How family caregivers of cancer patients manage symptoms at home: A systematic review

Evaluation of a training program using the SBAR communication tool for caregivers managing acute respiratory distress in lung cancer patients: A pilot randomized controlled trial protocol

Background

Family-based caregivers are increasingly important in the management of non-hospitalized lung cancer patients. However, lack of training can negatively impact care including diagnostic errors that can lead to delays in providing appropriate medical treatment. Acute respiratory failure (ARF) is common symptom of lung cancer and requires urgent intervention as well as adequate communication with healthcare professionals (HCPs) to enable appropriate decision-making and improve patient outcomes. Standardized tools such as the Situation, Background, Assessment, Recommendation (SBAR) tool and its French adaptation SAED, standing for Situation, Antécédent, Évaluation et Demande, are designed to facilitate communication among (HCPs).Additionally, digital interventions, such as serious games, are increasingly used to train HCPs though its use for caregivers has not been studied. This pilot study aims to assess an innovative serious game training using the SAED tool combined with standard instructions on self-efficacy for family-based caregivers of lung cancer patients when facing a simulated situation of ARF. The study also aims to examine caregivers' emotional state, quality of life, satisfaction and knowledge about the SBAR tool.

Methods

A monocentric, randomized, controlled, open-label, superiority, parallel-arm trial will be conducted for 18 months with 3 mid-study assessments (NCT05839353). Family caregivers of lung cancer patients will be recruited at the University Hospital Center of Saint Pierre, Reunion Island, France. Participants will be randomized (1:1) into two groups: the experimental group receiving training using the SBAR/SAED tool and standard instructions for managing respiratory distress/dyspnea, and the control group, receiving standard instructions only. The primary outcome will be to determine perceived self-efficacy as measured by the Generalized Self-Efficacy Scale.

Discussion

This study will present a preliminary assessment of training family caregivers in using the SBAR/SAED tool in simulated episodes of ARF in lung cancer patients. Our findings may provide valuable insights into effective training methods for caregivers in critical home care situations and could be widely used for lung cancer management.

Application of virtual reality for supportive care in cancer patients: a systematic review

BACKGROUND

In recent years, virtual reality (VR) technology has been widely used to support cancer patients with physical, emotional, and functional needs. This systematic review aimed to investigate the application of VR in the supportive care of cancer patients.

METHOD

This systematic review was conducted in 2024. In this study, various databases including PubMed, Web of Science, Scopus, the Cochrane Library, Ovid, IEEE Xplore, and ProQuest were searched, and quantitative, qualitative, and mixed-method studies which were in English and published up to 20th May 2024 were included. The keywords consisted of "virtual reality," "supportive care," and "cancer". Studies were assessed in terms of quality and risk of bias using standard tools, and results were analyzed and reported narratively.

RESULTS

A total of 33 articles were reviewed. VR interventions, primarily using fully immersive head-mounted displays, were associated with significant reductions in anxiety, pain, and fatigue. VR also improved mood, relaxation, and overall quality of life, and some studies noted enhanced vital signs such as heart rate and blood pressure. This technology could be used along with other medical interventions. Both patients and healthcare providers reported high level of satisfaction with VR, and appreciated its ease of use and therapeutic benefits. However, some technical barriers, like inadequate visual performance and realism, were reported.

CONCLUSION

VR demonstrates substantial potential benefits as a supportive care tool for cancer patients, effectively addressing their psychological, physiological, psychosocial needs. Despite technical challenges, high level of user satisfaction and benefits underscore the need for further research to optimize VR interventions in cancer care.

"Like not having an arm": a qualitative study of the impact of visitor restrictions on cancer care during the COVID-19 pandemic

PURPOSE

Visitor restriction policies to prevent the spread of COVID-19 among patients and clinicians were widespread during the pandemic, resulting in the exclusion of caregivers at key points of cancer care and treatment decision-making. The aim of this study was to explore how visitor restrictions impacted cancer treatment decision-making and care from patient and physician perspectives.

METHODS

Sixty-seven interviews, including 48 cancer patients and 19 cancer and palliative care physicians from four academic cancer centers in the USA between August 2020 and July 2021.

RESULTS

Visitor restrictions that prevented caregivers from participating in clinic appointments and perioperative hospital care created challenges in cancer care that spanned three domains: practical, social, and informational. We identified eight themes that characterized challenges within the three domains across all three groups, and that these challenges had negative emotional and psychological consequences for both groups. Physicians perceived that patients' negative experiences due to lack of support through the physical presence of caregivers may have worsened patient outcomes.

CONCLUSIONS

Our data demonstrate the tripartite structure of the therapeutic relationship in cancer care with caregivers providing critical support in the decision-making and care process to both patients and physicians. Caregiver absences led to practical, psychosocial, and informational burdens on both groups, and likely increased the risk of burnout among physicians. Our findings suggest that the quality of cancer care can be enhanced by engaging caregivers and promoting their physical presence during clinical encounters.

Impact of an automated, remote monitoring and coaching intervention in reducing hospice cancer family caregiving burden: A multisite randomized controlled trial

BACKGROUND

Care for those with life-limiting cancer heavily involves family caregivers who may experience significant physical and emotional burden. The purpose of this study was to test the impact of Symptom Care at Home (SCH), an automated digital family caregiver coaching intervention, during home hospice, when compared to usual hospice care (UC) on the primary outcome of overall caregiver burden. Secondary outcomes included Caregiver Burden at weeks 1 and 8, Mood and Vitality subscales, overall moderate-to-severe caregiving symptoms, and sixth month spouse/partner bereavement outcomes.

METHODS

Using a randomized, multisite, nonblinded controlled trial, 332 cancer family caregivers were enrolled and analyzed (159 SCH vs. 173 UC). Caregivers were primarily White (92%), female (69%), and spouse caregivers (53%). Caregivers provided daily reports on severity levels (0-10 scale) for their anxiety, depressed mood, fatigue, disturbed sleep, and caregiving interference with normal activities. These scores combined constituted the Caregiver Burden primary outcome. Based on reported symptoms, SCH caregivers received automated, tailored coaching about improving their well-being. Reports of moderate-to-severe caregiving symptoms also triggered hospice nurse notification. Secondary outcomes of Mood and Vitality were subcomponents of the Caregiver Burden score. A combined bereavement adjustment tool captured sixth month bereavement.

RESULTS

The SCH intervention reduced overall Caregiver Burden compared to UC (p < .001), with a 38% reduction at 8 weeks and a medium-to-large effect size (d = .61). SCH caregivers experienced less (p < .001) disruption in both Mood and Vitality. There were higher levels of moderate-to-severe caregiving symptoms overtime in UC (OR, 2.722). All SCH caregivers benefited regardless of caregiver: sex, caregiver relationship, age, patient diagnosis and family income. SCH spouse/partner caregivers achieved better sixth month bereavement adjustment than UC (p < .007).

CONCLUSIONS

The SCH intervention significantly decreased caregiving burden over UC and supports the maintenance of family caregiver mood and vitality throughout caregiving with extended benefit into bereavement.

'A Constant Black Cloud': The Emotional Impact of Informal Caregiving for Someone With a Lower-Grade Glioma

Those closest to people with lower-grade gliomas (LGGs) often assume the role of informal caregiver (IC). The additional responsibilities mean ICs of people with cancer can experience adverse impacts on their own lives. We explored the emotional impact of informal caregiving for people with LGGs. This was a descriptive qualitative study within the multi-method Ways Ahead project. We conducted semi-structured interviews with individuals from the United Kingdom, who currently, or in the past 5 years, informally cared for someone with an LGG. Interviews encompassed experiences of emotional impact as a consequence of caregiving for someone with an LGG. Inductive thematic analysis was undertaken. We interviewed 19 ICs (mean age 54.6 years; 14 females, 5 males). Participants reported substantial emotional impact. Four themes and associated subthemes were generated: Emotional responses to the illness (e.g. feeling helpless), Emotional responses to the unknown (e.g. anxiety about future uncertainty), Emotional consequences of care recipient changes (e.g. challenges of changed relationship dynamics), and Emotional weight of the responsibility (e.g. feeling burnout). Emotional impact in one area often exacerbated impact in another (e.g. future uncertainty impacted feelings of helplessness). Participants detailed the factors that helped them manage the emotional impact (e.g. being resilient). ICs of people with LGGs can experience wide-ranging emotional responses to and impacts of the illness, uncertain prognosis, care recipient changes, and the toll of caregiving. Adjustment and resilience are key protective factors, though further consideration of ways to identify and fulfil the emotional support needs of ICs of people with LGGs is required.

"You nearly feel a little bit like you've less right to grieve": a qualitative study on the impact of cancer on adult siblings

PURPOSE

Family members of cancer patients experience a range of challenges and are impacted in various ways by cancer. To our knowledge, the impact of cancer on adult siblings has yet to be explored. Sibling relationships are one of the longest relationships individuals have across the lifespan. Thus, the current study sought to investigate the perspectives of siblings of those who previously had cancer.

METHODS

Ten participants were recruited using purposive sampling. A qualitative, cross-sectional design was implemented with both virtual and in-person semi-structured interviews. Interviews were audio-recorded, transcribed and analysed using thematic analysis.

RESULTS

The researchers identified five themes relating to both the impact of cancer on siblings and the supports they received: changes in family relationships, sibling's grief is forgotten, benefits of social support networks, supporting their sibling and caregiving and self-support.

CONCLUSIONS

Cancer organizations and support services should focus on signposting services for siblings in order to ensure they can access support. Further research is needed with siblings to gain greater insight into what supports siblings feel are available for them to access, whether there are any for them to access or how supports can be improved.

IMPLICATIONS FOR CANCER SURVIVORS

The provision of appropriate psychological support for siblings of cancer patients will ensure they can provide optimal support and care to their siblings. This will in turn benefit cancer patients along their cancer trajectory as adequate support from their caregivers will enhance their quality of life.

An integrative review of adult cancer patients' experiences of nursing telephone and virtual triage systems for symptom management

PURPOSE

Telephone and virtual triage services are becoming increasingly common in ambulatory oncology settings. Few studies have evaluated their implementation from the perspective of service users. This study aims to evaluate the experiences of engaging with nurse-delivered telephone and virtual triage systems for symptom management among people undergoing cancer treatment.

METHODS

An integrative review was undertaken. MEDLINE, CINAHL, PsycInfo, Academic Search Complete and Scopus were systematically searched. Twelve publications met the inclusion criteria, and data related to cancer patients' perceptions of the triage process were extracted and analysed.

RESULTS

Telephone-based (n=7), app-based (n=5) and video-based teleconferencing (n=2) triage systems were evaluated positively overall, enhancing ease of health system navigation, avoidance of emergency department for consultation, and the information, reassurance and support provided to support self-management of symptoms. However, several factors influenced the users' engagement with triage services, including confidence to articulate symptoms, limited opening hours, waiting times for initial triage or follow-up and digital literacy. Collectively, these factors contributed to delayed reporting or under-reporting of symptoms, undermining the potential impact of services. Studies included variable reporting of intervention characteristics, including the qualification of nurses delivering and leading services.

CONCLUSIONS

Future evaluations of triage services must give greater consideration to the characterisation of interventions to ensure transferability, including nursing roles and qualifications. To ensure effective intervention and optimal supportive care for symptom management, patients must be prepared to engage triage services early. Future evaluations must ensure the impact of digital literacy on engagement with, and experience of, virtual triage is investigated.

What is the evidence behind cancer care reviews, a primary care cancer support tool? A scoping review

PURPOSE

A "cancer care review" (CCR) is a conversation between a patient recently diagnosed with cancer and primary care practitioner soon after a diagnosis of cancer in the UK. This scoping review aimed to identify: methodology and validated outcome measures used to evaluate CCRs, the impact of CCRs on quality of life or symptoms, and the views of patients, their carers and healthcare professionals on CCRs.

METHODS

A scoping review was performed and five databases (MEDLINE, Embase, PsychINFO, Scopus, Web of Science, Google Scholar) were searched systematically from January 2000 to March 2022.

RESULTS

Of 4133 articles, ten met the inclusion criteria. These included surveys, qualitative research on stakeholders' views and a small study evaluating group consultation CCRs. There were no studies on methodology to evaluate CCRs or the impact of CCRs on patient quality of life or symptoms. Some primary care professionals felt CCRs were a tick-box exercise, and that they had inadequate time to deliver care, compounded by inadequate primary-secondary care coordination and lack of expertise which was echoed by patients. Interviews with patients found few recalled CCRs and those that recalled CCRs did, did not find them particularly helpful. Partners of patients would welcome CCRs to raise personal health concerns and remain updated on patient care.

CONCLUSIONS

Further studies should identify the role that stakeholders believe they should have in CCRs, improve care coordination between primary care and secondary care and how to support caregivers.

IMPLICATIONS FOR CANCER SURVIVORS

There is currently insufficient evidence to support the use of CCRs in general practice.

Technology-Assisted mHealth Caregiver Support to Manage Cancer Patient Symptoms: A Randomized Controlled Trial

CONTEXT

Caregivers managing symptoms of family members with cancer during home hospice care, often feel ill-prepared and need patient care coaching.

OBJECTIVES

This study tested the efficacy of an automated mHealth platform that included caregiver coaching on patient symptom care and nurse notifications of poorly controlled symptoms. The primary outcome was caregiver perception of patients' overall symptom severity throughout hospice care and at weeks one, two, four, and eight. Secondary outcomes compared individual symptom severity.

METHODS

Caregivers (n = 298) were randomly assigned to the Symptom Care at Home (SCH) intervention (n = 144) or usual hospice care (UC) (n = 154). All caregivers placed daily calls to the automated system that assessed the presence and severity of 11 end-of-life patient physical and psychosocial symptoms. SCH caregivers received automated coaching on symptom care based on reported patient symptoms and their severity. Moderate-to-severe symptoms were also relayed to the hospice nurse.

RESULTS

The SCH intervention produced a mean overall symptom reduction benefit, over UC, of 4.89 severity points (95% CI 2.86-6.92) (P < 0.001), with a moderate effect size (d = 0.55). The SCH benefit also occurred at each timepoint (P < 0.001- 0.020). There was a 38% reduction in days reporting moderate-to-severe patient symptoms compared to UC (P < 0.001) with 10/11 symptoms significantly reduced in SCH compared to UC.

CONCLUSION

Automated mHealth symptom reporting by caregivers, paired with tailored caregiver coaching on symptom management and nurse notifications, reduces cancer patients' physical and psychosocial symptoms during home hospice, providing a novel and efficient approach to improving end-of-life care.

Family Caregiver Reports of Their Own and Patient Symptoms in Cancer Home Hospice Approaching End-of-Life

Context: Family caregivers assume the primary responsibility of assessing and managing hospice cancer patient symptoms while simultaneously managing their own wellbeing and symptoms. Objectives: Describe caregivers' assessment of hospice cancer patient and their own symptoms during the last 60 days of patient life, and assess the relationship between patient and caregiver symptoms over time. Methods: Caregiver symptom report of self and cancer home hospice patient symptom data were collected via telephone in the final 60 days of patient life. Descriptive data on symptom severity and prevalence were summarized. Exploratory Factor Analysis was used to group individual symptoms. Factors representing patient symptoms, caregiver symptoms, and caregiver outlook were analyzed using mixed-effects analysis to determine relationships between factors and change in relationship between factors over time. Results: Data from 61 patient-caregiver dyads are presented. At least 1 day of moderate-to-severe symptoms were reported in the majority of dyads. Significant auto-regressive associations were found, namely previous factor scores for an individual positively predicted the next factor scores for that individual. Previous caregiver report of patient symptoms was also positively associated with the next report of caregiver symptoms; previous caregiver report of their own symptoms were negatively associated with their next report of patient symptoms. Patient and caregiver symptoms and caregiver outlook worsened over time and the relationship between patient and caregiver symptoms strengthened closer to death. Conclusion: Our findings may guide hospice care team responses to caregiver and patient symptoms to promote individual level and unit level functioning.

Emotional distress, supportive care needs and age in the prediction of quality of life of cancer patients' caregivers: A cross-sectional study

INTRODUCTION

The existing literature shows a significant impact of cancer on caregivers' quality of life (QoL) and divergent results according to associated factors. To better understand the experience of cancer patients' caregivers, the present study aimed at comparing caregivers' QoL according to cancer care pathway and type of cancer, and at identifying the factors associated with their QoL.

METHODS

Caregivers were included in the study either during chemotherapy or follow-up to assess their QoL (CARGOQoL), unmet supportive care needs (SCNS-P&C), and anxiety and depression levels (HADS). CARGOQoL scores were then compared using ANOVA or Mann-Whitney non-parametric tests (objective 1). Based on univariate analyses, a multivariate analysis of covariance or linear regression model was performed for each CARGOQoL dimension (objective 2).

RESULTS

Among 583 participants (57.29% included during the follow-up phase), 523 completed the questionnaires. There was no effect of treatment phase and little effect of cancer site or disease stage on caregivers' QoL. Although significant factors associated with caregivers' QoL varied according to the dimensions assessed, the main associated factors were psychological experience (p < 0.05), satisfaction with the patient's care and supportive care needs (p < 0.01), and age of the patient or caregiver (p < 0.005).

CONCLUSION

This study shows the necessity to support caregivers during both active treatment and follow-up. It highlights the crucial role of emotional distress, supportive care and age in caregivers' QoL, regardless of the patients' oncological status.

The effectiveness of psychoeducational interventions on caregiver-oriented outcomes in caregivers of adult cancer patients: A systematic review and meta-analysis

OBJECTIVE

Cancer caregiving can result in increased psychosocial distress and poor health-related quality of life (QOL). Psychoeducation has been shown to be effective in enhancing caregiving-oriented outcomes. A systematic assessment of the overall effect of psychoeducational intervention (PEI) and identification of individual intervention characteristics that may contribute to the effectiveness of PEI is needed.

METHODS

For this meta-analysis, relevant articles were identified through electronic databases using key search terms and their medical subject heading such as "family caregiver," "cancer," and "psychoeducational intervention."

RESULTS

Twenty-eight controlled trials with 3876 participants were included. PEIs had beneficial effect on depression (Standardized Mean Difference [SMD] -0.26; 95% CI = -0.50 to -0.01, p < 0.04), anxiety (SMD -0.41; 95% CI = -0.82 to 0.01, p < 0.05), caregiver burden (SMD -0.84; 95% CI = -1.22 to -0.46, p < 0.0001) and QOL (SMD 0.59, 95% CI 0.24-0.93; p < 0.0009) at the immediate post-intervention period. At longer-term follow-up, the effectiveness of PEI was maintained on QOL (SMD 0.39, 95% CI = -0.00 to -0.77, p < 0.05), and anxiety (SMD -0.57; 95% CI = -1.09 to -0.06, p < 0.03). Moderation analysis showed that intervention characteristics such as studies conducted in high-income countries, group intervention and studies that focused on specific and mixed cancers explain some of the high variations observed among the included studies.

CONCLUSIONS

PEI may benefit caregivers of cancer patients through the significant effects on caregiver burden, QOL, anxiety, and depression. The findings from the moderation analysis may be important for the design of future interventions.

Using video consultations for clinical assessment and decision of treatment readiness before chemotherapy: A mixed-methods study among patients with gastrointestinal cancer and oncology nurses

Objective

To investigate the feasibility of clinical assessment and decision of treatment readiness before chemotherapy using video consultations, as perceived by gastrointestinal cancer patients and oncology nurses. In addition, to estimate reductions in travel time for patients and environmental carbon dioxide (CO2) emissions.

Methods

In a mixed-method study, patients with gastrointestinal cancer who participated in at least one video consultation during April-October 2019 completed a questionnaire on socioeconomic status, time and kilometers saved on travel. Kilometers saved were converted into reduced CO2 emissions. Descriptive statistics were used for analysis. Patients (n = 15) participated in semi-structured individual interviews, and five oncology nurses participated in a focus group interview.

Results

A total of 84/119 patients (71%) consented to video consultation and responded to the questionnaire. 69% were male, with a mean age of 66 years. For 46% of patients, a video consultation saved more than an hour of travel time. Avoiding a median travel distance of 120 km per patient (range, 2-450 km) reduced CO2 emissions by 7018 lb. Video consultations had other positive effects on patients, including avoiding waiting rooms, having more energy, and experiencing more focused interactions with nurses. Technical issues occurred rarely. Nurses found technical issues more troublesome, sometimes precluding complete assessments. They reported a need to rethink nursing practice to effectively provide care during video consultations.

Conclusions

Video consultations reduced CO2 emissions. In addition, they were beneficial for patients with gastrointestinal cancer. However, providing an optimal clinical assessment and decision of treatment readiness before chemotherapy requires testing patient equipment, technical skills and new oncology nursing competencies.

A rapid review of patient-reported outcomes investigated in the context of advanced renal cell cancer or advanced hepatocellular cancer

BACKGROUND

Patient-reported outcomes (PROs) are key indicators of health status and functioning, coming directly from the patient. Comprehensive monitoring of PROs enables implementation of person-centred care. Currently, the PROs that patients with advanced renal cell carcinoma (RCC) or hepatocellular carcinoma (HCC) consider of greatest importance remains unknown.

METHODS

A rapid literature review was carried out to identify PROs commonly reported in clinical studies of patients with advanced RCC/HCC. We searched MEDLINE, CINAHL & PsycInfo for relevant peer-reviewed publications in the period from 2000 to 2021. Pre-specified selection criteria were applied to all retrieved records. Findings were integrated into a narrative synthesis.

RESULTS

Eighty-one studies met our selection criteria and were retained. Most research was on advanced RCC (n = 64, 79%); 46 studies (57%) were drug trials. Only twenty-six studies (32%) employed PROs as their primary endpoint. Most PROs concerned physical symptoms (45% RCC, 54% HCC) and emotional wellbeing (19% RCC, 16% HCC). The most common outcome measured was quality of life (65% of the total), followed by fatigue (62%) and pain (54%). Whether selection of these PROs was patient-driven was not reported.

CONCLUSIONS

A wide range of PROs were assessed. Deficits in PROs often cause patients to seek out help; however, which PROs matter the most to people with advanced RCC/HCC must be further clarified. Targeting, monitoring, and responding to the 'right' PROs can enhance provision of person-centred care in advanced RCC/HCC and augment the clinical efficacy of established and emerging targeted therapies.

Home Cancer Care Research: A Bibliometric and Visualization Analysis (1990-2021)

Home cancer care research (HCCR) has accelerated, as considerable attention has been placed on reducing cancer-related health costs and enhancing cancer patients' quality of life. Understanding the current status of HCCR can help guide future research and support informed decision-making about new home cancer care (HCC) programs. However, most current studies mainly detail the research status of certain components, while failing to explore the knowledge domain of this research field as a whole, thereby limiting the overall understanding of home cancer care. We carried out bibliometric and visualization analyses of Scopus-indexed papers related to home cancer care published between 1990-2021, and used VOSviewer scientometric software to investigate the status and provide a structural overview of the knowledge domain of HCCR (social, intellectual, and conceptual structures). Our findings demonstrate that over the last three decades, the research on home cancer care has been increasing, with a constantly expanding stream of new papers built on a solid knowledge base and applied to a wide range of research themes.

Unmet supportive care needs of caregivers according to medical settings of cancer patients: a cross-sectional study

PURPOSE

The objectives of this study were to compare the unmet supportive care needs (SCN) of caregivers and describe the 10 most frequent of them according to various cancer settings: phase of cancer care pathway (i.e., treatment vs. follow-up), cancer site (i.e., breast, digestive, or lung cancer), and cancer status (i.e., metastatic vs. non-metastatic).

METHODS

Participants completed a self-reported questionnaire to assess their unmet SCN (SCNS-P&C). According to their cancer settings, non-parametric ANOVA or Mann-Whitney tests were performed to compare the SCNS-P&C scores. The prevalence of caregivers with unmet SCN was described using percentages.

RESULTS

Among 583 participants, 516 caregivers (88.5%) completed the SCNS-P&C questionnaire. Most patients had digestive (47.3%), non-metastatic cancer (67.6%) and were recruited during the follow-up phase (56.2%). The results revealed no significant difference in SCNS-P&C scores according to cancer settings except for caregivers of patients with metastatic cancer, who reported more unmet SCN related to health care service and information needs. The more qualitative item per item analysis seems to indicate the existence of five frequently unsatisfied SCN across situations, especially concerns about the recurrence and reduction of stress in patients, with variable ranking among the most unmet SCN.

CONCLUSION

Although there was no significant difference in unmet SCN scores between medical settings, examining the prevalence of unmet SCN helps identify the issues to focus on when supporting caregivers and developing dedicated consultations or interventions for them.

The Implementation of Palliative Home Care in Southeast Asian Countries: An Integrative Review

In Asia where family caregiving is part of the culture, palliative home care becomes the most suitable service to keep patients close to their family and to reduce costs. There is a wide variety of palliative home care services due to different cultures and levels of involvement of the family. This review aims to explore the implementation of palliative home care in East and Southeast Asian countries. The articles reviewed in this study were obtained from 3 electronic databases: EbscoHost, PubMed, and Scopus. Journal articles that discussed palliative home care for patients with cancer in East and Southeast Asia countries were included. Review papers were excluded. Seven studies were used in the current review. In general, there are 6 services provided for palliative home care in this region, which are daily activity living care, planning and preparation for palliative home care, education and counseling, patients’ follow-up, symptom management, and direct care for family. Most of the programs involve family caregivers during the treatment. The palliative home care team consists of at least a doctor and a nurse. Symptom management is the most common service and direct care for family is the least offered palliative home care service in this region. Alleviating symptoms is one of the targets in palliative care, therefore involving family in symptom management for palliative home care is fundamental. Although caregiving is part of the culture, family members need to be supported to maintain their quality of life.

The Project ENABLE Cornerstone randomized controlled trial: study protocol for a lay navigator-led, early palliative care coaching intervention for African American and rural-dwelling advanced cancer family caregivers

Background

Family caregivers play a vital, yet stressful role in managing the healthcare needs and optimizing the quality of life of patients with advanced cancer, from the time they are newly diagnosed until end of life. While early telehealth palliative care has been found to effectively support family caregivers, little work has focused on historically under-resourced populations, particularly African American and rural-dwelling individuals. To address this need, we developed and are currently testing Project ENABLE (Educate, Nurture, Advise, Before Life Ends) Cornerstone, a lay navigator-led, early palliative care coaching intervention for family caregivers of African American and rural-dwelling patients with newly diagnosed advanced cancer.

Methods

This is a 2-site, single-blind, hybrid type I implementation-effectiveness trial of the Cornerstone intervention versus usual care. Cornerstone is a multicomponent intervention based on Pearlin’s Stress-Health Process Model where African American and/or rural-dwelling family caregivers of patients with newly diagnosed advanced cancer (target sample size = 294 dyads) are paired with a lay navigator coach and receive a series of six, brief 20–60-min telehealth sessions focused on stress management and coping, caregiving skills, getting help, self-care, and preparing for the future/advance care planning. Subsequent to core sessions, caregivers receive monthly follow-up indefinitely until the patient’s death. Caregiver and patient outcomes are collected at baseline and every 12 weeks until the patient’s death (primary outcome: caregiver distress at 24 weeks; secondary outcomes: caregiver: quality of life and burden; patient: distress, quality of life, and healthcare utilization). Implementation costs and the intervention cost effectiveness are also being evaluated.

Discussion

Should this intervention demonstrate efficacy, it would yield an implementation-ready model of early palliative care support for under-resourced family caregivers. A key design principle that has centrally informed the Cornerstone intervention is that every caregiving situation is unique and each caregiver faces distinct challenges that cannot be addressed using a one-size-fits all approach. Hence, Cornerstone employs culturally savvy lay navigator coaches who are trained to establish a strong, therapeutic alliance with participants and tailor their coaching to a diverse range of individual circumstances.

Trial registration

ClinicalTrials.gov NCT04318886. Registered on 20 March, 2020.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13063-022-06305-w.

Effect of support groups on caregiver's quality of life

The objective of this study was to evaluate the effect that participating in support groups for caregivers has on the quality of life and psychotropic drug use of family caregivers of adults with limitations in activities of daily living. A controlled quasi-experimental longitudinal design was used with 134 caregivers (64 in the experimental group and 70 in the control group). The outcomes were health-related quality of life (EuroQol 5D3L test) and psychotropic drug use (no/yes). The analyses were performed using SPSS and R statistical software. An interaction was observed between the condition and the level of limitations in activities of daily living of the care receiver, having an effect on the caregiver's psychotropic drug use (p = 0.003), with this use being lower among caregivers who attend support groups when their relatives present fewer limitations in activities of daily living. Moreover, the quality of life was higher in the post-test in the experimental group (B = 8.66, p = 0.015). In conclusion, support groups could improve the caregiver's quality of life and decrease psychotropic drug use when the care receiver has low limitations in activities of daily living.

CUIDADOS DE FAMILIARES ÀS PESSOAS COM FERIDAS NEOPLÁSICAS MALIGNAS EM DOMICÍLIO

Objetivos:Conhecer como os cuidadores de pessoas com feridas neoplásicas malignas realizam o cuidado em domicílio. Método: Estudo qualitativo que envolveu sete familiares de pessoas com feridas malignas em tratamento em uma unidade de alta complexidade em oncologia. Os dados foram produzidos por meio de entrevista semiestruturada e submetidos à análise de conteúdo temático, proposto por Bardin. Resultados: Entrevistadas sete familiares-cuidadoras, todas do sexo feminino, jovens que abandonaram o trabalho para se dedicarem à pessoa enferma. Emergiram três categorias após análise do conteúdo: familiares buscam orientações para cuidar do paciente com feridas neoplásicas malignas em domicílio; adotam estratégias no cuidado das feridas; e referem necessidade de apoio dos profissionais e instituições de saúde, porque enfrentam dificuldades no atendimento, principalmente nas unidades de atenção primária. Conclusão: Os familiares de pessoas com feridas neoplásicas malignas enfrentam dificuldades, principalmente pela escassez de conhecimento técnico e por falta de apoio das instituições e dos profissionais de saúde.

CARE OF FAMILY MEMBERS OF PEOPLE WITH MALIGNANT NEOPLASTIC WOUNDS AT HOME

Objectives: To understand how caregivers of people with malignant neoplastic wounds perform care at home. Method: A qualitative study that involved seven relatives of people with malignant wounds undergoing treatment in a high complexity oncology unit. The data were produced through semistructured interviews and submitted to thematic content analysis, proposed by Bardin. Results: Seven family-caregivers, all female, young people who left work to dedicate themselves to the sick person were interviewed. Three categories emerged after content analysis: family members seek guidance to care for patients with malignant neoplastic wounds at home; they adopt strategies in wound care; and report the need for support from health professionals and institutions, because they face difficulties in care, especially in primary care units. Conclusion: Family members of people with malignant neoplastic wounds face difficulties, mainly due to the scarcity of technical knowledge and lack of support from health institutions and from professionals.

Family caregiver ambassador support for caregivers of patients with newly diagnosed hematological cancer: a feasibility study

PURPOSE

This study investigated the feasibility of a one-on-one peer support intervention in family caregivers of newly diagnosed patients with a hematological cancer during initial treatment.

METHODS

The study was a one-arm feasibility study including family caregivers of newly diagnosed patients with hematological cancer (n = 26) and caregiver ambassadors who were family caregivers of previously treated patients as peer supporters (n = 17). The one-on-one peer support intervention consisted of three components: a caregiver ambassador preparatory course; 12 weeks of one-on-one peer support, and caregiver ambassador network meetings.

RESULTS

Family caregivers reported high satisfaction with the delivery and flexibility of one-on-one peer support and improved in most psychosocial outcomes over time. Telephone and text messages were the most used form of contact between the peers. Caregiver ambassadors reported high satisfaction with the preparatory course and used the available support from the network meetings. No adverse events were reported.

CONCLUSION

One-on-one peer support provided by a caregiver ambassador is feasible and safe in family caregivers of newly diagnosed hematological cancer patients during their initial treatment. Utilizing volunteer caregiver ambassadors has the potential to be a new support model in family caregivers of hematological cancer patients across diagnostic groups within a clinical setting.

CLINICAL TRIAL REGISTRATION NUMBER

NCT04039100, July 29, 2019.

Designing Supportive e-Interventions for Partners of Men With Prostate Cancer Using Female Partners' Experiences: Qualitative Exploration Study

BACKGROUND

Partners of men living with prostate cancer (PCa) can experience a variety of unmet needs that are largely unaddressed by health care professionals. There is limited evidence to suggest which approach may be most effective in supporting partners' unmet needs and further research is required to determine how to provide support to caregivers and how technology solutions can be designed.

OBJECTIVE

This study aims to explore the experience of partners of men living with PCa and their perceptions of the potential role of information technology in supporting their needs.

METHODS

A qualitative descriptive methodology using focus groups and phone interviews was used. Purposive sampling was used to recruit people attending a national conference supported by a national PCa organization. Interview guides were adapted from an existing evidence-based smartphone app for caregivers of people with colorectal cancer. Sessions were audio recorded and transcribed verbatim. A coding framework was developed, and transcripts were coded line by line into the framework. Codes within the framework were grouped into descriptive categories that were then developed into analytical themes.

RESULTS

A total of 17 female partners participated in the study, with an average age of 64 (SD 8.5) years. The following two main themes emerged: In the first theme, that is, How technology can be shaped to support female partners of prostate cancer survivors, the content and design of the smartphone app was discussed in addressing female partners' needs. The following four subthemes were developed: getting support from social networks and resources, the lack of relevant information, demystifying future care expectations during and following a PCa diagnosis, and delivering the smartphone app-to whom and from whom. In the second theme, that is, The benefits and barriers of technology, the suitability of smartphone apps as a supportive modality for female partners was described. This included three subthemes: the smartphone app as an appropriate modality for supporting female partners, the future anticipated benefits of using the smartphone app, and concerns for storing and accessing information on the internet.

CONCLUSIONS

A smartphone app may be a suitable modality for providing information and peer support to female partners of men living with PCa. There is a need to provide peer support for female partners in future interventions to ensure that female partners' intimacy and daily practical needs are met.

Randomized Clinical Trial to Evaluate a Cancer Pain Self-Management Intervention for Outpatients

Objective

Unrelieved pain is common in patients with advanced cancer. Although psychoeducational interventions were found to decrease pain, effects were moderate. The purpose of this study was to evaluate the efficacy of a pain self-management intervention compared with usual care and to explore participants’ experiences with pain management and study participation.

Methods

A multicenter randomized controlled trial design with post-trial interviews was used. Outpatients with cancer pain and their family caregivers were recruited from three Swiss university hospitals. The intervention group (IG) received the six-week intervention consisting of education, skills building, and nurse coaching. The control group (CG) received usual care. Outcome variables were analyzed using multilevel models. Interpretive description guided the qualitative study part.

Results

Twenty-one patients with advanced cancer and seven family caregivers completed the study. The group x time effect showed a statistically significant decrease in average pain (P ​= ​0.04), but no significant group x time effect for worst pain (P ​= ​0.06). Pain scores, pain-related knowledge, Pain Management Index, self-efficacy, and performance status improved in the IG (P ​< ​0.05). Almost all of the interviewed participants perceived the pain management diary, tailored intervention sessions, and weekly support as useful. None experienced study participation as burdensome.

Conclusions

This study was the first to test the efficacy of a psychoeducational cancer pain self-management intervention in a German-speaking context, with most patients receiving palliative care. Clinicians can recommend the use of pain management diaries. Tailoring interventions to an individual's situation and dynamic pain trajectory may improve patients' pain self-management.

Registration number

This study has been registered via ClinicalTrials.gov: NCT02713919.https://clinicaltrials.gov/ct2/show/NCT02713919?term=NCT02713919&amp;draw=2&amp;rank=1.

The Relationship between Cancer Caregiver Burden and Psychological Outcomes: The Moderating Role of Social Connectedness

The present study: (a) examined the extent of caregiver burden and psychological wellbeing and (b) tested whether social connectedness moderated the association between caregiver burden and psychological symptoms in caregivers of people with cancer. The cross-sectional survey study included 189 cancer caregivers (mean age = 36.19 years, standard deviation = 11.78; 80.4% female). Data were collected on caregiver burden, social connectedness, and depression and anxiety. Moderation analysis was conducted to examine the effect of social connectedness on the relationship between caregiver burden and depression and anxiety. Caregiver burden was positively associated with depression and anxiety symptoms. Controlling for significant demographic and caregiver characteristics, the moderation model showed as perceived social connectedness increased, the relationship between caregiver burden and depression decreased (β = −0.007, se = 0.004, 95% CI: −0.014, 0.000, p = 0.05). By contrast, social connectedness did not moderate the association between caregiver burden and anxiety. Findings have implications for the management of depression in cancer caregivers. Social connectedness appears to provide a protective buffer from the negative impacts of caregiving, providing increased psychological resources to manage the burden associated with caregiving, resulting in lower depression. Research on strategies to improve caregiver wellbeing through enhancing engagement with social networks in ways that improve perceived sense of connectedness with others is warranted.

The 'work' of managing medications when someone is seriously ill and dying at home: A longitudinal qualitative case study of patient and family perspectives'

BACKGROUND

Managing medications can impose difficulties for patients and families which may intensify towards the end of life. Family caregivers are often assumed to be willing and able to support patients with medications, yet little is known about the challenges they experience or how they cope with these.

AIM

To explore patient and family caregivers' views of managing medications when someone is seriously ill and dying at home.

DESIGN

A qualitative design underpinned by a social constructionist perspective involving interviews with bereaved family caregivers, patients and current family caregivers. A thematic analysis was undertaken.

SETTING/PARTICIPANTS

Two English counties. Data reported in this paper were generated across two data sets using: (1) Interviews with bereaved family caregivers (n = 21) of patients who had been cared for at home during the last 6 months of life. (2) Interviews (n = 43) included within longitudinal family focused case studies (n = 20) with patients and current family caregivers followed-up over 4 months.

RESULTS

The 'work of managing medications' was identified as a central theme across the two data sets, with further subthemes of practical, physical, emotional and knowledge-based work. These are discussed by drawing together ideas of illness work, and how the management of medications can substantially add to the burden placed on patients and families.

CONCLUSIONS

It is essential to consider the limits of what it is reasonable to ask patients and families to do, especially when fatigued, distressed and under pressure. Focus should be on improving support via greater professional understanding of the work needed to manage medications at home.

Exploring dyadic management of nutrition care throughout and beyond head and neck cancer treatment

AIMS AND OBJECTIVES

To identify how patients and carers collaborate to manage nutrition care throughout and beyond head and neck cancer (HNC) treatment as a step towards identifying changes to service delivery that are inclusive of the needs of the patient-carer dyad.

BACKGROUND

Research in the field of dyadic interventions in cancer care is emerging, and there has been little work exploring patient-carer dyad needs in the provision of nutrition care in HNC.

DESIGN

A qualitative study design was used.

METHODS

Narrative interviews were completed with 13 patients and 15 carers over a 12-month period (prior to treatment commencing, and 2 weeks, 3 months and 12 months post-treatment completion). Deductive analysis of interview transcripts was performed using directed content analysis guided by the Theory of Dyadic Illness Management (TDIM). COREQ guidelines were used.

RESULTS

Seven themes across four TDIM constructs were identified: (1) understanding and adapting to physical challenges impacting nutrition intake, (2) adjusting to emotional impact of changes to eating and drinking, (3) providing practical support, (4) intrapersonal characteristics, (5) interpersonal characteristics, (6) healthcare culture and (7) managing carer burnout.

CONCLUSION

This study highlights the importance of healthcare professionals recognising the patient and carer dyad as a team to enhance engagement in nutrition care and to ensure that their physical and psychological support needs across the cancer continuum are met.

RELEVANCE TO CLINICAL PRACTICE

It is important that healthcare professionals understand information and support needs and preferences within patient-carer dyads prior to HNC treatment commencing and adapt care and interventions based on their changing needs throughout and beyond the treatment period.

Avoidant coping as mediator of the relationship between rumination and mental health among family caregivers of Chinese breast cancer patients

INTRODUCTION

Family caregivers of cancer patients were often referred to the 'forgotten patients', yet little researches have been conducted on their mental health. Rumination might put family caregivers at risk for psychological distress during the caregiving, such as stress and anxiety. The aim of the present study was to explore the relationship between rumination, stress and anxiety among family caregivers of breast cancer patients in China and examine the mediating role of avoidant coping in this relationship.

METHODS

Face-to-face questionnaire interviews were conducted with a sample of 99 caregivers from the public oncology hospital. They were assessed with stress, anxiety, rumination and avoidant coping by Chinese Perceived Stress Scale, Zung's Self-Rating Anxiety Scale, Ruminative Responses Scale and Coping Strategy Indicator. Structural equation modelling was applied to assess the mediation analysis.

RESULTS

The reporting scores of participants indicated the incidence of anxiety was 17.2%. Rumination could directly predict stress (β = 0.58, p < 0.01) and anxiety (β = 0.46, p < 0.01) and also predict stress and anxiety via the mediator of avoidant coping (stress: β = 0.087, p < 0.01; anxiety: β = 0.109, p < 0.01).

CONCLUSIONS

The important role played by family caregivers in supporting breast cancer patients is well recognised. The findings suggested that rumination and avoidant coping may be two critical risk factors for family caregivers of breast cancer developing stress and anxiety. This study highlights the importance of preventing avoidant coping, which plays a critical role for developing interventions for this vulnerable group.

Volunteer activity and depression among the elderly in China: A study on rural-urban differences

ABSTRACT

Participation in volunteer activity has positive effects on health among elderly. Few studies have investigated the association between volunteer activity and depression among Chinese elderly. This study aimed to examine the association between volunteer activity and depression among the elderly in China regarding rural-urban differences.Totally 8255 subjects from the 2015 China Health and Retirement Longitudinal Study were selected in this study. Depression was assessed by 10-item Center for Epidemiologic Studies Depression Scale. Types and frequency of volunteer activity were measured in the questionnaire. Multiple linear regression analysis was used to explore the relationship between volunteer activity and depression of elderly.In our study, the urban elderly had lower depressive scores than rural elderly (6.7 ± 5.8 vs. 9.1 ± 6.7). After adjustment for all covariates, our results revealed that almost daily participation in formal volunteer activities was negatively associated with depression among urban elderly (B = -2.69, SE = 1.05, P = .010); almost daily caring for a sick or disabled adult was positively associated with depression among both urban and rural elderly (urban:B = 3.13, SE = 1.54, P = .043; rural:B = 2.56, SE = 1.18, P = .031).These findings suggested that there was a negative association between formal volunteer activity and depression among urban elderly, while there was a positive association between caring for a sick or disabled adult and depression among both urban and rural elderly. The government should take effective measures to encourage the elderly to participate in formal volunteer activities to prevent them from depression.

The Challenges of Enrollment and Retention: A Systematic Review of Psychosocial Behavioral Interventions for Patients With Cancer and Their Family Caregivers

CONTEXT

Psychosocial behavioral interventions (PBIs) that target patients with cancer and their caregivers face challenges in participant enrollment and retention.

OBJECTIVES

1) Describe characteristics of the patient-caregiver PBI studies; 2) examine participant enrollment and retention rates; 3) identify factors influencing participant enrollment and retention rates; and 4) explore the strategies to promote enrollment and retention rates.

METHODS

We identified randomized controlled trials that tested PBIs among adult patients with cancer and caregivers in five electronic databases. We conducted narrative and quantitative analyses to synthesize our findings.

RESULTS

Among 55 qualified studies reviewed, most tested the efficacy of PBIs (n = 42) and used two study arms (n = 48). In-person meeting was the most common PBI delivery mode. The primary outcomes included quality of life, physical health, and symptoms. The average of enrollment rates of patient-caregiver dyads was 33% across studies (range 8%-100%; median = 23%). The average retention rate at the end of follow-ups was 69% (range 16%-100%; median = 70%). The number of study arms, recruitment method, type of patient-caregiver relationship, and intervention duration influenced enrollment rates. Study design (efficacy vs. pilot), follow-up duration, mode of delivery, type of relationship, and intervention duration influenced retention rates. Sixteen studies reported retention strategies, including providing money/gift cards upon study completion and/or after follow-up survey, and excluding patients with advanced cancer.

CONCLUSION

Researchers need to incorporate effective strategies to optimize enrollment and retention in patient-caregiver PBI trials. Researchers need to report detailed study processes and PBI information to improve research transparency and increase consistency.

Patient and carer experience of nutrition care throughout and beyond treatment for head and neck cancer: a qualitative longitudinal study

Nutrition care plays a critical role in optimising outcomes for patients receiving treatment for head and neck cancer (HNC), with carers playing an important role in supporting patients to maintain nutrition intake. This study explores patient and carer experience of nutrition care from diagnosis of HNC to 1 year post treatment completion to identify areas for improvement of service delivery. A longitudinal qualitative study design was used with a heterogeneous sample of 20 patients and 15 carers of patients undergoing curative intent treatment for HNC. Interviews conducted at four time points provided a total of 117 interview datasets that were analysed using reflexive thematic analysis based on Gadamerian hermeneutic inquiry. Patient and carer experiences were reflected in two primary themes: (1) the battle to maintain control and (2) navigating the road ahead. This research identifies the need to co-design strategies to improve nutrition care that is inclusive of patients and carers.

Family and health-care professionals managing medicines for patients with serious and terminal illness at home: a qualitative study

Background

More effective ways of managing symptoms of chronic and terminal illness enable patients to be cared for, and to die, at home. This requires patients and family caregivers to manage complex medicines regimens, including powerful painkillers that can have serious side effects. Little is known about how patients and family caregivers manage the physical and emotional work of managing medicines in the home or the support that they receive from health-care professionals and services.

Objective

To investigate how patients with serious and terminal illness, their family caregivers and the health-care professionals manage complex medication regimens and routines of care in the domestic setting.

Design

A qualitative study involving (1) semistructured interviews and group discussions with 40 health-care professionals and 21 bereaved family caregivers, (2) 20 patient case studies with up to 4 months’ follow-up and (3) two end-of-project stakeholder workshops.

Setting

This took place in Nottinghamshire and Leicestershire, UK.

Results

As patients’ health deteriorated, family caregivers assumed the role of a care co-ordinator, undertaking the everyday work of organising and collecting prescriptions and storing and administering medicines around other care tasks and daily routines. Participants described the difficulties of navigating a complex and fragmented system and the need to remain vigilant about medicines prescribed, especially when changes were made by different professionals. Access to support, resilience and coping capacity are mediated through the resources available to patients, through the relationships that they have with people in their personal and professional networks, and, beyond that, through the wider connections – or disconnections – that these links have with others. Health-care professionals often lacked understanding of the practical and emotional challenges involved. All participants experienced difficulties in communication and organisation within a health-care system that they felt was complicated and poorly co-ordinated. Having a key health professional to support and guide patients and family caregivers through the system was important to a good experience of care.

Limitations

The study achieved diversity in the recruitment of patients, with different characteristics relating to the type of illness and socioeconomic circumstances. However, recruitment of participants from ethnically diverse and disadvantaged or hard-to-reach populations was particularly challenging, and we were unable to include as many participants from these groups as had been originally planned.

Conclusions

The study identified two key and inter-related areas in which patient and family caregiver experience of managing medicines at home in end-of-life care could be improved: (1) reducing work and responsibility for medicines management and (2) improving co-ordination and communication in health care. It is important to be mindful of the need for transparency and open discussion about the extent to which patients and family caregivers can and should be co-opted as proto-professionals in the technically and emotionally demanding tasks of managing medicines at the end of life.

Future work

Priorities for future research include investigating how allocated key professionals could integrate and co-ordinate care and optimise medicines management; the role of domiciliary home care workers in supporting medicines management in end-of-life care; patient and family perspectives and understanding of anticipatory prescribing and their preferences for involvement in decision-making; the experience of medicines management in terminal illness among minority, disadvantaged and hard-to-reach patient groups; and barriers to and facilitators of increased involvement of community pharmacists in palliative and end-of-life care.

Funding

This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 14. See the NIHR Journals Library website for further project information.

Associations Between Spirituality, Mindfulness, and Psychological Symptoms Among Advanced Lung Cancer Patients and Their Spousal Caregivers

CONTEXT

Patients with metastatic lung cancer and their spousal caregivers are at high risk of psychological symptoms. Mindfulness may improve psychological symptoms via spiritual well-being (SW); yet, this mediation model has not been examined in a dyadic context.

OBJECTIVES

We examined the mediating role of two dimensions of SW (meaning/peace and faith) in the mindfulness-symptoms link in Stage IV lung cancer patients and their spousal caregivers.

METHODS

We examined the actor-partner interdependence model of mediation using multivariate multilevel modeling with 78 couples. Four actor-partner interdependence model of mediation analyses were conducted to examine one predictor (mindfulness) × two mediators (meaning/peace and faith) × two psychological symptoms (depressive symptoms and cancer distress). We also tested four alternative models in which mindfulness mediates the associations between SW and psychological symptoms.

RESULTS

The alternative model (SW → mindfulness → psychological symptoms) was preferred than the original model (mindfulness → SW → psychological symptoms). For patients, meaning/peace was directly associated with their own psychological symptoms, whereas faith was only indirectly associated with their own psychological symptoms via mindfulness. For spouses, meaning/peace was both directly and indirectly associated with their own psychological symptoms, whereas faith was only directly associated with their own depressive symptoms (but not cancer distress). Moreover, spouses' faith was indirectly associated with patients' psychological symptoms through patients' mindfulness.

CONCLUSION

SW is associated with patients' and spouses' psychological symptoms both directly and indirectly through mindfulness. Thus, interventions that target SW, particularly meaning and peace, along with mindfulness may be beneficial to the psychological management of patients facing a terminal disease and their spousal caregivers.

Gaining Experience Over Time: The Family Caregivers' Perception of Patients with a Tracheostomy in Home Care

Background

The transition of tracheostomy patients to the home poses many challenges for both the patient and the family. Identifying and understanding the experiences of family caregivers pave the road for discovering and meeting care needs. This study has been aimed to explain the experiences of family caregivers of patients with a tracheostomy about patient care at home.

Materials and Methods

This qualitative study was conducted using a conventional content analysis approach from September 2018 to January 2019. Participants included nine family caregivers and one professional caregiver who were selected through purposive sampling method. The in-depth interviews were conducted at home or in health centers using field notes. Data were recorded manually and analyzed using the five-step method proposed by Granehim and Lundman.

Results

The data led to the emergence of 1591 initial codes, 23 subcategories, and 6 categories. Categories include the need for training, the need for receiving care support, care challenges, care burden, gaining experience, hope, and inner satisfaction.

Conclusions

In this study, the family caregivers faced with lots of challenges in caring patients with tracheostomy so that they were in needs of training and support from professionals. Although they got skillful in care and endure burden, they were so hopeful and satisfied with their attempts. Hence, there is a need for official nongovernmental organizations with the aim of maintaining care and protecting their families.

Understanding the support needs of family members of people undergoing chemotherapy: A longitudinal qualitative study

PURPOSE

Capture change in family members' experiences as they look after patients during chemotherapy, and understand variability in their needs for support.

METHOD

Longitudinal digitally-recorded qualitative semi-structured interviews with family carers at the beginning, mid-point, and end of treatment. Twenty-five family members (17 women, 8 men), mean age 53, were interviewed. Fifteen participants were supporting a relative having chemotherapy with curative intent, and 10 a patient receiving palliative chemotherapy. They were recruited from two UK locations: a regional cancer centre in Southampton and a comprehensive cancer centre in London. Sixty-three interviews were conducted in total, and the data were analysed using Framework Analysis.

RESULTS

Three themes were generated from the data: Changing lives, Changing roles; Confidence in caring, and Managing uncertainty. These captured family carers' evolving needs and sense of confidence in caregiving during chemotherapy. Carers reported considerable anxiety at the outset of treatment which persisted throughout. Anxiety was underpinned by fears of disease recurrence or progression and concerns about treatment outcomes.

CONCLUSIONS

This study presents original fine-grained work that captures the changes over time in family carers' experiences of chemotherapy and their adaptation to caregiving. It provides fundamental evidence of the challenges that cancer carers face during patients' treatment; evidence that can be used as a basis for carer assessment and to build much-needed carer interventions. Oncology nurses should assess carers': ability to care; needs for information and support to prepare them for this; wellbeing over time; and, any support they may require to prevent them from becoming overburdened.

Factors associated with healthcare utilisation during first year after cancer diagnose-a population-based study

Background

Improved cancer treatments and models of care (such as early palliative care) has developed during recent years. Aspects of healthcare utilisation—unplanned care have been used for evaluation of coordination and quality. The aim was to explore factors associated with cancer healthcare utilisation, during the first year after a cancer diagnosis.

Methods

Population‐based registry and patient‐reported data, (The European Organisation of Research and Treatment of Cancer (EORTC), QLQ‐ C30 questionnaire and study‐specific questions) were collected. Descriptive statistics and multivariate regression models were performed.

Results

The sample consists of 1718 patients (haematological, gynaecological, upper gastrointestinal and head and neck cancers). Living alone were associated with unplanned hospital admissions (OR 1.35; 95% CI [1.15, 1.59], p < 0.001). Patients with specialised palliative home care had a higher likelihood of unplanned hospital admissions, (OR 4.35; 95% CI [3.22‐5.91], p < 0.001) and re‐admissions within 30 days, (OR, 5.8; 95% CI [4.12‐8.19], p < 0.001).

Conclusions

Sociodemographic and clinical factors, such as living alone and disease stage, is associated with healthcare utilisation. Patients with specialised palliative home care report lower levels of HRQoL and higher levels of unplanned care, and our findings stresses the importance of a holistic view when planning care.

'It's like trying to ice a cake that's not been baked': a qualitative exploration of the contextual factors associated with implementing an evidence-based information intervention for family carers at the end of life

Aim:

To explore the introduction of an evidence-based information intervention – the ‘Caring for Someone with Cancer’ booklet – within home care and end-of-life care, to inform future implementation and practice development within this setting.

Background:

Family carers’ contribution is crucial to enable care and death of people at home. The ‘Caring for Someone with Cancer’ booklet received positive responses from family carers and District Nurses and is an evidence-based intervention designed to support carers to deliver basic nursing tasks. Further feasibility work was required to establish how it should be implemented. Little is known about how to successfully translate interventions into practice, particularly within home care settings and end-of-life care.

Methods:

Implementation of the ‘Caring for Someone with Cancer’ booklet, utilising a qualitative case study approach, in four home care sites. Semi-structured interviews, informed by Normalization Process Theory (NPT), were undertaken at implementation sites in May 2016–June 2017. Participants were generalist and specialist nurses, managers, and Healthcare Assistants (HCAs). A framework approach to analysis was adopted.

Findings:

Forty-five members of staff participated. Failed implementation was associated with organisational-level characteristics and conditions, including workforce composition and predictability of processes. Unstable work environments meant home care providers focused on short-term rather than long-term goals, precluding practice development. Staff’s perceptions of the time available to engage with and implement the intervention inhibited adoption, as many participants were “just getting through the day”. Implementation was successful in sites with explicit management support, including proactive implementation attempts by managers, which legitimatised the change process, and if all staff groups were engaged. To encourage uptake of evidence-based interventions in home care settings, practitioners should be given opportunities to critically reflect upon taken-for-granted practices. Future implementation should focus on work pertaining to the NPT construct ‘Collective Action’, including how staff interact and build confidence in new practices.

Symptom Experience and Related Predictors in Liver Transplantation Recipients

PURPOSE

Symptom experience after liver transplantation (LT) provides healthcare professionals with important information about the benefits and limitations of LT from patients' perspective. This study aims to explore the multidimensional symptom experience and analyze related predictive factors in LT recipients.

METHODS

This cross-sectional study evaluated the occurrence, frequency, intensity, and level of distress of 40 symptoms in 265 LT recipients. Stepwise multiple regression analysis was performed to analyze the influencing factors of symptom experience.

RESULTS

The analysis of patient-reported data indicated that the ten most common symptoms were fatigue (42.3%), frequent sleep interruptions (38.9%), difficulty falling asleep (35.9%), decreased memory (34.0%), dreaminess (29.8%), itch (28.7%), muscular weakness (26.4%), shortness of breath (25.3%), anxiety (24.5%), and hand tremor (21.9%). Patients were classified into four groups according to survival time (1-month, 2-6-month, 7-12-month, and >1-year groups) after LT, and the most common symptom was fatigue in the one-month and 2-6-month groups, difficulty falling asleep in the 7-12-month group, and decreased memory in the >1-year group. Type of the primary caregiver, complications, concerns about the decreased ability to perform household and outdoor activities, and concerns about being a burden to the family were predictors of symptoms burden.

CONCLUSION

LT recipients experienced complicated symptoms. In clinical practice, it is critical to integrate physicians, nurses, and social workers as a medical team to help LT recipients develop suitable coping strategies that can potentially address patients' concerns, increase the sense of confidence, and improve symptom outcomes.

Developing and Assessing the Effectiveness of a Nurse-Led Home-Based Educational Programme for Managing Breathlessness in Lung Cancer Patients. A Feasibility Study

Introduction: Breathlessness is the most common and refractory symptom in lung cancer patients. Even though various educational programmes have been developed, only a few were intended for implementation in the home setting for its management.

Aim: Feasibility of a study for implementing a nurse-led educational programme for breathlessness management of lung cancer patients at home.

Method: A randomized feasibility study was undertaken between February 2017 and October 2018. Patients were recruited through referral from oncologists from two oncology centers in Cyprus under certain inclusion and exclusion criteria. Patients were randomized in the intervention or control group via a computer programme, and their named family caregivers (f.c.) were allocated in the same group. Participants were not blinded to group assignment. The intervention consisted of a PowerPoint presentation and implementation of three non-pharmacological interventions. The control group received usual care. Patients were assessed for breathlessness, anxiety, and depression levels, whereas f.c. were assessed for anxiety, depression, and burden levels. F.c. also assessed patients' dyspnea level. The duration of the study process for both the intervention and control group was over a period of 4 weeks.

Results: Twenty-four patients and their f.c. (n = 24) were allocated equally in the intervention and control group. Five patients withdrew, and the final sample entered analysis was 19 patients and 19 family caregivers. In the intervention group n = 11 + 11, and in the control group n = 8 + 8. In the intervention group patients' breathlessness and anxiety levels showed improvement and their f.c.s in the anxiety and burden levels. Major consideration was the sample size and the recruitment of the patients by the referring oncologists. Attrition was minor during the study process. No harm was recorded by the participants of the study.

Conclusions: The study provided evidence of the feasibility of the implementation of the educational programme. For the future definitive study major consideration should be patients' recruitment method in order to achieve adequate sample size. Moreover, qualitative data should be collected in relation to the intervention and the involvement of f.c. The feasibility study was registered to the Cyprus Bioethics Committee with the registration number 2016/16. There was no funding of the study.

Exploring the Score Equivalence of the English and Chinese Versions of the Brief Assessment Scale for Caregivers

Background:

Multilingual outcome measures are used so that research studies are more generalizable across language contexts.

Objective:

To determine the score equivalence of the English and Chinese versions of Brief Assessment Scale for Caregivers (BASC) in Singapore.

Method:

Caregivers of patients with advanced cancer completed the BASC in either English or Chinese. Multivariable linear regression analysis was used to compare the mean BASC total and factor scores between the 2 language versions, with adjustment for possible confounding variables. Equivalence was declared if the 90% confidence interval of the mean scores fell entirely within an equivalence zone of ±0.5 standard deviation.

Results:

There were 521 ethnic Chinese participants, of whom 214 answered the English version and 307 answered the Chinese version. The BASC total and factor scores met the criteria for equivalence. Cronbach α coefficients were similar and exploratory factor analysis showed similar 2-factor structures for both language versions.

Conclusion:

The English and Chinese versions of the BASC were found to be equivalent in terms of similar adjusted mean scores, Cronbach α, and factor structures.

How do family-caregivers of patients with advanced cancer provide symptom self-management support? A qualitative study

PURPOSE

The family-caregiver role is of critical importance to the success of symptom-related self-management of patients with advanced cancer. This study examined the perspectives of patients and family-caregivers regarding the role of the family-caregiver in symptom-related self-management support ( SMS).

METHODS

Semi-structured interviews were conducted in patients with advanced cancer experiencing significant symptom burden and their family-caregivers. An inductive content analysis approach was used to analyse data.

RESULTS

Eleven patients and ten family caregivers were included. Identified themes were 1) engaging in specific symptom-related SMS; 2) interacting with health care professionals; and 3) balancing patient need versus expectation. These themes were applicable to both the family-caregiver and patient cohorts, regardless of the individual symptom profile of each patient.

CONCLUSIONS

The role of family-caregivers of patients with advanced cancer is complex and varied in providing symptom-related SMS at home; often requiring family-caregivers to have diverse knowledge and skills in the management of a range of cancer-related symptoms. Health care professionals can support family-caregivers by anticipating needs, tailoring evidence-based information to those needs, and ensuring family-caregivers have an appropriate contact point for advice or help.

Patient and carer experience of nutrition care throughout treatment for head and neck cancer: a systematic qualitative review and thematic synthesis

Nutrition care plays a critical role in the provision of best practice care to head and neck cancer (HNC) patients, with carers playing an important role in supporting patients to maintain nutrition intake. This qualitative systematic review investigated patient and carer experience of nutrition care throughout and beyond HNC treatment. Five databases were systematically searched for qualitative studies reporting on patient and carer experience of nutrition care throughout HNC. Twenty-five studies including 435 patients and 46 carers were identified, revealing three themes: information and support in the healthcare setting, enteral feeding challenges and management, and life outside hospital. Findings highlight the importance of providing individualised person-centred nutrition care to patients with HNC and their carers. Further qualitative research is needed to inform healthcare professionals about the needs of patients and carers to provide appropriate support throughout the treatment trajectory across and between different treatment modalities.

Enabling people with dementia to access and receive cancer treatment and care: The crucial role of supportive networks

OBJECTIVES

Despite cancer and dementia being conditions in which prevalence increases with age, there remains limited research on the cancer treatment and care needs of this population. Our study aimed to address this gap and this paper reports on the role of supportive networks in enabling people with dementia to access cancer treatment and care.

MATERIALS AND METHODS

An ethnographic study involving seventeen people with cancer and dementia, 22 relatives and nineteen oncology staff. It comprised observations (46 h) of and informal conversations during oncology appointments attended by people with dementia and their relatives and semi-structured interviews (n = 37) with people living with cancer and dementia, their relatives and staff working in various roles across oncology services. Data were analysed using thematic analysis.

RESULTS

Patients and oncology staff relied on and expected relatives to provide practical and emotional support around cancer treatment and care. Families varied in their ability to provide required support due to extent of the family network, practical issues, knowledge of the patient and their wishes, family conflict and the patient's willingness to accept help. Where no family network was available, support provision was complex and this could compromise access to cancer treatment.

CONCLUSIONS

People with comorbid cancer and dementia rely heavily on a supportive family network to access treatment and care. Oncology services need to assess the supportive networks available to individual patients in developing cancer treatment plans. Urgent consideration needs to be given to how those with no family networks can be appropriately supported.

Caregiving motivations and experiences among family caregivers of patients living with advanced breast cancer in Ghana

INTRODUCTION

Significant number of women present with advanced-stage breast cancer in Ghana. These women usually depend on family caregivers for their multi-dimensional needs. Yet, there are gaps in research about what motivates family caregivers to assume the caring role and their experiences with caregiving within the Ghanaian context.

AIM

To explore and describe the caregiving motivations and experiences among family caregivers of patients living with advanced breast cancer.

METHODS

In-depth, semi-structured qualitative interviews were conducted with 15 family caregivers who were providing unpaid care for women living with advanced breast cancer. Colaizzi's thematic analysis was used to analyze the data.

RESULTS

Family relationship normally prescribed the caregiving role among family caregivers. Due to the lack of home-based palliative services in Ghana, findings suggest that family caregivers are the main managers of advanced breast cancer-related symptoms in the home. These findings are discussed under three major themes: (i) motivation for assuming the caregiving role; (ii) meeting self-care and psychosocial needs of the patient; and (iii) symptom management and monitoring.

CONCLUSION

Socio-cultural values influence the role of family caregivers in Ghana. This presents opportunities for health professionals and relevant stakeholders to develop a culturally-appropriate intervention to support informal caregivers in their home-based care for women living with advanced breast cancer in Ghana.

Strain Among Caregivers of Older Adults Diagnosed With Breast Cancer

OBJECTIVES

To illustrate the predictors of strain among caregivers of older adults diagnosed with breast cancer.

SAMPLE & SETTING

This study involved 39 women diagnosed with breast cancer who were aged 69 years or older, receiving any type of treatment, and seeking an initial assessment in a geriatric oncology program at a large cancer center in the midwestern United States and their caregivers.

METHODS & VARIABLES

This cross-sectional study evaluated relationships among the variables of caregiver strain, age, employment status, patient characteristics, and patient scores on the comprehensive geriatric assessment. Bivariate statistics and logistic regression models were used.

RESULTS

Increasing age of the caregiver was associated with less caregiver strain. Caregivers employed part-time experienced greater strain than those employed full-time.

IMPLICATIONS FOR NURSING

Nurses must assess for strain in caregivers of individuals diagnosed with cancer, particularly if they are younger and employed part-time. Caregivers of depressed patients should be assessed for strain and offered support.

Living with dying: A narrative inquiry of people with chronic kidney disease and their family members

Aims

To describe how people diagnosed with chronic kidney disease and their family members describe uncertainty related to impending death.

Background

There has been little research about the experiences of people with chronic kidney disease and their family members as they near the end‐of‐life. We need to understand these experiences to give holistic person‐centred care.

Design

A narrative enquiry was undertaken using a social constructionist perspective.

Methods

Data were collected in two in‐depth interviews, approximately 3–4 months apart, followed by a telephone follow‐up 2–3 months later.

Results

Eleven people with advanced chronic kidney disease and nine family members/significant others participated. For both participants in the dyad, a number of key themes/storylines were identified. These included recognition that: @life has a boundary, living on the edge, I'm not afraid to die but… and remembering loss and death experiences@.

Conclusions

This enquiry illuminated four key storylines of about death and dying with advanced chronic kidney disease for people with the illness and their family members. Discussion about past experiences with illness, loss, death, and dying can give an entry for discussion about end‐of‐life. The person with illness and family members often held very similar perceptions and desires, but healthcare professionals’ contributions to understanding of the experience were not mentioned. Implications for clinicians include attending to peoples’ awareness of death as a distinct opportunity, listening attentively and posing questions that genuinely invite concerns and wishes about end–of‐life and living well.