1
|
Bayliss K, Shield T, Wearden A, Flynn J, Rowland C, Bee P, Farquhar M, Harris D, Hodkinson A, Panagioti M, Booth M, Cotterill D, Goodburn L, Knipe C, Grande G. Understanding what affects psychological morbidity in informal carers when providing care at home for patients at the end of life: a systematic qualitative evidence synthesis. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2023:1-53. [PMID: 37843444 DOI: 10.3310/pytr4127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
Background Informal carers are central in supporting patients at the end of life, but this has substantial negative impacts on carers' own mental health. When carers are unable to cope, this may affect their ability to support the patient and increase the likelihood of patient hospital admissions. Further, demographic changes mean demands for care at and before end of life are increasing and existing services will struggle to meet these demands. It is important to recognise carers as a vital resource and prevent adverse health outcomes from caregiving (and thereby limit their consequences). Large individual variation in the level of psychological morbidity from end-of-life caregiving suggests there is scope for interventions to improve carer mental health if we can understand the underlying factors. Objectives This meta-synthesis of qualitative studies aims to identify factors reported by carers as important to their mental health. Data sources Searches of MEDLINE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Social Science Citation Index, EMBASE, Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews of Effects, and Cochrane Qualitative Reviews 1 January 2009 to 24 November 2019 for empirical publications from Organization for Economic Cooperation and Development countries in English/Scandinavian on factors affecting adult carer mental health during end-of-life caregiving in home settings. Review methods Systematic qualitative meta-synthesis in collaboration with a Public Patient Involvement carer Review Advisory Panel, included thematic synthesis, followed by a best-fit framework synthesis, informed by principles of meta-ethnography. Critical Appraisal Skills Programme Qualitative Studies Checklist was used. Results Thirty-three eligible studies identified six themes encompassing factors perceived by carers to affect their mental health during end-of-life caregiving. These were: (1) the patient condition (including patient decline); (2) impact of caring responsibilities (including exhaustion, lack of time for own needs, isolation); (3) relationships (including quality of the patient-carer relationship); (4) finances (including financial concerns, impact on work); (5) carers' internal processes (including loss of autonomy, lack of confidence, coping strategies); and (6) support (including lack of informal support, inadequacies in formal support information and care provision, limited collaboration, disjointed care). Reported strategies to improve mental health were linked to the final two themes, with suggestions on how to manage carers' internal processes and build appropriate support. Findings correspond with literature 1998-2008, indicating consistency in factors affecting carers and adding validity to findings. Limitations The review was limited to caregiving in the home setting and studies from Organization for Economic Cooperation and Development countries published in English and Scandinavian. Identified papers predominantly considered carers of people with cancer, with little research into ethnic-minority perspectives. The review may therefore not fully encompass factors affecting carers of people with longer-term conditions, or those within other care settings, countries and population groups. Conclusions and future work A wide range of both internal and contextual factors may lead to psychological morbidity when caring for someone at the end of life. Future work within practice therefore requires a broad-based rather than narrow approach to sustaining and improving carer mental health. Future work within research requires collaboration between researchers and stakeholders within policy, commissioning, practice and carer organisations to develop solutions and assess their effectiveness. Further, researchers need to develop better models for factors affecting carer mental health and their interaction, to build a stronger evidence base and better guide interventions. Study registration This study is registered as PROSPERO CRD42019130279. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number HSDR 18/01/01 and will be published in full in Health and Social Care Delivery Research. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Kerin Bayliss
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, UK
| | - Tracey Shield
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, UK
| | - Alison Wearden
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, UK
| | - Jackie Flynn
- Public and Community Involvement and Engagement Panel, NIHR Applied Research Collaboration Greater Manchester, UK
| | - Christine Rowland
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, UK
| | - Penny Bee
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, UK
| | - Morag Farquhar
- School of Health Sciences, University of East Anglia, UK
| | - Danielle Harris
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, UK
| | - Alexander Hodkinson
- NIHR Greater Manchester Patient Safety Translational Research Centre, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, University of Manchester, UK
| | - Maria Panagioti
- NIHR Greater Manchester Patient Safety Translational Research Centre, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, University of Manchester, UK
| | - Margaret Booth
- Carer Review Advisory Panel, NIHR HS&DR Project 18/01/01, University of Manchester, UK
| | - David Cotterill
- Carer Review Advisory Panel, NIHR HS&DR Project 18/01/01, University of Manchester, UK
| | - Lesley Goodburn
- Carer Review Advisory Panel, NIHR HS&DR Project 18/01/01, University of Manchester, UK
| | - Cedric Knipe
- Carer Review Advisory Panel, NIHR HS&DR Project 18/01/01, University of Manchester, UK
| | - Gunn Grande
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, UK
| |
Collapse
|
2
|
Weiss CR, Baker C, Gillespie A, Jones J. Ambiguous loss in family caregivers of loved ones with cancer, a synthesis of qualitative studies. J Cancer Surviv 2023; 17:484-498. [PMID: 36396909 DOI: 10.1007/s11764-022-01286-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 10/24/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE The purpose of this synthesis of qualitative studies is to explore manifestations of ambiguous loss within the lived experiences of family caregivers (FCG) of loved ones with cancer. Grief and loss are familiar companions to the family caregivers of loved ones with cancer. Anticipatory loss, pre-loss grief, complicated grief, and bereavement loss have been studied in this caregiver population. It is unknown if family caregivers also experience ambiguous loss while caring for their loved ones along the uncertain landscape of the cancer illness and survivorship trajectory. METHODS We conducted a four-step qualitative meta-synthesis of primary qualitative literature published in three databases between 2008 and 2021. Fourteen manuscripts were analyzed using a qualitative appraisal tool and interpreted through thematic synthesis and reciprocal translation. RESULTS Five themes were derived, revealing FCGs appreciate change in their primary relationship with their loved ones with cancer, uncertainty reconciling losses, an existence that is static in time, living with paradox, and disenfranchised grief. The results of this synthesis of qualitative studies complement the descriptors of ambiguous loss presented in previous research. CONCLUSIONS The results of this synthesis of qualitative studies complement the descriptors of ambiguous loss presented in previous theoretical and clinical research. By understanding ambiguous loss as a complex and normal human experience of cancer FCGs, oncology and palliative care healthcare providers can introduce interventions and therapeutics to facilitate caring-healing and resiliency. IMPLICATIONS FOR CANCER SURVIVORS Untreated ambiguous loss can result in a decrease in wellbeing, loss of hope, and loss of meaning in life. It is imperative that cancer FCGs experiencing ambiguous loss are recognized and supported so that they may live well in the family disease of cancer.
Collapse
Affiliation(s)
- Charlotte R Weiss
- College of Nursing, University of Colorado, Denver-Anschutz Medical Campus, Denver, CO, USA.
- , Wilmington, USA.
| | - Christina Baker
- College of Nursing, University of Colorado, Denver-Anschutz Medical Campus, Denver, CO, USA
| | - Anne Gillespie
- College of Nursing, University of Colorado, Denver-Anschutz Medical Campus, Denver, CO, USA
| | - Jacqueline Jones
- College of Nursing, University of Colorado, Denver-Anschutz Medical Campus, Denver, CO, USA
| |
Collapse
|
3
|
Zhu S, Yang C, Chen S, Kang L, Li T, Li J, Li L. Effectiveness of a perioperative support programme to reduce psychological distress for family caregivers of patients with early-stage lung cancer: study protocol for a randomised controlled trial. BMJ Open 2022; 12:e064416. [PMID: 35998958 PMCID: PMC9403120 DOI: 10.1136/bmjopen-2022-064416] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
Abstract
INTRODUCTION Family caregivers play a key role in providing ongoing long-term care and assistance to their loved ones during cancer treatment. However, family caregivers of patients with lung cancer are frequently unprepared for their roles and they may undergo psychological distress, thus reducing their own quality of life while affecting patients' health outcomes. Interventions that specifically target this population are lacking. This study aims to evaluate the effectiveness of a perioperative support programme on family caregivers of patients with early-stage lung cancer. METHODS AND ANALYSIS This study is guided by the Stress-Coping Model. Family caregivers of patients diagnosed with early-stage lung cancer and those who are scheduled for lung resection treatment will be invited to participate. Participants will be randomised to groups that either receive the perioperative support programme or usual care. The intervention consists of four face-to-face intervention sessions during the hospital stay and two weekly telephone follow-up sessions after discharge. Primary and secondary outcomes will be assessed at baseline and at 4 and 12 weeks after the intervention. Primary outcomes will include psychological distress and secondary outcomes will include caregiving burden, quality of life, coping style and social support. Generalised estimation equation model will be used to analyse the intervention effects. ETHICS AND DISSEMINATION The study was approved by the Ethics Committee of the Second Xiangya Hospital of Central South University (LYG2022003). The authors will disseminate the study's findings by publishing them in international scientific journals. TRIAL REGISTRATION NUMBER ChiCTR2200058280.
Collapse
Affiliation(s)
- Song Zhu
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South University, Changsha, China
- Department of Thoracic Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Chen Yang
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Shihao Chen
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Lu Kang
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South University, Changsha, China
- Department of Thoracic Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Tong Li
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South University, Changsha, China
- Department of Thoracic Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Jina Li
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South University, Changsha, China
- Department of Thoracic Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Lezhi Li
- Xiangya Nursing School, Central South University, Changsha, Hunan, China
| |
Collapse
|
4
|
Urbutienė E, Pukinskaitė R. Fear of Cancer Recurrence as Reminder About Death: Lived Experiences of Cancer Survivors' Spouses. OMEGA-JOURNAL OF DEATH AND DYING 2022:302228221123152. [PMID: 35995573 DOI: 10.1177/00302228221123152] [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: 11/15/2022]
Abstract
Fear of cancer recurrence is the most prevalent and burdensome emotional concern among cancer survivors' spouses after treatment. This qualitative study aimed to reveal death-related experiences of spouses of cancer survivors in remission, in the context of fear of cancer recurrence. Seven spouses (aged 35-56), four women and three men were explored. Data were obtained using an unstructured interview and analyzed by inductive thematic analysis. The spouses associate cancer relapse with death, risk of losing their spouse. The threat of death triggers not only the feelings of insecurity, uncertainty about the future and loss of control, but also appreciation of life, focus on positive aspects in relationships. Planning for the "worst" scenarios and avoidance helped spouses to reduce tension and enhance control. Interventions for spouses should focus on promotion of emotional expression of death related concerns underlying fear of relapse, also developing new coping strategies to accept and tolerate uncertainty.
Collapse
Affiliation(s)
- Eglė Urbutienė
- Institute of Psychology, Mykolas Romeris University, Vilnius, Lithuania
| | - Rūta Pukinskaitė
- Institute of Psychology, Mykolas Romeris University, Vilnius, Lithuania
| |
Collapse
|
5
|
Rinner MT, Haller E, Meyer AH, Gloster AT. Is giving receiving? The influence of autonomy on the association between prosocial behavior and well-being. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2022. [DOI: 10.1016/j.jcbs.2022.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
6
|
Reflections on Experiencing Parental Bereavement as a Young Person: A Retrospective Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042083. [PMID: 35206275 PMCID: PMC8872611 DOI: 10.3390/ijerph19042083] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 02/06/2022] [Accepted: 02/10/2022] [Indexed: 02/04/2023]
Abstract
Background: It is estimated that approximately 41,000 children and young people experience the death of a parent each year. Grief responses, such as anxiety and depression, can follow. This research investigated the adult reflections of experiencing parental death as a young person. Methods: Semi-structured interviews were conducted with adults (N = 14; female n = 8) who experienced parental death as a young person, which occurred over 5 years ago (time since death, M = 12.9 years; age at death, M = 16.4 years; age at interview, M = 30.9 years). The data were analysed inductively using thematic analysis. Results: Seven themes revealed that parental bereavement can lead to (1) “Distance and isolation” and is an (2) “Emotional journey” with (3) a “Physical impact”. Many experienced (4) “Post-traumatic growth” but acknowledged that (5) “Life will never be the same”, highlighting the importance of (6) “Support and understanding” and triggers for (7) “Re-grief”. Conclusions: Parental bereavement has significant emotional and physical consequences, but can also lead to personal growth. Talking therapies were rarely accessed, often due to a lack of awareness or desire to engage, revealing a translational gap between existing support services and uptake. Enabling open conversations about grief and identifying suitable support is a public health priority. This need has been amplified since the start of the COVID-19 pandemic, which may be a trigger for grief empathy and re-grief in those who have already been bereaved.
Collapse
|
7
|
Fee A, Hanna J, Hasson F. Pre-loss grief experiences of adults when someone important to them is at end-of-life: A qualitative systematic review. DEATH STUDIES 2021; 47:1-15. [PMID: 34751635 DOI: 10.1080/07481187.2021.1998935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Pre-loss grief can be experienced by relatives before impending death; however, limited understanding exists about the impact of pre-loss grief on bereavement. This systematic review aimed to synthesize qualitative research evidence reporting adults' experiences of pre-loss grief within cancer care. Thirteen studies were selected, and three key themes identified. Findings indicate that relatives transitioned through lived experiences during end-stage cancer, and that meanings attached to these experiences influenced how they experienced pre-loss grief. Limited formal support was identified to navigate these experiences; however, context was seen as important, and skilled healthcare practitioners and physical environment were key to facilitating preparedness.
Collapse
Affiliation(s)
- Anne Fee
- Institute of Nursing and Health Research, Ulster University, Northern Ireland, UK
| | - Jeff Hanna
- School of Nursing and Midwifery, Queen's University Belfast, Northern Ireland, UK
| | - Felicity Hasson
- Institute of Nursing and Health Research, Ulster University, Northern Ireland, UK
| |
Collapse
|
8
|
Semple CJ, McCaughan E, Beck ER, Hanna JR. 'Living in parallel worlds' - bereaved parents' experience of family life when a parent with dependent children is at end of life from cancer: A qualitative study. Palliat Med 2021; 35:933-942. [PMID: 33765868 PMCID: PMC8114437 DOI: 10.1177/02692163211001719] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND When a parent of dependent children (<18 years old) is at end of life from cancer, this has a profound impact on the family. Children less prepared for the death of a parent are more susceptive to poorer psychosocial adjustment in later life. There is a lack of understanding from the literature surrounding what support parents require, and how they navigate this end of life experience. AIM To explore bereaved parents' experience and needs for families when a parent is at end of life from cancer with dependent children. DESIGN In-depth, semi-structured qualitative interviews were conducted with 21 bereaved mothers and fathers, identified from the general public, a family support service and hospice. Data were analysed thematically. RESULTS Parents often live in 'parallel worlds' throughout the end of life period. In one world, 'living in the moment', cherishing the ordinariness of family life, remaining hopeful treatment will prolong life, whilst adapting as the illness unfolds. The other world presents as 'intermitted glimpses that death is approaching', shadowed with painful emotional concerns surrounding their children and the future. At the end, death rapidly approaches, characterised as suddenly 'falling off the cliff'; placing significant demands on the well-parent. CONCLUSIONS Amidst challenges, clinicians should provide parents with clear information surrounding a poor prognosis, so families can plan and prepare for parental death. There is a need for healthcare professionals to engage, encourage and equip parents, as they prepare their children throughout the end of life experience for the inevitable death of a parent.
Collapse
Affiliation(s)
- Cherith J Semple
- School of Nursing, Ulster University, Newtownabbey, Co. Antrim, UK
- South Eastern Health and Social Care Trust, Cancer Services, Ulster Hospital, Belfast, UK
| | - Eilís McCaughan
- School of Nursing, Ulster University, Coleraine, Co. L’Derry, UK
| | - Esther R Beck
- School of Nursing, Ulster University, Newtownabbey, Co. Antrim, UK
| | - Jeffrey R Hanna
- School of Nursing, Ulster University, Newtownabbey, Co. Antrim, UK
| |
Collapse
|
9
|
Falzarano F, Prigerson HG, Maciejewski PK. The Role of Advance Care Planning in Cancer Patient and Caregiver Grief Resolution: Helpful or Harmful? Cancers (Basel) 2021; 13:cancers13081977. [PMID: 33924214 PMCID: PMC8074595 DOI: 10.3390/cancers13081977] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 04/17/2021] [Accepted: 04/19/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Grief is a common emotion felt by advanced cancer patients and their family caregivers, yet little is known of the relationship between grief in patients and caregivers, how grief in patients and caregivers changes as patients get closer to death, and the way advance care planning (ACP) relates to grief in both members of this “care pair.” In a sample of advanced cancer patients and caregivers, we found their grief tended to be synchronized and that, on average, patients’ grief remained stable whereas caregivers’ grief declined. Further, results revealed that completion of a living will (LW) for the patient increased levels of patient grief, while completion of a do-not-resuscitate (DNR) order decreased levels of caregiver grief. Results suggest that grieving may be synchronized between patients and caregivers and that while ACP may promote grief resolution for family caregivers, it is evocative of grief for patients. Abstract Cancer patients and their family caregivers experience various losses when patients become terminally ill, yet little is known about the grief experienced by patients and caregivers and factors that influence grief as patients approach death. Additionally, few, if any, studies have explored associations between advance care planning (ACP) and grief resolution among cancer patients and caregivers. To fill this knowledge gap, the current study examined changes in grief over time in patients and their family caregivers and whether changes in patient grief are associated with changes in caregiver grief. We also sought to determine how grief changed following the completion of advance directives. The sample included advanced cancer patients and caregivers (n = 98 dyads) from Coping with Cancer III, a federally funded, multi-site prospective longitudinal study of end-stage cancer care. Participants were interviewed at baseline and at follow-up roughly 2 months later. Results suggest synchrony, whereby changes in patient grief were associated with changes in caregiver grief. We also found that patients who completed a living will (LW) experienced increases in grief, while caregivers of patients who completed a do-not-resuscitate (DNR) order experienced reductions in grief, suggesting that ACP may prompt “grief work” in patients while promoting grief resolution in caregivers.
Collapse
Affiliation(s)
- Francesca Falzarano
- Cornell Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, NY 10021, USA; (F.F.); (P.K.M.)
- Department of Medicine, Weill Cornell Medicine, New York, NY 10021, USA
| | - Holly G. Prigerson
- Cornell Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, NY 10021, USA; (F.F.); (P.K.M.)
- Department of Medicine, Weill Cornell Medicine, New York, NY 10021, USA
- Correspondence:
| | - Paul K. Maciejewski
- Cornell Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, NY 10021, USA; (F.F.); (P.K.M.)
- Department of Medicine, Weill Cornell Medicine, New York, NY 10021, USA
- Department of Radiology, Weill Cornell Medicine, New York, NY 10021, USA
| |
Collapse
|
10
|
An exploration of spousal caregivers' well-being after the death of their partners who were older cancer patients - A phenomenological approach. Eur J Oncol Nurs 2020; 47:101779. [PMID: 32559712 DOI: 10.1016/j.ejon.2020.101779] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 05/11/2020] [Accepted: 06/04/2020] [Indexed: 11/22/2022]
Abstract
PURPOSE The aim of this study was to gain more insight into the psychosocial well-being of the recently bereaved spouses who took care of their partners with cancer. METHOD A qualitative study was developed, taking a phenomenological approach. Eleven former caregivers and spouses of patients who died of cancer at, or after, the age of 64, participated in individual in-depth interviews. Only caregivers who were bereaved for a minimum of three months and maximum of one year were interviewed. The analysis of the data was based on the Qualitative Analysis Guide of Leuven. RESULTS The first moments of bereavement included feelings of disbelief, regret and relief. A feeling of being overwhelmed during this time was reported by some, others sought distraction from their grief. Loneliness, emotional fluctuations and a sense of appreciation for the support of loved ones were dominant themes. Also, gratitude and the importance of consolation played a role in the participants' well-being. When participants addressed the matter of moving forward in life, most explained how they wanted to keep the memories of their partner alive while rebuilding their lives. CONCLUSIONS The present study offers insight into the experiences of the bereaved spousal caregiver and highlights the need of social support during the bereavement period. All participants expressed loss-oriented and restoration-oriented coping strategies. Also, loneliness is considered a dominant feeling throughout the bereavement period. Social contact can ease these feelings of loneliness through providing either distraction or possibilities to share the burden. This paper emphasized the importance of improving access to healthcare professionals during bereavement.
Collapse
|
11
|
Coelho A, de Brito M, Teixeira P, Frade P, Barros L, Barbosa A. Family Caregivers' Anticipatory Grief: A Conceptual Framework for Understanding Its Multiple Challenges. QUALITATIVE HEALTH RESEARCH 2020; 30:693-703. [PMID: 31526106 DOI: 10.1177/1049732319873330] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The end-of-life trajectory of cancer patients in palliative care (PC) elicits an anticipatory grief (AG) process in family caregivers (FCs). Although widely recognized, AG lacks conceptual clarification. This study aims to qualitatively explore the experience of FCs of patients with terminal cancer to identify the core characteristics and the specific adaptive challenges related to AG in the context of end-of-life caregiving. Data were collected through in-depth semi-structured interviews conducted in a clinical sample of 26 FCs of cancer patients in PC. Findings from thematic analysis suggest that the AG experience is characterized by traumatic distress from being exposed to life-threatening conditions and the separation distress induced by loss anticipation and current relational losses, challenging the FCs to long-term emotional regulation effort demands. These results contribute to the conceptualization of AG and may inform intervention programs for the main challenges the FCs face when adjusting to loss during end-of-life caregiving.
Collapse
Affiliation(s)
- Alexandra Coelho
- Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Centro Hospitalar Universitário Lisboa Norte, EPE, Lisboa, Portugal
| | - Maja de Brito
- Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal
| | - Pedro Teixeira
- Escola de Medicina, Universidade do Minho, Braga, Portugal
| | - Pedro Frade
- Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Centro Hospitalar Universitário Lisboa Norte, EPE, Lisboa, Portugal
| | - Luísa Barros
- Faculdade de Psicologia, Universidade de Lisboa, Lisboa, Portugal
| | - António Barbosa
- Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Centro Hospitalar Universitário Lisboa Norte, EPE, Lisboa, Portugal
| |
Collapse
|
12
|
Experiences of spouses of patients with cancer from the notification of palliative chemotherapy discontinuation to bereavement: A qualitative study. Eur J Oncol Nurs 2020; 45:101721. [PMID: 32065935 DOI: 10.1016/j.ejon.2020.101721] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 12/04/2019] [Accepted: 01/13/2020] [Indexed: 01/06/2023]
Abstract
PURPOSE Many patients with advanced cancer choose palliative chemotherapy. Considering its purpose of palliation and not treatment, it is important to consider the life of family caregivers. Family caregivers who experience bereavement undergo extreme stress, which is particularly high among patients' spouses. The present study aims to clarify the experiences of the spouses of patients at the hospitals in Japan after the notification of palliative chemotherapy discontinuation until bereavement. METHOD We interviewed the spouses of 13 patients who received palliative chemotherapy using a semistructured interview guide. Each spouse was interviewed twice. The interviews were transcribed verbatim, and key concepts were identified using a grounded theory analytic approach. RESULTS After the hospital's recommendation for palliative chemotherapy discontinuation, the spouses had "bewilderment over having to discontinue palliative chemotherapy" and experienced "difficulty in facing bereavement." The spouses having "difficulty to give up hope for the patient's survival," felt "bafflement over caregiving at the terminal stage," which would be their responsibility in the future. Further, they had "hesitation in being honest to the patient" and were engaged in "knowing how to live with the patient until bereavement." CONCLUSION Nurses need to encourage the patients and spouses to honestly express how they feel from the early stages of palliative chemotherapy. Furthermore, nurses should help spouses with how they face bereavement. This result may help prevent anticipatory grief, which may lead to excessive stress and emotional distress on the family caregivers.
Collapse
|
13
|
Meeker MA, McGinley JM, Jezewski MA. Metasynthesis: Dying adults' transition process from cure-focused to comfort-focused care. J Adv Nurs 2019; 75:2059-2071. [PMID: 30734354 DOI: 10.1111/jan.13970] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 11/13/2018] [Accepted: 11/20/2018] [Indexed: 11/30/2022]
Abstract
AIM To describe and explain the process of transition from cure-focused to comfort-focused health care as perceived and reported by patients, family members, and healthcare providers. BACKGROUND Moving into the last phase of life due to advanced illness constitutes a developmental transition with increased vulnerability for patients and family. DESIGN Qualitative metasynthesis. DATA SOURCES Medline, CINAHL, and PsycInfo databases searched from inception through March 2016. Primary research reports published from 1990 to 2015, using qualitative designs to report transition experiences of patients, family members, and/or healthcare providers were included. REVIEW METHODS Key elements were extracted and organized into matrices. Findings from each report were analysed using qualitative coding. RESULTS The sample was 56 unique reports from 50 primary studies. Patients and families emphasized the importance of receiving understandable information, emotional support, respect for personhood and control. The critical juncture of 'realizing terminality' preceded a transition to comfort-focused care. Subsequently, a shift in goals of care emphasizing comfort and quality of life could occur. Continued provision of information, effective support, respect and control promoted 'reframing perceptions' and capacity to embrace a changed identity. Reframing allowed patient and family to find meaning and value in this last phase of life and to embrace the opportunity to prepare for death, nurture relationships, and focus on quality of living. CONCLUSION Understanding the developmental process that can be engaged by patients and families at the end of life provides a theoretical basis that can inform choice and timing of interventions to reduce suffering and enhance positive outcomes.
Collapse
|
14
|
Madsen R, Birkelund R, Uhrenfeldt L. Transition experiences during courses of incurable cancer from the perspective of bereaved spouses. Eur J Oncol Nurs 2019; 38:28-35. [PMID: 30717933 DOI: 10.1016/j.ejon.2018.11.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 11/14/2018] [Accepted: 11/23/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE The present study explores transition experiences during courses of incurable cancer from the perspective of bereaved spouses. METHOD Ten bereaved spouses participated in individual semi-structured interviews conducted in participants' private homes. The study takes a phenomenological-hermeneutic approach and data was analysed inspired by the French philosopher Paul Ricoeur's theory of interpretation. FINDINGS Two main themes were identified. The first one: "Being present when the life of their loved one is ending" consisted of three subthemes: "Challenged by suffering", "Transitions during the final days" and "Moving on in life". The second main theme: "Meaningful transitions in palliative care" consisted of two subthemes: "Changing direction towards palliative care" and "Transitions in palliative care". CONCLUSION Bereaved spouses experienced meaningful transitions when the life of their loved one was ending and related to receiving palliative care. Spouses were challenged by witnessing their loved one's suffering and experienced a deviation in the quality of professional palliative care offered in the system of healthcare.
Collapse
Affiliation(s)
- Rikke Madsen
- Horsens Regional Hospital, Hospitalsenheden Horsens, Sundvej 30, 8700, Horsens, Denmark.
| | - Regner Birkelund
- Health Services Research Unit, Lillebælt Hospital, Institute of Regional Health Research, University of Southern Denmark, Kabbeltoft 25, Bygning S100, 7100, Vejle, Denmark.
| | | |
Collapse
|
15
|
Lorentsen VB, Nåden D, Sæteren B. The paradoxical body: A glimpse of a deeper truth through relatives' stories. Nurs Ethics 2018; 26:1611-1622. [PMID: 29695197 DOI: 10.1177/0969733018768660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND People with progressive cancer experience that their bodies change due to disease and/or treatment. The body is integral to the unity of the human being, a unity that must be perceived as whole if dignity shall be experienced. Relatives are in touch with the suffering bodies of their dear ones, physically, socially, mentally, and existentially, and thus the relatives' experiences of the bodies of their dear ones might yield insight into the concept of dignity. AIM The aim of this study is to explore relatives' experiences of the patients' bodily changes from a perspective of dignity. RESEARCH DESIGN AND METHOD A total of 12 relatives from a hospice in Norway were interviewed. Gadamer's ontological hermeneutics inspired the interpretation. ETHICAL CONSIDERATIONS The principles of voluntariness, confidentiality, withdrawal, and anonymity were respected during the whole research process. The Norwegian Social Science Data Services approved the study. RESULTS AND CONCLUSION The conversations about the body were conversations about ambivalent or paradoxical matters that shed light on the concept of dignity. The results show that the relatives got in touch with elements that otherwise would have remained tacit and unspoken, and which gave glimpses of a deeper truth, which might reveal the core of dignity. Furthermore, the relatives' confirmation of the ambivalence might be understood as a strong ethical obligation to treat the other with dignity. The confirmation may also reveal the relatives' unselfish love of the other, which can be understood as the core of ethics and ethos. Finally, the results reveal the relatives' limited insight into their dear ones' bodily changes, and we discuss the challenges of truly seeing the other. Body knowledge and the relationship between body and dignity as phenomena cannot be ignored and needs more attention and articulation in clinical nursing practice and in nursing research.
Collapse
Affiliation(s)
| | - Dagfinn Nåden
- Oslo and Akershus University College of Applied Sciences, Norway
| | - Berit Sæteren
- Oslo and Akershus University College of Applied Sciences, Norway
| |
Collapse
|
16
|
Lau BHP, Chow AYM, Wong DFK, Chan JSM, Chan CHY, Ho RTH, So TH, Lam TC, Lee VHF, Lee AWM, Chow SF, Chan CLW. Study protocol of a randomized controlled trial comparing integrative body-mind-spirit intervention and cognitive behavioral therapy in fostering quality of life of patients with lung cancer and their family caregivers. ACTA ACUST UNITED AC 2018; 15:258-276. [PMID: 29400621 DOI: 10.1080/23761407.2018.1435325] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Compared to cancers at other sites, lung cancer often results in greater psychosocial distress to both the patients and their caregivers, due to the poor prognosis and survival rate, as well as the heavy symptom burden. In recent years, making protocols of proposed or on-going studies publicly available via clinical trial registries and/or peer-reviewed journals has benefited health sciences with timely communication of the latest research trends and improved transparency in reporting. However, such practice is yet to be a common sight in evidence-informed social work. Hence, this paper discusses the value of publishing protocols in social work research and presents the protocol of a randomized controlled trial that compares the effectiveness of integrative body-mind-spirit intervention with cognitive behavioral therapy for enhancing quality of life of patients with lung cancer and their family caregivers. The data collection process was still on-going at the time of manuscript submission.
Collapse
Affiliation(s)
- Bobo Hi-Po Lau
- a Department of Social Work & Social Administration , University of Hong Kong , Pokfulam , Hong Kong
| | - Amy Y M Chow
- a Department of Social Work & Social Administration , University of Hong Kong , Pokfulam , Hong Kong
| | - Daniel F K Wong
- a Department of Social Work & Social Administration , University of Hong Kong , Pokfulam , Hong Kong
| | - Jessie S M Chan
- a Department of Social Work & Social Administration , University of Hong Kong , Pokfulam , Hong Kong
| | - Celia H Y Chan
- a Department of Social Work & Social Administration , University of Hong Kong , Pokfulam , Hong Kong
| | - Rainbow T H Ho
- a Department of Social Work & Social Administration , University of Hong Kong , Pokfulam , Hong Kong
| | - Tsz-Him So
- b Department of Clinical Oncology , University of Hong Kong , Pokfulam , Hong Kong
| | - Tai-Chung Lam
- b Department of Clinical Oncology , University of Hong Kong , Pokfulam , Hong Kong
| | - Victor Ho-Fun Lee
- b Department of Clinical Oncology , University of Hong Kong , Pokfulam , Hong Kong
| | - Anne W M Lee
- b Department of Clinical Oncology , University of Hong Kong , Pokfulam , Hong Kong
| | | | - Cecilia L W Chan
- a Department of Social Work & Social Administration , University of Hong Kong , Pokfulam , Hong Kong
| |
Collapse
|
17
|
Holtslander L, Baxter S, Mills K, Bocking S, Dadgostari T, Duggleby W, Duncan V, Hudson P, Ogunkorode A, Peacock S. Honoring the voices of bereaved caregivers: a Metasummary of qualitative research. BMC Palliat Care 2017; 16:48. [PMID: 28877699 PMCID: PMC5585890 DOI: 10.1186/s12904-017-0231-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 08/31/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Family caregiving in the context of advanced disease in particular, can be physically and emotionally taxing. Caregivers can subsequently face bereavement exhausted with few supports, limited resources and a significant proportion will develop negative psychological and social outcomes. Although some research has attended to the bereavement experiences of family caregivers who had cared for a person requiring palliative care, a comprehensive qualitative understanding of the impact of caregiving on bereavement has not been articulated. The purpose of this study was to conduct a qualitative metasummary to explore the experiences of bereaved family caregivers of people who received palliative care services, regardless of their underlying disease. METHODS Sandelowski and Barroso's qualitative metasummary method was utilized: 1287 articles were identified through extensive database searches (i.e. - MEDLINE, PsychINFO, and CINAHL) and reviewed to determine if they fit the criteria. Those included in the review were assessed for study quality. Findings from each study were then thematically coded and a frequency of themes was calculated. RESULTS The sample consisted of 47 qualitative studies. A total of 15 themes emerged. In descending order of frequency, the 15 themes were: the individual emotions of serenity, sadness, guilt, uncertainty, trauma, escape, and anger; post-loss experiences that helped the caregiver in bereavement; post-loss experiences that hindered; practical life changes; caregiver role identity; pre-loss experiences that helped; pre-loss experiences that hindered; caregiver context; and a need for different kinds of supports. Three key findings emerged from the themes: (1) many different aspects of the caregiving experience impact the bereavement experience, (2) every bereavement experience is unique, and (3) a variety of supports must be developed and made available to caregivers to meet these unique needs. CONCLUSIONS Based on the metasummary findings, changes are needed in practice and policy to ensure the health and well-being of the family caregiver is maintained by offering support both during caregiving and bereavement.
Collapse
Affiliation(s)
- Lorraine Holtslander
- College of Nursing, University of Saskatchewan, Rm 4216, E-Wing Health Sciences, 104 Clinic Place, Saskatoon, SK S7N 2Z2 Canada
- University of the Witwatersrand, Johannesburg, South Africa
| | - Sharon Baxter
- Executive Director of the Canadian Hospice Palliative Care Association, Ottawa, ON Canada
| | - Kelly Mills
- RA; College of Education, University of Saskatchewan, Saskatoon, SK Canada
| | - Sarah Bocking
- RA, College of Nursing, University of Saskatchewan, Saskatoon, SK Canada
| | | | - Wendy Duggleby
- Faculty of Nursing, University of Alberta, Edmonton, AB Canada
| | - Vicky Duncan
- University of Saskatchewan, Saskatoon, SK Canada
| | - Peter Hudson
- Palliative Care c/o St. Vincent’s Hospital and Collaborative Centre of the University of Melbourne, Melbourne, Australia
- Palliative Care, Queen’s University, Northern Ireland, UK
| | - Agatha Ogunkorode
- College of Nursing, University of Saskatchewan, Saskatoon, SK Canada
| | - Shelley Peacock
- College of Nursing, University of Saskatchewan, Saskatoon, SK Canada
| |
Collapse
|
18
|
Thorn H, Uhrenfeldt L. Experiences of non-specialist nurses caring for patients and their significant others undergoing transitions during palliative end-of-life cancer care: a systematic review. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2017; 15:1711-1746. [PMID: 28628524 DOI: 10.11124/jbisrir-2016-003026] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Non-specialist nurses, who are providing palliative end-of-life cancer care to patients and significant others undergoing psychosocial and existential transitions, may experience dissatisfaction, frustration and sorrow. On the other hand, they may also experience happiness, increased knowledge and personal growth. OBJECTIVE/QUESTION What are non-specialist nurses' experiences when providing palliative end-of-life cancer care that involves the psychosocial and existential transitions of their patients and significant others? INCLUSION CRITERIA TYPES OF PARTICIPANTS The current review considered studies that included a description of the experiences of non-specialist trained registered nurses (RNs) working in non-specialist wards. PHENOMENA OF INTEREST The current review considered studies that investigated experiences of RNs when providing palliative end-of-life cancer care that involves the psychosocial and existential transitions of their patients and significant others. CONTEXT The contact and care for patients and their significant others during palliative end-of-life cancer care. TYPES OF STUDIES The current review considered studies that focused on qualitative data including, but not limited to, designs such as phenomenology, grounded theory, ethnography, action research and feminist research. SEARCH STRATEGY The search aimed at finding both published and unpublished studies in English, Danish, Norwegian, Swedish and German, and was unrestricted by time. Eleven electronic databases and seven websites were searched. METHODOLOGICAL QUALITY Methodological validity of the qualitative papers was assessed independently by two reviewers using the standardized critical appraisal instruments from the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI). DATA EXTRACTION Data were extracted from papers included in the review using the standardized data extraction tool from the JBI-QARI. DATA SYNTHESIS Qualitative research findings were synthesized using the JBI-QARI. RESULTS A total of 81 findings were extracted from the three studies and allocated to five categories and merged into a meta-synthesis with the overarching synthesized finding related to the challenges that non-specialist nurses faced when providing palliative end-of-life cancer care. The summary of findings is illustrated below. CONCLUSION The studies in this review provided useful and credible statements from non-specialist nurses working in non-specialist wards about their challenges when providing palliative end-of-life cancer care to patients and their significant others undergoing psychosocial and existential transitions.
Collapse
Affiliation(s)
- Hrønn Thorn
- 1Department of Gynecology and Obstetrics, Horsens Regional Hospital, Horsens, Denmark 2Department of Research, Horsens Regional Hospital, Horsens, Denmark 3Department of Health Science and Technology, Aalborg University, Aalborg, Denmark 4Danish Center of Systematic Reviews: a Joanna Briggs Institute Centre of Excellence, the Center of Clinical Guidelines - Clearing House, Aalborg University, Aalborg, Denmark 5Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
| | | |
Collapse
|
19
|
Anderson EW, White KM. "It Has Changed My Life": An Exploration of Caregiver Experiences in Serious Illness. Am J Hosp Palliat Care 2017; 35:266-274. [PMID: 28413927 PMCID: PMC5768253 DOI: 10.1177/1049909117701895] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background: Informal, unpaid caregivers shoulder much of the care burden for individuals with serious illness. As part of a project to create an innovative model of supportive care for serious illness, a series of user interviews were conducted, forming the basis for this article. Objective: To understand both individual and interpersonal aspects of caregiving for serious illness. Methods: Twelve semistructured group interviews were conducted with patients, families, and professionals as part of a larger study of late-life serious illness. Transcript data were analyzed with descriptive coding, and then coded material was analyzed to elicit major themes and subthemes. Results: A total of 73 individuals participated in group interview sessions. Using descriptive coding, quotes were assigned to first-order codes of rewards, challenges, and a category of learnings and adaptations. Subthemes of reward included gratitude, a sense of accomplishment or mastery, and closeness in personal relationships. The most oft-cited challenges included emotional and physical stresses of caregiving and feeling unprepared or unsupported in caregiving. Reflecting on their experiences, caregivers cited new ways in which they had learned to be creative, to show assertiveness and advocacy, and to create personal balance in a demanding situation. Conclusions: The experience of caregiving is a life-altering journey as individuals rise to challenges and reflect on the rewards. Caregivers described intensive caregiving, often without acknowledgment or understanding of their role from the health-care system. This invisibility created its own iatrogenic caregiving challenge. The identified themes suggest avenues of meaningful caregiver support that bear further exploration.
Collapse
Affiliation(s)
- Eric W Anderson
- 1 Late Life Supportive Care, Division of Applied Research, Allina Health, Minneapolis, MN, USA
| | - Katie M White
- 2 Division of Health Policy & Management, University of Minnesota School of Public Health, Minneapolis, MN, USA
| |
Collapse
|
20
|
|
21
|
Coelho A, Barbosa A. Family Anticipatory Grief: An Integrative Literature Review. Am J Hosp Palliat Care 2016; 34:774-785. [DOI: 10.1177/1049909116647960] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Despite all the investment in research, uncertainty persists in anticipatory grief (AG) literature, concerning its nuclear characteristics and definition. This review aimed to synthesize recent research in order to develop further knowledge about the family experience of AG during a patient’s end of life. An integrative review was performed using standard methods of analysis and synthesis. The electronic databases Medline, Web of Knowledge, and EBSCO and relevant journals were systematically searched since 1990 to October 2015. Twenty-nine articles were selected, the majority with samples composed of caregivers of terminally ill patients with cancer. From systematic comparison of data referring to family end-of-life experience emerged 10 themes, which correspond to AG nuclear characteristics: anticipation of death, emotional distress, intrapsychic and interpersonal protection, exclusive focus on the patient care, hope, ambivalence, personal losses, relational losses, end-of-life relational tasks, and transition. For the majority of family caregivers in occidental society, AG is a highly stressful and ambivalent experience due to anticipation of death and relational losses, while the patient is physically present and needed of care, so family must be functional and inhibit grief expressions. The present study contributes to a deeper conceptualization of this term and to a more sensitive clinical practice.
Collapse
Affiliation(s)
- Alexandra Coelho
- Palliative Medicine Unit, Santa Maria Hospital, Lisbon, Portugal
| | - António Barbosa
- Medicine Faculty, Palliative Medicine Unit, Santa Maria Hospital, University of Lisbon, Lisbon, Portugal
| |
Collapse
|
22
|
van Eechoud I, Grypdonck M, Leman J, Van Den Noortgate N, Deveugele M, Verhaeghe S. Balancing truth-telling: relatives acting as translators for older adult cancer patients of Turkish or northwest African origin in Belgium. Eur J Cancer Care (Engl) 2016; 26. [DOI: 10.1111/ecc.12498] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2016] [Indexed: 11/27/2022]
Affiliation(s)
- I. van Eechoud
- Department of Social Work and Diversity & Intercultural Mediation of the University Hospital Ghent; Ghent Belgium
- Department of Public Health; University Centre for Nursing and Midwifery; Ghent University; Ghent Belgium
| | - M. Grypdonck
- Department of Public Health; University Centre for Nursing and Midwifery; Ghent University; Ghent Belgium
| | - J. Leman
- Department of Social Sciences; KULeuven; Leuven Belgium
| | | | - M. Deveugele
- Department of Family Practice and Primary Health Care; Ghent University; Ghent Belgium
| | - S. Verhaeghe
- Department of Public Health; University Centre for Nursing and Midwifery; Ghent University; Ghent Belgium
| |
Collapse
|
23
|
Holtslander L, Duggleby W, Teucher U, Cooper D, Bally JM, Solar J, Steeves M. Developing and pilot-testing a Finding Balance Intervention for older adult bereaved family caregivers: A randomized feasibility trial. Eur J Oncol Nurs 2016; 21:66-74. [DOI: 10.1016/j.ejon.2016.01.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 01/07/2016] [Accepted: 01/17/2016] [Indexed: 11/26/2022]
|
24
|
Möllerberg ML, Sandgren A, Lithman T, Noreen D, Olsson H, Sjövall K. The effects of a cancer diagnosis on the health of a patient's partner: a population-based registry study of cancer in Sweden. Eur J Cancer Care (Engl) 2016; 25:744-52. [DOI: 10.1111/ecc.12487] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2016] [Indexed: 01/28/2023]
Affiliation(s)
- M.-L. Möllerberg
- Department of Health and Caring Sciences; Linnaeus University; Växjö Sweden
- Department of Oncology; Skåne University Hospital; Lund Sweden
| | - A. Sandgren
- Department of Health and Caring Sciences; Linnaeus University; Växjö Sweden
- Center for Collaborative Palliative Care; Linnaeus University; Växjö Sweden
| | - T. Lithman
- Department of Cancer Epidemiology; Clinical Sciences; Lund University; Lund Sweden
| | - D. Noreen
- Department of Cancer Epidemiology; Clinical Sciences; Lund University; Lund Sweden
| | - H. Olsson
- Department of Oncology; Skåne University Hospital; Lund Sweden
- Department of Cancer Epidemiology; Clinical Sciences; Lund University; Lund Sweden
- Department of Oncology; Clinical Sciences; Lund University; Lund Sweden
| | - K. Sjövall
- Department of Oncology; Skåne University Hospital; Lund Sweden
- Department of Oncology; Clinical Sciences; Lund University; Lund Sweden
| |
Collapse
|
25
|
Toyama H, Honda A. Using Narrative Approach for Anticipatory Grief Among Family Caregivers at Home. Glob Qual Nurs Res 2016; 3:2333393616682549. [PMID: 28462354 PMCID: PMC5342864 DOI: 10.1177/2333393616682549] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 10/16/2016] [Accepted: 10/25/2016] [Indexed: 01/01/2023] Open
Abstract
Family caregivers of patients with terminal-stage cancer have numerous roles as caregivers, which can influence their anticipatory grief. The purpose of this study was to clarify how talking to family caregivers of patients with terminal illness using the narrative approach can influence such caregivers' process of anticipatory grief. We conducted the narrative approach as an intervention with two family caregivers several times and qualitatively analyzed their narratives. The results indicated that these family caregivers had two primary roles-family member and caregiver-and that family caregivers felt trapped in their caregiver role. The narrative approach helped them transition into the role needed for coping with the loss.
Collapse
Affiliation(s)
- Hiroko Toyama
- The JIKEI University school of Nursing, Tokyo, Japan
- Tokyo Medical and Dental University Graduate School of Health Care Sciences, Tokyo, Japan
| | - Akiko Honda
- Tokyo Medical and Dental University Graduate School of Health Care Sciences, Tokyo, Japan
| |
Collapse
|
26
|
LeSeure P, Chongkham-Ang S. The Experience of Caregivers Living with Cancer Patients: A Systematic Review and Meta-Synthesis. J Pers Med 2015; 5:406-39. [PMID: 26610573 PMCID: PMC4695863 DOI: 10.3390/jpm5040406] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 11/10/2015] [Accepted: 11/12/2015] [Indexed: 11/16/2022] Open
Abstract
The objectives of this meta-synthesis were to: (1) explore the experience of caregivers who were caring for cancer patients, including their perceptions and responses to the situation; and (2) describe the context and the phenomena relevant to the experience. Five databases were used: CINAHL, MEDLINE, Academic Search, Science Direct, and a Thai database known as the Thai Library Integrated System (ThaiLIS). Three sets of the context of the experience and the phenomena relevant to the experience were described. The contexts were (1) having a hard time dealing with emotional devastation; (2) knowing that the caregiving job was laborious; and (3) knowing that I was not alone. The phenomenon showed the progress of the caregivers’ thoughts and actions. A general phenomenon of the experience—balancing my emotion—applied to most of the caregivers; whereas, more specific phenomenon—keeping life as normal as possible and lifting life above the illness—were experienced by a lesser number of the caregivers. This review added a more thorough explanation of the issues involved in caregiving for cancer patients. A more comprehensive description of the experience of caregiving was described. The findings of this review can be used to guide clinical practice and policy formation in cancer patient care.
Collapse
Affiliation(s)
- Peeranuch LeSeure
- McCormick Faculty of Nursing, Payap University, Chiang Mai 50000, Thailand.
| | | |
Collapse
|
27
|
Henoch I, Carlander I, Holm M, James I, Kenne Sarenmalm E, Lundh Hagelin C, Lind S, Sandgren A, Öhlén J. Palliative Care Research - A Systematic Review of foci, designs and methods of research conducted in Sweden between 2007 and 2012. Scand J Caring Sci 2015; 30:5-25. [DOI: 10.1111/scs.12253] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 05/06/2015] [Indexed: 12/14/2022]
Affiliation(s)
- Ingela Henoch
- Institute of Health and Care Sciences; The Sahlgrenska Academy at the University of Gothenburg; Gothenburg Sweden
- University of Gothenburg Centre for Person-Centred Care (GPCC); University of Gothenburg; Gothenburg Sweden
| | - Ida Carlander
- Palliative Research Centre; Ersta Sköndal University College and Ersta Hospital; Stockholm Sweden
- Medical Management Center; Department of Learning, Informatics, Management and Ethics; Karolinska Institutet; Stockholm Sweden
| | - Maja Holm
- Palliative Research Centre; Ersta Sköndal University College and Ersta Hospital; Stockholm Sweden
- Department of Neurobiology; Care Sciences and Society; Karolinska Institutet; Stockholm Sweden
| | - Inger James
- School of Health and Medical Sciences; Örebro University; Örebro Sweden
| | - Elisabeth Kenne Sarenmalm
- Palliative Research Centre; Ersta Sköndal University College and Ersta Hospital; Stockholm Sweden
- Research and Development Centre; Skaraborg Hospital; Skövde Sweden
| | - Carina Lundh Hagelin
- Medical Management Center; Department of Learning, Informatics, Management and Ethics; Karolinska Institutet; Stockholm Sweden
- Sophiahemmet University; Stockholm Sweden
- Research and Development Unit in Palliative care; Stockholms Sjukhem Foundation; Stockholm Sweden
| | - Susanne Lind
- Palliative Research Centre; Ersta Sköndal University College and Ersta Hospital; Stockholm Sweden
- Department of Neurobiology; Care Sciences and Society; Karolinska Institutet; Stockholm Sweden
| | - Anna Sandgren
- School of Health Sciences; Jönköping University; Jönköping Sweden
- Center for Collaborative Palliative Care; Department of Health and Caring Sciences; Linneaus University; Kalmar/Växjö Sweden
| | - Joakim Öhlén
- Institute of Health and Care Sciences; The Sahlgrenska Academy at the University of Gothenburg; Gothenburg Sweden
- University of Gothenburg Centre for Person-Centred Care (GPCC); University of Gothenburg; Gothenburg Sweden
- Palliative Research Centre; Ersta Sköndal University College and Ersta Hospital; Stockholm Sweden
| |
Collapse
|
28
|
Abstract
OBJECTIVE Caregiving partners constitute a unique group, who provide both physical and emotional care for patients. There has been extensive research conducted on caregivers during either the caregiving or bereavement phase; however, these phases are often treated as separate entities rather than as part of a continuum. METHOD In this paper, utilizing relevant literature and clinical observations, we map the emotional journey and lived experience of caregivers moving from disease progression, to the end of life, to the dying process itself, and then through life after the death of a partner. Along this journey, we identify the links between pre-death caregiving and bereavement. RESULTS Our illustration raises awareness regarding the unmet needs experienced by caregiving partners across the continuum and provides an alternative framework through which clinicians can view this course. SIGNIFICANCE of Results We bolster arguments for improved palliative care services and early interventions with distressed caregiving partners by emphasizing continuity of care both before and after a patient's death.
Collapse
|
29
|
Sherman DW, McGuire DB, Free D, Cheon JY. A pilot study of the experience of family caregivers of patients with advanced pancreatic cancer using a mixed methods approach. J Pain Symptom Manage 2014; 48:385-99.e1-2. [PMID: 24291294 DOI: 10.1016/j.jpainsymman.2013.09.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 09/18/2013] [Accepted: 09/19/2013] [Indexed: 01/06/2023]
Abstract
CONTEXT Pancreatic cancer presents a wide spectrum of significant symptomatology. The high symptom burden, coupled with a rapidly fatal diagnosis, limits preparation or time for adjustment for both patients and their family caregivers. From the initial diagnosis and throughout the illness experience, the physical and emotional demands of caregiving can predispose caregivers themselves to illness and a greater risk of mortality. Understanding the negative and positive aspects of caregiving for patients with advanced pancreatic cancer will inform interventions that promote positive caregiver outcomes and support caregivers in their role. OBJECTIVES To provide feasibility data for a larger, mixed methods, longitudinal study focused on the experience of family caregivers of patients with advanced pancreatic cancer and preliminary qualitative data to substantiate the significance of studying this caregiver population. METHODS This was a mixed methods study guided by the Stress Process Model. Eight family caregivers of patients with advanced pancreatic cancer from oncology practices of a university-affiliated medical center were surveyed. RESULTS The pilot results supported the ability to recruit and retain participants and informed recruitment and data collection procedures. The qualitative results provided preliminary insights into caregiver experiences during the diagnosis and treatment phases. Key findings that substantiated the significance of studying these caregivers included the caregiving context of the history of sentinel symptoms, the crisis of diagnosis, the violation of assumptions about life and health, recognition of the circle of association, and contextual factors, as well as primary and secondary stressors, coping strategies, resources, discoveries, gains and growth, associated changes/transitions, and unmet caregiver needs. CONCLUSION Findings indicated caregivers' willingness to participate in research, highlighted the negative and positive aspects of the caregiver experience, and reinforced the significance of the future study and the need to develop interventions to support family caregivers in their roles.
Collapse
Affiliation(s)
| | | | - David Free
- Department of Pain Medicine and Palliative Care, Beth Israel Medical Center, New York, New York, USA
| | - Joo Young Cheon
- University of Maryland School of Nursing, Baltimore, Maryland, USA
| |
Collapse
|
30
|
Stenberg U, Ekstedt M, Olsson M, Ruland CM. Living close to a person with cancer: a review of the international literature and implications for social work practice. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2014; 57:531-555. [PMID: 24611782 DOI: 10.1080/01634372.2014.881450] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
To help family caregivers (FCs), social workers need to understand the complexity of FC's experiences and challenges. For this systematic review, several relevant, multidisciplinary electronic databases were searched. Of 1,643 titles identified, 108 articles met the inclusion criteria and are included in this review. Various experiences, symptoms, and burden related to caregiving responsibilities are described and discussed. The understanding evolving from this study about the FC's own health risk, caregiver burden, and experiences over time can enhance a social worker's awareness of an FC's challenging situation and the potential impact this has on the FC's ability to provide care to the patient.
Collapse
Affiliation(s)
- Una Stenberg
- a Center for Shared Decision Making and Collaborative Care Research and Section for Physiotherapy and Social Medicine, Oslo University Hospital , Oslo , Norway
| | | | | | | |
Collapse
|
31
|
Madsen R, Uhrenfeldt L. Palliative patients’ and their significant others’ experiences of transitions concerning organizational, psychosocial and existential issues during the course of incurable cancer: a systematic review protocol. ACTA ACUST UNITED AC 2014. [DOI: 10.11124/jbisrir-2014-1161] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
|
32
|
Thorn H, Uhrenfeldt L. Experiences of non-specialist nurses with patients and their significant others undergoing transitions during palliative end-of-life care: a systematic review protocol. ACTA ACUST UNITED AC 2014. [DOI: 10.11124/jbisrir-2014-1534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
|
33
|
|
34
|
Milbury K, Badr H, Fossella F, Pisters KM, Carmack CL. Longitudinal associations between caregiver burden and patient and spouse distress in couples coping with lung cancer. Support Care Cancer 2013; 21:2371-9. [PMID: 23546537 DOI: 10.1007/s00520-013-1795-6] [Citation(s) in RCA: 113] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Accepted: 03/14/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE While spouses play a vital role in the care of cancer patients, caregiving exerts a physical and psychological toll. Caregiving burden may not only compromise spouses' quality of life but also the quality of care and support they are able to provide. Consequently, spousal caregiving burden may also negatively impact patients' psychological adjustment. However, the effect of caregiving burden on patients' psychological distress is unknown. Thus, this 6-month longitudinal study examined the associations between caregiving burden and distress in both lung cancer patients and their spouses. METHODS Patients and their spouses individually completed questionnaires within 1 month of treatment initiation (baseline) and at 3- and 6-month follow-up. Distress was measured with the Brief Symptom Inventory and caregiving burden with the Caregiver Reaction Assessment. RESULTS Multilevel modeling of data from 158 couples revealed that baseline spouses' reports of caregiving-related health problems were significantly associated with 3-month (p < 0.001) and 6-month (p = 0.01) follow-up distress in both patients and spouses even when controlling for baseline distress and dyadic adjustment. Furthermore, there was evidence that baseline spouses' reports of schedule disruption (p = 0.05) predicted 3-month patients' distress and baseline spouses' reports of financial strain (p < 0.05) and lack of support (p < 0.10) predicted their own distress at 6 month. CONCLUSION Caregiving burden is problematic for both patients and spouses. Couples in which spouses report caregiving-related health problems may be at particular high risk of long-term elevated distress. Targets of future couple-focused interventions such as self-care and use of social support are discussed.
Collapse
Affiliation(s)
- Kathrin Milbury
- Department of General Oncology, Unit 642, The University of Texas MD Anderson Cancer Center, 1400 Holcombe Blvd, Houston, TX 77030-4006, USA.
| | | | | | | | | |
Collapse
|
35
|
Abstract
PURPOSE OF REVIEW The support of family caregivers in palliative care is critical and well recognized; yet the fact that caregivers still face significant unmet needs highlights a considerable gap in addressing this issue. Current themes on the caregiving experience in palliative care are presented. RECENT FINDINGS The recent literature suggests a shift towards a broader understanding of the caregiving experience in palliative care in terms of better integration of caregivers of patients with noncancer illnesses into palliative care, improved continuity of care among different settings and better integration of guidelines and evidence into practice. Several risk groups and factors of caregiving in palliative care have been identified. The literature review emphasizes a public health approach as an important step in addressing the caregivers' burden. While 'the right way' of supporting caregivers is still to be established, consideration of caregivers' roles as co-providers and co-recipients of care offers numerous implications for research and clinical practice. SUMMARY This review demonstrates the need for the development of specific strategies aimed at supporting informal caregivers in caring for their loved ones in different settings and periods of advanced life-threatening illnesses. Open issues in searching for 'the right way' to care for caregivers in palliative care are presented.
Collapse
|