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Becqué YN, Rietjens JAC, van der Heide A, Witkamp E. Failed implementation of a nursing intervention to support family caregivers: An evaluation study using Normalization Process Theory. J Adv Nurs 2024. [PMID: 38884574 DOI: 10.1111/jan.16261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 04/26/2024] [Accepted: 05/29/2024] [Indexed: 06/18/2024]
Abstract
AIM To evaluate the failed implementation of the Carer Support Needs Assessment Tool Intervention for family caregivers in end-of-life care, within a trial context using Normalization Process Theory (NPT). DESIGN An evaluation study was conducted to learn lessons from our trial, which was not successful due to the low number of participants. The evaluation study utilized various data sources, including published data from interviews and questionnaires, and unpublished data derived from emails and conversation notes. METHODS Data were retrospectively collected. Thematic analysis was conducted guided by the NPT framework. This framework emphasizes that successful implementation of an intervention relies on its 'normalization', consisting of four constructs: coherence, cognitive participation, collective action and reflexive monitoring. RESULTS Coherence (sense making): Nurses felt the intervention could contribute to their competence in assessing family caregivers' needs, but some were unsure how it differed from usual practice. Cognitive participation (relational work): Nurse champions played a crucial role in building a community of practice. However, sustaining this community was challenging due to staff turnover and shortages. Collective action (work done to enable the intervention): Nurses felt the Carer Support Needs Assessment Tool training enabled them to improve their support of family caregivers. However, contextual factors complicated implementation, such as being used to a patient rather than a family-focused approach and a high workload. Reflexive monitoring (appraisal of the intervention): Positive experiences of the nurses with the intervention motivated them to implement it. However, the research context made nurses hesitant to recruit family caregivers because of the potential burden of participation. CONCLUSION Although the intervention demonstrated potential to assist nurses in providing tailored support to family caregivers, its integration into daily practice was not optimal. Contextual factors, such as a patient-focused approach to care and the research context, hampered normalization of the intervention. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Assessing and considering contextual factors that may influence implementation of a complex care intervention is needed. The NPT provided a valuable framework for evaluating the implementation process in our study. IMPACT What problem did the study address? This evaluation study analysed the factors that promoted or hindered the implementation of a nursing intervention to support family caregivers in end-of-life care. What were the main findings? Both the intervention and the intervention training have potential and value for nurses in providing tailored support to family caregivers. However, the implementation faced challenges due to organizational factors and the research context, including recruitment. Where and on whom will the research have an impact? This insight is valuable for all stakeholders involved in implementing complex nursing interventions, including researchers, nurses and funders. REPORTING METHOD This study has adhered to the relevant EQUATOR guidelines: Standards for Reporting Qualitative Research (SRQR). PATIENT OR PUBLIC CONTRIBUTION There was no patient or public involved. TRIAL REGISTRATION The trial was prospectively registered on the Dutch Trial Register (NL7702).
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Affiliation(s)
- Yvonne N Becqué
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Judith A C Rietjens
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Design, Organisation and Strategy, Faculty of Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands
| | - Agnes van der Heide
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Erica Witkamp
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Muralidharan S, Sikalgar FR, B D, Nikalje MR, Subramaniam T, Kumar M. Exploring the Unmet Needs of Cancer Caregivers in India: A Cross-Sectional Survey. Cureus 2024; 16:e62159. [PMID: 38868547 PMCID: PMC11167582 DOI: 10.7759/cureus.62159] [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: 05/24/2024] [Accepted: 06/11/2024] [Indexed: 06/14/2024] Open
Abstract
Introduction Caregivers of individuals with head, neck, and face cancer play a pivotal role in providing support, yet they face distinct challenges. This study aims to explore caregiving experiences and consequences among this population. Methods A multicentric cross-sectional study involving 200 caregivers using a convenience sampling method was conducted in Pune. Caregivers involved in patient care were included in head, neck, and face cancer. The Cancer Caregiving Consequences Inventory (CaTCoN) questionnaire was utilized to assess various dimensions of caregiving. Ethical clearance was obtained from institutional review boards. Results The demographic profile revealed that 89% of caregivers were spouses/partners, primarily females (77%), aged 25-40 (81.5%), and urban dwellers (68.5%). Caregivers were predominantly married or cohabiting (100%) and had children (95%). Most had a graduate-level education (97.5%) and were employed full-time (82.5%). The mean scores from the CaTCoN questionnaire highlighted substantial caregiving responsibilities, with significant associations found in multivariate regression analysis. Spouses/partners showed stronger correlations with increased workload, personal growth challenges, financial difficulties, and the need to maintain an everyday life. Conclusion This study comprehensively explains caregiving consequences among head, neck, and face cancer cases. The predominance of spouses/partners as caregivers emphasizes the need for targeted interventions to address their unique challenges. The study highlights the demanding nature of caregiving, with potential positive outcomes.
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Affiliation(s)
| | - Farha R Sikalgar
- Community Medicine, ZVM Unani Medical College and Hospital, Pune, IND
| | - Deepak B
- Clinical Naturopathy, National Registration Board, Ministry of Ayush, Pune, IND
| | - Monali R Nikalje
- Dentistry, Symbiosis Medical College for Women and Symbiosis University Hospital and Research Centre, Pune, IND
| | - Tulsi Subramaniam
- Dentistry, Symbiosis Medical College for Women and Symbiosis University Hospital and Research Centre, Pune, IND
| | - Manasvi Kumar
- Health Care, School for Skill Development and Allied Health Sciences, Bharati Vidyapeeth (Deemed to be) University, Pune, IND
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Wang Z, Yu S, Liu Y, Han Y, Zhao W, Zhang W. Effectiveness of family centred interventions for family caregivers: A systematic review and meta-analysis of randomized controlled trials. J Clin Nurs 2024; 33:1958-1975. [PMID: 38439168 DOI: 10.1111/jocn.17091] [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: 07/16/2023] [Revised: 01/11/2024] [Accepted: 02/19/2024] [Indexed: 03/06/2024]
Abstract
AIMS AND OBJECTIVES To examine the effectiveness of family-centred interventions among family caregivers. BACKGROUND Family-centred interventions are an emerging form of intervention that can be effective at improving physical and mental health outcomes for patients and family caregivers. To date, no reviews have examined the effectiveness of family-centred interventions for family caregivers. DESIGN A systematic review, including a meta-analysis, was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA 2020) checklist. METHODS Seven English and two Chinese electronic databases were compressively searched from the outset to March 2023. Two researchers independently reviewed the abstracts and full texts, extracted the data and assessed the risk of bias independently by using the Cochrane 'Risk of bias assessment tool'. RESULTS This systematic review and meta-analysis included 20 articles. The results of the meta-analysis showed that family-centred interventions could significantly improve caregiver burden (p=0.003), quality of life (p = 0.007), depression (p = 0.0002), and stress (p < 0.0001) but not anxiety or family functioning. According to our subgroup analysis, the family-centred empowerment model (p = 0.009) was superior to the other family intervention (p=0.004) in reducing caregiver burden. Family-centred interventions are more effective at reducing the burden of caregiving on family caregivers of adolescent patients (SMD=-0.79, 95% CI[-1.22,-0.36], p = 0.0003) than on adult patients (SMD=-0.37, 95% CI [-0.61,-0.12], p = 0.004). CONCLUSIONS Family-centred interventions could enhance family caregivers' burden, quality of life, stress and depression but had no significant impact on anxiety or family functioning. RELEVANCE TO CLINICAL PRACTICE Family-centred interventions have the potential to improve the health status and caregiving burden of family caregivers. Rigorous and high-quality evidence is needed to confirm the long-term effects of these interventions on family caregivers. TRIAL REGISTRATION DETAILS The protocol has been registered in the PROSPERO international prospective register of systematic reviews (Protocol registration ID: CRD42023453607).
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Affiliation(s)
- Ziqi Wang
- School of Nursing, Jilin University, Changchun, China
| | - Shuanghan Yu
- School of Nursing, Jilin University, Changchun, China
| | - Yantong Liu
- School of Nursing, Jilin University, Changchun, China
| | - Yujie Han
- School of Nursing, Jilin University, Changchun, China
| | - Wei Zhao
- School of Nursing, Jilin University, Changchun, China
| | - Wei Zhang
- School of Nursing, Jilin University, Changchun, China
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Theißen T, Ullrich A, Oechsle K, Wikert J, Bokemeyer C, Schieferdecker A. "Being an informal caregiver - strengthening resources": mixed methods evaluation of a psychoeducational intervention supporting informal caregivers in palliative care. BMC Palliat Care 2024; 23:95. [PMID: 38600500 PMCID: PMC11007958 DOI: 10.1186/s12904-024-01428-0] [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: 12/06/2023] [Accepted: 04/04/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Informal caregivers are key support for patients with progressive incurable diseases. However, their own needs often remain unmet. Therefore, we developed, manualised and implemented the intervention "Being an informal caregiver - strengthening resources" aiming to support and empower informal caregivers by addressing relevant information-related, physical, psychological and social needs. METHODS In this pilot study, we evaluated the acceptance and experiences with this psychoeducational intervention. The study was conducted over two years (2019-2021). Informal caregivers were recruited from the University Medical Centre Hamburg-Eppendorf and the metropolitan region of Hamburg, Germany. The intervention was aimed at adult persons who identified themselves as an informal caregiver to an adult patient with a progressive incurable cancer and non-cancer disease. For the evaluation we used a mixed methods approach, combining a longitudinal questionnaire survey (pre-intervention, after each module, 3-months follow-up) and semi-structured interviews post-intervention. Quantitative data were analysed using descriptive statistics and a paired t-Test, interviews were analysed based on the qualitative content analysis according to Mayring. Results were triangulated using a convergent triangulation design. RESULTS Of 31 informal caregivers who received the intervention, 25 returned the follow-up questionnaire and 20 informal caregivers were interviewed. Triangulated results showed a high satisfaction with the implementation of the intervention. Of a broad range of subjective benefits, gaining knowledge, self-awareness and self-efficacy were most apparent. Informal caregivers reported improved preparedness, awareness of own needs as well as confidence regarding handling own emotions and interacting with the ill person. However, implementing the learned skills into daily life can be challenging due to internal and external factors. Motivations and challenges for participating as well as potential for improvement were identified. CONCLUSIONS This pilot study showed an overall positive evaluation and several subjective benefits of the psychoeducational intervention "Being an informal caregiver - strengthening resources". Further research is needed to measure the efficacy of this intervention on informal caregivers' outcomes. Therefore, a multicentre randomized prospective study is planned.
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Affiliation(s)
- Tabea Theißen
- Palliative Care Unit, Department of Oncology, Haematology and BMT, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Anneke Ullrich
- Palliative Care Unit, Department of Oncology, Haematology and BMT, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Karin Oechsle
- Palliative Care Unit, Department of Oncology, Haematology and BMT, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Julia Wikert
- Palliative Care Unit, Department of Oncology, Haematology and BMT, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
- Department of Palliative Medicine, LMU University Hospital, Munich, Germany
| | - Carsten Bokemeyer
- Palliative Care Unit, Department of Oncology, Haematology and BMT, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Aneta Schieferdecker
- Palliative Care Unit, Department of Oncology, Haematology and BMT, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
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Ham L, Fransen HP, de Graeff A, Hendriks MP, de Jong WK, Kloover J, Kuip E, Mandigers C, Sommeijer D, van de Poll L, Raijmakers N, van Zuylen L. Relatives' Unmet Needs in the Last Year of Life of Patients With Advanced Cancer: Results of a Dutch Prospective, Longitudinal Study (eQuiPe). J Palliat Care 2024:8258597241239614. [PMID: 38515425 DOI: 10.1177/08258597241239614] [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: 03/23/2024]
Abstract
Objective(s): Unmet needs of relatives of patients with advanced cancer not only reduce their own health-related quality of life, but may also negatively affect patients' health outcomes. The aim of this study was to assess changes in relatives' unmet needs of patients with advanced cancer in the last year of life and to identify differences in unmet needs by gender and type of relationship. Methods: Relatives of patients with advanced cancer in the Netherlands were included in a prospective, longitudinal, observational study. Relatives' unmet needs were measured every 3 months with an adapted version of the Problems and Needs in Palliative Care (PNPC) questionnaire Caregiver form (44 items, 12 domains). Questionnaires completed in the patients' last year of life were analyzed. Change of unmet needs in the last year, and differences in unmet needs by gender and type of relationship were analyzed. Results: A total of 409 relatives were included with a median of 4 unmet needs in the patient's last year. Unmet needs were most prevalent at all time points during the last year in the domains "caring for the patient" (highest need = 35%) and "psychological issues" (highest need = 40%). The number of unmet needs of relatives did not change significantly during the last year of life (P=.807). There were no significant differences in the number of unmet needs between male and female partners and between partners and other relatives. Conclusion: The most unmet needs for relatives were in the domains "caring for the patient" and "psychological issues." Professional support should focus on these items. Within these domains, it seems especially important that relatives get more knowledge and support about what scenarios to expect and how to deal with them.
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Affiliation(s)
- Laurien Ham
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, the Netherlands
- Netherlands Association for Palliative Care (PZNL), Utrecht, the Netherlands
| | - Heidi P Fransen
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, the Netherlands
- Netherlands Association for Palliative Care (PZNL), Utrecht, the Netherlands
| | - Alexander de Graeff
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Mathijs P Hendriks
- Department of Medical Oncology, Northwest Clinics, Alkmaar, the Netherlands
| | - Wouter K de Jong
- Department of Pulmonology, Hospital Gelderse Vallei, Ede, the Netherlands
| | - Jeroen Kloover
- Department of Pulmonology, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | - Evelien Kuip
- Department of Medical Oncology and Department of Anesthesiology, Pain and Palliative Care, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Caroline Mandigers
- Department of Internal Medicine, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands
| | - Dirkje Sommeijer
- Department of Medical Oncology, Flevo Hospital, Almere, the Netherlands
| | - Lonneke van de Poll
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, the Netherlands
- Department of Medical and Clinical Psychology, CoRPS - Center for Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, the Netherlands
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Natasja Raijmakers
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, the Netherlands
- Netherlands Association for Palliative Care (PZNL), Utrecht, the Netherlands
| | - Lia van Zuylen
- Department of Medical Oncology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
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Cui P, Yang M, Hu H, Cheng C, Chen X, Shi J, Li S, Chen C, Zhang H. The impact of caregiver burden on quality of life in family caregivers of patients with advanced cancer: a moderated mediation analysis of the role of psychological distress and family resilience. BMC Public Health 2024; 24:817. [PMID: 38491454 PMCID: PMC10941369 DOI: 10.1186/s12889-024-18321-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 03/10/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND The caregiver burden frequently experienced by family members tending to advanced cancer patients significantly impacts their psychological well-being and quality of life (QoL). Although family resilience might function as a mitigating factor in this relationship, its specific role remains to be elucidated. This study aims to probe the mediating effect of psychological distress on the relationship between caregiver burden and QoL, as well as the moderating effect of family resilience. METHODS A cross-sectional study was conducted between June 2020 and March 2021 in five tertiary hospitals in China. Data were collected on caregiver burden, family resilience, psychological distress (including anxiety and depression), and QoL. Moderated mediation analysis was performed. RESULTS Data analysis included 290 caregivers. It confirmed the mediating role of psychological distress in the caregiver burden-QoL relationship (P < 0.001). Both overall family resilience and the specific dimension of family communication and problem-solving (FCPS) demonstrated significant moderating effects on the "psychological distress/anxiety-QoL" paths (P < 0.05). The utilization of social and economic resources (USER) significantly moderated the association between depression and QoL (P < 0.05). CONCLUSIONS The study corroborates psychological distress's mediation between caregiver burden and QoL and family resilience's moderation between psychological distress and QoL. It underscores the need for minimizing psychological distress and bolstering family resilience among caregivers of advanced cancer patients. Accordingly, interventions should be tailored, inclusive of psychological assistance and promotion of family resilience, particularly focusing on FCPS and USER, to augment the caregivers' well-being and QoL.
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Affiliation(s)
- Panpan Cui
- Department of Nursing, Henan Provincial Key Medicine Laboratory of Nursing, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, No. 7 Weiwu Road, Zhengzhou, China
- School of Nursing, Zhengzhou University, Zhengzhou, China
| | - Ming Yang
- Nursing Department, Xinyang Central Hospital, Xinyang, China
| | - Hengyu Hu
- Department of Nursing, Henan Provincial Key Medicine Laboratory of Nursing, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, No. 7 Weiwu Road, Zhengzhou, China
| | - Chunyan Cheng
- Hemangiomatology Department, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Xinyi Chen
- Medical Oncology, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Jiaoxia Shi
- Medical Oncology, People's Hospital of Jiaozuo City, Jiaozuo, China
| | - Shifeng Li
- Medical Oncology, Xinyang Central Hospital, Xinyang, China
| | - Changying Chen
- The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe Dong Road, Zhengzhou, China.
- Institute for Hospital Management of Henan Province, Zhengzhou, China.
| | - Hongmei Zhang
- Department of Nursing, Henan Provincial Key Medicine Laboratory of Nursing, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, No. 7 Weiwu Road, Zhengzhou, China.
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Dhumal T, Siddiqui ZA, Kelley GA, Harper F, Kelly KM. Systematic review and meta-analysis of randomized controlled trials of interventions addressing caregiver distress and burden among cancer caregivers. PEC INNOVATION 2023; 2:100145. [PMID: 37214528 PMCID: PMC10194362 DOI: 10.1016/j.pecinn.2023.100145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 02/23/2023] [Accepted: 02/26/2023] [Indexed: 05/24/2023]
Abstract
Objective Informal caregivers (ICs) are vital to supportive cancer care and assisting cancer patients, but this caregiving burden is associated with significant distress. While addressing caregiving, it is important to explore if the caregivers are receiving care they need. Evaluating interventions that address burden and distress is integral to targeting ICs needs. This study evaluated interventions addressing IC burden and distress. Methods Randomized control trials (RCT) assessing interventions for IC burden and distress and exploring supportive care as an adjunct to the intervention were included. Six electronic databases were searched in accordance with the Preferred Reporting Items for Systematic reviews and Meta-analyses guidelines through October 2021. Effect sizes were estimated, and risk of bias was assessed. Results Of 678 studies, 11 were included. Most ICs were spouses, females, and white. Interventions included educational programs, cognitive behavioral treatment, and a telephone support program. Five studies utilized behavioral theories and seven included supportive care. Pooled results showed no significant effect on reducing caregiver distress (ES, -0.26, p<0.001). Conclusions Caring for the caregiver with interventions for reducing burden and distress are not efficacious. Innovative, well-designed, more pragmatic RCTs are needed. Innovation This study exclusively focused on interventions and supportive care needs for reducing distress and burden among cancer ICs.
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Affiliation(s)
- Trupti Dhumal
- Pharmaceutical Systems and Policy, West Virginia University School of Pharmacy, Health Sciences Center, P.O. Box 9500, Morgantown, WV 26506-9190, USA
| | - Zasim Azhar Siddiqui
- Pharmaceutical Systems and Policy, West Virginia University School of Pharmacy, Health Sciences Center, P.O. Box 9500, Morgantown, WV 26506-9190, USA
| | - George A. Kelley
- School of Public Health, Department of Biostatistics, Health Sciences Center, West Virginia University, Morgantown, WV 26506-9190, USA
| | - Felicity Harper
- Karmanos Cancer Institute, Cancer Research Centre, 4100 John R, Detroit, MI 48201, USA
| | - Kimberly M. Kelly
- Pharmaceutical Systems and Policy, West Virginia University School of Pharmacy, Health Sciences Center, P.O. Box 9500, Morgantown, WV 26506-9190, USA
- West Virginia University Cancer Institute, West Virginia University, Morgantown, WV 26505, USA
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Mulcahy Symmons S, Ryan K, Aoun SM, Selman LE, Davies AN, Cornally N, Lombard J, McQuilllan R, Guerin S, O'Leary N, Connolly M, Rabbitte M, Mockler D, Foley G. Decision-making in palliative care: patient and family caregiver concordance and discordance-systematic review and narrative synthesis. BMJ Support Palliat Care 2023; 13:374-385. [PMID: 35318213 PMCID: PMC10804031 DOI: 10.1136/bmjspcare-2022-003525] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 03/06/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Decision-making in palliative care usually involves both patients and family caregivers. However, how concordance and discordance in decision-making manifest and function between patients and family caregivers in palliative care is not well understood. OBJECTIVES To identify key factors and/or processes which underpin concordance and/or discordance between patients and family caregivers with respect to their preferences for and decisions about palliative care; and ascertain how patients and family caregivers manage discordance in decision-making in palliative care. METHODS A systematic review and narrative synthesis of original studies published in full between January 2000 and June 2021 was conducted using the following databases: Embase; Medline; CINAHL; AMED; Web of Science; PsycINFO; PsycARTICLES; and Social Sciences Full Text. RESULTS After full-text review, 39 studies were included in the synthesis. Studies focused primarily on end-of-life care and on patient and family caregiver preferences for patient care. We found that discordance between patients and family caregivers in palliative care can manifest in relational conflict and can result from a lack of awareness of and communication about each other's preferences for care. Patients' advancing illness and impending death together with open dialogue about future care including advance care planning can foster consensus between patients and family caregivers. CONCLUSIONS Patients and family caregivers in palliative care can accommodate each other's preferences for care. Further research is needed to fully understand how patients and family caregivers move towards consensus in the context of advancing illness.
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Affiliation(s)
- Sophie Mulcahy Symmons
- Discipline of Occupational Therapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Karen Ryan
- St Francis Hospice Dublin, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Samar M Aoun
- Palliative Care Unit, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
- Perron Institute for Neurological and Translational Science, Perth, Western Australia, Australia
| | - Lucy E Selman
- Palliative and End of Life Care Research Group, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Andrew Neil Davies
- Academic Department of Palliative Medicine, Our Lady's Hospice and Care Services, Dublin, Ireland
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Nicola Cornally
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - John Lombard
- School of Law, University of Limerick, Limerick, Ireland
| | - Regina McQuilllan
- St Francis Hospice Dublin, Dublin, Ireland
- Department of Palliative Care, Beaumont Hospital, Dublin, Ireland
| | - Suzanne Guerin
- School of Psychology, University College Dublin, Dublin, Ireland
| | - Norma O'Leary
- Our Lady's Hospice and Care Services, Dublin, Ireland
- Department of Palliative Care, St James's Hospital, Dublin, Ireland
| | - Michael Connolly
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
- Our Lady's Hospice and Care Services, Dublin, Ireland
| | - Mary Rabbitte
- All Ireland Institute of Hospice and Palliative Care, Dublin, Ireland
| | - David Mockler
- John Stearne Medical Library, Trinity College Dublin, Dublin, Ireland
| | - Geraldine Foley
- Discipline of Occupational Therapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
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Kurtgöz A, Edis EK. Spiritual care from the perspective of family caregivers and nurses in palliative care: a qualitative study. BMC Palliat Care 2023; 22:161. [PMID: 37884938 PMCID: PMC10601296 DOI: 10.1186/s12904-023-01286-2] [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: 04/18/2023] [Accepted: 10/16/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND The palliative care period not only affects patients but also family caregivers in many ways. Palliative care units are places where the spiritual needs of family caregivers become important. According to a holistic care approach, palliative care nurses should determine the spiritual needs of family caregivers and help meet these needs. OBJECTIVE This study aims at exploring nurses' and family caregivers' experiences of spiritual care. METHODS A phenomenological study was designed in this qualitative research. A total of 10 nurses working in palliative care and 11 family caregivers participated in the study. Nurses' experiences of delivering spiritual care and family caregivers' experiences of receiving spiritual care were examined through the in-depth interviewing method on a one-to-one basis. The data were examined using thematic analysis. RESULTS Four main themes were obtained by the data analysis: (I) Impacts of being in a palliative care unit; (II) Coping methods; (III) Importance of spirituality and spiritual care; (IV) Spiritual care. The results were presented according to the COREQ criteria. CONCLUSION Although spiritual care is very necessary for family caregivers, it is not offered sufficiently due to nurse-and institution-related reasons. Palliative care nurses should determine the spiritual needs of family caregivers in line with the holistic care approach. Nurse managers should determine factors preventing nurses from offering spiritual care and create solutions for these factors. The lack of nurses' knowledge about spiritual care should be resolved by providing continuous training and therefore, nurses' competencies in spiritual care should be improved.
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Affiliation(s)
- Aslı Kurtgöz
- Department of Therapy and Rehabilitation, Sabuncuoglu Serefeddin Health Services Vocational School, Amasya University, Amasya, 05100, Türkiye.
| | - Elif Keten Edis
- Department of Nursing, Health Science Faculty, Amasya University, Amasya, Türkiye
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Ullrich A, Goldbach S, Hollburg W, Wagener B, Rommel A, Müller M, Kirsch D, Kopplin-Foertsch K, Schulz H, Bokemeyer C, Oechsle K. Specialist palliative care until the very end of life - reports of family caregivers and the multiprofessional team. BMC Palliat Care 2023; 22:153. [PMID: 37814271 PMCID: PMC10563273 DOI: 10.1186/s12904-023-01266-6] [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: 06/30/2022] [Accepted: 09/20/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND Specialist palliative care (SPC) includes care for incurably ill patients and their family caregivers at home or on a palliative care ward until the very end of life. However, in the last days of life, patients can rarely express their needs and little is known about SPC outcomes as reported by multiprofessional SPC teams and family caregivers. METHODS Using the Palliative Care Outcome Scale (POS; Score 0-40), proxy assessments of SPC outcomes in the patient's last 3 days of life were performed by SPC teams and primary family caregivers of three home care and three inpatient services. Additional questions were asked about problems solved 'particularly well' or 'inadequately' (last 7 days), which were content analyzed and quantified. RESULTS Proxy assessments by SPC teams were available in 142 patients (of whom 51% had died at home). Family caregiver assessments exist for a subgroup of 60 of these patients. SPC teams (POS total score: mean 13.8, SD 6.3) reported SPC outcomes slightly better than family caregivers (mean 16.7, SD 6.8). The POS items consistently rated as least affected (= 0) by both, SPC teams and family caregivers, were 'not wasted time' (team 99%/family caregivers 87%), 'information' (84%/47%) and 'support' (53%/31%). Items rated as most affected (= 4) were 'patient anxiety' (31%/51%), 'life not worthwhile' (26%/35%) and 'no self-worth' (19%/30%). Both groups indicated more problems solved 'particularly well' than 'inadequately'; the latter concerned mainly clinically well-known challenges during end-of-life care and family caregiver care. CONCLUSIONS This study shows the range and type of symptoms and other concerns reported in the patient's last days. Starting points for further improvements in family caregiver care and psychosocial and spiritual issues were identified.
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Affiliation(s)
- Anneke Ullrich
- Palliative Care Unit, Department of Oncology, Hematology and BMT, University Medical Center Eppendorf, Hamburg, Germany.
| | - Sven Goldbach
- Specialist outpatient palliative care team 'PalliativPartner Hamburg GbR', Hamburg, Germany
| | - Wiebke Hollburg
- Specialist outpatient palliative care team 'PalliativPartner Hamburg GbR', Hamburg, Germany
| | - Bettina Wagener
- Specialist outpatient palliative care team 'PalliativPartner Hamburg GbR', Hamburg, Germany
| | - Annette Rommel
- Specialist outpatient palliative care team 'Das Palliativteam', Hamburg, Germany
| | - Marten Müller
- Palliative care ward, Asklepios Hospital Rissen, Hamburg, Germany
| | - Denise Kirsch
- Specialist outpatient palliative care team 'PCT Hamburg-West', Hamburg, Germany
| | | | - Holger Schulz
- Department of Medical Psychology, University Medical Center Eppendorf, Hamburg, Germany
| | - Carsten Bokemeyer
- Palliative Care Unit, Department of Oncology, Hematology and BMT, University Medical Center Eppendorf, Hamburg, Germany
| | - Karin Oechsle
- Palliative Care Unit, Department of Oncology, Hematology and BMT, University Medical Center Eppendorf, Hamburg, Germany
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11
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Aurén-Møkleby M, Thoresen L, Mengshoel AM, Solbrække KN, Aasbø G. 'It's not just about me': a qualitative study of couples' narratives about home death when one of the partners is dying of cancer. Palliat Care Soc Pract 2023; 17:26323524231189517. [PMID: 37545874 PMCID: PMC10399270 DOI: 10.1177/26323524231189517] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 07/05/2023] [Indexed: 08/08/2023] Open
Abstract
Background Most cancer patients state a preference for home death. Care and support from primary caregivers are important to enable dying at home. A preference for home death from the perspective of couples has rarely been investigated. Objectives To explore how a preference for home death is understood and enacted in couples where one of the partners is dying of cancer. Design A qualitative interview research design with a narrative approach was used. Methods Five couples participated in dyad interviews. During the analysis, two interviews that particularly illuminated couples' shared and individual views were chosen as the primary cases. Results The interviews show, in two highly different ways, how a preference for home death is a significant relational matter. The interviews are presented as two cases: 'Struggles in an Unknown Terrain' and 'Reliance at the Kitchen Table'. They show how a preference for home death can be understood and enacted as a struggle or as reliance based on the couple's shared biography and the partner's ability to care for the partner during the end-of-life phase. The analysis highlighted the negotiations that underpin a preference for home death. In these negotiations, the couples drew on idealised understandings of home death. These ideas were supported by cultural values related to autonomy and independence as well as participation and citizenship. Thus, in the negotiations about being cared for and caring, legitimate dependency and the maintenance of a reciprocal relationship were balanced. The presence of healthcare professionals and medical devices in the home had to be balanced with the need to maintain a sense of self and an authentic home. Conclusion A relational perspective on a preference for home death made us attentive to couples' negotiations. These negotiations give couples the opportunity to re-evaluate and reconfirm individual and mutual needs in the end-of-life phase.
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Affiliation(s)
| | - Lisbeth Thoresen
- Institute of Health and Society, University of Oslo, Oslo, Norway
| | | | | | - Gunvor Aasbø
- Institute of Health and Society, University of Oslo, Oslo, NorwayDepartment of Research, Cancer Registry of Norway, Oslo, Norway
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12
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Rojas-Garcia C, Vargas-Escobar LM, Giraldo-Castro M. Palliative Care Needs of Families of Adults With Advanced Cancer. J Hosp Palliat Nurs 2023; 25:197-203. [PMID: 37171389 DOI: 10.1097/njh.0000000000000954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Diagnosis and treatment of a terminal illness can significantly impact patients and their families, as well as their functionality and daily routines. This study aimed to understand the palliative care needs of a group of families with an adult relative with advanced cancer receiving palliative care. A qualitative approach was used to conduct a content analysis. Fourteen semistructured interviews were carried out with family members in Cundinamarca (Colombia) between March and April 2022. The information was analyzed by coding and categorizing the emerging themes using NVivo. Three main categories emerged: the diagnosis' harsh surprise, the family's coping with the disease, and the palliative care needs of families. Identifying the resources available to families to care for relatives with advanced cancer can facilitate the work of palliative care teams. It is necessary to prevent the family from giving up on caring, which can result from exhaustion due to various causes. Families who have an adult relative with advanced cancer in palliative care face significant challenges. Their situation involves accepting the diagnosis, changing family routines, dealing with the disease and the health care system, and coping with circumstances that create needs of different kinds.
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13
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Reblin M, Tay DL, Iacob E, Cloyes KG, Hebdon MCT, Ellington L. Hospice Caregivers' Perception of Family and Non-Family Social Support and Stress over Time: Associations with Reports of General Support. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5009. [PMID: 36981917 PMCID: PMC10049686 DOI: 10.3390/ijerph20065009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 03/09/2023] [Accepted: 03/10/2023] [Indexed: 06/18/2023]
Abstract
Social support has been identified as a key factor to protect wellbeing for home hospice cancer caregivers. However, few studies have assessed social support over time in this context, and measures of support are often limited to general assessments of perceived support. Our goal was to (1) describe change in cancer home hospice caregivers' social support over time during care and into bereavement and (2) explore the impact of perceived stress and support from family and non-family members on caregivers' perceived general social support. We conducted a secondary analysis of longitudinal prospective questionnaire data. Forty caregivers completed measures of general perceived support, family and non-family support and stress during hospice enrollment and 2 and 6 months post the patient's death. Linear mixed models were used to determine change in support over time and the contribution of specific support/stress ratings to general support assessments. Caregivers overall had moderate and stable levels of social support over time, though there was significant variation between and within individuals. Family and non-family support and stress from family predicted general perceptions of social support, while no effects were found for non-family stress. This work suggests a need for more specific measures of support and stress, and the need for research to focus on improving baseline levels of caregiver perceived support.
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Affiliation(s)
- Maija Reblin
- Department of Family Medicine, Larner College of Medicine, University of Vermont, Burlington, VT 05405, USA
| | - Djin L. Tay
- College of Nursing, University of Utah, Salt Lake City, UT 84112, USA
| | - Eli Iacob
- College of Nursing, University of Utah, Salt Lake City, UT 84112, USA
| | - Kristin G. Cloyes
- School of Nursing, Oregon Health & Sciences University, Portland, OR 97239, USA
| | | | - Lee Ellington
- College of Nursing, University of Utah, Salt Lake City, UT 84112, USA
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14
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Schulman-Green D, Linsky S, Blatt L, Jeuland J, Kapo J, Jeon S. Improving Breast Cancer Family Caregivers' Palliative Care Literacy: A Pilot Randomized Trial. JOURNAL OF FAMILY NURSING 2023; 29:99-114. [PMID: 35670155 DOI: 10.1177/10748407221099541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Self- and family management (SFM) refers to patients' and family caregivers' activities to co-manage illness. Two barriers to SFM are low palliative care literacy and lack of goals of care communication, which potentially result in SFM activities that are unsupportive of patients' goals. Managing Cancer Care: A Caregiver's Guide (MCC-CG) aims to improve palliative care literacy and communication within a SFM training program. In this pilot randomized trial, we enrolled breast cancer family caregivers and collected data at 0, 1, and 3 months on palliative care literacy, SFM engagement, communication, transitions management, uncertainty, caregiver burden, and caregiver competence/personal gain. Participants (n = 35) had a mean age of 54 (range: 18-81) and were 66% white and 34% racial/ethnic minorities. Intervention participants improved their palliative care literacy and SFM engagement, reduced uncertainty and caregiver burden, increased competence/personal gain, and had more goals of care conversations over time. MCC-CG has preliminary efficacy, warranting further study.
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15
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Fernandes JB, Domingos J, Castro C, Simões A, Fernandes S, Almeida AS, Bernardes C, Miranda L, Risso S, Ferreira R, Baixinho CL, Silvestre M, Godinho C. Needs and expectations of family caregivers of cancer patients in palliative care: A study protocol. Front Psychol 2023; 13:1071711. [PMID: 36687876 PMCID: PMC9853914 DOI: 10.3389/fpsyg.2022.1071711] [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: 10/16/2022] [Accepted: 12/19/2022] [Indexed: 01/07/2023] Open
Abstract
Cancer has an associated burden that continues to grow, affecting patients, family caregivers, and the individual's community. The family caregivers' unmet needs may harmfully jeopardize their well-being and the patient's health outcomes. Therefore, it is essential to understand the needs and expectations of family caregivers of cancer patients to develop and improve care practices. The present study aims to explore the needs and expectations of family caregivers of cancer patients in palliative care. This qualitative, descriptive exploratory study will use purposive sampling to recruit family caregivers and healthcare professionals from the palliative care units of two hospital centers in Lisbon and Tagus Valley. First, the Focus group will be performed until data saturation occurs. Then, a conventional thematic analysis will be applied to analyze data with the help of the coding software QDA Miner Lite database. This study's findings will help identify gaps in care and provide data that can support healthcare professionals in providing evidence-based centered care to family caregivers. It can also generate knowledge that may help stakeholders to develop a comprehensive support system for cancer survivors in palliative care and their family caregivers.
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Affiliation(s)
- Júlio Belo Fernandes
- Escola Superior de Saúde Egas Moniz, Almada, Portugal,Grupo de Patologia Médica, Nutrição e Exercício Clínico (PaMNEC), Almada, Portugal,Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Almada, Portugal,*Correspondence: Júlio Belo Fernandes,
| | - Josefa Domingos
- Grupo de Patologia Médica, Nutrição e Exercício Clínico (PaMNEC), Almada, Portugal,Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Almada, Portugal
| | - Cidália Castro
- Escola Superior de Saúde Egas Moniz, Almada, Portugal,Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Almada, Portugal
| | - Aida Simões
- Escola Superior de Saúde Egas Moniz, Almada, Portugal,Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Almada, Portugal
| | | | - Ana Silva Almeida
- Department of Nursing, Centro Hospitalar de Setúbal E.P.E., Setúbal, Portugal
| | - Catarina Bernardes
- Escola Superior de Saúde Egas Moniz, Almada, Portugal,Grupo de Patologia Médica, Nutrição e Exercício Clínico (PaMNEC), Almada, Portugal,Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Almada, Portugal
| | - Luís Miranda
- Escola Superior de Saúde Egas Moniz, Almada, Portugal,Department of Nursing, Centro Hospitalar Barreiro Montijo E.P.E., Barreiro, Portugal
| | - Sandra Risso
- Escola Superior de Saúde Egas Moniz, Almada, Portugal,Department of Nursing, Centro Hospitalar Barreiro Montijo E.P.E., Barreiro, Portugal
| | - Rogério Ferreira
- Departamento de Saúde, Instituto Politécnico de Beja, Escola Superior de Saúde, Beja, Portugal,Comprehensive Health Research Center, Évora, Portugal
| | - Cristina Lavareda Baixinho
- Nursing School of Lisbon, Lisbon, Portugal,Nursing Research, Innovation and Development Center of Lisbon (CIDNUR), Lisbon, Portugal
| | - Milene Silvestre
- Department of Nursing, Centro Hospitalar Barreiro Montijo E.P.E., Barreiro, Portugal
| | - Catarina Godinho
- Escola Superior de Saúde Egas Moniz, Almada, Portugal,Grupo de Patologia Médica, Nutrição e Exercício Clínico (PaMNEC), Almada, Portugal,Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Almada, Portugal
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16
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Kremeike K, Bausewein C, Freytag A, Junghanss C, Marx G, Schnakenberg R, Schneider N, Schulz H, Wedding U, Voltz R. [DNVF Memorandum: Health Services Research in the Last Year of Life]. DAS GESUNDHEITSWESEN 2022. [PMID: 36220106 DOI: 10.1055/a-1889-4705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
This memorandum outlines current issues concerning health services research on seriously ill and dying people in the last year of their lives as well as support available for their relatives. Patients in the last phase of life can belong to different disease groups, they may have special characteristics (e. g., people with cognitive and complex impairments, economic disadvantage or migration background) and be in certain phases of life (e. g., parents of minor children, (old) age). The need for a designated memorandum on health services research in the last year of life results from the special situation of those affected and from the special features of health services in this phase of life. With reference to these special features, this memorandum describes methodological and ethical specifics as well as current issues in health services research and how these can be adequately addressed using quantitative, qualitative and mixed methods. It has been developed by the palliative medicine section of the German Network for Health Services Research (DNVF) according to the guidelines for DNVF memoranda.
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Affiliation(s)
- Kerstin Kremeike
- Zentrum für Palliativmedizin, Universitätsklinikum Köln, Köln, Deutschland
| | - Claudia Bausewein
- Klinik und Poliklinik für Palliativmedizin, LMU Klinikum München, München, Deutschland
| | - Antje Freytag
- Institut für Allgemeinmedizin, Universitätsklinikum Jena, Jena, Deutschland
| | - Christian Junghanss
- Hämatologie, Onkologie und Palliativmedizin, Zentrum für Innere Medizin, Universitätsmedizin Rostock, Rostock, Deutschland
| | - Gabriella Marx
- Institut und Poliklinik Allgemeinmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | | | - Nils Schneider
- Institut für Allgemeinmedizin und Palliativmedizin, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Holger Schulz
- Institut und Poliklinik für Medizinische Psychologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Ulrich Wedding
- Abteilung Palliativmedizin, Universitätsklinikum Jena, Jena, Deutschland
| | - Raymond Voltz
- Zentrum für Palliativmedizin, Universitätsklinikum Köln, Köln, Deutschland
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17
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Anu SJ, Kaisa M, Heli V, Andreas C, Elina H. Family members’ experiences of psychosocial support in palliative care inpatient units: A descriptive qualitative study. Eur J Oncol Nurs 2022; 61:102201. [DOI: 10.1016/j.ejon.2022.102201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 08/08/2022] [Accepted: 09/18/2022] [Indexed: 11/26/2022]
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18
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Bronsema A, Theißen T, Oechsle K, Wikert J, Escherich G, Rutkowski S, Bokemeyer C, Ullrich A. Looking back: Identifying supportive care and unmet needs of parents of children receiving specialist paediatric palliative care from the bereavement perspective. Palliat Care 2022; 21:87. [PMID: 35610720 PMCID: PMC9131617 DOI: 10.1186/s12904-022-00971-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 05/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study examined care needs and utilisation of psychosocial support services among parents of children who had received specialist paediatric palliative care, as well as the relationship between need fulfilment and grief. Possible differences between parents of children who died of cancer versus a non-cancer disease were explored. METHODS This exploratory study, conducted in two specialist paediatric palliative care facilities, included parents who had lost a child within a period of 0.5 to 8 years before this investigation. From the bereavement perspective, parents reported their needs during paediatric palliative care using the Family Inventory of Needs - Peadiatric II (FIN-PED II). Utilisation of psychosocial support services during paediatric palliative care and after the child's death, as well as potential barriers to accessing services were assessed. Grief symptoms were measured using the Inventory of Complicated Grief - German Version (ICG-D). RESULTS Overall, 56 of 157 approached parents participated in the study. Mean time interval after the child's death was 3.2 years. Of the 17 FIN-PED II needs, 13 needs were reported to be very/extremely important to more than 75% of the parents each. Highest ranked needs related to asking questions at any time (100%), sincere care for the child (100%), and information about changes in the child's condition (98%). The highest ranked unmet needs related to hope (61%), interactions with siblings (41-42%), and trust in the health care system (39%). Comparisons showed no significant differences between parents whose child died of cancer (n = 18) versus a non-cancer disease (n = 38). During paediatric palliative care, 61% of the parents had accessed at least one psychosocial support service and 84% had done so after the child's death. The most prominent barriers for accessing services were sufficient informal support (38%), no subjective need (23%), and lack of time (20%). Overall, 52% of the parents showed noticeable symptoms for complicated grief (ICG-D > 25). A higher level of grief symptoms significantly correlated with a lower fulfilment of the need to say goodbye to the child (p = .042) with a medium correlational effect. CONCLUSIONS Our findings may help to guide health care professionals in their assessment of parental needs and provision of support to parents during paediatric palliative care.
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Affiliation(s)
- Annika Bronsema
- Clinic of Paediatric Haematology and Oncology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Tabea Theißen
- Palliative Care Unit, Department of Oncology, Hematology and BMT, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Karin Oechsle
- Palliative Care Unit, Department of Oncology, Hematology and BMT, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julia Wikert
- Palliative Care Unit, Department of Oncology, Hematology and BMT, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Palliative Medicine, University Hospital LMU, Munich, Germany
| | - Gabriele Escherich
- Clinic of Paediatric Haematology and Oncology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Stefan Rutkowski
- Clinic of Paediatric Haematology and Oncology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Carsten Bokemeyer
- Palliative Care Unit, Department of Oncology, Hematology and BMT, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anneke Ullrich
- Palliative Care Unit, Department of Oncology, Hematology and BMT, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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19
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Agbayani CJ, Tucker JA, Nelson EL, Martinez F, Cortes H, Khoury D, Kain ZN, Lin C, Torno L, Fortier MA. Immunological and psychosocial functioning in parents of children with cancer. Support Care Cancer 2022; 30:3379-3388. [PMID: 34994860 PMCID: PMC9833860 DOI: 10.1007/s00520-021-06770-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 12/16/2021] [Indexed: 01/13/2023]
Abstract
PURPOSE Research has shown that parents of children with cancer exhibit an altered immune profile compared to parents of healthy children, reflective of increased susceptibility to illness. These parents are also at risk for poorer psychosocial outcomes and quality of life. The current study compares peripheral blood cell analyses and psychosocial self-reports from parents of children being treated for cancer (n = 21) to parents of healthy children (n = 30). METHODS A blood sample was drawn from parents to analyze immune profiles. Parents also completed the Perceived Stress Scale (PSS), Medical Outcomes Study Short Form-36 (MOS), and Patient-Reported Outcomes Measurement Information System Short Form v1.0 Emotional Distress-Anxiety 8a, and Emotional Distress-Depression 8a (PROMIS). Mann-Whitney U tests and independent samples t-tests were conducted to examine differences in outcomes between parent groups. RESULTS Parents of children with cancer exhibited higher monocyte percentages in their peripheral blood compared to peers with healthy children. Parents of children with cancer also reported poorer psychosocial outcomes: higher perceived stress, higher anxiety and depression symptoms, more role disability resulting from emotional problems, poorer general and mental health, and poorer social functioning. CONCLUSION These findings support research that has shown a direct effect of chronic stress on the immune system. Symptoms reported by parents of children with cancer indicate unmet psychosocial needs that could potentially affect long-term health. Given the central role of parents in their children's cancer care, it is compelling to address and work to improve parent immunological and psychosocial well-being.
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Affiliation(s)
- Crystle-Joie Agbayani
- UCI Center on Stress and Health, School of Medicine, University of California-Irvine, Irvine, CA, USA,Department of Psychological Science, University of California-Irvine, Irvine, CA, USA
| | - Jo A. Tucker
- Department of Medicine, Division of Hematology Oncology, University of California-Irvine, Irvine, CA, USA,Institute for Immunology, University of California-Irvine, Irvine, CA, USA
| | - Edward L. Nelson
- Department of Medicine, Division of Hematology Oncology, University of California-Irvine, Irvine, CA, USA,Institute for Immunology, University of California-Irvine, Irvine, CA, USA,NCI-Designated Chao Family Comprehensive Cancer Center, Irvine, CA, USA
| | - Freddy Martinez
- UCI Center on Stress and Health, School of Medicine, University of California-Irvine, Irvine, CA, USA
| | - Haydee Cortes
- UCI Center on Stress and Health, School of Medicine, University of California-Irvine, Irvine, CA, USA,Department of Anesthesiology & Perioperative Care, University of California-Irvine, Irvine, CA, USA
| | - Dina Khoury
- UCI Center on Stress and Health, School of Medicine, University of California-Irvine, Irvine, CA, USA,Department of Medicine, Division of Hematology Oncology, University of California-Irvine, Irvine, CA, USA
| | - Zeev N. Kain
- UCI Center on Stress and Health, School of Medicine, University of California-Irvine, Irvine, CA, USA,Department of Anesthesiology & Perioperative Care, University of California-Irvine, Irvine, CA, USA,Department of Pediatrics, CHOC, Orange, CA, USA,Child Study Center, School of Medicine, Yale University, New Haven, CT, USA
| | - Carol Lin
- Hyundai Cancer Institute, CHOC, Orange, CA, USA
| | | | - Michelle A Fortier
- UCI Center on Stress and Health, School of Medicine, University of California-Irvine, Irvine, CA, USA,Department of Psychological Science, University of California-Irvine, Irvine, CA, USA,NCI-Designated Chao Family Comprehensive Cancer Center, Irvine, CA, USA,Department of Anesthesiology & Perioperative Care, University of California-Irvine, Irvine, CA, USA,Department of Psychology, CHOC, Orange, CA, USA,Sue & Bill Gross School of Nursing, University of California-Irvine, Irvine, CA, USA
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20
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Abstract
Informal caregivers invest a significant amount of time and effort to provide cancer patients with physical, psychological, information, and social support. These challenging tasks can harm their own health and well-being, while a series of social-ecological factors may also influence the outcomes of cancer caregiving. Several instruments have been developed to help clinicians and researchers understand the multi-dimensional needs and concerns of caregivers. A growing body of evidence indicates that supportive interventions including psychoeducation, skills training, and therapeutic counseling can help improve the burden, information needs, coping strategies, physical functioning, psychological well-being, and quality of life of caregivers. However, there is difficulty in translating research evidence into practice. For instance, some supportive interventions tested in clinical trial settings are regarded as inconsistent with the actual needs of caregivers. Other significant considerations are the lack of well-trained interdisciplinary teams for supportive care provision and insufficient funding. Future research should include indicators that can attract decision-makers and funders, such as improving the efficient utilization of health care services and satisfaction of caregivers. It is also important for researchers to work closely with key stakeholders, to facilitate evidence dissemination and implementation, to benefit caregivers and the patient.
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21
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Cheng Q, Xu B, Ng MS, Duan Y, So WK. Effectiveness of psychoeducational interventions among caregivers of patients with cancer: A systematic review and meta-analysis. Int J Nurs Stud 2021; 127:104162. [DOI: 10.1016/j.ijnurstu.2021.104162] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 10/23/2021] [Accepted: 12/11/2021] [Indexed: 01/23/2023]
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22
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Cheng HL, Leung DYP, Ko PS, Chung MW, Lam WM, Lam PT, Luk AL, Lam SC. Reliability, validity and acceptability of the traditional Chinese version of the carer support needs assessment tool in Hong Kong palliative care settings. BMC Palliat Care 2021; 20:152. [PMID: 34627225 PMCID: PMC8502334 DOI: 10.1186/s12904-021-00852-w] [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] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 09/23/2021] [Indexed: 12/04/2022] Open
Abstract
Background Among the few existing needs assessment tools for family carers, the 14-item Carer Support Needs Assessment Tool (CSNAT) is the only brief and holistic needs screening tool designed for everyday use in palliative care practices. The aim of this study was to evaluate the reliability, validity, and acceptability of the traditional Chinese version of the CSNAT in palliative care settings in Hong Kong. Methods This adopted a cross-sectional and correlation design with repeated measures. The participants were 125 family carers of palliative cancer patients and 10 healthcare providers (HCPs) that were recruited from two local hospitals. The evaluation of psychometric properties included the following: (1) content validity through HCPs including frontline physicians, nurses, social workers, and clinical psychologists; (2) construct validity between the CSNAT items and those of the validated tools that measured caregiver burden, social support, and caregiving self-efficacy; and (3) one-week test-retest reliability in a sub-sample of 81 caregivers. The acceptability of the tool was assessed by the carers using several closed-ended questions. Results The content validity index of the CSNAT at the scale level was 0.98. Each item of the CSNAT was significantly and moderately correlated with caregiver burden (Spearman’s r = 0.24 to 0.50) and caregiving self-efficacy (r = − 0.21 to − 0.52), but not for social support. All CSNAT items had fair to moderate test-retest reliability (weighted kappa = 0.21 to 0.48), with the exception of two items “managing your relatives’ symptoms, including giving medicines” and “having time for yourself in the day”. Regarding the acceptability of the CSNAT, almost all HCPs were willing to use the CSNAT for carer assessment and support. 89.6% of the carers demonstrated a comprehensibility of the CSNAT tool and 92.9% felt comfortable answering the questions. Around 90% of the carers agreed to use the tool for screening, discussing needs, and making referrals. Conclusion The traditional Chinese version of the CSNAT is a tool with high validity and acceptability and adequate reliability that measures family carers’ support needs, which should be considered for wide application in local palliative care practices.
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Affiliation(s)
- Hui-Lin Cheng
- School of Nursing, The Hong Kong Polytechnic University, Hom Hung, Kowloon, Hong Kong SAR, China.
| | - Doris Yin Ping Leung
- School of Nursing, The Hong Kong Polytechnic University, Hom Hung, Kowloon, Hong Kong SAR, China
| | - Po Shan Ko
- Nursing Services Division, United Christian Hospital, Hong Kong SAR, China
| | - Ming Wai Chung
- School of Nursing, The Hong Kong Polytechnic University, Hom Hung, Kowloon, Hong Kong SAR, China
| | - Wai Man Lam
- Department of Medicine, Haven of Hope Hospital, Hong Kong SAR, China
| | - Po Tin Lam
- Department of Medicine and Geriatrics, United Christian Hospital, Hong Kong SAR, China
| | - Andrew Leung Luk
- Nethersole Institute of Continuing Holistic Health Education, Hong Kong SAR, China
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Oechsle K, Theißen T, Heckel M, Schwenzitzki L, Ullrich A, Ostgathe C. [Support for and involvement of family caregivers in Comprehensive Cancer Center - an Assessment of the Palliative Care Working Group within the network of Comprehensive Cancer Center funded by the German Cancer Aid]. Dtsch Med Wochenschr 2021; 146:e74-e80. [PMID: 34416786 PMCID: PMC8439962 DOI: 10.1055/a-1543-2511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND According to current oncological guidelines, early integration of specialist palliative care (SPC) represents standard cancer care supporting not only the patients, but also their family caregivers. Data on the actual implementation in daily oncology practice in Germany are lacking. METHODS The Palliative Care Working Group of the network of Comprehensive Cancer Centers certified by the German Cancer Aid (CCC) assessed the implementation of measures for family caregiver support and involvement within the CCC/within SPC in the CCC/local outside the CCC in all 17 CCC locations. RESULTS In the CCC/in SPC psycho-oncological (100 %/94 %), social (94 %/100 %) and spiritual counselling of family caregivers (94 % each) as well as support for children with parental cancer (88 %/100 %) and information materials for family caregivers (88 % each) are well established. Training on nursing skills (77 %/94 %) and family conferences (59 %/88 %) are established more frequently within SPC than in the rest of the CCC. SOPs are rather rare (23 %/18 %) as well as screenings for family caregiver needs (0/24 %). Bereavement or self-help groups are with 82 % each more frequent locally outside the CCC. Psycho-oncological and social counselling as well as support for children with parental cancer were scored as most important (94 % each). For SPC, training on nursing skills and information materials were rated equally (94 % each). SOPs were rated as very/extremely important in 47 %/41 % and routine screening for family caregiver in 53 %/65 %. CONCLUSION In correspondence to their importance, psychosocial and spiritual counselling and support for children with parental cancer are well implemented in CCC. In SPC, training on nursing skills and family conferences are also well implemented. SOPs for family caregiver support and involvement as well as routine screenings for family caregiver needs have to be implemented urgently in the CCC.
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Affiliation(s)
- Karin Oechsle
- Palliativmedizin, 2. Medizinische Klinik, Universitäres Cancer Center Hamburg, Universitätsklinikum Hamburg-Eppendorf
| | - Tabea Theißen
- Palliativmedizin, 2. Medizinische Klinik, Universitäres Cancer Center Hamburg, Universitätsklinikum Hamburg-Eppendorf
| | - Maria Heckel
- Palliativmedizinische Abteilung, Comprehensive Cancer Center CCC Erlangen-EMN, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg
| | - Lisa Schwenzitzki
- Palliativmedizin, 2. Medizinische Klinik, Universitäres Cancer Center Hamburg, Universitätsklinikum Hamburg-Eppendorf
| | - Anneke Ullrich
- Palliativmedizin, 2. Medizinische Klinik, Universitäres Cancer Center Hamburg, Universitätsklinikum Hamburg-Eppendorf
| | - Christoph Ostgathe
- Palliativmedizinische Abteilung, Comprehensive Cancer Center CCC Erlangen-EMN, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg
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