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Marcussen J, Madsen R, Bonner A, Agerskov H. Perceptions of haemodialysis nurses regarding patients' and families' loss and grief. J Ren Care 2024; 50:223-231. [PMID: 37717218 DOI: 10.1111/jorc.12479] [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: 03/30/2023] [Revised: 08/21/2023] [Accepted: 09/01/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND The experience of loss and grief in patients' lives with life-long treatment in haemodialysis, and in their families' lives is a major cause of mental health problems. In practice, nurses often describe a lack of time and limited knowledge of how to provide nursing care in situations of loss and grief, thus finding out from nurses' perspectives of what competencies they need to provide care would be useful for the development of nursing practice. OBJECTIVES To develop knowledge in a nursing perspective of competencies to provide care for patients and their families, who experience grief linked to loss due to kidney failure, haemodialysis and/or death. DESIGN The study took a phenomenological-hermeneutical approach. Semi-structured interviews were conducted 12 nurses caring for patients receiving haemodialysis with no kidney transplantation option and family members. Ricoeur's interpretation theory involving naïve reading, structural analysis and critical interpretation and discussion was used for analysis. RESULTS Four themes emerged of nurse's experiences: (1) patient's loss and grief in everyday life, (2) dealing with supportive conversations when caring for patients, (3) families' losses are resulting in grief reactions and (4) importance of close relationships when caring for families. CONCLUSIONS To nurses, patients on haemodialysis and their families have multiple loss and grief experiences. Nurses' working in kidney care need to develop competencies to support patients and families to cope with grief and loss. Further research is needed to develop these competencies and then to implement in education and practice.
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Affiliation(s)
- Jette Marcussen
- OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Health and Nature, University of Greenland, Nuuk, Greenland
- Faculty of Health Sciences, Health Science Research Center, UCL University College, Niels Bohrs Alle 1, Odense M, Denmark
| | - Rikke Madsen
- Faculty of Health Sciences, Faculty of Nursing, Health Science Research Center, UCL University College, Vejle, Denmark
| | - Ann Bonner
- School of Nursing and Midwifery, Griffith University, Brisbane, QLD, Australia
- Kidney Health Service, Townsvill University Hospital, Townsville, QLD, Australia
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Hanne Agerskov
- Department of Nephrology, Odense University Hospital, Odense, Denmark
- Department of Clinical Institute and Family Focused Health Care Research Centre, University of Southern Denmark, Odense, Denmark
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Phillips CS, Hebdon M, Cleary C, Ravandi D, Pottepalli V, Siddiqi Z, Rodriguez E, Jones BL. Expressive Arts Interventions to Improve Psychosocial Well-Being in Caregivers: A Systematic Review. J Pain Symptom Manage 2024; 67:e229-e249. [PMID: 38043748 DOI: 10.1016/j.jpainsymman.2023.11.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 11/20/2023] [Accepted: 11/24/2023] [Indexed: 12/05/2023]
Abstract
CONTEXT Over 43 million caregivers provide care and support in the United States. Increased stress and burden may contribute to poor psychosocial well-being. Recently, there has been an emergence of art-based interventions to improve well-being among care receivers and caregivers. A synthesis of this literature evaluating expressive arts interventions (EAIs) with caregivers is needed. OBJECTIVES Identify the nature and impact of EAIs for caregivers and outline directions for future research. METHODS Systematic searches were conducted in PubMed/MEDLINE, CINAHL, PsychINFO, and Web of Science for relevant studies between 2001 and 2022. Inclusion criteria included EAI addressing psychosocial well-being of caregivers, quantitative and mixed methods studies, and written in English. RESULTS Twenty-seven studies were included (1359 participants). There was a diverse global representation of countries (n = 14). Twelve studies were randomized controlled trials. The majority (n = 11) were conducted with dementia/alzheimers caregivers and 41% (n = 11) were delivered to the caregiver/receiver dyad. Fifty-nine percent of the EAIs were music-based, 22% were visual arts, and 10% were writing. Intervention length varied from a single one-hour session to biweekly for 10-months; eight lasted two-weeks. Overall, stress improved in 80% of the studies, anxiety in 69%, caregiver burden in 57%, and depressive symptoms in 31%. CONCLUSION Caregivers are essential to the care of people with medically complex and life-limiting conditions. EAIs hold the potential to improve psychosocial outcomes for caregivers, are used globally, and can be culturally tailored. Future research should examine intervention duration and intensity, measures to address additional dimensions of psychsocial well-being, and implementation in additional caregiver populations.
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Affiliation(s)
- Carolyn S Phillips
- The University of Texas at Austin (C.S.P., M.H., C.C.), School of Nursing, Austin, Texas, USA.
| | - Megan Hebdon
- The University of Texas at Austin (C.S.P., M.H., C.C.), School of Nursing, Austin, Texas, USA
| | - Catie Cleary
- The University of Texas at Austin (C.S.P., M.H., C.C.), School of Nursing, Austin, Texas, USA
| | - Dona Ravandi
- The University of Texas at Austin (C.S.P., M.H., C.C.), School of Nursing, Austin, Texas, USA
| | | | - Zaniah Siddiqi
- The University of Texas at Austin (D.R., V.P., Z.S.), Austin, Texas, USA
| | - Erin Rodriguez
- Department of Educational Psychology (E.R.), The University of Texas at Austin, Austin, Texas, USA
| | - Barbara L Jones
- The University of Texas at Austin (B.L.J.), Steve Hicks School of Social Work, Austin, Texas, USA
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Thrower C, Barrie C, Baxter S, Bloom M, Borja MC, Butters A, Dudgeon D, Haque A, Lee S, Mahmood I, Mirhosseini M, Mirza RM, Murzin K, Ankita A, Skantharajah N, Vadeboncoeur C, Wan A, Klinger CA. Interventions for Grieving and Bereaved Informal Caregivers: A Scoping Review of the Canadian Literature. J Palliat Care 2023; 38:215-224. [PMID: 35726197 PMCID: PMC10026166 DOI: 10.1177/08258597221101826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: The palliative approach to care is playing a larger role in the healthcare of older adults in Canada. Within (hospice) palliative care, informal caregivers play a crucial role as part of the interdisciplinary care team. Ensuring high quality palliative care includes providing effective grief and bereavement supports for them. Objective: This study aimed to identify current interventions addressing the grief and bereavement experiences of informal caregivers of geriatric patients in the Canadian (hospice) palliative/end-of-life care realm. Methods: A scoping review was undertaken using Arksey and O'Malley's framework. Seven electronic health and social science databases were searched. In addition, several stakeholder organizations' websites were reviewed to identify grey literature sources. Interventions that took place in Canada, were in English, and explored grief and bereavement supports for informal caregivers in an adult/geriatric (hospice) palliative care setting were included. After full text review, data were extracted and charted. Major themes were established following thematic content analysis. Results: Within a total of 18 sources, three themes were identified: (1) Classification of intervention, (2) Format of intervention, and (3) Intervention target. Method of delivery and type of intervention for grief and bereavement supports were aligned with the international literature. There is a need for large-scale evaluations of interventions and informal caregivers should be engaged in this process. Practitioners should be encouraged to direct bereavement interventions toward grieving caregivers, and to collaborate with them to improve access to these interventions. Policy makers should provide additional funding for grief interventions for informal caregivers. Conclusions: It is important to better understand the needs of informal caregivers experiencing grief and bereavement. Interdisciplinary collaborations will be necessary to develop, evaluate, and scale future interventions.
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Affiliation(s)
- Carly Thrower
- Translational Research Program, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Carol Barrie
- Canadian Frailty Network (CFN), Kingston, Ontario, Canada
- Quality End-of-Life Care Coalition of Canada (QELCCC), Ottawa, Ontario, Canada
| | - Sharon Baxter
- Quality End-of-Life Care Coalition of Canada (QELCCC), Ottawa, Ontario, Canada
- Canadian Hospice Palliative Care Association (CHPCA), Ottawa, Ontario, Canada
| | - Meryl Bloom
- Global Health Office, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Maria Carolina Borja
- Health Studies Program, Faculty of Arts and Science, University of Toronto, Toronto, Ontario, Canada
| | - Anica Butters
- Health Studies Program, Faculty of Arts and Science, University of Toronto, Toronto, Ontario, Canada
| | - Deborah Dudgeon
- Quality End-of-Life Care Coalition of Canada (QELCCC), Ottawa, Ontario, Canada
- Canadian Partnership Against Cancer (CPAC), Toronto, Ontario, Canada
- School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Ayeshah Haque
- Translational Research Program, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Suzanna Lee
- Health Studies Program, Faculty of Arts and Science, University of Toronto, Toronto, Ontario, Canada
| | - Iqra Mahmood
- Health Studies Program, Faculty of Arts and Science, University of Toronto, Toronto, Ontario, Canada
| | - Mehrnoush Mirhosseini
- Quality End-of-Life Care Coalition of Canada (QELCCC), Ottawa, Ontario, Canada
- College of Family Physicians of Canada (CFPC), Mississauga, Ontario, Canada
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Raza M Mirza
- Translational Research Program, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Life Course and Aging, Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
- National Initiative for the Care of the Elderly (NICE), Toronto, Ontario, Canada
| | - Kate Murzin
- Quality End-of-Life Care Coalition of Canada (QELCCC), Ottawa, Ontario, Canada
- Realize, Toronto, Ontario Canada
| | - Ankita Ankita
- Translational Research Program, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Neerjah Skantharajah
- Translational Research Program, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Christina Vadeboncoeur
- Quality End-of-Life Care Coalition of Canada (QELCCC), Ottawa, Ontario, Canada
- Canadian Network of Palliative Care for Children (CNPCC), Ottawa, Ontario, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Andrew Wan
- Translational Research Program, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Christopher A Klinger
- Translational Research Program, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Quality End-of-Life Care Coalition of Canada (QELCCC), Ottawa, Ontario, Canada
- Life Course and Aging, Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
- National Initiative for the Care of the Elderly (NICE), Toronto, Ontario, Canada
- Department of Family Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Pallium Canada, Ottawa, Ontario, Canada
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Nursing care and nurses' understandings of grief and bereavement among patients and families during cancer illness and death - A scoping review. Eur J Oncol Nurs 2023; 62:102260. [PMID: 36610290 DOI: 10.1016/j.ejon.2022.102260] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 12/08/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE Grief and bereavement is often present among patients and families during courses of cancer. Offering support for both patients and families is essential in the context of cancer nursing. Present scoping review offers an overview of existing knowledge, which can be used for inspiration in cancer-nursing. Hence, the objective of this study was to identify understandings of grief and bereavement, which is present in a cancer-nursing context and to develop insight on existing knowledge about nursing interventions targeted patients and their families' experiences of grief and bereavement due to cancer illness. METHOD The scoping review is conducted, inspired by the methodology of Joanna Briggs Institute. Sources of evidence are retrieved from a large number of databases and resources. RESULTS Twenty-two studies are included in the scoping review. The studies are retrieved from eight different countries. Findings are mapped in nine categories. Eight categories related to nursing care targeted patients and/or families experiencing grief and/or bereavement; One category related to understandings of grief and/or bereavement targeted patients and families. CONCLUSION Nursing interventions to support patients and their families during grief and bereavement covers a broad spectrum of interventions. E.g. communication; using artwork; cultural and spiritual care; bereavement care; supporting coping strategies. Different models and theoretical understandings were identified. E.g. The dual process model of coping with bereavement; A Divorced Family-focused Care Model; Family Strengths-Oriented Therapeutic Conversation (Fam-SOTC); and understandings of children's grieving process.
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You H, Wang Y, Xiao LD, Liu L. Prevalence of and Factors Associated with Negative Psychological Symptoms among Elderly Widows Living Alone in a Chinese Remote Sample: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:ijerph20010264. [PMID: 36612585 PMCID: PMC9819587 DOI: 10.3390/ijerph20010264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 12/15/2022] [Accepted: 12/21/2022] [Indexed: 06/12/2023]
Abstract
(1) Background: Research indicates that most elderly widows are at a high risk of experiencing negative psychological symptoms. It is common for elderly women in rural and remote areas to live alone without family support to cope with stress due to the mass rural-to-urban migration of China’s youth labor force. Such a situation further worsens their psychological health and well-being. However, the prevalence of and risk factors associated with negative psychological symptoms (loneliness, depression, and anxiety) among remote elderly widows living alone in China are currently unclear; (2) Methods: A cross-sectional study was conducted in Hunan Province, China. The loneliness was assessed through the University of California at Los Angeles Loneliness Scale (ULS-8). The depression and anxiety were assessed with the Short Form Geriatric Depression Scale (GDS-15) and Generalized Anxiety Disorder Scale (GAD-7), respectively. The Chi-square test and correlation analysis were conducted to identify factors associated with negative psychological symptoms. Logistic regression was performed to predict risk and protective factors contributing to loneliness, depression, and anxiety symptoms. The significance level was set as p < 0.05; (3) Results: A total of 271 remote elderly widows living alone were enrolled in the present study. Additionally, 234 valid questionnaires were returned (valid response rate = 86.3%). The prevalence of loneliness, depression and anxiety was 8.1%, 44.0%, and 16.7%, respectively. Acute or chronic medical conditions, marital happiness, being the primary caregiver before widowhood and anticipating the death of the spouse differed significantly in the distribution of negative psychological symptoms. Logistic regression analysis predicted that participants who were satisfied with their marriage had a lower likelihood to experience loneliness, depression, and anxiety (p < 0.05). Being the spouse’s primary caregiver before widowhood was more likely to have symptoms of loneliness (p < 0.01). Those with various acute or chronic medical conditions were more likely to suffer from depression (p < 0.01); (4) Conclusions: Remote elderly widows living alone in China are prone to loneliness, depression, and anxiety symptoms. Being the primary caregiver before widowhood and having many acute or chronic medical conditions are risk factors for loneliness and depression, respectively. Marital happiness is the protective factor against negative psychological symptoms. To accomplish the goal of equitable access to mental health care in China, evidence-based policy and resource development to support psycho-social interventions that prevent and manage negative psychological symptoms for remote elderly widows living alone are urgently needed.
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Affiliation(s)
- Hui You
- Department of Midwifery, Xiangya School of Nursing, Central South University, Changsha 410013, China
| | - Yao Wang
- Department of Midwifery, Xiangya School of Nursing, Central South University, Changsha 410013, China
| | - Lily Dongxia Xiao
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA 5042, Australia
| | - Li Liu
- Department of Community Nursing, Xiangya School of Nursing, Central South University, Changsha 410013, China
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Davidow JB, Zide BS, Levin LL, Biddle KD, Urizar JC, Donovan NJ. A Scoping Review of Interventions for Spousal Bereavement in Older Adults. Am J Geriatr Psychiatry 2022; 30:404-418. [PMID: 34493416 DOI: 10.1016/j.jagp.2021.08.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/08/2021] [Accepted: 08/09/2021] [Indexed: 01/14/2023]
Abstract
The loss of a spouse is a common and natural life event for older adults. Nearly one of four older bereaved spouses experience prolonged grief, impaired function or chronic depression. Mechanisms underlying these and other long-term health risks are not well understood. We conducted a scoping literature review to examine the interventions and outcomes that have been studied for late-life spousal bereavement to date. We identified 22 studies of group and individual-level interventions with most studies concerning grief processes within the first year. Nearly all studies evaluated emotional and psychological symptoms of loss and a small number evaluated the restoration of adaptive functioning. Four interventions addressed the treatment of complicated grief or grief with major depressive disorder. Qualitative studies explored themes of spirituality and mindfulness. There were 17 controlled studies, including 13 randomized controlled trials. Findings were eclectic, with evidence supporting mindfulness techniques in a group format for emotional and life satisfaction outcomes; an individual, function-based therapy addressing sleep to improve emotion and function; an individual, writing-based emotional expression therapy for short-term improvement in emotion and function; nortriptyline for the treatment of bereavement-related major depressive disorder; a group-based, complicated grief therapy for this condition; an internet-based CBT intervention for prolonged grief; and pharmacotherapy for cardiovascular changes during bereavement. These findings highlight the small literature of methodologically strong intervention studies addressing spousal bereavement in older adults and the need for greater exploration of relevant biological, social, cognitive and behavioral factors to improve short and long term health outcomes.
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Affiliation(s)
- Jennie B Davidow
- Division of Geriatric Psychiatry (JBD, BSZ, KDB, JCU, NJD), Brigham and Women's Hospital, Boston, MA; Harvard Medical School (JBD, LLL, KDB, JCU, NJD), Boston, MA; Department of Psychiatry (NJD), Massachusetts General Hospital, Boston, MA
| | - Benjamin S Zide
- Division of Geriatric Psychiatry (JBD, BSZ, KDB, JCU, NJD), Brigham and Women's Hospital, Boston, MA; Dartmouth College (BSZ), Hanover, NH
| | - Leonard L Levin
- Harvard Medical School (JBD, LLL, KDB, JCU, NJD), Boston, MA
| | - Kelsey D Biddle
- Division of Geriatric Psychiatry (JBD, BSZ, KDB, JCU, NJD), Brigham and Women's Hospital, Boston, MA; Harvard Medical School (JBD, LLL, KDB, JCU, NJD), Boston, MA
| | - Juan Carlos Urizar
- Division of Geriatric Psychiatry (JBD, BSZ, KDB, JCU, NJD), Brigham and Women's Hospital, Boston, MA; Harvard Medical School (JBD, LLL, KDB, JCU, NJD), Boston, MA
| | - Nancy J Donovan
- Division of Geriatric Psychiatry (JBD, BSZ, KDB, JCU, NJD), Brigham and Women's Hospital, Boston, MA; Harvard Medical School (JBD, LLL, KDB, JCU, NJD), Boston, MA; Department of Psychiatry (NJD), Massachusetts General Hospital, Boston, MA; Department of Neurology (NJD), Brigham and Women's Hospital, MA.
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Thiessen M, Harris D, Pinches A, Vaska M, Moules N, Raffin Bouchal S, Sinclair S. Qualitative Studies Conducted Alongside Randomized Controlled Trials in Oncology: A Scoping Review of Use and Rigour of Reporting. Int J Nurs Stud 2022; 128:104174. [DOI: 10.1016/j.ijnurstu.2022.104174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 12/22/2021] [Accepted: 01/05/2022] [Indexed: 01/08/2023]
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Grafiadeli R, Glaesmer H, Hofmann L, Schäfer T, Wagner B. Suicide risk after suicide bereavement: The role of loss-related characteristics, mental health, and hopelessness. J Psychiatr Res 2021; 144:184-189. [PMID: 34673315 DOI: 10.1016/j.jpsychires.2021.09.056] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 08/31/2021] [Accepted: 09/29/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Suicide bereavement is associated with increased risk for severe negative mental health outcomes and suicidality. The purpose of this study was to examine the association between mental health symptoms and suicidal ideation among suicide bereaved while taking multiple factors into account. METHODS The sample consisted of N = 157 German suicide bereaved who were interested in receiving an online intervention. The Beck Scale for Suicide Ideation (BSS) was used to distinguish between participants with and without suicidal ideation. A hierarchical regression analysis determined the effect of the most common mental health symptoms on suicidal ideation: symptoms of depression (BDI-II), prolonged grief (ICG-D), post-traumatic stress (IES-R), and hopelessness (H-RB). RESULTS No significant differences emerged for sociodemographic or loss-related characteristics between suicide bereaved individuals with and without suicidal ideation. Depressive symptom severity was associated with higher suicidal ideation. When controlling for hopelessness, the effect of depression decreased considerably, while hopelessness itself turned out to be the most important predictor variable. DISCUSSION Increased levels of hopelessness commonly reported by suicide bereaved may represent a stronger risk factor for suicidal ideation than mental health disorders. Screening for and targeting hopelessness appears crucial for suicide prevention in this population.
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Tur C, Campos D, Herrero R, Mor S, López-Montoyo A, Castilla D, Quero S. Internet-delivered Cognitive-Behavioral Therapy (iCBT) for Adults with Prolonged Grief Disorder (PGD): A Study Protocol for a Randomized Feasibility Trial. BMJ Open 2021; 11:e046477. [PMID: 34230018 PMCID: PMC8261880 DOI: 10.1136/bmjopen-2020-046477] [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] [Received: 11/02/2020] [Accepted: 06/11/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Grief is an emotional reaction to the loss of a loved one with a natural recovery. Approximately 10% of people who lose a loved one develop prolonged grief disorder (PGD). Internet-based and computer-based interventions (ie, internet-delivered cognitive-behavioural therapy, iCBT) are a cost-effective alternative that makes it possible to reach more people with PGD. The main aim of this study is to assess the feasibility of a new iCBT-called GROw-for PGD. As a secondary objective, the potential effectiveness of GROw will be explored. METHODS AND ANALYSIS This study is a two-arm feasibility randomised trial. A total of 48 adults with PGD who meet the eligibility criteria will be randomised to the experimental group (iCBT: GROw) or the active control group (face-to-face CBT treatment). The treatment is organised sequentially in eight modules in the iCBT format and 8-10 sessions in the face-to-face format, and both formats have the same therapeutic components. There will be five assessment points with qualitative and quantitative evaluations: screening, baseline, after the intervention, 3-month follow-up and 12-month follow-up. Consistent with the objectives, the measures are related to the feasibility outcomes for the main aim of the study (participant adherence, expectations and satisfaction with the treatment, preferences, alliance and utility) and psychological and mental health outcomes for secondary analyses (symptoms of grief, symptoms of depression, symptoms of anxiety, affectivity, quality of life, work and social adaptation, post-traumatic growth, purpose in life, mindfulness and compassion). ETHICS AND DISSEMINATION The Ethics Committee of the Universitat Jaume I (Castellón, Spain) granted approval for the study (CD/002/2019). Dissemination will include publications and presentations at national and international conferences. TRIAL REGISTRATION NUMBER NCT04462146.
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Affiliation(s)
- Cintia Tur
- Department of Basic, Clinical Psychology and Psychobiology, Universitat Jaume I, Castellón de la Plana, Spain
| | - Daniel Campos
- Department of Psychology and Sociology, University of Zaragoza, Huesca, Spain
| | - Rocio Herrero
- Department of Personality, Evaluation and Psychological Treatments, Universidad de Valencia, Valencia, Spain
| | - Sonia Mor
- Department of Basic, Clinical Psychology and Psychobiology, Universitat Jaume I, Castellón de la Plana, Spain
| | - Alba López-Montoyo
- Department of Basic, Clinical Psychology and Psychobiology, Universitat Jaume I, Castellón de la Plana, Spain
| | - Diana Castilla
- Department of Personality, Evaluation and Psychological Treatments, Universidad de Valencia, Valencia, Spain
| | - Soledad Quero
- Department of Basic, Clinical Psychology and Psychobiology, Universitat Jaume I, Castellón de la Plana, Spain
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Carlos III Institute of Health, Madrid, Spain
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Abstract
Objectives: Hope/hopelessness is an important determinant of health and death, and is a modifiable risk factor for older adults. The present review aimed to evaluate the effectiveness of interventions on hope among older populations. Methods: PsychINFO and PubMed were systematically searched. Publications reporting on interventions delivered to older adults that included quantitative data on hope/hopelessness were systematically reviewed. Results: Thirty-six studies were included, most with hope/hopelessness as a secondary outcome. Interventions based on CBT alone or combined with antidepressants significantly decreased hopelessness in depressed older adults. Psychological interventions based on life review effectively improved hope/hopelessness in a range of samples, including depressed, bereaving, or medically ill older adults. Little to no support was found for exercise programs for healthy older adults, educational interventions for medically ill individuals, or Dignity Therapy for palliative care patients. Conclusions: Hope/hopelessness in older adults can be improved using psychological interventions based on CBT and life review. Controlled trials with hope/hopelessness as a primary objective are needed to more clearly demonstrate effectiveness. Clinical implications: Cognitive-behavioral interventions can improve hopelessness in depressed older adults. Life-review based interventions can positively impact hope in a range of older populations. Dignity Therapy, physical exercise, and educational programs may not effectively improve hope/hopelessness in older adults.
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Affiliation(s)
- Silvia C Hernandez
- Department of Psychological Sciences, Case Western Reserve University , Cleveland, Ohio, USA
| | - James C Overholser
- Department of Psychological Sciences, Case Western Reserve University , Cleveland, Ohio, USA
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Abstract
Purpose of review a)The purpose of this systematic review was to characterize the studies published on grief interventions for bereaved older adults in the last 5 years. Grief intervention studies were included that exclusively focused on older adults as well as those that included older adults in their samples, in order to summarize the most up-to-date treatment options available for bereaved older adults. Recent findings b)Twenty-four articles that investigated grief interventions in older adults were identified. Generally, findings suggest viable treatment approaches for bereaved older adults are those incorporating behavioral activation and guidance on restoration-oriented coping. However, similar to studies of broader adult populations, grief interventions had small effects on grief-related symptoms in older adults. Few studies examined age as a moderator of treatment effects. Studies varied greatly by study design, sample size, and outcomes measured, which all likely impacted the efficacy of results. Summary c)This review suggests that, while there has been a growing focus on older adults, who have unique vulnerabilities in bereavement, the evidence-base of efficacious interventions for this population is limited. Given the need for specialized bereavement support for older adults will increase in the coming years, future research should prioritize rigorous investigations of grief treatment options leveraging technology to increase access and incorporate techniques that enhance engagement in life and connectedness for this vulnerable population.
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Harrop E, Morgan F, Longo M, Semedo L, Fitzgibbon J, Pickett S, Scott H, Seddon K, Sivell S, Nelson A, Byrne A. The impacts and effectiveness of support for people bereaved through advanced illness: A systematic review and thematic synthesis. Palliat Med 2020; 34:871-888. [PMID: 32419630 PMCID: PMC7341024 DOI: 10.1177/0269216320920533] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Bereavement support is a key component of palliative care, with different types of support recommended according to need. Previous reviews have typically focused on specialised interventions and have not considered more generic forms of support, drawing on different research methodologies. AIM To review the quantitative and qualitative evidence on the effectiveness and impact of interventions and services providing support for adults bereaved through advanced illness. DESIGN A mixed-methods systematic review was conducted, with narrative synthesis of quantitative results and thematic synthesis of qualitative results. The review protocol is published in PROSPERO ( www.crd.york.ac.uk/prospero , CRD42016043530). DATA SOURCES The databases MEDLINE, Embase, PsycINFO, CINAHL and Social Policy and Practice were searched from 1990 to March 2019. Studies were included which reported evaluation results of bereavement interventions, following screening by two independent researchers. Study quality was assessed using GATE checklists. RESULTS A total of 31 studies were included, reporting on bereavement support groups, psychological and counselling interventions and a mix of other forms of support. Improvements in study outcomes were commonly reported, but the quality of the quantitative evidence was generally poor or mixed. Three main impacts were identified in the qualitative evidence, which also varied in quality: 'loss and grief resolution', 'sense of mastery and moving ahead' and 'social support'. CONCLUSION Conclusions on effectiveness are limited by small sample sizes and heterogeneity in study populations, models of care and outcomes. The qualitative evidence suggests several cross-cutting benefits and helps explain the impact mechanisms and contextual factors that are integral to the support.
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Affiliation(s)
- Emily Harrop
- Marie Curie Research Centre, Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Fiona Morgan
- Marie Curie Research Centre and SURE, Cardiff University, Cardiff, UK
| | - Mirella Longo
- Marie Curie Research Centre, Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Lenira Semedo
- Marie Curie Research Centre, Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Jim Fitzgibbon
- Marie Curie Research Centre, Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Sara Pickett
- Swansea Centre for Health Economics, Swansea University, Swansea, UK
| | - Hannah Scott
- School of Dentistry, Cardiff University, University Hospital Wales, Cardiff, UK
| | - Kathy Seddon
- Marie Curie Research Centre, Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Stephanie Sivell
- Marie Curie Research Centre, Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Annmarie Nelson
- Marie Curie Research Centre, Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Anthony Byrne
- Marie Curie Research Centre, Division of Population Medicine, Cardiff University, Cardiff, UK
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Peacock S, Bayly M, Gibson K, Holtslander L, Thompson G, O'Connell M. Development of a bereavement intervention for spousal carers of persons with dementia: The Reclaiming Yourself tool. DEMENTIA 2020; 20:653-671. [PMID: 32126810 DOI: 10.1177/1471301220909604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A dearth of supportive interventions exists for bereaved spouses who were carers of persons with dementia, despite an identified need for such supports. The purpose of the current work was to develop and evaluate a supportive writing intervention for this population that was informed by the experiences of spouses who were bereaved and was specific to the unique context of dementia. Following development of the Reclaiming Yourself tool, a mixed methods design was utilized to assess its effects on grief, depressive symptoms, and balance between restoration and loss. Fifteen participants residing in Saskatchewan and Manitoba were provided the writing intervention and visited three times approximately four weeks apart, completing quantitative measures (for grief, depressive symptoms, and finding balance) at each visit and an exit interview about the intervention. Paired-sample t-tests illustrated trivial effect sizes and no significant differences in grief, depressive symptoms, or balance orientation, with overall means suggesting low levels of depressive symptoms and grief, and a slight orientation towards restoration. Thematic analysis illustrated benefits from the tool, with participants reporting that it provided a structured approach to grief, was a catalyst for emotional expression, and facilitated reflection. The format and timing of the intervention was not ideal for all participants. Although Reclaiming Yourself did not affect quantitatively measured grief, depressive symptoms, and balance, carers accrued benefits from the tool that align with beneficial processes observed in other writing interventions. While more research on the effectiveness of this tool is needed, such interventions are valuable to support the well-being of carers who are bereaved following the death of a spouse with dementia.
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Affiliation(s)
| | - Melanie Bayly
- Centre for Canadian Health and Safety in Agriculture, College of Medicine, University of Saskatchewan, Canada
| | - Kirstian Gibson
- Department of Psychology, College of Arts & Science, University of Saskatchewan, Canada
| | - Lorraine Holtslander
- College of Nursing, University of Saskatchewan, Canada; University of the Witwatersrand, South Africa
| | | | - Megan O'Connell
- Department of Psychology, University of Saskatchewan, Canada
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Xiu D, Chow AYM, Tang S. Predictive factors for differential changes in grief symptoms following group bereavement intervention for Chinese widowed older adults. Clin Psychol Psychother 2020; 27:267-277. [PMID: 31944474 DOI: 10.1002/cpp.2425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 12/29/2019] [Accepted: 01/06/2020] [Indexed: 11/09/2022]
Abstract
This study aimed to delineate changes in the patterns of prolonged grief severity in widowed adults following group bereavement interventions and to identify the predictive factors impacting these patterns. We performed a secondary analysis of data from a randomized trial of 125 Chinese widowed older adults who participated in either LOGBI or DPGBI. Self-ratings of prolonged grief symptoms via Inventory of Complicated Grief (ICG) were subjected to latent class growth analysis to identify subgroups according to symptomatic changes among baseline, post-treatment, and 8-week follow-up. Multinomial regression analysis examined whether participant classification could be predicted by demographics, loss-related characteristics, and the relationship with the deceased and baseline symptom severity. In the results, intervention sample comprised 96 completers with an attendance greater than 60%. A three-class categorization yielded the best model fit for changes in prolonged grief severity for both randomized and intervention samples: improved class (41.6% in the randomized sample, 42.8% in the intervention sample), partial responded class (48.1%/45.5%), and relapse class (10.3%/11.8%). Older widowed adults experiencing a high level of grief at baseline and bereavement following chronic illness had an elevated risk of symptomatic relapse after the completion of intervention. These findings indicated that Chinese widowed adults experienced different changing patterns of prolonged grief severity following group bereavement interventions. Practically, widowed adults with a higher risk of symptomatic relapse might need more intensive or longer term intervention or follow-up support.
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Affiliation(s)
- Daiming Xiu
- Department of Social Work and Social Administration, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Amy Y M Chow
- Department of Social Work and Social Administration, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Suqin Tang
- Department of Sociology, Law School, Shenzhen University, Shenzhen, China
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Fiore J. A Systematic Review of the Dual Process Model of Coping With Bereavement (1999-2016). OMEGA-JOURNAL OF DEATH AND DYING 2019; 84:414-458. [PMID: 31829782 DOI: 10.1177/0030222819893139] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This systematic review addressed the question whether the Dual Process Model of Coping with Bereavement (DPM) accurately represents the bereavement experience, and whether DPM-based interventions are more effective than traditional grief therapy. Twenty databases were searched to identify publications related to the DPM between 1999 and June 30, 2016. Coded material included source, title, research design, research question(s), data source, measures, method, and outcomes. Of the 474 articles initially identified, 86 underwent full-text review, with 22 quantitative or mixed-methods studies included. The DPM accurately represents the bereavement experience and can be used to understand how bereaved individuals cope. Interventions based upon the DPM may be more effective than traditional grief therapy. Further research is needed to test both the model and intervention design, especially in regard to oscillation, with use of consistent measures between studies.
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17
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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.
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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
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Abstract
This article contains a review of literature published from 2010 to 2016 on family caregiving in oncology. An analysis of 810 citations resulted in 50 randomized trials. These trials describe the need to prepare family caregivers for the complex role they play in cancer care. Several studies have demonstrated improved quality of life for family caregivers and improved emotional support from interventions. Several studies addressed communication and relational intimacy, which are key concerns. An additional focus of these trials was in the area of caregiving tasks and ways to diminish the burden of caregiving and preparedness for this role. Further research is needed in this area given the shift to outpatient care and as family caregivers become the primary providers of care. Future research should include expanding tested models of family caregiver support in clinical practice and in diverse populations. CA Cancer J Clin 2017. © 2017 American Cancer Society. CA Cancer J Clin 2017;67:318-325. © 2017 American Cancer Society.
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Affiliation(s)
- Betty Ferrell
- Director, Division of Nursing Research and Education, City of Hope National Medical Center, Duarte, CA
| | - Elaine Wittenberg
- Associate Professor, Division of Nursing Research and Education, City of Hope National Medical Center, Duarte, CA
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Tofthagen C, Kip K, Witt A, McMillan S. Complicated Grief: Risk Factors, Interventions, and Resources for Oncology Nurses. Clin J Oncol Nurs 2017; 21:331-337. [DOI: 10.1188/17.cjon.331-337] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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