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Alvariza A, Häger-Tibell L, Holm M, Steineck G, Kreicbergs U. Increasing preparedness for caregiving and death in family caregivers of patients with severe illness who are cared for at home - study protocol for a web-based intervention. BMC Palliat Care 2020; 19:33. [PMID: 32183803 PMCID: PMC7079472 DOI: 10.1186/s12904-020-0530-6] [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: 06/13/2019] [Accepted: 02/20/2020] [Indexed: 11/24/2022] Open
Abstract
Background Family caregivers of patients with severe illness and in need for a palliative care approach, face numerous challenges and report having insufficient preparedness for the caregiver role as well as a need for information and psychosocial support. Preparing to care for a severely ill family members also means becoming aware of death. Feelings of being prepared are associated with positive aspects and regarded protective against negative health consequences. Methods The study adheres to the SPIRIT-guidelines (Supplementary 1), uses a pre-post design and include a web-based intervention. Inclusion criteria are; being a family caregiver of a patient with severe illness and in need of a palliative care approach. The intervention which aims to increase preparedness for caregiving and death is grounded in theory, research and clinical experience. The topics cover: medical issues, symptoms and symptom relief; communication within the couple, how to spend the time before death, being a caregiver, planning for the moment of death and; considerations of the future. The intervention is presented through videos and informative texts. The website also holds an online peer-support discussion forum. Study aims are to: evaluate feasibility in terms of framework, content, usage and partners’ experiences; explore how the use of the website, influences family caregivers’ preparedness for caregiving and death; explore how the use of the website influences family caregivers’ knowledge about medical issues, their communication with the patient and their considerations of the future; and to investigate how the family caregivers’ preparedness for caregiving and death influences their physical and psychological health and quality of life 1 year after the patient’s death. Data will be collected through qualitative interviews and a study-specific questionnaire at four time-points. Discussion This project will provide information about whether support via a website has the potential to increase preparedness for caregiving and death and thereby decrease negative health consequences for family caregivers of patients affected by severe illness. It will provide new knowledge about intervention development, delivery, and evaluation in a palliative care context. Identification of factors before death and their association with family caregivers’ preparedness and long-term health may change future clinical work. Trial registration The study is registered at ClinicalTrials.gov: NCT03676283.
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Affiliation(s)
- Anette Alvariza
- The Department of Health Care Science/Palliative Research Centre, Ersta Sköndal Bräcke University College, Stigbergsgatan 30, 100 61, Stockholm, Sweden.,Capio Palliative Care Unit, Dalen Hospital, Åstorpsringen 6, 121 31, Enskededalen, Sweden
| | - Louise Häger-Tibell
- The Department of Health Care Science/Palliative Research Centre, Ersta Sköndal Bräcke University College, Stigbergsgatan 30, 100 61, Stockholm, Sweden. .,Tema Cancer, BES: Breast-endocrine tumors and sarcoma, Karolinska University Hospital, Eugeniavägen 3, 171 76, Solna, Sweden.
| | - Maja Holm
- The Department of Health Care Science/Palliative Research Centre, Ersta Sköndal Bräcke University College, Stigbergsgatan 30, 100 61, Stockholm, Sweden.,Department of Nursing Science, Sophiahemmet University, Valhallavägen 91, 114 28, Stockholm, Sweden
| | - Gunnar Steineck
- Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical sciences, Sahlgrenska Academy at the University of Gothenburg, Blå Stråket 2 SU/Jubileumskliniken, 413 45, Gothenburg, Sweden.,Department of Oncology and Pathology, Division of Clinical Cancer Epidemiology, Karolinska Institutet, Solnavägen 1, 171 77, Solna, Sweden
| | - Ulrika Kreicbergs
- The Department of Health Care Science/Palliative Research Centre, Ersta Sköndal Bräcke University College, Stigbergsgatan 30, 100 61, Stockholm, Sweden.,Department of Women's and Children's Health, Karolinska Institutet, Solnavägen 1, 171 77, Solna, Sweden
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The association of time since spousal loss and depression in widowhood: a systematic review and meta-analysis. Soc Psychiatry Psychiatr Epidemiol 2019; 54:781-792. [PMID: 30887075 DOI: 10.1007/s00127-019-01680-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 02/25/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE To conduct a systematic review and meta-analysis examining the association of the prevalence of depression and time since spousal loss in widowed people. METHODS The databases MEDLINE, Embase and PsycInfo were searched (May 2017) for papers reporting on time since spousal loss in widowed people and the prevalence of common mental disorders. A systematic review was conducted according to MOOSE guidelines. Random effects meta-analyses of the prevalence of depression were conducted by intervals of time since spousal loss. RESULTS The literature search identified 12,982 studies of which 22 were eligible for inclusion in the systematic review. Of these, 14 were furthermore eligible for inclusion in the meta-analysis. The summary estimates found in the meta-analysis for the prevalence of depression in the intervals of time since spousal loss were: ≤ 1 month: 38.2% (21.9-55.8%); > 1 month to 3 months: 25.0% (17.3-33.5%); > 3 months to 6 months: 23.1% (18.0-28.7%); > 6 months to 12 months: 19.4% (15.2-24.0%); > 12 months to 18 months: 11.1% (5.3-18.7%); > 18 months to 24 months: 15.2% (12.3-18.2%); > 24 months to 60 months: 10.5% (4.3-18.5%). CONCLUSION Widowhood is associated with a high prevalence of depression and the study identifies a population group needing special attention in daily clinical practice. The prevalence is highest in the first month of widowhood, however, continues to be high at least 5 years into widowhood.
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Zhou H, Zhang L, Ye F, Wang HJ, Huntington D, Huang Y, Wang A, Liu S, Wang Y. The Effect of Maternal Death on the Health of the Husband and Children in a Rural Area of China: A Prospective Cohort Study. PLoS One 2016; 11:e0157122. [PMID: 27280717 PMCID: PMC4900542 DOI: 10.1371/journal.pone.0157122] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 05/25/2016] [Indexed: 11/21/2022] Open
Abstract
Objective To examine the effects of maternal death on the health of the index child, the health and educational attainment of the older children, and the mental health and quality of life of the surviving husband. Methods A cohort study including 183 households that experienced a maternal death matched to 346 households that experienced childbirth but not a maternal death was conducted prospectively between June 2009 and October 2011 in rural China. Data on household sociodemographic characteristics, physical and mental health were collected using a quantitative questionnaire and medical examination at baseline and follow-up surveys. Multivariate linear regression, logistic regression models and difference-in-difference (DID) were used to compare differences of outcomes between two groups. Findings The index children who experienced the loss of a mother had a significantly higher likelihood of dying, abandonment and malnutrition compared to children whose mothers survived at the follow-up survey. The risk of not attending school on time and dropping out of school among older children in the affected group was higher than those in the control group during the follow-up. Husbands whose wife died had significantly lower EQ-5D index and EQ-VAS both at baseline and at follow-up surveys compared to those without experiencing a wife’s death, suggesting an immediate and sustained poorer mental health quality of life among the surviving husbands. Also the prevalence of posttraumatic stress disorder (PTSD) was 72.6% at baseline and 56.2% at follow-up among husbands whose wife died. Conclusions Maternal death has multifaceted and spillover effects on the physical and mental health of family members that are sustained over time. Programmes that reduce maternal mortality will mitigate repercussions on surviving family members are critical and needed.
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Affiliation(s)
- Hong Zhou
- Division of Maternal and Child Health, School of Public Health, Peking University, No.38 Xueyuan Road Haidian District, Beijing, China
| | - Long Zhang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Fang Ye
- Department of Preventive Health Care, China-Japan Friendship Hospital, Beijing, China No.38 Xueyuan Road Haidian District, Beijing, China
| | - Hai-jun Wang
- Institute of Child and Adolescent Health, School of Public Health, Peking University, No.38 Xueyuan Road Haidian District, Beijing, China
| | - Dale Huntington
- Asia Pacific Observatory on Health Systems and Policies, World Health Organization Western Pacific Regional Office, Manila, Philippines
| | - Yanjie Huang
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Anqi Wang
- Division of Maternal and Child Health, School of Public Health, Peking University, No.38 Xueyuan Road Haidian District, Beijing, China
| | - Shuiqing Liu
- Division of Maternal and Child Health, School of Public Health, Peking University, No.38 Xueyuan Road Haidian District, Beijing, China
| | - Yan Wang
- Division of Maternal and Child Health, School of Public Health, Peking University, No.38 Xueyuan Road Haidian District, Beijing, China
- * E-mail:
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