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Sanders JJ, Temin S, Ghoshal A, Alesi ER, Ali ZV, Chauhan C, Cleary JF, Epstein AS, Firn JI, Jones JA, Litzow MR, Lundquist D, Mardones MA, Nipp RD, Rabow MW, Rosa WE, Zimmermann C, Ferrell BR. Palliative Care for Patients With Cancer: ASCO Guideline Update. J Clin Oncol 2024; 42:2336-2357. [PMID: 38748941 DOI: 10.1200/jco.24.00542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 03/22/2024] [Accepted: 03/28/2024] [Indexed: 06/28/2024] Open
Abstract
PURPOSE To provide evidence-based guidance to oncology clinicians, patients, nonprofessional caregivers, and palliative care clinicians to update the 2016 ASCO guideline on the integration of palliative care into standard oncology for all patients diagnosed with cancer. METHODS ASCO convened an Expert Panel of medical, radiation, hematology-oncology, oncology nursing, palliative care, social work, ethics, advocacy, and psycho-oncology experts. The Panel conducted a literature search, including systematic reviews, meta-analyses, and randomized controlled trials published from 2015-2023. Outcomes of interest included quality of life (QOL), patient satisfaction, physical and psychological symptoms, survival, and caregiver burden. Expert Panel members used available evidence and informal consensus to develop evidence-based guideline recommendations. RESULTS The literature search identified 52 relevant studies to inform the evidence base for this guideline. RECOMMENDATIONS Evidence-based recommendations address the integration of palliative care in oncology. Oncology clinicians should refer patients with advanced solid tumors and hematologic malignancies to specialized interdisciplinary palliative care teams that provide outpatient and inpatient care beginning early in the course of the disease, alongside active treatment of their cancer. For patients with cancer with unaddressed physical, psychosocial, or spiritual distress, cancer care programs should provide dedicated specialist palliative care services complementing existing or emerging supportive care interventions. Oncology clinicians from across the interdisciplinary cancer care team may refer the caregivers (eg, family, chosen family, and friends) of patients with cancer to palliative care teams for additional support. The Expert Panel suggests early palliative care involvement, especially for patients with uncontrolled symptoms and QOL concerns. Clinicians caring for patients with solid tumors on phase I cancer trials may also refer them to specialist palliative care.Additional information is available at www.asco.org/supportive-care-guidelines.
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Affiliation(s)
| | - Sarah Temin
- American Society of Clinical Oncology (ASCO), Alexandria, VA
| | - Arun Ghoshal
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Erin R Alesi
- Virginia Commonwealth University Health System, Massey Cancer Center, Richmond, VA
| | | | | | - James F Cleary
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN
| | | | | | | | | | | | | | | | - Michael W Rabow
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
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Kaufman BG, Huang RW, Holland DE, Vanderboom CE, Ingram C, Wild EM, Dose AM, Stiles C, Gustavson AM, Mandrekar J, Van Houtven CH, Griffin JM. Healthcare use and out-of-pocket costs for rural family caregivers and care recipients in a randomized controlled trial. J Am Geriatr Soc 2024. [PMID: 38698643 DOI: 10.1111/jgs.18934] [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: 10/09/2023] [Revised: 03/19/2024] [Accepted: 03/29/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND Rural family caregivers (FCGs) in the United States often experience high economic costs. This randomized controlled trial compared a transitional palliative care intervention (TPC) to support FCGs of seriously ill care recipients (CRs) to an attention control condition. We evaluated the TPC's effect on healthcare use and out-of-pocket spending for both FCGs and CRs. METHODS TPC FCGs received teaching, guidance, and counseling via video calls for 8 weeks following CR discharge from the hospital. After discharge, a research assistant called all FCGs once a month for up to 6 months or CR death to collect self-reported healthcare utilization (e.g., outpatient, emergency department, and hospital), out-of-pocket healthcare spending (e.g., deductibles and coinsurance), and health-related travel costs (e.g., transportation, lodging, food) for FCGs and CRs. Incidence rate ratios (IRRs) were estimated using negative binomial regressions. RESULTS The study included 282 FCG-CR dyads across three U.S. states. Follow-up over the 6-month period was shortened by high CR mortality rates across both arms (29%), but was similar across arms. TPC reduced nights in the hospital for CR (IRR = 0.75; 95% confidence interval [CI] = 0.56-0. 99). Total out-of-pocket spending was not significantly different for TPC versus control. Across both groups, mean out-of-pocket spending for dyads was $1401.85, with healthcare payments contributing $1048.58 and transportation expenses contributing $136.79. TPC dyads reported lower lodging costs (IRR = 0.71; 95% CI = 0.56-0.89). CONCLUSIONS This study contributes to evidence that palliative care interventions reduce the number of nights in the hospital for seriously ill patients. Yet, overall rural FCGs and seriously ill CRs experience substantial out-of-pocket economic costs in the 6 months following hospitalization. Transitional care intervention design should consider impacts on patient and caregiver spending. CLINICALTRIALS gov # is NCT03339271.
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Affiliation(s)
- Brystana G Kaufman
- Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Margolis Institute for Health Policy, Duke University, Durham, North Carolina, USA
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, North Carolina, USA
| | - Ro W Huang
- Margolis Institute for Health Policy, Duke University, Durham, North Carolina, USA
| | - Diane E Holland
- Kern Center for the Science of Healthcare Delivery Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Catherine E Vanderboom
- Kern Center for the Science of Healthcare Delivery Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Cory Ingram
- Department of Community Internal Medicine, Geriatrics, and Palliative Care, Mayo Clinic, Rochester, Minnesota, USA
| | - Ellen M Wild
- Department of Palliative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Ann Marie Dose
- Kern Center for the Science of Healthcare Delivery Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Carole Stiles
- Kern Center for the Science of Healthcare Delivery Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Allison M Gustavson
- Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Healthcare System, Minneapolis, Minnesota, USA
- Department of Medicine, University of Minnesota, Rochester, Minnesota, USA
| | - Jay Mandrekar
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Courtney H Van Houtven
- Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Margolis Institute for Health Policy, Duke University, Durham, North Carolina, USA
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, North Carolina, USA
| | - Joan M Griffin
- Kern Center for the Science of Healthcare Delivery Research, Mayo Clinic, Rochester, Minnesota, USA
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, Minnesota, USA
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Cui P, Yang M, Hu H, Cheng C, Chen X, Shi J, Li S, Chen C, Zhang H. The impact of caregiver burden on quality of life in family caregivers of patients with advanced cancer: a moderated mediation analysis of the role of psychological distress and family resilience. BMC Public Health 2024; 24:817. [PMID: 38491454 PMCID: PMC10941369 DOI: 10.1186/s12889-024-18321-3] [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: 09/18/2023] [Accepted: 03/10/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND The caregiver burden frequently experienced by family members tending to advanced cancer patients significantly impacts their psychological well-being and quality of life (QoL). Although family resilience might function as a mitigating factor in this relationship, its specific role remains to be elucidated. This study aims to probe the mediating effect of psychological distress on the relationship between caregiver burden and QoL, as well as the moderating effect of family resilience. METHODS A cross-sectional study was conducted between June 2020 and March 2021 in five tertiary hospitals in China. Data were collected on caregiver burden, family resilience, psychological distress (including anxiety and depression), and QoL. Moderated mediation analysis was performed. RESULTS Data analysis included 290 caregivers. It confirmed the mediating role of psychological distress in the caregiver burden-QoL relationship (P < 0.001). Both overall family resilience and the specific dimension of family communication and problem-solving (FCPS) demonstrated significant moderating effects on the "psychological distress/anxiety-QoL" paths (P < 0.05). The utilization of social and economic resources (USER) significantly moderated the association between depression and QoL (P < 0.05). CONCLUSIONS The study corroborates psychological distress's mediation between caregiver burden and QoL and family resilience's moderation between psychological distress and QoL. It underscores the need for minimizing psychological distress and bolstering family resilience among caregivers of advanced cancer patients. Accordingly, interventions should be tailored, inclusive of psychological assistance and promotion of family resilience, particularly focusing on FCPS and USER, to augment the caregivers' well-being and QoL.
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Affiliation(s)
- Panpan Cui
- Department of Nursing, Henan Provincial Key Medicine Laboratory of Nursing, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, No. 7 Weiwu Road, Zhengzhou, China
- School of Nursing, Zhengzhou University, Zhengzhou, China
| | - Ming Yang
- Nursing Department, Xinyang Central Hospital, Xinyang, China
| | - Hengyu Hu
- Department of Nursing, Henan Provincial Key Medicine Laboratory of Nursing, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, No. 7 Weiwu Road, Zhengzhou, China
| | - Chunyan Cheng
- Hemangiomatology Department, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Xinyi Chen
- Medical Oncology, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Jiaoxia Shi
- Medical Oncology, People's Hospital of Jiaozuo City, Jiaozuo, China
| | - Shifeng Li
- Medical Oncology, Xinyang Central Hospital, Xinyang, China
| | - Changying Chen
- The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe Dong Road, Zhengzhou, China.
- Institute for Hospital Management of Henan Province, Zhengzhou, China.
| | - Hongmei Zhang
- Department of Nursing, Henan Provincial Key Medicine Laboratory of Nursing, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, No. 7 Weiwu Road, Zhengzhou, China.
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Ritschl V, Stamm T, Selzer A, Boesendorfer A, Eibensteiner F, Kaltenegger L, Mosor E, Omara M, Vachuda N, Sperl L, Masel EK, Aufricht C, Boehm M. Life outcomes after paediatric kidney transplantation: a qualitative, biographical study in long-term survivors. Arch Dis Child 2024; 109:240-246. [PMID: 38212079 PMCID: PMC10894829 DOI: 10.1136/archdischild-2023-326432] [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: 10/09/2023] [Accepted: 12/06/2023] [Indexed: 01/13/2024]
Abstract
OBJECTIVE The objective of this study was to analyse the narrative life stories of children with end-stage kidney disease (ESKD) and their families to determine how health professionals can effectively support these children to achieve better life outcomes. DESIGN Qualitative narrative biographic study. SETTING We invited every long-term survivor of paediatric kidney transplants and their families at the Medical University of Vienna between 2008 and 2013 to participate in this study. PARTICIPANTS Nineteen patients (women: n=8, 42%) and 34 family members (women: n=22, 65%) were interviewed. The patients had a mean age of 7.6 (SD±5.6) years at the time of transplantation and 22.2 (SD±5.4) at the time of interview. MAIN OUTCOMES MEASURES A qualitative narrative biographical analysis was combined with computational structured topic models using the Latent Dirichlet Allocation. RESULTS The overarching finding was the desire for normality in daily life in long-term survivors and their families but with different perceptions of what normality looks like and predominance of this aspect evolving. Different strategies were used by patients (focused on their advancement) and caregivers (normality for all family members). Siblings played a major role in supporting survivors' social inclusion. CONCLUSIONS The strong desire for normality confirms recent findings of the Standardised Outcomes in Nephrology Group initiative, which proposes survival and life participation as core outcomes in children with chronic kidney disease. Our study should be a starting point for an international effort to identify typologies and stratified interventions for children with ESKD and their families, particularly siblings.
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Affiliation(s)
- Valentin Ritschl
- Institute for Outcomes Research, Centre for Medical Data Science, Medical University of Vienna, Wien, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Tanja Stamm
- Institute for Outcomes Research, Centre for Medical Data Science, Medical University of Vienna, Wien, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Axana Selzer
- Division of Pediatric Nephrology and Gastroenterology, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Wien, Austria
| | - Anna Boesendorfer
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Wien, Austria
| | - Fabian Eibensteiner
- Division of Pediatric Nephrology and Gastroenterology, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Wien, Austria
| | - Lukas Kaltenegger
- Division of Pediatric Nephrology and Gastroenterology, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Wien, Austria
| | - Erika Mosor
- Institute for Outcomes Research, Centre for Medical Data Science, Medical University of Vienna, Wien, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Maisa Omara
- Institute for Outcomes Research, Centre for Medical Data Science, Medical University of Vienna, Wien, Austria
| | - Natalie Vachuda
- Institute for Outcomes Research, Centre for Medical Data Science, Medical University of Vienna, Wien, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Lisa Sperl
- Institute for Outcomes Research, Centre for Medical Data Science, Medical University of Vienna, Wien, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Eva K Masel
- Division of Palliative Medicine, Department of Medicine I, Medical University of Vienna, Wien, Austria
| | - Christoph Aufricht
- Division of Pediatric Nephrology and Gastroenterology, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Wien, Austria
| | - Michael Boehm
- Division of Pediatric Nephrology and Gastroenterology, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Wien, Austria
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Zhang Y, Flannery M, Zhang Z, Underhill-Blazey M, Bobry M, Leblanc N, Rodriguez D, Zhang C. Digital Health Psychosocial Intervention in Adult Patients With Cancer and Their Families: Systematic Review and Meta-Analysis. JMIR Cancer 2024; 10:e46116. [PMID: 38315546 PMCID: PMC10877499 DOI: 10.2196/46116] [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: 02/01/2023] [Revised: 11/13/2023] [Accepted: 12/06/2023] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Patients with cancer and their families often experience significant distress and deterioration in their quality of life. Psychosocial interventions were used to address patients' and families' psychosocial needs. Digital technology is increasingly being used to deliver psychosocial interventions to patients with cancer and their families. OBJECTIVE A systematic review and meta-analysis were conducted to review the characteristics and effectiveness of digital health interventions on psychosocial outcomes in adult patients with cancer and their family members. METHODS Databases (PubMed, Cochrane Library, Web of Science, Embase, CINAHL, PsycINFO, ProQuest Dissertations and Theses Global, and ClinicalTrials.gov) were searched for randomized controlled trials (RCTs) or quasi-experimental studies that tested the effects of a digital intervention on psychosocial outcomes. The Joanna Briggs Institute's critical appraisal checklists for RCTs and quasi-experimental studies were used to assess quality. Standardized mean differences (ie, Hedges g) were calculated to compare intervention effectiveness. Subgroup analysis was planned to examine the effect of delivery mode, duration of the intervention, type of control, and dosage on outcomes using a random-effects modeling approach. RESULTS A total of 65 studies involving 10,361 patients (mean 159, SD 166; range 9-803 patients per study) and 1045 caregivers or partners (mean 16, SD 54; range 9-244 caregivers or partners per study) were included in the systematic review. Of these, 32 studies were included in a meta-analysis of the effects of digital health interventions on quality of life, anxiety, depression, distress, and self-efficacy. Overall, the RCT studies' general quality was mixed (applicable scores: mean 0.61, SD 0.12; range 0.38-0.91). Quasi-experimental studies were generally of moderate to high quality (applicable scores: mean 0.75, SD 0.08; range 0.63-0.89). Psychoeducation and cognitive-behavioral strategies were commonly used. More than half (n=38, 59%) did not identify a conceptual or theoretical framework. Most interventions were delivered through the internet (n=40, 62%). The median number of intervention sessions was 6 (range 1-56). The frequency of the intervention was highly variable, with self-paced (n=26, 40%) being the most common. The median duration was 8 weeks. The meta-analysis results showed that digital psychosocial interventions were effective in improving patients' quality of life with a small effect size (Hedges g=0.05, 95% CI -0.01 to 0.10; I2=42.7%; P=.01). The interventions effectively reduced anxiety and depression symptoms in patients, as shown by moderate effect sizes on Hospital Anxiety and Depression Scale total scores (Hedges g=-0.72, 95% CI -1.89 to 0.46; I2=97.6%; P<.001). CONCLUSIONS This study demonstrated the effectiveness of digital health interventions on quality of life, anxiety, and depression in patients. Future research with a clear description of the methodology to enhance the ability to perform meta-analysis is needed. Moreover, this study provides preliminary evidence to support the integration of existing digital health psychosocial interventions in clinical practice. TRIAL REGISTRATION PROSPERO CRD42020189698; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=189698.
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Affiliation(s)
- Yingzi Zhang
- Magnet Program and Nursing Research Department, UT Southwestern Medical Center, Dallas, TX, United States
| | - Marie Flannery
- School of Nursing, University of Rochester Medical Center, Rochester, NY, United States
| | - Zhihong Zhang
- School of Nursing, University of Rochester Medical Center, Rochester, NY, United States
| | | | - Melanie Bobry
- School of Nursing, University of Rochester Medical Center, Rochester, NY, United States
| | - Natalie Leblanc
- School of Nursing, University of Rochester Medical Center, Rochester, NY, United States
| | - Darcey Rodriguez
- Edward G Miner Library, University of Rochester Medical Center, Rochester, NY, United States
| | - Chen Zhang
- School of Nursing, University of Rochester Medical Center, Rochester, NY, United States
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Low NJH, Leow DGW, Klainin-Yobas P. Effectiveness of Technology-Based Psychosocial Interventions on Psychological Outcomes Among Adult Cancer Patients and Caregivers: A Systematic Review and Meta-Analysis. Semin Oncol Nurs 2024; 40:151533. [PMID: 37977974 DOI: 10.1016/j.soncn.2023.151533] [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: 05/11/2023] [Revised: 10/12/2023] [Accepted: 10/16/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVE Technology-based psychosocial interventions (TBPIs) have increasingly gained intention. However, the effectiveness of TBPIs on psychological outcomes remains inconclusive. This review aimed to evaluate the effectiveness of TBPIs on health-related quality of life (HRQOL), coping, self-efficacy, and depression among adult cancer patients and caregivers. DATA SOURCES Randomised controlled trials (RCTs) evaluating the effectiveness of TBPIs targeting adult cancer patients, caregivers, or patient-caregiver dyads were included. English articles dated from 2012 to 2022 were retrieved from eight electronic databases, three clinical trial registries, and six grey literature databases. Two reviewers independently screened, appraised, and extracted data. The Cochrane risk of bias assessment tool and GRADE were used to appraise the methodological quality of included studies. Meta-analyses and subgroup analyses were undertaken with statistical pooling of standardized mean differences based on the random-effects model. CONCLUSION Totally, 37 RCTs were included in the review, with 35 trials for meta-analysis. Results demonstrated improvements in HRQOL, self-efficacy, and depression among cancer patients and caregivers with varying pooled effect sizes. Subgroup analyses suggested that dyadic TBPIs were more effective in improving HRQOL among cancer patients and caregivers, compared with those solely targeted at cancer patients or caregivers. IMPLICATION FOR NURSING PRACTICE Findings value-added to the existing evidence base on TBPIs. An interactive patient-caregiver dyadic program integrating TBPIs into routine oncology care is recommended to improve health outcomes for cancer patients and caregivers. Well-designed future RCTs are required to further evaluate the effectiveness of dyadic TBPIs, with emphasis on coping and self-efficacy outcomes among cancer patients and caregivers.
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Affiliation(s)
| | - Darryl Ge Wei Leow
- Staff Nurse, Woodlands Health Campus, Yishun Community Hospital, Singapore
| | - Piyanee Klainin-Yobas
- Associate Professor, Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore
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Chow R, Mathews JJ, Cheng EY, Lo S, Wong J, Alam S, Hannon B, Rodin G, Nissim R, Hales S, Kavalieratos D, Quinn KL, Tomlinson G, Zimmermann C. Interventions to improve outcomes for caregivers of patients with advanced cancer: a meta-analysis. J Natl Cancer Inst 2023; 115:896-908. [PMID: 37279594 PMCID: PMC10407714 DOI: 10.1093/jnci/djad075] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 04/04/2023] [Accepted: 05/01/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Family caregivers of patients with advanced cancer often have poor quality of life (QOL) and mental health. We examined the effectiveness of interventions offering support for caregivers of patients with advanced cancer on caregiver QOL and mental health outcomes. METHODS We searched Ovid MEDLINE, EMBASE, Cochrane CENTRAL, and Cumulative Index to Nursing and Allied Health Literature databases from inception through June 2021. Eligible studies reported on randomized controlled trials for adult caregivers of adult patients with advanced cancer. Meta-analysis was conducted for primary outcomes of QOL, physical well-being, mental well-being, anxiety, and depression, from baseline to follow-up of 1-3 months; secondary endpoints were these outcomes at 4-6 months and additional caregiver burden, self-efficacy, family functioning, and bereavement outcomes. Random effects models were used to generate summary standardized mean differences (SMD). RESULTS Of 12 193 references identified, 56 articles reporting on 49 trials involving 8554 caregivers were eligible for analysis; 16 (33%) targeted caregivers, 19 (39%) patient-caregiver dyads, and 14 (29%) patients and their families. At 1- to 3-month follow-up, interventions had a statistically significant effect on overall QOL (SMD = 0.24, 95% confidence interval [CI] = 0.10 to 0.39); I2 = 52.0%), mental well-being (SMD = 0.14, 95% CI = 0.02 to 0.25; I2 = 0.0%), anxiety (SMD = 0.27, 95% CI = 0.06 to 0.49; I2 = 74.0%), and depression (SMD = 0.34, 95% CI = 0.16 to 0.52; I2 = 64.4) compared with standard care. In narrative synthesis, interventions demonstrated improvements in caregiver self-efficacy and grief. CONCLUSIONS Interventions targeting caregivers, dyads, or patients and families led to improvements in caregiver QOL and mental health. These data support the routine provision of interventions to improve well-being in caregivers of patients with advanced cancer.
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Affiliation(s)
- Ronald Chow
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jean J Mathews
- Division of Palliative Medicine, Department of Medicine and Department of Oncology, Queen’s University, Kingston, ON, Canada
| | - Emily YiQin Cheng
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Samantha Lo
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Joanne Wong
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Sorayya Alam
- Palliative Medicine, Sobell House, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Breffni Hannon
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Medicine, University Health Network, Toronto, ON, Canada
| | - Gary Rodin
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Centre for Mental Health, University Health Network, Toronto, ON, Canada
| | - Rinat Nissim
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Centre for Mental Health, University Health Network, Toronto, ON, Canada
| | - Sarah Hales
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Centre for Mental Health, University Health Network, Toronto, ON, Canada
| | - Dio Kavalieratos
- Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University, Atlanta, GA, USA
| | - Kieran L Quinn
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Division of General Internal Medicine and Palliative Care, Department of Medicine, Sinai Health System, Temmy Latner Centre for Palliative Care, Toronto, ON, Canada
| | - George Tomlinson
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Medicine, University Health Network, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Camilla Zimmermann
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Medicine, University Health Network, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Chen Y, Qiao C, Zhang X, Li W, Yang H. The Effect of Tele-palliative Care on Patient and Caregiver Outcomes: A Systematic Review. Am J Hosp Palliat Care 2023; 40:907-925. [PMID: 36113129 DOI: 10.1177/10499091221123566] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
Objectives: To describe the use of tele-palliative care in patients with advanced disease and assess its effectiveness on quality of life (QOL), symptom burden and other outcomes for patients and their caregivers. Methods: We searched for randomised controlled trials to assess the outcomes of tele-palliative care on patients with advanced disease and their caregivers. Eight databases were searched for studies published in Chinese or English from inception to November 27, 2021. Data from the included trials were extracted independently by 2 reviewers and evaluated independently for methodological quality using the Cochrane Collaboration's tool. A narrative synthesis of the results of all trials was performed. Results: Thirty trials were included ultimately with more than one half of the studies were moderate to high quality, including, which involved 19 665 patients and 1153 caregivers. Results from 10/15 included trials (reporting patient QOL), 5/14 trials (reporting patient symptoms), 1/3 trials (reporting survival), 8/13 trials (reporting patient mood), 3/6 trials (reporting ACP related indicators), 3/7 trials (reporting resource utilization) showed statistically significant between tele-palliative care and control care groups. Of 30 trials, 8 measured caregiver outcomes, 1/4 trials (reporting caregiver QOL) showed statistically significant, and results from 3/3 trials (reporting caregiver mood), 3/4 trials (reporting caregiver burden) showed benefit in at least 1 domain at 1 or more time points. Conclusions: This systematic review suggests that although tele-palliative care can improve patient physical, patient and caregiver psychological health outcomes to some extent, there is still a lack of sufficient evidence to substantiate its application effects. Moreever, regional and cultural characteristics should also be taken into account when tele-palliative care interventions are carried out.
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Affiliation(s)
- Yiping Chen
- School of nursing, Shanxi Medical University, Shanxi Province, China
- Department of Neurology, First Hospital of Shanxi Medical University, Shanxi Province, China
| | - Caihong Qiao
- Department of Neurology, First Hospital of Shanxi Medical University, Shanxi Province, China
| | - Xianhui Zhang
- School of nursing, Shanxi Medical University, Shanxi Province, China
- Department of Neurology, First Hospital of Shanxi Medical University, Shanxi Province, China
| | - Wei Li
- International Medical Department, Peking Union Medical College Hospital, Beijing, China
| | - Hui Yang
- School of nursing, Shanxi Medical University, Shanxi Province, China
- Department of Neurology, First Hospital of Shanxi Medical University, Shanxi Province, China
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Holloway EE, Gray S, Halliday J, Harrap B, Hines C, Skinner TC, Speight J, Hendrieckx C. Feasibility and acceptability of 'low-intensity mental health support via a telehealth-enabled network' for adults with type 1 and type 2 diabetes: the LISTEN pilot study. Pilot Feasibility Stud 2023; 9:133. [PMID: 37501203 PMCID: PMC10373371 DOI: 10.1186/s40814-023-01367-2] [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: 11/12/2022] [Accepted: 07/18/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND This study examined the feasibility and acceptability of the low-intensity mental health support via telehealth-enabled network (LISTEN) intervention, for adults with diabetes, facilitated by diabetes health professionals (HPs). METHODS LISTEN training. Three HPs participated in three half-day online workshops and applied their learnings during training cases (maximum four). Competency was assessed with a validated tool and achieved 'satisfactory' ratings for three consecutive sessions. LISTEN pilot. A single-group, pre-post study (up to four LISTEN sessions) with online assessments at baseline, post-intervention, and 4-week follow-up. Eligible participants were adults with type 1 or type 2 diabetes, with diabetes distress, but excluded if they had moderate/severe depressive and/or anxiety symptoms. Feasibility was assessed via recruitment and session completion rates. Acceptability was assessed with post-intervention self-report data. Changes in diabetes distress and general emotional well-being from baseline (T1) were explored at post-intervention (T2) and at 4-week follow-up (T3). RESULTS Two HPs achieved competency (median training case sessions required: 7) and progressed to deliver LISTEN in the pilot study. In the pilot, N = 16 adults (Med [IQR] age: 60 [37-73] years; 13 women) with diabetes participated (median sessions per participant: 2). Twelve participants (75%) completed the post-intervention assessment (T2): 92% endorsed the number of sessions offered as 'just right', 75% felt comfortable talking with the HP, and 67% were satisfied with LISTEN. Perceived limitations were the structured format and narrow scope of problems addressed. Diabetes distress scores were lower post-intervention. CONCLUSIONS This pilot demonstrates the feasibility of training HPs to deliver LISTEN, and the acceptability and potential benefits of LISTEN for adults with diabetes. The findings highlight adaptations that may enhance the delivery of, and satisfaction with, LISTEN that will be tested in a hybrid type 1 effectiveness-implementation trial.
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Affiliation(s)
- Edith E Holloway
- School of Psychology, Deakin University, Geelong, VIC, Australia.
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, ACBRD, 570 Elizabeth Street, Melbourne, VIC, 3000, Australia.
- Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, VIC, Australia.
| | - Shikha Gray
- School of Psychology, Deakin University, Geelong, VIC, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, ACBRD, 570 Elizabeth Street, Melbourne, VIC, 3000, Australia
| | - Jennifer Halliday
- School of Psychology, Deakin University, Geelong, VIC, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, ACBRD, 570 Elizabeth Street, Melbourne, VIC, 3000, Australia
- Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - Benjamin Harrap
- Deakin Rural Health, School of Medicine, Deakin University, Warrnambool, VIC, Australia
| | | | - Timothy C Skinner
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, ACBRD, 570 Elizabeth Street, Melbourne, VIC, 3000, Australia
- La Trobe Rural Health School, La Trobe University, Flora Hill, VIC, Australia
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Jane Speight
- School of Psychology, Deakin University, Geelong, VIC, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, ACBRD, 570 Elizabeth Street, Melbourne, VIC, 3000, Australia
- Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - Christel Hendrieckx
- School of Psychology, Deakin University, Geelong, VIC, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, ACBRD, 570 Elizabeth Street, Melbourne, VIC, 3000, Australia
- Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, VIC, Australia
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10
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Mathews JJ, Chow R, Wennberg E, Lau J, Hannon B, Zimmermann C. Telehealth palliative care interventions for patients with advanced cancer: a scoping review. Support Care Cancer 2023; 31:451. [PMID: 37421447 DOI: 10.1007/s00520-023-07907-z] [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: 05/24/2023] [Accepted: 06/26/2023] [Indexed: 07/10/2023]
Abstract
PURPOSE Telehealth allows patients to maintain contact with healthcare providers without necessitating travel, and is becoming increasingly utilized. The purpose of this study is to describe the components of telehealth palliative care interventions for patients with advanced cancer before the COVID-19 pandemic; identify any intervention components associated with improvements in outcomes; and evaluate reporting of interventions. METHODS This scoping review was registered on the Open Science Framework. We searched 5 medical databases from inception to June 19, 2020. Inclusion criteria were: age ≥ 18, advanced cancer, asynchronous or synchronous telehealth intervention, and specialized palliative care interventions in any setting. We assessed the quality of intervention reporting using the Template for Intervention Description and Replication (TIDieR) checklist. RESULTS Twenty-three studies met the inclusion criteria: 15 (65%) quantitative (7 randomized controlled trials, 5 feasibility trials, 3 retrospective chart reviews); 4 (17%) mixed methods, and 4 (17%) qualitative. Most quantitative and mixed methods studies were conducted in North America (12/19, 63%), reported on hybrid (in-person and telehealth) interventions (9/19, 47%), and were delivered by nurses (12/19, 63%) in the home setting (14/19, 74%). In most studies that reported improvements in patient- or caregiver-reported outcomes, the content was psychoeducational and resulted in improvements for psychological symptoms. No study provided complete reporting on all 12 TIDieR checklist items. CONCLUSION Telehealth studies are needed that reflect palliative care's mission to provide multidisciplinary team-based care that improves quality of life in diverse settings, and that provide detailed reporting of interventions.
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Affiliation(s)
- Jean Jacob Mathews
- Division of Palliative Medicine, Department of Medicine and Department of Oncology, Queen's University, Kingston, Ontario, Canada
| | - Ronald Chow
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 620 University Ave, 12-300, Toronto, Ontario, M5G 2C1, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Erica Wennberg
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Jenny Lau
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 620 University Ave, 12-300, Toronto, Ontario, M5G 2C1, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Palliative Care, Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Breffni Hannon
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 620 University Ave, 12-300, Toronto, Ontario, M5G 2C1, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Palliative Care, Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Camilla Zimmermann
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 620 University Ave, 12-300, Toronto, Ontario, M5G 2C1, Canada.
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
- Division of Palliative Care, Department of Medicine, University Health Network, Toronto, Ontario, Canada.
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11
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Benson JJ, Washington KT, Landon OJ, Chakurian DE, Demiris G, Parker Oliver D. When Family Life Contributes to Cancer Caregiver Burden in Palliative Care. JOURNAL OF FAMILY NURSING 2023:10748407231167545. [PMID: 37190779 DOI: 10.1177/10748407231167545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
The difficulties of caring for a family member with advanced cancer are well documented. Support from a caregiver's social network-especially other family-is vital to reducing caregiver burden and psychological distress. However, the family environment is not always supportive as reports of family conflict and dissatisfaction with support are common. Despite knowing that family relationships are complex, little is known about the types of family stress that caregivers of advanced cancer patients face in their daily lives. To address this gap, researchers applied concepts from the double ABCX model to conduct a reflexive thematic analysis of interviews with 63 caregivers of cancer patients receiving outpatient palliative care. Four themes of family stress were identified: failed support, relational tensions, denial, and additional care work. Findings inform clinical assessment and caregiver intervention development by revealing the importance of measuring the mundane machinations of family life for caregivers of adult cancer patients.
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12
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Guerra-Martín MD, Casado-Espinosa MDR, Gavira-López Y, Holgado-Castro C, López-Latorre I, Borrallo-Riego Á. Quality of Life in Caregivers of Cancer Patients: A Literature Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1570. [PMID: 36674325 PMCID: PMC9863368 DOI: 10.3390/ijerph20021570] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/11/2023] [Accepted: 01/12/2023] [Indexed: 06/17/2023]
Abstract
(1) Background: Cancer constitutes one of the principal causes of morbi-mortality in the world and generates an important loss of patients' self-sufficiency. People who are their caregivers usually become the main care providers, which impacts their quality of life; (2) Aim: Analyze the different problems (physical, emotional, social, and financial) faced by people who are caregivers of adults with cancer and describe the strategies required to improve their quality of life; (3) Method: A literature review was conducted on the following database: PubMed, Cinahl, PsycINFO, and Scopus. The following eligibility criteria were specified: (a) research studies of quantitative, qualitative, or mixed methods, (b) consistent with objective, and (c) published in the English language or Spanish during the last five years; (4) Results: 36 studies were selected from those found in the literature. Regarding the problems mentioned: eight studies described physical issues, 26 emotional effects, 10 social implications, and seven financial strains. Twenty-eight studies described strategies to improve the quality of life of caregivers; (5) Conclusions: Caregivers are usually women around the age of 50. Problems faced are mostly emotional in nature, followed by social, physical, and financial ones. In order to cope with this burden, there are some strategies that can be developed to help to build skills to manage both the disease and the impact derived from it, therefore improving their quality of life.
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Affiliation(s)
- María Dolores Guerra-Martín
- Department of Nursing, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, 41009 Seville, Spain
| | | | - Yelena Gavira-López
- Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, 41009 Seville, Spain
| | | | | | - Álvaro Borrallo-Riego
- Department of Nursing, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, 41009 Seville, Spain
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13
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Nuwamanya S, Nkola R, Najjuka SM, Nabulo H, Al-Mamun F, Mamun MA, Kaggwa MM. Depression in Ugandan caregivers of cancer patients: The role of coping strategies and social support. Psychooncology 2023; 32:113-124. [PMID: 36289590 DOI: 10.1002/pon.6057] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 08/06/2022] [Accepted: 09/28/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Palliative care services involve the psychological care of the caregivers of cancer patients. Psychological conditions, especially depression among caregivers, distort caregiving roles; thus, it can increase a patient's psychological suffering. OBJECTIVE To determine the prevalence of depression and associated coping strategies among caregivers of cancer patients at a rural cancer care facility. METHODS This cross-sectional study was among 366 caregivers of cancer patients. The data was collected using a pretested questionnaire, where the symptoms of depression were assessed using the Patient Health Questionnaire-9 at a cutoff of 10 out of 27. The coping strategies were assessed based on the Brief-coping orientation to problems experienced Inventory. Logistic regression was used to determine the factors associated with depression. RESULTS The mean age of the participants was 39.01 (±11.50) years; most were females (60.38%). The prevalence of depression was 8.2%. The identified factors associated with increased likelihood of depression were coping strategies: active coping (aOR = 1.55, 95% Confidence Interval (CI) = 1.05-2.28, p = 0.026), denial (aOR = 1.62, 95% CI = 1.20-2.19, p = 0.001), and humor (aOR = 1.43, 95% CI = 1.11-1.84, p = 0.005). However, coping with positive reframing reduced the likelihood of depression (aOR = 0.70, 95% CI = 0.52-0.94, p = 0.019). There was no significant association between depression and social support. CONCLUSION The lower prevalence of depression reported in this study than in the prior Ugandan studies reflects that depression severity among caregivers in rural settings is less prevalent because of the fewer care-associated burdens they experience. Therefore, establishing palliative care near the patients can be a protective factor for caregivers' depression. In addition, the role of social support and coping strategies in depression might be helpful in mental health strategies.
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Affiliation(s)
- Simpson Nuwamanya
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Rahel Nkola
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.,African Centre for Suicide Prevention and Research, Mbarara, Uganda
| | | | - Harriet Nabulo
- Department of Nursing, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Firoj Al-Mamun
- CHINTA Research Bangladesh, Savar, Dhaka, Bangladesh.,Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka, Bangladesh.,Department of Public Health, University of South Asia, Dhaka, Bangladesh
| | - Mohammed A Mamun
- CHINTA Research Bangladesh, Savar, Dhaka, Bangladesh.,Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka, Bangladesh
| | - Mark Mohan Kaggwa
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.,African Centre for Suicide Prevention and Research, Mbarara, Uganda.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
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14
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Chi NC, Nakad L, Han S, Washington K, Hagiwara Y, Riffin C, Oliver DP, Demiris G. Family Caregivers' Challenges in Cancer Pain Management for Patients Receiving Palliative Care. Am J Hosp Palliat Care 2023; 40:43-51. [PMID: 35503240 PMCID: PMC10201988 DOI: 10.1177/10499091221094564] [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] [Indexed: 12/16/2022] Open
Abstract
CONTEXT Family caregivers (FCs) of cancer patients play a crucial role in managing their care partner's pain, but little research has examined FCs' specific challenges regarding the provision of pain management (PM) to cancer patients receiving palliative care. OBJECTIVES To determine the demographic and clinical characteristics of FCs who encounter challenges in PM and to elucidate the specific challenges that FCs face when managing pain for their care partner with cancer. METHODS We conducted a secondary analysis of 40 interview transcripts of FCs who were caring for persons with cancer. Interviews were audio-recorded, transcribed verbatim, and analyzed using deductive thematic analysis. RESULTS The three major identified challenges to PM for FCs of persons with cancer were: (1) communication and teamwork issues, (2) caregiver-related issues, and (3) patient-related issues. Communication and teamwork issues encompassed caregivers' receipt of inadequate information regarding PM, and inappropriate and ineffective communication from the healthcare team. Caregiver issues pertained to caregivers' fear and beliefs, concurrent responsibilities, and lack of pain-related knowledge and skills. Patient issues related to their own fear and beliefs, psychological and physiological well-being, adherence to medications, and reluctance to report pain. CONCLUSION Findings of this study have implications for future research and practice related to cancer PM in palliative care. Results suggest the need for FC training in PM as well as clear clinical practice guidelines and resources to help providers prepare, educate, and communicate with FCs regarding PM.
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Affiliation(s)
- Nai-Ching Chi
- College of Nursing, University of Iowa, Iowa City, IA, USA
| | - Lynn Nakad
- College of Nursing, University of Iowa, Iowa City, IA, USA
| | - Soojeong Han
- School of Nursing, University of Washington, Seattle, WA, USA
| | - Karla Washington
- School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Yuya Hagiwara
- College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Catherine Riffin
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | | | - George Demiris
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
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15
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Bruton AE, Debosik LR, Pitzer KA, Csikai EL, Washington KT. Problem-Solving Dimensions among Caregivers of People with Cancer Receiving Outpatient Palliative Care. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2023; 19:23-32. [PMID: 36301742 PMCID: PMC9998336 DOI: 10.1080/15524256.2022.2139333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Family caregivers of people with cancer encounter a wide range of problems including challenges managing patients' symptoms, difficulties navigating complex healthcare systems, and financial stressors associated with caregiving. Outpatient palliative care teams are ideally positioned to help caregivers respond to these challenges; however, little evidence is available to inform problem-solving support for caregivers in this setting. This article presents results from a secondary analysis of data obtained as part of a randomized clinical trial of a problem-solving intervention for family caregivers of people with cancer receiving outpatient palliative care. It describes the extent to which caregivers report adoption of positive and negative problem orientations and use of rational, impulsive, and avoidant problem-solving styles, and examines whether these problem-solving dimensions differ by age and gender. Results reveal statistically significant negative correlations between caregiver age and positive and negative problem orientations and use of a rational problem-solving style, and statistically significant gender differences with regard to negative problem orientation and use of an impulsive problem-solving style. Findings from this exploratory study highlight unique potential strengths and needs of caregivers, and set the stage for future research on problem-solving among cancer caregivers in the growing field of outpatient palliative care.
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Affiliation(s)
- Adrian E Bruton
- School of Social Work, University of Alabama, Tuscaloosa, Alabama, USA
| | - Lindsey R Debosik
- Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA
| | - Kyle A Pitzer
- Division of Palliative Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Ellen L Csikai
- School of Social Work, University of Alabama, Tuscaloosa, Alabama, USA
| | - Karla T Washington
- Division of Palliative Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
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16
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Zaslavsky O, Kaneshiro J, Chu F, Teng A, Domoto-Reilly K, Chen AT. Virtual Intervention for Caregivers of Persons With Lewy Body Dementia: Pilot Quasi-Experimental Single-Arm Study. JMIR Form Res 2022; 6:e37108. [PMID: 35904843 PMCID: PMC9377445 DOI: 10.2196/37108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 07/13/2022] [Accepted: 07/13/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Compared to other types of dementia, family caregivers of people with Lewy body dementia (LBD) report higher stress levels and more severe depressive symptoms. Although several digital support interventions for caregivers of persons with dementia exist, few target LBD specifically or leverage a fully remote and asynchronous approach suitable for pandemic circumstances. OBJECTIVE We performed a pilot evaluation of a digital intervention designed to help caregivers of people with LBD address challenges they have experienced, with the end goal of reducing psychological distress in this population. METHODS We recruited 15 family caregivers of people with LBD to participate in the quasi-experimental, single-arm, mixed methods study titled Virtual Online Communities for Aging Life Experience-Lewy Body Dementia (VOCALE-LBD). The study offers an 8-week web-based intervention that uses a digital discussion platform and involves moderation, peer-to-peer support, didactic training, and problem-solving skill enactment. RESULTS Participants' baseline characteristics were the following: mean age 66 (SD 8) years; 14 of 15 (93%) of them were female; all (15/15, 100%) were White; and 8 (53%) of them had at least a postgraduate degree. Throughout the intervention, participants engaged in weekly web-based discussions, generating a total of 434 posts (average 4 posts per week). Attrition was 20% (3/15). Upon study exit, participants showed the following average improvements: 3.0 (SD 6.0) in depression, 8.3 (SD 16.7) in burden, 2.9 (SD 6.8) in stress, and 0.3 (SD 0.8) in loneliness. When looking at the proportion of participants with clinically significant improvement versus those with a worsening of ≥0.5 SD for each outcome, we observed net improvements of 50% (6/12), 33% (4/12), 25% (3/12), and 25% (3/12) in depression, loneliness, burden, and stress, respectively. In terms of the benefits of participation, participants reported that participation helped them "a great deal" to (1) improve their understanding of LBD (9/12, 75%), (2) gain confidence in dealing with difficult behaviors of the care recipient (6/12, 50%), and (3) improve in one's abilities to provide care to the care recipient (4/12, 33%). CONCLUSIONS The study generated promising feasibility and preliminary efficacy data for a low-cost, web-based intervention designed for caregivers of persons with LBD. Though the study was not powered for significance, we observed nominal average and net improvements in important psychological outcomes. Moreover, many caregivers reported that study participation helped them better understand the disease, feel more confident in dealing with difficult behaviors of the care recipient, and improve their ability to care for the care recipient. If validated in future studies, the intervention could be an accessible, on-demand resource for caregivers, enabling them to engage in moderated remote discussions with peers at their own convenience in terms of location, time of the day, and frequency.
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Affiliation(s)
| | | | - Frances Chu
- University of Washington, Seattle, WA, United States
| | - Andrew Teng
- University of Washington, Seattle, WA, United States
| | | | - Annie T Chen
- University of Washington, Seattle, WA, United States
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17
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Washington KT, Demiris G, White P, Mathis HC, Forsythe JE, Parker Oliver D. A Goal-Directed Model of Collaborative Decision Making in Hospice and Palliative Care. J Palliat Care 2022; 37:120-124. [PMID: 34787009 PMCID: PMC9106802 DOI: 10.1177/08258597211049138] [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] [Indexed: 11/16/2022]
Abstract
Hospice and palliative care teams face numerous barriers to the meaningful involvement of patients and families in medical decision making, which limits opportunities for exploration of the very values, preferences, and goals that ideally inform serious illness care. Researchers who develop and test interventions to address these barriers have noted the complementary utility of two existing models in supporting collaborative relationships between hospice and palliative care teams and the patients and families they serve: (1) the social problem-solving model, and (2) the integrative model of shared decision making in medical encounters. This paper describes the integration and extension of these two highly synergistic models, resulting in a goal-directed model of collaborative decision making in hospice and palliative care. Directions for practice innovation and research informed by the model are discussed at length.
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Affiliation(s)
| | - George Demiris
- Penn Integrates Knowledge (PIK) University Professor, University of Pennsylvania, USA
| | | | | | | | - Debra Parker Oliver
- Washington University in St. Louis, USA
- Barnes-Jewish College, Goldfarb School of Nursing, USA
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18
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Pop RS, Puia A, Mosoiu D. Factors Influencing the Quality of Life of the Primary Caregiver of a Palliative Patient: Narrative Review. J Palliat Med 2022; 25:813-829. [PMID: 35007441 DOI: 10.1089/jpm.2021.0322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Introduction: Quality of life is a difficult concept to understand and therefore difficult to evaluate. From the general definition to the individuality of the person, there are factors that positively or negatively influence quality of life. Aim: The aim is to identify the factors that influence the quality of life of primary caregivers of patients with progressive life-threatening illnesses. Methodology: PUBMED was searched to retrieve the relevant literature for our research questions used the following keywords: "Quality of life and caregiver or caretaker and palliative care or life threatening disease." Only quantitative studies containing randomized trials were included using at least one caregiver's quality-of-life tool, not older than 10 years, written in English, and with subjects older than 18 years, who considered they were involved in the active care of a palliative patient. Results: A number of 687 articles were identified from which only 38 were analyzed in detail regarding the impact of different interventions over the quality-of-life of the caregiver. The factors that influence the quality-of-life can be distributed into four areas: social, psycho-emotional, financial, and physical. The disruption of daily routine, non-existential financial resources, multiple responsibilities and psychological tension are reduce the caregiver's quality-of-life. Family involvment, knowledge about disease and treatment, abilities to communicate patient and the team and optimistic atitude improve caregiver's quality-of-life. Conclusions: The quality of life of the caregiver be improved by social, and relaxation techniques, reduction of insecurity or anxiety. Furthermore, the caregiver's quality of increases through and adequate communication diagnosis, a proper conducted treatment and education over the care maneuvers.
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Affiliation(s)
- Rodica Sorina Pop
- University of Medicine and Pharmacy Iuliu Hatieganu, Cluj-Napoca, Romania
| | - Aida Puia
- University of Medicine and Pharmacy Iuliu Hatieganu, Cluj-Napoca, Romania
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19
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Su Z, Li X, McDonnell D, Fernandez AA, Flores BE, Wang J. Technology-Based Interventions for Cancer Caregivers: Concept Analysis. JMIR Cancer 2021; 7:e22140. [PMID: 34783664 PMCID: PMC8663574 DOI: 10.2196/22140] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 12/01/2020] [Accepted: 10/13/2021] [Indexed: 01/16/2023] Open
Abstract
Background Cancer is a taxing chronic disease that demands substantial care, most of which is shouldered by informal caregivers. As a result, cancer caregivers often have to manage considerable challenges that could result in severe physical and psychological health consequences. Technology-based interventions have the potential to address many, if not all, of the obstacles caregivers encounter while caring for patients with cancer. However, although the application of technology-based interventions is on the rise, the term is seldom defined in research or practice. Considering that the lack of conceptual clarity of the term could compromise the effectiveness of technology-based interventions for cancer caregivers, timely research is needed to bridge this gap. Objective This study aims to clarify the meaning of technology-based interventions in the context of cancer caregiving and provide a definition that can be used by cancer caregivers, patients, clinicians, and researchers to facilitate evidence-based research and practice. Methods The 8-step concept analysis method by Walker and Avant was used to analyze the concept of technology-based interventions in the context of cancer caregiving. PubMed, PsycINFO, CINAHL, and Scopus were searched for studies that examined technology-based interventions for cancer caregivers. Results The defining attributes of technology-based interventions were recognized as being accessible, affordable, convenient, and user-friendly. On the basis of insights gained on the defining attributes, antecedents to, and consequences of technology-based interventions through the concept analysis process, technology-based interventions were defined as the use of technology to design, develop, and deliver health promotion contents and strategies aimed at inducing or improving positive physical or psychological health outcomes in cancer caregivers. Conclusions This study clarified the meaning of technology-based interventions in the context of cancer caregiving and provided a clear definition that can be used by caregivers, patients, clinicians, and researchers to facilitate evidence-based oncology practice. A clear conceptualization of technology-based interventions lays foundations for better intervention design and research outcomes, which in turn have the potential to help health care professionals address the needs and preferences of cancer caregivers more cost-effectively.
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Affiliation(s)
- Zhaohui Su
- Center on Smart and Connected Health Technologies, School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Xiaoshan Li
- Program of Public Relations and Advertising, Beijing Normal University-Hong Kong Baptist University United International College, Zhuhai, China
| | - Dean McDonnell
- Department of Humanities, Institute of Technology, Carlow, Ireland
| | - Andrea A Fernandez
- School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Bertha E Flores
- School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Jing Wang
- Florida State University College of Nursing, Tallahassee, FL, United States
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20
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Toor H, Barrett R, Myers J, Parry N. Implementing a Novel Interprofessional Caregiver Support Clinic: A Palliative Medicine and Social Work Collaboration. Am J Hosp Palliat Care 2021; 39:913-917. [PMID: 34702061 DOI: 10.1177/10499091211051669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND High levels of burden and, in more severe instances, burnout represents a significant issue for caregivers of patients with advanced cancer. Early identification and management of caregiver distress and cultivating caregiver resiliency are seldom considered elements of routine care. AIM To leverage the complementary expertise of palliative medicine and social work using an integrated model of care to assess and manage caregiver needs. METHODS This quality improvement initiative involved the design and implementation of a novel and collaborative Caregiver Support Clinic (CSC), providing joint palliative medicine-social work encounters to caregivers of patients with advanced cancer. RESULTS Caregivers felt the CSC provided a forum to discuss and review relevant, but previously neglected, care elements. The concerted collaborative efforts demonstrated by clinicians were found to be reassuring and comforting. Clinicians felt CSC visits prevented duplicative information gathering processes, enabled the ability to efficiently arrive at recommendations and both ensured continuity with, and avoided fragmentation of, care. CONCLUSIONS By addressing the needs of caregivers through a dyadic, joint encounter, fragmentation and duplication in care can be reduced and both integrated and coordinated management can be efficiently provided. Caregiver and clinician experiences confirm this model of care for caregivers is likely to be beneficial and feasible.
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Affiliation(s)
- Harleen Toor
- Temmy Latner Centre for Palliative Care, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
| | - Rebecca Barrett
- Department of Social Work, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
| | - Jeff Myers
- Temmy Latner Centre for Palliative Care, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
| | - Natalie Parry
- Temmy Latner Centre for Palliative Care, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
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21
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Caring for people who take care: What is already done? Palliat Support Care 2021; 20:720-730. [DOI: 10.1017/s147895152100119x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Objective
The growing prevalence and impact of cancer on the family system calls for a palliative care approach with the family as the unit of care. This study aimed at providing an overview of the intervention programs that have been developed to offer support to the family caregivers of oncologic patients receiving palliative care.
Method
Sixteen articles were included in the final review, encompassing (i) studies focused on intervention programs with family caregivers of cancer patients in palliative care, (ii) studies including a pre- and post-test evaluation of the intervention program, (iii) and studies whose cancer patients were at least 18 years old.
Results
A great heterogeneity was verified with respect to care settings, number of sessions, outcome measures, or timing of assessment within the reviewed programs. These findings mirrored the complexity of the palliative care approach, which is difficult to standardize. Nonetheless, some interventions with different features accomplished good and sometimes similar results. The studies’ main outcomes were clustered in five categories: psychological symptomatology, general quality of life, caregiving role, family relational variables, and bereavement/grief. Moreover, 44% of the main outcomes were psychological symptomatology of family caregivers, with an emphasis toward anxiety and depression. Also shown was a growing emergence of technology use among these interventions.
Significance of results
Results revealed a scarcity of family-oriented programs and lack of certified mental health professionals as interventionists. Future studies and interventions should focus on the positive outcomes of the caregiving experience and must acknowledge the cultural differences when trying to replicate programs. Considering that there is no precise formula for dealing with terminal illness and grief, we submit that family-centered and systemic lenses are excellent approaches for support during this adjustment process. In conclusion, the present study advocates for increased investment in the field, underscoring the importance of family caregivers’ mental health.
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22
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Effects of psychosocial interventions on psychological outcomes among caregivers of advanced cancer patients: a systematic review and meta-analysis. Support Care Cancer 2021; 29:7237-7248. [PMID: 34240256 DOI: 10.1007/s00520-021-06102-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 02/23/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE This systematic review aimed to synthesize the effectiveness of psychosocial interventions on caregivers of advanced cancer patients, in comparison with usual care, on caregivers' quality of life (QoL), anxiety, and depression symptoms. METHODS Comprehensive searches for published and unpublished studies were performed using nine electronic databases, two trial registers, and reference lists of included studies. Two reviewers independently screened, appraised, and extracted data. The Cochrane risk of bias tool was used to appraise the methodological quality of included studies, while the Cochrane data extraction tool was used to elicit relevant information. Meta-analysis, narrative analysis, and sensitivity analysis were conducted to synthesize data. Standardized mean differences (SMD) represented effects of psychosocial interventions. RESULTS Fifteen randomized controlled trials were included in this review. At post-intervention, findings revealed a significant small pooled effect size (SMD = 0.45) on QoL and significant moderate effect on depression (SMD = - 0.65). However, a small non-significant pooled effect size was observed on anxiety (SMD = - 0.24). At follow-up assessments, effect sizes of all outcomes were small and non-significant. Overall quality of evidence was rated very low for all outcomes and most studies had unclear or high risk of bias. Thus, results should be interpreted with caution. CONCLUSION Psychosocial interventions were effective in improving QoL and depression among caregivers of persons with advanced cancer. However, future randomized control trials with lower risk of bias, larger sample size, detailed participant characteristics, and informative interventions are desirable.
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Washington KT, Benson JJ, Chakurian DE, Popejoy LL, Demiris G, Rolbiecki AJ, Oliver DP. Comfort Needs of Cancer Family Caregivers in Outpatient Palliative Care. J Hosp Palliat Nurs 2021; 23:221-228. [PMID: 33605647 PMCID: PMC8084891 DOI: 10.1097/njh.0000000000000744] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Rapid expansion of outpatient palliative care has been fueled by the growing number of people living with cancer and other chronic illnesses whose symptoms are largely managed in the community rather than inpatient settings. Nurses and other palliative care professionals support seriously ill patients and their families, yet little research has specifically examined the needs of cancer family caregivers receiving services from outpatient palliative care teams. To address this gap in the knowledge base, researchers conducted a reflective thematic analysis of qualitative interviews conducted with 39 family caregivers, using Comfort Theory as a theoretical guide. Seven themes describing caregivers' comfort needs were identified, including the need to understand, need for self-efficacy, need to derive meaning, need for informal support, need for formal support, need for resources, and need for self-care. Findings have clear implications for palliative nursing, as they directly address cancer family caregivers' needs in 5 of the 8 domains of care delineated by the National Consensus Project for Quality Palliative Care's Clinical Practice Guidelines. Comprehensive, holistic nursing assessment is suggested to identify family caregivers' needs and plan for delivery of evidence-based interventions shown to decrease burden and improve quality of life.
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Affiliation(s)
- Karla T. Washington
- Washington University in St. Louis, School of Medicine, Division of Palliative Medicine
| | - Jacquelyn J. Benson
- University of Missouri, College of Human Environmental Sciences, Department of Human Development and Family Science
| | | | | | - George Demiris
- University of Pennsylvania, School of Nursing, Department of Biobehavioral and Health Sciences
- University of Pennsylvania, School of Medicine, Department of Biostatistics, Epidemiology, and Informatics
| | - Abigail J. Rolbiecki
- University of Missouri, School of Medicine, Department of Family and Community Medicine
| | - Debra Parker Oliver
- Washington University in St. Louis, School of Medicine, Division of Palliative Medicine
- Barnes-Jewish College, Goldfarb School of Nursing
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24
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Chen AT, Chu F, Teng AK, Han S, Lin SY, Demiris G, Zaslavsky O. Promoting Problem Solving About Health Management: A Mixed-Methods Pilot Evaluation of a Digital Health Intervention for Older Adults With Pre-Frailty and Frailty. Gerontol Geriatr Med 2021; 7:2333721420985684. [PMID: 33457461 PMCID: PMC7797575 DOI: 10.1177/2333721420985684] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 11/12/2020] [Accepted: 11/22/2020] [Indexed: 11/15/2022] Open
Abstract
Background: There is a need for interventions to promote health management of older adults with pre-frailty and frailty. Technology poses promising solutions, but questions exist about effective delivery. Objectives: We present the results of a mixed-methods pilot evaluation of Virtual Online Communities for Older Adults (VOCALE), an 8-week intervention conducted in the northwestern United States, in which participants shared health-related experiences and applied problem solving skills in a Facebook group. Methods: We performed a mixed-methods process evaluation, integrating quantitative and qualitative data, to characterize the intervention and its effects. We focus on four areas: health-related measures (health literacy and self-efficacy), participation, problem solving skills enacted, and subjective feedback. Results: Eight older adults with pre-frailty and frailty (age = 82.7 ± 6.6 years) completed the study. There was an upward trend in health literacy and health self-efficacy post-intervention. Participants posted at least two times per week. Content analysis of 210 posts showed participants were able to apply the problem solving skills taught, and exit interviews showed participants' increased awareness of the need to manage health, and enjoyment in learning about others. Conclusion: This mixed-methods evaluation provides insight into feasibility and design considerations for online interventions to promote health management among vulnerable older adults.
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Affiliation(s)
| | - Fay J Hlubocky
- University of Chicago Medicine, Maclean Center for Clinical Medical Ethics, Program for Supportive Oncology, Chicago, IL
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26
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Given CW. Family Caregiving for Cancer Patients: the State of the Literature and a Direction for Research to Link the Informal and Formal Care Systems to Improve Quality and Outcomes. Semin Oncol Nurs 2019; 35:389-394. [PMID: 31229345 DOI: 10.1016/j.soncn.2019.06.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Based on recent shifts in reimbursement for cancer treatment from fee-for-service to bundled and value-based payment, this concluding article summarizes data from these papers and the large body of literature on caregiving to suggest how caregiving research might be redirected to link the formal with the informal systems to achieve higher-quality and lower-cost care. Caregiver dyads, the tasks of care, and strategies for training are presented. DATA SOURCES Articles in this issue of Seminars in Oncology Nursing, the larger body of caregiving literature, and the Oncology Care Model driving bundled payments and value-based care. CONCLUSION Research on informal caregiving for cancer patients should begin to reframe the rich body of evidence available toward a focus on caregivers reactions to the tasks of care, the training necessary for caregivers to perform them, and how each contributes to quality care at lower costs and appropriate outcomes given patients' stage of disease and goals of treatment. IMPLICATIONS FOR NURSING PRACTICE Oncology systems must take a more active role in including patients and their families as partners to manage treatments and side effects to achieve the best possible patient outcomes. They must be able to evaluate the patient and the caregiver to determine what tasks they will be able to perform, and then make sure they have the training and resources to carry out those tasks. Training could be done by social media and through communication using patient portals that could be expanded through the electronic medical records to include caregiver portals, enabling caregiver questions and reports of patients' conditions.
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Affiliation(s)
- Charles W Given
- College of Nursing, Michigan State University, East Lansing, MI.
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27
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Innovative Tools to Support Family Caregivers of Persons with Cancer: The Role of Information Technology. Semin Oncol Nurs 2019; 35:384-388. [PMID: 31229338 DOI: 10.1016/j.soncn.2019.06.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To describe the current evidence of studies examining the use of information technology for family caregivers of persons with cancer. We highlight emerging technologies and trends and discuss ethical and practical implications. DATA SOURCES Review scientific studies and systematic reviews of technology use to support caregivers of persons with cancer. CONCLUSION The evidence base is growing; however, more studies are needed to test the effectiveness of technology. IMPLICATIONS FOR NURSING PRACTICE Several tools have potential to provide support to family caregivers but the selection of such tools needs to address access, privacy, interoperability, and usability considerations.
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28
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Washington KT, Craig KW, Parker Oliver D, Ruggeri JS, Brunk SR, Goldstein AK, Demiris G. Family caregivers' perspectives on communication with cancer care providers. J Psychosoc Oncol 2019; 37:777-790. [PMID: 31204604 DOI: 10.1080/07347332.2019.1624674] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose/Objectives: Family caregivers of individuals living with cancer are often highly involved in communication with healthcare teams, yet little is known about their experiences, needs, and preferences in this role. To address this gap in the knowledge base, researchers sought to explore family caregivers' perspectives on communication with oncology care providers. Design and Methods: Researchers conducted a secondary inductive thematic analysis of qualitative interviews originally collected as part of a randomized clinical trial of a supportive intervention for family caregivers of patients with cancer (N = 63). Participants: Participants were family caregivers of adult patients with cancer. Most were patients' spouses/long-term partners (52.3%) or adult children/grandchildren (29.2%). Caregivers of patients with all cancer types and stages of disease progression were eligible for study enrollment. Findings: Caregivers valued communication with healthcare providers who were attentive, genuine, broadly focused on patients and caregivers' experiences, sensitive to unmet information needs, and responsive to the potentially different communication preferences of patients and caregivers. Interpretation: Family caregivers expressed a strong preference for person-centered communication, conceptualized as communication that helps healthcare providers meet the needs of patients and caregivers both as individuals and as an interdependent unit of care, and that acknowledges individuals' experiences beyond their prescribed roles of "cancer patient" and "caregiver." Implications for Psychosocial Oncology Practice: Psychosocial oncology providers' strong orientation to the biopsychosocial and spiritual aspects of cancer care delivery make them uniquely positioned to support family caregivers. Findings suggest that providers should explicitly communicate their commitment to both patient and family care, involve family caregivers in psychosocial assessment activities and subsequent intervention, and strive to honor patients and caregivers' potentially different communication preferences.
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Affiliation(s)
| | - Kevin W Craig
- School of Medicine, University of Missouri , Columbia , Missouri , USA
| | | | - Jeffrey S Ruggeri
- School of Medicine, University of Missouri , Columbia , Missouri , USA
| | - Samantha R Brunk
- School of Medicine, University of Missouri , Columbia , Missouri , USA
| | | | - George Demiris
- School of Nursing, University of Pennsylvania , Philadelphia , Pennsylvania , USA
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