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McAndrew NS, Gray TF, Wallace L, Calkins K, Guttormson J, Harding ES, Applebaum AJ. Existential distress in family caregivers: scoping review of meaning-making interventions. BMJ Support Palliat Care 2024; 13:e676-e685. [PMID: 37604657 PMCID: PMC11040498 DOI: 10.1136/spcare-2023-004448] [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: 06/18/2023] [Accepted: 08/03/2023] [Indexed: 08/23/2023]
Abstract
OBJECTIVES Family and friend caregivers often feel overwhelmed by and ill-prepared for their responsibilities. Many feel helpless living with uncertainty about the outcome of the patient's illness, which leads to existential distress. Supportive care interventions that address existential distress by promoting meaning and purpose buffer the negative effects of caregiver burden and promote resilience and growth. The purpose of this scoping review is to describe the depth and breadth of available interventions targeting caregiver existential distress. METHODS We followed the Joanna Briggs Institute's scoping review methods and applied the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension checklist. SCOPUS, Ovid MEDLINE and PsycINFO databases were searched for interventions that targeted existential distress by promoting meaning-making, spiritual well-being, post-traumatic growth and/or benefit finding for caregivers of seriously ill adult patients. RESULTS We screened 1377 titles/abstracts and 42 full-text articles. Thirty-one articles (28 unique studies) met inclusion criteria. Most interventions were designed for caregivers supporting patients with cancer (n=14) or patients receiving palliative care (n=9). Promising interventions included Meaning-Centered Psychotherapy for Cancer Caregivers, Meaning-Based Intervention for Patients and their Partners, Legacy Intervention for Family Enactment, Family Participatory Dignity Therapy and Existential Behavioural Therapy. More than half of the studies (n=20, 64%) were in the feasibility/acceptability/pilot stage of intervention testing. CONCLUSION Large randomised controlled trials with more diverse samples of caregivers are needed. Future research should explore the impact of delivering meaning-making interventions to caregivers throughout the illness trajectory. Developing strategies for scaling up and conducting cost analyses will narrow the research and practice gap for meaning-making interventions.
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Affiliation(s)
- Natalie S McAndrew
- School of Nursing, College of Health Professions & Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
- Department of Patient Care Research, Froedtert & the Medical College of Wisconsin, Froedtert Hospital, Milwaukee, Wisconsin, USA
| | - Tamryn F Gray
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Lyndsey Wallace
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Kelly Calkins
- College of Nursing, Marquette University, Milwaukee, Wisconsin, USA
| | - Jill Guttormson
- College of Nursing, Marquette University, Milwaukee, Wisconsin, USA
| | - Eric S Harding
- Medical College of Wisconsin Libraries, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Allison J Applebaum
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Psychiatry, Weill Cornell Medicine, New York, New York, USA
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2
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Knight JM, Taylor MR, Rentscher KE, Henley EC, Uttley HA, Nelson AM, Turcotte LM, McAndrew NS, Amonoo HL, Mohanraj L, Kelly DL, Costanzo ES. Biobehavioral Implications of Covid-19 for Transplantation and Cellular Therapy Recipients. Front Immunol 2022; 13:877558. [PMID: 35865530 PMCID: PMC9295749 DOI: 10.3389/fimmu.2022.877558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 06/01/2022] [Indexed: 01/13/2023] Open
Abstract
A growing body of literature has emphasized the importance of biobehavioral processes - defined as the interaction of behavior, psychology, socioenvironmental factors, and biological processes - for clinical outcomes among transplantation and cellular therapy (TCT) patients. TCT recipients are especially vulnerable to distress associated with pandemic conditions and represent a notably immunocompromised group at greater risk for SARS-CoV-2 infection with substantially worse outcomes. The summation of both the immunologic and psychologic vulnerability of TCT patients renders them particularly susceptible to adverse biobehavioral sequelae associated with the Covid-19 pandemic. Stress and adverse psychosocial factors alter neural and endocrine pathways through sympathetic nervous system and hypothalamic-pituitary-adrenal axis signaling that ultimately affect gene regulation in immune cells. Reciprocally, global inflammation and immune dysregulation related to TCT contribute to dysregulation of neuroendocrine and central nervous system function, resulting in the symptom profile of depression, fatigue, sleep disturbance, and cognitive dysfunction. In this article, we draw upon literature on immunology, psychology, neuroscience, hematology and oncology, Covid-19 pathophysiology, and TCT processes to discuss how they may intersect to influence TCT outcomes, with the goal of providing an overview of the significance of biobehavioral factors in understanding the relationship between Covid-19 and TCT, now and for the future. We discuss the roles of depression, anxiety, fatigue, sleep, social isolation and loneliness, and neurocognitive impairment, as well as specific implications for sub-populations of interest, including pediatrics, caregivers, and TCT donors. Finally, we address protective psychological processes that may optimize biobehavioral outcomes affected by Covid-19.
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Affiliation(s)
- Jennifer M. Knight
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, United States,Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, United States,Department of Microbiology & Immunology, Medical College of Wisconsin, Milwaukee, WI, United States,*Correspondence: Jennifer M. Knight,
| | - Mallory R. Taylor
- Department of Pediatrics, Division of Hematology/Oncology, University of Washington School of Medicine, Seattle, WA, United States,Palliative Care and Resilience Program, Center for Clinical and Translational Research, Seattle Children’s Research Institute, Seattle, WA, United States
| | - Kelly E. Rentscher
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Elisabeth C. Henley
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Hannah A. Uttley
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Ashley M. Nelson
- Department of Psychiatry, Harvard Medical School/Massachusetts General Hospital, Boston, MA, United States
| | - Lucie M. Turcotte
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, United States
| | - Natalie S. McAndrew
- College of Nursing, University of Wisconsin – Milwaukee, Milwaukee, WI, United States,Froedtert Hospital, Froedtert & The Medical College of Wisconsin, Milwaukee, WI, United States
| | - Hermioni L. Amonoo
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, United States,Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Lathika Mohanraj
- Department of Adult Health and Nursing Systems, School of Nursing, Virginia Commonwealth University, Richmond, VA, United States
| | - Debra Lynch Kelly
- Department of Nursing, University of Florida, Gainesville, FL, United States,Cancer Population Science, University of Florida Health Cancer Center, University of Florida, Gainesville, FL, United States
| | - Erin S. Costanzo
- Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
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3
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Bei E, Zarzycki M, Morrison V, Vilchinsky N. Motivations and willingness to provide care from a geographical distance, and the impact of distance care on caregivers' mental and physical health: a mixed-method systematic review protocol. BMJ Open 2021; 11:e045660. [PMID: 34233972 PMCID: PMC8264892 DOI: 10.1136/bmjopen-2020-045660] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Distance caregivers (DCGs) are a growing population with substantial contribution to informal care. While a reasonable amount is known on the determinants of motives and willingness to provide local informal care, and the local caregiver outcomes, reports for the distance caregiving population are lacking. An evidence synthesis of what motivates and makes DCGs willing to care from a distance and the impact of that care on their mental and physical health would highlight any gaps or consensus in knowledge. This would guide the research needed towards the development of tailored interventions, in order to support DCGs and promote the sustainability of distance care. METHODS AND ANALYSIS This protocol adheres to Preferred Items for Reporting of Systematic Reviews and Meta-Analyses Protocols guidelines and the Joanna Briggs Institute (JBI) Methodology for mixed-method reviews. A comprehensive search strategy will be conducted in four electronic databases (CINAHL, MEDLINE, PubMed and PsycINFO). Grey literature will also be assessed to minimise publication bias. Two independent reviewers will assess each study for inclusion and any discrepancies will be resolved with the consultation of a third reviewer. Eligible studies for inclusion will be English language studies exploring the motives and willingness to care for a care recipient with a chronic disease, disability or frailty from a geographical distance; or studies focusing on the mental and physical health outcomes of DCGs. Qualitative and quantitative data will be integrated in a single qualitative synthesis following the JBI convergent integrated approach. Study quality will be assessed using the Mixed Methods Appraisal Tool version 2018. ETHICS AND DISSEMINATION Ethical approval is not required for this study as no primary data will be collected. Findings will be disseminated through peer-reviewed publication and presentations at academic conferences and lay summaries for various stakeholders. PROSPERO REGISTRATION NUMBER CRD42020156350.
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Affiliation(s)
- Eva Bei
- Department of Psychology, Bar-Ilan University, Ramat Gan, Israel
| | | | - Val Morrison
- School of Psychology, Bangor University, Bangor, UK
| | - Noa Vilchinsky
- Department of Psychology, Bar-Ilan University, Ramat Gan, Israel
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4
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Beckmann NB, Dietrich MS, Hooke MC, Gilmer MJ, Akard TF. Parent Caregiving Experiences and Posttraumatic Growth Following Pediatric Hematopoietic Stem Cell Transplant. J Pediatr Oncol Nurs 2021; 38:242-253. [PMID: 33750237 DOI: 10.1177/1043454221992306] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Parents of children recovering from hematopoietic stem cell transplant (HSCT) experience significant distress due to unpredictable and potentially life-threatening complications. Distress is heightened by intensive caregiving parents provide the child during the first 100 days after HSCT. Management of distress and adaptation to caregiving responsibilities may be enhanced if parents find benefit in their experiences through posttraumatic growth (PTG), yet little is known about how parents' experiences after HSCT foster PTG. This study aimed to explore how parents experience caregiving and PTG 100 days after children's HSCT. Methods: Thirty-one parents completed semi-structured interviews ∼100 days after children received HSCT. Results: Four major themes emerged from the data to describe parent experiences after HSCT: (1) psychosocial and healthcare contextual factors; (2) cognitive, affective, and social support reactions to HSCT; (3) problem-based, emotion-based, and cognitive coping strategies; and (4) PTG. Discussion: Results increase the understanding of how parents' experiences and caregiving responsibilities contribute to PTG. These findings may guide future research to understand how these experiences influence PTG. Nurses are integral to the parents' experiences. Future work should focus on nursing interventions that enhance positive reinterpretation of parents' experiences after their children's HSCT.
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Affiliation(s)
- Nicole B Beckmann
- School of Nursing, 16194Vanderbilt University, Nashville, USA.,Pediatric Blood & Marrow Transplant, 65830University of Minnesota Masonic Children's Hospital, Minneapolis, USA
| | - Mary S Dietrich
- School of Nursing, 16194Vanderbilt University, Nashville, USA
| | - Mary C Hooke
- School of Nursing, University of Minnesota, Minneapolis, USA
| | - Mary J Gilmer
- School of Nursing, 16194Vanderbilt University, Nashville, USA
| | - Terrah F Akard
- School of Nursing, 16194Vanderbilt University, Nashville, USA
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5
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Laudenslager ML, Simoneau TL, Mikulich-Gilbertson SK, Natvig C, Brewer BW, Sannes TS, Kilbourn K, Gutman J, McSweeney P. A randomized control trial of stress management for caregivers of stem cell transplant patients: Effect on patient quality of life and caregiver distress. Psychooncology 2019; 28:1614-1623. [PMID: 31127974 DOI: 10.1002/pon.5126] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 04/27/2019] [Accepted: 05/13/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Psychological interventions reduce caregiver distress (CG-distress). Less distress in caregivers may contribute to improved patient quality of life (QoL), but empirical evidence is lacking. Will a caregiver stress management intervention improve patient QoL? METHODS In this replication study, we randomized 155 allogeneic hematopoietic stem cell transplant (Allo-HSCT) patients and caregivers to PsychoEducation, Paced Respiration, and Relaxation (PEPRR) or enhanced treatment as usual (eTAU). We provided PEPRR over 3 months following transplant. Functional Assessment of Cancer Therapy-Bone Marrow Transplant (FACT-BMT) evaluated patient QoL, and CG-distress was based on depressive, anxious, and stress symptoms. Hierarchical linear models tested intervention, time, and interactions as fixed effects with participant as random effects. RESULTS Patients whose caregivers received PEPRR did not differ on FACT-BMT between baseline and 6 months (mean = +3.74; 95% CI, -3.54 to 11.02) compared with patients of caregivers in eTAU (mean = +3.16; 95% CI, -2.88 to 9.20) even though CG-distress was decreased by PEPRR (mean = -0.23; 95% CI, -0.448 to -0.010) compared with those receiving eTAU (mean = +0.27; 95% CI, 0.033-0.504) at 6 months. CONCLUSIONS PEPRR reduced CG-distress without affecting their patient's FACT-BMT score. The FACT-BMT may not have distinguished unique psychological changes associated with their caregiver receiving PEPRR.
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Affiliation(s)
- Mark L Laudenslager
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Teresa L Simoneau
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | | | - Crystal Natvig
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Benjamin W Brewer
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Timothy S Sannes
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Kristin Kilbourn
- Department of Psychology, University of Colorado Denver, Denver, Colorado
| | - Jon Gutman
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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6
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Caregiver Sleep and Patient Neutrophil Engraftment in Allogeneic Hematopoietic Stem Cell Transplant: A Secondary Analysis. Cancer Nurs 2018; 41:77-85. [PMID: 27922914 DOI: 10.1097/ncc.0000000000000447] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Caregiving for allogeneic hematopoietic stem cell transplant (Allo-HSCT) patients can be significantly burdensome. Caregiver well-being often mirrors patients' suffering. However, to our knowledge, this dyadic relationship has not been linked to patient outcome. OBJECTIVE Caregiver's objective and subjective sleep and overall distress before transplantation were hypothesized to be related to patient's time to engraftment in secondary analyses. METHODS Dyads (N = 124) were Allo-HSCT patients (mean [SD] age, 49.2 [12.7] years) and their caregivers (mean [SD] age, 52.7 [12.3] years). Caregiver's subjective sleep quality was measured via the Pittsburgh Sleep Quality Index, objective sleep was measured by actigraphy, and distress was measured by combining validated psychological measures. RESULTS Both caregiver reports of worse sleep (β = .22; P < .05) and objective measurement of caregiver sleep patterns (higher sleep efficiency; less time awake after sleep onset) collected before engraftment significantly predicted shorter time to patient engraftment (β values = -.34 and .29, respectively; P values < .05). Caregiver distress was unrelated to engraftment (β = .14; P = .22). CONCLUSIONS Despite limitations in available patient data, these findings appear to link caregiver well-being to patient outcome. This underscores the interrelatedness of the patient-caregiver dyad in Allo-HSCT. Future research should examine psychological and biomedical mediators. IMPLICATIONS FOR PRACTICE Given that caregiver well-being during the peritransplantation period was associated with patient outcome in this study, such findings highlight the need to address caregiver and patient well-being during Allo-HSCT. There may be potential to improve patient outcome by focusing on the caregiver, which nursing staff is well positioned to monitor.
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7
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Park J, Ross A, Klagholz SD, Bevans MF. The Role of Biomarkers in Research on Caregivers for Cancer Patients: A Scoping Review. Biol Res Nurs 2017; 20:300-311. [PMID: 29130313 DOI: 10.1177/1099800417740970] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Biomarkers can be used as prognostic, predictive, or monitoring indicators of an associated outcome. The purpose of this review was to provide a comprehensive summary of the research examining the use of biomarkers as surrogate end points for clinical outcomes in family caregivers for cancer patients, identify gaps, and make recommendations for future research. METHODS A scoping review, a process of mapping the existing literature, was conducted. Studies comparing biomarkers across caregivers and controls and/or examining relationships between biomarkers and psychological health were reviewed. RESULTS The studies ( N = 18) of caregivers for cancer patients who were identified used biomarkers to predict outcomes ( n = 13) and to monitor the efficacy of interventions ( n = 6). Biomarkers were divided into two categories based on physiological systems involved: (1) neuroendocrine function (sympathetic-adrenal-medullary axis activity, hypothalamic-pituitary-adrenal axis activity) and (2) immune function. Predictive biomarkers were sensitive to differences between caregivers and controls. The biomarkers were used to evaluate outcomes frequently associated with stress, depression, and anxiety. Cortisol was the biomarker most commonly measured to monitor the efficacy of interventions. DISCUSSION Biomarkers are most commonly incorporated into caregiver studies to predict group membership and psychological health. Neuroendocrine biomarkers, specifically cortisol, are most frequently assessed. Future research should include biomarkers of other physiologic functions (e.g., cardiovascular function, cognitive dysfunction, and cell aging) and those that serve as multisystem indicators. Expanding the scientific study of biomarkers will contribute to our understanding of the mechanisms through which stress may influence caregiver health.
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Affiliation(s)
- Jumin Park
- 1 National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Alyson Ross
- 1 National Institutes of Health Clinical Center, Bethesda, MD, USA
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8
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Bennett JM, Leggett AN. Caregiving Stress and Its Toll on Health From a Psychoneuroimmunological Perspective. CURRENT BREAST CANCER REPORTS 2017. [DOI: 10.1007/s12609-017-0246-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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9
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Ross A, Shamburek R, Wehrlen L, Klagholz SD, Yang L, Stoops E, Flynn SL, Remaley AT, Pacak K, Shelburne N, Bevans MF. Cardiometabolic risk factors and health behaviors in family caregivers. PLoS One 2017; 12:e0176408. [PMID: 28472106 PMCID: PMC5417518 DOI: 10.1371/journal.pone.0176408] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 04/09/2017] [Indexed: 11/30/2022] Open
Abstract
The purpose of this study was to compare components of cardiometabolic risk and health behaviors of 20 family caregivers of allogeneic hematopoietic stem cell transplant patients to those of age, gender, and race/ethnicity-matched controls. A prospective, repeated measures design was used to compare cardiometabolic risk and health behaviors in caregivers and controls at three time-points: pre-transplantation, discharge, and six weeks post-discharge. Measures included components of metabolic syndrome, Reynolds Risk Score, NMR serum lipoprotein particle analyses, and the Health-Promoting Lifestyle Profile II (HPLP-II). Mixed-model repeated measure analyses were used. There were no between or within group differences in LDL cholesterol, HDL cholesterol, and triglycerides. There was a significant interaction effect between time and role in large VLDL concentration (VLDL-P) (F (2, 76) = 4.36, p = .016), with the trajectory of large VLDL-P increasing over time in caregivers while remaining stable in controls. Within caregivers, VLDL particle size (VLDL-Z) was significantly larger at time-point three compared to time-points one (p = .015) and two (p = .048), and VLDL-Z was significantly larger in caregivers than in controls at time point three (p = .012). HPLP-II scores were lower in caregivers than controls at all time-points (p < .01). These findings suggest that caregiving may have a bigger impact on triglycerides than on other lipids, and it is through this pathway that caregivers may be at increased cardiometabolic risk. More sensitive measurement methods, such as NMR lipoprotein particle analyses, may be able to detect early changes in cardiometabolic risk.
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Affiliation(s)
- Alyson Ross
- Nursing Department, Clinical Center, National Institutes of Health, Bethesda, Maryland, United States of America
- * E-mail:
| | - Robert Shamburek
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Leslie Wehrlen
- Nursing Department, Clinical Center, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Stephen D. Klagholz
- Nursing Department, Clinical Center, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Li Yang
- Nursing Department, Clinical Center, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Elyssa Stoops
- Nursing Department, Clinical Center, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Sharon L. Flynn
- Nursing Department, Clinical Center, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Alan T. Remaley
- Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Karel Pacak
- National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Nonniekaye Shelburne
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Margaret F. Bevans
- Nursing Department, Clinical Center, National Institutes of Health, Bethesda, Maryland, United States of America
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10
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Mehta SK, Laudenslager ML, Stowe RP, Crucian BE, Feiveson AH, Sams CF, Pierson DL. Latent virus reactivation in astronauts on the international space station. NPJ Microgravity 2017; 3:11. [PMID: 28649633 PMCID: PMC5445581 DOI: 10.1038/s41526-017-0015-y] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 12/21/2016] [Accepted: 01/07/2017] [Indexed: 12/20/2022] Open
Abstract
Reactivation of latent herpes viruses was measured in 23 astronauts (18 male and 5 female) before, during, and after long-duration (up to 180 days) spaceflight onboard the international space station . Twenty age-matched and sex-matched healthy ground-based subjects were included as a control group. Blood, urine, and saliva samples were collected before, during, and after spaceflight. Saliva was analyzed for Epstein-Barr virus, varicella-zoster virus, and herpes simplex virus type 1. Urine was analyzed for cytomegalovirus. One astronaut did not shed any targeted virus in samples collected during the three mission phases. Shedding of Epstein-Barr virus, varicella-zoster virus, and cytomegalovirus was detected in 8 of the 23 astronauts. These viruses reactivated independently of each other. Reactivation of Epstein-Barr virus, varicella-zoster virus, and cytomegalovirus increased in frequency, duration, and amplitude (viral copy numbers) when compared to short duration (10 to 16 days) space shuttle missions. No evidence of reactivation of herpes simplex virus type 1, herpes simplex virus type 2, or human herpes virus 6 was found. The mean diurnal trajectory of salivary cortisol changed significantly during flight as compared to before flight (P = 0.010). There was no statistically significant difference in levels of plasma cortisol or dehydoepiandosterone concentrations among time points before, during, and after flight for these international space station crew members, although observed cortisol levels were lower at the mid and late-flight time points. The data confirm that astronauts undertaking long-duration spaceflight experience both increased latent viral reactivation and changes in diurnal trajectory of salivary cortisol concentrations.
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Affiliation(s)
| | - Mark L. Laudenslager
- University of Colorado Denver, Anschutz Medical Campus, 12700 E. 19th Ave, Aurora, CO 80045 USA
| | | | - Brian E. Crucian
- NASA Johnson Space Center, Mail code SK, 2101 NASA Parkway, Houston, TX 77058 USA
| | - Alan H. Feiveson
- NASA Johnson Space Center, Mail code SK, 2101 NASA Parkway, Houston, TX 77058 USA
| | - Clarence F. Sams
- NASA Johnson Space Center, Mail code SK, 2101 NASA Parkway, Houston, TX 77058 USA
| | - Duane L. Pierson
- NASA Johnson Space Center, Mail code SK, 2101 NASA Parkway, Houston, TX 77058 USA
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11
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A randomized controlled pilot study of inflammatory gene expression in response to a stress management intervention for stem cell transplant caregivers. J Behav Med 2016; 39:346-54. [DOI: 10.1007/s10865-015-9709-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 12/19/2015] [Indexed: 10/22/2022]
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12
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Bevans MF, Ross A, Wehrlen L, Klagholz SD, Yang L, Childs R, Flynn SL, Remaley AT, Krumlauf M, Reger RN, Wallen GR, Shamburek R, Pacak K. Documenting stress in caregivers of transplantation patients: initial evidence of HPA dysregulation. Stress 2016; 19:175-84. [PMID: 26949170 PMCID: PMC4976925 DOI: 10.3109/10253890.2016.1146670] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
There is growing evidence linking caregiver stress with an increased risk for morbidity and mortality. While the emotional and practical burden experienced by caregivers is well established, the physiological changes that may affect the caregiver's health are less understood. This study sought to compare self-reported stress, anxiety and depression along with neuroendocrine and immune markers of stress among adult caregivers of allogeneic hematopoietic stem cell transplantation patients during the acute transplant recovery period to matched non-caregivers controls. Biomarkers and self-reported data were collected at three points during the patient's HSCT: (1) before transplant, (2) after initial transplantation discharge (±7 days) and (3) 6 weeks after initial transplantation discharge. Mixed linear modeling was used to examine differences by group and time. Twenty-one caregivers and 20 controls completed all study procedures. The majority of caregivers were female (57% or 57.1%) and married (95.2%), with a mean age of 52 ± 11.4 years. Caregiver perceived stress, anxiety and depression scores were significantly higher than controls (p < 0.001) with effect sizes (ES) ranging from 1.37 to 1.80 and they did not change over time (p > 0.05) for either group. Caregivers had significantly lower serum cortisol levels than controls at both discharge (p = 0.013; ES = 0.81) and 6 weeks after discharge (p = 0.028; ES = 0.72) but exhibited no significant relationship between self-reported stress and serum cortisol. In addition, caregivers showed a significant inverse relationship between stress and epinephrine levels (r(s)=-0.654, p = 0.021). These findings support the evidence of the caregiving experience being stressful. The counter-intuitive relationship between cortisol and epinephrine might suggest dysregulation of the HPA axis and central nervous system but additional research on the physiological impact of caregiving is warranted.
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Affiliation(s)
- Margaret F. Bevans
- National Institutes of Health Clinical Center, 10 Center Drive, Bethesda, MD, USA
| | - Alyson Ross
- National Institutes of Health Clinical Center, 10 Center Drive, Bethesda, MD, USA
| | - Leslie Wehrlen
- National Institutes of Health Clinical Center, 10 Center Drive, Bethesda, MD, USA
| | - Stephen D. Klagholz
- National Institutes of Health Clinical Center, 10 Center Drive, Bethesda, MD, USA
| | - Li Yang
- National Institutes of Health Clinical Center, 10 Center Drive, Bethesda, MD, USA
| | - Richard Childs
- National Heart, Lung, and Blood Institute, 10 Center Drive, Bethesda, MD, USA
| | - Sharon L. Flynn
- National Institutes of Health Clinical Center, 10 Center Drive, Bethesda, MD, USA
| | - Alan T. Remaley
- National Institutes of Health Clinical Center, 10 Center Drive, Bethesda, MD, USA
| | - Michael Krumlauf
- National Institutes of Health Clinical Center, 10 Center Drive, Bethesda, MD, USA
| | - Robert N. Reger
- National Heart, Lung, and Blood Institute, 10 Center Drive, Bethesda, MD, USA
| | - Gwenyth R. Wallen
- National Institutes of Health Clinical Center, 10 Center Drive, Bethesda, MD, USA
| | - Robert Shamburek
- National Heart, Lung, and Blood Institute, 10 Center Drive, Bethesda, MD, USA
| | - Karel Pacak
- National Institute of Child Health and Human Development, 10 Center Drive, Bethesda, MD, USA
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13
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Thiessen C, Gordon EJ, Reese PP, Kulkarni S. Development of a Donor-Centered Approach to Risk Assessment: Rebalancing Nonmaleficence and Autonomy. Am J Transplant 2015; 15:2314-23. [PMID: 25868787 DOI: 10.1111/ajt.13272] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 02/11/2015] [Accepted: 02/17/2015] [Indexed: 01/25/2023]
Abstract
Living kidney donors are often excluded from the shared decision making and patient-centered models that are advocated in medical practice. Thresholds for acceptable risk vary between transplant centers, and between clinicians and donors. Although donor selection committees commonly focus on medical risks, potential donors also consider nonmedical risks and burdens, which may alter their assessment of an acceptable level of medical risk. Thus, transplant centers may encounter ethical tensions between nonmaleficence and respect for donor autonomy. A donor-centered model of risk assessment and risk reconciliation would integrate the donor's values and preferences in a shared decision about their eligibility to donate. This paper argues for shifting to a donor-centered model of risk assessment, and presents a research agenda to facilitate the greater participation of donors in their own evaluation and approval processes.
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Affiliation(s)
- C Thiessen
- Department of Surgery, Section of Organ Transplantation & Immunology, Yale University School of Medicine, New Haven, CT
| | - E J Gordon
- Comprehensive Transplant Center, Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - P P Reese
- Renal-Electrolyte and Hypertension Division, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA
| | - S Kulkarni
- Department of Surgery, Section of Organ Transplantation & Immunology, Yale University School of Medicine, New Haven, CT
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14
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Laudenslager ML, Simoneau TL, Kilbourn K, Natvig C, Philips S, Spradley J, Benitez P, McSweeney P, Mikulich-Gilbertson SK. A randomized control trial of a psychosocial intervention for caregivers of allogeneic hematopoietic stem cell transplant patients: effects on distress. Bone Marrow Transplant 2015; 50:1110-8. [PMID: 25961767 PMCID: PMC4527944 DOI: 10.1038/bmt.2015.104] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 03/13/2015] [Accepted: 03/18/2015] [Indexed: 01/20/2023]
Abstract
Caregivers of patients receiving allogeneic hematopoietic stem cell transplants (Allo-HSCT) serve a pivotal role in patient care but experience high stress, anxiety, and depression as a result. We theorized that a stress management adapted for Allo-HSCT caregivers would reduce distress compared to treatment as usual (TAU). From 267 consecutive caregivers of Allo-HSCT patients approached, 148 (mean=53.5 years, 75.7% female) were randomized to either psychosocial intervention (n=74) or TAU (n=74). Eight 1-on-1 stress management sessions delivered across the 100 day post-transplant period focused on understanding stress, changing role(s) as caregiver, cognitive behavioral stress management, pacing respiration, and identifying social support. Primary outcomes included perceived stress (psychological) and salivary cortisol awakening response (CAR) (physiological). Randomized groups were not statistically different at baseline. Mixed models analysis of covariance (intent-to-treat) showed that intervention was associated with significantly lower caregiver stress 3 months post-transplant (Mean=20.0, CI95=17.9-22.0) compared to TAU (Mean=23.0, CI95=21.0-25.0) with an effect size (ES) of 0.39 (p=0.039). Secondary psychological outcomes, including depression and anxiety, were significantly reduced with ESs of 0.46 and 0.66 respectively. Caregiver CAR did not differ from non-caregiving controls at baseline and was unchanged by intervention. Despite significant caregiving burden, this psychosocial intervention significantly mitigated distress in Allo-HSCT caregivers.
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Affiliation(s)
- M L Laudenslager
- Department of Psychiatry, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
| | - T L Simoneau
- Department of Psychiatry, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
| | - K Kilbourn
- Department of Psychology, Univerity of Colorado Denver, Denver, CO, USA
| | - C Natvig
- Department of Psychiatry, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
| | - S Philips
- Department of Psychiatry, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
| | - J Spradley
- 1] Presbyterian/St Luke's Medical Center, Denver, CO, USA [2] Colorado Blood Cancer Institute, Denver, CO, USA
| | - P Benitez
- Department of Psychiatry, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
| | - P McSweeney
- 1] Presbyterian/St Luke's Medical Center, Denver, CO, USA [2] Colorado Blood Cancer Institute, Denver, CO, USA
| | - S K Mikulich-Gilbertson
- Department of Psychiatry, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
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15
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Ouseph R, Croy C, Natvig C, Simoneau T, Laudenslager ML. Decreased mental health care utilization following a psychosocial intervention in caregivers of hematopoietic stem cell transplant patients. Ment Illn 2014; 6:5120. [PMID: 25478136 PMCID: PMC4253397 DOI: 10.4081/mi.2014.5120] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Revised: 01/04/2014] [Accepted: 01/08/2014] [Indexed: 11/22/2022] Open
Abstract
Caregivers are known to experience increased morbidity when compared to noncaregivers. Does an intervention targeting caregiver distress affect their health care utilization? One hundred forty-eight caregivers of allogeneic hematopoietic stem cell transplant patients were randomized to treatment as usual (TAU) or a psychoeducation, paced respiration, and relaxation (PEPRR) intervention. Assessments of caregivers’ service utilization were collected at baseline and 1, 3, and 6 months post-transplant. During the first 30 days after patient transplant, caregiver medical and mental health professional service use decreased while support group attendance peaked. Mixed model regressions showed a significant decrease in mental health service use by the PEPRR group (P=0.001). At six months caregivers in TAU had predicted marginal probabilities of mental health services utilization over 10 times as high as caregivers in PEPRR (18.1% vs 1.5%). Groups failed to differ in medical service (P=0.861) or support group (P=0.067) use. We can conclude that participation in PEPRR compared to TAU was associated with reduced mental health service utilization. Caregiver psychosocial support services are critical to improve caregiver outcomes.
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Affiliation(s)
- Rita Ouseph
- Duke University , Durham, NC ; Anschutz Medical Campus, University of Colorado , Denver, CO
| | - Calvin Croy
- Anschutz Medical Campus, University of Colorado , Denver, CO
| | - Crystal Natvig
- Anschutz Medical Campus, University of Colorado , Denver, CO
| | - Teresa Simoneau
- Anschutz Medical Campus, University of Colorado , Denver, CO
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