1
|
Crape B, Akhmetova M, Akhmetniyaz P, Foster F, Nadyrov K, Toleubekova L. Number of palliative care nurse home visits and duration of palliative care associated with domains of the Good Death Inventory: A national survey of bereaved family caregivers in a middle income country. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2024; 7:100217. [PMID: 39040616 PMCID: PMC11261078 DOI: 10.1016/j.ijnsa.2024.100217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 06/11/2024] [Accepted: 06/14/2024] [Indexed: 07/24/2024] Open
Abstract
Background In the lower-middle-income country of Kazakhstan, palliative care services are in the early stages of integration into healthcare services. No prior studies have investigated associations between palliative care service factors and a good death in lower-middle-income countries, nor explored how palliative care nurses contribute to a good death. In this paper, a good death is referred to as the control of pain and symptoms, clear decision-making, a sense of closure, being recognized and perceived as an individual, preparation for death, and still being able to contribute to others, all taken together. Objectives To identify new opportunities for palliative care service nurses by investigating associations between palliative care service factors and a good death, as measured by the Good Death Inventory. Methods Family caretakers of deceased patients from palliative care units and hospices were surveyed across six different regions of Kazakhstan. Data collected included demographics for patients and caregivers, palliative care service data, and Good Death Inventory items. Poisson regression analysis with r variance and linear regressions were conducted to identify determinants for achieving a Good Death and for the 18 Good Death Inventory domains. Results Two hundred and eleven family caregivers participated in the survey. Bivariate analysis revealed five statistically significant associations (p ≤ 0.05) with the outcome of a good death. In multivariate linear regression analyses, a palliative care duration of greater-than-6-months, compared to less-than-1-month, was associated with improvements in 10 out of 18 domains of the Good Death Inventory (p ≤ 0.05). More-than-once-weekly palliative care home visits by nurses, compared to no visits, were also associated with improvements in four domains (p ≤ 0.05). Conclusion We provide new directions for improvements in palliative care services in low-middle-income countries, giving impetus for resource allocation to palliative care home visits by nurses for achieving a good death for greater numbers of patients.
Collapse
Affiliation(s)
- Byron Crape
- Department of Biomedical Sciences, School of Medicine, Nazarbayev University, Astana, Kazakhstan
| | - Makpal Akhmetova
- Department of Medicine, School of Medicine, Nazarbayev University, Astana, Kazakhstan
| | - Pana Akhmetniyaz
- Department of Medicine, School of Medicine, Nazarbayev University, Astana, Kazakhstan
| | - Faye Foster
- Department of Medicine, School of Medicine, Nazarbayev University, Astana, Kazakhstan
| | | | - Lyazzat Toleubekova
- Department of Medicine, School of Medicine, Nazarbayev University, Astana, Kazakhstan
| |
Collapse
|
2
|
Zhu L, Wang Y, Li J, Zhou H, Li N, Wang Y. Depressive symptoms and all-cause mortality among middle-aged and older people in China and associations with chronic diseases. Front Public Health 2024; 12:1381273. [PMID: 38841667 PMCID: PMC11151855 DOI: 10.3389/fpubh.2024.1381273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 05/02/2024] [Indexed: 06/07/2024] Open
Abstract
Introduction It remains unclear whether depressive symptoms are associated with increased all-cause mortality and to what extent depressive symptoms are associated with chronic disease and all-cause mortality. The study aims to explore the relationship between depressive symptoms and all-cause mortality, and how depressive symptoms may, in turn, affect all-cause mortality among Chinese middle-aged and older people through chronic diseases. Methods Data were collected from the China Health and Retirement Longitudinal Study (CHARLS). This cohort study involved 13,855 individuals from Wave 1 (2011) to Wave 6 (2020) of the CHARLS, which is a nationally representative survey that collects information from Chinese residents ages 45 and older to explore intrinsic mechanisms between depressive symptoms and all-cause mortality. The Center for Epidemiological Studies Depression Scale (CES-D-10) was validated through the CHARLS. Covariates included socioeconomic variables, living habits, and self-reported history of chronic diseases. Kaplan-Meier curves depicted mortality rates by depressive symptom levels, with Cox proportional hazards regression models estimating the hazard ratios (HRs) of all-cause mortality. Results Out of the total 13,855 participants included, the median (Q1, Q3) age was 58.00 (51.00, 63.00) years. Adjusted for all covariates, middle-aged and older adults with depressive symptoms had a higher all-cause mortality rate (HR = 1.20 [95% CI, 1.09-1.33]). An increased rate was observed for 55-64 years old (HR = 1.23 [95% CI, 1.03-1.47]) and more than 65 years old (HR = 1.32 [95% CI, 1.18-1.49]), agricultural Hukou (HR = 1.44, [95% CI, 1.30-1.59]), and nonagricultural workload (HR = 1.81 [95% CI, 1.61-2.03]). Depressive symptoms increased the risks of all-cause mortality among patients with hypertension (HR = 1.19 [95% CI, 1.00-1.40]), diabetes (HR = 1.41[95% CI, 1.02-1.95]), and arthritis (HR = 1.29 [95% CI, 1.09-1.51]). Conclusion Depressive symptoms raise all-cause mortality risk, particularly in those aged 55 and above, rural household registration (agricultural Hukou), nonagricultural workers, and middle-aged and older people with hypertension, diabetes, and arthritis. Our findings through the longitudinal data collected in this study offer valuable insights for interventions targeting depression, such as early detection, integrated chronic disease care management, and healthy lifestyles; and community support for depressive symptoms may help to reduce mortality in middle-aged and older people.
Collapse
Affiliation(s)
- Lan Zhu
- School of Education and Psychology, Key Research Institute of Humanities and Social Sciences of State Ethnic Affairs Commission, and Research Centre of Sichuan Minzu Education Development, Southwest Minzu University, Chengdu, China
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yixi Wang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jiaqi Li
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, China; School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China
| | - Huan Zhou
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ningxiu Li
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yuanyuan Wang
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, China; School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China
| |
Collapse
|
3
|
Liu X, Jin J, Yu M, Shen L, Ning L, Zheng B. Association between personality traits and psychological distress among postmenopausal women with coronary heart disease: A cross-sectional survey and mediation analysis. Nurs Health Sci 2024; 26:e13109. [PMID: 38467127 DOI: 10.1111/nhs.13109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 01/28/2024] [Accepted: 02/23/2024] [Indexed: 03/13/2024]
Abstract
Postmenopausal women with negative personality characteristics are at an increased risk of psychological disorders, yet little is known about the mechanism underlying the relationship between type D personality and psychological distress in postmenopausal women with coronary disease. This study assessed the mediating roles of perceived social support and self-perceived burden in the relationship between type D and psychological distress based on the equity theory and stress-buffering model. Demographic characteristics, type D, psychological distress, perceived social support, and self-perceived burden were completed by 335 participants with self-reported questionnaires using a cross-sectional design in Southeast China. The results revealed that perceived social support and self-perceived burden both separately and serially mediated the relationship between type D personality and psychological distress. Effective intervention strategies aimed at improving perceived social support or reducing self-perceived burden may be beneficial in reducing psychological distress.
Collapse
Affiliation(s)
- Xin Liu
- Department of Cardiovascular Medicine, Affiliated Hangzhou First People's Hospital, School of Medicine, Westlake University, Hangzhou, Zhejiang, China
| | - Jianfen Jin
- Department of Nursing, Affiliated Hangzhou First People's Hospital, School of Medicine, Westlake University, Hangzhou, Zhejiang, China
| | - Mengying Yu
- Department of Nursing, Affiliated Hangzhou First People's Hospital, School of Medicine, Westlake University, Hangzhou, Zhejiang, China
| | - Lishui Shen
- Cardiology Department, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Li Ning
- Department of Nursing, Affiliated Hangzhou First People's Hospital, School of Medicine, Westlake University, Hangzhou, Zhejiang, China
| | - Beibei Zheng
- Department of Cardiovascular Medicine, Affiliated Hangzhou First People's Hospital, School of Medicine, Westlake University, Hangzhou, Zhejiang, China
| |
Collapse
|
4
|
Chen X, Wang Z, Zhou J, Loke AY, Li Q. A scoping literature review of factors influencing cancer patients' self-perceived burden. Eur J Oncol Nurs 2024; 68:102462. [PMID: 37995428 DOI: 10.1016/j.ejon.2023.102462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 10/19/2023] [Accepted: 10/30/2023] [Indexed: 11/25/2023]
Abstract
PURPOSE A cancer diagnosis disrupts the peaceful lives and plans of patients and even their caregivers, and patients can easily feel burdened when they are being cared for by others. However, the influencing factors of self-perceived burden (SPB) have not been summarized, and related research is still in its infancy. This review explores factors related to the SPB of cancer patients and identifies future research directions. METHOD A systematic search, including trolling through six electronic databases, was conducted to identity articles published in English and Chinese from January 2003 to April 2022, using key terms related to cancer patients' burden on others; a manual search was also performed on the articles' reference lists. RESULTS Thirty-three articles were identified. The content was described into three groups: patient-related factors, caregiver-related factors, and family-related (financial) factors. Despite the heterogeneity, patients' physical/disease factors, psychological factors, social factors, caregiver type, quality of care provided, caregiver physical and psychological status, and financial factors were all correlated with SPB. CONCLUSIONS This literature review shows that SPB imposes a huge burden on cancer patients, and that SPB in cancer patients is influenced by patient-related factors, caregiver-related factors, and family factors. These influencing factors directly or indirectly affect SPB. In addition, SPB is complex and studies related to its factors deserve a further detailed analysis based on the actual situation of the patients in order to make the results more accurate and relevant.
Collapse
Affiliation(s)
- Xuan Chen
- Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu Province, China
| | - Zhiming Wang
- Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu Province, China
| | - Junrui Zhou
- Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu Province, China
| | - Alice Yuen Loke
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon Hong Kong, China
| | - Qiuping Li
- Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu Province, China; Affiliated Hospital of Jiangnan University, Wuxi, China.
| |
Collapse
|
5
|
Lee W, Sheehan C, Chye R, Chang S, Bayes A, Loo C, Draper B, Agar MR, Currow DC. Subcutaneous ketamine infusion in palliative patients for major depressive disorder (SKIPMDD)-Phase II single-arm open-label feasibility study. PLoS One 2023; 18:e0290876. [PMID: 37963146 PMCID: PMC10645343 DOI: 10.1371/journal.pone.0290876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 08/17/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Ketamine at subanaesthetic dosages (≤0.5mg/kg) exhibits rapid onset (over hours to days) antidepressant effects against major depressive disorder in people who are otherwise well. However, its safety, tolerability and efficacy are not known for major depressive disorder in people with advanced life-limiting illnesses. OBJECTIVE To determine the feasibility, safety, tolerability, acceptability and any antidepressant signal/activity to justify and inform a fully powered study of subcutaneous ketamine infusions for major depressive disorder in the palliative setting. METHODS This was a single arm, open-label, phase II feasibility study (Australian New Zealand Clinical Trial Registry Number-ACTRN12618001586202). We recruited adults (≥ 18-years-old) with advanced life-limiting illnesses referred to four palliative care services in Sydney, Australia, diagnosed with major depressive disorder from any care setting. Participants received weekly subcutaneous ketamine infusion (0.1-0.4mg/kg) over two hours using individual dose-titration design. Outcomes assessed were feasibility, safety, tolerability and antidepressant activity. RESULTS Out of ninety-nine referrals, ten participants received ketamine and were analysed for responses. Accrual rate was 0.54 participants/month across sites with 50% of treated participants achieving ≥ 50% reduction in baseline Montgomery-Åsberg Depression Rating Scale, meeting feasibility criteria set a priori. There were no clinically relevant harms encountered. CONCLUSIONS A future definitive trial exploring the effectiveness of subcutaneous infusion of ketamine for major depressive disorder in the palliative care setting may be feasible by addressing identified study barriers. Individual dose-titration of subcutaneous ketamine infusions over two hours from 0.1mg/kg can be well-tolerated and appears to produce transient antidepressant signals over hours to days.
Collapse
Affiliation(s)
- Wei Lee
- University of Technology Sydney, Ultimo, NSW, Australia
- St. Vincent Health Australia, Sydney, NSW, Australia
- HammondCare, Royal North Shore Hospital, St. Leonards, NSW, Australia
- University of Sydney, Northern Clinical School, St. Leonards, NSW, Australia
| | | | - Richard Chye
- University of Technology Sydney, Ultimo, NSW, Australia
- St. Vincent Health Australia, Sydney, NSW, Australia
- University of Notre Dame Australia, Fremantle, NSW, Australia
- University of New South Wales, Randwick, NSW, Australia
| | - Sungwon Chang
- University of Technology Sydney, Ultimo, NSW, Australia
| | - Adam Bayes
- University of New South Wales, Randwick, NSW, Australia
- Blackdog Institute, Hospital Road, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Colleen Loo
- University of New South Wales, Randwick, NSW, Australia
- Blackdog Institute, Hospital Road, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Brian Draper
- University of New South Wales, Randwick, NSW, Australia
| | - Meera R. Agar
- University of Technology Sydney, Ultimo, NSW, Australia
- University of New South Wales, Randwick, NSW, Australia
| | | |
Collapse
|
6
|
Crampton E, Weisse CS. Antidepressant Use During Hospice Patients' Final Months on Routine Home Care. Am J Hosp Palliat Care 2023; 40:953-958. [PMID: 36242518 DOI: 10.1177/10499091221134028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Antidepressants can be used to manage symptoms at the end of life, but the dying process can impact their use. Objectives: To examine the use of antidepressants during hospice patients' final months of home care. Methods: A retrospective case records review of 227 hospice patients in their last three months of care in a residential setting. Chart reviews were conducted of medication logs, hospice staff notes, and caregiver narratives to examine antidepressant use including types of medications prescribed and factors associated with medication maintenance. Results: Thirty percent of patients were prescribed at least 1 antidepressant for symptoms including depression, anxiety, pain, disturbances in sleep, and poor appetite. The majority (96.1%) of patients were not administered their antidepressant on the day of death, and more than half (61.8%) did not receive their antidepressant during their last 3 days of life. A quarter (25.5%) of patients on antidepressants did not receive medication 4-7 days prior to death while some (12.7%) went without their antidepressant for 8 or more days. Antidepressant use was discontinued by hospice staff or caregivers due to a variety of reasons including difficulty swallowing, minimal consciousness, confusion, nausea, or patient refusal. Conclusions: Antidepressants are prescribed to manage multiple symptoms at the end of life, but use is often disrupted during patients' final days. Tapering and other prescription adjustments may be warranted to avoid risk of antidepressant discontinuation syndrome (ADS).
Collapse
Affiliation(s)
| | - Carol S Weisse
- Director of Health Professions/Professor of Psychology, Union College, Schenectady, NY, USA
| |
Collapse
|
7
|
Barbosa ARC, Nunes DP, Lima DB, Colombo FA, Nunes JB, Santos Orlandi AAD, Rocha GDS, Pereira DS, Corona LP, Brito TRPD. Association of Social Support Network with Telomere Length: A Cross-Sectional Study with Community-Dwelling Older Adults. Rejuvenation Res 2022; 25:253-259. [PMID: 36103374 DOI: 10.1089/rej.2022.0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Considering that telomere length can be determined not only by issues related to cell biology but also by aspects related to social factors and environmental exposures, studies on the relationship between social aspects and telomere length can help to better understand the still scarcely known aspects of the human aging process. Thus, this research seeks to verify whether social support networks are associated with telomere length in older adults. This is a cross-sectional study conducted with 448 individuals aged at least 60 years living in the urban area of an inland Brazilian municipality. Relative quantification of telomere length was obtained through real-time qPCR. Social support was assessed through the Medical Outcomes Study Social Support Scale. Descriptive statistics and multiple logistic regression were used in data analysis. The evaluated social support networks for older adults consist in a mean of 16.4 people, and the percentage of older adults who reported up to five members in their network was 27.75%. Shorter telomere length was identified in 25% of the participants, and the older adults who reported having up to five members in their support network were more likely to have a shorter telomere length than those who reported more numerous networks (odds ratio: 1.89, p = 0.011) regardless of gender, age, household arrangement, cognitive decline, and dependence for basic and instrumental activities of daily living, which suggests that measures that stimulate the creation and maintenance of social support networks should be implemented to improve older adults' health.
Collapse
|
8
|
Magill N, Walker J, Symeonides S, Gourley C, Hobbs H, Rosenstein D, Frost C, Sharpe M. Depression and anxiety during the year before death from cancer. J Psychosom Res 2022; 158:110922. [PMID: 35500323 DOI: 10.1016/j.jpsychores.2022.110922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 04/11/2022] [Accepted: 04/15/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Previous studies of depression and anxiety during the year before death have reported different findings. We therefore aimed to study depression and anxiety in patients who had died from cancer and had previously attended cancer clinics. METHODS We analysed routine data on 4869 deceased patients who had completed the Hospital Anxiety and Depression Scale (HADS) as part of their routine cancer care. The HADS data were linked with demographic, cancer and mortality data from national registries. We used data from all HADS completed in the last year of life to investigate the relationships between mean depression (HADS-D) and anxiety (HADS-A) scores and the percentages of high scores (≥11 on each subscale) and time to death (Analysis 1). This analysis used multivariable linear regression with cubic splines and robust standard errors to allow for multiple HADS from the same patients. We also investigated within-patient changes in scores (Analysis 2) in a subset of patients who had completed more than one HADS. RESULTS In Analysis 1, modelled mean HADS-D scores increased by around 2.5 and the percentage of high HADS-D scores increased from 13% at six months before death to 30% at one month before death. Changes in HADS-A were smaller and occurred later. In Analysis 2, similar patterns were observed in individual patients' HADS scores. CONCLUSION Depression should be looked for and treated in patients with cancer and a prognosis of six months or less, in order to maximise the quality of patients' remaining life.
Collapse
Affiliation(s)
- Nicholas Magill
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Jane Walker
- Psychological Medicine Research, University of Oxford Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - Stefan Symeonides
- Cancer Research UK Edinburgh Centre, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - Charlie Gourley
- Cancer Research UK Edinburgh Centre, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - Harriet Hobbs
- Psychological Medicine Research, University of Oxford Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - Donald Rosenstein
- Departments of Psychiatry and Medicine, University of North Carolina at Chapel Hill, NC, USA
| | - Chris Frost
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Michael Sharpe
- Psychological Medicine Research, University of Oxford Department of Psychiatry, Warneford Hospital, Oxford, UK.
| |
Collapse
|
9
|
Hill EM, Frost A. Loneliness and Psychological Distress in Women Diagnosed with Ovarian Cancer: Examining the Role of Self-Perceived Burden, Social Support Seeking, and Social Network Diversity. J Clin Psychol Med Settings 2022; 29:195-205. [PMID: 34114151 DOI: 10.1007/s10880-021-09789-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2021] [Indexed: 10/21/2022]
Abstract
The aim of the present study was to examine the role of self-perceived burden, social support seeking, and social network diversity in loneliness and psychological distress among women with ovarian cancer. A cross-sectional design was employed whereby 130 women diagnosed with ovarian cancer, recruited through various online sources (e.g., social media), completed the study via Qualtrics. Participants completed questionnaires that assessed self-perceived burden, social support seeking, social network diversity, loneliness, and psychological distress (anxiety, depressive symptoms). The models examined indicated that there were indirect effects of self-perceived burden and social network diversity on psychological distress via loneliness. Social support seeking was not significant in the models. Loneliness, self-perceived burden, and social network diversity should be of clinical concern among those working to support women with ovarian cancer. Future studies on longitudinal patterns or examining other factors associated with loneliness are needed to better understand the mental health of women with ovarian cancer.
Collapse
Affiliation(s)
- Erin M Hill
- Department of Psychology, West Chester University, West Chester, PA, 19383, USA.
| | - Andriana Frost
- Department of Psychology, West Chester University, West Chester, PA, 19383, USA
| |
Collapse
|
10
|
Sartor SF, das Mercês NNA, Torrealba MNR. Death in the Hospital: The Witnessing of the Patient with Cancer. Indian J Palliat Care 2021; 27:538-543. [PMID: 34898949 PMCID: PMC8655633 DOI: 10.25259/ijpc_119_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 09/15/2021] [Indexed: 11/04/2022] Open
Abstract
Objectives The aim of the study was to know the witnessing of death from the perspective of the cancer patient in the hospital environment. Materials and Methods This is a qualitative and descriptive study, which was carried out in a cancer hospital in southern Brazil, with 27 cancer patients, through semi-structured interview, after the institutional research ethics committee approval. For categorisation and data analysis, Iramuteq software and Creswell content analysis were used. Results Six classes emerged from the Iramuteq software and four categories were formed: (1) The reflection of the other itself; (2) feelings and emotions aroused; (3) the witnessing of a peaceful death and (4) death as a habitual event. Conclusion Patients felt sad and distressed, and some perceived death as something natural, often necessary for the relief of suffering. They put themselves in the place of the dying patient and their family members, imagining their loved ones and the suffering they would experience. Participants considered peaceful deaths to be good, unlike those in which patients had some kind of discomfort, described as horrible, distressing, sad and bad.
Collapse
Affiliation(s)
- Silvia Francine Sartor
- Department of Nursing, Graduate Program, Federal University of Paraná, Curitiba, Paraná, Brazil
| | | | | |
Collapse
|
11
|
Abstract
BACKGROUND Self-perceived burden (SPB) causes stress and negatively impacts the quality of life and mental health of patients. It is important to identify effective coping methods to reduce SPB when supporting advanced cancer patients. OBJECTIVE To qualitatively elucidate advanced cancer patients' strategies for coping with SPB. METHODS Eleven participants with advanced cancer were recruited from 2 palliative care units. The data were collected through semistructured interviews and analyzed by content analysis. RESULTS One of the coping strategies that advanced cancer patients used to reduce their SPB was "making individual efforts to deal with their own circumstances." This category included subcategories: "making proactive action," "expressing their gratitude verbally," "suppressing their feelings," "searching for positive meanings," and "avoiding thinking about the burden on their families." Another coping strategy used was "exploring the solutions with their family," which consisted of one subcategory and indicated an open dialogue between patients and their families to reach acceptable and mutual decisions about patient care. CONCLUSION Nurses should not only support patients' efforts to tackle the situation by themselves, but also help the family as a whole to tackle problems together. By facilitating meaningful dialogue between family members, patients' feelings of SPB can be alleviated. IMPLICATIONS FOR PRACTICE Nurses should facilitate dialogue between patients and their family members in order to help them discover solutions to reduce their SPB and to find positive meanings in the caregiving-receiving situation.
Collapse
|
12
|
Lee W, Pulbrook M, Sheehan C, Kochovska S, Chang S, Hosie A, Lobb E, Parker D, Draper B, Agar MR, Currow DC. Clinically Significant Depressive Symptoms Are Prevalent in People With Extremely Short Prognoses-A Systematic Review. J Pain Symptom Manage 2021; 61:143-166.e2. [PMID: 32688012 DOI: 10.1016/j.jpainsymman.2020.07.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 07/09/2020] [Accepted: 07/13/2020] [Indexed: 12/13/2022]
Abstract
CONTEXT Currently, systematic evidence of the prevalence of clinically significant depressive symptoms in people with extremely short prognoses is not available to inform its global burden, assessment, and management. OBJECTIVES To determine the prevalence of clinically significant depressive symptoms in people with advanced life-limiting illnesses and extremely short prognoses (range of days to weeks). METHODS A systematic review and meta-analysis (random-effects model) were performed (PROSPERO: CRD42019125119). MEDLINE, Embase, PsycINFO, CINAHL, and CareSearch were searched for studies (1994-2019). Data were screened for the prevalence of clinically significant depressive symptoms (assessed using validated depression-specific screening tools or diagnostic criteria) of adults with advanced life-limiting illnesses and extremely short prognoses (defined by survival or functional status). Quality assessment was performed using the Joanna Briggs Institute Systematic Reviews Checklist for Prevalence Studies for individual studies and Grading of Recommendations Assessment, Development and Evaluation (GRADE) across studies. RESULTS Thirteen studies were included. The overall pooled prevalence of clinically significant depressive symptoms in adults with extremely short prognoses (n = 10 studies; extremely short prognoses: N = 905) using depression-specific screening tools was 50% (95% CI: 29%-70%; I2 = 97.6%). Prevalence of major and minor depression was 10% (95% CI: 4%-16%) and 5% (95% CI: 2%-8%), respectively. Major limitations included high heterogeneity, selection bias, and small sample sizes in individual studies. CONCLUSIONS Clinically, significant depressive symptoms were prevalent in people with advanced life-limiting illnesses and extremely short prognoses. Clinicians need to be proactive in the recognition and assessment of these symptoms to allow for timely intervention.
Collapse
Affiliation(s)
- Wei Lee
- University of Technology Sydney, Ultimo, New South Wales, Australia; St Vincent Hospital, Darlinghurst, New South Wales, Australia.
| | - Marley Pulbrook
- St Vincent Hospital, Darlinghurst, New South Wales, Australia
| | | | | | - Sungwon Chang
- University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Annmarie Hosie
- St Vincent Hospital, Darlinghurst, New South Wales, Australia; University of Notre Dame Australia, New South Wales, Australia
| | - Elizabeth Lobb
- Calvary Hospital, Kogarah, New South Wales, Australia; University of Notre Dame Australia, New South Wales, Australia
| | - Deborah Parker
- University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Brian Draper
- University of New South Wales, Randwick, New South Wales, Australia
| | - Meera R Agar
- University of Technology Sydney, Ultimo, New South Wales, Australia
| | - David C Currow
- University of Technology Sydney, Ultimo, New South Wales, Australia
| |
Collapse
|
13
|
Social Constraints and PTSD among Chinese American breast cancer survivors: not all kinds of social support provide relief. J Behav Med 2020; 44:29-37. [PMID: 32519299 DOI: 10.1007/s10865-020-00165-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 06/03/2020] [Indexed: 10/24/2022]
Abstract
Research has demonstrated the association between social constraints and posttraumatic stress disorder (PTSD) symptoms among breast cancer survivors. Although perceived social support can buffer stress and improve emotional well-being, little is known about which type of social support is most effective in buffering the negative effects of social constraints among cancer survivors. We investigated the moderation of four types of social support (i.e., positive interaction, tangible support, emotional/informational support and affectionate support) on the association between social constraints and PTSD symptoms among Chinese American breast cancer survivors. One hundred and thirty-six Chinese American breast cancer survivors completed questionnaires that assessed social constraints, PTSD symptoms and perceived social support. Results of hierarchical regression analysis indicated that only support of positive interaction exerted a buffering effect, with social constraints associated with greater PTSD severity among survivors with low but not high levels of support of positive interaction. In contrast, high levels of tangible support potentiated the association between social constraints and PTSD symptoms. There were no moderating effects of emotional/informational support and affectionate support. These results demonstrated the roles of different types of social support in moderating the stress imposed by social constraints. Our findings highlight the importance of recognizing the potential cultural sensitivity of ethnic minorities in PTSD intervention and mental health services for cancer patients.
Collapse
|
14
|
Schlaeger JM, Weng LC, Huang HL, Tsai HH, Takayama M, Ngamkham S, Yao Y, Wilkie DJ. Pain Quality by Location in Outpatients with Cancer. Pain Manag Nurs 2019; 20:425-431. [PMID: 31160180 DOI: 10.1016/j.pmn.2019.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 03/21/2019] [Accepted: 04/24/2019] [Indexed: 01/17/2023]
Abstract
BACKGROUND The McGill Pain Questionnaire (MPQ) pain quality descriptors have been analyzed to characterize the sensory, affective, and evaluative domains of pain, but have not been differentiated by pain location. AIM To examine MPQ pain quality descriptors by pain location in outpatients with lung or prostate cancer. DESIGN Cross sectional. SETTINGS Eleven oncology clinics or patients' homes. SUBJECTS 264 adult outpatients (80% male; mean age 62.2 ± 10.0 years, 85% White). METHODS Subjects completed a 100 mm visual analogue scale of pain intensity and MPQ clinic or home visit, marking sites where they had pain on a body outline and circling from 78 verbal descriptors those that described their pain. A researcher noted next to the descriptor spontaneous comments about sites feeling like a selected word and queried the subjects about any other words to obtain the site(s). RESULTS Pain quality descriptors were assigned to all 7 pain locations marked by ≥ 20% of 198 lung or 66 prostate cancer patients. Four pain locations were marked with pain quality descriptors significanlty (p < .05) more frequently for lung cancer (53% chest-aching, burning; 58% back-aching, stabbing; 48% head-aching, sharp; and 19% arms-aching, stabbing) than for prostate cancer, which had significantly more frequent pain locations in the abdomen (64%-aching, burning) and lower back/buttocks (55%-aching, burning). CONCLUSIONS This type of pain characterization is innovative and has the potential to help implement targeted treatments for patients with cancer and other chronic pain conditions.
Collapse
Affiliation(s)
- Judith M Schlaeger
- Department of Women, Children and Family Health Science, University of Illinois at Chicago College of Nursing, Chicago, Illinois
| | - Li-Chueh Weng
- Chang Gung University School of Nursing, College of Medicine, Taoyuan, Taiwan, ROC
| | - Hsiu-Li Huang
- National Taipei University of Nursing and Health Sciences, Department of Long-term Care, College of Health Technology, Taipei, Taiwan, ROC
| | - Hsiu-Hsin Tsai
- Chang Gung University School of Nursing, College of Medicine, Taoyuan, Taiwan, ROC
| | - Miho Takayama
- Tokyo Ariake University of Medical and Health Sciences, Department of Acupuncture and Moxibustion, Tokyo, Japan
| | - Srisuda Ngamkham
- Boromarajonani College of Nursing Sawanpracharak Nakhonsawan, Paknampho, Maung, Nakhonsawan, Thailand
| | - Yingwei Yao
- Department of Biobehavioral Nursing Science, University of Florida College of Nursing, Gainesville, Florida
| | - Diana J Wilkie
- Department of Biobehavioral Nursing Science, University of Florida College of Nursing, Gainesville, Florida.
| |
Collapse
|
15
|
Kuo SC, Chou WC, Hou MM, Wu CE, Shen WC, Wen FH, Tang ST. Changes in and modifiable patient- and family caregiver-related factors associated with cancer patients’ high self-perceived burden to others at the end of life: A longitudinal study. Eur J Cancer Care (Engl) 2018; 27:e12942. [DOI: 10.1111/ecc.12942] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Revised: 05/18/2018] [Accepted: 09/02/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Su-Ching Kuo
- Department of Nursing; Yuanpei University of Medical Technology; Hsinchu Taiwan
- Graduate Institute of Clinical Medical Sciences; Chang Gung University; Taoyuan Taiwan
| | - Wen-Chi Chou
- Division of Hematology-Oncology; Chang Gung Memorial Hospital at Linkou; Taoyuan Taiwan
| | - Ming-Mo Hou
- Division of Hematology-Oncology; Chang Gung Memorial Hospital at Linkou; Taoyuan Taiwan
| | - Chiao-En Wu
- Division of Hematology-Oncology; Chang Gung Memorial Hospital at Linkou; Taoyuan Taiwan
| | - Wen-Chi Shen
- Division of Hematology-Oncology; Chang Gung Memorial Hospital at Linkou; Taoyuan Taiwan
| | - Fur-Hsing Wen
- Department of International Business; Soochow University; Taipei Taiwan
| | - Siew-Tzuh Tang
- Division of Hematology-Oncology; Chang Gung Memorial Hospital at Linkou; Taoyuan Taiwan
- School of Nursing; Chang Gung University; Taoyuan Taiwan
- Department of Nursing; Chang Gung Memorial Hospital at Kaohsiung; Kaohsiung Taiwan
| |
Collapse
|
16
|
Lehto RH, Miller SEL, Flanigan M, Wyatt G. Mental health in patients with advanced cancer at the end of life: evaluation of evidence and future directions. ACTA ACUST UNITED AC 2018. [DOI: 10.1080/23809000.2018.1483192] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Rebecca H Lehto
- Michigan State University College of Nursing, East Lansing, MI, USA
| | - Sara EL Miller
- University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Megan Flanigan
- Michigan State University College of Nursing, East Lansing, MI, USA
| | - Gwen Wyatt
- Michigan State University College of Nursing, East Lansing, MI, USA
| |
Collapse
|
17
|
Lycken M, Drevin L, Garmo H, Stattin P, Adolfsson J, Lissbrant IF, Holmberg L, Bill-Axelson A. The use of palliative medications before death from prostate cancer: Swedish population-based study with a comparative overview of European data. Eur J Cancer 2018; 88:101-108. [DOI: 10.1016/j.ejca.2017.10.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 10/17/2017] [Accepted: 10/22/2017] [Indexed: 11/16/2022]
|
18
|
Ryu E, Chamberlain AM, Pendegraft RS, Petterson TM, Bobo WV, Pathak J. Quantifying the impact of chronic conditions on a diagnosis of major depressive disorder in adults: a cohort study using linked electronic medical records. BMC Psychiatry 2016; 16:114. [PMID: 27112538 PMCID: PMC4845377 DOI: 10.1186/s12888-016-0821-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 04/18/2016] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Major depressive disorder (MDD) is often comorbid with other chronic mental and physical health conditions. Although the literature widely acknowledges the association of many chronic conditions with the risk of MDD, the relative importance of these conditions on MDD risk in the presence of other conditions is not well investigated. In this study, we aimed to quantify the relative contribution of selected chronic conditions to identify the conditions most influential to MDD risk in adults and identify differences by age. METHODS This study used electronic health record (EHR) data on patients empanelled with primary care at Mayo Clinic in June 2013. A validated EHR-based algorithm was applied to identify newly diagnosed MDD patients between 2000 and 2013. Non-MDD controls were matched 1:1 to MDD cases on birth year (±2 years), sex, and outpatient clinic visits in the same year of MDD case diagnosis. Twenty-four chronic conditions defined by Chronic Conditions Data Warehouse were ascertained in both cases and controls using diagnosis codes within 5 years of index dates (diagnosis dates for cases, and the first clinic visit dates for matched controls). For each age group (45 years or younger, between 46 and 60, and over 60 years), conditional logistic regression models were used to test the association between each condition and subsequent MDD risk, adjusting for educational attainment and obesity. The relative influence of these conditions on the risk of MDD was quantified using gradient boosting machine models. RESULTS A total of 11,375 incident MDD cases were identified between 2000 and 2013. Most chronic conditions (except for eye conditions) were associated with risk of MDD, with different association patterns observed depending on age. Among 24 chronic conditions, the greatest relative contribution was observed for diabetes mellitus for subjects aged ≤ 60 years and rheumatoid arthritis/osteoarthritis for those over 60 years. CONCLUSIONS Our results suggest that specific chronic conditions such as diabetes mellitus and rheumatoid arthritis/osteoarthritis may have greater influence than others on the risk of MDD.
Collapse
Affiliation(s)
- Euijung Ryu
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN USA
| | | | | | | | - William V. Bobo
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN USA
| | - Jyotishman Pathak
- Division of Health Informatics, Department of Healthcare Policy & Research, Weill Cornell Medicine, Cornell University, New York, NY, USA.
| |
Collapse
|
19
|
Tang ST, Hsieh CH, Chiang MC, Chen JS, Chang WC, Chou WC, Hou MM. Impact of high self-perceived burden to others with preferences for end-of-life care and its determinants for terminally ill cancer patients: a prospective cohort study. Psychooncology 2016; 26:102-108. [PMID: 26950036 DOI: 10.1002/pon.4107] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 12/19/2015] [Accepted: 01/29/2016] [Indexed: 11/12/2022]
Abstract
BACKGROUND/OBJECTIVE Self-perceived burden to others (SPB) is a major concern of terminally ill cancer patients and is frequently factored into end-of-life (EOL) care decision-making. However, changes in and determinants of SPB and its longitudinal impact on preferences for EOL care over the dying process have not been investigated. Our study was aimed at filling this gap in knowledge. METHODS A convenience sample of 325 cancer patients was followed until death. High SPB was identified as scoring >20 on the Self-perceived Burden Scale. Preferences for EOL care included EOL-care goals, life-sustaining treatments, and hospice care. Factors potentially precipitating/minimizing patients' high SPB included demographics, disease characteristics and burden, and social support and were examined by multivariate logistic regression modeling with the generalized estimating equation. RESULTS Prevalence of high SPB increased as death approached (51.78%, 58.26%, 62.66%, and 65.38% for 181-365, 91-180, 31-90, and 1-30 days before death, respectively). High SPB was precipitated by women, younger age, having inadequate financial resources, without religious affiliation, and suffering from severe symptom distress and heavy functional dependence but was independent of time proximity to patient death, disease characteristics, and social support. Furthermore, high SPB was not associated with EOL-care preferences, whether aggressive life-sustaining treatments or hospice care. CONCLUSIONS High SPB was prevalent among terminally ill cancer patients but independent of preferences for EOL care. Cancer patients' SPB may be lessened by adequate symptom relief to facilitate functional independence. These strategies to ease SPB may improve the quality of death and dying. Copyright © 2016 John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- Siew Tzuh Tang
- School of Nursing and Department of Nursing, Chang Gung Memorial Hospital at Kaohsiung, Chang Gung University, 259 Wen-Hwa 1st Road, Kwei-Shan, Tao-Yuan, Taiwan
| | - Chia-Hsun Hsieh
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan
| | - Ming-Chu Chiang
- Department of Nursing, Chang Gung Memorial Hospital at Kaohsiung, Kaohsiung, Taiwan
| | - Jen-Shi Chen
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Tao-Yuan, Taiwan
| | - Wen-Cheng Chang
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Tao-Yuan, Taiwan
| | - Wen-Chi Chou
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan
| | - Ming-Mo Hou
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Tao-Yuan, Taiwan
| |
Collapse
|
20
|
Alexander K, Goldberg J, Korc-Grodzicki B. Palliative Care and Symptom Management in Older Patients with Cancer. Clin Geriatr Med 2015; 32:45-62. [PMID: 26614860 DOI: 10.1016/j.cger.2015.08.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Older patients with cancer are best served by a multidisciplinary approach with palliative care (PC) playing an integral role. PC focuses on symptom control irrespective of its cause and should not be associated only with terminal care. It provides an additional layer of support in the care of patients with cancer with an emphasis on quality of life. This article discusses the evaluation and management of pain and other common nonpain symptoms that occur in elderly patients with cancer, as well as end-of-life care.
Collapse
Affiliation(s)
- Koshy Alexander
- Geriatrics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, Box 205, New York, NY 10065, USA; Department of Medicine, Weill Cornell Medical College, 425 East 61st Street, New York, NY 10065, USA.
| | - Jessica Goldberg
- Palliative Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Beatriz Korc-Grodzicki
- Geriatrics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, Box 205, New York, NY 10065, USA; Department of Medicine, Weill Cornell Medical College, 425 East 61st Street, New York, NY 10065, USA
| |
Collapse
|