Sleep disturbances and related factors among family caregivers of patients with advanced cancer

Prevalence of sleep disturbances among intensive care nurses: A systematic review and meta-analysis

BACKGROUND

Demanding intensive care unit (ICU) work environments may lead to sleep disturbances in nurses, impacting their health and potentially patient safety. Yet, the prevalence remains unclear around the world.

AIMS

To quantify the prevalence of sleep disturbances in intensive care nurses.

STUDY DESIGN

Systematic review and meta-analysis. A database search was conducted in Embase, PubMed, Web of Science, Scopus and CINAHL from their inception to April 2024 for relevant studies. Data from observational studies (cross-sectional or cohort) that reported the prevalence of sleep disturbances, assessed using the Pittsburgh Sleep Quality Index (PSQI > 5), pooled in random-effects meta-analyses. Subgroup analyses were used to investigate variations in the prevalence estimates in terms of available variables. A Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA)-compliant protocol was registered in PROSPERO (CRD42023476428).

RESULTS

In total, 24 articles were included in this study published from 1996 to 2023. Included studies were from 15 unique countries. Almost all of the studies were descriptive cross-sectional studies (n = 22; 91.7%). The included studies encompassed a range of intensive care nurses, from 42 to 605, involving a total of 3499 intensive care nurses. The reported proportion of intensive care nurses with sleep disturbances ranged from 20.0% to 100.0%, with a median of 76.7% (interquartile range: 62.9-85.7). The pooled prevalence of sleep disturbances in intensive care nurses was 75.1% (95% confidence interval: 37.2-53.1; 95% prediction interval: 30.5-95.4).

CONCLUSIONS

Sleep disturbance is a common issue in intensive care nurses. The study results highlight the importance of implementing effective interventions as early as possible to improve ICU sleep quality.

RELEVANCE TO CLINICAL PRACTICE

High prevalence of sleep disturbances among intensive care nurses necessitates global interventions. Gender-neutral approaches that acknowledge comparable risks and stable prevalence over time require long-term strategies. Raising awareness through programmes is vital for implementing evidence-based interventions to promote sleep health in intensive care nurses.

Longitudinal Analysis of Cancer Family Caregiver Perception of Sleep Difficulty During Home Hospice

BACKGROUND

Sleep difficulty in caregivers is associated with poor physical and psychological outcomes. The purpose of this study was to describe family caregivers' perception of sleep difficulty through the hospice trajectory after a cancer diagnosis as predicted by age, sex, self-report of anxiety or depression, and cohabitation.

METHODS

We conducted a secondary analysis of longitudinal data using multilevel modeling with nested model comparisons. Beginning with an unconditional growth model, predictors were added to nested models to test differential impact.

RESULTS

Caregivers (n = 164) were predominately white (n = 160; 97%) and female (n = 113, 69%). We hypothesized that age, sex, history of anxiety or depression, and cohabitation would predict sleep difficulty. The cohabitation predictor model was a statistically significant model for caregiver perception of sleep difficulty that worsened throughout hospice caregiving (b = .184, χ 2 = 7.199, P = 0.027) but age, sex, and history of depression or anxiety did not improve model fit.

CONCLUSION

Our findings indicate that family caregivers who cohabitate exhibit increased perception of sleep difficulty over the course of hospice. Future studies and interventions for hospice family caregivers' sleep should consider cohabitation between the patient and the caregiver as a significant predictor of sleep difficulty to observe and potentially mediate the negative outcomes associated with caregiver sleep difficulty. Further, determining the underlying reasons for sleep difficulty in cohabitation (e.g., patient symptoms or treatments) should be explored.

Characterization of sleep efficiency transitions in family caregivers

Family caregivers are at high risk of psychological distress and low sleep efficiency resulting from their caregiving responsibilities. Although psychological symptoms are associated with sleep efficiency, there is limited knowledge about the association of psychological distress with variations in sleep efficiency. We aimed to characterize the short- and long-term patterns of caregivers' sleep efficiency using Markov chain models and compare these patterns between groups with high and low psychological symptoms (i.e., depression, anxiety, and caregiving stress). Based on 7-day actigraphy data from 33 caregivers, we categorized sleep efficiency into three states, < 75% (S1), 75-84% (S2), and ≥ 85% (S3), and developed Markov chain models. Caregivers were likely to maintain a consistent sleep efficiency state from one night to the next without returning efficiently to a normal state. On average, it took 3.6-5.1 days to return to a night of normal sleep efficiency (S3) from lower states, and the long-term probability of achieving normal sleep was 42%. We observed lower probabilities of transitioning to or remaining in a normal sleep efficiency state (S3) in the high depression and anxiety groups compared to the low symptom groups. The differences in the time required to return to a normal state were inconsistent by symptom levels. The long-term probability of achieving normal sleep efficiency was significantly lower for caregivers with high depression and anxiety compared to the low symptom groups. Caregivers' sleep efficiency appears to remain relatively consistent over time and does not show rapid recovery. Caregivers with higher levels of depression and anxiety may be more vulnerable to sustained suboptimal sleep efficiency.

Caregiver fear of cancer recurrence: A systematic review and meta-analysis of quantitative studies

OBJECTIVE

Fear of cancer recurrence (FCR) is reported by both cancer survivors and caregivers however less is known about caregiver FCR. This study aimed to (a) conduct a meta-analysis to compare survivor and caregiver FCR levels; (b) examine the relationship between caregiver FCR and depression, and anxiety; (c) evaluate psychometric properties of caregiver FCR measures.

METHODS

CINAHL, Embase, PsychINFO and PubMed were searched for quantitative research examining caregiver FCR. Eligibility criteria included caregivers caring for a survivor with any type of cancer, reporting on caregiver FCR and/or measurement, published in English-language, peer-review journals between 1997 and November 2022. The COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) taxonomy was used to evaluate content and psychometric properties. The review was pre-registered (PROSPERO ID: CRD42020201906).

RESULTS

Of 4297 records screened, 45 met criteria for inclusion. Meta-analysis revealed that caregivers reported FCR levels as high as FCR amongst survivors, with around 48% of caregivers reporting clinically significant FCR levels. There was a strong correlation between anxiety and depression and medium correlation with survivor FCR. Twelve different instruments were used to measure caregiver FCR. Assessments using the COSMIN taxonomy revealed few instruments had undergone appropriate development and psychometric testing. Only one instrument met 50% or more of the criteria, indicating substantial development or validation components were missing in most.

CONCLUSIONS

Results suggest FCR is as often a problem for caregivers as it is for survivors. As in survivors, caregiver FCR is associated with more severe depression and anxiety. Caregiver FCR measurement has predominately relied on survivor conceptualisations and unvalidated measures. More caregiver-specific research is urgently needed.

Effects of home-based specialized palliative care and dyadic psychological intervention on caregiver burden: results from a randomized controlled trial

Background The Domus study, a randomized controlled trial (RCT), evaluated the effect of home-based specialized palliative care (SPC) reinforced with a psychological intervention for the patient-caregiver dyad on increasing advanced cancer patients' time spent at home, as opposed to hospitalized, and the number of home deaths. As palliative care extends to include support for patients' families and may thus assist caregivers and decrease demands on them, in this study we evaluated a secondary outcome, caregiver burden.Material and Methods Patients with incurable cancer and their caregivers were randomized (1:1) to care as usual or home-based SPC. Caregiver burden was assessed using the Zarit Burden Interview (ZBI) at baseline and 2, 4, 8 weeks and 6 months after randomization. Intervention effects were assessed in mixed effects models.Results A total of 258 caregivers were enrolled. Eleven per cent of informal caregivers experienced severe caregiver burden at baseline. Caregiver burden increased significantly over time in both groups (p = 0.0003), but no significant effect of the intervention was seen on overall caregiver burden (p = 0.5046) or burden subscales measuring role and personal strain.Conclusion In line with the majority of previous RCTs, the Domus intervention was not able to significantly reduce caregiver burden. Future interventions should consider targeting only caregivers reporting the greatest caregiver burden.

Sleep quality, caregiver burden, and individual resilience among parents of children with epilepsy

PURPOSE

Parents caring for children with epilepsy have poor sleep quality and experience a certain level of caregiving burden. Individual resilience is a crucial psychological variable that contributes to health during extraordinary challenges. This study aimed to determine the relationships among individual resilience, caregiver burden, and sleep quality.

METHODS

This was a descriptive cross-sectional study with a convenience sample, following the STROBE guidelines. One hundred and ninety-one parents of children with epilepsy were invited to participate in the study. Of these, 173 participants completed measures of sleep quality, caregiver burden, and individual resilience. Path analysis was performed to probe the indirect relationship between individual resilience and sleep quality via caregiver burden.

RESULTS

Correlation analysis revealed that individual resilience total scores were significantly and marginally negatively correlated with caregiver burden and sleep quality total scores (r = -0.215, P <.01; r = -0.250, P <.01). Moreover, there was a significant moderate positive correlation between the total caregiver burden scores and total sleep quality scores (r = 0.389, P <.001). The path model showed that individual resilience is indirectly associated with sleep quality via caregiver burden.

CONCLUSION

The higher the level of individual resilience, the less the caregiver burden and the better the sleep quality for parents of children with epilepsy.

Sleep, depression, and anxiety in family caregivers of nasopharyngeal carcinoma patients before therapy

Sleep disturbance, anxiety, and depression are frequently observed in cancer patients. There have fewer studies about the sleep and emotional status of nasopharyngeal carcinoma (NPC) patient family caregivers (FCs) before treatment. We explored the sleep, depression, and anxiety in NPC patient FCs before therapy, compared sleep quality between caregivers with and without depression and anxiety, and examined and related factors of sleep disturbance in FCs of NPC patients before therapy. FC-patient dyads included from two centers were 92 in total. The proportions of poor sleep, anxiety, and depression in NPC patient FCs were 45.7%, 43.5%, and 54.3%, respectively. FCs with anxiety or depression were more inclined to report decreased sleep quality. Depressed caregivers were 11.11 times more to be poor quality sleep before patients treatment (OR = 11.11, 95%; CI = 2.94-42.05). NPC patient FCs before treatment are at high risk of sleep disturbances, depression, and anxiety, especially those already experiencing anxiety and depression symptoms.

The influence of symptom severity of palliative care patients on their family caregivers

Background

This study anlyzed whether family caregivers of patients with advanced cancer suffer impaired sleep quality, increased strain, reduced quality of life or increased care burden due to the presence and heightened intensity of symptoms in the person being cared for.

Method

A total of 41 patient-caregiver dyads (41 caregivers and 41 patients with advanced cancer) were recruited at six primary care centres in this cross-sectional study. Data were obtained over a seven-month period. Caregiver’s quality of sleep (Pittsburgh Sleep Quality Index), caregiver’s quality of life (Quality of Life Family Version), caregiver strain (Caregiver Strain Index), patients’ symptoms and their intensity (Edmonton Symptom Assessment System), and sociodemographic, clinical and care-related data variables were assessed. The associations were determined using non-parametric Spearman correlation.

Results

Total Edmonton Symptom Assessment System was significantly related to overall score of the Pittsburgh Sleep Quality Index (r = 0.365, p = 0.028), the Caregiver Strain Index (r = 0.45, p = 0.005) and total Quality of Life Family Version (r = 0.432, p = 0.009), but not to the duration of daily care (r = -0.152, p = 0.377).

Conclusions

Family caregivers for patients with advanced cancer suffer negative consequences from the presence and intensity of these patients’ symptoms. Therefore, optimising the control of symptoms would benefit not only the patients but also their caregivers. Thus, interventions should be designed to improve the outcomes of patient-caregiver dyads in such cases.

Sleep Quality in Young Adult Informal Caregivers: Understanding Psychological and Biological Processes

BACKGROUND

Providing informal care for a relative or friend with medical or mental needs can extol a physical burden on the caregiver, including impaired aspects of sleep quality such as suboptimal sleep duration, lengthened sleep latency, frequent awakenings, daytime sleepiness, and poor self-rated sleep quality. Diminished sleep quality can worsen the health in the caregiver, including dysregulation of hypothalamic-pituitary-adrenal axis (HPA) activity. Few studies have attempted to describe sleep in young adults who provide regular informal care. This study examines subjective and objective indicators of sleep quality and diurnal cortisol rhythms among young adult caregivers relative to non-caregiving peers. We expect that caregivers will exhibit poorer objective and subjective sleep quality and greater dysregulation in diurnal cortisol indices, than demographically similar non-caregivers, and that caregivers with poorer sleep will exhibit pronounced cortisol dysregulation.

METHODS

Participant self-reported sleep quality over the prior month via the Pittsburgh Sleep Quality Index and objective sleep quality was observed via wrist actigraph for three consecutive days. Diurnal salivary cortisol was also measured across the three days of actigraph monitoring.

RESULTS

Informal caregivers exhibited more self-reported sleep disturbance and greater sleep latency than non-caregivers, as well as more objectively measured sleep fragmentation. Caregivers with a shorter sleep duration were observed to have flatter diurnal cortisol slopes than caregivers with a relatively longer sleep duration.

CONCLUSIONS

Young adult caregivers appear to be at risk for impairment in sleep quality, which in turn might impact health through HPA axis dysregulation. Longitudinal research is needed to identify these relationships across time.

Predictors of sleep disturbances in caregivers of patients with advanced cancer receiving home palliative care: A descriptive cross-sectional study

PURPOSE

To evaluate the quality of sleep in caregivers of patients with advanced cancer receiving home palliative care, basing the analysis on subjective and objective measures, and to develop a predictive model of sleep disturbances among this population.

METHOD

A descriptive cross-sectional study was conducted in six clinical management units within primary healthcare centres. Data were obtained during a period of six months, from a sample population of 41 caregivers. The Pittsburgh Sleep Quality Index (PSQI) and a 7-day accelerometry evaluation were performed to assess sleep quality. Daytime sleepiness, caregiver strain and quality of life were also evaluated.

RESULTS

According to the PSQI, 90.2% of participants had poor sleep quality. The average duration of night-time sleep, measured by accelerometry and the PSQI, was 6 h. Taking PSQI as the dependent variable, the study model predicted 40.7% of the variability (p < 0.01). The variables "Caregiver strain" and "Daily hours dedicated to care" produced the following results: B coefficient 0.645; p = 0.001; and B coefficient 0.230; p = 0.010, respectively.

CONCLUSIONS

The caregivers presented significant health-related alterations, including sleep disturbances, which were directly related to two variables: the index of caregiver strain and the number of hours per day dedicated to providing care.

Burden of Care and Perceived Psycho-Social Outcomes among Family Caregivers of Patients Living with Cancer

Objective:

Caring for patients living with cancer requires the support of family caregivers. Literature reports experiences of diverse burdens and health effects among caregivers. This study examined the burden, physical, psycho-social, and financial outcomes of caregiving among caregivers of patients living with cancer.

Methods:

This cross-sectional descriptive study was conducted in the University College Hospital, Ibadan, Nigeria, between January and March 2019. A convenient sample of 201 caregivers who were direct family relatives were selected to complete a validated Zarit Burden Interview (ZBI) Questionnaire (r = 0.994) and perceived outcomes of caregiving questionnaire. The burden scale score ranged from 0 to 20 (no burden) to 61–88 (severe burden). Other outcomes of caregiving were measured on a Likert scale 0–4 (where 2.00 is the threshold score of effect of caregiving experienced), to determine the strength of the effect of caregiving on each variable of interest. The factors that contributed to the health outcomes were also identified. The Statistical Package for the Social Sciences version 22.0 was used for data analysis.

Results:

The mean age was 37.68 ± 14.29 years and majority (60.4%) were female. The mean duration of caregiving was 2.34 ± 1.14. Caregivers (44.5%) reported a mild level of the burden while 4.4% reported severe burden. The mean burden score was 28.30 ± 15.78. Findings also indicate that caregiving affected the physical health (mean = 2.58 ≥ 2.00) and social well-being (mean = 2.42 ≥ 2.00) of the caregivers. The impact on psychological health was less than the threshold value (mean = 1.88 ≤ 2.00), suggesting less impact. Some factors associated with physical effects include poor eating (mean = 2.80) and lack of sleep (mean = 2.92). However, the psychological outcomes were associated with loss of hope (mean = 1.53) and feelings of frustration (mean = 1.65).

Conclusions:

Reported burden of care was mild; although negative health outcomes were noted. Health-care professionals can ameliorate such effects through a regular systemic assessment with standardized instruments, for early identification and intervention.

Cancer caregiver reports of post-traumatic growth following spousal hematopoietic stem cell transplant

BACKGROUND AND OBJECTIVES

Cancer caregivers are at risk for experiencing health issues due to the stress of caregiving. Despite this, it is possible to prompt adaptive coping during the cancer experience. Adaptive coping is associated with improved health for caregiver populations. Forms of emotional disclosure are associated with caregiver reports of post-traumatic growth (PTG), which is an adaptive coping mechanism that comprises positive change following trauma. This study sought to identify areas of PTG identified by spousal hematopoietic stem-cell transplant (HSCT) cancer caregivers, via emotional disclosure writings.

DESIGN & METHOD

Twenty-two spousal caregivers of patients who underwent a (HSCT) submitted emotional disclosure writings three times at one-week intervals. Writings centered on positive outcomes arising in light of the cancer experience. A qualitative grounded theory approach was used to evaluate caregiver accounts of PTG that arose while caring for their spouse.

RESULTS & CONCLUSIONS

Findings suggest seven areas of PTG recognized through the disclosure process: living in the moment, a sense of honor and pride, choosing positivity, uninfluenced self-choice and expression, deprioritizing materialism, personal and/or spiritual connection, and altruistic expansion. The primary theoretical advancement arising from this study includes the notion that PTG largely appears to be a socially dependent process.Trial registration: ClinicalTrials.gov identifier: NCT02339870..

Effectiveness of Self-administered Acupressure for Family Caregivers of Advanced Cancer Patients With Insomnia: A Randomized Controlled Trial

BACKGROUND

Sleep disturbances are common among family caregivers (FCs) of patients with advanced cancer. Self-administered acupressure can combat insomnia, but no study has been conducted to evaluate its efficacy in caregivers of patients with advanced cancer.

OBJECTIVE

The aim of this study is to investigate whether self-administered acupressure improves sleep quality for FCs of patients with advanced cancer.

METHODS

Family caregivers of patients with advanced cancer who reported sleep disturbance (Pittsburgh Sleep Quality Index scores >5 in recent months) were recruited. The experimental group self-administered acupressure at the Baihui (GV20), Fengchi (GB20), Neiguan (PC6), and Shenmen (HT7) points over a 12-week period, whereas the comparison group received sleep hygiene education. Sleep quality was assessed subjectively at 4, 8, and 12 weeks after the intervention using the Pittsburgh Sleep Quality Index and objectively using actigraphy measurements. Improvements in sleep quality were analyzed using a generalized estimating equation.

RESULTS

Compared with the control group, the experimental group demonstrated significantly lower sleep latency (Wald χ2 = 11.49, P = .001) and significantly better sleep efficiency (Wald χ2 = 5.24, P = .02) according to actigraphy measurements, but Pittsburgh Sleep Quality Index scores did not differ significantly between the groups.

CONCLUSIONS

Self-administered acupressure did not demonstrate favorable effects on subjective sleep quality, but did reduce sleep latency and improve sleep efficiency, according to actigraphy measurements. Self-administered acupressure may help relaxation and sedation and promote sleep in FCs.

IMPLICATIONS FOR PRACTICE

Healthcare providers may consider advising FCs to apply this self-administered acupressure to improve their sleep latency and sleep efficiency.

Relationships between informal caregiving, health and work in the Health and Employment After Fifty study, England

BACKGROUND

To investigate the prevalence of caregiving and its relationship with work, health and socio-economic circumstances in the Health and Employment After Fifty (HEAF) study.

METHODS

The HEAF study comprises 8134 men and women aged 50-64 years recruited from 24 general practices. Socio-demographic, lifestyle and health characteristics and hours per week giving personal care were elicited by postal questionnaire. Objective clinical information about diagnoses/medications was retrieved from health records. Work-related and health risk factors for intense caring responsibilities (≥20 h/week vs. no hours) were explored using logistic regression with adjustment for age and social class.

RESULTS

In all, 644 (17%) men and 1153 (26%) women reported caring responsibilities, of whom 93 and 199 were intense caregivers, who were more likely to be socio-economically disadvantaged; less likely to be working and, if combining caring with working (41 men and 90 women), more likely to be part-time/working shifts, than non-carers. Men caring ≥20 h/week were more likely to have COPD and to report musculoskeletal pain, poor/fair self-rated health, depression and sleep problems. Among working women, caring ≥20 h/week was associated with these same health outcomes and also with a doctor-diagnosed mental health problem or musculoskeletal pain in the previous year.

CONCLUSIONS

Caregiving is common and unequal in the HEAF cohort, with more high-intensity informal care provided by those with greater levels of socio-economic deprivation, which could affect their employment and health. Caregivers need support to lead long, healthy lives, rather than becoming care needers themselves. Employers and governments need to take caregiving into account and support it actively.

Concomitant Benefits of an Auricular Acupressure Intervention for Women With Cancer on Family Caregiver Sleep Quality

BACKGROUND

Sleep disturbance is a frequent and significant problem challenge for family caregivers of patients with cancer. A previously tested 6-week auricular acupressure intervention was found to reduce symptom burden in women with cancer. It is possible that such an intervention has a concomitant benefit for family caregivers.

OBJECTIVES

The aim of this study was to explore if the effects of an auricular acupressure intervention on major symptoms experienced by women with ovarian cancer improves the sleep quality of family caregivers.

METHODS

A quasi-randomized controlled trial with a repeated-measures design was used. Family caregivers (n = 68) of cancer patients were recruited and completed the Pittsburgh Sleep Quality Index on 4 occasions. Demographic information included age, sex, duration of caring role, and relationship to the patient.

RESULTS

Family members with a longer duration of caregiving reported more sleep disturbance at baseline. As the symptom burden of treated women decreased, their family caregivers reported improved Pittsburgh Sleep Quality Index scores at 4 weeks (time 2; Cohen d = 1.075) and 6 weeks (time 3; Cohen d = 1.022).

CONCLUSIONS

Reducing the symptom burden of patients with cancer can improve the sleep quality of family caregivers.

IMPLICATIONS FOR PRACTICE

Auricular acupressure is a noninvasive and easy-to-apply intervention that can be applied by caregivers to assist their family member. Nursing staff can implement and test the acupressure intervention into their clinical practice and better support family-based strategies and interventions. Further studies with larger samples are needed to confirm our findings.

Caregiving burden and sleep quality amongst family caregivers of Chinese male patients with advanced cancer: A cross-sectional study

PURPOSE

To examine the level of caregiving burden and sleep quality as well as their interrelationship amongst family caregivers of Chinese male patients with advanced cancer.

METHOD

A cross-sectional study was conducted in Hong Kong. The Caregiver Reaction Assessment (CRA) and the Pittsburgh Sleep Quality Index (PSQI) were used to measure caregiving burden and sleep quality of the family caregivers.

RESULTS

A total of 96 family caregivers were recruited. Disrupted schedule (3.8; SD = 0.8) was rated as the most affected consequence of caregiving burden. Around 78.1% of the caregivers suffered from sleep problems. Hierarchical multiple regression revealed that health problems due to caregiving burden was independently associated with poor sleep quality after controlling for socio-demographic characteristics of both patients and caregivers (regression coefficient, B = 2.09, P = 0.012).

CONCLUSIONS

Caregiving burden amongst family caregivers of male patients with advanced cancer was remarkably high and associated with poor sleep quality. Strategies aiming to alleviate caregiving burden of caregivers may help break this vicious cycle to enhance the sleep quality of caregivers. Results also underscore the need to assess and develop intervention to relieve caregiving burden for family caregivers of cancer patients.

Tolerating Uncertainty in the Dark: Insomnia Symptoms, Distress, and Well-Being Among Parents of Adolescents and Young Adults with Cancer

BACKGROUND

Given the need to better understand mechanisms linking poor sleep and psychological distress in the context of chronic illness, we explored a novel factor, intolerance of uncertainty (IU), in relation to insomnia among parents of adolescents and young adults (AYAs) with cancer. We hypothesized that parents with higher IU would report greater insomnia symptoms, which would be associated with higher anxiety and depressive symptoms. These greater levels of anxiety and depressive symptoms are hypothesized to mediate the relationship between insomnia symptoms and subjective well-being (SWB).

METHOD

Surveying 59 parents of AYAs with cancer, we computed a parallel-serial mediational analysis using bootstrapping techniques for ordinary least squares regression to test two pathways (adjusting for whether the AYA currently resided with the parent). The first serial pathway was IU→insomnia symptoms→anxiety symptoms→SWB. The second pathway was IU→insomnia symptoms→depressive symptoms→SWB.

RESULTS

Although the first pathway involving sleep and anxiety as serial mediators was nonsignificant, the second pathway with sleep and depressive symptoms was significant. The relationship between IU and SWB was mediated through insomnia and depressive symptoms. An alternative serial mediation analysis wherein depressive symptoms preceded sleep was not significant, lending support to study findings.

CONCLUSION

This study provides preliminary evidence that IU's detrimental influence on depression and SWB may operate through its influence on insomnia symptoms. Given implications for parents' well-being and, likely, their subsequent capacity to care for the AYA with cancer, interventions addressing IU and disturbed sleep among this underserved population deserve attention.

Dyadic effects of distress on sleep duration in advanced cancer patients and spouse caregivers

OBJECTIVE

Short sleep duration is a common problem for both advanced cancer patients and their spouse caregivers. Sleep and distress have been shown to be interdependent in patient-caregiver and spouse dyads, yet virtually, no work has explored the dyadic effects of psychological distress on sleep in advanced cancer patients and spouse caregivers. The goal of the present study was to examine the dyadic impact of anxiety and depression on sleep duration in a sample of advanced cancer patients and their spouse caregivers. It was hypothesized that, for both patients and caregivers, anxiety and depression in individuals would be associated with sleep duration in both themselves (actor effects) and in their spouses (partner effects).

METHOD

Advanced cancer patients and their spouse caregivers (N = 87 dyads) completed cross-sectional questionnaires assessing demographic variables, subjective health, subjective sleep duration, and anxiety and depression symptoms.

RESULTS

Controlling for sex, age, and subjective health, individuals' anxiety was negatively associated with their own and their partner's sleep duration. No significant actor or partner effects were found for depression.

CONCLUSIONS

Results provided partial support for hypotheses. Although past work has demonstrated links between subjective sleep disturbance and anxiety/psychological distress, this is one of the first studies to examine partner effects of distress on sleep disturbance in advanced cancer patients and spouse caregivers.

The hidden patient: chronic physical morbidity, psychological distress, and quality of life in caregivers of older adults

AIM

Increasing demands for care provision to older adults require good physical and mental health among caregivers. Few studies have examined the health status and correlates of quality of life among caregivers of older adults. The present study therefore sought to examine the prevalence of chronic physical conditions, psychological distress, and correlates of physical and mental quality of life among caregivers of older adults (≥60 years) in Singapore.

METHODS

Participants were 285 informal caregivers who were providing care to an older relative. Participants were recruited at the Institute of Mental Health, Singapore, and they completed self-report measures on chronic physical morbidity, psychological distress, and physical and mental quality of life. Multiple regression models were constructed to examine correlates of physical and mental quality of life.

RESULTS

More than half of the caregivers had at least one chronic physical condition (58.6%) and psychological distress (52.6%). Chronic physical morbidity, psychological distress, and secondary education status were associated with lower physical quality of life. Psychological distress, younger age, primary education status, and more time spent caregiving were associated with lower mental quality of life.

CONCLUSION

Poor physical and mental health among caregivers may impair their ability to provide adequate care to older adults with progressive medical needs. It is important for medical practitioners not to neglect the physical and mental health of caregivers through continued assessment of chronic physical morbidity, psychological distress, and quality of life.

Work and Health Correlates of Sleep Quantity and Quality Among Correctional Nurses

BACKGROUND/OBJECTIVES

The correctional environment exposes nurses to unique physical and psychosocial work stressors, such as inmate violence and safety concerns. Nurses often experience short and poor sleep; however, the quantity and quality of sleep in this specialty practice group of nurses are underexplored. The study objective was to examine a wide range of work and health correlates of sleep quantity and quality in correctional nurses.

METHODS

A Web-based survey was administered to nurses within a Northeastern State Correctional Healthcare System, covering questions on sleep quantity and quality, working conditions, health outcomes, and work outcomes.

RESULTS

Among the 89 correctional nurses who participated, 56.2% reported short sleep duration (≤6 hours/day) and 31.8% reported poor sleep quality. Multivariate Poisson regression modeling suggested that night shift (prevalence ratio [PR] = 1.95, p < 0.05) and single marital status (PR = 2.25, p < 0.05) were significantly associated with increased prevalence of short sleep duration, whereas none of the work and health variables were significantly associated with increased prevalence of poor sleep quality, after adjustment for sociodemographics and other covariates.

CONCLUSION

Correctional nurses experience a high prevalence of short and poor sleep. Similar to previous studies, we found that short sleep duration was associated with night shift work. Interventions targeting work schedule remodeling (e.g., reduce the number of consecutive night shifts) and shift work coping mechanisms may promote sleep health of correctional nurses.

Randomized controlled trial of an 8-week intervention combining self-care and hypnosis for post-treatment cancer patients: study protocol

Background

Cancer has a lot of consequences on patients’ quality of life (such as cancer-related fatigue (CRF), sleep difficulties and emotional distress) and on patients’ partners and their relationship, such as distress and communication difficulties. These consequences are undertreated, and interventions based on hypnosis often focus on breast cancer patients only. This paper describes the study protocol of a longitudinal randomized controlled trial aiming to assess the efficacy of an 8-week intervention combining hypnosis and self-care to improve cancer patients’ CRF, sleep and emotional distress and to indirectly improve their partners’ distress.

Methods

A power analysis required a total sample of 88 patients. To test the efficacy of the intervention, results of the experimental group receiving the intervention will be compared to those of the control group. Data will be collected by questionnaires, relaxation tasks, an attentional bias task, and everyday life assessments measured at four different times: 1.) before inclusion in the study (baseline); 2.) after the intervention; and 3.) at 4- and 12-month follow-up. Partners’ symptoms will also be evaluated with questionnaires at the same measurement times.

Discussion

There is a growing interest in alternative approaches (such as hypnosis) in addition to standard therapies in oncology settings. The results of this study should be useful for improving knowledge about long-term efficacy of hypnosis-based group interventions for CRF, sleep and distress among all types of cancer patients and their partners, and to better understand the mechanisms of emotional regulation in cancer patients through the attentional bias task.

Trial registration

ClinicalTrials.gov (NCT03144154). Retrospectively registered on the 1st of May, 2017.

Electronic supplementary material

The online version of this article (10.1186/s12885-018-5046-6) contains supplementary material, which is available to authorized users.

Sleep Disturbance and Related Factors in Patients with Nasopharyngeal Carcinoma and Their Family Caregivers Prior to the Initiation of Treatment

Sleep disturbance is a common complaint in cancer patients. However, less is known about the parameters of sleep in patients with nasopharyngeal cancer (NPC) and their family caregivers (FCs) when they are about to begin treatment. We investigated the sleep quality in patients with NPC and their FCs before treatment and determined the related factors that predict sleep disturbance in these patients before therapy. A total of 101 patient-FC dyads were recruited. They completed the Pittsburgh Sleep Quality Index (PSQI) prior to treatment. No differences were found in sleep disturbance between patients (38.6%) and their FCs (31.7%). Patients reported significantly higher rates of short sleep duration than their FCs (P = 0.011). Logistic regression analyses showed that older patients were more prone to suffer from poor sleep quality before treatment (OR = 1.06, 95% CI = 1.01-1.10, P = 0.008), while patients with a higher BMI were less likely to experience sleep disturbance (OR = 0.83, 95% CI = 0.71-0.96, P = 0.012). Sleep disturbance is a significant problem in patients with NPC and their FCs before therapy. Older patients and those with a lower BMI appear to be more inclined to suffer from poor sleep before treatment.

Prevalence and determinants of depression in caregivers of cancer patients: A systematic review and meta-analysis

BACKGROUND

Aim of this study was to estimate the prevalence rate of depression in cancer patient caregivers and to identify factors affecting depression and quality of life of cancer caregivers.

METHODS

Relevant research articles were retrieved after literature search in several electronic databases. Random effects meta-analyses were performed to obtain pooled estimates of the prevalence rates of depression and anxiety; their respective scores, and quality of life scores. Significant relationships between depression and factors related to depression and quality of life reported in individual studies were identified.

RESULTS

Thirty studies were included. Overall, 21,149 caregivers were appraised in these studies (age 52.65 years [95% CI: 49.65, 55.65]; 31.14% [28.40, 33.89] men). The prevalence of depression and anxiety were 42.30% [33.31, 51.29] % and 46.55% [35.59, 57.52], respectively. Quality of life score, as measured with Caregiver Quality of Life-Cancer scale was 64.55 [47.44, 81.66]. Patient's condition, caregiving burden, duration of caregiving, spouse caregiver, caregiver being unemployed, caregiver with chronic disease, caregiver's sleep quality, caregiver's avoidance, financial problems, and female sex were positively associated with depression whereas overall quality of life of caregiver, pre-loss grief, caregiver's education level, caregiver's age, caregiver's sense of coherence, and caregiver's bondage with patient were negatively associated with depression in caregivers.

CONCLUSION

A considerably high prevalence of depression is found in cancer patient caregivers. Several factors may affect depression and their quality of life of cancer patient caregivers.

Sleep Pattern and Predictors of Sleep Disturbance Among Family Caregivers of Terminal Ill Patients With Cancer in Taiwan: A Longitudinal Study

Background:

Sleep disturbance commonly has a negative impact on the well-being of family caregivers (FCs) of terminally ill patients with cancer. The effect of sleep disturbance on FCs has not been explored through long-term follow-up studies in Taiwan.

Objective:

The purposes of this study were to (1) identify the trajectory of sleep quality of FCs of terminally ill patients with cancer in Taiwan and (2) examine the determinants of sleep disturbance through a longitudinal follow-up until patient death.

Methods:

A prospective, longitudinal study was conducted among 95 FCs of terminally ill patients with cancer. The FCs’ sleep quality was measured subjectively by using the Pittsburgh Sleep Quality Index and objectively by wearing a wrist actigraphy for 48 hours each month during the 6-month follow-up assessments. The trajectory and determinants of sleep quality were identified using a generalized estimation equation approach.

Results:

The FCs’ sleep quality significantly decreased as the patient’s death approached. Family caregivers who were women or older, had a relative with a longer survival period after diagnosis, reported higher levels of depression and fatigue, and provided lower levels of assistance to their relatives experienced more sleep disturbance.

Conclusion:

The sleep quality of Taiwanese FCs significantly deteriorated as the death of the terminally ill patients with cancer approached. Early detection of the FCs’ sleep disturbance, increasing their self-awareness of sleep problems, and providing nonpharmacological interventions and psychosocial support may be helpful for FCs to improve their quantity and quality of sleep.

Family Caregivers to Adults with Cancer: The Consequences of Caring

A person living with cancer will potentially have some degree of physical, cognitive, and/or psychological impairment, periods of unemployment, financial concerns, social isolation, and existential questions, any or all of which can impact the family and friends who surround them. In our current era of health care, patients with cancer receive invasive diagnostic studies and aggressive treatment as outpatients, and then convalesce at home. As such, cancer family caregivers are de facto partners with the healthcare team. The cancer family caregiver role is demanding and may lead to increased morbidity and mortality-in effect, the cancer family caregiver can become a second patient in need of care. This chapter discusses the consequences cancer family caregivers may accrue. The topics covered include caregiver mood disturbance and psychological impairment and some of the mutable factors that contribute to these states (i.e., sleep disturbance, decline in physical health, restriction of activities, and financial concerns), uncertainty, spiritual concerns, and caregiver witnessing. There is a discussion of the factors that influence the caregiving experience (caregiver characteristics, patient characteristics, and social supports). The chapter concludes with comments on intervention studies that have been conducted to ameliorate the burden of caregiving, and the state of caregiver research.

The role of informal caregivers at the end of life: providing support through Advance Care Planning

In the palliative phase of a person's illness, the needs of the patient and informal caregivers are paramount. Caregivers often look to palliative care practitioners for support, guidance and emotional comfort. This article reviews the role of the informal caregiver at the end of life, summarising their concerns and needs. The paper also highlights caregiver difficulties in making the coping transition when the patient's medical condition becomes advanced and they require end-of-life care. The focus of the review is placed on discussions about Advanced Care Planning (ACP). ACP is a complex legal, ethical and practical issue that can enable caregivers to consider future strategies and enable them to provide high quality care at the end of life. The paper looks at some of the ethical and legal issues associated with this sensitive end-of-life issue.

Advanced cancer caregiving as a risk for major depressive episodes and generalized anxiety disorder

OBJECTIVE

Caregivers of advanced cancer patients provide extensive care associated with high levels of caregiver distress. The degree to which cancer caregiving increases caregivers' risk for a psychiatric disorder is unknown. The current study examines whether advanced cancer caregiving poses distinct risks for initial and recurrent major depressive episodes (MDEs) and generalized anxiety disorder (GAD) relative to the general population.

METHODS

Caregivers of advanced cancer patients (N = 540) from Coping with Cancer were compared to general population controls (N = 9282) from the National Comorbidity Survey Replication. The general population comparison sample was propensity-weighted to be demographically similar to the caregiver sample.

RESULTS

Caregivers of advanced cancer patients were more likely than individuals in the general population to have an initial MDE (OR = 7.7; 95% CI, 3.5-17.0; P < .001), but no more likely than the general population to have a recurrent MDE (OR = 1.1; 95% CI, 0.6-2.1; P = .662). Caregivers were also more likely than the general population to have GAD (OR = 3.0; 95% CI, 1.9-4.8; P < .001) and comorbid MDE and GAD (OR = 2.5; 95% CI, 1.1-5.9; P = .038).

CONCLUSIONS

The increased risk of meeting diagnostic criteria for current MDE and GAD and comorbid MDE and GAD associated with advanced cancer caregiving highlights the degree of emotional burden among cancer caregivers. Clinical services that assess, prevent, and treat depression and anxiety in cancer caregivers are needed to reduce the burden of caregiving and improve the mental health of this growing population.

An exploration into caring for a stroke-survivor in Lima, Peru: Emotional impact, stress factors, coping mechanisms and unmet needs of informal caregivers

INTRODUCTION

Understanding local complexities and challenges of stroke-related caregiving are essential to develop appropriate interventions. Our study aimed to characterize the impact of post-stroke care among caregivers in a setting of transitioning economy.

MATERIALS AND METHODS

Qualitative study based on in-depth interviews with primary caregivers of stroke survivors in Lima, Peru. Transcribed data was organized into the emotional impact of caregiving, main stress factors and coping mechanisms to deal with the caregiving role, as well as the unmet needs of caregivers.

RESULTS

We interviewed twelve caregivers, mean age 52.5 years, 8/12 were females, who were either the spouse or child of the stroke survivor. Stroke patients had a median age of 70 years, range 53-85 years. All participants reported having experienced emotional stress and depressive symptoms as a result of caregiving. Although most had family support, reduced social activities and added unanticipated financial burdens increased caregiver's stress. None of the caregivers had received training in post-stroke care tasks after the patient's discharge and only a few had received some psychological support, yet almost all expressed the need to see a professional to improve their mental health. Keeping a positive attitude towards their relative's physical post-stroke condition was a key coping mechanism.

CONCLUSIONS

In the absence of structured institutional responses, family members endure with the provision of care for stroke survivors, a task escorted by major emotional, financial, and social strains. This burden could be prevented or curtailed if caregivers were to be targeted by interventions providing psychological and financial support, together with basic training on post-stroke care.

Sleep disturbances in caregivers of patients with advanced cancer: A systematic review

OBJECTIVE

Sleep disturbances are a common issue for those who provide informal care to someone with a life-limiting condition. The negative consequences of poor sleep are well documented. The purpose of the present study was to determine the sleep patterns of caregivers of patients with advanced cancer.

METHOD

An extensive systematic review of studies reporting empirical sleep data was undertaken in 2015 in accordance with the PRISMA Statement. A total of eight electronic databases were searched, with no date restrictions imposed. Additionally, a search of the bibliographies of the studies identified during the electronic search was conducted. Search terms included: "sleep," "insomnia," "sleep disturbance," "circadian rhythm," "caregiver," "carer," "advanced cancer," "palliative cancer," and MESH suggestions. The inclusion criteria required studies to be in English and to report primary qualitative and/or quantitative research that examined sleep in caregivers of patients with advanced cancer. Unpublished studies, conference papers, and dissertations were excluded.

RESULTS

Overall, 10 studies met the inclusion criteria and were included in the review. Two major findings emerged from the data synthesis. First, at least 72% of caregivers reported moderate to severe sleep disturbance as measured by the Pittsburgh Sleep Quality Index. Second, objective measurement of caregivers' sleep identified that some caregivers experienced up to a 44% reduction in their total sleep time compared to the recommended eight hours.

SIGNIFICANCE OF RESULTS

Reduction in total sleep time appears to be the biggest issue facing caregivers' sleep. Future studies need to explore the specific factors that cause these sleep disturbances and thus help to identify interventions to optimize sleep.

The unmet supportive care needs-what advanced lung cancer patients' caregivers need and related factors

PURPOSE

To identify the unmet supportive care needs and related factors in caregivers of patients with advanced lung cancer.

METHODS

A cross-sectional study of 166 lung cancer patient-caregivers dyads was recruited at a medical center. The supportive care needs, fatigue, and sleep disturbance of caregivers were collected. Patients were assessed for symptom severity, anxiety, and depression. Logistic regression was used to reveal the related factors of unmet supportive care needs.

RESULTS

Of the 166 dyads surveyed, the top unmet needs were information needs, health care professional/health care service needs, and daily living needs. Patients' anxiety was positively correlated to overall caregiving needs, health care professional/health care service needs, interpersonal communication needs, and psychological/emotional needs of caregivers. The information needs and health care professional/health care service needs were related to the caregivers' fatigue. The sleep disturbance of caregivers was associated with their overall caregiving needs, daily living needs, and psychological/emotional needs.

CONCLUSIONS

Future interventions to meet the needs of caregivers should include specific needs assessment and continuing education in caregiving.

Contributing influences of work environment on sleep quantity and quality of nursing assistants in long-term care facilities: A cross-sectional study

The effect of shift work on nurses' sleep is well-studied, but there are other challenging aspects of health care work that might also affect the sleep of direct caregivers. This study examined the influence of the long-term care work environment on sleep quantity and quality of nursing assistants. A cross-sectional survey collected data from 650 nursing assistants in 15 long-term care facilities; 46% reported short sleep duration and 23% reported poor sleep quality. A simple additive index of the number of beneficial work features (up to 7) was constructed for analysis with Poisson regression. With each unit increase of beneficial work features, nursing assistants were 7% less likely to report short sleep duration and 17% less likely to report poor sleep quality. These results suggest that effective workplace interventions should address a variety of work stressors, not only work schedule arrangements, in order to improve nursing assistants' sleep health.