Variation in health literacy among family caregiver communication types

Close but Not Close Enough: How Distance Caregiving is Associated with Hospice Family Caregiver Hospice Communication Experiences

Half of hospice family caregivers report having unmet information needs, which can contribute to poor pain and symptom management, emergency department use, and hospice disenrollment for care-recipients and to caregiver strain and stress. Effective communication between hospice teams and family caregivers is critical yet communication inadequacies persist. Despite the growing prevalence of distance caregiving, including in hospice care, and the relationship between caregiver proximity and communication effectiveness, little is known about how caregiver proximity is associated with caregiver perceptions of hospice communication. In this secondary analysis of quantitative data from two multisite randomized clinical trials (NCT03712410 and NCT02929108) for hospice family caregivers (N = 525), multivariate linear models with demographic and contextual controls were used to analyze caregivers' perceptions of caregiver-centered communication with hospice providers based on caregiver proximity to the hospice care-recipient. In multivariate models, "local" hospice family caregivers who lived within 1 hour of the hospice care-recipient reported less effective communication with the hospice team than co-residing caregivers; and older caregivers rated communication more favorably than younger caregivers. To improve communication and collaboration between hospice teams and caregivers, regardless of proximity, distance communication training for hospice teams and interventions such as telehealth communication and virtual tools that enable triadic collaboration are recommended. Research is needed to understand why local caregivers, specifically, perceive communication quality less favorably and how hospice teams can better meet local and distance caregiver communication needs.

Health literacy, eHealth literacy and their association with burden, distress, and self-efficacy among cancer caregivers

Purpose

Health literacy skills are vital for cancer caregivers in helping cancer survivors to navigate their diagnosis, treatment, and recovery but little is known. This study explored health literacy and eHealth literacy among cancer caregivers and the relationship between health literacy/eHealth literacy and potential associated factors.

Methods

Informal caregivers who had cared for an individual with cancer completed a survey which collected demographic data and measured caregiver health literacy, eHealth literacy, self-efficacy, burden, and distress.

Results

Seven percent of caregivers had inadequate health literacy. Caregivers scored lowest on health literacy domains related to caregiver social support, information seeking and understanding care recipient preferences. eHealth literacy was associated with self-efficacy and burden while, different health literacy domains were associated with burden ('Understanding care recipient needs and preferences'), self-efficacy ('Cancer-related communication with the care recipient' and 'Understanding care recipients needs and preferences') and distress ('Proactivity and determination to seek information', 'Understanding care recipient needs and preferences', 'Understanding the healthcare system').

Conclusion

Findings highlight key areas of need regarding cancer caregiver health literacy which future research can target. Given the observed relationship between aspects of health literacy and burden, distress and self-efficacy future work could be carried out on how to alleviate high levels of burden and distress and how to enhance self-efficacy among cancer caregivers by addressing health literacy skills.

Implications for cancer survivors

Findings from this study will inform the development of health literacy interventions to support caregivers to build their health literacy skills and enable this group to better support cancer survivors as a result.

Family Communication in Autism Spectrum Disorder: Applying the Family Caregiver Communication Typology to Parent Caregivers

Parents of children with Autism Spectrum Disorder (ASD) experience greater stress and caregiver burden than parents of children with other disabilities. To cope with the stress of long-term caregiving, they rely on professionals for support and guidance. However, parents continue to report unmet communication and support needs. To inform tailored communication for parents of a child with ASD, this study used the existing Family Caregiver Communication Typology framework which identifies four caregiver communication types (manager, carrier, partner, and lone) and their unique communication and support needs. In-depth, structured interviews were conducted with parents (n = 22) and ASD professionals (n = 28) to explore communication characteristics of ASD parent caregivers. A thematic analysis revealed communication behaviors among four ASD parent caregiver types, further validating the typology. Future research is needed to develop targeted interventions for improving family-centered care based on ASD parent caregiver types.

Assessing the Comprehensive Training Needs of Informal Caregivers of Cancer Patients: A Qualitative Study

Introduction: The increasing demand for cancer services is projected to overwhelm the cancer care system, leading to a potential shortfall in human resource capacity. Informal caregivers (unpaid family/friend caregivers of cancer patients) provide a significant amount of care to patients and the cancer care system could not cope without them. The aim of this study was to analyze the needs of informal caregivers (CGs) through interviews with cancer patients and CGs, and to assess the content and utility of a comprehensive caregiver training course. Methods: Cancer patients and CGs were recruited from an academic cancer centre to elicit their thoughts and perceptions of cancer CG education needs through a qualitative, phenomenological design using semi-structured interviews and a curriculum review activity. Results: Six patients and seven CGs were interviewed. Patients averaged 53.8 years of age and CGs averaged 53.1 years. Caregiver participants reported that they were unprepared for their caregiving role. Depending on the severity of the disease, CGs reported significant emotional strain. Most participants wanted more practical information, and all expressed the desire for greater social support for CGs. While there were differences in terms of desired modality (e.g., online, in-person), support for greater CG education was strong. Discussion: CGs experience a significant learning curve and receive little to no direct training or education to help them acquire the knowledge and skills they need to support a cancer patient. This is especially challenging for new CGs, for whom emotional and informational needs are particularly acute. Participants shared a great deal of endorsement for a comprehensive training course for new CGs. Given the multiple demands on their time, some participants suggested that consideration be made to establish synchronous classes. Participants held that having the course take place (online or in-person) at a specific time, on a specific date could help CGs prioritize their learning. Participants also endorsed the idea of “required” learning because even though CGs may recognize that a course could be beneficial, some may lack the motivation to participate unless it was “prescribed” to them by a healthcare provider.

Quality of Life in Caregivers of Cancer Patients: A Literature Review

(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.

Receiving and breaking bad news: A qualitative study of family carers managing a cancer diagnosis and interactions with healthcare services

AIMS

To explore family carer experiences of managing the process of receiving and breaking bad news about cancer.

BACKGROUND

Family carers' experiences of bad news are underrepresented in the literature. This study involved oncology staff with personal experience of caregiving and carers to develop broader insights into the range of needs and difficulties experienced by family members in the process of managing a cancer diagnosis. This can help facilitate subsequent interactions with healthcare professionals and improve continuity of care.

DESIGN

This is a descriptive qualitative study informed by the theory of social constructionism. Data were analysed using template analysis.

METHODS

Data were collected using semi-structured interviews and focus groups with 4 healthcare professionals and 17 family carers between January and July 2018. A purposive sampling strategy was used. Interviews were transcribed verbatim to explore participant experiences and perspectives on family carers managing a cancer diagnosis.

FINDINGS

Three key themes were identified: (1) receiving the bad news; (2) management of bad news and (3) interaction with healthcare and support services. These and associated subthemes are discussed, with recommendations for future research and practice.

CONCLUSIONS

There was variability in the experiences and needs of carers involved in receiving and breaking the bad news.

IMPACT

Although family members experienced a multitude of difficult emotions when the bad news was shared, they were not often able to discern help from healthcare professionals with sharing the diagnosis with the patient and others. This impacted on access to and use of healthcare and support services. Individualized approaches to communication are needed to enable carers to seek support and provide perspectives on the patient home environment and family structure. This can help tailor breaking the bad news and care plans.

PUBLIC CONTRIBUTION

Anonymised results were shared with family carers to validate the congruency of the codes with their experiences.

Collective caregivers: A novel examination of health literacy management approaches

OBJECTIVE

Health literacy and communication skills are necessary for family caregivers who often work in pairs, known as collective caregiving. Health literacy management is a relational process where communication between caregivers can be a barrier or pathway to improving or co-creating health literacy. The purpose of this study was to examine how collective caregivers manage health literacy.

METHODS

Semi-structured interviews were conducted separately for 42 caregiving pairs (n = 84). The interview guide was developed using a cancer caregiver health literacy framework. Caregiving pairs were placed into one of three collective caregiving communication patterns (absolute concordant, semi-concordant, absolute discordant). Interviews were audio-recorded, transcribed, and a thematic analysis was performed by independent coders.

RESULTS

The analysis revealed three different health literacy management approaches: a defined approach where caregiver roles were clearly designated (absolute concordant pairs); a contrasting approach where one caregiver was the health literacy expert (semi-concordant pairs); an independent approach characterized by individual information seeking, processing, and patient/provider engagement (absolute discordant pairs).

CONCLUSIONS

Health literacy support should address aspects of the family system such as caregiver-caregiver communication which influence variance in health literacy management. Practice implications Our study can inform provider communication and healthcare interventions aimed at supporting health literacy for caregivers.

Assessing Family Caregiver Communication in Chronic Illness: Validation of the FCCT-CI

Background: Chronic illness care demands attention to the unique needs of family caregivers who support care at home, yet few tools exist for family caregiver assessment in the social domain of practice. Objectives: The Family Caregiver Communication Tool (FCCT) assesses caregiver communication as part of the family system and was originally developed for cancer caregivers. The aim of this study was to develop and psychometrically-validate a version of the FCCT for Chronic Illness (FCCT-CI). Methods: We revised the FCCT, including the generation of new items, and psychometrically tested it in 303 family caregivers recruited through Amazon Prime Panels. Item reduction through exploratory factor analysis was conducted, internal consistency was assessed using Cronbach's alpha, and concurrent validity was conducted to demonstrate correlation of the new scale with previously validated instruments. Results: A principal axis analysis with promax rotation initially revealed a five-factor structure of the 27 items initially tested, but, after statistical and theoretical reduction and refinement, a 10 item FCCT-CI emerged. Cronbach's alpha ranged from .74 to .86 for the FCCT-CI instrument. Concurrent validity was supported by bivariate correlation tests. Conclusions: The FCCT-CI is the first psychometrically tested scale designed to assess caregiver communication with chronically ill patients, family members, and palliative care providers about caregiving. The FCCT-CI scale includes but is not limited to cancer caregiving and palliative care contexts and has good reliability and validity. Palliative care providers can use this tool to assess, design, and test interventions to support family caregivers.

Health literacy in cancer caregivers: a systematic review

PURPOSE

Cancer caregivers play a vital role in the care and health decision-making of cancer survivors. Consequently, their health literacy levels may be particularly important, as low levels may impede adequate care provision. As such, the current review aimed to systematically examine the literature on health literacy amongst cancer caregivers.

METHODS

We systematically searched the following databases using controlled vocabulary and free-text terms: PsychINFO, MEDLINE, EMBASE, CINAHL and Web of Science. Peer-reviewed empirical studies that explicitly measured and reported cancer caregiver health literacy levels were included.

RESULTS

The search yielded six articles consisting of 593 cancer caregivers exploring health literacy and eHealth literacy. There was substantial variation in health literacy measurement tools used across included studies, precluding the possibility of conducting a meta-analysis. The included articles reported significant associations (limited to single studies) between caregiver health/eHealth literacy and (i) cancer survivor demographics, (ii) caregivers' communication style, (iii) caregiver Internet access and (iv) caregiver coping strategies.

CONCLUSIONS

Findings highlight a need for future longitudinal research regarding cancer caregiver health literacy incorporating more standardized and population-specific measurement approaches. In particular, there is a pressing need to investigate factors associated with cancer caregiver health literacy to inform the development/delivery of future interventions.

IMPLICATIONS FOR CANCER SURVIVORS

Future high-quality research which investigates the factors which contribute towards sub-optimal health literacy amongst cancer caregivers would aid in the development of appropriate and effective health literacy interventions in these groups. Such interventions would allow this important group to provide appropriate support to cancer survivors and enhance survivors' engagement in their health and wellbeing.