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Alfaro-Diaz C, Esandi N, Clausen AM, Canga-Armayor N, Pueyo-Garrigues M, Dieperink KB. Instruments for Assessing Family Functioning in Adults Patients with Cancer: A Systematic Review of Measurement Properties. Semin Oncol Nurs 2024:151729. [PMID: 39277506 DOI: 10.1016/j.soncn.2024.151729] [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: 04/25/2024] [Revised: 08/09/2024] [Accepted: 08/16/2024] [Indexed: 09/17/2024]
Abstract
OBJECTIVES To identify instruments for assessing family functioning in adults patients with cancer and summarize their psychometric properties. METHODS Psychometric systematic literature review was conducted to June 2023 using four databases: PubMed, CINAHL, Psych INFO, and Web of Science. The psychometric properties of the instruments and the methodological quality of the studies were evaluated using the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used to rate the best available evidence. RESULTS Forty-four studies reporting 13 instruments were included. The instruments measured varied attributes of family functioning and the dimensions were heterogeneous. The Cancer Communication Assessment Tool for Patients and Families (CCAT-PF) was rated the highest in terms of both methodological rigor and instrument quality. However, the Family Adaptability and Cohesion Evaluation Scale (FACES) and the Ice-Expressive Family Functioning Questionnaire (ICE-EFFQ) offer a more comprehensive measure of family functioning, since they assess multiple dimensions of family functioning and demonstrate high-quality measurement properties. CONCLUSIONS Instruments to assess family functioning were heterogeneous and exhibited limited reliability and validity. The FACES and the ICE-EFFQ seem to be the most suitable measures for adult cancer patients and their families. Future research should aim to refine the content of existing instruments and rigorously assess their psychometric properties. IMPLICATIONS FOR NURSING PRACTICE Given the profound impact of cancer on family functioning, the initial step in crafting effective interventions is providing valid and reliable instruments to measure the impact of these interventions. This paper could assist nursing professionals in making informed decisions regarding the most suitable instrument for assessing family functioning in adults patients living with life-threatening illness as is the case with cancer.
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Affiliation(s)
- Cristina Alfaro-Diaz
- Department of Nursing Care for Adult Patients, School of Nursing, Universidad de Navarra, Navarra, Spain; IdiSNa, Navarra Institute for Health Research, Universidad de Navarra, Navarra, Spain
| | - Nuria Esandi
- Department of Nursing Care for Adult Patients, School of Nursing, Universidad de Navarra, Navarra, Spain; IdiSNa, Navarra Institute for Health Research, Universidad de Navarra, Navarra, Spain.
| | - Anne Møller Clausen
- Department of Haematology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Family focused healthcare research Center, University of Southern Denmark, Odense, Denmark
| | - Navidad Canga-Armayor
- IdiSNa, Navarra Institute for Health Research, Universidad de Navarra, Navarra, Spain; Department of Community, Maternity and Pediatric Nursing, School of Nursing, Universidad de Navarra, Navarra, Spain
| | - María Pueyo-Garrigues
- IdiSNa, Navarra Institute for Health Research, Universidad de Navarra, Navarra, Spain; Department of Community, Maternity and Pediatric Nursing, School of Nursing, Universidad de Navarra, Navarra, Spain
| | - Karin B Dieperink
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Family focused healthcare research Center, University of Southern Denmark, Odense, Denmark; Department of Oncology, Odense University Hospital, Odense, Denmark
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Zhong M, Sun S, Long J, Yuan M, Wang M, Zhang Z. Tools to measure the burden on informal caregivers of cancer patients: A literature review. J Clin Nurs 2024; 33:2949-2970. [PMID: 38528583 DOI: 10.1111/jocn.17112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/23/2024] [Accepted: 03/01/2024] [Indexed: 03/27/2024]
Abstract
OBJECTIVES (1) To describe existing tools to assess the burden of informal caregivers of people with cancer, (2) to describe how these tools have been validated and (3) to describe the areas of interest of existing assessment tool entries. BACKGROUND The caregiver burden of informal caregivers of people with cancer greatly affects their lives. There is a wide variety of relevant assessment tools available, but there are no studies to help researchers to select tools. METHODS A search was conducted using the keywords 'cancer', 'caregiver', 'burden' and 'scale' in Medline (PubMed), CINAHL and EMBASE to include articles that developed or applied tools to assess the burden on informal caregivers of cancer patients. Once eligible tools were identified, we searched their 'primary reference' studies. If the original scale was assessed in a population other than informal caregivers of cancer patients, we again searched for psychometric measures in the population of caregivers of cancer patients. RESULTS This study retrieved 938 articles on developing or applying the informal caregiver burden instrument for cancer patients, including 42 scales. Internal consistency of the original scales ranged from 0.53 to 0.96. Nineteen scales initially developed to assess caregiver burden for patients with dementia, stroke and other disorders were later used for caregivers of cancer patients, eight of which have not yet been validated. Reclassifying all scale domains of concern revealed that scale assessments focused more on caregivers' physical health, emotional state and caregiving tasks. CONCLUSION This review identifies many scales for assessing informal caregiver burden in cancer patients and gives scales recommended. However, a portion still needs to be validated. The development of a new scale proposes to be based on a theoretical framework and to consider dimensions for assessing support resources. IMPACT What problem did the study address?: This paper collates assessment tools on the burden of informal carers of people with cancer. It also provides information on the applicable population, reliability and validity. What were the main findings?: 41 scales could be considered for use, eight of which have not been validated. The scales focus more on assessing caregivers' physical health, emotional state and caregiving tasks, and less on the dimension of support resources. Where and on whom will the research have an impact?: There are implications for informal carers of cancer patients in hospitals or in the community, as well as for relevant researchers. REPORTING METHOD Retrieved with reference to systematic evaluation. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Mingming Zhong
- School of Nursing, Lanzhou University, Lanzhou, Gansu, PR China
- Department of Critical Care Medicine, Lanzhou University First Hospital, Lanzhou, Gansu, PR China
| | - Shanshan Sun
- School of Nursing, Lanzhou University, Lanzhou, Gansu, PR China
- Department of Critical Care Medicine, Lanzhou University First Hospital, Lanzhou, Gansu, PR China
| | - Jianying Long
- School of Nursing, Lanzhou University, Lanzhou, Gansu, PR China
- Department of Critical Care Medicine, Lanzhou University First Hospital, Lanzhou, Gansu, PR China
| | - Mengyuan Yuan
- School of Nursing, Lanzhou University, Lanzhou, Gansu, PR China
- Department of Critical Care Medicine, Lanzhou University First Hospital, Lanzhou, Gansu, PR China
| | - Min Wang
- School of Nursing, Lanzhou University, Lanzhou, Gansu, PR China
- Department of Critical Care Medicine, Lanzhou University First Hospital, Lanzhou, Gansu, PR China
| | - Zhigang Zhang
- School of Nursing, Lanzhou University, Lanzhou, Gansu, PR China
- Department of Critical Care Medicine, Lanzhou University First Hospital, Lanzhou, Gansu, PR China
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Zacharias L, Thomas PT, Warrier MG, Yadav R, Alladi S, Nalini A, Pal PK. Neuropalliative Care Needs Checklist for Motor Neuron Disease and Parkinson's Disease: A Biopsychosocial Approach. Indian J Palliat Care 2024; 30:232-238. [PMID: 39371494 PMCID: PMC11450826 DOI: 10.25259/ijpc_181_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 07/14/2024] [Indexed: 10/08/2024] Open
Abstract
Objectives Neurodegenerative disorders necessitate comprehensive palliative care due to their progressive and irreversible nature. Limited studies have explored the comprehensive assessment needs of this population. This present study is designed to develop a checklist for evaluating the palliative care needs of individuals with motor neuron disease (MND) and Parkinson's disease (PD). Materials and Methods The checklist was created through an extensive literature review and discussions with stakeholders in neuropalliative. Feedback from six field experts led to the finalisation of the checklist, which comprised 53 items addressing the unique biopsychosocial needs of MND and PD. Sixty patient-caregiver dyads receiving treatment in a tertiary referral care centre for neurology in south India completed the checklist. Results People with MND had more identified needs with speech, swallowing, and communication, while people with PD reported needs in managing tremors, reduced movements, and subjective feelings of stiffness. People denying the severity of the illness was found to be a major psychosocial issue. The checklist addresses the dearth of specific tools for assessing palliative care needs in neurodegenerative disorders, particularly MND and PD. By incorporating disease-specific and generic items, the checklist offers a broad assessment of patients' multidimensional needs. Conclusion This study contributes to the area of neuropalliative care by developing the neuropalliative care needs checklist (NPCNC) as a valuable tool for assessing the needs of individuals with neurodegenerative diseases. Future research should focus on refining and validating the NPCNC with larger and more diverse groups, applicability in different contexts, and investigating its sensitivity to changes over time.
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Affiliation(s)
- Lithin Zacharias
- Faculty of Health, Science, Social Care and Education, Kingston University, London, United Kingdom
| | - Priya Treesa Thomas
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | | | - Ravi Yadav
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Suvarna Alladi
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Atchayaram Nalini
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Pramod Kumar Pal
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Lyon ME, Fraser JL, Thompkins JD, Clark H, Brodie N, Detwiler K, Torres C, Guerrera MF, Younge T, Aoun S, Trujillo Rivera EA. Advance Care Planning for Children With Rare Diseases: A Pilot RCT. Pediatrics 2024; 153:e2023064557. [PMID: 38699801 PMCID: PMC11153326 DOI: 10.1542/peds.2023-064557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 02/28/2024] [Accepted: 03/05/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND AND OBJECTIVE Pediatric rare diseases are often life-limiting conditions and/or require constant caregiving. Investigators assessed the initial efficacy of the FAmily CEntered (FACE) pediatric advance care planning (pACP), FACE-Rare, intervention on families' quality of life. METHODS A pilot-phase, single-blinded, intent-to-treat, randomized controlled clinical trial enrolled families from 1 pediatric quaternary hospital between 2021 and 2023. Intervention families received 3 weekly 60-minute (FACE-Rare pACP) sessions: (1) Carer Support Needs Assessment Tool or Action Plan, (2) Carer Support Needs Assessment Tol Action Plan Review, and (3) Pediatric Next Steps: Respecting Choices pACP. Controls received treatment as usual (TAU). Outcome measures were Beck Anxiety Inventory, Family Appraisal of Caregiving, Functional Assessment of Chronic Illness Therapy (FACIT)-Spirituality, and health care utilization. Generalized mixed effect models with γ response assessed the intervention effect at 3-month follow-up. RESULTS Children (n = 21) were aged 1 to 10 years, 48% male, 24% Black; and 100% technology dependent. Primary family caregivers (n = 21) were aged 30 to 43 years, 19% male, 19% Black; and 27% household income below the Federal poverty level. Dyads underwent 1:1 randomization: 9 to FACE-Rare and 12 to TAU. TAU caregivers reported statistically lower meaning and peace than FACE-Rare caregivers (0.9, P = .03, confidence interval [CI]: 0.75-0.99). Black caregivers reported significantly less caregiver distress (0.7, P = .04, CI: 0.47-0.98) than non-Black caregivers. Poor families reported more anxiety (3.5, P = .002, CI: 1.62-7.94), more caregiver strain (1.2, P = .006, CI: 1.07-1.42); and less family well-being (0.8, P = .02, CI: 0.64-0.95). CONCLUSIONS FACE®-Rare was feasible, acceptable, safe, and demonstrated initial efficacy, providing greater feelings of meaning and peace to caregivers. Poverty impacted well-being. A multisite trial is needed to determine generalizability.
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Affiliation(s)
- Maureen E. Lyon
- Children’s National Hospital, Washington, District of Columbia
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Jamie L. Fraser
- Children’s National Hospital, Washington, District of Columbia
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | | | - Heidi Clark
- Children’s National Hospital, Washington, District of Columbia
| | - Nicola Brodie
- Children’s National Hospital, Washington, District of Columbia
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | | | - Clarivet Torres
- Children’s National Hospital, Washington, District of Columbia
| | | | - Tamiko Younge
- Children’s National Hospital, Washington, District of Columbia
| | - Samar Aoun
- Peron Institute, Palliative Care, The Western University of Australia, Perth, Washington, Australia
| | - Eduardo A. Trujillo Rivera
- Children’s National Hospital, Washington, District of Columbia
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
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Domeisen Benedetti F, Hechinger M, Fringer A. Self-Assessment Instruments for Supporting Family Caregivers: An Integrative Review. Healthcare (Basel) 2024; 12:1016. [PMID: 38786426 PMCID: PMC11120749 DOI: 10.3390/healthcare12101016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/21/2024] [Accepted: 04/30/2024] [Indexed: 05/25/2024] Open
Abstract
Family caregivers take on a variety of tasks when caring for relatives in need of care. Depending on the situation and the intensity of care, they may experience multidimensional burdens, such as physical, psychological, social, or financial stress. The aim of the present study was to identify and appraise self-assessment instruments (SAIs) that capture the dimensions of family caregivers' burdens and that support family caregivers in easily identifying their caregiving role, activities, burden, and needs. We performed an integrative review with a broad-based strategy. A literature search was conducted on PubMed, Google Scholar, Google, and mobile app stores in March 2020. After screening the records based on the eligibility criteria, we appraised the tools we found for their usefulness for family care and nursing practice. From a total of 2654 hits, 45 suitable SAIs from 274 records were identified and analyzed in this way. Finally, nine SAIs were identified and analyzed in detail based on further criteria such as their psychometric properties, advantages, and disadvantages. They are presented in multi-page vignettes with additional information for healthcare professionals. These SAIs have proven useful in assessing the dimensions of caregiver burden and can be recommended for application in family care and nursing practice.
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Affiliation(s)
- Franzisca Domeisen Benedetti
- School of Health Professions, Institute of Nursing, ZHAW—Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, 8401 Winterthur, Switzerland (A.F.)
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Cayrol J, Wakefield CE, Ilbawi A, Donoghoe M, Hoffman R, Echodu M, Schilstra C, Ortiz R, Wiener L. The lived experience of people affected by cancer: A global cross-sectional survey protocol. PLoS One 2024; 19:e0294492. [PMID: 38394101 PMCID: PMC10889872 DOI: 10.1371/journal.pone.0294492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 10/31/2023] [Indexed: 02/25/2024] Open
Abstract
A diagnosis of cancer impacts the person's physical and mental health and the psychosocial and financial health of their caregivers. While data on the experience of living with cancer is available, there is a dearth of data from persons in low- and middle-income countries (LMICs). The perspectives of other impacted individuals also remain understudied (e.g., bereaved family members), as well as the impact on survivors and their families over time. The objective of this study is to describe the psychosocial and financial impact of cancer on people diagnosed with cancer as a child, adolescent or adult, their families/caregivers, and the family members of those who have died from cancer, in high-income countries (HICs) and LMICs. This study is an observational, descriptive, quantitative study. Data will be collected anonymously via a digital online cross-sectional survey distributed globally by the World Health Organization (WHO) via the LimeSurvey software. Participants will include (a) adults aged 18+ who have been diagnosed with cancer at any age, who are currently undergoing cancer treatment or who have completed cancer treatment; (b) adult family members of individuals of any age with a cancer diagnosis, who are currently undergoing cancer treatment or who have completed cancer treatment; and (c) bereaved family members. Participants will be anonymously recruited via convenience and snowball sampling through networks of organisations related to cancer. Survey results will be analysed quantitatively per respondent group, per time from diagnosis, per disease and country. Results will be disseminated in peer-reviewed journals and at scientific conferences; a summary of results will be available on the WHO website. This study will suggest public health interventions and policy responses to support people affected by cancer and may also lead to subsequent research focusing on the needs of people affected by cancer.
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Affiliation(s)
- Julie Cayrol
- The Royal Children’s Hospital and Murdoch Children’s Research Institute, Melbourne, Australia
- Department of Paediatrics, Faculty of Medicine, The University of Melbourne, Melbourne, Australia
- World Health Organization, Department of Non-Communicable Diseases, Geneva, Switzerland
| | - Claire E. Wakefield
- School of Clinical Medicine, UNSW Medicine & Health, Randwick Clinical Campus, Discipline of Paediatrics, UNSW Sydney, NSW Sydney, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Randwick, Australia
| | - André Ilbawi
- World Health Organization, Department of Non-Communicable Diseases, Geneva, Switzerland
| | - Mark Donoghoe
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Randwick, Australia
- Stats Central, Mark Wainwright Analytical Centre, UNSW Sydney, NSW Sydney, Australia
| | - Ruth Hoffman
- American Childhood Cancer Organization, Beltsville, Maryland, United States of America
| | | | - Clarissa Schilstra
- School of Clinical Medicine, UNSW Medicine & Health, Randwick Clinical Campus, Discipline of Paediatrics, UNSW Sydney, NSW Sydney, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Randwick, Australia
| | - Roberta Ortiz
- World Health Organization, Department of Non-Communicable Diseases, Geneva, Switzerland
| | - Lori Wiener
- National Cancer Institute, Center for Cancer Research, National Institute of Health, Bethesda, Maryland, United States of America
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Nogueira AJ, Ribeiro MT. A psychological experience assessment protocol of parent caregivers in paediatric palliative care. Ann Med 2023; 55:2268093. [PMID: 38010855 PMCID: PMC10836293 DOI: 10.1080/07853890.2023.2268093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 10/02/2023] [Indexed: 11/29/2023] Open
Abstract
Background: Paediatric Palliative Care (PPC) has undergone rapid growth in Portugal, where there are over 7800 children with life-limiting conditions. This is a complex experience for families due to the ongoing threat and vulnerability caused by the emergence of an illness, and therefore several studies have tended to focus on the adaptation of parent caregivers. The aim of the present study is to present a psychological experience assessment protocol of parents in PPC. Methods: It consists of a socio-demographic and clinical questionnaire and a semi-structured interview based on an incomplete narrative deriving from the Unwanted Guest Metaphor. Results: On the basis of the latter, 10 dimensions of the experience in the parental subsystem were explored through parents' own perspective, namely: confrontation with the diagnosis; representation of the illness; emotional impact; day-to-day challenges; family impact; resources and social support; coping strategies; posttraumatic growth; representation of the sick child; and future perspectives. Discussion: The protocol can be used in person or remotely and its application enables the identification of specific needs and the establishment of psychotherapeutic goals and strategies for each family, thus enhancing their well-being and resilience, from an eco-systemic perspective. Conclusions: The protocol is presented in detail and its importance in the context of research and systemic intervention in PPC is discussed.
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Affiliation(s)
- Alexandra Jóni Nogueira
- CICPSI, Faculty of Psychology, University of Lisbon, Alameda da Universidade, Lisboa, Portugal
| | - Maria Teresa Ribeiro
- CICPSI, Faculty of Psychology, University of Lisbon, Alameda da Universidade, Lisboa, Portugal
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Limonero JT, Maté-Méndez J, Gómez-Romero MJ, Mateo-Ortega D, González-Barboteo J, Bernaus M, López-Postigo M, Sirgo A, Viel S, Sánchez-Julve C, Bayés R, Gómez-Batiste X, Tomás-Sábado J. Family caregiver emotional distress in advanced cancer: the DME-C scale psychometric properties. BMJ Support Palliat Care 2023; 13:e177-e184. [PMID: 33277319 PMCID: PMC10646856 DOI: 10.1136/bmjspcare-2020-002608] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 11/03/2020] [Accepted: 11/16/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Family caregivers of patients with advanced illness at end of life often report high levels of emotional distress. To address this emotional distress is necessary to have adequate and reliable screening tools. AIM This study analyses the psychometric properties and clinical utility of the Family Caregiver Emotional Detection Scale for caregivers of patients with end-stage cancer (DME-C, Spanish acronym) who are receiving palliative care (PC). DESIGN Multicentre, cross-sectional study. SETTINGS/PARTICIPANTS Family caregivers of patients with advanced cancer at end of life receiving palliative treatment were interviewed to explore their emotional distress through the DME-C scale and other instruments measuring anxiety and depression (Hospital Anxiety and Depression Scale (HADS)), distress thermometer (DT) and overload (B), as well as a clinical psychological assessment (CPA). RESULTS 138 family caregivers, 85 (61.6%) female and 53 (38.4%) male, with an average age of 59.69±13.3 participated in the study. The reliability of the scale, as measured by Cronbach's alpha, was 0.76, and its stability over time was 0.734. Positive, significant correlations were found between the DME-C and the scores for anxiety and depression registered on the HADS scale, as well as with the total result of this latter scale and the results for B, the DT and the CPA. A statistical analysis of the receiver-operating characteristic curves showed that the scale has a sensitivity and specificity of 75%, and that the cut-off point for the detection of emotional distress was a score ≥11. Fifty-four per cent of the caregivers displayed emotional distress according to this scale. CONCLUSIONS The DME-C displays good psychometric properties. It is simple, short, reliable and easy to administer. We believe that the instrument is useful for the detection of emotional distress in the family caregivers of hospitalised patients suffering from end-stage illnesses and receiving PC.
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Affiliation(s)
- Joaquín T Limonero
- School of Psychology, Stress and Health Research Group, Universitat Autonoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Catalunya, Spain
| | - Jorge Maté-Méndez
- School of Psychology, Stress and Health Research Group, Universitat Autonoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Catalunya, Spain
- Psycho-oncology Care Unit, Institut Catala d' Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain
| | - María José Gómez-Romero
- School of Psychology, Stress and Health Research Group, Universitat Autonoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Catalunya, Spain
- Psychology Unit, Egarsat, Mutua Colaboradora con la Seguridad Social nº 276, Terrassa, Barcelona, Spain
| | - Dolors Mateo-Ortega
- Palliative Care Unit, Consorci Sanitari de Terrassa, Terrassa, Catalunya, Spain
| | - Jesús González-Barboteo
- Palliative Care Unit, Institut Catala d' Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Montserrat Bernaus
- Palliative Care Unit, Consorci Corporació Sanitària Parc Taulí de Sabadell, Sabadell, Barcelona, Spain
| | - Montserrat López-Postigo
- Palliative Care Unit, Consorci Corporació Sanitària Parc Taulí de Sabadell, Sabadell, Barcelona, Spain
| | - Agustina Sirgo
- Psycho-oncology Unit, Oncology Department, University Hospital Sant Joan de Reus, Reus, Barcelona, Spain
| | - Silvia Viel
- School of Psychology, Stress and Health Research Group, Universitat Autonoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Catalunya, Spain
- Member of the Group of Psychologists of the Catalan-Balearic Society for Palliative Care, Barcelona, Spain
| | - Cruz Sánchez-Julve
- Palliative Care Unit, Sant Camil Hospital-Residence Foundation-Sant Pere de Ribes, Sant Pere de Ribes, Barcelona, Spain
| | - Ramon Bayés
- School of Psychology, Stress and Health Research Group, Universitat Autonoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Catalunya, Spain
| | - Xavier Gómez-Batiste
- The 'Qualy' Observatory. WHO Collaborating Centre for Public Health Palliative Care Programmes, Institut Catala d' Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain
- Chair of Palliative Care, University of Vic, Vic, Barcelona, Spain
| | - Joaquín Tomás-Sábado
- University of Gimbernat and Tomas Cerda School of Nursing, Sant Cugat del Vallés, Barcelona, Spain
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Lyon ME, Thompkins JD, Fratantoni K, Fraser JL, Schellinger SE, Briggs L, Friebert S, Aoun S, Cheng YI, Wang J. Family caregivers of children and adolescents with rare diseases: a novel palliative care intervention. BMJ Support Palliat Care 2022; 12:e705-e714. [PMID: 31345846 PMCID: PMC8040699 DOI: 10.1136/bmjspcare-2019-001766] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 04/24/2019] [Accepted: 05/29/2019] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To develop and pilot test a palliative care intervention for family caregivers of children with rare diseases (FAmily-CEntered pediatric Advance Care Planning-Rare (FACE-Rare)). METHODS FACE-Rare development involved an iterative, family-guided process including review by a Patient and Family Advisory Council, semistructured family interviews and adaptation of two evidence-based person-centred approaches and pilot testing their integration. Eligible families were enrolled in FACE-Rare (the Carer Support Needs Assessment Tool (CSNAT) Approach Paediatric sessions 1 and 2; plus Respecting Choices Next Steps pACP intervention sessions 3 and 4). Satisfaction, quality of communication and caregiver appraisal were assessed. RESULTS Parents were mean age 40 years, and children 7 years. Children's diseases were rare enough that description would identify patients. All children were technology dependent. Telemedicine, used with four of seven families, was an effective engagement strategy and decreased subject burden. Families found FACE-Rare valuable following a strategy that first elicited palliative care needs and a support plan. Eight families were approached for pilot testing. Of the seven mothers who agreed to participate, six began session 1, and of those, 100% completed: all four FACE-Rare sessions, baseline and 2-week postintervention assessments, and a written pACP which described their preferences for medical decision-making to share with their providers. 100% reported FACE-Rare was helpful. The top three CSNAT concerns were: knowing what to expect in the future, having enough time for yourself and financial issues. Benchmarks were achieved and questionnaires were acceptable to parents and thus feasible to use in a larger trial. CONCLUSIONS FACE-Rare provides an innovative, structured approach for clinicians to deliver person-centred care.
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Affiliation(s)
- Maureen E Lyon
- Adolescent and Young Adult Medicine, Children's National Health System, Washington, DC, USA
| | - Jessica D Thompkins
- Center for Translational Research, Children's National Health System, Washington, DC, USA
| | - Karen Fratantoni
- Complex Care Program, Children's National Health System, Washington, DC, USA
| | - Jamie L Fraser
- Division of Genetics and Metabolism, Children's National Health System, Washington, DC, USA
| | | | - Linda Briggs
- A Division of C-TAC Innovations, Respecting Choices, Washington, DC, USA
| | - Sarah Friebert
- Palliative Care, Akron Children's Hospital, Akron, Ohio, USA
| | - Samar Aoun
- Perron Institute for Neurological and Translational Science, Perth, Western Australia, Australia
- School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Yao Iris Cheng
- Biostatistics, Children's National Health System, Washington, DC, USA
| | - Jichuan Wang
- Biostatistics, Children's National Health System, Washington, DC, USA
- Center for Translational Science, Children's National Health System, Washington, DC, USA
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Murali KP, Kang JA, Bronstein D, McDonald MV, King L, Chastain AM, Shang J. Measuring Palliative Care-Related Knowledge, Attitudes, and Confidence in Home Health Care Clinicians, Patients, and Caregivers: A Systematic Review. J Palliat Med 2022; 25:1579-1598. [PMID: 35704053 PMCID: PMC9639230 DOI: 10.1089/jpm.2021.0580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2022] [Indexed: 11/12/2022] Open
Abstract
Background: Integrating palliative care services in the home health care (HHC) setting is an important strategy to provide care for seriously ill adults and improve symptom burden, quality of life, and caregiver burden. Routine palliative care in HHC is only possible if clinicians who provide this care are prepared and patients and caregivers are well equipped with the knowledge to receive this care. A key first step in integrating palliative care services within HHC is to measure preparedness of clinicians and readiness of patients and caregivers to receive it. Objective: The objective of this systematic review was to review existing literature related to the measurement of palliative care-related knowledge, attitudes, and confidence among HHC clinicians, patients, and caregivers. Methods: We searched PubMed, CINAHL, Web of Science, and Cochrane for relevant articles between 2000 and 2021. Articles were included in the final analysis if they (1) reported specifically on palliative care knowledge, attitudes, or confidence, (2) presented measurement tools, instruments, scales, or questionnaires, (3) were conducted in the HHC setting, (4) and included HHC clinicians, patients, or caregivers. Results: Seventeen articles were included. While knowledge, attitudes, and confidence have been studied in HHC clinicians, patients, and caregivers, results varied significantly across countries and health care systems. No study captured knowledge, attitudes, and confidence of the full HHC workforce; notably, home health aides were not included in the studies. Conclusion: Existing instruments did not comprehensively contain elements of the eight domains of palliative care outlined by the National Consensus Project (NCP) for Quality Palliative Care. A comprehensive psychometrically tested instrument to measure palliative care-related knowledge, attitudes, and confidence in the HHC setting is needed.
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Affiliation(s)
- Komal Patel Murali
- Center for Health Policy, Columbia University School of Nursing, New York, New York, USA
| | - Jung A. Kang
- Center for Health Policy, Columbia University School of Nursing, New York, New York, USA
| | - David Bronstein
- Columbia University Mailman School of Public Health, New York, New York, USA
- George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Margaret V. McDonald
- Center for Home Care Research and Policy, Visiting Nurse Service of New York, New York, New York, USA
| | - Lori King
- Center for Home Care Research and Policy, Visiting Nurse Service of New York, New York, New York, USA
| | - Ashley M. Chastain
- Center for Health Policy, Columbia University School of Nursing, New York, New York, USA
| | - Jingjing Shang
- Center for Health Policy, Columbia University School of Nursing, New York, New York, USA
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11
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Sharif Nia H, Sivarajan Froelicher E, Hosseini L, Ashghali Farahani M, Hejazi S. Development and validation of the care challenge scale in family caregivers of people with Alzheimer's disease. Front Public Health 2022; 10:921858. [PMID: 35968470 PMCID: PMC9366672 DOI: 10.3389/fpubh.2022.921858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 06/29/2022] [Indexed: 11/13/2022] Open
Abstract
Background Alzheimer's disease (AD) is a progressive and debilitating disorder that strongly affects people with AD and their families. The changes in signs of the disease and its treatment lead to many challenges in people with AD that affect the performance and the ability of caregivers, their social life, and physical, emotional, and psychological aspects of caregivers' health. Therefore, this study was designed to develop and validate the Care Challenge Scale (CCS) for family caregivers of people with AD in the care context of Iran. Method This is a cross-sectional study, and the primary scale was based on 14 semi-structured interviews with family caregivers of Iranian people with AD. In the next phase, the psychometric features were assessed, including the face validity (qualitative and quantitative), content validity (qualitative and quantitative), item analysis, structural validity (exploratory and confirmatory factors), and construct validity (convergent and discriminant validity). Finally, the reliability was assessed using internal consistency (Cronbach's alpha, McDonald's omega coefficient, and the average inter-item correlation), stability (intraclass correlation coefficient), and absolute reliability. Results Totally, 435 Iranian family caregivers filled out online questionnaires, with a mean age of 50.26(±13.24) years. Based on the results of the qualitative phase, an item pool was generated with 389 items, and after deleting overlapping and unrelated items, the CCS with 14 items was created. The results of the quantitative phase showed that the CCS consists of two factors with 10 items each, which are named effective role-play challenge and lack of social–financial support, and they explained 42.23% of the total variance. Furthermore, the results of confirmatory factor analysis showed a good fitness of the scale structure model, and it had convergent and discriminant validity. The reliability indexes showed this scale has internal consistency and stability. Conclusion The most care challenge among Iranian family caregivers of people with AD is effective role-play challenges and lack of social–financial support. The scale as designed has good validity, internal consistency, and stability that can be used by therapists, nurses, and researchers for the assessment of the challenges of this population.
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Affiliation(s)
- Hamid Sharif Nia
- School of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran
| | - Erika Sivarajan Froelicher
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, San Francisco, CA, United States
- Department of Epidemiology & Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Lida Hosseini
- School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
- *Correspondence: Lida Hosseini
| | - Mansoureh Ashghali Farahani
- School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
- Mansoureh Ashghali Farahani
| | - Sima Hejazi
- Nursing Department, Bojnurd Faculty of Nursing, North Khorasan University of Medical Sciences, Bojnourd, Iran
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12
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Is there a relationship between end-of-life cancer patients' dignity-related distress and caregivers' distress? An exploratory study. Palliat Support Care 2022:1-7. [PMID: 35866268 DOI: 10.1017/s1478951522000840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES The mutual influence between end-of-life cancer patients and their family caregivers is widely endorsed. The present study aimed to explore the relationship between end-of-life cancer patients' dignity-related distress and the distress of their caregivers. METHOD A cross-sectional approach was used. The sample consisted of 128 patients with a Karnofsky Performance Status (KPS) below 50 and a life expectancy of a few weeks, and their family caregivers. Personal and clinical data were collected and validated rating scales were administered: Patient Dignity Inventory (PDI) to terminal cancer patients; Hospital Anxiety and Depression Scale (HADS), Demoralization Scale (DS), Herth Hope Index (HHI), Caregiver Reaction Assessment (CRA), Short Form Health Survey 36 (SF-36), and Distress Thermometer (DT) to caregivers. RESULTS Findings highlighted significant correlations between patients' scores on the Psychological Distress PDI subscale and the PDI Total Score and caregivers' Emotional Role. Patients' Psychological Distress, PDI Total Score, and Loss of Purpose and Meaning were associated with caregivers' Disrupted Schedule. Finally, patients' Physical Symptoms and Dependency, Loss of Purpose and Meaning, and PDI Total Score were correlated with caregivers' Disheartenment. SIGNIFICANCE OF RESULTS The results highlighted the key role of dignity as a relational dimension during the end-of-life phase. Therefore, because of caregivers' distress could affect patients' dignity-related distress by influencing the interpersonal aspects of patients' autonomy, it would be important to relieve caregivers' distress in order to promote patients' autonomy and minimize their fear of being a burden.
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13
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Pop RS, Payne S, Tint D, Pop CP, Mosoiu D. Instruments to assess the burden of care for family caregivers of adult palliative care patients. Int J Palliat Nurs 2022; 28:80-99. [PMID: 35446673 DOI: 10.12968/ijpn.2022.28.2.80] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND A primary caregiver shares the illness experience of the patient and undertakes vital care work, alongside managing the patient's emotions, and is actively involved in care process without being paid. When faced with the palliative care patient's needs, caregivers are affected on multiple levels (physical, psychological and socio-economic), thereby experiencing a moderate or severe burden of care. AIM To identify assessment instruments for the burden of care for family caregivers that are suitable to be used in clinical practice. METHOD A narrative review was conducted using an electronic search in Pubmed, PsychINFO, CINAHL of articles published in English between 2009-2019, using the search terms: 'caregiver/family, caregiver/carer and burden and palliative care/hospice/end of life'. An assessment grid was developed to appraise the clinical use of identified instruments. RESULTS Of the 568 articles identified, 40 quantitative studies were selected using 31 instruments to measure the caregiver burden of cancer, noncancer and terminally ill patients. Most instruments 23 (74.11%) evaluate the psycho-emotional and, 22 (70.96%) the social domain, 12 instruments (38.7%) focused on the physical domain, three (9.67%) on the spiritual field and six instruments (19.35%) on economic aspects. For the multidimensional instruments, the assessment grid scored highest for the Burden Scale for Family Caregiver (BSFC). CONCLUSION The BSFC is the tool that seems to meet the most requirements, being potentially the most useful tool in clinical practice.
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Affiliation(s)
- Rodica Sorina Pop
- Assistant Professor, Department of Family Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Faculty of Medicine, Cluj-Napoca, Romania
| | - Sheila Payne
- Professor, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Diana Tint
- Professor, Transilvania University, Faculty of Medicine, Brasov, Romania
| | | | - Daniela Mosoiu
- Associate Professor, Transilvania University, Faculty of Medicine, Brasov, Romania
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Hill AM, Moorin R, Slatyer S, Bryant C, Hill K, Waldron N, Aoun S, Kamdar A, Grealish L, Reberger C, Jones C, Bronson M, Bulsara MK, Maher S, Claverie T, Moyle W. Evaluating the provision of Further Enabling Care at Home (FECH+) for informal caregivers of older adults discharged home from hospital: protocol for a multicentre randomised controlled trial. BMJ Open 2021; 11:e046600. [PMID: 34155075 PMCID: PMC8217916 DOI: 10.1136/bmjopen-2020-046600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION There are personal and societal benefits from caregiving; however, caregiving can jeopardise caregivers' health. The Further Enabling Care at Home (FECH+) programme provides structured nurse support, through telephone outreach, to informal caregivers of older adults following discharge from acute hospital care to home. The trial aims to evaluate the efficacy of the FECH+ programme on caregivers' health-related quality of life (HRQOL) after care recipients' hospital discharge. METHODS AND ANALYSIS A multisite, parallel-group, randomised controlled trial with blinded baseline and outcome assessment and intention-to-treat analysis, adhering to Consolidated Standards of Reporting Trials guidelines will be conducted. Participants (N=925 dyads) comprising informal home caregiver (18 years or older) and care recipient (70 years or older) will be recruited when the care recipient is discharged from hospital. Caregivers of patients discharged from wards in three hospitals in Australia (one in Western Australia and two in Queensland) are eligible for inclusion. Participants will be randomly assigned to one of the two groups. The intervention group receive the FECH+ programme, which provides structured support and problem-solving for the caregiver after the care recipient's discharge, in addition to usual care. The control group receives usual care. The programme is delivered by a registered nurse and comprises six 30-45 min telephone support sessions over 6 months. The primary outcome is caregivers' HRQOL measured using the Assessment of Quality of Life-eight dimensions. Secondary outcomes include caregiver preparedness, strain and distress and use of healthcare services. Changes in HRQOL between groups will be compared using a mixed regression model that accounts for the correlation between repeated measurements. ETHICS AND DISSEMINATION Participants will provide written informed consent. Ethics approvals have been obtained from Sir Charles Gairdner and Osborne Park Health Care Group, Curtin University, Griffith University, Gold Coast Health Service and government health data linkage services. Findings will be disseminated through presentations, peer-reviewed journals and conferences. TRIAL REGISTRATION NUMBER ACTRN12620000060943.
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Affiliation(s)
- Anne-Marie Hill
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
| | - Rachael Moorin
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Susan Slatyer
- Discipline of School of Nursing, Murdoch University, Murdoch, Western Australia, Australia
| | - Christina Bryant
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Keith Hill
- Rehabilitation Ageing and Independent Living (RAIL) Research Centre, Monash University, Melbourne, Victoria, Australia
| | | | - Samar Aoun
- School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
- Perron Institute for Neurological and Translational Science, Perth, Western Australia, Australia
| | - Ami Kamdar
- Department of General Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Laurie Grealish
- Gold Coast Hospital and Health Services, Gold Coast, Queensland, Australia
- School of Nursing and Midwifery Nathan and Gold Coast, Griffith University, Brisbane, Queensland, Australia
| | - Caroline Reberger
- Department of Rehabilitation and Aged Care, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Cindy Jones
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Mary Bronson
- Medical Division, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Max K Bulsara
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Sean Maher
- Department of Rehabilitation and Aged Care, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Tracey Claverie
- Gold Coast Hospital and Health Services, Gold Coast, Queensland, Australia
| | - Wendy Moyle
- School of Nursing and Midwifery Nathan and Gold Coast, Griffith University, Brisbane, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
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15
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Thompkins JD, Needle J, Baker JN, Briggs L, Cheng YI, Wang J, Friebert S, Lyon ME. Pediatric Advance Care Planning and Families' Positive Caregiving Appraisals: An RCT. Pediatrics 2021; 147:peds.2020-029330. [PMID: 33958436 PMCID: PMC8442842 DOI: 10.1542/peds.2020-029330] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/06/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Little is known about how families respond to pediatric advance care planning. Physicians are concerned that initiating pediatric advance care planning conversations with families is too distressing for families. We examined the effect of family centered pediatric advance care planning intervention for teens with cancer (FACE-TC) advance care planning on families' appraisals of their caregiving, distress, and strain. METHODS In a randomized clinical trial with adolescents with cancer and their families conducted from July 2016 to April 2019 in 4 tertiary pediatric hospitals, adolescents and family dyads were randomly assigned at a 2:1 intervention/control ratio to either the 3 weekly sessions of FACE-TC (Advance Care Planning Survey; Next Steps: Respecting Choices; Five Wishes) or treatment-as-usual. Only the family member was included in this study. Generalized estimating equations assessed the intervention effect measured by Family Appraisal of Caregiving Questionnaire. RESULTS Families' (n = 126) mean age was 46 years; 83% were female, and 82% were white. FACE-TC families significantly increased positive caregiving appraisals at 3-months postintervention, compared with those in the control group (β = .35; 95% confidence interval [CI] 0.19 to 0.36; P = .03). No significant differences were found between groups for strain (β = -.14; 95% CI = -0.42 to 0.15; P = .35) or distress (β = -.01; CI = -0.35 to 0.32; P = .93). CONCLUSIONS Families benefited from participation in FACE-TC, which resulted in positive appraisals of their caregiving for their child with cancer, while not significantly burdening them with distress or strain. Clinicians can be assured of the tolerability of this family-supported model.
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Affiliation(s)
| | - Jennifer Needle
- Department of Pediatrics, Medical School and,Center for Bioethics, University of Minnesota,
Minneapolis, Minnesota
| | | | - Linda Briggs
- Respecting Choices, Coalition to Transform Advanced
Care Innovations, Washington, DC
| | | | - Jichuan Wang
- Division of Biostatistics and Study Methodology and
Children’s National Research Institute, Washington, DC
| | - Sarah Friebert
- Haslinger Family Pediatric Palliative Care Center
and,Rebecca D. Considine Research Institute, Akron
Children’s Hospital, Akron, Ohio
| | - Maureen E. Lyon
- Center for Translational Research and,Department of Pediatrics, School of Medicine and
Health Sciences, George Washington University, Washington, DC; and,Division of Adolescent and Young Adult Medicine,
Children’s National Hospital, Washington, DC
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16
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Lee J, Cagle JG. Measures of financial burden for families dealing with serious illness: A systematic review and analysis. Palliat Med 2021; 35:280-294. [PMID: 33274681 DOI: 10.1177/0269216320973161] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Many families coping with serious illness report experiencing financial burden, which negatively impacts coping and quality of life. Financial burden, however, is a complex construct that has been inconsistently operationalized in the literature. AIM To review the available literature to identify, and describe the properties of, measurement tools or scales used to assess financial burden, including financial stress and strain, for families dealing with serious illness. DESIGN A systematic review. DATA SOURCES Six databases were searched for articles published between 2006 and 2020. The review included studies in English, that reported empirical data, and used at least one measure of financial burden. To obtain a full copy of measures, an environmental scan was conducted. RESULTS A total of 31 measures were included. Only five of the total were designed for patient self-report, 23 of the total were designed for caregiver report. Whereas 11 measures relied on a single-item, 17 were multi-item. The remaining measures provided no information about target population and items. The most popular measures-based on Google Scholar citations-tended to only include one financial burden item. Given the complexity of financial burden, and its subjective and objective aspects, the utility of these single item measures remains questionable. Also, although patients may experience financial burden, there is a lack of patient-reported measures. CONCLUSION To measure financial burden, we identified a need to develop and test multi-item measures, measures appropriate for patient populations and greater attention to the temporal aspects of self-report assessments.
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Affiliation(s)
- Joonyup Lee
- School of Social Work, University of Maryland, Baltimore, MD, USA
| | - John G Cagle
- School of Social Work, University of Maryland, Baltimore, MD, USA
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17
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de Nooijer K, Pivodic L, Van Den Noortgate N, Pype P, Van den Block L. Timely short-term specialised palliative care service intervention for frail older people and their family carers in primary care: study protocol for a pilot randomised controlled trial. BMJ Open 2021; 11:e043663. [PMID: 33472789 PMCID: PMC8483035 DOI: 10.1136/bmjopen-2020-043663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION There is limited evidence regarding the effectiveness of timely integration of short-term specialised palliative care services for older people in primary care. Using a Theory of Change approach, we developed such an intervention, the Frailty+ intervention. We present the protocol of a pilot randomised controlled trial (RCT) with a process evaluation that aims to assess the feasibility and preliminary effectiveness of the Frailty+ intervention. METHODS AND ANALYSIS We will conduct a pilot RCT in Flanders, Belgium. Frail older people who are discharged to home from hospital will be identified and recruited. Seventy-six will be randomly assigned either to the control group (standard care) or the intervention group (Frailty+ intervention alongside standard care). Data will be collected from patients and family carers. At the core of the Frailty+ intervention is the provision of timely short-term specialised palliative care facilitated by a nurse from the specialised palliative home care service over a period of 8 weeks. We will assess feasibility in terms of recruitment, randomisation, acceptability of the intervention, retention in the programme and data completion. The primary outcome for assessing preliminary effectiveness is a mean score across five key symptoms that are amenable to change (ie, breathlessness, pain, anxiety, constipation, fatigue), measured at baseline and 8 weeks post-baseline. The process evaluation will be conducted in the intervention group only, with measurements at 8-11 weeks post-baseline to evaluate implementation, mechanisms of change and contextual factors. ETHICS AND DISSEMINATION The study has been approved by the ethics committee of University Hospital Ghent. Results will be used to inform the design of a full-scale RCT and will be published in a peer-reviewed, open access journal. TRIAL REGISTRATION NUMBER ISRCTN39282347; Pre-results.
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Affiliation(s)
- Kim de Nooijer
- End-of-Life Care Research Group, Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel, Brussels, Belgium
| | - Lara Pivodic
- End-of-Life Care Research Group, Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel, Brussels, Belgium
| | - Nele Van Den Noortgate
- End-of-Life Care Research Group, Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Geriatric Medicine, University Hospital Ghent, Ghent, Belgium
| | - Peter Pype
- End-of-Life Care Research Group, Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Lieve Van den Block
- End-of-Life Care Research Group, Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Clinical Sciences, Vrije Universiteit Brussel, Brussels, Belgium
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18
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Patchwood E, Woodward-Nutt K, Rhodes SA, Batistatou E, Camacho E, Knowles S, Darley S, Grande G, Ewing G, Bowen A. Organising Support for Carers of Stroke Survivors (OSCARSS): a cluster randomised controlled trial with economic evaluation. BMJ Open 2021; 11:e038777. [PMID: 33436463 PMCID: PMC7805348 DOI: 10.1136/bmjopen-2020-038777] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 12/10/2020] [Accepted: 12/14/2020] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE Investigated clinical effectiveness and cost-effectiveness of a person-centred intervention for informal carers/caregivers of stroke survivors. DESIGN Pragmatic cluster randomised controlled trial (cRCT) with economic and process evaluation. SETTING Clusters were services, from a UK voluntary sector specialist provider, delivering support primarily in the homes of stroke survivors and informal carers. PARTICIPANTS Adult carers in participating clusters were referred to the study by cluster staff following initial support contact. INTERVENTIONS Intervention was the Carer Support Needs Assessment Tool for Stroke: a staff-facilitated, carer-led approach to help identify, prioritise and address the specific support needs of carers. It required at least one face-to-face support contact dedicated to carers, with reviews as required. Control was usual care, which included carer support (unstructured and variable). OUTCOME MEASURES Participants provided study entry and self-reported outcome data by postal questionnaires, 3 and 6 months after first contact by cluster staff. PRIMARY OUTCOME 3-month caregiver strain (Family Appraisal of Caregiving Questionnaire, FACQ). SECONDARY OUTCOMES FACQ subscales of caregiver distress and positive appraisals of caregiving, mood (Hospital Anxiety and Depression Scale) and satisfaction with stroke services (Pound). The economic evaluation included self-reported healthcare utilisation, intervention costs and EQ-5D-5L. RANDOMISATION AND MASKING Clusters were recruited before randomisation to intervention or control, with stratification for size of service. Cluster staff could not be masked as training was required for participation. Carer research participants provided self-reported outcome data unaware of allocation; they consented to follow-up data collection only. RESULTS Between 1 February 2017 and 31 July 2018, 35 randomised clusters (18 intervention; 17 control) recruited 414 cRCT carers (208 intervention; 206 control). Study entry characteristics were well balanced. PRIMARY OUTCOME MEASURE intention-to-treat analysis for 84% retained participants (175 intervention; 174 control) found mean (SD) FACQ carer strain at 3 months to be 3.11 (0.87) in the control group compared with 3.03 (0.90) in the intervention group, adjusted mean difference of -0.04 (95% CI -0.20 to 0.13). Secondary outcomes had similarly small differences and tight CIs. Sensitivity analyses suggested robust findings. Intervention fidelity was not achieved. Intervention-related group costs were marginally higher with no additional health benefit observed on EQ-5D-5L. No adverse events were related to the intervention. CONCLUSIONS The intervention was not fully implemented in this pragmatic trial. As delivered, it conferred no clinical benefits and is unlikely to be cost-effective compared with usual care from a stroke specialist provider organisation. It remains unclear how best to support carers of stroke survivors. To overcome the implementation challenges of person-centred care in carers' research and service development, staff training and organisational support would need to be enhanced. TRIAL REGISTRATION NUMBER ISRCTN58414120.
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Affiliation(s)
- Emma Patchwood
- Division of Neuroscience and Experimental Psychology, The University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care Greater Manchester (NIHR CLAHRC GM), Manchester, UK
| | - Kate Woodward-Nutt
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care Greater Manchester (NIHR CLAHRC GM), Manchester, UK
| | - Sarah A Rhodes
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care Greater Manchester (NIHR CLAHRC GM), Manchester, UK
- Centre for Biostatistics, Division of Population Health, Health Services Research & Primary Care, The University of Manchester, Manchester, UK
| | - Evridiki Batistatou
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care Greater Manchester (NIHR CLAHRC GM), Manchester, UK
- Centre for Biostatistics, Division of Population Health, Health Services Research & Primary Care, The University of Manchester, Manchester, UK
| | - Elizabeth Camacho
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, The University of Manchester, Manchester, UK
| | - Sarah Knowles
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care Greater Manchester (NIHR CLAHRC GM), Manchester, UK
- Alliance Manchester Business School, The University of Manchester, Manchester, UK
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Sarah Darley
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care Greater Manchester (NIHR CLAHRC GM), Manchester, UK
- Alliance Manchester Business School, The University of Manchester, Manchester, UK
| | - Gunn Grande
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care Greater Manchester (NIHR CLAHRC GM), Manchester, UK
- Division of Nursing Midwifery and Social Work, School of Health Sciences, The University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
| | - Gail Ewing
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care Greater Manchester (NIHR CLAHRC GM), Manchester, UK
- Centre for Family Research, University of Cambridge, Cambridge, UK
| | - Audrey Bowen
- Division of Neuroscience and Experimental Psychology, The University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care Greater Manchester (NIHR CLAHRC GM), Manchester, UK
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19
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Gill FJ, Hashem Z, Stegmann R, Aoun SM. The support needs of parent caregivers of children with a life-limiting illness and approaches used to meet their needs: A scoping review. Palliat Med 2021; 35:76-96. [PMID: 33103579 DOI: 10.1177/0269216320967593] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Provision of paediatric palliative care is complex and optimally covers meeting the individual needs of a heterogenous population of children and their parent caregivers throughout a life-limiting illness. It is unclear whether existing approaches comprehensively address parent caregivers' needs. AIM To examine support needs of parents caring for children with life limiting illnesses and identify specific approaches used to identify and address needs. DESIGN A scoping review. DATA SOURCES MEDLINE, EMBASE, PsycINFO, CINAHL and ProQuest Central, were searched for peer reviewed English language full text research published from 2008 to 2019. Study quality appraisal was undertaken. Fourteen quantitative, 18 qualitative and 12 mixed methods studies were synthesised and themed using summative content analysis and mapped to the Parent Supportive Care Needs Framework (PSCNF). RESULTS Themes were communication, choice, information, practical, social, psychological, emotional and physical. Communication and choice were central and additional to domains of the PSCNF. Unmet were needs for supporting siblings, for respite care, out of hours, psychological, home and educational support. Six articles reported using instruments to identify parent carer support needs. CONCLUSION Support needs of parent caregivers of children with life limiting illnesses are substantial and heterogenous. While studies report evidence of burden and distress in parent caregivers, this rarely translates into improvements in practice through the development of interventions. A systematic and regular assessment of individual parent caregiver support needs is required by using instruments appropriate to use in clinical practice to move the focus to palliative care interventions and improved services for parents.
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Affiliation(s)
- Fenella J Gill
- Perth Children's Hospital, Child and Adolescent Health Service, Nedlands, Western Australia, Australia.,School of Nursing, Midwifery and Paramedicine, Faculty Health Sciences, Curtin University, Bentley, Western Australia, Australia
| | - Zahraa Hashem
- School of Nursing, Midwifery and Paramedicine, Faculty Health Sciences, Curtin University, Bentley, Western Australia, Australia
| | - Roswitha Stegmann
- School of Psychology and Public Health, La Trobe University, Victoria, Australia
| | - Samar M Aoun
- School of Psychology and Public Health, La Trobe University, Victoria, Australia.,Perron Institute for Neurological and Translational Science, Western Australia, Australia
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20
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Lund L, Ross L, Petersen MA, Blach A, Rosted E, Bollig G, Juhl GI, Farholt HB, Winther H, Laursen L, Hasse M, Weensgaard S, Guldin MB, Ewing G, Grande G, Groenvold M. Effect of the Carer Support Needs Assessment Tool intervention (CSNAT-I) in the Danish specialised palliative care setting: a stepped-wedge cluster randomised controlled trial. BMJ Support Palliat Care 2020:bmjspcare-2020-002467. [PMID: 33115831 DOI: 10.1136/bmjspcare-2020-002467] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 09/16/2020] [Accepted: 09/21/2020] [Indexed: 11/12/2022]
Abstract
BACKGROUND The Carer Support Needs Assessment Tool intervention (CSNAT-I) has been shown to improve end-of-life care support for informal caregivers. This study investigated the impact of the CSNAT-I on caregivers of patients recently enrolled in specialised palliative care (SPC) at home in Denmark. METHODS A stepped-wedge cluster randomised controlled trial with nine clusters (ie, SPC teams). Outcome measures were collected using caregiver questionnaires at baseline (T0) and 2-week (T1) and 4-week (T2) follow-up. RESULTS A total of 437 caregivers were enrolled (control group, n=255; intervention group, n=182). No intervention effect was found on the primary outcome, caregiver strain at T1 (p=0.1865). However, positive effects were found at T1 and T2 on attention to caregivers' well-being (p<0.0001), quality of information and communication (p<0.0001), amount of information (T1: p=0.0002; T2: p<0.0001), involvement (T1: p=0.0045; T2: p<0.0001), talking about greatest burdens (p<0.0001) and assistance in managing greatest burdens (p<0.0001). The effect sizes of these differences were medium or large and seemed to increase from T1 to T2. At T1, positive effects were found on distress (p=0.0178) and home care responsibility (p=0.0024). No effect was found on the remaining outcomes. CONCLUSION Although no effect was found on caregiver strain, the CSNAT-I showed positive effects on caregiver distress, home care responsibility and key outcomes regarding caregivers' experience of the interaction with healthcare professionals. TRIAL REGISTRATION NUMBER NCT03466580.
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Affiliation(s)
- Line Lund
- Palliative Care Research Unit, Department of Geriatrics and Palliative Medicine GP, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Lone Ross
- Palliative Care Research Unit, Department of Geriatrics and Palliative Medicine GP, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Morten Aagaard Petersen
- Palliative Care Research Unit, Department of Geriatrics and Palliative Medicine GP, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | | | - Elizabeth Rosted
- Department of Oncology and Palliative Care, Zealand University Hospital, Roskilde, Denmark
| | - Georg Bollig
- Palliative Care Team, Medical Department Soenderborg/Toender, South Jutland Hospital, Soenderborg, Denmark
- Medical Research Unit, Institute of Regional Health Research, University of Southern Denmark, Aabenraa, Denmark
| | - Gitte Irene Juhl
- Palliative Care Unit, Department of Oncology and Palliative Care, North Zealand Hospital, Frederikssund, Denmark
| | - Hanne Bollerup Farholt
- Department of Geriatrics and Palliative Medicine GP, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Helen Winther
- Palliative Care Unit, Odense University Hospital, Odense, Denmark
| | - Louise Laursen
- Department of Palliative Care, Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | | | | | - Mai-Britt Guldin
- Palliative Care Team, Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Gail Ewing
- Centre for Family Research, University of Cambridge, Cambridge, UK
| | - Gunn Grande
- School of Health Sciences, University of Manchester, Manchester, UK
| | - Mogens Groenvold
- Palliative Care Research Unit, Department of Geriatrics and Palliative Medicine GP, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Section of Health Services Research, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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21
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McAuliffe L, Ong B, Kinsella G. Mediators of burden and depression in dementia family caregivers: Kinship differences. DEMENTIA 2020; 19:2234-2250. [PMID: 30572713 DOI: 10.1177/1471301218819345] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To investigate kinship differences in the caregiver stress process by developing multiple mediation models for two distinct caregiver subgroups (spouses and adult children of older adults living with dementia). The effect of four potential mediating variables (mastery, self-efficacy, satisfaction with social support, positive caregiving appraisals) on the relationship between perceived burden and depression was evaluated. METHOD Family caregivers of a person living with dementia were recruited through national dementia and carer organisations. Participants completed a paper-based or electronic version of the study survey. A bias-corrected, accelerated bootstrapping method was used to test the effect of the four proposed mediating variables on the relationship between perceived burden and depression in each caregiver subgroup (spouses and adult children). RESULTS Perceived burden was directly and significantly related to depression for both spouse caregivers and adult child caregivers. The mediation models explained approximately 50% of the variance in the burden-to-depression pathway for both caregiver subgroups. Mastery and social support (but not self-efficacy, nor positive caregiving appraisals) were found to individually significantly influence the impact of perceived burden on depression in spouse caregivers. All four proposed mediators failed to reach statistical significance as individual mediators of the burden-to-depression pathway in adult child caregivers. CONCLUSION These findings demonstrate differences in the dementia caregiver experience according to kinship, and that certain mediating variables are more relevant for some subgroups of caregivers than others. Implications for the design of psychosocial interventions are discussed.
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Affiliation(s)
- Linda McAuliffe
- Department of Psychology and Counselling, School of Psychology and Public Health, College of Science, Health & Engineering, La Trobe University, Melbourne, Australia
| | - Ben Ong
- Department of Psychology and Counselling, School of Psychology and Public Health, College of Science, Health & Engineering, La Trobe University, Melbourne, Australia
| | - Glynda Kinsella
- Department of Psychology and Counselling, School of Psychology and Public Health, College of Science, Health & Engineering, La Trobe University, Melbourne, Australia
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22
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Aoun SM, Gill FJ, Phillips MB, Momber S, Cuddeford L, Deleuil R, Stegmann R, Howting D, Lyon ME. The profile and support needs of parents in paediatric palliative care: comparing cancer and non-cancer groups. Palliat Care Soc Pract 2020; 14:2632352420958000. [PMID: 33033802 PMCID: PMC7525220 DOI: 10.1177/2632352420958000] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 08/17/2020] [Indexed: 12/05/2022] Open
Abstract
Background: Parents of children with life-limiting illnesses experience considerable
burden and distress, yet few interventions have targeted their
well-being. Objectives: Evaluate the use and feasibility of the Paediatric Carer Support Needs
Assessment Tool (pCSNAT) in assessing and addressing parents’ needs caring
for cancer and non-cancer conditions. Carer well-being outcomes were also
tested. Methods: A non-randomised prospective intervention pilot study. Twenty-eight parents
(out of 42 approached) and 5 health professionals working in paediatric
palliative care services in Western Australia (2018–2019) completed the
pilot study. Results: Two-thirds of eligible parents completed the study. The highest support needs
included having time for yourself; practical help in the home; knowing what
to expect in the future; financial, legal or work issues; and knowing who to
contact if you are concerned. Almost all needs were considerably more
pronounced for the non-cancer group. The pCSNAT seemed feasible and outcomes
demonstrated a tendency to improve. Conclusion: Using the pCSNAT provided a concise and comprehensive ‘one stop shop’ for
health professionals to evaluate difficulties encountered by parents. The
disadvantages reported by the non-cancer group warrant increased attention.
Paediatric palliative care should adopt routine assessment of parents’
support needs to anticipate early and tailored supports including
partnerships with the community.
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Affiliation(s)
- Samar M Aoun
- Professor, Perron Institute for Neurological and Translational Science, 8 Verdun Street, Nedlands, WA 6009, Australia
| | - Fenella J Gill
- Child and Adolescent Health Service, Perth Children's Hospital, Nedlands, WA, Australia; Curtin University, Perth, WA, Australia
| | - Marianne B Phillips
- Child and Adolescent Health Service, Perth Children's Hospital, Nedlands, WA, Australia
| | - Suzanne Momber
- Child and Adolescent Health Service, Perth Children's Hospital, Nedlands, WA, Australia
| | - Lisa Cuddeford
- Child and Adolescent Health Service, Perth Children's Hospital, Nedlands, WA, Australia
| | - Renee Deleuil
- Child and Adolescent Health Service, Perth Children's Hospital, Nedlands, WA, Australia
| | | | - Denise Howting
- La Trobe University, Melbourne, VIC, Australia; Centre for Medical Research, Harry Perkins Institute of Medical Research, The University of Western Australia, Perth, WA, Australia
| | - Maureen E Lyon
- Children's National Hospital, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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23
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Feasibility of e-Pain Reporter: A Digital Pain Management Tool for Informal Caregivers in Home Hospice. J Hosp Palliat Nurs 2020; 21:193-199. [PMID: 31045994 DOI: 10.1097/njh.0000000000000548] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Informal hospice caregivers often have difficulty managing patient pain at home. We developed a digital application, e-Pain Reporter, for informal caregivers to record and providers to monitor patient pain and pain management. The purpose of this study was (1) to assess the feasibility of informal caregivers using the e-Pain Reporter for 9 days in home hospice by investigating recruitment and retention and caregiver satisfaction with and frequency of use of the e-Pain Reporter and (2) describe patient pain characteristics and caregiver's barriers to pain management and self-efficacy in providing patient care in the home. One-group pre-post design was used. Patient-caregiver dyads were recruited from 1 hospice agency. Caregivers were asked to report all patient pain and pain management using the e-Pain Reporter. Feasibility of the e-Pain Reporter was assessed by the average number of times caregivers recorded breakthrough and daily pain and caregiver satisfaction with the app. The 27-item Barriers Questionnaire II and 21-item Caregiver Self-efficacy Scale were administered at baseline. Fourteen dyads enrolled, 2 patients died, and 12 dyads completed the study. Mean number of pain reports over 9 days was 10.5. Caregivers reported high overall satisfaction with the e-Pain Reporter. Barriers scores were moderately high, suggesting erroneous beliefs and misconceptions about pain reporting and use of analgesics, but self-efficacy in managing pain was also high (93% confidence). Findings suggest that the e-Pain Reporter is a feasible method to report and monitor caregiver management of pain at home. Caregiver high barriers and high overconfidence suggest the need for an educational component to the e-Pain Reporter to address misconceptions about pain and pain management.
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24
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Lichtenthal WG, Roberts KE, Catarozoli C, Schofield E, Holland JM, Fogarty JJ, Coats TC, Barakat LP, Baker JN, Brinkman TM, Neimeyer RA, Prigerson HG, Zaider T, Breitbart W, Wiener L. Regret and unfinished business in parents bereaved by cancer: A mixed methods study. Palliat Med 2020; 34:367-377. [PMID: 32020837 PMCID: PMC7438163 DOI: 10.1177/0269216319900301] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Prior research has demonstrated that the presence of regret and unfinished business is associated with poorer adjustment in bereavement. Though there is a growing literature on these constructs among caregivers of adult patients, the literature on regret and unfinished business in bereaved parents has been limited. AIM The aim of this study was to examine regret and unfinished business in parents bereaved by cancer, as well as their associations with caregiving experiences and prolonged grief. DESIGN This was a cross-sectional mixed methods study that utilized self-report questionnaires with open-ended items. SETTING/PARTICIPANTS The multisite study took place at a tertiary cancer hospital and pediatric cancer clinical research institution. Participants were 118 parents (mothers = 82, fathers = 36) who lost a child aged 6 months to 25 years to cancer between 6 months and 6 years prior. RESULTS Results showed that 73% of the parents endorsed regret and 33% endorsed unfinished business, both of which were more common among mothers than fathers (p ⩽ 0.05). Parents were on average moderately distressed by their regrets and unfinished business, and both regret-related and unfinished business-related distress were associated with distress while caregiving and prolonged grief symptoms. CONCLUSION Findings have implications for how providers work with families, including increasing treatment decision-making support, supporting parents in speaking to their child about illness, and, in bereavement, validating choices made. Grief interventions that use cognitive-behavioral and meaning-centered approaches may be particularly beneficial.
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Affiliation(s)
- Wendy G Lichtenthal
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Weill Cornell Medicine, New York, NY, USA
| | - Kailey E Roberts
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Elizabeth Schofield
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Justin J Fogarty
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Taylor C Coats
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | | | | | | | - Talia Zaider
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Weill Cornell Medicine, New York, NY, USA
| | - William Breitbart
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Weill Cornell Medicine, New York, NY, USA
| | - Lori Wiener
- Pediatric Oncology Branch, National Cancer Institute, Bethesda, MD, USA
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25
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Collins A, Burchell J, Remedios C, Thomas K. Describing the psychosocial profile and unmet support needs of parents caring for a child with a life-limiting condition: A cross-sectional study of caregiver-reported outcomes. Palliat Med 2020; 34:358-366. [PMID: 32103697 DOI: 10.1177/0269216319892825] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is a lack of studies examining the prevalence and severity of psychosocial distress in parents caring for a child with life-limiting condition. More research is also needed to better understand the experience, support needs and quality-of-life of this population. AIM To describe the experience and support needs of caring for children with life-limiting conditions and examine the level of distress and quality-of-life experienced by parents. DESIGN Cross-sectional, prospective, quantitative study guided by an advisory group. Participants completed a survey that included demographics and self-report outcome measures of unmet support needs, appraisal of caregiving, psychological distress and quality-of-life. Bivariate correlation analyses were performed to examine for associations between measures. SETTING/PARTICIPANTS Parents currently caring for one or more children (⩽18 years) with a life-limiting condition and registered with a paediatric palliative care service (Australia). RESULTS In total, 143 parents (88% female) completed the questionnaire (36% RR). Compared with population norms, participants reported low quality-of-life, high carer burden and high psychological distress. Almost half (47%) of the sample met the criteria for one or more diagnoses of clinically elevated stress, anxiety or depression. There were significant associations between the psychosocial outcome variables; carer strain and depression had the strongest correlations with quality-of-life (r = -.63, p < .001, for both). Participants also reported multiple unmet needs related to emotional and practical support. CONCLUSIONS This study contributes to the growing body of evidence on paediatric palliative care, specifically that parents caring for a child with a life-limiting condition report high levels of distress and burden, low quality-of-life and need more emotional and practical support targeted at their unmet needs. Paediatric palliative care services should routinely assess parent mental health and provide appropriate support.
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Affiliation(s)
- Anna Collins
- Department of Medicine, St Vincent's Hospital, The University of Melbourne, Melbourne, VIC, Australia
| | - Jodie Burchell
- Department of Medicine, St Vincent's Hospital, The University of Melbourne, Melbourne, VIC, Australia
| | | | - Kristina Thomas
- Centre for Palliative Care, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
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26
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Slatyer S, Aoun SM, Hill KD, Walsh D, Whitty D, Toye C. Caregivers' experiences of a home support program after the hospital discharge of an older family member: a qualitative analysis. BMC Health Serv Res 2019; 19:220. [PMID: 30971236 PMCID: PMC6458630 DOI: 10.1186/s12913-019-4042-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Accepted: 03/25/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The ageing global population has seen increasing numbers of older people living with chronic health problems, declining function, and frailty. As older people seek to live out their years at home, family members, friends and neighbours (informal caregivers) are increasingly relied upon for support. Moreover, pressured health systems and shorter hospital length of stay mean that informal caregivers can find themselves supporting the older person who is still unwell after discharge. The Further Enabling Care at Home (FECH) program was developed as a nursing outreach intervention designed to systematically address support needs of family caregivers of older people after hospital discharge to sustain their home-based caregiving. The objective of this study was to explore the experiences of informal caregivers who participated in the FECH program after an older family member's discharge from hospital. METHODS The study employed a qualitative descriptive design. Caregivers of older people discharged home from a Medical Assessment Unit in an Australian hospital who were included in the program were interviewed to explore their experiences and perceptions of the FECH program. Data were audio-recorded, transcribed, and subjected to thematic analysis. RESULTS Twenty-one family caregivers (81% female, aged 25-89 years) participated in the interviews. Themes emerging were 'The experience of caregiving'; 'The experience of receiving FECH program support'; and 'Caregivers' suggestions for improvement'. Caregivers indicated that reflective discussions with the FECH nurse enabled them to recognise the complexity of the caregiving role and determine aspects where they needed support. Caregivers valued guidance from the FECH nurse in accessing information and resources, which helped them to feel more connected to support, more prepared to care for the older person and themselves, and more secure in the caregiving role. CONCLUSIONS Caregivers' experiences indicated that the structured reflective FECH discussions prompted thought and provided guidance in navigating health and care systems. The FECH program appears to offer a means to address the practical, physical and psychosocial needs of informal caregivers as partners in person-centred health and social care. TRIAL REGISTRATION ANZCTR Trial ID: ACTRN126140011746773 .
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Affiliation(s)
- Susan Slatyer
- Discipline of Nursing, College of Science, Health, Engineering and Education, Murdoch University, Murdoch, Western Australia, 6150, Australia. .,School of Nursing, Midwifery and Paramedicine, Curtin University , GPO Box U1987, Perth, Western Australia, 6845, Australia. .,Centre for Nursing Research, Sir Charles Gairdner Hospital , Hospital Avenue, Nedlands, Western Australia, 6009, Australia.
| | - Samar M Aoun
- School of Psychology & Public Health, La Trobe University, Boondoora, 3086, Victoria, Australia.,Perron Institute for Neurological and Translational Science, Verdun Street, Nedlands, Western Australia, 6009, Australia
| | - Keith D Hill
- Faculty of Health Sciences, Curtin University , GPO Box U1987, Perth, 6845, Western Australia, Australia
| | - Debbie Walsh
- Medical Division, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, Western Australia, 6009, Australia
| | - Dee Whitty
- Medical Division, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, Western Australia, 6009, Australia
| | - Christine Toye
- School of Nursing, Midwifery and Paramedicine, Curtin University , GPO Box U1987, Perth, Western Australia, 6845, Australia.,Centre for Nursing Research, Sir Charles Gairdner Hospital , Hospital Avenue, Nedlands, Western Australia, 6009, Australia
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27
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The cost-effectiveness of a telephone-based intervention to support caregivers of older people discharged from hospital. BMC Geriatr 2019; 19:68. [PMID: 30832575 PMCID: PMC6399869 DOI: 10.1186/s12877-019-1085-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 02/25/2019] [Indexed: 11/10/2022] Open
Abstract
Background A telephone intervention for caregivers of older people discharged from hospital was shown to improve preparedness to care, reduce caregiver strain and caregiver distress. No cost-effectiveness analysis has been published on this, or similar interventions. The study aims addressed here were to examine whether positive outcomes for caregivers resulting from the Further Enabling Care at Home (FECH) program changed the use and costs of health services by patients; and to assess cost-effectiveness. Methods A single-blind randomised controlled trial compared FECH to usual care. FECH involved a specially trained nurse addressing support needs of caregivers of older patients discharged from hospital. A minimum clinically important difference in preparedness to care was defined as an increase in Preparedness for Caregiving scale score of ≥ two points from baseline. Designated data collection was at: Time 1, within four days of discharge; Time 2, 15–21 days post-discharge; and Time 3, six weeks post-discharge. A last observation carried forward approach to loss to follow-up was used, with a sensitivity analysis including only those who completed all time points. Patient use of hospital, emergency department (ED) and ambulance services were captured for 12 weeks post-discharge using administrative data. Costs included nurse time supporting caregivers, resources used by the nurse, and time taken training the nurse to deliver FECH. Cost-effectiveness was assessed using decision trees for preparedness for caregiving. Results Sixty-two intervention dyads and 79 controls provided complete data. A significantly greater proportion of intervention group caregivers reported improved preparedness to care to Time 2 (36.4% v 20.9%, p = 0.029), though this was not sustained to Time 3. The intervention cost $AUD268.28 above usual care per caregiver. No significant differences were observed in health service use between groups. The incremental cost-effectiveness ratio for each additional caregiver reporting improved preparedness to care at Time 2 was $AUD1,730.84. Conclusions To our knowledge this is the first work to calculate the cost-effectiveness of a telephone-delivered intervention designed to support caregivers of older people post-discharge, and will support decision-making regarding implementation. Further research should examine different settings, and assess impacts on health service use with larger samples and a longer follow-up. Trial registration Australian and New Zealand Clinical Trial Registry: ACTRN12614001174673. Registered 07/11/2014.
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28
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Janssen DJ, Boyne J, Currow DC, Schols JM, Johnson MJ, La Rocca HPB. Timely recognition of palliative care needs of patients with advanced chronic heart failure: a pilot study of a Dutch translation of the Needs Assessment Tool: Progressive Disease - Heart Failure (NAT:PD-HF). Eur J Cardiovasc Nurs 2019; 18:375-388. [PMID: 30760021 DOI: 10.1177/1474515119831510] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The Needs Assessment Tool: Progressive Disease - Heart Failure (NAT:PD-HF) was developed to identify and triage palliative care needs in patients with chronic heart failure. A Dutch version is currently lacking. AIMS The aim of this study was to investigate the feasibility and acceptability of a Dutch NAT:PD-HF in chronic heart failure outpatients; and to gain preliminary data regarding the effect of the NAT:PD-HF on palliative care referral, symptoms, health status, care dependency, caregiver burden and advance directives. METHODS A mixed methods study including 23 outpatients with advanced chronic heart failure and 20 family caregivers was performed. Nurses conducted patient consultations using a Dutch translation of the NAT:PD-HF and rated acceptability. Before this visit and 4 months later, symptoms, health status, performance status, care dependency, caregiver burden and recorded advance directives were assessed. A focus group with participating nurses discussed barriers and facilitators towards palliative care needs assessment. RESULTS Acceptability was rated as 7 (interquartile range 6-7 points) on a 10-point scale. All patients had palliative care needs. In 48% actions were taken, including two patients referred to palliative care. Symptoms, performance status, care dependency, caregiver burden and advance directives were unchanged at 4 months, while health status deteriorated in patients completing follow-up ( n=17). Barriers towards palliative care needs assessment included feeling uncomfortable to initiate discussions and concerns about the ability to address palliative care needs. CONCLUSIONS The NAT:PD-HF identified palliative care needs in all participants, and triggered action to address these in half. However, training in palliative care communication skills as well as palliative care interventions should accompany the introduction of a palliative care needs assessment tool. NETHERLANDS NATIONAL TRIAL REGISTER (NTR) 5616. http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5616.
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Affiliation(s)
- Daisy Ja Janssen
- 1 Department of Research and Education, CIRO, The Netherlands.,2 Centre of Expertise for Palliative Care, Maastricht University Medical Centre (MUMC+), The Netherlands
| | - Josiane Boyne
- 3 Department of Patient and Care, Maastricht University Medical Centre (MUMC+), The Netherlands
| | - David C Currow
- 4 IMPACCT, Faculty of Health, University of Technology Sydney, Australia
| | - Jos Mga Schols
- 5 Department of Health Services Research and Department of Family Medicine, Maastricht University, The Netherlands
| | - Miriam J Johnson
- 6 Wolfson Palliative Care Research Centre, University of Hull, UK
| | - H-P Brunner- La Rocca
- 7 Department of Cardiology, Maastricht University Medical Centre (MUMC+), The Netherlands
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29
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Patchwood E, Rothwell K, Rhodes S, Batistatou E, Woodward-Nutt K, Lau YS, Grande G, Ewing G, Bowen A. Organising Support for Carers of Stroke Survivors (OSCARSS): study protocol for a cluster randomised controlled trial, including health economic analysis. Trials 2019; 20:19. [PMID: 30616692 PMCID: PMC6323775 DOI: 10.1186/s13063-018-3104-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 12/04/2018] [Indexed: 11/10/2022] Open
Abstract
Background Stroke often results in chronic disability, with partners and family members taking on the role of informal caregiver. There is considerable uncertainty regarding how best to identify and address carers’ needs. The Carer Support Needs Assessment Tool (CSNAT) is a carer-led approach to individualised assessment and support for caregiving that may be beneficial in palliative care contexts. CSNAT includes an implementation toolkit. Through collaboration, including with service users, we adapted CSNAT for stroke and for use in a UK stroke specialist organisation providing long-term support. The main aims of OSCARSS are to investigate the clinical and cost-effectiveness of CSNAT-Stroke relative to current practice. This paper focuses on the trial protocol, with the embedded process evaluation reported separately. Methods Longitudinal, multi-site, pragmatic, cluster randomised controlled trial with a health economic analysis. Clusters are UK services randomised to CSNAT-Stroke intervention or usual care, stratified by size of service. Eligible carer participants are: adults aged > 18 years; able to communicate in English; referred to participating clusters; and seen face-to-face at least once by the provider, for support. The ‘date seen’ for initial support denotes the start of intervention (or control) and carers are referred to the research team after this for study recruitment. Primary outcome is caregiver strain (FACQ - Strain) at three months after ‘date seen’. Secondary outcomes include: caregiver distress; positive caregiving appraisals (both FACQ subscales); Pound Carer Satisfaction with Services; mood (HADs); and health (EQ-5D5L) at three months. All outcomes are followed up at six months. Health economic analyses will use additional data on caregiver health service utilisation and informal care provision. Discussion OSCARSS is open to recruitment at the time of article submission. Study findings will allow us to evaluate the clinical and cost-effectiveness of the CSNAT-Stroke intervention, directed at improving outcomes for informal carers of stroke survivors. Trial findings will be interpreted in the context of our embedded process evaluation including qualitative interviews with those who received and provided services as well as data on treatment fidelity. OSCARSS will contribute to knowledge of the unmet needs of informal stroke caregivers and inform future stroke service development. Trial registration ISRCTN Registry, ISRCTN58414120. Registered on 26 July 2016. Electronic supplementary material The online version of this article (10.1186/s13063-018-3104-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Emma Patchwood
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care Greater Manchester (CLAHRC GM), Salford Royal Foundation NHS Trust, Salford, UK. .,Division of Neuroscience and Experimental Psychology, School of Biological Sciences, University of Manchester, Manchester Academic Helath Sciences Centre (MAHSC), Manchester, UK.
| | - Katy Rothwell
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care Greater Manchester (CLAHRC GM), Salford Royal Foundation NHS Trust, Salford, UK
| | - Sarah Rhodes
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care Greater Manchester (CLAHRC GM), Salford Royal Foundation NHS Trust, Salford, UK.,Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
| | - Evridiki Batistatou
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care Greater Manchester (CLAHRC GM), Salford Royal Foundation NHS Trust, Salford, UK.,Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
| | - Kate Woodward-Nutt
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care Greater Manchester (CLAHRC GM), Salford Royal Foundation NHS Trust, Salford, UK
| | - Yiu-Shing Lau
- Centre for Health Economics, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, UK
| | - Gunn Grande
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care Greater Manchester (CLAHRC GM), Salford Royal Foundation NHS Trust, Salford, UK.,Division of Nursing, Midwifery & Social Work, School of Health Sciences, University of Manchester, MAHSC, Manchester, UK
| | - Gail Ewing
- Centre for Family Research, University of Cambridge, Cambridge, UK
| | - Audrey Bowen
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care Greater Manchester (CLAHRC GM), Salford Royal Foundation NHS Trust, Salford, UK.,Division of Neuroscience and Experimental Psychology, School of Biological Sciences, University of Manchester, Manchester Academic Helath Sciences Centre (MAHSC), Manchester, UK
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Aoun SM, Ewing G, Grande G, Toye C, Bear N. The Impact of Supporting Family Caregivers Before Bereavement on Outcomes After Bereavement: Adequacy of End-of-Life Support and Achievement of Preferred Place of Death. J Pain Symptom Manage 2018; 55:368-378. [PMID: 29030206 DOI: 10.1016/j.jpainsymman.2017.09.023] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 09/21/2017] [Accepted: 09/21/2017] [Indexed: 11/17/2022]
Abstract
CONTEXT The investigation of the situation of bereaved family caregivers following caregiving during the end-of-life phase of illness has not received enough attention. OBJECTIVES This study investigated the extent to which using the Carer Support Needs Assessment Tool (CSNAT) intervention during the caregiving period has affected bereaved family caregivers' perceptions of adequacy of support, their grief and well-being, and achievement of their preferred place of death. METHOD All family caregivers who participated in a stepped-wedge cluster trial of the CSNAT intervention in Western Australia (2012-2014) and completed the pre-bereavement study (n = 322) were invited to take part in a caregiver survey by telephone four to six months after bereavement (2015). The survey measured the adequacy of end-of-life support, the level of grief, the current physical and mental health, and the achievement of the preferred place of death. RESULTS The response rate was 66% (152, intervention; 60, control). The intervention group perceived that their pre-bereavement support needs had been adequately met to a significantly greater extent than the control group (d = 0.43, P < 0.001) and that patients have achieved their preferred place of death more often according to their caregivers (79.6% vs. 63.6%, P = 0.034). There was also a greater agreement on the preferred place of death between patients and their caregivers in the intervention group (P = 0.02). CONCLUSIONS The results from this study provide evidence that the CSNAT intervention has a positive impact on perceived adequacy of support of bereaved family caregivers and achievement of preferred place of death according to caregivers. The benefits gained by caregivers in being engaged in early and direct assessment of their support needs before bereavement reinforce the need for palliative care services to effectively support caregivers well before the patient's death.
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Affiliation(s)
- Samar M Aoun
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia; Adjunct Professor, LaTrobe University, Melbourne, Victoria, Australia.
| | - Gail Ewing
- Centre for Family Research, University of Cambridge, Cambridge, United Kingdom
| | - Gunn Grande
- Division of Nursing, Midwifery & Social Work, The University of Manchester, Manchester, United Kingdom
| | - Chris Toye
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia; Centre for Nursing Research, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Natasha Bear
- Department of Clinical Research and Education, Child and Adolescent Health Services, Perth, Western Australia, Australia
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Aslakson RA, Dy SM, Wilson RF, Waldfogel J, Zhang A, Isenberg SR, Blair A, Sixon J, Lorenz KA, Robinson KA. Patient- and Caregiver-Reported Assessment Tools for Palliative Care: Summary of the 2017 Agency for Healthcare Research and Quality Technical Brief. J Pain Symptom Manage 2017; 54:961-972.e16. [PMID: 28818633 DOI: 10.1016/j.jpainsymman.2017.04.022] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 04/11/2017] [Accepted: 04/13/2017] [Indexed: 12/21/2022]
Abstract
CONTEXT Assessment tools are data collection instruments that are completed by or with patients or caregivers and which collect data at the individual patient or caregiver level. OBJECTIVES The objectives of this study are to 1) summarize palliative care assessment tools completed by or with patients or caregivers and 2) identify needs for future tool development and evaluation. METHODS We completed 1) a systematic review of systematic reviews; 2) a supplemental search of previous reviews and Web sites, and/or 3) a targeted search for primary articles when no tools existed in a domain. Paired investigators screened search results, assessed risk of bias, and abstracted data. We organized tools by domains from the National Consensus Project Clinical Practice Guidelines for Palliative Care and selected the most relevant, recent, and highest quality systematic review for each domain. RESULTS We included 10 systematic reviews and identified 152 tools (97 from systematic reviews and 55 from supplemental sources). Key gaps included no systematic review for pain and few tools assessing structural, cultural, spiritual, or ethical/legal domains, or patient-reported experience with end-of-life care. Psychometric information was available for many tools, but few studies evaluated responsiveness (sensitivity to change) and no studies compared tools. CONCLUSION Few to no tools address the spiritual, ethical, or cultural domains or patient-reported experience with end-of-life care. While some data exist on psychometric properties of tools, the responsiveness of different tools to change and/or comparisons between tools have not been evaluated. Future research should focus on developing or testing tools that address domains for which few tools exist, evaluating responsiveness, and comparing tools.
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Affiliation(s)
- Rebecca A Aslakson
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland, USA; Department of Oncology, Palliative Care Program, Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland, USA.
| | - Sydney M Dy
- Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Renee F Wilson
- Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Julie Waldfogel
- Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Allen Zhang
- Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Sarina R Isenberg
- Department of Health, Behavior and Society, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Alex Blair
- Department of Surgery, The Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Joshua Sixon
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
| | - Karl A Lorenz
- VA Palo Alto Health Care System, Palo Alto, California; Stanford School of Medicine, Department of Medicine, Palo Alto, California
| | - Karen A Robinson
- Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, Maryland, USA; Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland, USA; Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Mi E, Mi E, Ewing G, Mahadeva R, Gardener AC, Holt Butcher H, Booth S, Farquhar M. Associations between the psychological health of patients and carers in advanced COPD. Int J Chron Obstruct Pulmon Dis 2017; 12:2813-2821. [PMID: 29033562 PMCID: PMC5628689 DOI: 10.2147/copd.s139188] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Objective Anxiety and depression are highly prevalent in patients with COPD and their informal carers, and associated with numerous risk factors. However, few studies have investigated these in primary care or the link between patient and carer anxiety and depression. We aimed to determine this association and factors associated with anxiety and depression in patients, carers, and both (dyads), in a population-based sample. Materials and methods This was a prospective, cross-sectional study of 119 advanced COPD patients and their carers. Patient and carer scores ≥8 on the Hospital Anxiety and Depression Scale defined symptoms of anxiety and depression, χ2 tests determined associations between patient and carer symptoms of anxiety/depression, and χ2 and independent t-tests for normally distributed variables (otherwise Mann–Whitney U tests) were used to identify other variables significantly associated with these symptoms in the patient or carer. Patient–carer dyads were categorized into four groups relating to the presence of anxious/depressive symptoms in: both patient and carer, patient only, carer only, and neither. Factors associated with dyad symptoms of anxiety/depression were determined with χ2 tests and one-way analysis of variance for normally distributed variables (otherwise Kruskal–Wallis tests). Results Prevalence of symptoms of anxiety and depression was 46.4% (n=52) and 42.9% (n=48) in patients, and 46% (n=52) and 23% (n=26) in carers, respectively. Patient and carer symptoms of anxiety/depression were significantly associated. Anxious and depressive symptoms in the patient were also significantly associated with more physical comorbidities, more exacerbations, greater dyspnea, greater fatigue, poor mastery, and depressive symptoms with younger age. Symptoms of carer anxiety were significantly associated with being female and separated/divorced/widowed, and depressive symptoms with younger age, higher educational level, and more physical comorbidities, and symptoms of carer anxiety and depression with more unmet support needs, greater subjective caring burden, and poor patient mastery. Dyad symptoms of anxiety/depression were significantly associated with greater patient fatigue. Conclusion Symptoms of anxiety and depression in COPD patients and carers are significantly associated. Given their high prevalence, considerable impact on mortality, impact on quality of life and health care use, and associations with each other, screening for and addressing patient and carer anxiety and depression in advanced COPD is recommended.
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Affiliation(s)
| | | | - Gail Ewing
- Centre for Family Research, University of Cambridge
| | - Ravi Mahadeva
- Department of Respiratory Medicine, Cambridge University Hospitals NHS Foundation Trust
| | - A Carole Gardener
- Department of Public Health and Primary Care, Institute of Public Health
| | - Hanne Holt Butcher
- Department of Public Health and Primary Care, Institute of Public Health
| | - Sara Booth
- Department of Oncology, University of Cambridge, Cambridge
| | - Morag Farquhar
- School of Health Sciences, University of East Anglia, Norwich, UK
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Pediatric advance care planning (pACP) for teens with cancer and their families: Design of a dyadic, longitudinal RCCT. Contemp Clin Trials 2017; 62:121-129. [PMID: 28844985 DOI: 10.1016/j.cct.2017.08.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 08/21/2017] [Accepted: 08/23/2017] [Indexed: 12/30/2022]
Abstract
Cancer is the leading cause of disease-related death for adolescents and young adults (AYAs) in the United States. Parents of AYAs with life-threatening illnesses have expressed the desire to talk to their children about end of life (EOL) care, yet, like caregivers of adult patients, struggle to initiate this conversation. Building Evidence for Effective Palliative/End of Life Care for Teens with Cancer is a longitudinal, randomized, controlled, single-blinded clinical trial aimed at evaluating the efficacy of FAmily CEntered disease-specific advance care planning (ACP) for teens with cancer (FACE-TC). A total of 130 dyads (260 subjects) composed of AYAs 14-20years old with cancer and their family decision maker (≥18years old) will be recruited from pediatric oncology programs at Akron Children's Hospital and St. Jude Children's Research Hospital. Dyads will be randomized to either the FACE-TC intervention or Treatment as Usual (TAU) control. FACE-TC intervention dyads will complete three 60-minute ACP sessions held at weekly intervals. Follow-up data will be collected at 3, 6, 12, and 18months post-intervention by a blinded research assistant (RA). The effects of FACE-TC on patient-family congruence in treatment preferences, quality of life (QOL), and advance directive completion will be analyzed. FACE-TC is an evidenced-based and patient-centered intervention that considers QOL and EOL care according to the AYA's representation of illness. The family is involved in the ACP process to facilitate shared decision making, increase understanding of the AYA's preferences, and make a commitment to honor the AYA's wishes.
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Cruz J, Marques A, Machado A, O'Hoski S, Goldstein R, Brooks D. Informal caregiving in COPD: A systematic review of instruments and their measurement properties. Respir Med 2017; 128:13-27. [DOI: 10.1016/j.rmed.2017.05.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 05/04/2017] [Accepted: 05/05/2017] [Indexed: 12/20/2022]
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Thienprayoon R, Porter K, Tate M, Ashby M, Meyer M. Risk Stratification for Opioid Misuse in Children, Adolescents, and Young Adults: A Quality Improvement Project. Pediatrics 2017; 139:peds.2016-0258. [PMID: 27980029 DOI: 10.1542/peds.2016-0258] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/30/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The Pediatric Palliative and Comfort Care Team (PACT) at Cincinnati Children's Hospital Medical Center (CCHMC) provides opioids to a large population of patients in the ambulatory setting. Before this project, PACT had no reliable system to risk stratify patients for opioid misuse. METHODS The global aim was safe opioid prescribing by the palliative care team. The specific, measurable, achievable, realistic, and timely aim was as follows: "In patients who present for follow up with PACT, we will use the "opioid bundle" to increase risk stratification for opioid misuse from 0% to 90% over 5 months." The opioid bundle includes a urine drug screen, Ohio Automated Rx Reporting System report, pill count, and screening history for drug abuse and mental health disorders. The setting was multiple CCHMC ambulatory clinics. Participants included all PACT members. RESULTS Since implementing the new system, we have increased risk stratification for opioid misuse among outpatients from 0% to >90%. Results have been sustained for 12 months. Key processes have become reliable: obtaining informed consent and controlled substance agreements for all new patients and obtaining the opioid bundle to enable risk stratification in a consistent and timely fashion. A total of 34% of patients have been stratified as high risk, and an additional 27% have been stratified as moderate risk. CONCLUSIONS A system to ensure safe opioid prescribing practices to all patients is critical for providers. Identifying key processes and executing them reliably has enabled the palliative care team at CCHMC to risk stratify >90% of patients receiving opioids in the ambulatory setting for opioid misuse.
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Affiliation(s)
- Rachel Thienprayoon
- The Pediatric Palliative and Comfort Care Team, Division of Pain, Department of Anesthesiology, .,Cancer and Blood Diseases Institute, Department of Pediatrics, and
| | - Kelly Porter
- The Pediatric Palliative and Comfort Care Team, Division of Pain, Department of Anesthesiology
| | - Michelle Tate
- The Pediatric Palliative and Comfort Care Team, Division of Pain, Department of Anesthesiology
| | - Marshall Ashby
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Mark Meyer
- The Pediatric Palliative and Comfort Care Team, Division of Pain, Department of Anesthesiology
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Nakken N, Janssen DJ, van Vliet M, de Vries GJ, Clappers-Gielen GA, Michels AJ, Muris JW, Vercoulen JH, Wouters EF, Spruit MA. Gender differences in partners of patients with COPD and their perceptions about the patients. Int J Chron Obstruct Pulmon Dis 2016; 12:95-104. [PMID: 28096665 PMCID: PMC5207329 DOI: 10.2147/copd.s118871] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background/objectives Chronic obstructive pulmonary disease (COPD) not only affects patients but also their partners. Gender-related differences in patients with COPD are known, for instance regarding symptoms and quality of life. Yet, research regarding gender differences in partners of patients with COPD has been conducted to a lesser extent, and most research focused on female partners. We aimed to investigate differences between male and female partners of patients with COPD regarding their own characteristics and their perceptions of patients’ characteristics. Design Cross-sectional study. Setting Four hospitals in the Netherlands. Participants One hundred and eighty-eight patient–partner couples were included in this cross-sectional study. Measurements General and clinical characteristics, health status, care dependency, symptoms of anxiety and depression, social support, caregiver burden, and coping styles were assessed during a home visit. Results Female partners had more symptoms of anxiety and a worse health status than male partners. Social support and caregiver burden were comparable, but coping styles differed between male and female partners. Female partners thought that male patients were less care dependent and had more symptoms of depression, while these gender differences did not exist in patients themselves. Conclusion Health care providers should pay attention to the needs of all partners of patients with COPD, but female partners in particular. Obtaining an extensive overview of the patient–partner couple, including coping styles, health status, symptoms of anxiety, and caregiver burden, is necessary to be able to support the couple as effectively as possible.
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Affiliation(s)
| | - Daisy Ja Janssen
- Department of Research and Education, CIRO, Horn; Centre of Expertise for Palliative Care, Maastricht University Medical Centre+ (MUMC+), Maastricht
| | | | | | | | | | - Jean Wm Muris
- Department of Family Medicine, CAPHRI School of Public Health and Primary Care, Maastricht University, Maastricht
| | - Jan H Vercoulen
- Department of Medical Psychology and Department of Pulmonary Diseases, Radboud University Nijmegen Medical Centre, Nijmegen
| | - Emiel Fm Wouters
- Department of Research and Education, CIRO, Horn; Department of Respiratory Medicine, Maastricht University Medical Centre+ (MUMC+), Maastricht, the Netherlands
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Toye C, Parsons R, Slatyer S, Aoun SM, Moorin R, Osseiran-Moisson R, Hill KD. Outcomes for family carers of a nurse-delivered hospital discharge intervention for older people (the Further Enabling Care at Home Program): Single blind randomised controlled trial. Int J Nurs Stud 2016; 64:32-41. [PMID: 27684320 DOI: 10.1016/j.ijnurstu.2016.09.012] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Revised: 09/07/2016] [Accepted: 09/18/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Hospital discharge of older people receiving care at home offers a salient opportunity to identify and address their family caregivers' self-identified support needs. OBJECTIVES This study tested the hypothesis that the extent to which family caregivers of older people discharged home from hospital felt prepared to provide care at home would be positively influenced by their inclusion in the new Further Enabling Care at Home program. DESIGN This single-blind randomised controlled trial compared outcomes from usual care alone with those from usual care plus the new program. The program, delivered by a specially trained nurse over the telephone, included: support to facilitate understanding of the patient's discharge letter; caregiver support needs assessment; caregiver prioritisation of urgent needs; and collaborative guidance, from the nurse, regarding accessing supports. SETTING AND PARTICIPANTS Dyads were recruited from the medical assessment unit of a Western Australian metropolitan public hospital. Each dyad comprised a patient aged 70 years or older plus an English speaking family caregiver. METHODS The primary outcome was the caregiver's self-reported preparedness to provide care for the patient. Data collection time points were designated as: Time 1, within four days of discharge; Time 2, 15-21days after discharge; Time 3, six weeks after discharge. Other measures included caregivers' ratings of: their health, patients' symptoms and independence, caregiver strain, family well-being, caregiver stress, and positive appraisals of caregiving. Data were collected by telephone. RESULTS Complete data sets were obtained from 62 intervention group caregivers and 79 controls. Groups were equivalent at baseline. Needs prioritised most often by caregivers were: to know whom to contact and what to expect in the future and to access practical help at home. Support guidance included how to: access help, information, and resources; develop crisis plans; obtain referrals and services; and organise legal requirements. Compared to controls, preparedness to care improved in the intervention group from Time 1 to Time 2 (effect size=0.52; p=0.006) and from Time 1 to Time 3 (effect size=0.43; p=0.019). These improvements corresponded to a change of approximately 2 points on the Preparedness for Caregiving instrument. Small but significant positive impacts were also observed in other outcomes, including caregiver strain. CONCLUSIONS These unequivocal findings provide a basis for considering the Furthering Enabling Care at Home program's implementation in this and other similar settings. Further testing is required to determine the generalisability of results.
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Affiliation(s)
- Christine Toye
- School of Nursing, Midwifery and Paramedicine, Curtin University, GPO Box U1987, Perth, Western Australia, 6845, Australia; Centre for Nursing Research, Sir Charles Gairdner Hospital, The Harry Perkins Institute of Medical Research, 6 Verdun Street, Nedlands Western Australia, 6009, Australia.
| | - Richard Parsons
- School of Pharmacy, Curtin University, GPO Box U1987 Perth, Western Australia 6845, Australia.
| | - Susan Slatyer
- School of Nursing, Midwifery and Paramedicine, Curtin University, GPO Box U1987, Perth, Western Australia, 6845, Australia; Centre for Nursing Research, Sir Charles Gairdner Hospital, The Harry Perkins Institute of Medical Research, 6 Verdun Street, Nedlands Western Australia, 6009, Australia.
| | - Samar M Aoun
- School of Nursing, Midwifery and Paramedicine, Curtin University, GPO Box U1987, Perth, Western Australia, 6845, Australia.
| | - Rachael Moorin
- School of Public Health, Curtin University, GPO Box U1987 Perth, Western Australia, 6845, Australia.
| | - Rebecca Osseiran-Moisson
- School of Nursing, Midwifery and Paramedicine, Curtin University, GPO Box U1987, Perth, Western Australia, 6845, Australia.
| | - Keith D Hill
- School of Physiotherapy and Exercise Science, Curtin University, GPO Box U1987 Perth, Western Australia 6845, Australia.
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A systematic review of instruments assessing dimensions of distress among caregivers of adult and pediatric cancer patients. Palliat Support Care 2016; 15:110-124. [DOI: 10.1017/s1478951516000079] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
AbstractObjective:Caregivers of cancer patients face intense demands throughout the course of the disease, survivorship, and bereavement. Caregiver burden, needs, satisfaction, quality of life, and other significant areas of caregiving are not monitored regularly in the clinic setting, resulting in a need to address the availability and clinical effectiveness of cancer caregiver distress tools. This review aimed to determine the availability of cancer caregiver instruments, the variation of instruments between different domains of distress, and that between adult and pediatric cancer patient populations.Method:A literature search was conducted using various databases from 1937 to 2013. Original articles on instruments were extracted separately if not included in the original literature search. The instruments were divided into different areas of caregiver distress and into adult versus pediatric populations. Psychometric data were also evaluated.Results:A total of 5,541 articles were reviewed, and 135 articles (2.4%) were accepted based on our inclusion criteria. Some 59 instruments were identified, which fell into the following categories: burden (n = 26, 44%); satisfaction with healthcare delivery (n = 5, 8.5%); needs (n = 14, 23.7%); quality of life (n = 9, 15.3%); and other issues (n = 5, 8.5%). The median number of items was 29 (4–125): 20/59 instruments (33.9%) had ≤20 items; 13 (22%) had ≤20 items and were psychometrically sound, with 12 of these 13 (92.3%) being self-report questionnaires. There were 44 instruments (74.6%) that measured caregiver distress for adult cancer patients and 15 (25.4%) for caregivers of pediatric patients.Significance of results:There is a significant number of cancer caregiver instruments that are self-reported, concise, and psychometrically sound, which makes them attractive for further research into their clinical use, outcomes, and effectiveness.
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Shilling V, Matthews L, Jenkins V, Fallowfield L. Patient-reported outcome measures for cancer caregivers: a systematic review. Qual Life Res 2016; 25:1859-76. [PMID: 26872911 PMCID: PMC4945691 DOI: 10.1007/s11136-016-1239-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2016] [Indexed: 10/28/2022]
Abstract
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.
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Affiliation(s)
- Valerie Shilling
- Sussex Health Outcomes Research and Education in Cancer, Brighton and Sussex Medical School, University of Sussex, Falmer, Brighton, BN1 9QG, UK.
| | - Lucy Matthews
- Sussex Health Outcomes Research and Education in Cancer, Brighton and Sussex Medical School, University of Sussex, Falmer, Brighton, BN1 9QG, UK
| | - Valerie Jenkins
- Sussex Health Outcomes Research and Education in Cancer, Brighton and Sussex Medical School, University of Sussex, Falmer, Brighton, BN1 9QG, UK
| | - Lesley Fallowfield
- Sussex Health Outcomes Research and Education in Cancer, Brighton and Sussex Medical School, University of Sussex, Falmer, Brighton, BN1 9QG, UK
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Michels CTJ, Boulton M, Adams A, Wee B, Peters M. Psychometric properties of carer-reported outcome measures in palliative care: A systematic review. Palliat Med 2016; 30:23-44. [PMID: 26407683 PMCID: PMC4708617 DOI: 10.1177/0269216315601930] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Informal carers face many challenges in caring for patients with palliative care needs. Selecting suitable valid and reliable outcome measures to determine the impact of caring and carers' outcomes is a common problem. AIM To identify outcome measures used for informal carers looking after patients with palliative care needs, and to evaluate the measures' psychometric properties. DESIGN A systematic review was conducted. The studies identified were evaluated by independent reviewers (C.T.J.M., M.B., M.P.). Data regarding study characteristics and psychometric properties of the measures were extracted and evaluated. Good psychometric properties indicate a high-quality measure. DATA SOURCES The search was conducted, unrestricted to publication year, in the following electronic databases: Applied Social Sciences Index and Abstracts, Cumulative Index to Nursing and Allied Health Literature, The Cochrane Library, EMBASE, PubMed, PsycINFO, Social Sciences Citation Index and Sociological Abstracts. RESULTS Our systematic search revealed 4505 potential relevant studies, of which 112 studies met the inclusion criteria using 38 carer measures for informal carers of patients with palliative care needs. Psychometric properties were reported in only 46% (n = 52) of the studies, in relation to 24 measures. Where psychometric data were reported, the focus was mainly on internal consistency (n = 45, 87%), construct validity (n = 27, 52%) and/or reliability (n = 14, 27%). Of these, 24 measures, only four (17%) had been formally validated in informal carers in palliative care. CONCLUSION A broad range of outcome measures have been used for informal carers of patients with palliative care needs. Little formal psychometric testing has been undertaken. Furthermore, development and refinement of measures in this field is required.
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Affiliation(s)
- Charlotte T J Michels
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Mary Boulton
- Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Astrid Adams
- Sir Michael Sobell House, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Bee Wee
- Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK Sir Michael Sobell House, Oxford University Hospitals NHS Trust, Oxford, UK Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Michele Peters
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Aoun SM, Deas K, Howting D, Lee G. Exploring the Support Needs of Family Caregivers of Patients with Brain Cancer Using the CSNAT: A Comparative Study with Other Cancer Groups. PLoS One 2015; 10:e0145106. [PMID: 26679505 PMCID: PMC4682982 DOI: 10.1371/journal.pone.0145106] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 11/29/2015] [Indexed: 11/18/2022] Open
Abstract
A substantial burden is placed on family caregivers of patients diagnosed with brain cancers. Despite this, the support needs of the caregivers are often under-recognised and not addressed adequately in current routine and patient centred clinical care. The Care Support Needs Assessment Tool (CSNAT) is a validated instrument designed to systematically identify and address caregiver needs. It has been trialled in an Australian palliative care community setting using a stepped wedge cluster design involving 322 family carers of terminally ill patients. The current article reports on a subset from this trial, 29 caregivers of patients with primary brain cancer, and compares their profile and outcomes to those of other cancer groups. Caregiver strain was assessed using the Family Appraisal of Caregiving Questionnaire, caregiver physical and mental wellbeing using SF12 and caregiver workload using a questionnaire on support with activities of daily living (ADL). In comparison to caregivers of patients with all other cancers, the primary brain cancer group had significantly higher levels of caregiver strain, lower levels of mental wellbeing and a higher level of ADL workload. Their physical wellness also deteriorated significantly over time. An action plan approach led to practical solutions for addressing highlighted concerns. Four themes evolved from the family caregivers’ feedback interviews: The extremely challenging caregiver experience with brain cancer; the systematic and practical approach of the CSNAT during rapid changes; connection with health professionals, feeling acknowledged and empowered; and timely advice and assurance of support during the caregiving journey. This preliminary study has demonstrated that the CSNAT provides a practical and useful tool for assessing the support needs of family caregivers of patients with brain cancer and has provided the basis for a larger scale, longitudinal study that allows a more detailed characterisation of the evolving caregiver needs at different stages of the disease.
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Affiliation(s)
- Samar M. Aoun
- School of Nursing, Midwifery & Paramedicine, Curtin University, Western Australia, Australia
- * E-mail:
| | - Kathleen Deas
- School of Nursing, Midwifery & Paramedicine, Curtin University, Western Australia, Australia
| | - Denise Howting
- School of Nursing, Midwifery & Paramedicine, Curtin University, Western Australia, Australia
| | - Gabriel Lee
- St John of God Hospital, Subiaco, Western Australia, Australia
- School of Surgery, University of Western Australia, Western Australia, Australia
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Thienprayoon R, Marks E, Funes M, Martinez-Puente LM, Winick N, Lee SC. Perceptions of the Pediatric Hospice Experience among English- and Spanish-Speaking Families. J Palliat Med 2015; 19:30-41. [PMID: 26618809 DOI: 10.1089/jpm.2015.0137] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE Many children who die are eligible for hospice enrollment but little is known about parental perceptions of the hospice experience, the benefits, and disappointments. The objective of this study was to explore parental perspectives of the hospice experience in children with cancer, and to explore how race/ethnicity impacts this experience. STUDY DESIGN We held 20 semistructured interviews with 34 caregivers of children who died of cancer and used hospice. Interviews were conducted in the caregivers' primary language: 12 in English and 8 in Spanish. Interviews were recorded, transcribed, and analyzed using accepted qualitative methods. RESULTS Both English and Spanish speakers described the importance of honest, direct communication by medical providers, and anxieties surrounding the expectation of the moment of death. Five English-speaking families returned to the hospital because of unsatisfactory symptom management and the need for additional supportive services. Alternatively, Spanish speakers commonly stressed the importance of being at home and did not focus on symptom management. Both groups invoked themes of caregiver appraisal, but English-speaking caregivers more commonly discussed themes of financial hardship and fear of insurance loss, while Spanish-speakers focused on difficulties of bedside caregiving and geographic separation from family. CONCLUSIONS The intense grief associated with the loss of a child creates shared experiences, but Spanish- and English-speaking parents describe their hospice experiences in different ways. Additional studies in pediatric hospice care are warranted to improve the care we provide to children at the end of life.
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Affiliation(s)
- Rachel Thienprayoon
- 1 The Pediatric Palliative and Comfort Care Team, Division of Pain, Department of Anesthesiology, Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio.,2 Cancer and Blood Disease Institute, Department of Pediatrics, Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio
| | - Emily Marks
- 3 Department of Clinical Sciences, University of Texas at Southwestern Medical Center , Dallas, Texas
| | - Maria Funes
- 3 Department of Clinical Sciences, University of Texas at Southwestern Medical Center , Dallas, Texas
| | | | - Naomi Winick
- 4 The Pauline Allen Gill Center for Cancer and Blood Disorders, Department of Pediatrics, University of Texas at Southwestern Medical Center , Dallas, Texas.,5 Children's Medical Center Dallas , Dallas, Texas
| | - Simon Craddock Lee
- 3 Department of Clinical Sciences, University of Texas at Southwestern Medical Center , Dallas, Texas.,6 Harold C. Simmons Cancer Center, University of Texas at Southwestern Medical Center , Dallas, Texas
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Carolan CM, Smith A, Forbat L. Conceptualising psychological distress in families in palliative care: Findings from a systematic review. Palliat Med 2015; 29:605-32. [PMID: 25802323 DOI: 10.1177/0269216315575680] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
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.
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Affiliation(s)
- Clare M Carolan
- School of Health Sciences, University of Stirling (Western Isles Campus), Stornoway, UK
| | - Annetta Smith
- School of Health Sciences, University of Stirling (Western Isles Campus), Stornoway, UK
| | - Liz Forbat
- School of Health Sciences, University of Stirling (Stirling Campus), Stirling, UK
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Toye C, Moorin R, Slatyer S, Aoun SM, Parsons R, Hegney D, Maher S, Hill KD. Protocol for a randomised controlled trial of an outreach support program for family carers of older people discharged from hospital. BMC Geriatr 2015; 15:70. [PMID: 26108207 PMCID: PMC4479237 DOI: 10.1186/s12877-015-0065-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 05/28/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Presentations to hospital of older people receiving family care at home incur substantial costs for patients, families, and the health care system, yet there can be positive carer outcomes when systematically assessing/addressing their support needs, and reductions in older people's returns to hospital attributed to appropriate discharge planning. This study will trial the Further Enabling Care at Home program, a 2-week telephone outreach initiative for family carers of older people returning home from hospital. Hypotheses are that the program will (a) better prepare families to sustain their caregiving role and (b) reduce patients' re-presentations/readmissions to hospital, and/or their length of stay; also that reduced health system costs attributable to the program will outweigh costs of its implementation. METHODS/DESIGN In this randomised controlled trial, family carers of older patients aged 70+ discharged from a Medical Assessment Unit in a Western Australian tertiary hospital, plus the patients themselves, will be recruited at discharge (N = 180 dyads). Carers will be randomly assigned (block allocation, assessors blinded) to receive usual care (control) or the new program (intervention). The primary outcome is the carer's self-reported preparedness for caregiving (Preparedness for Caregiving Scale administered within 4 days of discharge, 2-3 weeks post-discharge, 6 weeks post-discharge). To detect a clinically meaningful change of two points with 80 % power, 126 carers need to complete the study. Patients' returns to hospital and subsequent length of stay will be ascertained for a minimum of 3 months after the index admission. Regression analyses will be used to determine differences in carer and patient outcomes over time associated with the group (intervention or control). Data will be analysed using an Intention to Treat approach. A qualitative exploration will examine patients' and their family carers' experiences of the new program (interviews) and explore the hospital staff's perceptions (focus groups). Process evaluation will identify barriers to, and facilitators of, program implementation. A comprehensive economic evaluation will determine cost consequences. DISCUSSION This study investigates a novel approach to identifying and addressing family carers' needs following discharge from hospital of the older person receiving care. If successful, the program has potential to be incorporated into routine post-discharge support. TRIAL REGISTRATION Australian and New Zealand Clinical Trial Registry: ACTRN12614001174673 .
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Affiliation(s)
- Christine Toye
- School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia. .,Centre for Nursing Research, Sir Charles Gairdner Hospital, Perth, WA, 6009, Australia.
| | - Rachael Moorin
- School of Public Health, Curtin University, Perth, WA, 6845, Australia. .,School of Population Health, The University of Western Australia, Perth, WA, 6009, Australia. .,Department of Research, Silver Chain Group, Osborne Park, Perth, WA, 6017, Australia.
| | - Susan Slatyer
- School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia. .,Centre for Nursing Research, Sir Charles Gairdner Hospital, Perth, WA, 6009, Australia.
| | - Samar M Aoun
- School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia.
| | - Richard Parsons
- School of Pharmacy, Curtin University, Perth, WA, 6845, Australia.
| | - Desley Hegney
- School of Nursing and Midwifery, The University of Southern Queensland, Toowoomba, QLD, 4350, Australia. .,School of Nursing, The University of Adelaide, Adelaide, South Australia, 5005, Australia.
| | - Sean Maher
- Department of Rehabilitation and Aged Care, Sir Charles Gairdner Hospital, Perth, WA, 6009, Australia.
| | - Keith D Hill
- School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, 6845, Australia.
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Predicting distress among people who care for patients living longer with high-grade malignant glioma. Support Care Cancer 2015; 24:43-51. [DOI: 10.1007/s00520-015-2739-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 04/13/2015] [Indexed: 11/26/2022]
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Aoun SM, Grande G, Howting D, Deas K, Toye C, Troeung L, Stajduhar K, Ewing G. The impact of the carer support needs assessment tool (CSNAT) in community palliative care using a stepped wedge cluster trial. PLoS One 2015; 10:e0123012. [PMID: 25849348 PMCID: PMC4388632 DOI: 10.1371/journal.pone.0123012] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 02/26/2015] [Indexed: 11/19/2022] Open
Abstract
Family caregiving towards the end-of-life entails considerable emotional, social, financial and physical costs for caregivers. Evidence suggests that good support can improve caregiver psychological outcomes. The primary aim of this study was to investigate the impact of using the carer support needs assessment tool (CSNAT), as an intervention to identify and address support needs in end of life home care, on family caregiver outcomes. A stepped wedge design was used to trial the CSNAT intervention in three bases of Silver Chain Hospice Care in Western Australia, 2012-14. The intervention consisted of at least two visits from nurses (2-3 weeks apart) to identify, review and address caregivers' needs. The outcome measures for the intervention and control groups were caregiver strain and distress as measured by the Family Appraisal of Caregiving Questionnaire (FACQ-PC), caregiver mental and physical health as measured by SF-12v2, and caregiver workload as measured by extent of caregiver assistance with activities of daily living, at baseline and follow up. Total recruitment was 620. There was 45% attrition for each group between baseline and follow-up mainly due to patient deaths resulting in 322 caregivers completing the study (233 in the intervention group and 89 in the control group). At follow-up, the intervention group showed significant reduction in caregiver strain relative to controls, p=0.018, d=0.348 (95% CI 0.25 to 0.41). Priority support needs identified by caregivers included knowing what to expect in the future, having time for yourself in the day and dealing with your feelings and worries. Despite the challenges at the clinician, organisational and trial levels, the CSNAT intervention led to an improvement in caregiver strain. Effective implementation of an evidence-informed and caregiver-led tool represents a necessary step towards helping palliative care providers better assess and address caregiver needs, ensuring adequate family caregiver support and reduction in caregiver strain.
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Affiliation(s)
- Samar M. Aoun
- School of Nursing and Midwifery, Curtin University, Perth, Western Australia, Australia
| | - Gunn Grande
- School of Nursing, Midwifery & Social Work, The University of Manchester, Manchester, United Kingdom
| | - Denise Howting
- School of Nursing and Midwifery, Curtin University, Perth, Western Australia, Australia
| | - Kathleen Deas
- School of Nursing and Midwifery, Curtin University, Perth, Western Australia, Australia
| | - Chris Toye
- School of Nursing and Midwifery, Curtin University, Perth, Western Australia, Australia
| | - Lakkhina Troeung
- School of Population Health, The University of Western Australia, Crawley, Western Australia, Australia
- School of Medicine, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Kelli Stajduhar
- School of Nursing and Centre on Aging, University of Victoria, Victoria, British Columbia, Canada
| | - Gail Ewing
- Centre for Family Research, University of Cambridge, Cambridge, United Kingdom
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Development and evaluation of an intervention to support family caregivers of people with cancer to provide home-based care at the end of life: A feasibility study. Eur J Oncol Nurs 2015; 19:154-61. [DOI: 10.1016/j.ejon.2014.09.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 09/15/2014] [Accepted: 09/23/2014] [Indexed: 11/23/2022]
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Breen LJ, Aoun SM, O'Connor M. The effect of caregiving on bereavement outcome: study protocol for a longitudinal, prospective study. BMC Palliat Care 2015. [PMID: 25798071 DOI: 10.1186/s12904‐015‐0009‐z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of the current study is to determine the effects of caregiving on bereavement outcome. The study will address two important gaps in the research literature: (1) the relationship between pre-death distress and post-death outcomes and (2) family caregivers' anticipation and preparation of the death of the person for whom they care. METHODS/DESIGN We will conduct a longitudinal, prospective study of adult family caregivers of adult patients receiving palliative care. All participants will complete a questionnaire administered at four points - approximately 4-8 weeks prior to bereavement, and 3-4, 6-7, and 9-10 months post-bereavement. The questionnaire includes measures of multidimensional caregiving experiences (strain, distress, positive appraisals, and family wellbeing), caregiver prolonged grief, multidimensional grief responses (despair, panic behaviour, blame and anger, detachment, disorganisation, and personal growth), prolonged grief, quality of life, general health (psychological and physical) and demographics. These caregivers' data will be compared to a comparison group matched for age, sex, and postcode, allowing the caregivers' general health and quality of life to be compared to a normative group. The caregivers will also be invited to participate in a semi-structured interview about preparing for impending bereavement. DISCUSSION This is the first study to address the methodological limitations in the current literature and will likely make a significant contribution to both our understanding of caregiving on bereavement outcome and to bereavement care offered in palliative and hospice settings.
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Affiliation(s)
- Lauren J Breen
- School of Psychology & Speech Pathology, Faculty of Health Sciences, Curtin University, GPO Box U1987, Perth, Western Australia 6845 Australia
| | - Samar M Aoun
- School of Nursing and Midwifery, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Moira O'Connor
- School of Psychology & Speech Pathology, Faculty of Health Sciences, Curtin University, GPO Box U1987, Perth, Western Australia 6845 Australia
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The effect of caregiving on bereavement outcome: study protocol for a longitudinal, prospective study. BMC Palliat Care 2015; 14:6. [PMID: 25798071 PMCID: PMC4367904 DOI: 10.1186/s12904-015-0009-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 03/04/2015] [Indexed: 11/16/2022] Open
Abstract
Background The aim of the current study is to determine the effects of caregiving on bereavement outcome. The study will address two important gaps in the research literature: (1) the relationship between pre-death distress and post-death outcomes and (2) family caregivers’ anticipation and preparation of the death of the person for whom they care. Methods/Design We will conduct a longitudinal, prospective study of adult family caregivers of adult patients receiving palliative care. All participants will complete a questionnaire administered at four points – approximately 4–8 weeks prior to bereavement, and 3–4, 6–7, and 9–10 months post-bereavement. The questionnaire includes measures of multidimensional caregiving experiences (strain, distress, positive appraisals, and family wellbeing), caregiver prolonged grief, multidimensional grief responses (despair, panic behaviour, blame and anger, detachment, disorganisation, and personal growth), prolonged grief, quality of life, general health (psychological and physical) and demographics. These caregivers’ data will be compared to a comparison group matched for age, sex, and postcode, allowing the caregivers’ general health and quality of life to be compared to a normative group. The caregivers will also be invited to participate in a semi-structured interview about preparing for impending bereavement. Discussion This is the first study to address the methodological limitations in the current literature and will likely make a significant contribution to both our understanding of caregiving on bereavement outcome and to bereavement care offered in palliative and hospice settings.
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Nakken N, Spruit MA, Wouters EF, Schols JM, Janssen DJ. Family caregiving during 1-year follow-up in individuals with advanced chronic organ failure. Scand J Caring Sci 2015; 29:734-44. [DOI: 10.1111/scs.12204] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 11/05/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Nienke Nakken
- Program Development Centre; CIRO+, Centre of Expertise for Chronic Organ Failure; Horn The Netherlands
| | - Martijn A. Spruit
- Program Development Centre; CIRO+, Centre of Expertise for Chronic Organ Failure; Horn The Netherlands
| | - Emiel F.M. Wouters
- Program Development Centre; CIRO+, Centre of Expertise for Chronic Organ Failure; Horn The Netherlands
- Department of Respiratory Medicine; Maastricht University Medical Centre+ (MUMC+); Maastricht The Netherlands
| | - Jos M.G.A. Schols
- Department of Family Medicine; Faculty of Health Medicine and Life sciences/CAPHRI; Maastricht University; Maastricht The Netherlands
| | - Daisy J.A. Janssen
- Program Development Centre; CIRO+, Centre of Expertise for Chronic Organ Failure; Horn The Netherlands
- Centre of Expertise for Palliative Care; Maastricht University Medical Centre+ (MUMC+); Maastricht The Netherlands
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