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Patra L, Ghoshal A, Damani A, Salins N. Cancer palliative care referral: patients' and family caregivers' perspectives - a systematic review. BMJ Support Palliat Care 2022:spcare-2022-003990. [PMID: 36328397 DOI: 10.1136/spcare-2022-003990] [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: 09/26/2022] [Accepted: 10/19/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Despite the evidence of palliative care benefits, referrals are infrequent and delayed. Patients and their caregivers are essential stakeholders in the referral process with valuable perspectives. This review systematically explored their perceived facilitators and barriers to palliative care referral. METHODS 4 subject-specific databases (PubMed, Cumulative Index to Nursing and Allied Health Literature, PsycINFO and EMBASE), 3 multidisciplinary databases (SCOPUS, Web of Science and Cochrane database) and 11 journals from 1 January 1990 to 31 May 2022 were searched; and scored for their methodological rigour using Hawker's tool. Findings were synthesised using Popay's Narrative Synthesis method and interpreted using decision-making theory. RESULTS 4 themes were generated from 14 studies: (1) The timing of referral should be right and communication must be comprehensive. Delays in initiating serious illness conversations, prognostication, and decision-making hindered referral. In contrast, the presence of symptoms facilitated it. (2) Referral was equated to death, and as an inferior form of treatment, a rebranding might mitigate the stigma. (3) Referral made families feel emotional and devastated; explanation and team initiatives enabled the normalisation and positive coping. (4) Long-term holistic palliative care facilitated a positive care experience and a sense of reassurance and satisfaction, enabling a smooth transition from curative to comfort care. The late referral was associated with perceived inadequate symptom management, diminished quality of life and death and complicated bereavement issues. CONCLUSION Patients' and caregivers' predisposition to palliative care engagement was influenced by timely referral, comprehensive communication, perception and stigma about palliative care. Longitudinal association with the palliative care team mitigated negative perceptions and improved satisfaction and coping. PROSPERO REGISTRATION NUMBER CRD42018091481.
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Affiliation(s)
- Lipika Patra
- Bagchi-Karunashraya Palliative Care Centre, Bangalore Hospice Trust, Bhubaneswar, India
| | | | - Anuja Damani
- Department of Palliative Medicine and Supportive Care, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Naveen Salins
- Department of Palliative Medicine and Supportive Care, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Kogan N, Tolley M, Cohen R. Family caregivers support their patient's decision to participate in a phase 1 clinical trial: Weighing the pros and cons, bearing the costs. Psychooncology 2022; 31:1374-1380. [PMID: 35460308 DOI: 10.1002/pon.5942] [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: 11/03/2021] [Revised: 02/24/2022] [Accepted: 04/06/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVES When patients with advanced cancer pursue phase 1 clinical trials, family caregivers are impacted as they adopt new roles and responsibilities in time-pressured, uncertain circumstances. This study explored the nature of the caregivers' participation in patients' decision to pursue phase 1 clinical trials and the early impact of the decision on the caregiver. METHODS Semi-structured interviews were conducted with 19 family caregivers of advanced cancer patients who had agreed to participate in phase 1 clinical trials. They were coded for information about the caregiver's relationship with the patient, typical style of decision-making together, understanding of the patient's prognosis and trial, contributions to decision-making and the initial impacts of the trial on the caregiver. Codes illuminating the research questions were grouped into categories and themes, compared across transcripts and examined against the literature. RESULTS Caregivers unequivocally supported the patients' decision to pursue the phase 1 trial as they hoped that the patient would derive medical benefit from the trial. They withheld their opinions and fears about the trial from the patients to support patient autonomy during the decision-making process. The patient's decision to participate increased the caregivers' burdens and deprived them of time spent on pleasurable activities at end of life. CONCLUSIONS Respecting the patients' personal autonomy, caregivers supported the trial, despite the complex caregiving required. As the success of phase 1 trials relies on caregiver involvement, it is imperative that healthcare professionals be sensitized to the support needs of these caregivers.
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Affiliation(s)
- Naomi Kogan
- Louise Granofsky Psychosocial Oncology Program, Segal Cancer Centre, Sir Mortimer B. Davis Jewish General Hospital, Montreal, Quebec, Canada
| | | | - Robin Cohen
- Departments of Oncology and Medicine, McGill University, and Lady Davis Research Institute, Sir Mortimer B. Davis Jewish General Hospital, Montreal, Quebec, Canada
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Srivastava R, Srivastava S. Parental Perspective in Paediatric Palliative Care: A Systematic Review of Literature Using the PRISMA Method. Indian J Palliat Care 2022; 28:199-215. [PMID: 35673689 PMCID: PMC9168285 DOI: 10.25259/ijpc_37_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 01/09/2022] [Indexed: 11/30/2022] Open
Abstract
Research in Parental Perspectives are pivotal in gaining understanding of parents’ experiences, issues, concerns and attitude in pediatric palliative care which affects their decision making. However only a limited number of such studies have included the first-person perspective of Parents. The aim of this article is to understand the contribution of previous research on parental perspectives in pediatric palliative care through a systematic review of literature. Nine articles that met the inclusion criteria were accessed and seven key themes emerged; Psychological perspective, parental concerns, parental needs, parental attitude, spiritual perspective, cultural perspective and financial perspective. This review highlights requirement of more research into parental perspective if possible, covering all key aspects along with additional research in cultural perspective and development of validated tools, checklists and psychometric questionnaires for the assessment of these perspectives in various domains: spiritual, financial, psychological, cultural and social.
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Affiliation(s)
- Rajashree Srivastava
- Department of Psychology, School of Liberal Education, Galgotias University, Greater Noida, Uttar Pradesh, India,
| | - Shikha Srivastava
- Department of Psychology, School of Liberal Education, Galgotias University, Greater Noida, Uttar Pradesh, India,
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Akkol-Solakoglu S, Hevey D, Richards D. A randomised controlled trial comparing internet-delivered cognitive behavioural therapy (iCBT) with and without main carer access versus treatment-as-usual for depression and anxiety among breast cancer survivors: Study protocol. Internet Interv 2021; 24:100367. [PMID: 33552931 PMCID: PMC7851185 DOI: 10.1016/j.invent.2021.100367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 01/08/2021] [Accepted: 01/13/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Depression and anxiety are common problems among breast cancer survivors. Carer support is one of the most important determinants of women's psychological wellbeing. Survivors' distress can be alleviated by giving carers access to survivors' evidence-based treatment, which will help carers understand what survivors have been going through and help survivors feel more supported. Given the limited access to evidence-based treatments, an adapted internet-delivered cognitive behavioural therapy (iCBT) intervention for breast cancer survivors, but also open for carers' access, has the potential to decrease survivors' depression and anxiety symptoms and improve cancer-related communication and relationship quality between survivors and carers. OBJECTIVES This study evaluates (1) the effectiveness of a guided iCBT intervention for depression and/or anxiety symptoms among breast cancer survivors with and without main carer access, and (2) the acceptability and satisfaction with the iCBT programme. METHOD In this pilot study comparing the effectiveness of an adapted 7-week iCBT without main carer access against the iCBT with main carer access and treatment-as-usual control, 108 breast cancer survivors will be recruited and then randomised to either (1) treatment (n = 72) or (2) treatment-as-usual control group (n = 36) with a 2:1 ratio. The participants in the treatment group will be assigned to either iCBT alone or iCBT with the main carer also having access to the same content based on their preference. The primary outcome measure is the Hospital Anxiety and Depression Scale, and alongside secondary measures such as Cancer-Related Quality of Life, Breast Cancer Worry Scale, Brief COPE, and Medical Outcomes Study Social Support Survey will be completed by the survivors at baseline, post-treatment, and 2-month follow-up. Survivors who have carers will also complete Survivor-Carer Cancer Communication and Relationship Quality measures to provide insights into the effects of carer access. To assess the acceptability and satisfaction with the programme, survivors and their main carers will fill out the Helpful Aspects of Therapy Form (HAT) and Satisfaction with Online Treatment (SAT). Programme effectiveness and the effects of carer access on primary and secondary outcome measures will be evaluated on intention-to-treat and per-protocol basis using Linear-Mixed-Models. DISCUSSION This is the first trial comparing the effectiveness and acceptability of iCBT with and without carer access for depression and anxiety among breast cancer survivors. The findings of this study will provide novel data on the acceptability of iCBT programmes for breast cancer survivors and the impact of carer access on them and their carers.
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Affiliation(s)
- Selin Akkol-Solakoglu
- Aras an Phiarsaigh, School of Psychology, Trinity College Dublin, Dublin, Ireland
- Corresponding author.
| | - David Hevey
- Aras an Phiarsaigh, School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Derek Richards
- Aras an Phiarsaigh, School of Psychology, Trinity College Dublin, Dublin, Ireland
- Clinical Research and Innovation, SilverCloud Health, Dublin, Ireland
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Roscoe LA, Barrison P. Dilemmas Adult Children Face in Discussing End-of-Life Care Preferences with Their Parents. HEALTH COMMUNICATION 2019; 34:1788-1794. [PMID: 30375899 DOI: 10.1080/10410236.2018.1536946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This study explored the perceived goals, barriers, and strategies that characterize family interactions about advance care planning (ACP), which is instrumental in guiding end-of-life care. Discussions within the family context can significantly improve end-of-life decision making but are complicated, partly because participants are attempting to achieve multiple, and often competing, goals. Participants (n = 75) responded to a hypothetical scenario about a conversation with a parent about ACP by completing an anonymous online survey. Respondents described their conversational goals, anticipated barriers, and strategies they thought would be helpful. Thematic data analysis identified four dilemmas participants faced while attempting to achieve multiple, conflicting goals: (1) the desire to make the parent feel wanted while discussing them not being around; (2) the need to be gentle but still direct; (3) the practical necessity of designating one decision-maker without provoking family conflict; and (4) the desire to lessen the burden on the designated decision-maker by providing necessary information while still placing them in a decision-making role. Participants reported using several strategies to manage these complex dilemmas. These findings provide support for the utility of Goldsmith's normative theory of social support in the context of discussions about ACP. The results also provide a foundation for developing conversational guides to facilitate high-quality family conversations about ACP between adult children and their parents.
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Affiliation(s)
- Lori A Roscoe
- Department of Communication, University of South Florida
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6
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Kim K, Heinze K, Xu J, Kurtz M, Park H, Foradori M, Nolan MT. Theories of Health Care Decision Making at the End of Life: A Meta-Ethnography. West J Nurs Res 2018; 40:1861-1884. [PMID: 28816094 PMCID: PMC6474239 DOI: 10.1177/0193945917723010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The aim of this meta-ethnography is to appraise the types and uses of theories relative to end-of-life decision making and to develop a conceptual framework to describe end-of-life decision making among patients with advanced cancers, heart failure, and amyotrophic lateral sclerosis (ALS) and their caregivers or providers. We used PubMed, Embase, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases to extract English-language articles published between January 2002 and April 2015. Forty-three articles were included. The most common theories included decision-making models ( n = 14) followed by family-centered ( n = 11) and behavioral change models ( n = 7). A conceptual framework was developed using themes including context of decision making, communication and negotiation of decision making, characteristics of decision makers, goals of decision making, options and alternatives, and outcomes. Future research should enhance and apply these theories to guide research to develop patient-centered decision-making programs that facilitate informed and shared decision making at the end of life among patients with advanced illness and their caregivers.
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Affiliation(s)
| | | | - Jiayun Xu
- University of Utah, Salt Lake City, USA
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Supporting Parent Caregivers of Children with Life-Limiting Illness. CHILDREN-BASEL 2018; 5:children5070085. [PMID: 29949926 PMCID: PMC6069074 DOI: 10.3390/children5070085] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 06/20/2018] [Indexed: 11/17/2022]
Abstract
The well-being of parents is essential to the well-being of children with life-limiting illness. Parents are vulnerable to a range of negative financial, physical, and psychosocial issues due to caregiving tasks and other stressors related to the illness of their child. Pediatric palliative care practitioners provide good care to children by supporting their parents in decision-making and difficult conversations, by managing pain and other symptoms in the ill child, and by addressing parent and family needs for care coordination, respite, bereavement, and social and emotional support. No matter the design or setting of a pediatric palliative care team, practitioners can seek to provide for parent needs by referral or intervention by the care team.
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Palmer-Wackerly AL, Krieger JL, Rhodes ND. The Role of Health Care Provider and Partner Decisional Support in Patients' Cancer Treatment Decision-Making Satisfaction. JOURNAL OF HEALTH COMMUNICATION 2017; 22:10-19. [PMID: 27967332 DOI: 10.1080/10810730.2016.1245804] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Cancer patients rely on multiple sources of support when making treatment decisions; however, most research studies examine the influence of health care provider support while the influence of family member support is understudied. The current study fills this gap by examining the influence of health care providers and partners on decision-making satisfaction. In a cross-sectional study via an online Qualtrics panel, we surveyed cancer patients who reported that they had a spouse or romantic partner when making cancer treatment decisions (n = 479). Decisional support was measured using 5-point, single-item scales for emotional support, informational support, informational-advice support, and appraisal support. Decision-making satisfaction was measured using Holmes-Rovner and colleagues' (1996) Satisfaction With Decision Scale. We conducted a mediated regression analysis to examine treatment decision-making satisfaction for all participants and a moderated mediation analysis to examine treatment satisfaction among those patients offered a clinical trial. Results indicated that partner support significantly and partially mediated the relationship between health care provider support and patients' decision-making satisfaction but that results did not vary by enrollment in a clinical trial. This study shows how and why decisional support from partners affects communication between health care providers and cancer patients.
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Affiliation(s)
- Angela L Palmer-Wackerly
- a Department of Communication Studies , University of Nebraska-Lincoln , Lincoln , Nebraska , USA
| | - Janice L Krieger
- b Department of Advertising , College of Journalism and Communications, University of Florida , Gainesville , Florida , USA
| | - Nancy D Rhodes
- c Department of Advertising and Public Relations, College of Communication Arts and Sciences , Michigan State University , Lansing , Michigan , USA
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9
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Miller LM, Sullivan DR, Lyons KS. Dyadic Perceptions of the Decision Process in Families Living With Lung Cancer. Oncol Nurs Forum 2017; 44:108-115. [PMID: 27991611 DOI: 10.1188/17.onf.108-115] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To use dyadic analyses to identify determinants of patients' and family members' perceptions of the positive and negative aspects of the decision-making process in families living with lung cancer.
. DESIGN Cross-sectional study.
. SETTING Community setting in Greater Portland, Oregon.
. SAMPLE 109 family care dyads (patient and family member) recruited from a statewide cancer registry.
. METHODS Surveys were completed in-person, separately, and privately by each member of the family care dyad. Secondary analysis was completed using multilevel modeling.
. MAIN RESEARCH VARIABLES Negative and positive aspects of the decision process.
. FINDINGS Level 1 data revealed significant variability across care dyads' positive or negative perceptions of the decision-making process. Level 2 results for negative perceptions of decision making indicated that patient and family member perceptions were significantly associated with their own depressive symptoms and feelings of not being listened to by others. Level 2 results for positive perceptions of decision making indicated that patient and family member perceptions were significantly inversely associated with their own feelings of not being listened to and being in nonspousal relationships. In addition, family members' perceptions were more positive when the patients were older.
. CONCLUSIONS This study highlighted the complexity of the decision-making process in families with lung cancer, and underscored the importance of the care dyad feeling listened to by family members in the context of life-threatening illnesses.
. IMPLICATIONS FOR NURSING Nurses assisting families with decisions about lung cancer should be aware of the dynamics of the care dyad and how the decision process is perceived by patients and their family members.
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Shin DW, Cho J, Roter DL, Kim SY, Yang HK, Park K, Kim HJ, Shin HY, Kwon TG, Park JH. Attitudes Toward Family Involvement in Cancer Treatment Decision Making: The Perspectives of Patients, Family Caregivers, and Their Oncologists. Psychooncology 2016; 26:770-778. [PMID: 27437905 DOI: 10.1002/pon.4226] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 07/04/2016] [Accepted: 07/12/2016] [Indexed: 01/30/2023]
Abstract
BACKGROUND To investigate how cancer patients, family caregiver, and their treating oncologist view the risks and benefits of family involvement in cancer treatment decision making (TDM) or the degree to which these perceptions may differ. PATIENTS AND METHODS A nationwide, multicenter survey was conducted with 134 oncologists and 725 of their patients and accompanying caregivers. Participant answered to modified Control Preferences Scale and investigator-developed questionnaire regarding family involvement in cancer TDM. RESULTS Most participants (>90%) thought that family should be involved in cancer TDM. When asked if the oncologist should allow family involvement if the patient did not want them involved, most patients and caregivers (>85%) thought they should. However, under this circumstance, only 56.0% of oncologists supported family involvement. Patients were significantly more likely to skew their responses toward patient rather than family decisional control than were their caregivers (P < .003); oncologists were more likely to skew their responses toward patient rather than family decisional control than caregivers (P < .001). Most respondents thought that family involvement is helpful and neither hamper patient autonomy nor complicate cancer TDM process. Oncologists were largely positive, but less so in these ratings than either patients or caregivers (P < .002). CONCLUSIONS Patients, family caregivers, and, to a lesser degree, oncologists expect and valued family involvement in cancer TDM. These findings support a reconsideration of traditional models focused on protection of patient autonomy to a more contextualized form of relational autonomy, whereby the patient and family caregivers can be seen as a unit for autonomous decision.
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Affiliation(s)
- Dong Wook Shin
- Department of Family Medicine and Health Promotion Center, Seoul National University Hospital, Seoul, Korea.,Cancer Survivorship Clinic, Seoul National University Cancer Hospital, Seoul, Korea
| | - Juhee Cho
- Cancer Education Center, Samsung Comprehensive Cancer Center, School of Medicine and SAHIST, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Debra L Roter
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - So Young Kim
- National Cancer Control Institute, National Cancer Center, Goyang, Korea.,College of Medicine/Graduate School of Health Science Business Convergence, Chungbuk National University, Cheongju, Korea
| | - Hyung Kook Yang
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Keeho Park
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Hyung Jin Kim
- Department of Urology, Chonbuk National University Medical School, Jeonju, Korea
| | - Hee-Young Shin
- Department of Biomedical Science, Chonnam National University Medical School, Gwangju, Korea
| | - Tae Gyun Kwon
- Department of Urology, Kyungpook National University School of Medicine, Daegu, Korea.,Joint Institute for Regenerative Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Jong Hyock Park
- National Cancer Control Institute, National Cancer Center, Goyang, Korea.,College of Medicine/Graduate School of Health Science Business Convergence, Chungbuk National University, Cheongju, Korea
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11
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Waldrop DP, Meeker MA, Kutner JS. Is It the Difference a Day Makes? Bereaved Caregivers' Perceptions of Short Hospice Enrollment. J Pain Symptom Manage 2016; 52:187-195.e1. [PMID: 27233144 PMCID: PMC4996677 DOI: 10.1016/j.jpainsymman.2016.03.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 03/17/2016] [Accepted: 04/06/2016] [Indexed: 11/30/2022]
Abstract
CONTEXT Hospice enrollment for less than one month has been considered too late by some caregivers and at the right time for others. Perceptions of the appropriate time for hospice enrollment in cancer are not well understood. OBJECTIVES The objectives of the study were to identify contributing factors of hospice utilization in cancer for ≤7 days, to describe and compare caregivers' perceptions of this as "too late" or at the "right time." METHODS Semistructured, in-depth, in-person interviews were conducted with a sample subgroup of 45 bereaved caregivers of people who died from cancer within seven days of hospice enrollment. Interviews were transcribed and entered into Atlas.ti for coding. Data were grouped by participants' perceptions of the enrollment as "right time" or "too late." RESULTS Overall, the mean length of enrollment was MLOE = 3.77 (SD = 1.8) days and ranged from three hours to seven days. The "right time" group (N = 25 [56%]) had a MLOE = 4.28 (SD = 1.7) days. The "too late" group (N = 20 [44%]) had a MLOE = 3.06 (SD = 1.03) days. The difference was statistically significant (P = 0.029). Precipitating factors included: late-stage diagnosis, continuing treatment, avoidance, inadequate preparation, and systems barriers. The "right time" experience was characterized by: perceived comfort, family needs were met, preparedness for death. The "too late" experience was characterized by perceived suffering, unprepared for death, and death was abrupt. CONCLUSION The findings suggest that one more day of hospice care may increase perceived comfort, symptom management, and decreased suffering and signal the need for rapid response protocols.
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Affiliation(s)
- Deborah P Waldrop
- University at Buffalo School of Social Work, Buffalo, New York, USA.
| | - Mary Ann Meeker
- University at Buffalo School of Nursing, Buffalo, New York, USA
| | - Jean S Kutner
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
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12
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A systematic review of instruments assessing dimensions of distress among caregivers of adult and pediatric cancer patients. Palliat Support Care 2016; 15:110-124. [DOI: 10.1017/s1478951516000079] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
AbstractObjective:Caregivers of cancer patients face intense demands throughout the course of the disease, survivorship, and bereavement. Caregiver burden, needs, satisfaction, quality of life, and other significant areas of caregiving are not monitored regularly in the clinic setting, resulting in a need to address the availability and clinical effectiveness of cancer caregiver distress tools. This review aimed to determine the availability of cancer caregiver instruments, the variation of instruments between different domains of distress, and that between adult and pediatric cancer patient populations.Method:A literature search was conducted using various databases from 1937 to 2013. Original articles on instruments were extracted separately if not included in the original literature search. The instruments were divided into different areas of caregiver distress and into adult versus pediatric populations. Psychometric data were also evaluated.Results:A total of 5,541 articles were reviewed, and 135 articles (2.4%) were accepted based on our inclusion criteria. Some 59 instruments were identified, which fell into the following categories: burden (n = 26, 44%); satisfaction with healthcare delivery (n = 5, 8.5%); needs (n = 14, 23.7%); quality of life (n = 9, 15.3%); and other issues (n = 5, 8.5%). The median number of items was 29 (4–125): 20/59 instruments (33.9%) had ≤20 items; 13 (22%) had ≤20 items and were psychometrically sound, with 12 of these 13 (92.3%) being self-report questionnaires. There were 44 instruments (74.6%) that measured caregiver distress for adult cancer patients and 15 (25.4%) for caregivers of pediatric patients.Significance of results:There is a significant number of cancer caregiver instruments that are self-reported, concise, and psychometrically sound, which makes them attractive for further research into their clinical use, outcomes, and effectiveness.
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13
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Tsai CF, Lee YT, Lee WJ, Hwang JP, Wang SJ, Fuh JL. Depression of Family Caregivers Is Associated with Disagreements on Life-Sustaining Preferences for Treating Patients with Dementia. PLoS One 2015; 10:e0133711. [PMID: 26230958 PMCID: PMC4521939 DOI: 10.1371/journal.pone.0133711] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 07/01/2015] [Indexed: 12/03/2022] Open
Abstract
Background Family caregivers may not agree with patients with dementia regarding attitudes toward end-of-life preferences, and the effects of this type of disagreement are not well understood. This study sought to identify such a disagreement and its predictors. Methods A cross-sectional sample of 84 family caregivers and patients with dementia was recruited from memory clinics. We used the Mini-Mental State Examination, Neuropsychiatric Inventory, Clinical Dementia Rating, and Katz index of independence in activities of daily living to assess patient symptoms, functions, and severity of dementia. Caregivers completed questionnaires on perceived patient end-of-life care preferences, caregiver end-of-life care preferences for patients, Zarit Burden Interview (ZBI), Center for Epidemiological Studies–Depression Scale (CES-D), and knowledge of clinical complications of advanced dementia. Results The self-disclosure rates of patient preferences were 34.5% for tube feeding, 39.3% for cardiopulmonary resuscitation, and 45.2% for mechanical ventilation. For patients who had disclosed preferences, the disagreement rate between them and their caregivers was 48.3% for tube feeding, 48.5% for cardiopulmonary resuscitation, and 60.3% for mechanical ventilation. Caregiver depression (i.e., CES-D ≥16) was associated with disagreements on cardiopulmonary resuscitation (adjusted odds ratio (aOR) = 6.6, 95% CI = 1.4–31.1, P = 0.01) and mechanical ventilation (aOR = 14, 95% CI = 2.2–87.2, P = 0.005) preferences. Conclusion The preferences of end-of-life issues differed greatly between dementia patients and their caregivers. Depression in caregivers is associated with such discrepancy.
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Affiliation(s)
- Chia-Fen Tsai
- Department of Psychiatry, Neurological Institute, Veterans General Hospital, Taipei, Taiwan
- Institute of Brain Science, National Yang-Ming University Schools of Medicine, Taipei, Taiwan
- Faculty of Medicine, National Yang-Ming University Schools of Medicine, Taipei, Taiwan
| | - Yao-Tung Lee
- Department of Psychiatry, Taipei Medical University–Shuang Ho Hospital, New Taipei City, Taiwan
| | - Wei-Ju Lee
- Institute of Clinical Medicine, National Yang-Ming University Schools of Medicine, Taipei, Taiwan
- Faculty of Medicine, National Yang-Ming University Schools of Medicine, Taipei, Taiwan
- Department of Neurology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Jen-Ping Hwang
- Department of Psychiatry, Neurological Institute, Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, National Yang-Ming University Schools of Medicine, Taipei, Taiwan
| | - Shuu-Jiun Wang
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, National Yang-Ming University Schools of Medicine, Taipei, Taiwan
| | - Jong-Ling Fuh
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, National Yang-Ming University Schools of Medicine, Taipei, Taiwan
- * E-mail:
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14
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Elucidating patient-perceived role in "decision-making" among African Americans receiving lung cancer care through a county safety-net system. J Cancer Surviv 2015; 10:153-63. [PMID: 26076590 DOI: 10.1007/s11764-015-0461-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 05/22/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE We explored patient-perceived role in "decision-making" related to active treatment and palliation among African Americans receiving lung cancer care through a county safety-net system. METHODS Drawing from a cohort of over 100 African Americans treated in a safety-net hospital, we invited a subsample of 13 patient-caregiver dyads to participate in a series of dyadic, ethnographic interviews conducted at the patients' homes. Over 40 h of transcripts were analyzed in an iterative process resulting in reported themes. RESULTS Findings from ethnographic interviews demonstrated that healthcare communication with physicians is difficult for patients. While caregivers and patients describe a deep engagement in lung cancer care, they expressed a concurrent lack of understanding of their prognosis and outcomes of treatment. Dyads did not discuss their lung cancer experience in terms of decision-making; rather, most articulated their role as following physician guidance. Distinct lack of understanding about disease course, severity, and prognosis may constrain patient perception of the need for informed decision-making over the course of care. CONCLUSIONS Dyadic interviews detailing safety-net patient experiences of lung cancer care raise important questions about how clinicians, as well as researchers, conceptualize processes of informed decision-making in vulnerable populations. IMPLICATIONS FOR CANCER SURVIVORS Safety-net patients may not perceive their role as involving informed decision-making and further may lack understanding of disease course and individual prognosis. Safety-net patient dyads expressed high involvement in care and a desire for clarity; clinicians should be prepared to clearly communicate disease stage and prognosis.
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Tanriverdi O, Yavuzsen T, Turhal S, Kilic D, Yalcin S, Ozkan A, Uzunoglu S, Uysal-Sonmez O, Akman T, Aktas B, Ulger S, Babacan T, Komurcu S, Yaren A, Cay-Senler F. Depression and socio-economical burden are more common in primary caregivers of patients who are not aware of their cancer: TURQUOISE Study by the Palliative Care Working Committee of the Turkish Oncology Group (TOG). Eur J Cancer Care (Engl) 2015; 25:502-15. [PMID: 25828949 DOI: 10.1111/ecc.12315] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2015] [Indexed: 11/26/2022]
Abstract
In this study, we aimed to determine the personal, social and economic burden and the frequency of depression, as well as in caregivers of cancer patients who are being treated with chemotherapy in Turkey. The study is designed as a cross-sectional survey study using a 5-point Likert-type response scale, and the last part of the questionnaire includes the Beck Depression Inventory. The depression rate was found to be 64% (n = 476) among all subjects (n = 968), with 91% of those with depression demonstrating signs of mild depression. In this study, a significant difference was found between the presence of depression and age (young), sex (female), educational level (high), economic status (low), financial loss during treatment, patient's lack of knowledge about his/her diagnosis, metastatic disease and short survival time. In addition, 64% of all subjects had concerns of getting cancer, and 44% of all subjects had feelings of anger/rage against other people. In a multivariate regression analysis, the patient's lack of knowledge of the diagnosis was the independent risk factor. In conclusion, depression incidence and burden rate increased among cancer caregivers, and care burden was highly associated with depression. Accordingly, approaches to reducing the psycho-social effects of cancer should focus intensively on both the patients and their caregivers in Turkey.
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Affiliation(s)
- O Tanriverdi
- Department of Medical Oncology, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey
| | - T Yavuzsen
- Department of Medical Oncology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - S Turhal
- Department of Medical Oncology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - D Kilic
- Department of Radiation Oncology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - S Yalcin
- Department of Medical Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - A Ozkan
- Clinical Psychology Unit, Department of Medical Oncology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - S Uzunoglu
- Department of Medical Oncology, Faculty of Medicine, Trakya University, Edirne, Turkey
| | - O Uysal-Sonmez
- Department of Medical Oncology, Sakarya University Education and Research Hospital, Sakarya, Turkey
| | - T Akman
- Department of Medical Oncology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - B Aktas
- Department of Medical Oncology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - S Ulger
- Department of Radiation Oncology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - T Babacan
- Department of Medical Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - S Komurcu
- Department of Medical Oncology, Bayindir Hospital, Ankara, Turkey
| | - A Yaren
- Department of Medical Oncology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - F Cay-Senler
- Department of Medical Oncology, Faculty of Medicine, Ankara University, Ankara, Turkey
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Shin DW, Shin J, Kim SY, Park B, Yang HK, Cho J, Lee ES, Kim JH, Park JH. Cross-cultural validation of Cancer Communication Assessment Tool in Korea. Psychooncology 2014; 24:197-203. [DOI: 10.1002/pon.3629] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 06/29/2014] [Accepted: 06/30/2014] [Indexed: 11/09/2022]
Affiliation(s)
- Dong Wook Shin
- Department of Family Medicine and Health Promotion Center; Seoul National University Hospital; Seoul Korea
- Cancer Survivorship Clinic; Seoul National University Cancer Hospital; Seoul Korea
| | - Jooyeon Shin
- Institute for Human Behavior Research; Department of Psychology, Yonsei University; Seoul Korea
| | - So Young Kim
- Cancer Policy Branch, National Cancer Control Institute; National Cancer Center; Goyang Korea
- College of Medicine/Graduate School of Health Science Business Convergence; Chungbuk National University; Cheongju Korea
| | - Boram Park
- Cancer Policy Branch, National Cancer Control Institute; National Cancer Center; Goyang Korea
| | - Hyung-Kook Yang
- Cancer Policy Branch, National Cancer Control Institute; National Cancer Center; Goyang Korea
| | - Juhee Cho
- Department of Health Sciences and Technology, SAHIST and School of Medicine; Sungkyunkwan University; Seoul Korea
- Department of Health, Behavior, and Society; Johns Hopkins Bloomberg School of Public Health; Baltimore MD USA
- Department of Epidemiology; Johns Hopkins Bloomberg School of Public Health; Baltimore MD USA
| | - Eun Sook Lee
- Research Institute; National Cancer Center; Goyang Korea
- Center for Breast Cancer; National Cancer Center; Goyang Korea
| | - Jong Heun Kim
- Mental Health Clinic, Center for Clinical Specialty; National Cancer Center; Goyang Korea
| | - Jong-Hyock Park
- Cancer Policy Branch, National Cancer Control Institute; National Cancer Center; Goyang Korea
- College of Medicine/Graduate School of Health Science Business Convergence; Chungbuk National University; Cheongju Korea
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Assessing patient–caregiver communication in cancer—a psychometric validation of the Cancer Communication Assessment Tool (CCAT-PF) in a German sample. Support Care Cancer 2014; 22:2473-8. [DOI: 10.1007/s00520-014-2241-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 03/31/2014] [Indexed: 10/25/2022]
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Shin DW, Cho J, Roter DL, Kim SY, Sohn SK, Yoon MS, Kim YW, Cho B, Park JH. Preferences for and experiences of family involvement in cancer treatment decision-making: patient-caregiver dyads study. Psychooncology 2013; 22:2624-31. [PMID: 23893390 DOI: 10.1002/pon.3339] [Citation(s) in RCA: 101] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 05/24/2013] [Accepted: 05/27/2013] [Indexed: 12/20/2022]
Abstract
BACKGROUND Despite the important role that family caregivers play in providing emotional and practical support to cancer patients, relatively little is known about the family caregiver's role in treatment decision-making (TDM). We sought to investigate patients' and family caregivers' preferences for and experiences of family involvement in TDM and factors associated with preference concordance. METHOD A national survey was performed with 990 patient-caregiver dyads (participation rate:76.2%). Questions examining preferences for and experiences of family involvement in TDM were administered independently to patients and family caregivers. Concordance was calculated with weighted kappa. Logistic regression analyses were used to identify predictors of patients' and caregivers' preferences for family involvement in TDM and concordance between them. RESULTS Few patients or family caregivers expressed a preference for unilateral decision-making; however, there was considerable variation and poor agreement within dyads in regard to whether the patient or family caregivers should take the lead in decision-making with input from the other (weighted kappa between respondents for TDM preferences and experiences = 0.10 and κ = 0.18, respectively). Greater TDM preference concordance was associated with higher patient education, whereas lower levels of concordance were evident for younger patients, less educated caregivers, adult child patient dyads (as opposed to a spouse-patient dyads) and problematic family communication about cancer. CONCLUSIONS Most patients and family caregivers valued and expected family involvement in TDM. However, there is little explicit agreement in regard to which party in the dyad should take decisional leadership and who should play a supporting role.
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Affiliation(s)
- Dong Wook Shin
- Department of Family Medicine & Health Promotion Center, Seoul National University Hospital, Seoul, Korea; Cancer Survivorship Clinic, Seoul National University Cancer Hospital, Seoul, Korea
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Assessing the social impact of cancer: a review of available tools. Support Care Cancer 2012; 20:2249-57. [PMID: 22869053 DOI: 10.1007/s00520-012-1545-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Accepted: 07/23/2012] [Indexed: 11/12/2022]
Abstract
OBJECTIVES Taking care of oncological patients holistically--from a biological, social, and psychological point of view--also involves evaluating the social aspects of the disease. In the present study, we provide further insights on how investigations regarding the social impact of an oncological disease are conducted with specifically designed tools on patients who have personally been affected. The objective is then to understand how the social dimension is theorized and, therefore, which practical aspects of subjective experience are employed to assess the social impact. METHOD We performed a systematic review of the literature identified by MedLine and PsycINFO databases. RESULTS Of the 469 articles obtained from the search, 27 deal with 14 different measurement instruments of the social impact of the oncological experience. Of the identified tools, 71% were specifically designed for the oncological setting and were heterogeneous both in the investigated domains as well as social referrals; 64% of these had a multidimensional structure. Internal consistency was reported for all instruments, while temporal stability only for 36% of the tools. Construct validity and concurrent validity were reported for 79% of the instruments, criterion and predictive validity for one instrument only, external validity for 18% of the tools, and cross-cultural validity for one instrument only. The content was directly available for most instruments. CONCLUSIONS The great interest in this subject as borne out by the amount of studies published in international psycho-oncological literature confirms the importance of having a valid and reliable instrument specifically dedicated to measuring the social impact of the oncological experience. At the same time, further investigation is required to investigate the psychometric properties of the existing tools.
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Siminoff LA, Dorflinger L, Agyemang A, Baker S, Wilson-Genderson M. Oncologists' assessments of lung cancer patient and family disagreements regarding treatment decision making. Lung Cancer 2012; 77:212-6. [PMID: 22405569 DOI: 10.1016/j.lungcan.2012.02.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Revised: 02/03/2012] [Accepted: 02/10/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Disagreements between cancer patients and their caregivers about treatment and care can affect the patient's physical and mental well-being. Therefore it is important to understand if oncologists can accurately identify the presence of patient-caregiver decisional conflict. This study examined assessments made by lung cancer patients, their caregivers, and their oncologists regarding patient-caregiver disagreements concerning treatment and care decisions. PARTICIPANTS AND METHODS We assessed the extent to which the patient, caregiver, and oncologist reported disagreement between the patient and the family member regarding treatment decisions in 134 patient-caregiver-oncologist triads. Descriptive statistics were used to explore rates of concordance amongst all possible combinations of raters. Loglinear models were tested for 3-way agreement. RESULTS Most patient-caregiver pairs, 82.1% (n = 110), reported agreement concerning presence or absence of decisional conflict. Oncologists were more successful in detecting absence of conflict than the presence of conflict. When the caregiver and the oncologist agreed, it was regarding the absence of conflict (64.9%), rather than the presence of conflict. In 10.6% (n = 15) of cases, oncologists reported that conflictual relationships negatively impacted their ability to provide patient care. CONCLUSIONS Recent models of cancer patient care promote including the caregiver fully in the process while respecting the primacy of the patient's perspective. However, these models assume that the oncologist will recognize when disagreements exist and be able to assist in conflict resolution. The degree to which the oncologist identified that conflict exists and implications for their ability to provide patient care when familial disagreements existed are discussed.
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Affiliation(s)
- Laura A Siminoff
- Department of Social and Behavioral Health, Massey Cancer Center, School of Medicine, Virginia Commonwealth University, VA 23298, USA.
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Waldrop DP, Meeker MA. Hospice decision making: diagnosis makes a difference. THE GERONTOLOGIST 2012; 52:686-97. [PMID: 22387234 DOI: 10.1093/geront/gnr160] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE This study explored the process of decision making about hospice enrollment and identified factors that influence the timing of that decision. METHODS This study employed an exploratory, descriptive, cross-sectional design and was conducted using qualitative methods. In-depth in-person semistructured interviews were conducted with 36 hospice patients and 55 caregivers after 2 weeks of hospice care. The study was guided by Janis and Mann's conflict theory model (CTM) of decision making. Qualitative data analysis involved a directed content analysis using concepts from the CTM. RESULTS A model of hospice enrollment decision making is presented. Concepts from the CTM (appraisal, surveying and weighing the alternatives, deliberations, adherence) were used as an organizing framework to illustrate the dynamics. Distinct differences were found by diagnosis (cancer vs. other chronic illness, e.g., heart and lung diseases) during the pre-encounter phase or before the hospice referral but no differences emerged during the post-encounter phase. IMPLICATIONS Differences in decision making by diagnosis suggest the need for research about effective means for tailored communication in end-of-life decision making by type of illness. Recognition that decision making about hospice admission varies is important for clinicians who aim to provide person-centered and family-focused care.
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Affiliation(s)
- Deborah P Waldrop
- University at Buffalo School of Social Work, 685 Baldy Hall, Buffalo, NY 14260, USA.
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Waldrop DP, Meeker MA, Kerr C, Skretny J, Tangeman J, Milch R. The nature and timing of family-provider communication in late-stage cancer: a qualitative study of caregivers' experiences. J Pain Symptom Manage 2012; 43:182-94. [PMID: 22248787 DOI: 10.1016/j.jpainsymman.2011.04.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2011] [Revised: 03/29/2011] [Accepted: 04/12/2011] [Indexed: 10/14/2022]
Abstract
CONTEXT Family members of people with advanced cancer can experience intensified distress and uncertainty during the final stages of their loved one's illness. Enhanced comprehension about disease progression, symptom management, and options for care can help families adapt, cope, and plan for the future. OBJECTIVES Guided by concepts from the Sense of Coherence Theory, which illuminates factors that contribute to adaptation in stressful situations, the objective of this study was to explore and describe family caregivers' accounts of the nature and timing of communication they had with a loved one's health care provider(s) during the advanced stages of cancer and before hospice enrollment. METHODS Retrospective in-depth interviews were conducted with caregivers of 46 people who died of cancer. Interviews were audiotaped, transcribed, and submitted to an iterative process of qualitative data analysis that included 1) systematic coding, 2) the use of data matrices to display summarized results and collapse the codes into themes, 3) and axial coding to characterize the nature of the themes. RESULTS Overall, communication with providers was found to be either 1) satisfactory or 2) unsatisfactory. Satisfactory communication was 1) compassionate, 2) responsive, and/or 3) dedicated. Unsatisfactory communication was described as 1) sparse, 2) conflicted, 3) contradictory, and/or 4) brink of death. CONCLUSION Communication with health care providers is critical for helping family caregivers understand and manage the changes that accompany a life-limiting illness. Timely communication with information and meaningful discussion about disease progression can help families prepare for the advanced stages of an illness and approaching death.
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Affiliation(s)
- Deborah P Waldrop
- University at Buffalo School of Social Work, Buffalo, New York 14260, USA.
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Factors affecting treatment choices in paediatric palliative care: Comparing parents and health professionals. Eur J Cancer 2011; 47:2182-7. [DOI: 10.1016/j.ejca.2011.04.038] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2011] [Revised: 04/05/2011] [Accepted: 04/28/2011] [Indexed: 11/24/2022]
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McCormack LA, Treiman K, Rupert D, Williams-Piehota P, Nadler E, Arora NK, Lawrence W, Street RL. Measuring patient-centered communication in cancer care: a literature review and the development of a systematic approach. Soc Sci Med 2011; 72:1085-95. [PMID: 21376443 DOI: 10.1016/j.socscimed.2011.01.020] [Citation(s) in RCA: 215] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2010] [Revised: 11/07/2010] [Accepted: 01/15/2011] [Indexed: 11/19/2022]
Abstract
Patient-centered communication (PCC) is a critical element of patient-centered care, which the Institute of Medicine (Committee on Quality of Health Care in America, 2001) promulgates as essential to improving healthcare delivery. Consequently, the US National Cancer Institute's Strategic Plan for Leading the Nation (2006) calls for assessing the delivery of PCC in cancer care. However, no comprehensive measure of PCC exists, and stakeholders continue to embrace different conceptualizations and assumptions about how to measure it. Our approach was grounded in the PCC conceptual framework presented in a recent US National Cancer Institute monograph (Epstein & Street, 2007). In this study, we developed a comprehensive inventory of domains and subdomains for PCC by reviewing relevant literature and theories, interviewing a limited number of cancer patients, and consulting experts. The resulting measurement domains are organized under the six core functions specified in the PCC conceptual framework: exchanging information, fostering healing relationships, recognizing and responding to emotions, managing uncertainty, making decisions, and enabling patient self-management. These domains represent a promising platform for operationalizing the complicated PCC construct. Although this study focused specifically on cancer care, the PCC measurements are relevant to other clinical contexts and illnesses, given that patient-centered care is a goal across all healthcare. Finally, we discuss considerations for developing PCC measures for research, quality assessment, and surveillance purposes. United States Department of Health and Human Services, National Institutes of Health, National Cancer Institute (2006). The NCI Strategic Plan for Leading the Nation: To Eliminate the Suffering and Death Due to Cancer. NIH Publication No. 06-5773.
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Affiliation(s)
- Lauren A McCormack
- Health Communication Program, RTI International, 3040 Cornwallis Road, RTP, NC 27709, USA.
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Siminoff LA, Wilson-Genderson M, Baker S. Depressive symptoms in lung cancer patients and their family caregivers and the influence of family environment. Psychooncology 2011; 19:1285-93. [PMID: 20119935 DOI: 10.1002/pon.1696] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE This study investigated depressive symptomatology in lung cancer patients and their identified caregiver. METHODS We conducted semi-structured interviews and administered measures of family environment, depressive symptomatology, and the extent to which the caregiver blamed the cancer on the patient not having taken better care of him/herself to 190 patient-caregiver dyads. Multivariate two-level models were used to estimate the unique effects for each dyad member and cross-partner effects while controlling for interdependencies in the data. RESULTS More than half the patients (55%) were male, whereas 74% of caregivers were female. The majority (57.4%) were spouses, followed by offspring, and other family or friends. The baseline model with covariates showed that younger caregivers, spouse caregivers, and caregivers who blamed the patient for the cancer had higher depressive symptom scores. When examining the unique effect for each dyad member, with the exception of patient report of familial conflict, patient and caregiver reports of lower familial cohesion and expressiveness and higher conflict were associated with higher depression scores for patient and caregiver, respectively. When examining cross-partner effects, patient reports of lower cohesion, lower expressiveness, and greater conflict were associated with higher caregiver depression scores. Offspring caregivers reported less depression than non-offspring caregivers. CONCLUSION The family environment and blaming the patient during times of illness can affect both patient and caregiver depression. Findings suggest that quality of the family dynamic is important for patients, but may be particularly influential for caregivers. Future research should aid clinicians' assessment of family environment when making treatment plans.
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Affiliation(s)
- Laura A Siminoff
- Department of Social and Behavioral Health, Massey Cancer Center, School of Medicine, Virginia Commonwealth University, VA 23298, USA.
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Schumm K, Skea Z, McKee L, N'Dow J. 'They're doing surgery on two people': a meta-ethnography of the influences on couples' treatment decision making for prostate cancer. Health Expect 2010; 13:335-49. [PMID: 20860778 DOI: 10.1111/j.1369-7625.2010.00624.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Current orthodoxy suggests that patients need to be provided with full information about their care and that treatment options should be discussed with patients and family members. This imperative is especially challenging when there is a lack of consensus about treatment effectiveness and equivocacy over different types of interventions. In the case of prostate cancer, evidence is contested as to the efficacy of different treatments. Thus, involving patients and their family members in treatment choices is complex and little is known about how patients and their partners process these decisions when there is uncertainty about different outcomes. This paper has reviewed the literature on the way couples approach such decision making in relation to treatment for prostate cancer. OBJECTIVE A meta-ethnographic synthesis of published qualitative papers that focused on the influences on patients', and their partners' treatment decision making for prostate cancer, was conducted in order to identify and understand barriers and facilitators which impact on this process. RESULTS Our synthesis indicates that the couples' relationship 'dynamic' provides a contextual background against which treatment decisions are negotiated and made. DISCUSSION AND CONCLUSIONS We propose that the findings from this synthesis can enhance the potential for shared decision making for patients, and their partners, when facing a treatment decision for prostate cancer. By understanding the couples' relationship dynamic pre-diagnosis, clinicians may be able to tailor the communication and information provision to both patients and their partners, providing a personalized approach to treatment decision making.
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Affiliation(s)
- Kate Schumm
- Academic Urology Unit Health Services Research Unit, Health Sciences Building, University of Aberdeen, Aberdeen, UK.
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Hisamura K, Matsushima E, Nagai H, Mikami A. Comparison of patient and family assessments of quality of life of terminally ill cancer patients in Japan. Psychooncology 2010; 20:953-60. [PMID: 20623804 DOI: 10.1002/pon.1802] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2009] [Revised: 05/31/2010] [Accepted: 06/08/2010] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This study examined the extent and the nature of agreement on health-related quality of life (QOL) assessments between terminally ill cancer patients and their primary family caregivers in Japan, using a multidimensional QOL instrument including psychosocial and spiritual domains. METHODS The Functional Assessment of Chronic Illness Therapy-Spiritual well-being questionnaire was used to assess patients' QOL. Study subjects were inpatients of a palliative care unit (PCU), outpatients who applied for admission to the PCU, and their primary family caregivers. RESULTS QOL ratings were obtained from 102 of 197 eligible patient-caregiver dyads. A moderate level of patient-family concordance on patients' overall QOL as well as families' underestimation of patients' QOL were observed. Families reported on observable domains of patients' QOL more reliably and assessed subjective aspects, such as psychospiritual concerns less accurately. Families tended to underrate the patients' social aspect of QOL, whereas most patients gave the highest rating on support from their families. The spiritual domain, particularly regarding faith, showed the least agreement. The size of the systematic bias between patient and family assessments on the patients' QOL was moderate (>0.50). CONCLUSIONS Families' limited ability to assess psychosocial and spiritual aspects of patients' QOL may suggest the need for better approaches or measures to assess these aspects of a patient's life. The systematic bias was larger than in earlier studies. Further investigation is needed to identify factors affecting patient-family discord on QOL assessments to guide effective interventions to enhance patient-caregiver agreement. Copyright © 2010 John Wiley & Sons, Ltd.
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Affiliation(s)
- Kazuho Hisamura
- Section of Liaison Psychiatry and Palliative Medicine, Department of Comprehensive Diagnosis and Therapeutics, Division of Comprehensive Patient Care, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan.
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Tomlinson D, Gibson F, Treister N, Baggott C, Judd P, Hendershot E, Maloney AM, Doyle J, Feldman B, Kwong K, Sung L. Refinement of the Children's International Mucositis Evaluation Scale (ChIMES): Child and parent perspectives on understandability, content validity and acceptability. Eur J Oncol Nurs 2010; 14:29-41. [DOI: 10.1016/j.ejon.2009.10.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2009] [Revised: 10/23/2009] [Accepted: 10/24/2009] [Indexed: 10/20/2022]
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Relationship quality and burden among caregivers for late-stage cancer patients. Support Care Cancer 2009; 18:1429-36. [DOI: 10.1007/s00520-009-0765-5] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Accepted: 10/12/2009] [Indexed: 10/20/2022]
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Rose JH, Bowman KF, Radziewicz RM, Lewis SA, O'Toole EE. Predictors of Engagement in a Coping and Communication Support Intervention for Older Patients with Advanced Cancer. J Am Geriatr Soc 2009; 57 Suppl 2:S296-9. [DOI: 10.1111/j.1532-5415.2009.02517.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Gleason MEJ, Harper FWK, Eggly S, Ruckdeschel JC, Albrecht TL. The influence of patient expectations regarding cure on treatment decisions. PATIENT EDUCATION AND COUNSELING 2009; 75:263-9. [PMID: 19147315 PMCID: PMC3785099 DOI: 10.1016/j.pec.2008.10.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2008] [Revised: 09/30/2008] [Accepted: 10/23/2008] [Indexed: 05/20/2023]
Abstract
OBJECTIVE To test whether cancer patients' expectations for cure prior to interacting with their oncologist influence their decisions to follow treatment recommendations. Further, to test whether patients' expectations for cure are affected by the strength of the oncologist-patient alliance or the extent to which companions (if present) share patients' expectations for cure. METHODS Interactions of 101 patients (and 114 companions) with oncologists about treatment were coded for the strength of the oncologist-patient alliance. Prior to the interaction, patients and companions reported expectations about whether the patient would be cured of cancer. After the interaction, patients reported whether they intended to follow the recommended treatment. RESULTS Patients who expected a cure were more likely to report an intention to follow oncologists' treatment recommendation when the strength of their alliance with their oncologist was weaker (B=-0.51, p<.05). Patients whose expectations for cure matched their companions' expectations were less likely to report intentions to follow treatment recommendations (B=-0.28, p<.05). CONCLUSION Patients who have an expectation of being cured of cancer prior to meeting with their oncologist are more likely to intend to follow recommended treatment when their alliance with the oncologist is weaker and their companions do not believe they will be cured. PRACTICE IMPLICATIONS To better understand patient treatment decisions and improve overall cancer care, oncologists should be aware of the complex ways that patients' expectations about cure influence treatment choices.
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Affiliation(s)
- Marci E J Gleason
- Barbara Ann Karmanos Cancer Institute, Wayne State University, Detroit, Michigan 48201, United States.
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Siminoff LA, Zyzanski SJ, Rose JH, Zhang AY. The Cancer Communication Assessment Tool for Patients and Families (CCAT-PF): a new measure. Psychooncology 2009; 17:1216-24. [PMID: 18504807 DOI: 10.1002/pon.1350] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVES Caregivers and cancer patients frequently have conflicting and unmet communication needs. The Cancer Communication Assessment Tool for Patients and Families (CCAT-PF) is a new instrument that assesses congruence in patient-family caregiver communication for both research and clinical purposes. METHODS The scale was developed using a sample of 190 lung cancer patient-caregiver pairs. Standard psychometric procedures were used to develop and test the scale including qualitative item pool development, item reduction and ascertainment of scale properties. RESULTS The multiple correlation of the 18-item CCAT-PF scale with the longer 30-item scale was 0.94. All but three items had less than 20% variance accounted for when each item was regressed on the remaining 17, indicating that responses to an individual item were not readily predicted by the remaining items. Test re-test reliability was 0.35 and Cronbach's alpha was 0.49 as the CCAT-PF scale represents the sum of mostly independent items. Higher CCAT-PF scores were significantly correlated with greater patient depression, greater patient perceived family conflict, lower patient-caregiver assessment and well-being and less expressiveness and family cohesion. For both patients and caregivers, physical, functional and emotional well-being were not associated with CCAT-PF scores. CONCLUSION The CCAT-PF is a brief but reliable and valid tool. Although administering both family and patient versions is optimal, administering it to a patient or family caregiver only also produces reliable information.
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Affiliation(s)
- Laura A Siminoff
- Department of Social and Behavioral Health, School of Medicine, Virginia Commonwealth University, Richmond, VA 23298, USA.
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Tomlinson D, Gibson F, Treister N, Baggott C, Judd P, Hendershot E, Maloney AM, Doyle J, Feldman B, Sung L. Designing an oral mucositis assessment instrument for use in children: generating items using a nominal group technique. Support Care Cancer 2008; 17:555-62. [PMID: 18982362 DOI: 10.1007/s00520-008-0523-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2008] [Accepted: 10/01/2008] [Indexed: 11/30/2022]
Abstract
GOALS OF WORK There was a need to develop a mucositis instrument that would be specific for use with children. This paper describes the step of generating items in the process of developing a new instrument for the assessment of oral mucositis in children. MATERIALS AND METHODS Nine health care professionals with expertise in pediatric cancer, mucositis assessment, and oral assessment in children were invited to participate in a nominal group technique to generate items that should be included in an instrument. RESULTS Thirty items were generated initially. Voting processes established that six of these items were thought to be necessary for inclusion: (1) presence of ulcers, (2) pain assessment, (3) amount of pain medication received, (4) effect on eating, (5) drooling-pooling of saliva, and (6) effect on drinking. Using these six items, an initial draft of an instrument was developed that could be used to assess oral mucositis in children, namely, the Children's International Mucositis Evaluation Scale. CONCLUSION The six items generated by this process provided the basis for a simple, feasible, and reliable instrument. With increased clinical research investigating interventions to reduce and prevent oral mucositis, such an instrument will be critical to the effective conduct of this research in children. Further testing of this instrument is necessary.
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Affiliation(s)
- Deborah Tomlinson
- Child Health Evaluative Sciences, Hospital for Sick Children, 123 Edward Street, Toronto, Ontario M5G 1E2, Canada.
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Rose JH, O'Toole EE, Einstadter D, Love TE, Shenko CA, Dawson NV. Patient Age, Well-Being, Perspectives, and Care Practices in the Early Treatment Phase for Late-Stage Cancer. J Gerontol A Biol Sci Med Sci 2008; 63:960-8. [DOI: 10.1093/gerona/63.9.960] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Higginson IJ, Gao W. Caregiver assessment of patients with advanced cancer: concordance with patients, effect of burden and positivity. Health Qual Life Outcomes 2008; 6:42. [PMID: 18518961 PMCID: PMC2435233 DOI: 10.1186/1477-7525-6-42] [Citation(s) in RCA: 106] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2008] [Accepted: 06/02/2008] [Indexed: 12/04/2022] Open
Abstract
Background Clinicians and researchers often have to rely on information from caregivers to assess patients with advanced cancer. This study aims to assess the validity (using patients' assessment as the gold standard) of caregiver reports of patient concerns and the roles of caregiver burden and positivity. Methods A total of 64 advanced cancer patient and informal caregiver dyads were recruited from regional palliative care services and interviewed. Patients' outcomes were assessed with both the patient and the caregiver version of the Palliative Outcome Scale (POS); caregiver burden and positivity were collected with the Zarit Burden interview (ZBI) and three questions on achievements and relationships. The agreement between patient- and caregiver-rated POS was measured with weighted kappa statistics. The roles of caregiver burden and positivity in POS agreement were studied with logistic regression controlling for potential confounders; adjusted odds ratios were estimated from the models. Results Agreement was substantial for pain, moderate for four items, fair for three items and slight for two items. Compared with patients self-ratings, caregivers described more problems with information given and sharing feelings and were less likely to assess the patient felt their life was worthwhile or felt good about themselves. Disagreement for three POS item ratings was significantly associated with higher caregiver burden: "feeling anxious"(OR: 4.5; 95%CI: 1.3 to 15.6), "life worthwhile"(OR: 12.4; 95%CI: 2.9 to 54.3) and "felt good" (OR: 7.7; 95%CI: 2.0 to 29.6). Caregivers with higher positivity scores were more likely to agree patients' rating of "felt good"(OR: 0.3; 95%CI: 0.1–0.9) but at increased risk of disagreeing about patient's "practical problems"(OR: 4.2; 95%CI: 1.1 to 16.6). Conclusion Caregiver burden and positivity affect their assessments, especially of psychological patient domains and whether patients assess their life as worthwhile. Awareness of this might help clinicians and researchers better interpret caregiver assessments.
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Affiliation(s)
- Irene J Higginson
- King's College London, School of Medicine at Guy's, King's College and St Thomas' Hospitals, Department of Palliative Care, Policy and Rehabilitation, Weston Education Centre, Cutcombe Road, London, SE5 9RJ, UK.
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Rose JH, Radziewicz R, Bowmans KF, O'Toole EE. A coping and communication support intervention tailored to older patients diagnosed with late-stage cancer. Clin Interv Aging 2008; 3:77-95. [PMID: 18488881 PMCID: PMC2544372 DOI: 10.2147/cia.s1262] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
As our society ages, increasing numbers of older Americans will be diagnosed and eventually will die of cancer. To date, psycho-oncology interventions for advanced cancer patients have been more successful in reaching younger adult age groups and generally have not been designed to respond to the unique needs and preferences of older patients. Theories and research on successful aging (Baltes and Baltes 1990; Baltes 1997), health information processing style (Miller 1995; Miller et al 2001) and non-directive client-centered therapy (Rogers 1951, 1967), have guided the development of a coping and communication support (CCS) intervention. Key components of this age-sensitive and tailored intervention are described, including problem domains addressed, intervention strategies used and the role of the CCS practitioner. Age group comparisons in frequency of contact, problems raised and intervention strategies used during the first six weeks of follow up indicate that older patients were similar to middle-aged patients in their level of engagement, problems faced and intervention strategies used. Middle-aged patients were more likely to have problems communicating with family members at intervention start up and practical problems as well in follow up contacts. This is the first intervention study specifically designed to be age sensitive and to examine age differences in engagement from the early treatment phase for late-stage cancer through end of life. This tailored intervention is expected to positively affect patients' quality of care and quality of life over time.
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Affiliation(s)
- Julia Hannum Rose
- Case Western Reserve University, School of Medicine, Cleveland, Ohio 44109, USA
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