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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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Garcia Rodrigues M, Rodrigues JD, Pereira AT, Azevedo LF, Pereira Rodrigues P, Areias JC, Areias ME. Impact in the quality of life of parents of children with chronic diseases using psychoeducational interventions - A systematic review with meta-analysis. PATIENT EDUCATION AND COUNSELING 2022; 105:869-880. [PMID: 34389225 DOI: 10.1016/j.pec.2021.07.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 06/20/2021] [Accepted: 07/27/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE This study aimed to identify psychoeducational interventions applied to parents of children with chronic diseases and evaluate their impact on their quality of life (QoL). METHODS It was conducted in six databases, complemented by references from the included studies and other reviews, manual search, and contact with experts. We included primary studies on parents of children with chronic diseases that studied psychoeducational interventions versus standard care. RESULTS We screened 6604 titles and abstracts, reviewed the full text of 60 records, and included 37 primary studies. Half of the studies were on Asthma. We found three intervention formats: one-to-one (43%), groups (49%), and combined approach with individual and group settings (8%). More than 60% of the included studies found statistically significant differences between the intervention and the control group (p < 0.05). CONCLUSION Several interventions have shown efficacy in improving parental QoL. Despite that, there is insufficient evidence of interventions' implementation. PRACTICE IMPLICATIONS A holistic approach encompassing the patient and the family's biopsychosocial dimensions is fundamental in successfully managing chronic disease in children. It is vital to design and implement interventions accommodating the common issues experienced by children, parents, and families that deal with chronic childhood conditions. Systematic review registration number PROSPERO 2018 CRD42018092135.
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Affiliation(s)
- Marisa Garcia Rodrigues
- Department of Pediatric Cardiology, Centro Hospitalar Universitário São João (CHUSJ), Porto, Portugal; Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal.
| | - José Daniel Rodrigues
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal.
| | - Ana Teresa Pereira
- Centro Hospitalar Vila Nova de Gaia/Espinho (CHVNG/E), Vila Nova de Gaia, Portugal.
| | - Luís Filipe Azevedo
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal; Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine of the University of Porto, Porto, Portugal.
| | - Pedro Pereira Rodrigues
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal; Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine of the University of Porto, Porto, Portugal.
| | - José Carlos Areias
- Cardiovascular R&D Unit (UnIC), Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal.
| | - Maria Emília Areias
- Cardiovascular R&D Unit (UnIC), Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal; Instituto Universitário de Ciências da Saúde (IUCS), Portugal.
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Law E, Fisher E, Eccleston C, Palermo TM. Psychological interventions for parents of children and adolescents with chronic illness. Cochrane Database Syst Rev 2019; 3:CD009660. [PMID: 30883665 PMCID: PMC6450193 DOI: 10.1002/14651858.cd009660.pub4] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Psychological therapies for parents of children and adolescents with chronic illness aim to improve parenting behavior and mental health, child functioning (behavior/disability, mental health, and medical symptoms), and family functioning.This is an updated version of the original Cochrane Review (2012) which was first updated in 2015. OBJECTIVES To evaluate the efficacy and adverse events of psychological therapies for parents of children and adolescents with a chronic illness. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, PsycINFO, and trials registries for studies published up to July 2018. SELECTION CRITERIA Included studies were randomized controlled trials (RCTs) of psychological interventions for parents of children and adolescents with a chronic illness. In this update we included studies with more than 20 participants per arm. In this update, we included interventions that combined psychological and pharmacological treatments. We included comparison groups that received either non-psychological treatment (e.g. psychoeducation), treatment as usual (e.g. standard medical care without added psychological therapy), or wait-list. DATA COLLECTION AND ANALYSIS We extracted study characteristics and outcomes post-treatment and at first available follow-up. Primary outcomes were parenting behavior and parent mental health. Secondary outcomes were child behavior/disability, child mental health, child medical symptoms, and family functioning. We pooled data using the standardized mean difference (SMD) and a random-effects model, and evaluated outcomes by medical condition and by therapy type. We assessed risk of bias per Cochrane guidance and quality of evidence using GRADE. MAIN RESULTS We added 21 new studies. We removed 23 studies from the previous update that no longer met our inclusion criteria. There are now 44 RCTs, including 4697 participants post-treatment. Studies included children with asthma (4), cancer (7), chronic pain (13), diabetes (15), inflammatory bowel disease (2), skin diseases (1), and traumatic brain injury (3). Therapy types included cognitive-behavioural therapy (CBT; 21), family therapy (4), motivational interviewing (3), multisystemic therapy (4), and problem-solving therapy (PST; 12). We rated risk of bias as low or unclear for most domains, except selective reporting bias, which we rated high for 19 studies due to incomplete outcome reporting. Evidence quality ranged from very low to moderate. We downgraded evidence due to high heterogeneity, imprecision, and publication bias.Evaluation of parent outcomes by medical conditionPsychological therapies may improve parenting behavior (e.g. maladaptive or solicitous behaviors; lower scores are better) in children with cancer post-treatment and follow-up (SMD -0.28, 95% confidence interval (CI) -0.43 to -0.13; participants = 664; studies = 3; SMD -0.21, 95% CI -0.37 to -0.05; participants = 625; studies = 3; I2 = 0%, respectively, low-quality evidence), chronic pain post-treatment and follow-up (SMD -0.29, 95% CI -0.47 to -0.10; participants = 755; studies = 6; SMD -0.35, 95% CI -0.50 to -0.20; participants = 678; studies = 5, respectively, moderate-quality evidence), diabetes post-treatment (SMD -1.39, 95% CI -2.41 to -0.38; participants = 338; studies = 5, very low-quality evidence), and traumatic brain injury post-treatment (SMD -0.74, 95% CI -1.25 to -0.22; participants = 254; studies = 3, very low-quality evidence). For the remaining analyses data were insufficient to evaluate the effect of treatment.Psychological therapies may improve parent mental health (e.g. depression, anxiety, lower scores are better) in children with cancer post-treatment and follow-up (SMD -0.21, 95% CI -0.35 to -0.08; participants = 836, studies = 6, high-quality evidence; SMD -0.23, 95% CI -0.39 to -0.08; participants = 667; studies = 4, moderate-quality evidence, respectively), and chronic pain post-treatment and follow-up (SMD -0.24, 95% CI -0.42 to -0.06; participants = 490; studies = 3; SMD -0.20, 95% CI -0.38 to -0.02; participants = 482; studies = 3, respectively, low-quality evidence). Parent mental health did not improve in studies of children with diabetes post-treatment (SMD -0.24, 95% CI -0.90 to 0.42; participants = 211; studies = 3, very low-quality evidence). For the remaining analyses, data were insufficient to evaluate the effect of treatment on parent mental health.Evaluation of parent outcomes by psychological therapy typeCBT may improve parenting behavior post-treatment (SMD -0.45, 95% CI -0.68 to -0.21; participants = 1040; studies = 9, low-quality evidence), and follow-up (SMD -0.26, 95% CI -0.42 to -0.11; participants = 743; studies = 6, moderate-quality evidence). We did not find evidence for a beneficial effect for CBT on parent mental health at post-treatment or follow-up (SMD -0.19, 95% CI -0.41 to 0.03; participants = 811; studies = 8; SMD -0.07, 95% CI -0.34 to 0.20; participants = 592; studies = 5; respectively, very low-quality evidence). PST may improve parenting behavior post-treatment and follow-up (SMD -0.39, 95% CI -0.64 to -0.13; participants = 947; studies = 7, low-quality evidence; SMD -0.54, 95% CI -0.94 to -0.14; participants = 852; studies = 6, very low-quality evidence, respectively), and parent mental health post-treatment and follow-up (SMD -0.30, 95% CI -0.45 to -0.15; participants = 891; studies = 6; SMD -0.21, 95% CI -0.35 to -0.07; participants = 800; studies = 5, respectively, moderate-quality evidence). For the remaining analyses, data were insufficient to evaluate the effect of treatment on parent outcomes.Adverse eventsWe could not evaluate treatment safety because most studies (32) did not report on whether adverse events occurred during the study period. In six studies, the authors reported that no adverse events occurred. The remaining six studies reported adverse events and none were attributed to psychological therapy. We rated the quality of evidence for adverse events as moderate. AUTHORS' CONCLUSIONS Psychological therapy may improve parenting behavior among parents of children with cancer, chronic pain, diabetes, and traumatic brain injury. We also found beneficial effects of psychological therapy may also improve parent mental health among parents of children with cancer and chronic pain. CBT and PST may improve parenting behavior. PST may also improve parent mental health. However, the quality of evidence is generally low and there are insufficient data to evaluate most outcomes. Our findings could change as new studies are conducted.
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Affiliation(s)
- Emily Law
- Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA
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Lindau ST, Makelarski JA, Abramsohn EM, Beiser DG, Boyd K, Chou C, Giurcanu M, Huang ES, Liao C, Schumm LP, Tung EL. CommunityRx: A Real-World Controlled Clinical Trial of a Scalable, Low-Intensity Community Resource Referral Intervention. Am J Public Health 2019; 109:600-606. [PMID: 30789775 DOI: 10.2105/ajph.2018.304905] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVES To test the effect of CommunityRx, a scalable, low-intensity intervention that matches patients to community resources, on mental health-related quality of life (HRQOL) (primary outcome), physical HRQOL, and confidence in finding resources. METHODS A real-world trial assigned publicly insured residents of Chicago, Illinois, aged 45 to 74 years to an intervention (n = 209) or control (n = 202) group by alternating calendar week, December 2015 to August 2016. Intervention group participants received usual care and an electronic medical record-generated, personalized list of community resources. Surveys (baseline, 1-week, 1- and 3-months) measured HRQOL and confidence in finding community resources to manage health. RESULTS At 3 months, there was no difference between groups in mental (-1.03; 95% confidence interval [CI] = -3.02, 0.96) or physical HRQOL (0.59; 95% CI = -0.98, 2.16). Confidence in finding resources was higher in the intervention group (odds ratio = 2.08; 95% CI = 1.18, 3.63); the effect increased at each successive time point. Among intervention group participants, 65% recalled receiving the intervention; 48% shared community resource information with others. CONCLUSIONS CommunityRx did not increase HRQOL, but its positive effect on confidence in finding resources for self-care suggests that this low-intensity intervention may have a role in population health promotion. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02435511.
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Affiliation(s)
- Stacy Tessler Lindau
- Stacy Tessler Lindau is with the Departments of Obstetrics and Gynecology and Medicine-Geriatrics and Palliative Medicine, The University of Chicago, Chicago, IL. Jennifer A. Makelarski, Emily M. Abramsohn, and Kelly Boyd are with the Department of Obstetrics and Gynecology, The University of Chicago. David G. Beiser is with the Department of Medicine, Section of Emergency Medicine, The University of Chicago. Chiahung Chou is with the Department of Health Outcomes Research and Policy, Auburn University, Auburn, AL. Mihai Giurcanu, Chuanhong Liao, and L. Philip Schumm are with the Department of Public Health Sciences, The University of Chicago. Elbert S. Huang and Elizabeth L. Tung are with the Department of Medicine, Section of General Internal Medicine, The University of Chicago
| | - Jennifer A Makelarski
- Stacy Tessler Lindau is with the Departments of Obstetrics and Gynecology and Medicine-Geriatrics and Palliative Medicine, The University of Chicago, Chicago, IL. Jennifer A. Makelarski, Emily M. Abramsohn, and Kelly Boyd are with the Department of Obstetrics and Gynecology, The University of Chicago. David G. Beiser is with the Department of Medicine, Section of Emergency Medicine, The University of Chicago. Chiahung Chou is with the Department of Health Outcomes Research and Policy, Auburn University, Auburn, AL. Mihai Giurcanu, Chuanhong Liao, and L. Philip Schumm are with the Department of Public Health Sciences, The University of Chicago. Elbert S. Huang and Elizabeth L. Tung are with the Department of Medicine, Section of General Internal Medicine, The University of Chicago
| | - Emily M Abramsohn
- Stacy Tessler Lindau is with the Departments of Obstetrics and Gynecology and Medicine-Geriatrics and Palliative Medicine, The University of Chicago, Chicago, IL. Jennifer A. Makelarski, Emily M. Abramsohn, and Kelly Boyd are with the Department of Obstetrics and Gynecology, The University of Chicago. David G. Beiser is with the Department of Medicine, Section of Emergency Medicine, The University of Chicago. Chiahung Chou is with the Department of Health Outcomes Research and Policy, Auburn University, Auburn, AL. Mihai Giurcanu, Chuanhong Liao, and L. Philip Schumm are with the Department of Public Health Sciences, The University of Chicago. Elbert S. Huang and Elizabeth L. Tung are with the Department of Medicine, Section of General Internal Medicine, The University of Chicago
| | - David G Beiser
- Stacy Tessler Lindau is with the Departments of Obstetrics and Gynecology and Medicine-Geriatrics and Palliative Medicine, The University of Chicago, Chicago, IL. Jennifer A. Makelarski, Emily M. Abramsohn, and Kelly Boyd are with the Department of Obstetrics and Gynecology, The University of Chicago. David G. Beiser is with the Department of Medicine, Section of Emergency Medicine, The University of Chicago. Chiahung Chou is with the Department of Health Outcomes Research and Policy, Auburn University, Auburn, AL. Mihai Giurcanu, Chuanhong Liao, and L. Philip Schumm are with the Department of Public Health Sciences, The University of Chicago. Elbert S. Huang and Elizabeth L. Tung are with the Department of Medicine, Section of General Internal Medicine, The University of Chicago
| | - Kelly Boyd
- Stacy Tessler Lindau is with the Departments of Obstetrics and Gynecology and Medicine-Geriatrics and Palliative Medicine, The University of Chicago, Chicago, IL. Jennifer A. Makelarski, Emily M. Abramsohn, and Kelly Boyd are with the Department of Obstetrics and Gynecology, The University of Chicago. David G. Beiser is with the Department of Medicine, Section of Emergency Medicine, The University of Chicago. Chiahung Chou is with the Department of Health Outcomes Research and Policy, Auburn University, Auburn, AL. Mihai Giurcanu, Chuanhong Liao, and L. Philip Schumm are with the Department of Public Health Sciences, The University of Chicago. Elbert S. Huang and Elizabeth L. Tung are with the Department of Medicine, Section of General Internal Medicine, The University of Chicago
| | - Chiahung Chou
- Stacy Tessler Lindau is with the Departments of Obstetrics and Gynecology and Medicine-Geriatrics and Palliative Medicine, The University of Chicago, Chicago, IL. Jennifer A. Makelarski, Emily M. Abramsohn, and Kelly Boyd are with the Department of Obstetrics and Gynecology, The University of Chicago. David G. Beiser is with the Department of Medicine, Section of Emergency Medicine, The University of Chicago. Chiahung Chou is with the Department of Health Outcomes Research and Policy, Auburn University, Auburn, AL. Mihai Giurcanu, Chuanhong Liao, and L. Philip Schumm are with the Department of Public Health Sciences, The University of Chicago. Elbert S. Huang and Elizabeth L. Tung are with the Department of Medicine, Section of General Internal Medicine, The University of Chicago
| | - Mihai Giurcanu
- Stacy Tessler Lindau is with the Departments of Obstetrics and Gynecology and Medicine-Geriatrics and Palliative Medicine, The University of Chicago, Chicago, IL. Jennifer A. Makelarski, Emily M. Abramsohn, and Kelly Boyd are with the Department of Obstetrics and Gynecology, The University of Chicago. David G. Beiser is with the Department of Medicine, Section of Emergency Medicine, The University of Chicago. Chiahung Chou is with the Department of Health Outcomes Research and Policy, Auburn University, Auburn, AL. Mihai Giurcanu, Chuanhong Liao, and L. Philip Schumm are with the Department of Public Health Sciences, The University of Chicago. Elbert S. Huang and Elizabeth L. Tung are with the Department of Medicine, Section of General Internal Medicine, The University of Chicago
| | - Elbert S Huang
- Stacy Tessler Lindau is with the Departments of Obstetrics and Gynecology and Medicine-Geriatrics and Palliative Medicine, The University of Chicago, Chicago, IL. Jennifer A. Makelarski, Emily M. Abramsohn, and Kelly Boyd are with the Department of Obstetrics and Gynecology, The University of Chicago. David G. Beiser is with the Department of Medicine, Section of Emergency Medicine, The University of Chicago. Chiahung Chou is with the Department of Health Outcomes Research and Policy, Auburn University, Auburn, AL. Mihai Giurcanu, Chuanhong Liao, and L. Philip Schumm are with the Department of Public Health Sciences, The University of Chicago. Elbert S. Huang and Elizabeth L. Tung are with the Department of Medicine, Section of General Internal Medicine, The University of Chicago
| | - Chuanhong Liao
- Stacy Tessler Lindau is with the Departments of Obstetrics and Gynecology and Medicine-Geriatrics and Palliative Medicine, The University of Chicago, Chicago, IL. Jennifer A. Makelarski, Emily M. Abramsohn, and Kelly Boyd are with the Department of Obstetrics and Gynecology, The University of Chicago. David G. Beiser is with the Department of Medicine, Section of Emergency Medicine, The University of Chicago. Chiahung Chou is with the Department of Health Outcomes Research and Policy, Auburn University, Auburn, AL. Mihai Giurcanu, Chuanhong Liao, and L. Philip Schumm are with the Department of Public Health Sciences, The University of Chicago. Elbert S. Huang and Elizabeth L. Tung are with the Department of Medicine, Section of General Internal Medicine, The University of Chicago
| | - L Philip Schumm
- Stacy Tessler Lindau is with the Departments of Obstetrics and Gynecology and Medicine-Geriatrics and Palliative Medicine, The University of Chicago, Chicago, IL. Jennifer A. Makelarski, Emily M. Abramsohn, and Kelly Boyd are with the Department of Obstetrics and Gynecology, The University of Chicago. David G. Beiser is with the Department of Medicine, Section of Emergency Medicine, The University of Chicago. Chiahung Chou is with the Department of Health Outcomes Research and Policy, Auburn University, Auburn, AL. Mihai Giurcanu, Chuanhong Liao, and L. Philip Schumm are with the Department of Public Health Sciences, The University of Chicago. Elbert S. Huang and Elizabeth L. Tung are with the Department of Medicine, Section of General Internal Medicine, The University of Chicago
| | - Elizabeth L Tung
- Stacy Tessler Lindau is with the Departments of Obstetrics and Gynecology and Medicine-Geriatrics and Palliative Medicine, The University of Chicago, Chicago, IL. Jennifer A. Makelarski, Emily M. Abramsohn, and Kelly Boyd are with the Department of Obstetrics and Gynecology, The University of Chicago. David G. Beiser is with the Department of Medicine, Section of Emergency Medicine, The University of Chicago. Chiahung Chou is with the Department of Health Outcomes Research and Policy, Auburn University, Auburn, AL. Mihai Giurcanu, Chuanhong Liao, and L. Philip Schumm are with the Department of Public Health Sciences, The University of Chicago. Elbert S. Huang and Elizabeth L. Tung are with the Department of Medicine, Section of General Internal Medicine, The University of Chicago
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