The cancer family caregiving experience: an updated and expanded conceptual model

Depressive symptoms predict cancer caregivers' physical health decline

BACKGROUND

Cancer caregiving has been associated with worsening health among caregivers themselves, yet demographic and psychosocial predictors of their long-term health decline are less known. This study examines changes in caregivers' physical health 2 to 8 years after their family members' cancer diagnosis and prospective predictors of that change.

METHODS

Caregivers (n = 664; mean age, 53.2 years) participated in a nationwide study at 2 (T1), 5 (T2), and 8 (T3) years after their family members' cancer diagnosis. Physical health (12-item Medical Outcomes Study Short Form Health Survey Physical Component Scale) was assessed T1 through T3 as outcome. Predictors were self-reported at T1, including caregiver demographics (age, sex, education, income, relationship to patient, and employment status), patient cancer severity (from medical records), and caregiver psychosocial factors (caregiving stress, caregiving esteem, social support, and depressive symptoms). Latent growth modeling tested predictors of caregivers' initial physical health and their physical health change across time.

RESULTS

At T1, caregivers reported slightly better physical health than the US population (M = 51.22, P = .002), which declined over the following 6 years (M_slope = -0.27, P < .001). All demographic factors, patient cancer severity, and T1 caregiving stress were related to caregivers' initial physical health (P ≤ .03). Higher depressive symptoms were unrelated to caregivers' initial physical health, but were the only significant predictor of caregivers' more rapid physical health decline (B = -0.02, P = .004).

CONCLUSION

Findings highlight the unique contribution of caregivers' depressive symptoms to their physical health decline. Assessing and addressing depressive symptoms among caregivers early in the cancer survivorship trajectory may help to prevent premature health decline among this important yet vulnerable population. Cancer 2017;123:4277-4285. © 2017 American Cancer Society.

Creating an upward spiral: A qualitative study of caregivers' experience of participating in a structured physical activity programme

Family caregivers' physical and emotional well-being may be negatively impacted while in the caregiver role. Interventions to support caregiver health have largely focused on psychological support, with only a few studies to date evaluating the role of exercise. Of the exercise studies conducted, there has been one qualitative study examining caregivers' perspectives on the value and impact of this type of intervention. This qualitative study was part of a larger mixed methods investigation including a randomised controlled trial investigating the effects of a 24-week exercise programme for cancer caregivers conducted in western Canada. We aimed to explore cancer family caregivers' experience of participating in a structured exercise programme. We conducted face-to-face interviews with 20 of the participants from the exercise intervention and analysed transcribed data using Thorne's interpretive description as a guiding framework. Two main patterns characterised the experiences of the caregivers. The metaphor of a downward spiral represented the experience of being in the caregiver role, while the metaphor of an upward spiral represented the experience of participating in the exercise programme. Our findings highlight that caregivers valued the exercise programme, experienced positivity through exercise and the group-based format, and noticed improvements to their physical and emotional well-being.

Informal Caregivers of Cancer Patients: Review of Interventions, Care Activities, and Outcomes

Family and friends are important resources for patients during cancer treatment and warrant an expanded review of not only what they contribute to patient care but also the support they need and the personal consequences of caregiving. A review of 14 randomized controlled trials published between 2009 and 2016 was completed utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The results of this review expand the scope of what is known regarding relationships among supportive interventions for caregivers, activities performed to care for cancer patients, caregiver characteristics, and health outcomes of caregivers. Specific results include (a) updated synthesis of literature associated with variables important to caregiving, (b) attention to interventions designed to support caregivers,

Construct validity of the 17-item Benefit Finding Scale in Chinese cancer patients and their family caregivers: a cross-sectional study

PURPOSE

With increasing interest in, and growing recognition of, the importance of evaluating benefit finding (BF) in cancer practice, the construct validity of a majority of the instruments that claim to assess BF, however, requires further validation. The purpose of the present study is to evaluate the construct validity of the 17-item Benefit Finding Scale (BFS) in Chinese cancer patient-caregiver dyads and to evaluate the association between the BFS patients and the BFS caregivers.

METHODS

There were 772 dyads of patients with cancer and their family caregivers who completed a survey assessing their demographic information and BF from November 2014 to December 2015. Both exploratory and confirmatory factor analysis was applied to evaluate the construct validity of the 17-item BFS.

RESULTS

Dimensionality analysis confirmed a three-dimensional structure validity. The extracted three factors were personal growth, improved relationships, and acceptance. The overall and three subscales of BFS in both cancer patients and family caregivers had good internal consistency, with all of the Cronbach's α ≥0.819. Scores of the three subscales and overall scale between cancer patients and family caregivers were correlated to one another (r = 0.224-0.437, P < 0.001).

CONCLUSIONS

This study provides the three-factor construct validity of the 17-item BFS when applied in the sample of Chinese patients with cancer and their family caregivers. The mutual impact of benefit finding between Chinese patients with cancer and their family caregivers highlights the importance that healthcare professionals need paying special attention to the BF on the dyadic level when supporting patients with cancer.

Cancer Communication and Family Caregiver Quality of Life

Family caregivers have enormous communication responsibilities tied to caregiving, such as sharing the patient’s medical history with providers, relaying diagnosis and prognosis to other family members, and making decisions about care with the patient. While caregiver stress and burden has been widely documented in the caregiving literature, little is known about how communication burden, real or perceived communication challenges, impacts caregiver quality of life. In family caregiving, the City of Hope (COH) Quality of Life model proposes that the caregiving experience is reciprocal to the patient experience, impacting physical, social, psychological, and spiritual quality of life. We used data from a pilot study testing a communication coaching call intervention with family caregivers of lung cancer patients to analyze caregiver reported communication burden and quality of life. We found variances in each quality of life domain, suggesting that caregiver interventions should range from self-care skill building for physical care to psycho-educational interventions that support caregiver coping and communication skill building. These findings demonstrate the importance of caregiver assessment and attention to communication burden in quality cancer care.

Management of Cancer in the Older Age Person: An Approach to Complex Medical Decisions

The management of cancer in older aged people is becoming a common problem due to the aging of the population. There are many variables determining the complex situation that are interconnected. Some of them can be assessed, such as risk of mortality and risk of treatment complications, but many others are still unknown, such as the course of disease, the host-related factors that influence cancer aggressiveness, and the phenotype heralding risk of permanent treatment-related damage.This article presents a dynamic and personalized approach to older people with cancer based on our experience on aging, cancer, and their biological interactions. Also, novel treatments and management approaches to older individuals, based on their functional age and their social and emotional needs, are thoughtfully explored here. The Oncologist 2017;22:335-342 IMPLICATIONS FOR PRACTICE: The goal of this article is to suggest a practical approach to complexity, a clinical situation becoming increasingly common with the aging of the population. Beginning with the analysis of two clinical cases, the authors offer an algorithm for approaching cancer in the older person that involves the assessment of life expectancy without cancer, the risk that cancer might compromise a patient's survival, function, or quality of life, and the potential benefits and risks of the treatments based on a clinical evaluation. The authors then review possible laboratory assessment of functional age and the importance of rapid-learning databases in the study of cancer and age.

Cancer Care: Supporting Underserved and Financially Burdened Family Caregivers

Family caregivers who provide care for a loved one with advanced cancer suffer physically and psychologically from the care demands of a family member with high symptom burden and a poor prognosis. Often, family members are also faced with financial burden and suffer financial strain from their loved one's care demands. This article describes an ongoing test of a palliative care intervention to support financially burdened caregivers of family members who have advanced cancer. The intervention is designed to decrease family caregiver burden, increase skills preparedness, improve family caregiver quality of life, decrease psychological distress, and increase family caregiver self-care. This intervention is an individualized intervention customized to a particular caregiver and situation. It combines adult teaching principles, the National Comprehensive Cancer Network (NCCN) Distress Guidelines, the Institute of Medicine (IOM) Report on Cancer Care for the Whole Patient, the National Consensus Project (NCP) Clinical Practice Guidelines for Quality Palliative Care, and the concept of self-care. Initial findings indicate that financially strained family caregivers of family members with advanced cancer can benefit from self-care strategies that are designed to meet specific goals and individual needs when combined with a care plan and subsequent evaluations. However, findings indicate that financially strained caregivers may have limited resources and opportunities to utilize self-care strategies.

The Experiences of Chinese Couples Living With Cancer: A Focus Group Study

BACKGROUND

With the research focus on family caregiving shifting from the individual to the dyadic level, there is a need to explore cancer dyads' concerns and needs and to understand their experiences of coping together with cancer.

OBJECTIVE

To objectives of this study were to gain a better understanding of the experience of couples living with cancer and to explore cancer couples' concerns and needs related to the caring role and experience of spousal caregivers.

METHODS

The focus group study design with a purposeful sampling strategy was adopted. We conducted 4 focus group interviews with 11 cancer patients and 17 spousal caregivers in a hospital.

RESULTS

Four themes and 15 subthemes emerged after a conventional content analysis. The 4 themes include communication dynamics, living with changes, negative and positive impacts, and network of support. Based on the findings, we drew a preliminary conceptualization of the couples' experience of coping and living with cancer as a whole.

CONCLUSIONS

This study provided insights to healthcare professionals regarding daily struggles of couples living with cancer and the development of intervention programs to support these couples.

IMPLICATIONS FOR PRACTICE

Healthcare professionals need to (1) be sensitive to the couples' needs and concerns, (2) offer sufficient and useful information to couples who are coping with cancer, (3) encourage and help spousal caregivers to take care of themselves while coping with the changes in their spouses, and (4) instill realistic hopes in couples and help them to sustain a positive attitude with a focus on the future, not just on the present.

Variances in family carers' quality of life based on selected relationship and caregiving indicators: A quantitative secondary analysis

AIMS AND OBJECTIVES

To determine subgroups of family carers based on family relational and caregiving variables and to explore group differences in relation to selected carer outcomes.

BACKGROUND

Family caregiving in later life holds a myriad of positive and negative outcomes for family members' well-being. However, factors that constitute family carers' experience and explain variances are less well understood.

DESIGN

A secondary data analysis using cross-sectional data from a controlled randomised trial with community-dwelling people 80 years or older and their families.

METHODS

A total of 277 paired data sets of older persons and their family carers were included into the analysis. Data were collected via mailed questionnaires and a geriatric nursing assessment. A two-step cluster analysis was performed to determine subgroups. To discern group differences, appropriate tests for differences with Bonferroni correction were used.

RESULTS

Two family carer groups were identified. The low-intensity caregiver group (57% of carers) reported high relationship quality and self-perceived ease of caregiving. In contrast, the high-intensity caregiver group (43% of carers) experienced significantly lower relationship quality, felt less prepared and appraised caregiving as more difficult, time intensive and burdensome. The latter cared for older, frailer and more dependent octogenarians and had significantly lower levels of quality of life and self-perceived health compared to the low-intensity caregiver group.

CONCLUSIONS

A combination of family relational and caregiving variables differentiates those at risk for adverse outcomes. Family carers of frailer older people tend to experience higher strain, lower relationship quality and ability to work together as a family.

IMPLICATIONS FOR PRACTICE

Nurses should explicitly assess family carer needs, in particular when older persons are frail. Family carer support interventions should address caregiving preparedness, demand and burden, as well as concerns situated in the relationship.

Health Related Quality of Life in Family Caregivers of Patients Suffering from Mental Disorders

INTRODUCTION

In the light of the advances in treatment measures and early discharge of patients with mental disorders from psychiatric hospitals, families play important role in caring for such patients.

AIM

The aim of this study is to determine the Quality of Life (QoL) of the family caregivers of patients with mental disorders.

MATERIALS AND METHODS

This cross-sectional study was conducted in teaching health care centers affiliated with medical universities in Tehran, Iran. Sampling was conducted by convenience random technique. Participants were 238 family caregivers of mental disorder patients and the Short-Form Health Survey Questionnaire was used to gather data. The data were analyzed by Spearman's correlation, t-test and ANOVA in SPSS 18.0.

RESULTS

The women's mean QoL was lower than the men's. Regarding family relationship with the patients, the lowest QoL was observed among the mothers. There was a significant relationship between the caregivers QoL and economic status, the caregivers gender, family relationship with the patients and the patients' gender (p<0.05).

CONCLUSION

The caregivers of mental disorder patients have lower QoL compared with general population. Appropriately developed plans should be implemented to improve QoL among the family caregivers of these patients.

Using Experience-Based Design to Improve the Care Experience for Patients With Pancreatic Cancer

PURPOSE

Despite the importance of the patient care experience to quality and outcome, the literature detailing the care experience in patients with pancreatic cancer is limited.

METHODS

To elicit the experience of patients with pancreatic cancer for care redesign, we deployed experience-based design, an emerging methodology based on identification of events of high emotional content, known as touch points, to delineate qualitatively what matters most to patients and families. We defined touch points through direct observations, interviews, and a focus group. We then used experience questionnaires to measure emotional content and develop an experience map to graphically display the fluctuating emotional journey through the care processes. Study subjects were patients with pancreatic cancer who were cared for at Virginia Mason Medical Center, family caregivers, and staff. Redesign was initiated through an all-day improvement event in September 2013.

RESULTS

During 2013 and 2014, we cared for 485 new patients with pancreatic cancer, the majority of whom had local disease at diagnosis. The response rate for the experience questionnaire was 23% (117 of 500 questionnaires distributed). The experience-based design results were often contrary to staff preconceptions of the care experience for patients with pancreatic cancer, and contributed to redesign in three key areas: understanding and documenting patient goals and values, providing better resources for caregivers/families, and improving care coordination and support services.

CONCLUSION

Experience-based design enabled us to understand the care experience and associated emotional content for patients with pancreatic cancer and their caregivers. This knowledge then supported care redesign targeted at areas of high negative emotional content.

The Chinese version of hospital anxiety and depression scale: Psychometric properties in Chinese cancer patients and their family caregivers

PURPOSE

The Hospital Anxiety and Depression Scale (HADS) acts as one of the most frequently used self-reported measures in cancer practice. The evidence for construct validity of HADS, however, remains inconclusive. The objective of this study is to evaluate the psychometric properties of the Chinese version HADS (C-HADS) in terms of construct validity, internal consistency reliability, and concurrent validity in dyads of Chinese cancer patients and their family caregivers.

METHODS

This was a cross-sectional study, conducted in multiple centers: one hospital in each of the seven different administrative regions in China from October 2014 to May 2015. A total of 641 dyads, consisting of cancer patients and family caregivers, completed a survey assessing their demographic and background information, anxiety and depression using C-HADS, and quality of life (QOL) using Chinese version SF-12. Data analysis methods included descriptive statistics, confirmatory factor analysis (CFA), and Pearson correlations.

RESULTS

Both the two-factor and one-factor models offered the best and adequate fit to the data in cancer patients and family caregivers respectively. The comparison of the two-factor and single-factor models supports the basic assumption of two-factor construct of C-HADS. The overall and two subscales of C-HADS in both cancer patients and family caregivers had good internal consistency and acceptable concurrent validity.

CONCLUSIONS

The Chinese version of the HADS may be a reliable and valid screening tool, as indicated by its original two-factor structure. The finding supports the basic assumption of two-factor construct of HADS.

A dyadic approach to understanding the impact of breast cancer on relationships between partners during early survivorship

BACKGROUND

The shared impact of breast cancer for women and their male partners is emerging as an important consideration during the experience of a breast cancer diagnosis, particularly during survivorship. This study aimed to explore the experiences of women and their partners during early survivorship and contributes a range of insights into the lives of those intimately affected by breast cancer.

METHODS

In-depth interviews were completed with Australian women survivors of breast cancer (n = 8) and their partners (n = 8), between six months and five years following cessation of treatment. Questions included a focus on the women and their partners' daily experiences during early survivorship, including the management of ongoing symptoms, engagement in leisure and social interests, returning to work, communicating with each other, maintenance of the current relationship and other important roles and responsibilities. Thematic analysis was employed to determine key themes arising from the dyadic accounts of women and their partners' experiences during early breast cancer survivorship.

RESULTS

Women and their partners experienced many changes to their previous roles, responsibilities and relationships during early breast cancer survivorship. Couples also reported a range of communication, intimacy and sexuality concerns which greatly impacted their interactions with each other, adding further demands on the relationship. Three significant themes were determined: (1) a disconnection within the relationship - this was expressed as the woman survivor of breast cancer needing to prioritise her own needs, sometimes at the expense of her partner and the relationship; (2) reformulating the relationship - this reflects the strategies used by couples to negotiate changes within the relationship; and (3) support is needed to negotiate the future of the relationship - couples emphasised the need for additional support and resources to assist them in maintaining their relationship during early survivorship.

CONCLUSION

It can be concluded that the early survivorship period represents a crucial time for both women and their partners and there are currently limited options available to meet their shared needs and preferences for support. Findings indicate that a suitable model of care underpinned by a biopsychosocial framework, access to comprehensive assessment, timely support and the provision of targeted resources are urgently needed to assist women and their partners during this critical time.

Cancer and dementia: an exploratory study of the experience of cancer treatment in people with dementia

OBJECTIVE

Patients with comorbid cancer and dementia have poorer outcomes than those without dementia. We observe oncology teams managing patients with dementia and memory loss and explore these patients' needs and experiences of outpatient cancer services.

METHODS

A single site investigation of case study design to examine practices in four clinics using multi-methods of data collection: retrospective note review, observation, interviews, and recorded consultations. A framework analytic approach identifies themes within and across cases.

RESULTS

Thirty-three clinical encounters with patients with memory loss were observed. Ten consultations were audio-recorded and 16 individuals interviewed (n = 6 patients-carer dyads, n = 1 lone patient, and n = 5 staff). Medical records were reviewed for 338 cases. Cancer referrals did not document memory health, so clinicians rely on patient/carer disclosure to identify patients with memory problems. In practice, the problem often remains hidden. Treating teams who do become aware of memory difficulties are unsure how to support patients, but marked memory loss can limit treatment options and preclude radical intent. Carers are key facilitators of successful cancer consultations and management. Their support needs are largely unrecognized.

CONCLUSIONS

Training that educates cancer teams on how to identify and support individuals with memory problems before and during treatment and recognize the carer role may facilitate complex cancer care and help reduce inequalities of outcomes.

Psychological Trauma and LGBT Caregivers: A Conceptual Framework to Guide Practice

LGBT adults face unique risk factors such as social isolation, discrimination, and victimization, and occasionally th ey engage in detrimental behaviors like high alcohol and drug use and risky sexual activity that negatively impacts psychological/physical health. These risks can affect their overall health and stress the relationship with an older caregiver/recipient-partner following exposure to acute medical event. The experience of an acute medical event among a LGBT caregiving partner can result in psychological trauma. In this article the authors present a conceptual framework involving stress process theory, life course theory, and family systems perspective to understand the effect of stressors on LGBT caregiving partners. Implications for social work practice include assessing, coordinating care, counseling and negotiating services at micro level, engaging family-centered approaches to support positive transition to caregiving role at mezzo level, and advocating for policy and cultural shifts to supports and diminish stigma of this group.

How are spousal depressed mood, distress, and quality of life associated with risk of depressed mood in cancer survivors? Longitudinal findings from a national sample

BACKGROUND

Spouses of cancer survivors experience both positive and negative effects from caregiving. However, it is less clear what role spousal well-being may have on cancer survivors. This study aimed to determine the impact of spousal psychosocial factors on survivor depressed mood and whether this association differed by gender.

METHODS

We examined longitudinal data on cancer survivors and their spouses (n = 910 dyads) from the 2004-2012 Medical Expenditures Panel Survey and a matched sample of cancer-free dyads. Subjects reported depressed mood, psychologic distress, and mental and physical health-related quality of life (HRQoL) at two time points (T1/T2). Dyadic multilevel models evaluated the impact of psychosocial factors at T1 on depressed mood at T2, controlling for sociodemographics, cancer type, survivor treatment status, and depressed mood at T1.

RESULTS

Cancer survivors whose spouses reported depressed mood at T1 were 4.27 times more likely to report depressed mood at T2 [95% confidence interval (CI), 2.01-9.07]; this was stronger for female survivors (OR, 9.49; 95% CI, 2.42-37.20). Better spousal mental and physical HRQoL at T1 were associated with a 30% decrease in survivor depressed mood risk at T2. Most spillover effects were not observed in comparison dyads.

CONCLUSION

Depressed mood and poor HRQoL in spouses may increase the risk of depressed mood in cancer survivors. The risk may be especially strong for female survivors.

IMPACT

Identifying and improving spousal mental health and HRQoL problems may reduce the risk of depressed mood in cancer survivors. Future research should examine whether incorporating spousal care into psychooncology and survivorship programs improves survivor outcomes.

Patient-reported outcome measures for cancer caregivers: a systematic review

PURPOSE

Informal caregivers provide invaluable help and support to people with cancer. As treatments extend survival and the potential burdens on carers increase, there is a need to assess the impact of the role. This systematic review identified instruments that measure the impact of caregiving, evaluated their psychometric performance specifically in cancer and appraised the content.

METHODS

A two-stage search strategy was employed to: (1) identify instruments that measure the impact of caregiving, and (2) run individual searches on each measure to identify publications evaluating psychometric performance in the target population. Searches were conducted in MEDLINE, EMBASE, CINAHL and PsycINFO and restricted to English for instrument used and article language. Psychometric performance was evaluated for content and construct validity, internal consistency, test-retest reliability, precision, responsiveness and acceptability. Individual scale items were extracted and systematically categorised into conceptual domains.

RESULTS

Ten papers were included reporting on the psychometric properties of eight measures. Although construct validity and internal consistency were most frequently evaluated, no study comprehensively evaluated all relevant properties. Few studies met our inclusion criteria so it was not possible to consider the psychometric performance of the measures across a group of studies. Content analysis resulted in 16 domains with 5 overarching themes: lifestyle disruption; well-being; health of the caregiver; managing the situation and relationships.

CONCLUSIONS

Few measures of caregiver impact have been subject to psychometric evaluation in cancer caregivers. Those that have do not capture well changes in roles and responsibilities within the family and career, indicating the need for a new instrument.

A systematic review and thematic synthesis of quality of life in the informal carers of cancer patients with cachexia

BACKGROUND

Informal carers of cancer patients with cachexia face additional challenges to those encountered by informal carers in general because of the central role food and eating play in everyday life. Patient weight loss and anorexia, core features of cancer cachexia, are frequent causes of distress in caregivers. Identification of quality of life issues can inform the development of interventions for both caregivers and patients and facilitate communication with healthcare professionals.

AIM

To identify quality of life issues that are relevant to carers of cancer patients with cachexia.

DESIGN

A systematic review and thematic synthesis of the qualitative literature were conducted. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

DATA SOURCES

PubMed, ISI Web of Knowledge, EMBASE, MEDLINE, CINAHL, PsycINFO and PsycARTICLES were searched for publications dated from January 1980 to February 2015 using search terms relating to cancer, cachexia, quality of life and carers. Papers written in the English language, featuring direct quotes from the carers of adult patients with any cancer diagnosis and cachexia or problems with weight loss or anorexia, were included.

RESULTS

Five themes were extracted from the 16 identified studies. These highlighted the impact on everyday life, the attempts of some carers to take charge, the need for healthcare professional's input, conflict with the patient and negative emotions.

CONCLUSION

The complexity of caring for a cancer patient with cachexia translates into a range of problems and experiences for informal carers. By addressing the impact of caring for a patient with cancer cachexia on carers, both caregiver and patient quality of life may improve.

The development of a complex intervention in China: the 'Caring for Couples Coping with Cancer "4Cs" Programme' to support couples coping with cancer

BACKGROUND

As the primary informal caregiver for cancer patients, spousal caregivers are a population at a high risk of hidden morbidity. The factors impacting couples coping with cancer are complex, and within spousal caregiver-patient dyads the impact is mutual. The aim of this study is to explain the process that led to the development of an acceptable, feasible, and potentially effective 'Caring for Couples Coping with Cancer "4Cs" Programme' to support couples coping with cancer as the unit of intervention in China.

METHODS

The Medical Research Council's (MRC) framework for developing and evaluating complex interventions was adopted to develop an intervention for couples coping with cancer. Three steps were taken in the process of developing the 4Cs programme, namely: (1) identifying the evidence base by conducting a series of extensive reviews of the relevant literature and conducting a focus group study; (2) identifying/developing a theory by proposing a preliminary Live with Love Conceptual Framework 'P-LLCF' for cancer couple dyads; and (3) modelling the process and outcomes of the 4Cs programme.

RESULTS

The programme that was developed is comprised of six individual sessions to be delivered by the researcher/therapists over 6 weeks. The main contents of the sessions of the 4Cs programme are: primary stressors (section 1); secondary stressors (section 2); dyadic mediator (section 3); dyadic appraisal (section 4); dyadic coping (section 5); and a programme overview (section 6). The emphasis of the programme is on supporting couples coping with cancer. A booklet was developed to provide the participants with easy access to written information about their common concerns in caring for loved ones with cancer.

CONCLUSIONS

Guided by the MRC guidelines, a potentially effective, feasible, and acceptable 4Cs programme aimed at supporting couples coping with cancer as a dyad was developed. Future research is needed to pilot and evaluate the feasibility, modelling, and outcomes of this 4Cs programme.

The Experience of Caregivers Living with Cancer Patients: A Systematic Review and Meta-Synthesis

The objectives of this meta-synthesis were to: (1) explore the experience of caregivers who were caring for cancer patients, including their perceptions and responses to the situation; and (2) describe the context and the phenomena relevant to the experience. Five databases were used: CINAHL, MEDLINE, Academic Search, Science Direct, and a Thai database known as the Thai Library Integrated System (ThaiLIS). Three sets of the context of the experience and the phenomena relevant to the experience were described. The contexts were (1) having a hard time dealing with emotional devastation; (2) knowing that the caregiving job was laborious; and (3) knowing that I was not alone. The phenomenon showed the progress of the caregivers’ thoughts and actions. A general phenomenon of the experience—balancing my emotion—applied to most of the caregivers; whereas, more specific phenomenon—keeping life as normal as possible and lifting life above the illness—were experienced by a lesser number of the caregivers. This review added a more thorough explanation of the issues involved in caregiving for cancer patients. A more comprehensive description of the experience of caregiving was described. The findings of this review can be used to guide clinical practice and policy formation in cancer patient care.

Psychological distress as a mediator of the association between disease severity and occupational functioning among employed spouses of women recently diagnosed with breast cancer

OBJECTIVE

The purpose was to evaluate whether patient and spouse cancer-specific distress mediated the association between cancer severity and occupational functioning among employed spouses of women diagnosed with breast cancer. We examined whether sociodemographic characteristics, lower spouse-reported marital quality, and lower spouse self-rated health were associated with poorer spouse occupational functioning.

METHODS

One hundred forty-three currently employed spouses of women diagnosed with breast cancer were administered measures of socioeconomic status, occupational functioning (work absenteeism, low productivity, and poor performance), cancer-specific distress, marital quality, and self-rated health. Patients completed measures of cancer-related distress and functional impairment and cancer stage were collected from medical charts.

RESULTS

In the model evaluating work absenteeism, greater patient functional impairment was associated with more absenteeism, but there was no evidence of a mediating effect for either partners' cancer-specific distress. Higher cancer stage and more functional impairment were associated with higher spouse cancer-specific distress, which in turn predicted poorer work productivity. Patient cancer-specific distress did not mediate the association between patient functional impairment or cancer stage and spouse work productivity. Finally, higher cancer stage was associated with more spouse cancer-specific distress, which in turn predicted poorer work performance. There were no direct or indirect effects of the patient's functional impairment on spouse work performance.

CONCLUSIONS

Distressed spouses are more likely to have poorer work productivity after their partners' breast cancer diagnosis. These spouses may need assistance in managing their distress and the patient's functional impairment to ensure that their work productivity is not adversely affected.

Re-affirmation of a Preliminary Live with Love Conceptual Framework for cancer couple dyads: A couple-based complex intervention study

PURPOSE

The relational dynamics of couples may be under great strain due to the diagnosis and treatment of cancer. A complex "Caring for Couples Coping with Cancer" (4Cs) intervention program, guided by a Preliminary Live with Love Conceptual Framework (P-LLCF) for Cancer Couple Dyads, was developed to support couples going through such hardship. The purpose of this paper is to present a re-analysis of the results of the 4Cs intervention program to determine whether the findings provide evidence to support the constructs in the P-LLCF.

METHODS

The 4Cs intervention was provided to support cancer patients and their spousal caregivers. The pre- and post-intervention findings of the 4Cs intervention program were re-analyzed using descriptive-correlational analysis and structural equation modeling (SEM) to test whether the findings provide evidence to support the constructs in the P-LLCF.

RESULTS

A total of 92 out of the 117 dyads at baseline (T0) were successfully followed-up at 6 weeks (T1). The re-analysis of the findings from the 4Cs program (T1 outcomes) showed inter-relationships among the components included in the P-LLCF: dyadic mediators, dyadic coping, dyadic appraisal, and dyadic outcomes. The SEM of all six models resulted in convergence and showed goodness of fit to the data and variables, which is supportive of the constructs in the P-LLCF.

CONCLUSIONS

The present analysis of the T1 outcome measures of the 4Cs program provides evidence to support the constructs in the P-LLCF. Multiple mutual effects existed between couples in the process of living and coping with cancer as dyads.

Activation for Health Management in Colorectal Cancer Survivors and Their Family Caregivers

Activation, the state of possessing the skills, knowledge, and confidence to manage one's own health, is associated with positive self-management behaviors in individuals with chronic illness. Little is known about its role in cancer survivorship. The aims of this study were to describe activation in patients with colorectal cancer and their family caregivers, examine the relationship between patient and caregiver activation, and determine whether activation is related to symptom distress, depression, anxiety, fatigue, physical activity, and work productivity. Using a longitudinal, correlational design, a convenience sample of 62 patients and 42 family caregivers completed surveys during postoperative hospitalization, and at 6 weeks and 4 months postop. Activation scores for both patients and caregivers were stable over time, were not correlated, and were at the third level of activation. Linear mixed effects models revealed that negative emotions were associated with less patient activation and lower caregiver self-efficacy for caring for oneself.

Conceptualising psychological distress in families in palliative care: Findings from a systematic review

BACKGROUND

Adult palliative care patients and their family members experience significant psychological distress and morbidity. Psychosocial interventions adopting a systemic approach may provide a cogent model to improve the psychosocial care of families in palliative care. To facilitate design of these interventions, the construct of psychological distress in families in palliative care should be empirically derived.

AIM

To ascertain how psychological distress is conceptualised in families receiving palliative care.

DESIGN

A systematic review of the literature; this was followed by a thematic analysis and narrative synthesis.

DATA SOURCES

Using pre-defined search terms, four electronic databases (MEDLINE, CINAHL, PsycINFO and Behavioural Sciences collections) were searched with no date restrictions imposed. Pre-determined inclusion and exclusion criteria were then applied.

RESULTS

A total of 32 papers were included in the review. Two findings emerged from data synthesis. First, distress is conceptualised as a multi-dimensional construct but little consensus exists as to how to capture and measure distress. Second, distress in the families within these studies can be conceptualised using a tiered approach, moving from individual non-interactive depictions of distress through gradations of interaction to convey a systemic account of distress within the family system. Thus, distress shifts from a unitary to a systemic construct.

CONCLUSION

Currently, there is a paucity of research examining distress informed by family systems theories. This review proposes that distress in families in palliative care can be conceptualised and illustrated within a tiered model of distress. Further research is merited to advance current explanatory frameworks and theoretical models of distress.

Tightrope walkers suffering in silence: A qualitative study into the experiences of older parents who have an adult child with cancer

BACKGROUND

Given the worldwide ageing of the population and the changes in the structure of society and family, the likelihood increases that older parents face a serious illness in an adult child and will even outlive their child.

OBJECTIVES

To gain insight into older parents' experiences, concerns, and dilemmas regarding their position and role as a parent of an adult child with cancer.

DESIGN

Qualitative interview design.

SETTING

A geriatric ward and four oncology wards of a university hospital, several nursing homes, local health service agencies.

PARTICIPANTS

Twenty-five parents (age range 65-91 years) of 22 adult children with cancer (age range 33-66 years) of differing stages and types (with a preponderance of breast cancer).

METHODS

Using a qualitative research methodology underpinned by grounded theory, we conducted semi-structured interviews with a fairly open framework.

RESULTS

Suffering in silence emerged as the core category encapsulating three interrelated balancing acts: (1) shielding their child while being shielded by their child, (2) being involved while keeping an adequate distance, and (3) shifting attentional priorities between their child, themselves, and others. The emotional interconnectedness between older parents and their adult child with cancer becomes tangible in the transformational process of their parental role and position described in the three balancing acts.

CONCLUSIONS

Faced with their child's illness and possible death, older parents experience overwhelming feelings often underestimated by their (close) environment. Nurses need to be susceptible for the needs and experiences of these older parents. For care by nurses to make a difference, their attention must be directed to how older parents can be invigorated in their parenthood while respecting the child's autonomy.

Testing a Preliminary Live with Love Conceptual Framework for cancer couple dyads: A mixed-methods study

PURPOSE

The purpose of this study was to test the previous proposed Preliminary Live with Love Conceptual Framework (P-LLCF) that focuses on spousal caregiver-patient couples in their journey of coping with cancer as dyads.

METHODS

A mixed-methods study that included qualitative and quantitative approaches was conducted. Methods of concept and theory analysis, and structural equation modeling (SEM) were applied in testing the P-LLCF.

RESULTS

In the qualitative approach in testing the concepts included in the P-LLCF, a comparison was made between the P-LLCF with a preliminary conceptual framework derived from focus group interviews among Chinese couples' coping with cancer. The comparison showed that the concepts identified in the P-LLCF are relevant to the phenomenon under scrutiny, and attributes of the concepts are consistent with those identified among Chinese cancer couple dyads. In the quantitative study, 117 cancer couples were recruited. The findings showed that inter-relationships exist among the components included in the P-LLCF: event situation, dyadic mediators, dyadic appraisal, dyadic coping, and dyadic outcomes. In that the event situation will impact the dyadic outcomes directly or indirectly through Dyadic Mediators. The dyadic mediators, dyadic appraisal, and dyadic coping are interrelated and work together to benefit the dyadic outcomes.

CONCLUSIONS

This study provides evidence that supports the interlinked components and the relationship included in the P-LLCF. The findings of this study are important in that they provide healthcare professionals with guidance and directions according to the P-LLCF on how to plan supportive programs for couples coping with cancer.

The Role of Spirituality in the Lives of Mothers of Breast Cancer Survivors

Breast cancer impacts an entire family system. A cancer diagnosis embeds the patient/survivor and their loved ones in the illness process. The mothers of breast cancer patients are likely impacted in a variety of ways by their daughters' diagnoses. To date, few researchers have investigated the experiences and perspectives of this population. In the present study, authors explored how mothers of breast cancer survivors managed adversities associated with this disease and illness. Using secondary data and narrative analysis, investigators analyzed data gathered from 30 mothers. Findings indicate that participants relied on their spirituality for the management of stress and hardship related to having a loved one with breast cancer. This research has implications for family health and well-being.

Family Avoidance of Communication about Cancer: A Dyadic Examination

Purpose

This study aimed to examine the following questions: to what extent do patients and caregivers perceive their family members to be avoidant of communication regarding patient’s cancer, and to what extent do these perceptions interrelate; and how do such perceptions influence their own and each other’s communication behaviors, communication outcome, mental health, and quality of life.

Materials and Methods

A national survey was performed with 990 patient-caregiver dyads (participation rate, 76.2%). To examine the dyadic interaction, we developed linked patient and family member questionnaires, including the Family Avoidance of Communication about Cancer (FACC) scale.

Results

The mean scores (standard deviations) of patient- and caregiver-perceived FACC were low at 10.9 (15.5) and 15.5 (17.5), respectively (p < 0.001), and concordance was low, a well (Spearman’s rho, 0.23). Patient-perceived FACC was associated with lower levels of disclosure and behaviors of holding back communication, as well as lower levels of mental health outcome and quality of life. The same was true for caregivers (all p < 0.05). Patient-perceived FACC was associated with caregiver holding back, caregiver’s depression level, and caregiver quality of life (all p < 0.05). Both patient- and caregiver-perceived FACC were independently associated with communication difficulty within the family.

Conclusion

Future research would benefit from the measurement of FACC from both patients and caregivers, and promote family intervention to enhance openness to communication, which would be helpful for improving mental health and quality of life for both patients and caregivers.

Psychosocial consequences for partners of patients after total laryngectomy and for the relationship between patients and partners

OBJECTIVE

This study explored the long-term impact of a Total Laryngectomy (TL) on the partner and on the relationship between laryngectomees and their partners.

METHODS

151 laryngectomees and 144 partners completed questionnaires assessing the psychosocial impact of a TL on the partner (quality of life, anxiety and depression, loss of control, fear, hopelessness, post-traumatic growth, caregiving burden) and on the spousal relationship (change in the quality of the spousal relationship and openness to discussion of the illness in the family).

RESULTS

A considerable number of partners of laryngectomees experience a psychosocial impact of the consequences of the TL, specifically on their social life (35%) and on their sexual relationship (31%). Also, the tendency of other people to neglect their laryngectomized life companion, affects more than half of the partners negatively. Clinical levels of anxiety and depression were found in around 20% of the partners. The consequences of a TL has a negative change on the sexual functioning for more than 30% of both laryngectomees and partners, the communication for around one fifth of both laryngectomees and partners, and feelings of dependency of the partner for one third of the laryngectomees.

CONCLUSIONS

A TL has a considerable impact on the psychosocial life of partners of laryngectomees and on the spousal relationship. The findings of this explorative study sets the stage for structural screening on the need for support, not only for patients, but also for their partners. Sexuality and intimacy should be part of this screening.

Significant life events and their impact on alcohol and drug use: a qualitative study

This study used a life-course perspective to identify and understand life events related to long-term alcohol and other drug (AOD) use trajectories across the life span. Using a purposive sample, we conducted semi-structured telephone interviews with 48 participants (n = 30 abstinent and 18 non-abstinent) from a longitudinal study of AOD outcomes 15 years following outpatient AOD treatment. A content analysis was conducted using ATLAS.ti software to identify events and salient themes. Caregiving for an ill or dependent family member was related to better AOD outcomes by reinforcing abstinence and reduced drinking, and contributing to alcohol cessation in most individuals who cited caregiving as a pivotal event. Grandparenting and parenting an adult child were motivational for sustaining abstinence and reduced drinking. Findings were mixed on death of a loved one, which was related to abstinence in some and relapse in others. Redemption and mutual fulfillment as caregivers, reconciliations with adult children, and legacy-building as grandparents were themes associated with maintaining abstinence and reduced drinking. AOD treatment has the opportunity to employ motivational interventions for relapse prevention that address the meaning and lifelong reach of intimate relationships for individuals and their AOD use across the life span.

Psychological well-being and posttraumatic growth in caregivers of cancer patients

INTRODUCTION

Although research has shown that many cancer patients report positive life changes following cancer diagnosis, there are few data in the literature related to PTG in caregivers of cancer patients. However, the few studies available have shown that this kind of positive changes can also be experienced by family members. The aims of this study were to explore PTG in caregivers of cancer patients and to investigate correlations between the Posttraumatic growth, psychological status and QoL of caregivers and those of patients, taking into account also clinical and socio-demographic aspects.

METHODS

We enrolled 60 patient/caregiver pairs in the Department of Medical Oncology of the National Research Center "Giovanni Paolo II" in Bari. Both patients and caregivers were assessed using the following scales: Posttraumatic growth Inventory (PTGI); Hospital anxiety and depression scale; Short Form (36) Health Survey (SF-36); ECOG Performance Status. Clinical and socio-demographic data were collected.

RESULTS

Caregivers showed significantly higher scores than patients in the dimension of "personal strength." Furthermore, we found a significantly close association between anxiety and depression of caregivers with those of patients. Younger caregivers were better than older ones in terms of physical activity, vitality, mental health, and social activities. Although the degree of relationship with the patient has no significant effect on the dependent variables of the study, it was found that caregivers with a degree of kinship more distant to the patient have less physical pain than the closest relatives.

CONCLUSION

RESULTS of the present study show that caregivers of cancer patients may experience post-traumatic growth as the result of their caregiver role. It would be interesting to investigate in future research which factor may mediate the presence of post-traumatic growth.

Living close to a person with cancer: a review of the international literature and implications for social work practice

To help family caregivers (FCs), social workers need to understand the complexity of FC's experiences and challenges. For this systematic review, several relevant, multidisciplinary electronic databases were searched. Of 1,643 titles identified, 108 articles met the inclusion criteria and are included in this review. Various experiences, symptoms, and burden related to caregiving responsibilities are described and discussed. The understanding evolving from this study about the FC's own health risk, caregiver burden, and experiences over time can enhance a social worker's awareness of an FC's challenging situation and the potential impact this has on the FC's ability to provide care to the patient.

Assessing the needs of informal caregivers to cancer survivors: a review of the instruments

OBJECTIVE

Cancer may impact negatively on an informal caregiver's health long after treatment has ended. This review identifies the self-report measures currently in use to measure caregivers need for support and determines their scientific soundness and clinical utility.

METHOD

A systematic electronic database search of Medline, CINAHL, PsychINFO, BNI ProQuest was conducted. The psychometric properties and clinical utility of needs assessment tools for caregivers of cancer survivors (excluding advanced disease) were extracted and summarised.

RESULTS

Seven cancer survivor caregiver needs assessment tools were identified. Data on instrument development was well reported, although variability was noted in their structure and content. The majority demonstrated some degree of reliability and validity; only two were evaluated for test-retest reliability (CaSPUN and SPUNS) with only the SPUNS showing a high degree of reliability over time. The Health Care Needs Survey (HCNS), Needs Assessment of Family Caregivers-Cancer (NAFC-C) and Cancer Caregiving Tasks Consequences and Needs Questionnaire (CaTCoN) have been validated at various stages of the cancer continuum. Minimal data was available on responsiveness.

CONCLUSION

All assessment tools identified require further psychometric analysis. For research purposes, the use of the SPUNS (with its acceptable test-retest reliability) appears most appropriate; although its length may be of concern for clinical use; therefore, the shorter SCNS-P&C is likely to be more suitable for use clinically. At present, the NAFC-C demonstrates a great potential in both the research and clinical environments; however, it requires further psychometric testing before it can be fully recommended. Further analysis is necessary on ideal response formats and the meaning of a total needs score.

Chronicles of informal caregiving in cancer: using 'The Cancer Family Caregiving Experience' model as an explanatory framework

BACKGROUND

Cancer caregiving has emerged as a dominant focus of research in recent years. A striking feature of this vast amount of literature is that it is static, examining certain points of the cancer trajectory, mostly the diagnosis and palliative care. Only The Cancer Caregiving Experience Model conceptualised the caregiving experience and explored the conceptual implications of cancer family caregiving research.

AIM

The data from this paper aim to empirically support the Cancer Caregiving Experience model, by exploring the cancer caregiving experience longitudinally.

METHODS

Semi-structured interviews with 53 caregivers were carried out at patient's diagnosis (T1), 3 months (T2), 6 months (T3) and 12 months (T4) post diagnosis.

RESULTS

Analysis of 139 interviews generated four themes that reflected a complex and dynamic process. The themes that mapped those of the model were "Primary stressors", "Secondary stressors", "Appraisal", "Cognitive-Behavioural responses" and "Health and Well Being".

CONCLUSIONS

The study adds empirical support to The Cancer Caregiving Experience Model and confirms that different primary and secondary stressors influence how the caregivers perceive the caregiving demands, the coping mechanisms they employ and their health and well being during the cancer trajectory. Access to support services should be offered to all the caregivers from as early as the diagnosis period and take into account their specific needs.

Anxiety, depression and related factors in family caregivers of newly diagnosed lung cancer patients before first treatment

OBJECTIVE

This study aimed to (i) explore the prevalence and levels (severity) of anxiety and depression in family caregivers (FCs) of patients newly diagnosed with advanced lung cancer (stage IIIb or IV) before first treatment, and (ii) identify the factors related to FCs' anxiety and depression.

METHODS

For this cross-sectional study, 106 patient-FC dyads were recruited from a medical center in northern Taiwan. FCs' anxiety and depression were measured using the self-report Hospital Anxiety and Depression Scale, and FCs' ability to manage patients' symptoms was assessed using the Self-Efficacy in Symptom Management Scale. FCs' risks for anxiety and depression were separately identified using two multivariate logistic regression models.

RESULTS

This study found two major results. First, before patients' first treatment, 50.9% and 32.1% of FCs were at risk for anxiety and depression, respectively. FCs' overall mean anxiety and depression scores were 7.7 (SD = 4.7) and 6.1 (SD = 4.5), respectively. Second, both FCs' anxiety and depression were significantly related to four factors: caring for another sick family member, younger age, having pain problems, and lower self-efficacy in managing symptoms.

CONCLUSION

Family caregivers of patients newly diagnosed with advanced lung cancer had anxiety and depression before the patients' first treatment. We strongly suggest developing and testing interventions to reduce FCs' psychological distress and enhance their quality of life, thus ensuring better quality of patient care.

A spectrum of hidden morbidities among spousal caregivers for patients with cancer, and differences between the genders: a review of the literature

OBJECTIVE

To explore the spectrum of hidden morbidities and gender differences in the spousal caregiving experience with regard to cancer patients across the cancer trajectory, and to discuss directions for future research and the implications for interventions to improve the caregiving experience.

METHODS

A systematic search was conducted to identity articles published in English or Chinese from January 2000 to July 2012. Studies were located using an electronic search, a manual search, and an author search.

RESULTS

A total of 19 articles were identified and included in this review. This review of the literature revealed that female spousal caregivers, in general, experienced more mental morbidity (higher levels of distress, depression, and anxiety, lower levels of mental health), physical morbidity (lower physical health scores, poorer physical functioning, and loss of physical strength), and social morbidity (lower marital satisfaction and less social support) than male spousal caregivers.

CONCLUSIONS

This review of the literature revealed that spousal caregivers, particularly female spousal caregivers for cancer patients, are at a high risk of falling victim to a wide spectrum of hidden morbidities due to their caregiving experience. The cultural influences on the couples and their patterns of communication that influence the caregiving experience for cancer patients should be further explored. A tailored-made intervention for spousal caregivers, both males and females, in the context of cancer care should be developed to cater to the needs of this population, which suffers from a spectrum of hidden morbidities.