. [DOI: 10.1212/wnl.0000000000005633] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 03/09/2018] [Indexed: 11/15/2022] Open
Abstract
ObjectiveTo evaluate temporal trends in early ambulatory status in patients with spontaneous intracerebral hemorrhage (ICH).MethodsAll patients with ICH between 1985 and 2011 were prospectively registered in a population-based registry in Dijon, France, and included in the study. Outcomes of ICH survivors were assessed at discharge from their stay in an acute care ward with the use of a 4-grade ambulation scale. Time trends in ambulation disability and place of discharge were analyzed in 3 periods (1985–1993, 1994–2002, and 2003–2011). Multivariable ordinal and logistic regression models were applied.ResultsFive hundred thirty-one patients with ICH were registered, of whom 200 (37.7%) died in the acute care ward. While the proportion of deaths decreased over time, that of patients with ambulation disability increased (odds ratio [OR] 1.67, 95% confidence interval [CI] 0.87–3.23, p = 0.124 for 1994–2002; and OR 1.97, 95% CI, 1.08–3.60, p = 0.027 for 2003–2011 vs 1985–1993 in ordinal logistic regression). The proportion of patients dependent in walking rose (OR 2.11, 95% CI 1.16–3.82, p = 0.014 for 1994–2002; and OR 2.73; 95% CI 1.54–4.84, p = 0.001 for 2003–2011), and the proportion of patients discharged to home decreased (OR 0.49, 95% CI 0.24–0.99, p = 0.048 for 1994–2002; and OR 0.32, 95% CI 0.16–0.64, p = 0.001 for 2003–2011).ConclusionThe decrease in in-hospital mortality of patients with ICH translated into a rising proportion of patients with ambulation disability at discharge. A lower proportion of patients returned home. These results have major implications for the organization of postacute ICH care.
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Hotter B, Padberg I, Liebenau A, Knispel P, Heel S, Steube D, Wissel J, Wellwood I, Meisel A. Identifying unmet needs in long-term stroke care using in-depth assessment and the Post-Stroke Checklist - The Managing Aftercare for Stroke (MAS-I) study. Eur Stroke J 2018; 3:237-245. [PMID: 31008354 DOI: 10.1177/2396987318771174] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 03/23/2018] [Indexed: 11/16/2022] Open
Abstract
Introduction Detailed data on the long-term consequences and treatment of stroke are scarce. We aimed to assess the needs and disease burden of community-dwelling stroke patients and their carers and to compare their treatment to evidence-based guidelines by a stroke neurologist. Methods We invited long-term stroke patients from two previous acute clinical studies (n = 516) in Berlin, Germany to participate in an observational, cross-sectional study. Participants underwent a comprehensive interview and examination using the Post-Stroke Checklist and validated standard measures of: self-reported needs, quality of life, overall outcome, spasticity, pain, aphasia, cognition, depression, secondary prevention, social needs and caregiver burden. Results Fifty-seven participants (median initial National Institutes of Health Stroke Scale score 10 interquartile range 4-12.75) consented to assessment (median 41 months (interquartile range 36-50) after stroke. Modified Rankin Scale was 2 (median; interquartile range 1-3), EuroQoL index value was 0.81 (median; interquartile range 0.70-1.00). The frequencies for disabilities in the major domains were: spasticity 35%; cognition 61%; depression 20%; medication non-compliance 14%. Spasticity (p = 0.008) and social needs (p < 0.001) had the strongest impact on quality of life. The corresponding items in the Post-Stroke Checklist were predictive for low mood (p < 0.001), impaired cognition (p = 0.015), social needs (p = 0.005) and caregiver burden (p = 0.031). In the comprehensive interview, we identified the following needs: medical review (30%), optimization of pharmacotherapy (18%), outpatient therapy (47%) and social work input (33%). Conclusion These results suggest significant unmet needs and gaps in health and social care in long-term stroke patients. Further research to develop a comprehensive model for managing stroke aftercare is warranted.Clinical Trial Registration: clinicaltrials.gov NCT02320994.
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Affiliation(s)
- Benjamin Hotter
- Center for Stroke Research Berlin and Department of Neurology, Charité University Hospital Berlin, Berlin, Germany
| | - Inken Padberg
- Center for Stroke Research Berlin and Department of Neurology, Charité University Hospital Berlin, Berlin, Germany
| | - Andrea Liebenau
- Center for Stroke Research Berlin and Department of Neurology, Charité University Hospital Berlin, Berlin, Germany
| | - Petra Knispel
- Center for Stroke Research Berlin and Department of Neurology, Charité University Hospital Berlin, Berlin, Germany
| | - Sabine Heel
- Zentrum für ambulante Neuropsychologie und Verhaltenstherapie, Berlin, Germany
| | | | - Jörg Wissel
- Department Neurorehabilitation and Physical Therapy, Department of Neurology, Vivantes Hospital Spandau, Berlin, Germany
| | - Ian Wellwood
- Department of Public Health and Primary Care, Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Andreas Meisel
- Center for Stroke Research Berlin and Department of Neurology, Charité University Hospital Berlin, Berlin, Germany
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Mei Y, Lin B, Li Y, Ding C, Zhang Z. Effects of modified 8-week reminiscence therapy on the older spouse caregivers of stroke survivors in Chinese communities: A randomized controlled trial. Int J Geriatr Psychiatry 2018; 33:633-641. [PMID: 29266450 DOI: 10.1002/gps.4833] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 11/02/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Our aim was to evaluate the effectiveness of a modified 8-week reminiscence therapy on the burden, positive experience, and life satisfaction of older spouse caregivers and the life satisfaction of stroke survivors. METHODS We conducted a randomized controlled trial by using 75 older stroke couples recruited from communities in Zhengzhou, China. We randomly assigned participants to 1 of 3 groups: Group 1 (G1 , 25 couples, all attend intervention) and Group 2 (G2 , 22 couples, only caregivers attend intervention), who participated in a modified 8-week reminiscence therapy, and a waiting list (control) group (G3 , 28 couples). Interviewers blinded to treatment group assignment administered the life satisfaction to both stroke survivors and caregivers, caregiver burden, and positive experience for caregivers, at preintervention, immediately postintervention, and at 1 month and 3 months after cessation of the intervention. RESULTS We found a statistically significant interaction between treatment groups and assessment time points for the 4 outcome measures (P < .001). Although the effects were decreased after intervention at 1 month, the improvement in caregivers' positive experience, life satisfaction, burden, and life satisfaction of stroke survivors were still significant (P < .001). CONCLUSIONS The use of a modified 8-week reminiscence therapy in this study sample improved the life satisfaction of stroke survivors and their spouse caregivers, improved the positive experience of caregivers, and decreased the burden of caregivers.
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Affiliation(s)
- Yongxia Mei
- School of Nursing, Zhengzhou University, Zhengzhou, Henan, P. R. China.,The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Beilei Lin
- School of Nursing, Zhengzhou University, Zhengzhou, Henan, P. R. China
| | - Yingshuang Li
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chunge Ding
- School of Nursing, Zhengzhou University, Zhengzhou, Henan, P. R. China
| | - Zhenxiang Zhang
- School of Nursing, Zhengzhou University, Zhengzhou, Henan, P. R. China
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Denham AMJ, Baker AL, Spratt N, Guillaumier A, Wynne O, Turner A, Magin P, Bonevski B. The unmet needs of informal carers of stroke survivors: a protocol for a systematic review of quantitative and qualitative studies. BMJ Open 2018; 8:e019571. [PMID: 29391371 PMCID: PMC5878248 DOI: 10.1136/bmjopen-2017-019571] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION Stroke events deeply affect not only the stroke survivor but also often the quality of life and physical and psychological health of the family and friends who care for them. There is a need for further information about the unmet needs of these informal carers in order to develop support services and interventions. The primary objective of this review is to report and synthesise the research describing the unmet needs of carers of stroke survivors. METHODS AND ANALYSIS A systematic review of quantitative and qualitative studies that report on the unmet needs of carers will be conducted. The following databases will be searched for relevant articles: MEDLINE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, EMBASE, Allied and Complementary Medicine Database and Scopus. No publication date constraints will be applied. Studies will be limited to those published in English and conducted among humans. Eligible studies will report on the unmet needs of informal carers of stroke survivors, defined as family members, friends and other unpaid caregivers. Studies which focus on formal, clinical or medical caregivers will be excluded. A narrative synthesis and pooled analysis of the main outcomes will be reported. ETHICS AND DISSEMINATION This review will be submitted to a peer-reviewed journal. Our findings are expected to provide new insights into the unmet needs of stroke survivors' carers. Knowledge about the unmet needs of carers will inform the development and refinement of interventions and services to address these needs and better support carers of stroke survivors. The findings of this systematic review will be disseminated publicly and in peer-reviewed journals and may be the topic of research presentations. TRIAL REGISTRATION NUMBER CRD42017067391.
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Affiliation(s)
- Alexandra M J Denham
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
| | - Amanda L Baker
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
| | - Neil Spratt
- School of Biomedical Sciences and Pharmacy, University of Newcastle, University Drive, Callaghan, New South Wales, Australia
| | - Ashleigh Guillaumier
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
| | - Olivia Wynne
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
| | - Alyna Turner
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
| | - Parker Magin
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
| | - Billie Bonevski
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
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Mei Y, Lin B, Li Y, Ding C, Zhang Z. Validity and reliability of Chinese version of Adult Carer Quality of Life questionnaire (AC-QoL) in family caregivers of stroke survivors. PLoS One 2017; 12:e0186680. [PMID: 29131845 PMCID: PMC5683601 DOI: 10.1371/journal.pone.0186680] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 10/05/2017] [Indexed: 11/24/2022] Open
Abstract
The Adult Carer Quality of Life questionnaire (AC-QoL) is a reliable and valid instrument used to assess the quality of life (QoL) of adult family caregivers. We explored the psychometric properties and tested the reliability and validity of a Chinese version of the AC-QoL with reliability and validity testing in 409 Chinese stroke caregivers. We used item-total correlation and extreme group comparison to do item analysis. To evaluate its reliability, we used a test-retest reliability approach, intraclass correlation coefficient (ICC), together with Cronbach’s alpha and model-based internal consistency index; to evaluate its validity, we used scale content validity, confirmatory factor analysis (CFA) and exploratory factor analysis (EFA) via principal component analysis with varimax rotation. We found that the CFA did not in fact confirm the original factor model and our EFA yielded a 31-item measure with a five-factor model. In conclusions, although some items performed differently in our analysis of the original English language version and our Chinese language version, our translated AC-QoL is a reliable and valid tool which can be used to assess the quality of life of stroke caregivers in mainland China. Chinese version AC-QoL is a comprehensive and good measurement to understand caregivers and has the potential to be a screening tool to assess QoL of caregiver.
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Affiliation(s)
- Yongxia Mei
- School of Nursing, Zhengzhou University, Zhengzhou, Henan Province, People’s Republic of China
- First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, People’s Republic of China
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, Unites States of America
| | - Beilei Lin
- School of Nursing, Zhengzhou University, Zhengzhou, Henan Province, People’s Republic of China
| | - Yingshuang Li
- School of Nursing, Zhengzhou University, Zhengzhou, Henan Province, People’s Republic of China
| | - Chunge Ding
- School of Nursing, Zhengzhou University, Zhengzhou, Henan Province, People’s Republic of China
| | - Zhenxiang Zhang
- School of Nursing, Zhengzhou University, Zhengzhou, Henan Province, People’s Republic of China
- * E-mail:
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Loft MI, Martinsen B, Esbensen BA, Mathiesen LL, Iversen HK, Poulsen I. Call for human contact and support: an interview study exploring patients’ experiences with inpatient stroke rehabilitation and their perception of nurses’ and nurse assistants’ roles and functions. Disabil Rehabil 2017; 41:396-404. [DOI: 10.1080/09638288.2017.1393698] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Mia Ingerslev Loft
- Department of Neurology, Rigshospitalet, Glostrup, Denmark
- Department of Public Health, Section of Nursing, Faculty of Health, Aarhus University, Copenhagen, Denmark
| | - Bente Martinsen
- Department of Public Health, Section of Nursing, Faculty of Health, Aarhus University, Copenhagen, Denmark
| | - Bente Appel Esbensen
- Centre for Rheumatology and Spine Diseases VRR, Head and Orthopaedics Centre, Rigshospitalet, Glostrup, Denmark
- Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Helle K. Iversen
- Department of Neurology, Rigshospitalet, Glostrup, Denmark
- Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Ingrid Poulsen
- Department of Public Health, Section of Nursing, Faculty of Health, Aarhus University, Copenhagen, Denmark
- Clinic of Neurorehabilitation, TBI unit, Rigshospitalet, Hvidovre, Denmark
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Anderson S, Keating NC, Wilson DM. Staying married after stroke: a constructivist grounded theory qualitative study. Top Stroke Rehabil 2017; 24:479-487. [PMID: 28693410 DOI: 10.1080/10749357.2017.1342335] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Marriages are one of the most powerful predictors of health and longevity, yet research in stroke has focused separately on survivors' experience of impairments and how spouses deal with caregiving. OBJECTIVES The purpose of this constructivist grounded theory study was to understand the key themes related to reconstruction or breakdown of marriages after stroke. METHODS In semi-structured interviews, 18 couples in long-term marriages discussed how their marriages were reconstructed or broke down after one member of the couple returned home after being hospitalized for a stroke. Constant comparison methods were used to compare the experiences of 12 couples in which both partners indicated their relationship was going well with 6 couples who either separated or remained in parallel marriages. RESULTS Analysis revealed an overarching process of reconstructing compatible role-identities and three themes related to the reconstruction or breakdown of the marital identity: feeling overwhelmed, resolving conflict, and perceiving value in the marriage. CONCLUSIONS Our findings highlight that marriages are contexts in which survivors and spouses can recalibrate their role-identities. Marriage relationships are not peripheral to survivors' and spouses' outcomes after stroke; rather, marriage is fundamental to the management of impairments and to the well-being of the couple.
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Affiliation(s)
- Sharon Anderson
- a Department of Human Ecology , University of Alberta , Edmonton , Alberta , Canada
| | - Norah C Keating
- b The Global Social Initiative on Ageing (GSIA), International Association of Gerontology and Geriatrics , Edmonton , Alberta , Canada.,c Centre for Innovative Ageing, Swansea University , Swansea , Wales , UK.,d Research on Aging, Policies and Practice (RAPP) , University of Alberta , Edmonton , Canada.,e Africa Unit for Transdisciplinary Health Research (AUTHeR) , North-West University , Potchefstroom , South Africa
| | - Donna M Wilson
- f Faculty of Nursing , University of Alberta , Edmonton , Alberta , Canada
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Fausto MCR, Campos EMS, Almeida PF, Medina MG, Giovanella L, Bousquat A, Carneiro A, Jerônimo AS, Aleluia ÍRS, Borges GA, Mota PHDS. Therapeutic itineraries for patients with cerebrovascular accident: fragmentation of care in a regionalized health network. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2017. [DOI: 10.1590/1806-9304201700s100004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Abstract Objectives: to analyze the itineraries of patients with cerebrovascular accident (CVA) in the Interstate health region in San Francisco Valley. Methods: this study uses the qualitative approach through the construction of Therapeutic Itineraries (IT). In the IT mapping the observation was prioritized on the different points and forms to access health service in search of care. Results: sixteen semi-structured interviews with healthcare users were conducted. There were diverse forms to access and provide services at the Rede Interestadual de Atenção à Saúde do Vale do Médio São Francisco-PEBA (Interstate Healthcare Network Region in the San Francisco Valley), which could be characterized by disorganized and uncoordinated care in the analyzed cases, despite the guarantee of hospital care. The Primary Health Care (APS) teams are present at a care point with most of the patients' itineraries, however, little integration to the regionalized network and they were unable to perform their functions and coordinate the care. It is observed pilgrimage assistance, fragmented care and difficulties in receiving care after post hospitalization which is essential for the patients’ rehabilitation. Conclusions: traces of fragments of the regional health system are important warning signs that points out fragility in PEBA and demonstrate persistent gaps in the public health system to fulfil the responsibility and guarantee individuals’ right for health.
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Hawkins RJ, Jowett A, Godfrey M, Mellish K, Young J, Farrin A, Holloway I, Hewison J, Forster A. Poststroke Trajectories: The Process of Recovery Over the Longer Term Following Stroke. Glob Qual Nurs Res 2017; 4:2333393617730209. [PMID: 28932766 PMCID: PMC5600296 DOI: 10.1177/2333393617730209] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 05/18/2017] [Accepted: 07/02/2017] [Indexed: 11/17/2022] Open
Abstract
We adopted a grounded theory approach to explore the process of recovery experienced by stroke survivors over the longer term who were living in the community in the United Kingdom, and the interacting factors that are understood to have shaped their recovery trajectories. We used a combination of qualitative methods. From the accounts of 22 purposively sampled stroke survivors, four different recovery trajectories were evident: (a) meaningful recovery, (b) cycles of recovery and decline, (c) ongoing disruption, (d) gradual, ongoing decline. Building on the concept of the illness trajectory, our findings demonstrate how multiple, interacting factors shape the process and meaning of recovery over time. Such factors included conception of recovery and meanings given to the changing self, the meanings and consequences of health and illness experiences across the life course, loss, sense of agency, and enacting relationships. Awareness of the process of recovery will help professionals better support stroke survivors.
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Affiliation(s)
| | - Adam Jowett
- Coventry University, Coventry, United Kingdom
| | | | | | - John Young
- University of Leeds, Leeds, United Kingdom
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
| | | | | | | | - Anne Forster
- University of Leeds, Leeds, United Kingdom
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
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Schutz REC, Coats HL, Engelberg RA, Curtis JR, Creutzfeldt CJ. Is There Hope? Is She There? How Families and Clinicians Experience Severe Acute Brain Injury. J Palliat Med 2016; 20:170-176. [PMID: 27763820 DOI: 10.1089/jpm.2016.0286] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Patients with severe acute brain injury (SABI) raise important palliative care considerations associated with sudden devastating injury and uncertain prognosis. OBJECTIVE The goal of this study was to explore how family members, nurses, and physicians experience the palliative and supportive care needs of patients with SABI receiving care in the neuroscience intensive care unit (neuro-ICU). DESIGN Semistructured interviews were audiotaped, transcribed, and analyzed using thematic analysis. SETTING/SUBJECTS Thirty-bed neuro-ICU in a regional comprehensive stroke and level-one trauma center in the United States. We completed 47 interviews regarding 15 patients with family members (n = 16), nurses (n = 15), and physicians (n = 16). RESULTS Two themes were identified: (1) hope and (2) personhood. (1) Families linked prognostic uncertainty to a need for hope and expressed a desire for physicians to acknowledge this relationship. The language of hope varied depending on the participant: clinicians used hope as an object that can be given or taken away, generally in the process of conveying prognosis, while families expressed hope as an action that supported coping with their loved one's acute illness and its prognostic uncertainty. (2) Participants described the loss of personhood through brain injury, the need to recognize and treat the brain-injured patient as a person, and the importance of relatedness and connection, including personal support of families by clinicians. CONCLUSIONS Support for hope and preservation of personhood challenge care in the neuro-ICU as identified by families and clinicians of patients with SABI. Specific practical approaches can address these challenges and improve the palliative care provided to patients and families in the neuro-ICU.
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Affiliation(s)
| | - Heather L Coats
- 2 Cambia Palliative Care Center of Excellence, University of Washington , Seattle, Washington
| | - Ruth A Engelberg
- 2 Cambia Palliative Care Center of Excellence, University of Washington , Seattle, Washington
| | - J Randall Curtis
- 2 Cambia Palliative Care Center of Excellence, University of Washington , Seattle, Washington
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