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Shapiro-Rosenbaum A, Jaffe MP. Education, Training, and Support Across the Continuum of Recovery for Caregivers of Persons with Disorders of Consciousness. Phys Med Rehabil Clin N Am 2024; 35:193-208. [PMID: 37993189 DOI: 10.1016/j.pmr.2023.06.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
Evolving knowledge highlights the deleterious effects of caregiving on the emotional, psychosocial, and financial well-being of caregivers of persons with disorders of consciousness (DoC). Current practice guidelines and minimal competency recommendations emphasize the importance of identifying and addressing DoC caregiver needs. This article serves as a dissemination tool to enhance communication between providers and caregivers. Essential components of education and training are outlined for each level of care. Addressing caregiver needs may mitigate the level of perceived burden, reduce the risk of burnout, and increase care proficiency and likelihood of community discharge, thus potentially reducing long-term costs of care for this population.
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Affiliation(s)
- Amy Shapiro-Rosenbaum
- Department of Brain Injury Rehabilitation, Park Terrace Care Center, Queens, NY, USA; TBI Model System, Icahn School of Medicine at Mount Sinai, New York, NY, USA; BrainMatters Neuropsychological Services, PLLC, Plainview, NY, USA.
| | - Michelle P Jaffe
- Department of Brain Injury Rehabilitation, Park Terrace Care Center, Queens, NY, USA; BrainMatters Neuropsychological Services, PLLC, Plainview, NY, USA; North Shore University Hospital, Northwell Health, Kings Point, NY, USA
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2
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Needs and Quality of Life of Caregivers of Patients with Prolonged Disorders of Consciousness. Brain Sci 2023; 13:brainsci13020308. [PMID: 36831851 PMCID: PMC9953960 DOI: 10.3390/brainsci13020308] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/30/2023] [Accepted: 02/04/2023] [Indexed: 02/15/2023] Open
Abstract
Background. Many patients with severe brain damage may survive and remain in a prolonged disorder of consciousness (PDoC), impacting the quality of life (QoL) and needs of their family caregivers. However, the current literature on the factors influencing these needs is contradictory. We aim to describe the needs, QoL, and emotional distress of caregivers of patients with PDoC. Methods. Questionnaires investigating the importance and satisfaction of six categories of needs (i.e., health information, emotional, instrumental, and professional supports, community support network, and involvement in care), QoL, and emotional distress were completed by the main caregivers of PDoC patients. Results. We analyzed 177 questionnaires. Seventy-nine percent of the needs were considered as important or very important, and 44% were partially met or unmet. The needs for health information and professional support were the most important, while the needs for involvement in care and for health information were the most satisfied. Mean QoL was low and emotional distress high. Variables such as care setting and time since brain injury affected the level of QoL and distress. Conclusion. The needs for health information and professional support should receive particular attention. Given their low QoL and high distress, adequate support structures should be provided to caregivers of PDoC patients.
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Boegle K, Bassi M, Comanducci A, Kuehlmeyer K, Oehl P, Raiser T, Rosenfelder M, Sitt JD, Valota C, Willacker L, Bender A, Grill E. Informal Caregivers of Patients with Disorders of Consciousness: a Qualitative Study of Communication Experiences and Information Needs with Physicians. NEUROETHICS-NETH 2022; 15:24. [PMID: 35912377 PMCID: PMC9307713 DOI: 10.1007/s12152-022-09503-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 07/11/2022] [Indexed: 10/27/2022]
Abstract
AbstractDue to improvements in medicine, the figures of patients with disorders of consciousness (DoC) are increasing. Diagnostics of DoC and prognostication of rehabilitation outcome is challenging but necessary to evaluate recovery potential and to decide on treatment options. Such decisions should be made by doctors and patients’ surrogates based on medico-ethical principles. Meeting information needs and communicating effectively with caregivers as the patients´ most common surrogate-decision makers is crucial, and challenging when novel tech-nologies are introduced. This qualitative study aims to explore information needs of informal DoC caregivers, how they manage the obtained information and their perceptions and experiences with caregiver-physician communication in facilities that implemented innovative neurodiagnostics studies. In 2021, we conducted semi-structured interviews with nine caregivers of clinically stable DoC patients in two rehabilitation centers in Italy and Germany. Participants were selected based on consecutive purposeful sampling. Caregivers were recruited at the facilities after written informed consent. All interviews were recorded, transcribed verbatim and translated. For analysis, we used reflexive thematic analysis according to Braun & Clarke (2006). Caregivers experienced the conversations emotionally, generally based on the value of the information provided. They reported to seek positive information, comfort and empathy with-in the communication of results of examinations. They needed detailed information to gain a deep understanding and a clear picture of their loved-one’s condition. The results suggest a mismatch between the perspectives of caregivers and the perspectives of medical profession-als, and stress the need for more elaborate approaches to the communication of results of neu-rodiagnostics studies.
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Proia-Lelouey N, Boissel A. Being a caregiver of a relative with a prolonged disorder of consciousness living at home: A scoping review. Neuropsychol Rehabil 2022; 33:718-744. [PMID: 35195048 DOI: 10.1080/09602011.2022.2042330] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
As recent reviews of the literature have shown, a growing number of studies have focused on the burden of caregivers of people living with a prolonged disorder of consciousness. However, none of these reviews have focused specifically on caregivers in the home care setting. It is therefore difficult to have a state of knowledge specific to this setting, even though many POCD patients live at home once their condition has stabilized. For this reason, we decided, after completing recent literature reviews, to conduct a quantitative and qualitative analysis of publications presenting data on the quality of life of caregivers whose relative with PDOC lives at home. While all the studies agree that the presence of a person with PDOC is a heavy burden for the caregiver, some authors refute the idea defended by others that this burden is the same whether the patient lives at home or in care facilities. All the studies also stress the need for public material and organisational assistance, without which caregivers find themselves in a state of great financial and psychological distress. Such support would also help to strengthen internal resilience factors.
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Affiliation(s)
| | - Anne Boissel
- Department of Psychology, University of Rouen, Rouen, France
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5
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Padua L, Fredda G, Coraci D, Reale G, Glorioso D, Loreti C, Pecchioli C, Bernabei R. COVID-19 and hospital restrictions: physical disconnection and digital re-connection in disorders of consciousness. Brain Inj 2021; 35:1134-1142. [PMID: 34495807 DOI: 10.1080/02699052.2021.1972335] [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: 10/20/2022]
Abstract
Purpose: The coronavirus disease 2019 (COVID-19) pandemic forced hospitals to adopt tighter restrictions, the most impacting is no access to visitors. Disorder of consciousness (DOC) due to severe acquired brain injury is a condition needing neurorehabilitation and the role of relatives is essential, hence besides physical "disconnection" digital "re-connection" is crucial. We aimed to assess whether digital communication benefits in patients with DOC, considering the sensorial and emotional deprivation due to the COVID-19 emergency lock-down.Methods: For eleven consecutive patients with DOC admitted to our Intensive Neurorehabilitation Care (mean age: 45; females: 9), two observers registered neurobehavioral changes during a video-calls with their relatives. Heart-rate variability was measured before and during the calls. The video-call was performed by using two displays of different sizes: tablet (T-video-call) and large screen (LS-Video-call).Results: The video-calls impacted on the patients' vigilance and in the relationship with relatives. Moreover, positively impacted on their relatives. The current results showed significant greater impact on patients during the LS-video-call than when they are exposed to T-video-call.Conclusions: During the COVID-19 pandemic, besides the physical disconnection to stop the contagion spread, a "digital re-connection" is needed for all and especially for fragile population groups as patients with DOC.
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Affiliation(s)
- Luca Padua
- Department of Orthopaedics and Geriatrics, Università Cattolica Del Sacro Cuore, Rome, Italy.,UOC High Intensity Neurorehabilitation, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giulia Fredda
- UOS Clinical Psychology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Daniele Coraci
- Department of Neuroscience, University of Padova, Padova, Italy
| | - Giuseppe Reale
- UOC High Intensity Neurorehabilitation, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Neurosciences, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Davide Glorioso
- Department of Orthopaedics and Geriatrics, Università Cattolica Del Sacro Cuore, Rome, Italy.,UOC High Intensity Neurorehabilitation, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Claudia Loreti
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Roberto Bernabei
- Department of Orthopaedics and Geriatrics, Università Cattolica Del Sacro Cuore, Rome, Italy.,Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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6
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Pinel-Jacquemin S, Althaus V, Boissel A. Patients in permanent vegetative or minimally conscious states: A literature review of the psychological and health impacts on healthcare personnel. Work 2021; 68:807-820. [PMID: 33612523 DOI: 10.3233/wor-203414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND To address the quality of life of patients in Permanent Vegetative or Minimally Conscious States, the occupational health of those around them must also be taken into account. OBJECTIVE By analyzing how the available scientific literature has addressed this issue, this study seeks to better understand how caring for these patients affects healthcare professionals' psychological and health status. METHODS We identified and selected 15 publications from both Anglophone and Francophone databases, i.e., Cairn, Francis, HAL, PsycINFO, PubMed, ResearchGate and ScienceDirect. RESULTS The reviewed publications and studies highlight the difficulties healthcare professionals face with regard to the relationship with patients and their families. Two studies in particular suggest that the difficulties these professionals experience daily can lead to burnout. Other potential burnout factors include the healthcare profession category, the work environment, lack of training and the time spent working with this specific group of patients. CONCLUSIONS Our literature review highlights the institutional and personal resources that may prevent these occupational risks. It also provides avenues for future research.
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Affiliation(s)
| | | | - Anne Boissel
- CRFDP, Université de Rouen Normandie, Mont-Saint-Aignan, France
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The Educational Needs of Family of Patients Discharged from the Intensive Care Units: The Viewpoints of Nurses and the Patients' Families. Crit Care Res Pract 2021; 2021:9956023. [PMID: 34007488 PMCID: PMC8110423 DOI: 10.1155/2021/9956023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 04/26/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction Thousands of patients are admitted to the intensive care units annually, which are stressful for patients and their families. The discharged patients and their families face different challenges in the caring process of the patients. Objectives This study aimed to determine the educational needs of the families of patients discharged directly home from the postintensive care units and to compare the views of families and nurses about these needs. Method This was a cross-sectional study. One hundred forty nurses and 140 family members of the patients discharged from intensive care units participated in the survey by convenience sampling method. A questionnaire of sociodemographic information and a researcher-made questionnaire on the educational needs of the family of patients discharged from the postintensive care units were used for data collection. Results The mean total score of the educational needs of the patients' families was 31.81 and 35.33 from views of families and nurses, respectively. Nurses significantly estimated the educational needs of families more than what they did (P < 0.001). The families and nurses reported the educational needs of self-care as well as nutrition and medicine at the highest level, respectively. Both groups reported the educational needs of defecation at the lowest level. Nurses estimated higher educational needs in all dimensions, except for the patient's mental health and family self-care than families (P < 0.001). Conclusion According to the present study, the educational needs were high from the views of nurses and families. Family need assessment is essential in designing and applying instructional interventions. Given the high level of family needs, implementing educational and practical interventions is necessary to enhance their skills.
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8
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Hajalizadeh A, Ahmadinejad M, Dehghan M, Arab M. Informational Needs of the Families of Patients Discharged From Intensive Care Units: A Case of Iran. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2020; 41:379-386. [PMID: 33143560 DOI: 10.1177/0272684x20972641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND thousands of patients are admitted to intensive care units annually, which is a stressful event. Many of these patients still require particular care after discharge. In many countries, families play an essential role in taking care of these patients after discharge. This study aimed to determine the informational needs of families of patients discharged from Intensive Care Units (ICU), Kerman, southeast Iran. METHODS this study had a cross-sectional design. Families were selected using the information extracted from patients' medical records. One hundred forty family members of the ICU discharged patients participated in the survey using convenience sampling. Data collection tools were a validated researcher-made questionnaire about informational needs and a demographic characteristics form. RESULTS the mean score of family informational needs was 31.18 ± 3.97 out of 40. Most families required a high level of information in all dimensions. However, the maximum need was associated with self-care subscale (4.89 out of 5), and the minimum need was associated with defecation (3.13 out of 5). CONCLUSION the families of patients discharged from intensive care units required much information about different areas of care particularly self-care. Health care providers, especially nurses, should be aware of the informational needs of the ICU patients' families post-discharge to provide better care.
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Affiliation(s)
- Asma Hajalizadeh
- Nursing and Midwifery School, Kerman University of Medical Sciences, Kerman, Iran
| | - Mehdi Ahmadinejad
- Anesthesiology and Critical Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Mahlagha Dehghan
- Nursing Research Center, Critical Care Department, Nursing and Midwifery School, Kerman University of Medical Sciences, Kerman, Iran
| | - Mansoor Arab
- Nursing and Midwifery School, Bam University of Medical Sciences, Bam
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9
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Imani-Goghary Z, Ghaljeh M. The experience of family caregivers caring for a patient with chronic disorders of consciousness: a qualitative content analysis. Int J Palliat Nurs 2020; 26:301-309. [PMID: 32841084 DOI: 10.12968/ijpn.2020.26.6.301] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Management of a patient with chronic disorders of consciousness is a long-term and stressful situation for family caregivers. AIMS The aim of this study was to describe the experiences of family caregivers of patients with chronic disorders of consciousness. METHODS Purposeful sampling was used, data were collected through semi-structured, in-depth interviews at participants' homes. Data were analysed using qualitative content analysis. FINDINGS Results indicated that family caregivers of patients with chronic disorders of consciousness face many difficulties in providing care to vegetative state (VS) and minimally conscious state (MCS) patients; they experience it as a challenging type of care, which influences their mental health. CONCLUSION Family caregivers are faced with many challenges because of the high burden of care, round-the-clock concern, taking care of an alive but unresponsive patient without receiving enough support. They experience mental and inner turmoil because of social isolation and dealing with contradictory feelings in their daily life.
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Affiliation(s)
- Zahra Imani-Goghary
- Assistant Professor of Nursing, Sirjan School of Medical Science, Sirjan, Iran
| | - Mahnaz Ghaljeh
- Assistant Professor of Nursing, Community Nursing Research Center, Zahedan University of Medical Science, Zahedan, Iran
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10
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Minimum Competency Recommendations for Programs That Provide Rehabilitation Services for Persons With Disorders of Consciousness: A Position Statement of the American Congress of Rehabilitation Medicine and the National Institute on Disability, Independent Living and Rehabilitation Research Traumatic Brain Injury Model Systems. Arch Phys Med Rehabil 2020; 101:1072-1089. [PMID: 32087109 DOI: 10.1016/j.apmr.2020.01.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 01/27/2020] [Accepted: 01/28/2020] [Indexed: 11/24/2022]
Abstract
Persons who have disorders of consciousness (DoC) require care from multidisciplinary teams with specialized training and expertise in management of the complex needs of this clinical population. The recent promulgation of practice guidelines for patients with prolonged DoC by the American Academy of Neurology, American Congress of Rehabilitation Medicine (ACRM), and National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) represents a major advance in the development of care standards in this area of brain injury rehabilitation. Implementation of these practice guidelines requires explication of the minimum competencies of clinical programs providing services to persons who have DoC. The Brain Injury Interdisciplinary Special Interest Group of the ACRM, in collaboration with the Disorders of Consciousness Special Interest Group of the NIDILRR-Traumatic Brain Injury Model Systems convened a multidisciplinary panel of experts to address this need through the present position statement. Content area-specific workgroups reviewed relevant peer-reviewed literature and drafted recommendations which were then evaluated by the expert panel using a modified Delphi voting process. The process yielded 21 recommendations on the structure and process of essential services required for effective DoC-focused rehabilitation, organized into 4 categories: diagnostic and prognostic assessment (4 recommendations), treatment (11 recommendations), transitioning care/long-term care needs (5 recommendations), and management of ethical issues (1 recommendation). With few exceptions, these recommendations focus on infrastructure requirements and operating procedures for the provision of DoC-focused neurorehabilitation services across subacute and postacute settings.
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11
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Corallo F, Bonanno L, Formica C, Corallo F, De Salvo S, Lo Buono V, Di Cara M, Alagna A, Rifici C, Bramanti P, Marino S. Religious Coping in Caregiver of Patients with Acquired Brain Injuries. JOURNAL OF RELIGION AND HEALTH 2019; 58:1444-1452. [PMID: 31098828 DOI: 10.1007/s10943-019-00840-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Caregivers play a crucial role in physical and psychological management in terms of assistance. For this reason, it is important for caregivers to find better coping strategies to minimize a possible physical and emotional burden. The aim of our study is to demonstrate how the religious coping can influence the burden of caregivers about health care of patients with severe brain injuries. Caregivers were, respectively, divided into two groups: 31 religious believers and 20 unbelievers. We submitted the questionnaires to participants, which investigate the caregiver burden, presence of depressive symptoms and kind of coping strategies adopted. Our results demonstrated that participants with religious belief used avoidance strategies more frequently compared to non-believers' group. We want to improve adaptive coping strategies to upgrade the awareness of caregiver, supporting burden and distress. A problem-solving training might improve quality of life in terms of social and psychological wellness.
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Affiliation(s)
- Francesco Corallo
- IRCCS Centro Neurolesi "Bonino Pulejo", S.S. 113, Via Palermo, C.da Casazza, 98124, Messina, Italy.
| | - Lilla Bonanno
- IRCCS Centro Neurolesi "Bonino Pulejo", S.S. 113, Via Palermo, C.da Casazza, 98124, Messina, Italy
| | - Caterina Formica
- IRCCS Centro Neurolesi "Bonino Pulejo", S.S. 113, Via Palermo, C.da Casazza, 98124, Messina, Italy
- Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Federica Corallo
- IRCCS Centro Neurolesi "Bonino Pulejo", S.S. 113, Via Palermo, C.da Casazza, 98124, Messina, Italy
| | - Simona De Salvo
- IRCCS Centro Neurolesi "Bonino Pulejo", S.S. 113, Via Palermo, C.da Casazza, 98124, Messina, Italy
| | - Viviana Lo Buono
- IRCCS Centro Neurolesi "Bonino Pulejo", S.S. 113, Via Palermo, C.da Casazza, 98124, Messina, Italy
| | - Marcella Di Cara
- IRCCS Centro Neurolesi "Bonino Pulejo", S.S. 113, Via Palermo, C.da Casazza, 98124, Messina, Italy
| | - Antonella Alagna
- IRCCS Centro Neurolesi "Bonino Pulejo", S.S. 113, Via Palermo, C.da Casazza, 98124, Messina, Italy
| | - Carmela Rifici
- IRCCS Centro Neurolesi "Bonino Pulejo", S.S. 113, Via Palermo, C.da Casazza, 98124, Messina, Italy
| | - Placido Bramanti
- IRCCS Centro Neurolesi "Bonino Pulejo", S.S. 113, Via Palermo, C.da Casazza, 98124, Messina, Italy
| | - Silvia Marino
- IRCCS Centro Neurolesi "Bonino Pulejo", S.S. 113, Via Palermo, C.da Casazza, 98124, Messina, Italy
- Department of Biomedical and Dental Sciences and Morphological and Functional Imaging, University of Messina, Via Consolare Valeria, Messina, Italy
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12
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Klingshirn H, Mittrach R, Braitmayer K, Strobl R, Bender A, Grill E, Müller M. RECAPDOC - a questionnaire for the documentation of rehabilitation care utilization in individuals with disorders of consciousness in long-term care in Germany: development and pretesting. BMC Health Serv Res 2018; 18:329. [PMID: 29728154 PMCID: PMC5936017 DOI: 10.1186/s12913-018-3153-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 04/25/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A multitude of different rehabilitation interventions and other specific health care services are offered for individuals with disorders of consciousness in long-term care settings. To investigate the association of those services and patient-relevant outcomes, a specific instrument to document the utilization of those services is needed. The purpose of this study was to develop such a questionnaire administered to caregivers in epidemiological studies or patient registries in Germany. METHODS The development process of the RECAPDOC questionnaire was carried out in three steps. Step 1 consisted of a systematic literature review and an online-based expert survey to define the general content. Step 2 was an expert interview to evaluate the preliminary content of the questionnaire. Step 3 was a pretest including cognitive interviews with caregivers. After each step, the results were combined into a new version of the questionnaire. RESULTS The first version of the questionnaire included items on utilization of medical care, medical aids, nursing and therapeutic care. The results of the expert interview led to the integration of five new items and the modification of six other items. The pretest led to some minor modifications of the questionnaire since it was rated as feasible and acceptable. The final questionnaire consisted of 29 items covering the domains "living situation", "social insurance status", "utilisation of home health care", "domestic services", "outpatient health care", "specific diagnostic measures", "adaptive technologies", "medical aids" and "utilization of therapies". Also the experience of family support and multidisciplinary collaboration of health professionals is covered. CONCLUSIONS The developed questionnaire is a first step to make the situation of patients with disorders of consciousness in the long-term care setting accessible for evaluation in epidemiological studies and in the context of patient registries. However, further reliability and validity studies are needed.
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Affiliation(s)
- Hanna Klingshirn
- Institute of Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Marchioninistr. 17, 81377, München, Germany
| | - Rene Mittrach
- Institute of Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Marchioninistr. 17, 81377, München, Germany
| | - Kathrin Braitmayer
- Institute of Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Marchioninistr. 17, 81377, München, Germany
| | - Ralf Strobl
- Institute of Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Marchioninistr. 17, 81377, München, Germany.,German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, München, Germany
| | - Andreas Bender
- Department of Neurology, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, München, Germany.,Therapiezentrum Burgau, Kapuzinerstraße 34, 89331, Burgau, Germany
| | - Eva Grill
- Institute of Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Marchioninistr. 17, 81377, München, Germany.,German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, München, Germany
| | - Martin Müller
- Institute of Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Marchioninistr. 17, 81377, München, Germany. .,Faculty of Applied Health and Social Sciences, Rosenheim University of Applied Sciences, Hochschulstr.1, 83024, Rosenheim, Germany.
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13
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Sattin D, Morganti L, De Torres L, Dolce G, Arcuri F, Estraneo A, Cardinale V, Piperno R, Zavatta E, Formisano R, D'Ippolito M, Vassallo C, Dessi B, Lamberti G, Antoniono E, Lanzillotti C, Navarro J, Bramanti P, Corallo F, Zampolini M, Scarponi F, Avesani R, Salvi L, Ferro S, Mazza L, Fogar P, Feller S, De Nigris F, Martinuzzi A, Buffoni M, Pessina A, Corsico P, Leonardi M. Care pathways models and clinical outcomes in Disorders of consciousness. Brain Behav 2017; 7:e00740. [PMID: 28828206 PMCID: PMC5561306 DOI: 10.1002/brb3.740] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 04/20/2017] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Patients with Disorders of consciousness, are persons with extremely low functioning levels and represent a challenge for health care systems due to their high needs of facilitating environmental factors. Despite a common Italian health care pathway for these patients, no studies have analyzed information on how each region have implemented it in its welfare system correlating data with patients' clinical outcomes. MATERIALS AND METHODS A multicenter observational pilot study was realized. Clinicians collected data on the care pathways of patients with Disorder of consciousness by asking 90 patients' caregivers to complete an ad hoc questionnaire through a structured phone interview. Questionnaire consisted of three sections: sociodemographic data, description of the care pathway done by the patient, and caregiver evaluation of health services and information received. RESULTS Seventy-three patients were analyzed. Length of hospital stay was different across the health care models and it was associated with improvement in clinical diagnosis. In long-term care units, the diagnosis at admission and the number of caregivers available for each patient (median value = 3) showed an indirect relationship with worsening probability in clinical outcome. Caregivers reported that communication with professionals (42%) and the answer to the need of information were the most critical points in the acute phase, whereas presence of Non-Governmental Organizations (25%) and availability of psychologists for caregivers (21%) were often missing during long-term care. The 65% of caregivers reported they did not know the UN Convention on the Rights of Persons with Disabilities. CONCLUSION This study highlights relevant differences in analyzed models, despite a recommended national pathway of care. Future public health considerations and actions are needed to guarantee equity and standardization of the care process in all European countries.
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Affiliation(s)
- Davide Sattin
- Neurology, Public Health, Disability Unit - Scientific Department Fondazione IRCCS Istituto Neurologico Carlo Besta Milan Italy
| | - Laura Morganti
- Neurology, Public Health, Disability Unit - Scientific Department Fondazione IRCCS Istituto Neurologico Carlo Besta Milan Italy
| | - Laura De Torres
- Neurology, Public Health, Disability Unit - Scientific Department Fondazione IRCCS Istituto Neurologico Carlo Besta Milan Italy
| | - Giuliano Dolce
- RAN (Research in Advanced Neurorehabilitation) - Istituto S. Anna Crotone Italy
| | - Francesco Arcuri
- RAN (Research in Advanced Neurorehabilitation) - Istituto S. Anna Crotone Italy
| | - Anna Estraneo
- Disorders of Consciousness Laboratory Salvatore Maugeri Foundation IRCCS Scientific Institute of Telese Terme Telese Terme Italy
| | - Viviana Cardinale
- Disorders of Consciousness Laboratory Salvatore Maugeri Foundation IRCCS Scientific Institute of Telese Terme Telese Terme Italy
| | - Roberto Piperno
- Neurorehabilitation Unit Emergency Department AUSL of Bologna Bologna Italy
| | - Elena Zavatta
- Centro Studi per la Ricerca sul Coma - "Gli Amici di Luca" ONLUSCasa dei Risvegli Luca De Nigris Bologna Italy
| | | | - Mariagrazia D'Ippolito
- Unità Post-ComaI RCCS Fondazione Santa Lucia Roma Italy.,Dipartimento di Psicologia Università "La Sapienza" Roma Italy
| | - Claudio Vassallo
- Centro di Riabilitazione Ambulatoriale Associazione Rinascita Vita ONLUS Genova Italy
| | - Barbara Dessi
- Centro di Riabilitazione Ambulatoriale Associazione Rinascita Vita ONLUS Genova Italy
| | - Gianfranco Lamberti
- S.C. Neuroriabilitazione ASL CN1 Ospedale "SS. Trinità" - Fossano Fossano Italy
| | - Elena Antoniono
- S.C. Neuroriabilitazione ASL CN1 Ospedale "SS. Trinità" - Fossano Fossano Italy
| | - Crocifissa Lanzillotti
- Fondazione San Raffaele - Presidio Ospedaliero di Ceglie Messapica Ceglie Messapica Italy
| | - Jorge Navarro
- Fondazione San Raffaele - Presidio Ospedaliero di Ceglie Messapica Ceglie Messapica Italy
| | | | | | - Mauro Zampolini
- Neurorehabilitation Unit "S.Giovanni Battista" Hospital Foligno Italy
| | - Federico Scarponi
- Neurorehabilitation Unit "S.Giovanni Battista" Hospital Foligno Italy
| | - Renato Avesani
- Dipartimento di Riabilitazione Ospedale Sacro Cuore Don Calabria Verona Italy
| | - Luca Salvi
- Dipartimento di Riabilitazione Ospedale Sacro Cuore Don Calabria Verona Italy
| | - Salvatore Ferro
- Emilia Romagna Region Direzione Generale Cura della Persona, Salute e Welfare Bologna Italy
| | - Luigi Mazza
- Emilia Romagna Region Servizio Integrazione Sociosanitaria e politiche per la Non Autosufficienza Bologna Italy
| | - Paolo Fogar
- Federazione Nazionale Associazioni Trauma cranico Carnago Italy
| | - Sandro Feller
- Federazione Nazionale Associazioni Trauma cranico Carnago Italy
| | | | | | - Mara Buffoni
- IRCCS Medea Conegliano Research Centre Conegliano Italy
| | - Adriano Pessina
- Bioethics University Centre Università Cattolica del Sacro Cuore Milan Italy
| | - Paolo Corsico
- Bioethics University Centre Università Cattolica del Sacro Cuore Milan Italy
| | - Matilde Leonardi
- Neurology, Public Health, Disability Unit - Scientific Department Fondazione IRCCS Istituto Neurologico Carlo Besta Milan Italy
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14
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Moretta P, Masotta O, Crispino E, Castronovo G, Ruvolo S, Montalbano C, Loreto V, Trojano L, Estraneo A. Psychological distress is associated with altered cognitive functioning in family caregivers of patients with disorders of consciousness. Brain Inj 2017; 31:1088-1093. [PMID: 28414249 DOI: 10.1080/02699052.2017.1290278] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To analyse the possible presence of reduced cognitive efficiency in family caregivers of patients with prolonged disorders of consciousness (DOC). SUBJECTS The participants were 27 caregivers of 25 patients with DOC admitted to the severe brain injury units of the ICS Maugeri, Institutes of Telese Terme and Sciacca, Italy. METHODS We examined cognitive functions such as short- and long-term memory, executive functions and attention by means of standardized tests. We also assessed features of psychological distress such as anxiety, depression, psychophysiological symptoms, prolonged grief disorder, psychological burden and quality of life. All scores on neuropsychological tests were compared with those of the 15 matched control subjects. RESULTS Enrolled family caregivers showed high frequency of clinically relevant depressive symptoms and anxiety; half of them met the criteria for prolonged grief disorder. Caregivers achieved scores lower than the matched controls on tests for selective attention, verbal fluency and long-term spatial memory. CONCLUSIONS Family caregivers' burden is associated with a reduced efficiency of selected executive measures and visuospatial learning. These results emphasize the need for appropriate psychological and cognitive supporting therapies for family caregivers of patients with DOC, also considering their delicate involvement in clinical decision-making and in providing care.
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Affiliation(s)
- P Moretta
- a Disorders of Consciousness Laboratory, ICS Maugeri, IRCCS , Scientific Institute of Telese Terme , Telese Terme , Italy
| | - O Masotta
- a Disorders of Consciousness Laboratory, ICS Maugeri, IRCCS , Scientific Institute of Telese Terme , Telese Terme , Italy
| | - E Crispino
- a Disorders of Consciousness Laboratory, ICS Maugeri, IRCCS , Scientific Institute of Telese Terme , Telese Terme , Italy
| | - G Castronovo
- b ICS Maugeri, Neurorehabilitation Unit , Presidio Sanitario di Sciacca , Sciacca , Italy
| | - S Ruvolo
- b ICS Maugeri, Neurorehabilitation Unit , Presidio Sanitario di Sciacca , Sciacca , Italy
| | - C Montalbano
- b ICS Maugeri, Neurorehabilitation Unit , Presidio Sanitario di Sciacca , Sciacca , Italy
| | - V Loreto
- a Disorders of Consciousness Laboratory, ICS Maugeri, IRCCS , Scientific Institute of Telese Terme , Telese Terme , Italy
| | - L Trojano
- a Disorders of Consciousness Laboratory, ICS Maugeri, IRCCS , Scientific Institute of Telese Terme , Telese Terme , Italy.,c Neuropsychology Laboratory, Department of Psychology , University of Campania 'Luigi Vanvitelli' , Caserta , Italy
| | - A Estraneo
- a Disorders of Consciousness Laboratory, ICS Maugeri, IRCCS , Scientific Institute of Telese Terme , Telese Terme , Italy
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15
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Soeterik SM, Connolly S, Playford ED, Duport S, Riazi A. The psychological impact of prolonged disorders of consciousness on caregivers: a systematic review of quantitative studies. Clin Rehabil 2017; 31:1374-1385. [PMID: 28933608 DOI: 10.1177/0269215517695372] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Systematic review of the nature, frequency and severity of psychological experiences of people who have a close relationship with a person with a prolonged disorder of consciousness. DATA SOURCES Cochrane Library, Web of Science, PsycINFO, PubMed, Embase®, MEDLINE®, Allied and Complementary Medicine™, were searched from inceptions until December 2016 with additional hand searching of reference lists of included articles. REVIEW METHODS Studies were included that used quantitative methodologies and psychological measures to investigate experiences. The PRISMA statement was followed with inclusion criteria set a priori. A data synthesis summarized psychological constructs studied. RESULTS A total of 18 studies (ranging between n = 16-487 participants) met the inclusion criteria with 15 of 18 studies focused on the primary caregiver. A total of 23 standardized psychological measures were identified to assess four primary psychological constructs: Loss and grief, psychological wellbeing changes, burden and use of coping strategies. CONCLUSIONS Small sample sizes, limited variables and reliance on observational methods affected quality. Caregivers do find ways to manage independently, but some exhibit clinically significant psychological distress that does not change over time alone and may get worse.
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Affiliation(s)
- Sonja M Soeterik
- 1 Department of Psychology, Royal Holloway University of London, Egham, UK.,2 Institute of Neuro-palliative Rehabilitation, Royal Hospital for Neuro-disability, London, UK
| | - Sarah Connolly
- 3 Ascot Rehab, Royal Hospital for Neuro-disability London, Surrey, UK
| | - E Diane Playford
- 2 Institute of Neuro-palliative Rehabilitation, Royal Hospital for Neuro-disability, London, UK.,4 Warwick Medical School, University of Warwick, Coventry, UK
| | - Sophie Duport
- 2 Institute of Neuro-palliative Rehabilitation, Royal Hospital for Neuro-disability, London, UK
| | - Afsane Riazi
- 1 Department of Psychology, Royal Holloway University of London, Egham, UK
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16
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Persons JE, Robinson JG, Payne ME, Fiedorowicz JG. Serum lipid changes following the onset of depressive symptoms in postmenopausal women. Psychiatry Res 2017; 247:282-287. [PMID: 27940323 PMCID: PMC6004601 DOI: 10.1016/j.psychres.2016.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 12/01/2016] [Indexed: 01/23/2023]
Abstract
A cross-sectional association between depression and serum low-density lipoprotein cholesterol (LDL-c) has been noted in psychiatric literature, raising the question of temporality: does low LDL-c predict depression, does depression lead to changes in LDL-c levels, or is this relationship bidirectional? In a previous longitudinal analysis of postmenopausal women ages 50-79 who participated in the Women's Health Initiative (WHI), we detected an association between low LDL-c and the subsequent onset of depressive symptoms (HR=1.25, 95% CI 1.05-1.49, p=0.01). This current study uses the WHI cohort to explore the question of temporality in the opposite direction, examining the influence of depressive symptoms on subsequent changes in LDL-c levels. This study provides no evidence to suggest an association between depression and subsequent changes in LDL-c level (-2.78mg/dL, 95% CI=-7.49 to 1.92, p=0.25), nor was any association detected for total cholesterol, HDL, or triglyceride changes over time. Further, this study demonstrates that the relationship between depression and serum LDL changes is not mediated by changes in weight, exercise, or energy intake.
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Affiliation(s)
- Jane E. Persons
- Department of Epidemiology, College of Public Health, The University of Iowa, Iowa City, IA, USA
| | - Jennifer G. Robinson
- Department of Epidemiology, College of Public Health, The University of Iowa, Iowa City, IA, USA,Department of Internal Medicine, Roy J. and Lucille A. Carver College of Medicine, The University of Iowa, Iowa City, IA, USA
| | - Martha E. Payne
- Office of Research Development, Duke University Medical Center, Durham, NC, USA
| | - Jess G. Fiedorowicz
- Department of Epidemiology, College of Public Health, The University of Iowa, Iowa City, IA, USA,Department of Internal Medicine, Roy J. and Lucille A. Carver College of Medicine, The University of Iowa, Iowa City, IA, USA,Department of Psychiatry, Roy J. and Lucille A. Carver College of Medicine, The University of Iowa, Iowa City, IA, USA,François M. Abboud Cardiovascular Research Center, Roy J. and Lucille A. Carver College of Medicine, The University of Iowa, Iowa City, IA, USA
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17
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Zucchella C, Di Santis M, Ciccone B, Pelella M, Scappaticci M, Badalassi G, Lavezzi S, Bartolo M. Is telemonitoring useful for supporting persons with consciousness disorders and caregivers? A preliminary observational study in a real-life population. J Telemed Telecare 2016; 24:56-62. [DOI: 10.1177/1357633x16673273] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Preliminary evidences showed that telemedicine may allow a reduction of costs and an enhancement of patients’ satisfaction and quality of life (QoL), with the same effectiveness of conventional methods of healthcare delivery. Literature is quite absent in relation to the use of telemedicine for patients with disorders of consciousness (DoC) whose management is delegated almost entirely to the family. In order to promote an alternative setting to manage persons affected by DoC, also supporting their families, a pilot project was designed to test the feasibility of home-care assistance based on a system of telemonitoring. Methods In total, 11 patients were supported by a telemonitoring system via a workstation installed at the patients’ homes. All patients underwent a clinical and functional evaluation at enrolment, after two months, after six months and at the end of the project, after 12 months by means of clinical scales (Glasgow Coma Scale, Rancho Los Amigos Levels of Cognitive Functioning Scale, Glasgow Outcome Scale, Disability Rating Scale), while the World Health Organization (WHO) QoL, the Hamilton Depression Rating Scale, the Hamilton Anxiety Rating Scale and a satisfaction score were completed by caregivers. Results Patients’ scores at the clinical scales did not show statistically significant differences from T0 to T3. A trend toward the improvement of caregivers’ QoL, anxiety and depression, as well as a high degree of satisfaction with regard to the intervention, were reported. The economic evaluation showed an average cost/day for a patient of about €70. Discussion Preliminary data suggest that the use of telemonitoring services in the management of persons affected by DoC is feasible and well accepted by caregivers, with a potential positive effect on their mood and QoL. Therefore, telemonitoring should be considered in the management of DoC patients to favour discharge from acute care and to support families in home care.
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Affiliation(s)
- Chiara Zucchella
- Department of Rehabilitation, Neurorehabilitation Unit, HABILITA Care & Research Rehabilitation Hospitals, Zingonia di Ciserano, Bergamo, Italy
- Gli Amici di Eleonora ONLUS, Napoli, Italy
| | | | | | | | | | | | | | - Michelangelo Bartolo
- Department of Rehabilitation, Neurorehabilitation Unit, HABILITA Care & Research Rehabilitation Hospitals, Zingonia di Ciserano, Bergamo, Italy
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18
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Giovannetti AM, Covelli V, Sattin D, Leonardi M. Caregivers of patients with disorder of consciousness: burden, quality of life and social support. Acta Neurol Scand 2015; 132:259-69. [PMID: 25808669 DOI: 10.1111/ane.12392] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate quality of life (QoL) and its predictors, psychological burden and level of perceived social support in caregivers of patients with disorder of consciousness. MATERIALS & METHODS World Health Organization Quality of Life-Bref (WHOQOL-BREF), State Trait Anxiety Inventory-Y (STAI-Y), Beck Depression Inventory (BDI-II), Prolonged Grief Disorder Questionnaire, Coping Orientations to Problem Experiences, State-Trait Anger Expression Inventory-2 (STAXI-2), and the Medical Outcome Study Social Support Survey (MOS-SSS) were administered. One-sample t-tests were performed to compare WHOQOL-BREF, STAI-Y and STAXI-2 mean scores to the respective normative sample (NS). Pearson correlation was calculated between time dedicated to patient's care, WHOQOL-BREF, BDI-II, STAI-Y and MOS-SSS scores. Hierarchical multiple regression analyses were performed to evaluate which variables have predictive power on QoL. RESULTS A total of 129 caregivers, 68.2% female, mean age 52.8 years, were enrolled. Three WHOQOL-BREF domains were significantly lower. Anxiety and anger were in line with NS. 28.7% of the sample reported high level of depressive symptoms; 20.9% satisfied the prolonged grief disorder criteria. No differences emerged between caregivers and chronic ill patients' scores at MOS-SSS. STAI-Y, BDI-II and WHOQOL-BREF scores positively correlated. MOS-SSS domains inversely correlate with BDI-II scores. BDI-II results the most relevant predictor of QoL. CONCLUSIONS Study results provided innovative information about caregivers' poor QoL, difficulties in social support and high levels of burden. Time dedicated to care is not strictly related to burden, while social support perceived is highly associated with caregivers' depressive symptoms that are strong predictor of poor QoL. Supportive intervention able to integrate psychological, social and environmental levels is needed.
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Affiliation(s)
- A. M. Giovannetti
- Neurology, Public Health and Disability Unit and Coma Research Centre; Scientific Directorate; Neurological Institute Carlo Besta IRCCS Foundation; Milan Italy
| | - V. Covelli
- Università degli Studi eCampus; Via Isimbardi; 10 - 22060 Novedrate (CO) Italy
| | - D. Sattin
- Neurology, Public Health and Disability Unit and Coma Research Centre; Scientific Directorate; Neurological Institute Carlo Besta IRCCS Foundation; Milan Italy
| | - M. Leonardi
- Neurology, Public Health and Disability Unit and Coma Research Centre; Scientific Directorate; Neurological Institute Carlo Besta IRCCS Foundation; Milan Italy
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19
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Goudarzi F, Abedi H, Zarea K, Ahmadi F. Multiple Victims: The Result of Caring Patients in Vegetative State. IRANIAN RED CRESCENT MEDICAL JOURNAL 2015; 17:e23571. [PMID: 26328066 PMCID: PMC4553169 DOI: 10.5812/ircmj.23571] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 09/29/2014] [Accepted: 10/22/2014] [Indexed: 11/16/2022]
Abstract
Background: Having a patient in a vegetative state in the family is a complicated and stressful experience. Caring for such patients with complete disability at home is very challenging. Objectives: The present study aimed to explore the outcomes of caring for patients in a vegetative state for families and caregivers at home. Patients and Methods: In this qualitative study, 16 vegetative patients’ caregivers were selected through purposive sampling. Unstructured interviews and observations were used for data gathering. Data collection was continued until saturation of data and emergence of the main themes. Data analysis was performed by the content analysis method. Results: The analysis of the gathered data led to three themes: “lost main caregiver”, “affected caring partner” and “affected family”. Each theme had some subthemes and subcategories. Conclusions: The three emerged themes in this study showed that all the family members of vegetative patients, depending on their responsibilities, were affected by physical, mental, social and economic issues.
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Affiliation(s)
- Fateme Goudarzi
- Department of Nursing, Nursing and Midwifery School, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
| | - Heidarali Abedi
- Faculty of Nursing and Midwifery, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, IR Iran
- Corresponding Author: Heidarali Abedi, Faculty of Nursing and Midwifery, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, IR Iran. Tel: +98-3135354058, Fax: +98-3135354065, E-mail:
| | - Kourosh Zarea
- Department of Nursing, Nursing and Midwifery School, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
| | - Fazlollah Ahmadi
- Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, IR Iran
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20
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Covelli V, Cerniauskaite M, Leonardi M, Sattin D, Raggi A, Giovannetti AM. A qualitative study on perceptions of changes reported by caregivers of patients in vegetative state and minimally conscious state: the "time gap experience". ScientificWorldJournal 2014; 2014:657321. [PMID: 25431794 PMCID: PMC4241276 DOI: 10.1155/2014/657321] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 09/15/2014] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Our purpose was to provide a comprehensive understanding of how women informal caregivers of patients in vegetative state (VS) or minimally conscious state (MCS) describe, represent, and experience changes that occurred in their life after the acute event of their family member. METHODS A qualitative study was conducted and fifteen women informal caregivers, mothers, or spouses of patients in VS or MCS were interviewed. RESULTS Caregivers' narratives revealed (1) important personal and interpersonal changes and (2) difficulties while facing the complex situation and integrating past, present, and future, defined as a "time gap experience." This difficulty is expressed in two ways. First, the reduction of variety of roles into one, caregiver's role. Second, the relationship with the relative is characterised by fluctuation in the relational style between caregiver and relative; it shifts from an adult to adult interaction to an adult to child one. Another fluctuation can be observed in the mixed use of present and past tenses when caregivers speak about their relatives. CONCLUSIONS Caregiving cause pervasive modifications in one's life. Targeted interventions aiming to empower the caregivers, to support them after the acute event in caregiving activities together with patient-focused interventions, and to promote their health should be implemented.
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Affiliation(s)
- Venusia Covelli
- Neurological Institute Carlo Besta IRCCS Foundation, Neurology, Public Health and Disability Unit, Via Celoria 11, 20133 Milan, Italy
| | - Milda Cerniauskaite
- Neurological Institute Carlo Besta IRCCS Foundation, Neurology, Public Health and Disability Unit, Via Celoria 11, 20133 Milan, Italy
| | - Matilde Leonardi
- Neurological Institute Carlo Besta IRCCS Foundation, Neurology, Public Health and Disability Unit, Via Celoria 11, 20133 Milan, Italy
| | - Davide Sattin
- Neurological Institute Carlo Besta IRCCS Foundation, Neurology, Public Health and Disability Unit, Via Celoria 11, 20133 Milan, Italy
| | - Alberto Raggi
- Neurological Institute Carlo Besta IRCCS Foundation, Neurology, Public Health and Disability Unit, Via Celoria 11, 20133 Milan, Italy
| | - Ambra Mara Giovannetti
- Neurological Institute Carlo Besta IRCCS Foundation, Neurology, Public Health and Disability Unit, Via Celoria 11, 20133 Milan, Italy
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