1
|
Kian A, Sharif-Nia H, Hejazi S. The Farsi version of Caregiver Preparedness Scale in Iranian family caregivers of the older adults undergoing hemodialysis: a psychometric study. BMC Geriatr 2024; 24:512. [PMID: 38867155 PMCID: PMC11170810 DOI: 10.1186/s12877-024-05103-0] [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: 10/02/2023] [Accepted: 05/23/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND Enhancing preparedness of family caregivers and support for caregiving is essential for the mutual benefit of both caregivers and the well-being of those under their care. This study aimed to translate and evaluate psychometric properties of the Caregiver Preparedness Scale among family caregivers of older adults undergoing hemodialysis. METHODS In this methodological study, 400 family caregivers of older adult patients undergoing hemodialysis enrolled to the study via convenience sampling method. The study was conducted in two stages: translation and psychometric evaluation. At first, the translation of the scale was done using Beaton et al. method. In the psychometric evaluation stage, quantitative face validity, content validity, item analysis and construct validity of the scale were evaluated. The internal consistency of the scale was assessed through the calculation of Cronbach's alpha, McDonald's omega, and average inter-item correlation coefficients. RESULTS All items had an impact score greater than 1.5. The content validity ratio and the kappa coefficient for all items were above 0.75. In the item analysis, item 2, which had a correlation with the total score of less than 0.3, was removed. Following exploratory factor analysis, only one factor composed of all items (7 items) was extracted, explaining 75.7% of the total variance. This model had acceptable fit indices in confirmatory factor analysis. Cronbach's alpha and omega of 0.95 and an average inter-item correlation of 0.75 were obtained. CONCLUSIONS The study results demonstrated that the Caregiver Preparedness Scale exhibits appropriate psychometric properties. Geriatric nurses can utilize this Scale for assessment of caregivers. This assessment can aid in decision-making regarding educational programs aimed at enhancing family caregiver preparedness.
Collapse
Affiliation(s)
- Arash Kian
- Student Research Committee, Department of Nursing, Bojnurd School of Nursing, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Hamid Sharif-Nia
- Psychosomatic Research Center, Mazandaran University of Medical Sciences, Sari, Iran
- Department of Nursing, Amol Faculty of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran
| | - Sima Hejazi
- Department of Nursing, Bojnurd School of Nursing, North Khorasan University of Medical Sciences, Shahriar Ave, Bojnurd, Iran.
| |
Collapse
|
2
|
Kuzmik A, BeLue R, Resnick B, Rodriguez M, Berish D, Galvin JE, Boltz M. Caregiver preparedness is associated with desire to seek long-term care admission of hospitalized persons with dementia. Int J Geriatr Psychiatry 2023; 38:e6006. [PMID: 37715936 DOI: 10.1002/gps.6006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 09/06/2023] [Indexed: 09/18/2023]
Abstract
INTRODUCTION Hospitalized patients with dementia are more likely to be discharged to long-term care compared to persons without dementia. Little research has been conducted to examine the associations of caregiver preparedness and strain with desire to seek long-term care in hospitalized persons with dementia at discharge. The purpose of this study was to examine caregiver preparedness and strain as factors associated with desire to seek long-term care admission in caregivers of persons with dementia at hospital discharge. METHODS Patient baseline and discharge data, and caregiver discharge data of 424 patient and caregiver dyads from a cluster randomized trial was used. Stepwise multiple linear regression was conducted to examine factors associated with caregiver desire to seek long-term care. RESULTS After controlling for caregiver and patient characteristics, lower caregiver preparedness (β = -0.069; p < 0.016) was significantly associated with increased desire to seek long-term care. DISCUSSION Findings underscore the need for clinicians and service providers to provide further attention to caregiver preparedness throughout the course of hospitalization.
Collapse
Affiliation(s)
- Ashley Kuzmik
- Pennsylvania State University, Ross and Nese College of Nursing, University Park, Pennsylvania, USA
| | - Rhonda BeLue
- University of Texas at San Antonio, College for Health Community and Policy, San Antonio, Texas, USA
| | - Barbara Resnick
- University of Maryland, School of Nursing, Baltimore, Maryland, USA
| | - Marleny Rodriguez
- Department of Psychology and Counseling, Immaculata University, Immaculata, Pennsylvania, USA
| | - Diane Berish
- Pennsylvania State University, Ross and Nese College of Nursing, University Park, Pennsylvania, USA
| | - James E Galvin
- Comprehensive Center for Brain Health, University of Miami, Miller School of Medicine, Boca Raton, Florida, USA
| | - Marie Boltz
- Pennsylvania State University, Ross and Nese College of Nursing, University Park, Pennsylvania, USA
| |
Collapse
|
3
|
Gazaway S, Wells RD, Azuero A, Pisu M, Guastaferro K, Rini C, Taylor R, Reed RD, Harrell ER, Bechthold AC, Bratches RW, McKie P, Lowers J, Williams GR, Rosenberg AR, Bakitas MA, Kavalieratos D, Dionne-Odom JN. Decision support training for advanced cancer family caregivers: Study protocol for the CASCADE factorial trial. Contemp Clin Trials 2023; 131:107259. [PMID: 37286131 PMCID: PMC10527385 DOI: 10.1016/j.cct.2023.107259] [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: 03/27/2023] [Revised: 05/31/2023] [Accepted: 05/31/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND Patients with advanced cancer face numerous decisions when diagnosed and often receive decision support from family caregivers. The CASCADE (CAre Supporters Coached to be Adept DEcision partners) factorial trial intervention aims to train caregivers in skills to provide effective decision support to patients and identify most effective intervention components. METHODS This is a 2-site, single-blind, 24 factorial trial to test components of the CASCADE decision support training intervention for family caregivers of patients with newly-diagnosed advanced cancer delivered by specially-trained, telehealth, palliative care lay coaches over 24 weeks. Family caregivers (target N = 352) are randomly assigned to one of 16 combinations of four components with two levels each: 1) psychoeducation on effective decision partnering principles (1 vs. 3 sessions); 2) decision support communication training (1 session vs. none); 3) Ottawa Decision Guide training (1 session vs. none) and 4) monthly follow-up (1 call vs. calls for 24 weeks). The primary outcome is patient-reported decisional conflict at 24 weeks. Secondary outcomes include patient distress, healthcare utilization, caregiver distress, and quality of life. Mediators and moderators (e.g., sociodemographics, decision self-efficacy, social support) will be explored between intervention components and outcomes. Results will be used to build two versions of CASCADE: one with only effective components (d ≥ 0.30) and another optimized for scalability and cost. DISCUSSION This protocol describes the first factorial trial, informed by the multiphase optimization strategy, of a palliative care decision-support intervention for advanced cancer family caregivers and will address the field's need to identify effective components that support serious illness decision-making. TRIAL REGISTRATION NCT04803604.
Collapse
Affiliation(s)
- Shena Gazaway
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Rachel D Wells
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Andres Azuero
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Maria Pisu
- Division of Preventive Medicine, UAB Heersink School of Medicine, Birmingham, AL, USA
| | - Kate Guastaferro
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, USA
| | - Christine Rini
- Cancer Survivorship Institute, Feinberg School of Medicine, Northwestern University, Evanston, IL, USA
| | - Richard Taylor
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Rhiannon D Reed
- Division of Transplantation, Department of Medicine, UAB, Birmingham, AL, USA
| | - Erin R Harrell
- Department of Psychology, University of Alabama, Tuscaloosa, AL, USA
| | - Avery C Bechthold
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Reed W Bratches
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Peg McKie
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Jane Lowers
- Division of Palliative Medicine, Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA, USA
| | | | - Abby R Rosenberg
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Department of Medicine, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Marie A Bakitas
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Dio Kavalieratos
- Division of Palliative Medicine, Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA, USA
| | | |
Collapse
|
4
|
Häger Tibell L, Årestedt K, Holm M, Wallin V, Steineck G, Hudson P, Kreicbergs U, Alvariza A. Preparedness for caregiving and preparedness for death: Associations and modifiable thereafter factors among family caregivers of patients with advanced cancer in specialized home care. DEATH STUDIES 2023; 48:407-416. [PMID: 37441803 DOI: 10.1080/07481187.2023.2231388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Abstract
The purpose of this study was to (1) explore associations between preparedness for caregiving and preparedness for death among family caregivers of patients with advanced cancer and (2) explore modifiable preparedness factors, such as communication and support. Data was derived from a baseline questionnaire collected in specialized home care. The questionnaire included socio-demographics, the Preparedness for Caregiving Scale, and single items addressing preparedness for death, received support and communication about incurable illness. Data was analyzed using descriptive statistics and Spearman correlations. Altogether 39 family caregivers participated. A significant association was found between preparedness for caregiving and preparedness for death. Received support and communication about the illness was associated with higher levels of preparedness for caregiving and death. This study contributes to evidence on the association between preparedness for caregiving and death, but also that communication and support employed by healthcare professionals could improve family caregiver preparedness and wellbeing.
Collapse
Affiliation(s)
- Louise Häger Tibell
- The Department of Health Care Science/Palliative Research Centre, Marie Cederschiöld University, Stockholm, Sweden
- Tema Cancer, BES: Breast-Endocrine Tumours and Sarcoma, Karolinska University Hospital, Stockholm, Sweden
| | - Kristofer Årestedt
- Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden
- Department of Research, Region Kalmar County, Kalmar, Sweden
| | - Maja Holm
- The Department of Health Care Science/Palliative Research Centre, Marie Cederschiöld University, Stockholm, Sweden
- Department of Nursing Science, Sophiahemmet University, Stockholm, Sweden
| | - Viktoria Wallin
- The Department of Health Care Science/Palliative Research Centre, Marie Cederschiöld University, Stockholm, Sweden
| | - Gunnar Steineck
- Department of Clinical Cancer Epidemiology, Karolinska Institutet, Stockholm, Sweden
- Division of Clinical Cancer Epidemiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Peter Hudson
- Centre for Palliative Care, St Vincent´s Hospital and The University of Melbourne, Melbourne, Australia
- Vrije University Brussels, Brussels, Belgium
| | - Ulrika Kreicbergs
- The Department of Health Care Science/Palliative Research Centre, Marie Cederschiöld University, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Anette Alvariza
- Research and Development-Unit/Palliative Care, Stockholms Sjukhem, Stockholm, Sweden
| |
Collapse
|
5
|
Fields NL, Xu L, Williams IC, Gaugler JE, Cipher DJ, Cassidy J, Feinhals G. The Senior Companion Program Plus: An Innovative Training Approach for Alzheimer's Disease and Related Dementia. Healthcare (Basel) 2023; 11:1966. [PMID: 37444800 PMCID: PMC10341164 DOI: 10.3390/healthcare11131966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 06/25/2023] [Accepted: 06/30/2023] [Indexed: 07/15/2023] Open
Abstract
African Americans adults are disproportionately affected by Alzheimer's disease and related dementias (ADRD) and are underrepresented in research about ADRD. Reducing gaps in the knowledge about ADRD in the African American community is important for addressing dementia care disparities. The existing psychoeducation interventions are often limited by cost and scalability; for these reasons, lay provider (i.e., volunteer) interventions are of increasing interest in ADRD research. The purpose of this study was to evaluate a training of African American Senior Companion (SC) volunteers (n = 11) with dementia-specific knowledge (i.e., Senior Companion Program/SCP Plus), as part of a culturally informed, in-home, psychoeducational intervention for African American ADRD family caregivers. Learning outcomes were measured pre- and post-training, using the Knowledge of Alzheimer's Disease/dementia scale (KAD), the Sense of Competence Questionnaire, and the Preparedness for Caregiving Scale. The results showed significant improvements in knowledge of Alzheimer's disease/dementia, one competence item, "It is clear to me how much care my care recipient needs", and preparedness for caregiving. Overall, the study findings suggest the SCP Plus is a promising, culturally relevant, and potentially scalable lay provider training for ADRD with potential benefits that augment the existing Senior Companion Program.
Collapse
Affiliation(s)
- Noelle L. Fields
- School of Social Work, University of Texas at Arlington, Arlington, TX 76019, USA; (L.X.); (J.C.)
| | - Ling Xu
- School of Social Work, University of Texas at Arlington, Arlington, TX 76019, USA; (L.X.); (J.C.)
| | - Ishan C. Williams
- School of Nursing, University of Virginia, Charlottesville, VA 22903, USA;
| | - Joseph E. Gaugler
- School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA;
| | - Daisha J. Cipher
- College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, TX 76019, USA;
| | - Jessica Cassidy
- School of Social Work, University of Texas at Arlington, Arlington, TX 76019, USA; (L.X.); (J.C.)
| | | |
Collapse
|
6
|
Xu J, Hebdon M, Beck A, Cloyes KG, Mooney K, Reblin M, Tay D, Appiah EO, Ellington L. Moderating Effect of Work on Burden and Hospice Family Caregiver Well-Being. J Palliat Med 2023; 26:941-950. [PMID: 36799950 PMCID: PMC10316524 DOI: 10.1089/jpm.2022.0395] [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] [Accepted: 12/28/2022] [Indexed: 02/18/2023] Open
Abstract
Background: Hospice family caregiving is often physically and emotionally taxing, but it is unclear how employment status impacts hospice caregiver burden and well-being. Objective(s): To examine the relationship between caregiver burden and well-being, and the moderating role of employment status (i.e., working, not working). Design, Setting/Subjects: This was a secondary data analysis of baseline data from a longitudinal observational study of family caregivers of home hospice cancer patients in the United States. Descriptive statistics, correlations, hierarchical linear regressions, and moderation analyses were used. Measurements: Baseline data included demographics, preparedness for caregiving, perceived burden, and well-being (i.e., global health, positive affect and well-being, anxiety, depression). Results: The majority of the 90 participants were White (86.7%), married (71.1%), and college educated (85.6%). The mean age was 58.27 ± 14.22, 53.3% cared for a spouse, and 56.6% worked full or part time. After controlling for demographics, and using employment status as a moderator, greater caregiver burden was significantly associated with lower global health (β = -0.82 [-1.22 to -0.42], p < 0.001), positive affect and well-being scores (β = -0.69 [-1.03 to -0.36], p < 0.001), and higher depression (β = 0.24 [0.12-0.37], p < 0.001) and anxiety scores (β = 0.22 [0.07-0.37], p < 0.005). Employment status significantly moderated the relationship between burden and global health (β = 0.65 [0.22 to 1.08], p < 0.005), and burden and positive affect and well-being (β = 0.45 [0.06 to 0.84], p < 0.05). At high levels of burden, workers had greater well-being than nonworkers. Conclusion(s): More burdened hospice caregivers may experience worse well-being, especially among nonworking caregivers. Employment may be a protective factor for highly burdened hospice family caregivers.
Collapse
Affiliation(s)
- Jiayun Xu
- School of Nursing, College of Health and Human Sciences, Purdue University, West Lafayette, Indiana, USA
| | - Megan Hebdon
- School of Nursing, University of Texas, Austin, Texas, USA
| | - Anna Beck
- School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Kristin G. Cloyes
- School of Nursing, Oregon Health & Sciences University, Portland, Oregon, USA
| | - Kathi Mooney
- College of Nursing, University of Utah, Salt Lake City, Utah, USA
| | - Maija Reblin
- College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Djin Tay
- College of Nursing, University of Utah, Salt Lake City, Utah, USA
| | - Evans Osei Appiah
- School of Nursing, College of Health and Human Sciences, Purdue University, West Lafayette, Indiana, USA
| | - Lee Ellington
- College of Nursing, University of Utah, Salt Lake City, Utah, USA
| |
Collapse
|
7
|
Fields B, Werner N, Shah MN, Hetzel S, Golden BP, Gilmore-Bykovskyi A, Farrar Edwards D. Adapting and Testing the Care Partner Hospital Assessment Tool for Use in Dementia Care: Protocol for a 2 Sequential Phase Study. JMIR Res Protoc 2023; 12:e46808. [PMID: 37347517 DOI: 10.2196/46808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 04/25/2023] [Accepted: 05/23/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND Research and policy demonstrate the value of and need for systematically identifying and preparing care partners for their caregiving responsibilities while their family member or friend living with dementia is hospitalized. The Care Partner Hospital Assessment Tool (CHAT) has undergone content and face validation and has been endorsed as appropriate by clinicians to facilitate the timely identification and preparation of care partners of older adult patients during their hospitalization. However, the CHAT has not yet been adapted or prospectively evaluated for use with care partners of hospitalized people living with dementia. Adapting and testing the CHAT via a pilot study will provide the necessary evidence to optimize feasibility and enable future efficacy trials. OBJECTIVE The purpose of this paper is to describe the study protocol for the adaptation and testing of the CHAT for use among care partners of hospitalized people living with dementia to better prepare them for their caregiving responsibilities after hospital discharge. METHODS Our protocol is based on the National Institutes of Health Stage Model and consists of 2 sequential phases, including formative research and the main trial. In phase 1, we will use a participatory human-centered design process that incorporates people living with dementia and their care partners, health care administrators, and clinicians to adapt the CHAT for dementia care (ie, the Dementia CHAT [D-CHAT]; stage IA). In phase 2, we will partner with a large academic medical system to complete a pilot randomized controlled trial to examine the feasibility and estimate the size of the effect of the D-CHAT on care partners' preparedness for caregiving (stage IB). We anticipate this study to take approximately 60 months to complete, from study start-up procedures to dissemination. The 2 phases will take place between December 1, 2022, and November 30, 2027. RESULTS The study protocol will yield (1) a converged-upon, ready-for-feasibility testing D-CHAT; (2) descriptive and feasibility characteristics of delivering the D-CHAT; and (3) effect size estimates of the D-CHAT on care partner preparedness. We anticipate that the resultant D-CHAT will provide clinicians with guidance on how to identify and better prepare care partners for hospitalized people living with dementia. In turn, care partners will feel equipped to fulfill caregiving roles for their family members or friends living with dementia. CONCLUSIONS The expected results of this study are to favorably impact hospital-based care processes and outcomes for people living with dementia and their care partners and to elucidate the essential caregiving role that so many care partners of people living with dementia assume. TRIAL REGISTRATION ClinicalTrials.gov NCT05592366; https://clinicaltrials.gov/ct2/show/NCT05592366. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/46808.
Collapse
Affiliation(s)
- Beth Fields
- Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, United States
| | - Nicole Werner
- Department of Health and Wellness Design, Indiana University School of Public Health-Bloomington, Bloomington, IN, United States
| | - Manish N Shah
- BerbeeWalsh Department of Emergency Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Scott Hetzel
- Department of Statistics, School of Computer, Data and Information Sciences, University of Wisconsin-Madison, Madison, WI, United States
| | - Blair P Golden
- Division of Hospital Medicine, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Andrea Gilmore-Bykovskyi
- BerbeeWalsh Department of Emergency Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Dorothy Farrar Edwards
- Department of Kinesiology, School of Education, University of Wisconsin-Madison, Madison, WI, United States
| |
Collapse
|
8
|
Xu L, Fields NL, Williams IC, Gaugler JE, Kunz-Lomelin A, Cipher DJ, Feinhals G. The Senior Companion Program Plus (SCP Plus): Examining the Preliminary Effectiveness of a Lay Provider Program to Support African American Alzheimer's Disease and Related Dementias (ADRD) Caregivers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5380. [PMID: 37047994 PMCID: PMC10094539 DOI: 10.3390/ijerph20075380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 03/10/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVES A culturally informed, peer-led, lay provider model, the Senior Companion Program (SCP) Plus, was implemented to decrease caregiving burden/stress and improve coping skills and social support for African American ADRD caregivers. This study reported the preliminary effectiveness of this intervention. METHODS An explanatory sequential mixed methods design was used in this study, and a randomized control trial was conducted for the SCP Plus intervention among participants in three sites (n = 20). A subsample of participants (n = 7) consented to a qualitative interview about their experiences with the intervention. Wilcoxon signed-rank tests, Friedman tests, and one-way repeated measures ANOVA were computed for quantitative analyses. Thematic analysis was used for the qualitative interviews. RESULTS Results demonstrated that knowledge of AD/dementia (KAD) and preparedness for caregiving were significantly improved for all senior companions in the intervention group. Results also showed that caregivers in the intervention group reported significantly decreased caregiving burden, as well as increased KAD, satisfaction with social support, and positive aspects of caregiving. Themes from the qualitative interviews included: learning new skills about caregiving, gaining knowledge about ADRD, and benefits for the dyad. DISCUSSIONS Findings from this study implied that SCP Plus was a promising model for African American family caregivers as it benefits both the SC volunteers and the African American ADRD family caregivers.
Collapse
Affiliation(s)
- Ling Xu
- School of Social Work, University of Texas at Arlington, Arlington, TX 76019, USA
| | - Noelle L. Fields
- School of Social Work, University of Texas at Arlington, Arlington, TX 76019, USA
| | - Ishan C. Williams
- School of Nursing, University of Virginia, Charlottesville, VA 22903, USA
| | - Joseph E. Gaugler
- School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA
| | - Alan Kunz-Lomelin
- School of Social Work, University of Texas at Arlington, Arlington, TX 76019, USA
| | - Daisha J. Cipher
- College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, TX 76019, USA
| | | |
Collapse
|
9
|
Lobb EA, Halkett GKB, McDougall E, Campbell R, Dhillon HM, Phillips JL, Nowak AK. Bereavement outcomes of carers of patients with high grade glioma: Experiences of support before and after the death. DEATH STUDIES 2023:1-10. [PMID: 36786747 DOI: 10.1080/07481187.2023.2167888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Carers of people with High Grade Glioma (HGG) completed a survey assessing their anxiety, depression, and grief in addition to open-ended questions exploring their experiences of support pre- and post-death (N = 25). One-third reported borderline or clinical levels of anxiety, depression, and grief related distress. Given the poor prognosis and rapid deterioration of patients with HGG, the findings highlight the importance of sensitive communication about prognosis early in the disease trajectory, information tailored to disease stage, the initiation of a referral to psychological support services, and timely discussions about the preferred place of care and death.
Collapse
Affiliation(s)
- Elizabeth A Lobb
- Calvary Health Care Kogarah, Sydney, Australia
- School of Medicine, The University of Notre Dame, Sydney, Australia
- Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | - Georgia K B Halkett
- Faculty of Health Sciences, Curtin School of Nursing/Curtin Health Innovation Research Institute, Curtin University, Bentley, Australia
| | - Emma McDougall
- Faculty of Health Sciences, Curtin School of Nursing/Curtin Health Innovation Research Institute, Curtin University, Bentley, Australia
| | - Rachel Campbell
- Psycho-Oncology Cooperative Research Group, Faculty of Science, School of Psychology, University of Sydney, Sydney, Australia
| | - Haryana M Dhillon
- Psycho-Oncology Cooperative Research Group, Faculty of Science, School of Psychology, University of Sydney, Sydney, Australia
- Centre for Medical Psychology & Evidence-Based Decision-Making, University of Sydney, Sydney, Australia
| | - Jane L Phillips
- Faculty of Health, University of Technology Sydney, Ultimo, Australia
- Faculty of Health, School of Nursing, Queensland University of Technology, Brisbane, Australia
| | - Anna K Nowak
- Medical School, University of Western Australia, Nedlands, Australia
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, Australia
| |
Collapse
|
10
|
Kirtane K, Reblin M, Oswald LB, Irizarry-Arroyo N, McCormick R, Locke FL, Ketcher D. Psychosocial characteristics of patients undergoing cellular immunotherapies and their caregivers across time. Leuk Lymphoma 2023; 64:364-370. [PMID: 36416677 DOI: 10.1080/10428194.2022.2148216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Chimeric antigen receptor T-cells and other immunotherapies have markedly changed the paradigm of treatment for patients with relapsed or refractory hematologic malignancies. While notable in efficacy, immunotherapy is characterized by a significant possibility of life-threatening side effects. Consequently, patients are often required to have informal family caregivers present and to stay near the treating center for several weeks after cell infusion. Further, the responsibility of managing a great deal of physical care and emotional support falls to these caregivers. Given the novelty of immunotherapy treatment, there is a need to better understand the psychosocial experience of patients receiving this treatment and their caregivers. This article describes the psychosocial characteristics of patients undergoing cellular immunotherapies and their caregivers across time, including patient/caregiver distress, coping, and caregiver burden and preparedness.
Collapse
Affiliation(s)
- Kedar Kirtane
- Department of Head and Neck-Endocrine Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Maija Reblin
- Department of Family Medicine, University of Vermont, Burlington, VT, USA
| | - Laura B Oswald
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | | | - Rachael McCormick
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Frederick L Locke
- Department of Blood and Marrow Transplantation, Moffitt Cancer Center, Tampa, FL, USA
| | - Dana Ketcher
- University of Minnesota Medical School, Duluth Campus, MN, USA
| |
Collapse
|
11
|
Halkett GKB, Lobb EA, Phillips JL, McDougall E, Clarke J, Campbell R, Dhillon HM, McGeechan K, Hudson P, King A, Wheeler H, Kastelan M, Long A, Nowak AK. Carer preparedness improved by providing a supportive educational intervention for carers of patients with high-grade glioma: RCT results. J Neurooncol 2023; 161:501-513. [PMID: 36658381 PMCID: PMC9992082 DOI: 10.1007/s11060-023-04239-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 12/24/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND High-grade glioma (HGG) is a rapidly progressing and debilitating disease. Family carers take on multiple responsibilities and experience high levels of distress. We aimed to deliver a nurse-led intervention (Care-IS) to carers to improve their preparedness to care and reduce distress. METHODS We conducted a randomised controlled trial (ACTRN:12612001147875). Carers of HGG patients were recruited during patients' combined chemoradiation treatment. The complex intervention comprised four components: (1) initial telephone assessment of carer unmet needs; (2) tailored hard-copy resource folder; (3) home visit; and, (4) monthly telephone support for up to 12 months. Primary outcomes included preparedness for caregiving and distress at 2, 4, 6 and 12 months. Intervention effects were estimated using linear mixed models which included a time by group interaction. Secondary outcomes included anxiety, depression, quality of life, carer competence and strain. RESULTS We randomised 188 carers (n = 98 intervention, n = 90 control). The intervention group reported significantly higher preparedness for caregiving at 4 months (model β = 2.85, 95% CI 0.76-4.93) and all follow-up timepoints including 12 months (model β = 4.35, 95% CI 2.08-6.62), compared to the control group. However, there was no difference between groups in carer distress or any secondary outcomes. CONCLUSIONS This intervention was effective in improving carer preparedness. However, carer distress was not reduced, potentially due to the debilitating/progressive nature of HGG and ongoing caring responsibilities. Future research must explore whether carer interventions can improve carer adjustment, self-efficacy and coping and how we support carers after bereavement. Additionally, research is needed to determine how to implement carer support into practice.
Collapse
Affiliation(s)
- Georgia K B Halkett
- Curtin School of Nursing/Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, GPO Box U1987, Bentley, Perth, WA, 6005, Australia.
| | - Elizabeth A Lobb
- Calvary Health Care Kogarah, Sydney, NSW, Australia.,School of Medicine, The University of Notre Dame, Sydney, NSW, Australia.,Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Jane L Phillips
- Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia.,School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Emma McDougall
- Curtin School of Nursing/Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, GPO Box U1987, Bentley, Perth, WA, 6005, Australia
| | - Jenny Clarke
- Curtin School of Nursing/Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, GPO Box U1987, Bentley, Perth, WA, 6005, Australia
| | - Rachel Campbell
- Psycho-Oncology Cooperative Research Group, School of Psychology, Faculty of Science, University of Sydney, Sydney, NSW, Australia
| | - Haryana M Dhillon
- Psycho-Oncology Cooperative Research Group, School of Psychology, Faculty of Science, University of Sydney, Sydney, NSW, Australia.,Centre for Medical Psychology & Evidence-Based Decision-Making, University of Sydney, Sydney, NSW, Australia
| | - Kevin McGeechan
- School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Peter Hudson
- Centre for Palliative Care St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia.,Department of Nursing, University of Melbourne, Melbourne, VIC, Australia.,Vrije University Brussels, Brussels, Belgium
| | - Anne King
- Cancer Network Western Australia, North Metropolitan Health Service, Perth, WA, Australia
| | - Helen Wheeler
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Marina Kastelan
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia.,The Brain Cancer Group, North Shore Private Hospital, St Leonards, NSW, Australia
| | - Anne Long
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Anna K Nowak
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia.,Medical School, University of Western Australia, Nedlands, WA, Australia
| | | |
Collapse
|
12
|
Milliron BJ, Klobodu C, Deutsch J, Martyn K, Dychtwald D, Riahi E, Carro S, Hisek T, Darcy N, Klassen AC. "Keep Your Chin Up, and Keep Eating": Perceptions of Barriers and Facilitators to Healthful Dietary Behaviors Among Individuals With Gastrointestinal Cancer and Caregivers. Cancer Control 2023; 30:10732748231208316. [PMID: 37914716 PMCID: PMC10623986 DOI: 10.1177/10732748231208316] [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: 02/14/2023] [Revised: 09/12/2023] [Accepted: 09/26/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND This study explored perceptions of barriers and facilitators to healthful dietary behaviors among patients with gastrointestinal (GI) cancer and their caregivers, including caregiver preparedness, patient and caregiver self-efficacy for symptom management, and other environmental, social, and familial factors that may serve as barriers and facilitators to healthful eating. METHODS Using a concurrent mixed methods cross-sectional study design, individuals with GI cancer receiving outpatient chemotherapy and their caregivers completed surveys, dietary assessments, and interviews. Caregiving preparedness, self-efficacy for symptom management, and dietary intake were assessed using validated instruments. Dietary quality was measured using the Healthy Eating Index (HEI)-2020. In-depth interviews explored barriers and facilitators to healthful eating, symptom management, and caregiver preparedness. RESULTS Twenty-seven patient-caregiver dyads completed study activities (N = 54). Dietary quality scores ranged from 26 to 81, with a median score of 43 for patients and 42 for caregivers. Thematic analysis identified three barriers to healthful eating: caregiver self-efficacy and preparedness, caregiver needs are neglected, and nutrition as a source of conflict. Overall self-efficacy scores (Mdn, [IQR]) were 69.1 (45.0) for caregivers and 75.6 (34.1) for patients. Caregiver preparedness score was 2.99 ± .87; problem areas were identified, including addressing emotional needs, fluctuating eating habits, advanced disease progression and making care activities pleasant. Despite the challenges, three main facilitators were identified: increased awareness and value of nutrition, influential others, and positive coping. CONCLUSION Our findings suggest the importance of developing interventions that increase nutrition-related preparedness among caregivers and self-efficacy for managing treatment side effects. Future research should continue to explore the relationship between positive coping and dietary behaviors. While engaging patients and caregivers together during dietary interventions is a promising modality, strategies for maintaining personal nutrition-related goals when facing contrasting priorities between patients and caregivers should be addressed.
Collapse
Affiliation(s)
- Brandy-Joe Milliron
- Department of Nutrition Sciences, College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA
| | - Cynthia Klobodu
- Department of Nutrition Sciences, College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA
| | - Jonathan Deutsch
- Department of Food and Hospitality Management, College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA
| | - Karon Martyn
- Asplundh Cancer Pavilion, Sidney Kimmel Cancer Center, Jefferson Health, Willow Grove, PA, USA
| | - Dan Dychtwald
- Department of Nutrition Sciences, College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA
| | - Emily Riahi
- Department of Nutrition Sciences, College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA
| | - Shawn Carro
- Department of Nutrition Sciences, College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA
| | - Taylor Hisek
- Department of Nutrition Sciences, College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA
| | - Natalie Darcy
- Asplundh Cancer Pavilion, Sidney Kimmel Cancer Center, Jefferson Health, Willow Grove, PA, USA
| | - Ann C Klassen
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| |
Collapse
|
13
|
Relationships among Demographic, Clinical, and Psychological Factors Associated with Family Caregiver Readiness to Participate in Intensive Care Unit Care. Ann Am Thorac Soc 2022; 19:1881-1891. [PMID: 35649201 DOI: 10.1513/annalsats.202106-651oc] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Rationale: There has been a paradigm shift to partner with family caregivers by actively involving them in the direct care of the patient throughout the critical illness trajectory. Before effectively engaging family members in patient care, clinicians must assess characteristics and circumstances that may affect caregiver readiness to assume a caregiving role in the intensive care unit (ICU). Objectives: To determine how demographic, clinical, and psychological factors are related to characteristics of family caregiver readiness to engage in ICU patient care. Methods: A convenience sample of ICU family caregivers of both adult and pediatric patients in the ICU was recruited for this cross-sectional study. Participants completed the following measures: PROMIS-29 (Patient-Reported Outcomes Measurement and Information System); HADS (Hospital Anxiety and Depression Scale); CaSES (Caregiver Self-Efficacy Scale); Prep Scale (Preparedness for Caregiving Scale); Patient Activation Measure for Caregivers; and FCMFHS (Family Caregiver's Motives for Helping Scale). Data were collected via self-report at a single time point while the caregiver was visiting the critically ill patient in the ICU. Data analysis consisted of descriptive statistics and bivariate correlations. Results: Caregivers (N = 127) were primarily White (82.7%), females (77.2%), with a mean age of 51.8 (standard deviation [SD], 15.6). Most were either spouses (37.8%) or parents (32.3%) of the patient in the ICU. Patients were primarily adult (76.4%) with a mean APACHE (Acute Physiology, Age, Chronic Health Evaluation) III of 45.9 (SD, 22.5). There were significant (P < 0.05) negative correlations between depression, anxiety, and fatigue and all subscales of self-efficacy (resilience r = -0.18 to -0.30; self-maintenance r = -0.44 to -0.63; emotional connectivity r = -0.27 to -0.41; instrumental giving r = -0.34 to -0.46). Caregiver depression was negatively correlated with caregiver activation (r = -0.199) and caregiver preparedness (r = -0.300). Social satisfaction was positively correlated (P < 0.05) with caregiving preparedness, motivation, and all subscales of self-efficacy (preparedness r = 0.19; motivation r = 0.24; resilience r = 0.21; self-maintenance r = 0.49; emotional connectivity r = 0.29; instrumental giving r = 0.36). Conclusions: We found that caregiver symptoms of depression, anxiety, and fatigue are inversely related to caregiver preparation, motivation, and self-efficacy. To develop effective interventions for ICU family caregivers, further research is needed to understand the relationship between caregiver well-being, caregiving readiness, and caregiver involvement in patient care.
Collapse
|
14
|
Implementation of Interprofessional Meetings Preparing Caregivers of Patients With Brain Injury for Discharge: A Pilot Study. Prof Case Manag 2022; 27:239-245. [PMID: 35901256 DOI: 10.1097/ncm.0000000000000562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF STUDY Caregivers are often unprepared to care for patients discharged with brain injury. Interprofessional team meetings with the caregiver used in some specialties improve discharge planning. The purpose of this study was to evaluate the effect of a standardized interprofessional caregiver meeting on caregiver readiness for caregiving. PRIMARY PRACTICE SETTING The study was implemented on an eight-bed brain injury unit within a 73-bed Magnet-designated surgery and rehabilitation hospital in south central Pennsylvania. METHODOLOGY AND SAMPLE This study used a pre-/post-quasi-experimental retrospective design. Caregivers of patients admitted to the brain injury unit completed the Preparedness for Caregiving Scale at admission and discharge. The intervention group received an interprofessional team meeting focused on the needs of the caregiver in preparation for caregiving within 3-4 days of admission compared with unscheduled meetings as needed. RESULTS Scores improved significantly from admission to discharge in usual care and intervention groups. Sample size was insufficient to detect differences between groups. Health care providers and caregivers expressed improvement in communication and readiness for discharge. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE Early interprofessional meetings with the purpose of getting to know and understanding the needs of caregivers of patients with brain injury could guide us to better prepare the caregiver for caregiving at home. The Preparedness for Caregiving Scale can be useful to assess multiple domains of caregiving. This proactive approach may improve communication and discharge readiness for patients with brain injury.
Collapse
|
15
|
da Rocha CG, Perrenoud B, Ramelet AS. Perceptions of Burden and Preparedness for Caregiving among the Family Caregivers of Hospitalised Older Adults: A Cross-Sectional Study. Geriatrics (Basel) 2022; 7:19. [PMID: 35200524 PMCID: PMC8872519 DOI: 10.3390/geriatrics7010019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 02/08/2022] [Accepted: 02/14/2022] [Indexed: 12/10/2022] Open
Abstract
BACKGROUND Due to the increasing care needs of older adults, family caregivers are more and more solicited. This can have a negative impact on their quality of life related to a lack of preparedness for caregiving and feelings of burden. OBJECTIVES To measure perceptions of burden and preparedness for caregiving among the family caregivers of hospitalised older adults, and to explore their possible associations. METHODS A cross-sectional study conducted in two university hospital geriatrics wards in Switzerland. Principal family caregivers of hospitalised older adults were invited to complete sociodemographic, the Zarit Burden Interview, and the Preparedness for Caregiving Scale questionnaires. Descriptive and correlational data analyses were performed. RESULTS Of the 38 responding caregivers, 80% provided informal care to their spouse or parent; 45% reported a lack of preparedness to provide care and 61% reported substantial levels of burden. There was no statistically significant correlation between preparedness and burden (ρ ≤ -0.30, p = 0.07). CONCLUSIONS A significant proportion of caregivers reported burden and a lack of preparedness. Healthcare professionals should provide adequate support to help informal caregivers to fulfil their roles.
Collapse
Affiliation(s)
- Carla Gomes da Rocha
- Acute Geriatric Care Unit, Lausanne University Hospital, Avenue Pierre Decker 5, CH-1011 Lausanne, Switzerland
| | - Béatrice Perrenoud
- Nursing Directorate, Lausanne University Hospital, Rue du Bugnon 21, CH-1011 Lausanne, Switzerland;
- La Source Institute and School of Nursing, University of Applied Sciences and Arts Western Switzerland, Avenue Vinet 30, CH-1004 Lausanne, Switzerland
| | - Anne-Sylvie Ramelet
- Institute of Higher Education and Research in Healthcare, University of Lausanne, Biopôle 2, Route de la Corniche 10, CH-1010 Lausanne, Switzerland;
| |
Collapse
|
16
|
Hebdon MCT, Xu J, Reblin M, Clayton MF, Mooney K, Ellington L. Balancing Work and Hospice Caregiving-A Closer Look at Burden, Preparedness, and Mental Health. J Pain Symptom Manage 2022; 63:283-292. [PMID: 34425211 DOI: 10.1016/j.jpainsymman.2021.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 08/04/2021] [Accepted: 08/10/2021] [Indexed: 10/20/2022]
Abstract
CONTEXT Navigating end-of-life is stressful and many caregivers feel unprepared for caregiving tasks. Being employed may further increase caregiver burden. OBJECTIVES Study objectives were 1) to examine the relationships among caregiver burden (financial burden, daily schedule disruption, lack of family support) and mental health (depression and anxiety), and 2) explore if preparedness for caregiving mediates these relationships in employed hospice caregivers. METHODS This was a secondary analysis of baseline data from a prospective multi-site project of hospice family caregivers of cancer patients. Employed hospice caregivers (n = 166) completed items assessing burden, mental health, and preparedness for caregiving. Hierarchical linear regression and mediation analysis were conducted. RESULTS Caregivers were primarily White (n = 155, 93%) and female (n = 116, 70%), with a mean age of 55 (SD = 11.7). After controlling for demographic variables, financial burden was significantly related to anxiety (b =.16[.001, .32], P <.05), lack of family support was significantly related to depression (b = 1.27[.76, 1.79], P <.01), and daily schedule disruption was significantly related to both anxiety (b = 1.92[1.07, 2.77], P <.01), and depression (b =.70[.14, 1.26], P <.05) in regression analyses. In mediation analysis, financial burden, daily schedule disruption, and lack of family support were indirectly related to both depression and anxiety through preparedness for caregiving. CONCLUSION To better support employed caregivers, hospice team members should be ready to address concerns about finances, daily schedule changes, and family support and screen for preparedness for caregiving. Developing strategies to help employed hospice caregivers feel more prepared may mitigate adverse mental health outcomes.
Collapse
Affiliation(s)
- Megan C Thomas Hebdon
- University of Utah College of Nursing (M.C.T.H., M.F.C., K.M., L.E.), Salt Lake City, Utah, USA.
| | - Jiayun Xu
- Purdue University School of Nursing (J.X.), West Lafayette, Indiana, USA
| | - Maija Reblin
- University of Vermont Larner College of Medicine (M.R.), Burlington, Vermont, USA
| | - Margaret F Clayton
- University of Utah College of Nursing (M.C.T.H., M.F.C., K.M., L.E.), Salt Lake City, Utah, USA
| | - Kathi Mooney
- University of Utah College of Nursing (M.C.T.H., M.F.C., K.M., L.E.), Salt Lake City, Utah, USA
| | - Lee Ellington
- University of Utah College of Nursing (M.C.T.H., M.F.C., K.M., L.E.), Salt Lake City, Utah, USA
| |
Collapse
|
17
|
Guo JW, Reblin M, Tay D, Ellington L, Beck AC, Cloyes KG. Patterns of stress and support in social support networks of in-home hospice cancer family caregivers. JOURNAL OF SOCIAL AND PERSONAL RELATIONSHIPS 2021; 38:3121-3141. [PMID: 34898795 PMCID: PMC8664070 DOI: 10.1177/02654075211024743] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Family caregivers of home hospice cancer patients often experience burden and distress, which can be mitigated by perceived social support. However, less attention has been paid to the non-family sources of support within social networks, or to how sources of support may also be sources of stress. We describe support and stress in social networks of hospice family caregivers and identify caregiving characteristics associated with classes identified in our data. We collected demographic and psychosocial self-report data from family caregivers providing in-home hospice care for advanced cancer patients (N = 90). Caregivers also reported perceived support and stress from specific family and non-family relationships. We identified three classes with unique patterns of stress and support within caregivers' support networks using a latent class analysis. Classes include: 1) high support, low stress across family and non-family network members ("supportive"; 53% of caregivers); 2) high support, high stress across family and non-family network ("ambivalent maximizers"; 26%); and 3) high support, high stress across family network only ("family-focused ambivalent"; 21%). Caregivers in the ambivalent maximizer class reported more burden than caregivers in the supportive class (p = .024). This is one of the first studies to systematically explore the role of non-family support, as well as how stress and support co-occur within relationships and across networks. As informal support networks of hospice family caregivers are complex and multifaceted, understanding the patterns of support and stress across various network members is essential to offer services to more effectively manage caregiver burden.
Collapse
Affiliation(s)
- Jia-Wen Guo
- University of Utah, College of Nursing, 10 South 2000 East, Salt Lake City, UT, USA 84112
| | - Maija Reblin
- Moffitt Cancer Centre, Health Outcomes and Behavior, 12902 Magnolia Dr, Tampa, FL, USA 33612
| | - Djin Tay
- University of Utah, College of Nursing, 10 South 2000 East, Salt Lake City, UT, USA 84112
| | - Lee Ellington
- University of Utah, College of Nursing, 10 South 2000 East, Salt Lake City, UT, USA 84112
| | - Anna C. Beck
- 1. University of Utah School of Medicine, Medical Oncology, 30 North 1900 East, Salt Lake City, UT, USA 84132; 2. University of Utah Health Huntsman Cancer Institute, Supportive Oncology and Survivorship, 1950 Circle of Hope, Salt Lake City, UT, USA 84112
| | - Kristin G Cloyes
- University of Utah, College of Nursing, 10 South 2000 East, Salt Lake City, UT, USA 84112
| |
Collapse
|
18
|
The Influence of Caregiver Preparedness on Caregiver Contributions to Self-care in Heart Failure and the Mediating Role of Caregiver Confidence. J Cardiovasc Nurs 2021; 35:243-252. [PMID: 32084078 DOI: 10.1097/jcn.0000000000000632] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Caregiver contributions (CC) to heart failure (HF) self-care maintenance (ie, CC to maintaining HF stability) and management (ie, CC to dealing with HF signs and symptoms) improve patient outcomes, but it is unknown whether caregiver preparedness influences CC to self-care and whether caregiver confidence mediates this process. OBJECTIVES We evaluated the influence of caregiver preparedness on CC to HF self-care maintenance and management and the mediating role of caregiver confidence. METHODS This is a secondary analysis of the MOTIVATE-HF study. Patients were 18 years or older, with a diagnosis of HF in New York Heart Association classes II to IV, who had insufficient self-care and did not have severe cognitive impairment. Patients' informal caregivers were those people inside or outside the family who gave most of the informal care to the patients. We used the Caregiver Preparedness Scale and the Caregiver Contribution to Self-Care of HF Index. We tested a path analysis model and the indirect effects. RESULTS Caregivers (n = 323) were 55 (SD, 15) years old on average and predominantly female (77%). The path analysis showed that higher scores in caregiver preparedness were associated with higher scores in caregiver confidence. In turn, higher caregiver confidence was associated with higher CC to self-care maintenance and management. Caregiver confidence mediated the association between caregiver preparedness and CC to self-care maintenance and management. CONCLUSIONS Caregiver confidence may play a role in CC to self-care. Interventions to improve CC to HF self-care should not only be focused on improving caregiver preparedness but also should consider the role of caregiver confidence.
Collapse
|
19
|
Gutierrez‐Baena B, Romero‐Grimaldi C. Development and psychometric testing of the Spanish version of the Caregiver Preparedness Scale. Nurs Open 2020; 8:1183-1193. [PMID: 33340272 PMCID: PMC8046102 DOI: 10.1002/nop2.732] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 11/09/2020] [Indexed: 01/10/2023] Open
Abstract
AIM To psychometrically test the Spanish version of the Caregiver Preparedness Scale (CPS) and document the preparedness level of caregivers. DESIGN A descriptive and validation study. METHOD Purposive sampling method was used to select 171 family caregivers Spain. The scale was cross-culturally adapted through a process that included translation, comparison with versions in other languages and back-translation, review, pre-testing and validity, and reliability tests. RESULTS The Spanish family caregivers are mainly female (79%) and married (75%). The Spanish version of the CPS presents changes with respect to the original. Confirmatory factor analysis supported the single-factor model. Analysis of internal consistency yielded a Cronbach's α of 0.89. Significant correlations (p < .01) with other scales supported convergent validity. A descriptive analysis of the validated scale showed average levels of preparation (2.16 out of 4). Caregivers felt better prepared to attend to the patient's physical needs than emotional or spiritual needs.
Collapse
Affiliation(s)
- Belen Gutierrez‐Baena
- Vocational training center “María de Madariaga”CádizSpain
- Hospital “Viamed Bahía de Cádiz,” Chiclana de la FronteraCádizSpain
| | - Carmen Romero‐Grimaldi
- Nursing Faculty “Salus Infirmorum”University of CadizCádizSpain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III.MadridSpain
| |
Collapse
|
20
|
Kühnel MB, Ramsenthaler C, Bausewein C, Fegg M, Hodiamont F. Validation of two short versions of the Zarit Burden Interview in the palliative care setting: a questionnaire to assess the burden of informal caregivers. Support Care Cancer 2020; 28:5185-5193. [PMID: 32060707 PMCID: PMC7546983 DOI: 10.1007/s00520-019-05288-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 12/29/2019] [Indexed: 01/23/2023]
Abstract
PURPOSE Several validated outcome measures, among them the Zarit Burden Interview (ZBI), are valid for measuring caregiver burden in advanced cancer and dementia. However, they have not been validated for a wider palliative care (PC) setting with non-cancer disease. The purpose was to validate ZBI-1 (ultra-short version and proxy rating) and ZBI-7 short versions for PC. METHODS In a prospective, cross-sectional study with informal caregivers of patients in inpatient (PC unit, hospital palliative support team) and outpatient (home care team) PC settings of a large university hospital, content validity and acceptability of the ZBI and its structural validity (via confirmatory factor analysis (CFA) and Rasch analysis) were tested. Reliability assessment used internal consistency and inter-rater reliability and construct validity used known-group comparisons and a priori hypotheses on correlations with Brief Symptom Inventory, Short Form-12, and Distress Thermometer. RESULTS Eighty-four participants (63.1% women; mean age 59.8, SD 14.4) were included. Structural validity assessment confirmed the unidimensional structure of ZBI-7 both in CFA and Rasch analysis. The item on overall burden was the best item for the ultra-short version ZBI-1. Higher burden was recorded for women and those with poorer physical health. Internal consistency was good (Cronbach's α = 0.83). Inter-rater reliability was moderate as proxy ratings estimated caregivers' burden higher than self-ratings (average measures ICC = 0.51; CI = 0.23-.69; p = 0.001). CONCLUSION The ZBI-7 is a valid instrument for measuring caregiver burden in PC. The ultra-short ZBI-1 can be used as a quick and proxy assessment, with the caveat of overestimating burden.
Collapse
Affiliation(s)
- Martina B Kühnel
- Department of Palliative Medicine, Munich University Hospital, LMU Munich, Munich, Germany.
| | - Christina Ramsenthaler
- Department of Palliative Medicine, Munich University Hospital, LMU Munich, Munich, Germany
| | - Claudia Bausewein
- Department of Palliative Medicine, Munich University Hospital, LMU Munich, Munich, Germany
| | - Martin Fegg
- Department of Palliative Medicine, Munich University Hospital, LMU Munich, Munich, Germany
| | - Farina Hodiamont
- Department of Palliative Medicine, Munich University Hospital, LMU Munich, Munich, Germany
| |
Collapse
|
21
|
Kisch AM, Bergkvist K, Alvariza A, Årestedt K, Winterling J. Family caregivers' support needs during allo-HSCT-a longitudinal study. Support Care Cancer 2020; 29:3347-3356. [PMID: 33125539 PMCID: PMC8062346 DOI: 10.1007/s00520-020-05853-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 10/22/2020] [Indexed: 01/04/2023]
Abstract
PURPOSE The study aimed to explore family caregivers' support needs prior to allo-HSCT, how these change over time and whether they are associated with demographic factors and caregiver outcome. METHODS This longitudinal repeated measure study included 87 family caregivers of allo-HSCT recipients: 63% were partners, 74% women, 65% lived with the recipient, and their mean age was 54 years. They completed the 14-item Carer Support Needs Assessment Tool (CSNAT) and caregiver outcome measures (caregiver burden, anxiety, depression, preparedness for caregiving and general health) prior to allo-HSCT and 3, 6 and 16 weeks later. RESULTS The two top support needs prior to allo-HSCT were 'knowing what to expect in the future' (79%) and 'dealing with your own feelings' (70%). Several support needs were associated with younger age and not being a partner, while higher needs implied worse caregiver outcomes for at least one of the outcomes prior to transplantation. Most support needs remained the same at the last follow-up. CONCLUSION The findings that high support needs are often associated with worse caregiver outcomes and most support needs do not diminish over time indicate that more attention should be placed on the situation of family caregivers.
Collapse
Affiliation(s)
- Annika M Kisch
- Haematology Department, Lund University Hospital, Lund, Sweden. .,Institute of Health Sciences, Lund University, Lund, Sweden.
| | - Karin Bergkvist
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Sophiahemmet University, Stockholm, Sweden
| | - Anette Alvariza
- Department of Health Care Sciences/Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
| | - Kristofer Årestedt
- Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden.,The Research Section, Region Kalmar County, Kalmar, Sweden
| | - Jeanette Winterling
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Medical Unit Hematology, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
22
|
Stepansky K, Sethi A, Toto P, Bleakley S. Caring for Our Caregivers: a feasibility study of caregiver preparedness training within inpatient brain injury rehabilitation. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2020. [DOI: 10.12968/ijtr.2019.0106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/aims Evidence-based inpatient caregiver training may ensure that caregiver needs are met and hospital readmission costs reduced. The aim of this study was to evaluate the feasibility of implementing a caregiver education model, Caring for Our Caregivers, within an inpatient brain injury programme. Methods A total of 32 adults were admitted to inpatient neurorehabilitation during the 7-week feasibility trial. The three-step Caring for Our Caregivers programme included evidence-based recommendations following a caregiver needs assessment, goal setting and hands-on training. Satisfaction levels and caregiver preparedness were assessed via a survey. Results The caregiver needs assessment and goal collaboration was completed within 5 days 66% of the time. Results indicated an even distribution of hands-on (47%) and discussion-based (53%) education. Caregivers and staff identified high levels of satisfaction with the programme. Conclusions Early engagement, collaborative goals and hands-on training of the family caregiver of a client with acquired brain injury during inpatient rehabilitation demonstrated initial feasibility with positive implications for caregiver satisfaction and community discharge.
Collapse
Affiliation(s)
- Kasey Stepansky
- Department of Occupational Therapy, Chatham University, Pittsburgh, PA, USA
| | - Amit Sethi
- Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Pamela Toto
- Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Scott Bleakley
- Encompass Health Rehabilitation Hospital, Pittsburgh, PA, USA
| |
Collapse
|
23
|
Becqué YN, Rietjens JAC, van der Heide A, Witkamp E. The effectiveness of a nurse-led intervention to support family caregivers in end-of-life care: Study protocol for a cluster randomized controlled trial. J Adv Nurs 2020; 76:1266-1272. [PMID: 32048316 PMCID: PMC7187191 DOI: 10.1111/jan.14326] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 01/14/2020] [Accepted: 02/05/2020] [Indexed: 12/31/2022]
Abstract
Aim To evaluate the feasibility of a structured nurse‐led supportive intervention and its effects on family caregivers in end‐of‐life care at home. Background Family caregivers are crucial in end‐of‐life care. They may experience burden due to the responsibilities associated with caregiving. Some family caregivers feel insufficiently prepared for their caregiver role. Nurses have a unique position to provide supportive interventions at home to reduce caregivers’ burden and improve preparedness. However, few nurse‐led interventions are available to support family caregivers in end‐of‐life care at home. Design We will perform a cluster randomized controlled trial. The clusters consist of twelve home care services, randomly assigned to the intervention group or the control group. Methods The study population consists of family caregivers of patients in the last phase of life. In the intervention group, nurses will systematically assess the supportive needs of family caregivers, using an assessment tool and the method of clinical reasoning. Family members of the control group receive care as usual. Primary outcome is burden measured by the Self‐Rated Burden Scale. Secondary outcomes are preparedness for caregiving, caregiving reactions and acute (hospital) admissions of the patient. In addition, the feasibility of the intervention will be evaluated. The study was funded in October 2016 and was ethically approved in April 2019. Impact Findings from this study will contribute to the scientific and practical knowledge of nursing interventions to support family caregivers in end‐of‐life care. Trial registration The Netherlands Trial Register (NL7702).
Collapse
Affiliation(s)
- Yvonne N Becqué
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands.,Department of Public Health, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Judith A C Rietjens
- Department of Public Health, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Agnes van der Heide
- Department of Public Health, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Erica Witkamp
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands.,Department of Public Health, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| |
Collapse
|
24
|
Fowler NR, Head KJ, Perkins AJ, Gao S, Callahan CM, Bakas T, Suarez SD, Boustani MA. Examining the benefits and harms of Alzheimer's disease screening for family members of older adults: study protocol for a randomized controlled trial. Trials 2020; 21:202. [PMID: 32075686 PMCID: PMC7031904 DOI: 10.1186/s13063-019-4029-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 12/23/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Multiple national expert panels have identified early detection of Alzheimer's disease and related dementias (ADRD) as a national priority. However, the United States Preventive Services Task Force (USPSTF) does not currently support screening for ADRD in primary care given that the risks and benefits are unknown. The USPSTF stresses the need for research examining the impact of ADRD screening on family caregiver outcomes. METHODS The Caregiver Outcomes of Alzheimer's Disease Screening (COADS) is a randomized controlled trial that will examine the potential benefits or harms of ADRD screening on family caregivers. It will also compare the effectiveness of two strategies for diagnostic evaluation and management after ADRD screening. COADS will enroll 1800 dyads who will be randomized into three groups (n = 600/group): the 'Screening Only' group will receive ADRD screening at baseline and disclosure of the screening results, with positive-screen participants receiving a list of local resources for diagnostic follow-up; the 'Screening Plus' group will receive ADRD screening at baseline coupled with disclosure of the screening results, with positive-screen participants referred to a dementia collaborative care program for diagnostic evaluation and potential care; and the control group will receive no screening. The COADS trial will measure the quality of life of the family member (the primary outcome) and family member mood, anxiety, preparedness and self-efficacy (the secondary outcomes) at baseline and at 6, 12, 18 and 24 months. Additionally, the trial will examine the congruence of depressive and anxiety symptoms between older adults and family members at 6, 12, 18 and 24 months and compare the effectiveness of two strategies for diagnostic evaluation and management after ADRD screening between the two groups randomized to screening (Screening Only versus Screening Plus). DISCUSSION We hypothesize that caregivers in the screening arms will express higher levels of health-related quality of life, lower depressive and anxiety symptoms, and better preparation for caregiving with higher self-efficacy at 24 months. Results from this study will directly inform the National Plan to Address Alzheimer's Disease, the USPSTF and other organizations regarding ADRD screening and early detection policies. TRIAL REGISTRATION ClinicalTrials.gov, NCT03300180. Registered on 3 October.
Collapse
Affiliation(s)
- Nicole R. Fowler
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202 USA
- Indiana University Center for Aging Research, Indianapolis, IN 46202 USA
- Regenstrief Institute, Inc., Indianapolis, IN 46202 USA
- Center for Health Innovation and Implementation Science, Indiana Clinical and Translational Science Institute, Indianapolis, IN 46202 USA
| | - Katharine J. Head
- Department of Communication Studies, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202 USA
| | - Anthony J. Perkins
- Department of Biostatistics, Indiana University School of Medicine & Richard M. Fairbanks School of Public Health, Indianapolis, IN 46202 USA
| | - Sujuan Gao
- Department of Biostatistics, Indiana University School of Medicine & Richard M. Fairbanks School of Public Health, Indianapolis, IN 46202 USA
| | - Christopher M. Callahan
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202 USA
- Indiana University Center for Aging Research, Indianapolis, IN 46202 USA
- Regenstrief Institute, Inc., Indianapolis, IN 46202 USA
- Eskenazi Health, Indianapolis, IN 46202 USA
| | - Tamilyn Bakas
- College of Nursing, University of Cincinnati, Cincinnati, OH 45219 USA
| | - Shelley D. Suarez
- Indiana University Center for Aging Research, Indianapolis, IN 46202 USA
- Regenstrief Institute, Inc., Indianapolis, IN 46202 USA
| | - Malaz A. Boustani
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202 USA
- Indiana University Center for Aging Research, Indianapolis, IN 46202 USA
- Regenstrief Institute, Inc., Indianapolis, IN 46202 USA
- Center for Health Innovation and Implementation Science, Indiana Clinical and Translational Science Institute, Indianapolis, IN 46202 USA
| |
Collapse
|
25
|
Hudson PL, Hayman-White K, Aranda S, Kristjanson LJ. Predicting Family Caregiver Psychosocial Functioning in Palliative Care. J Palliat Care 2019. [DOI: 10.1177/082585970602200302] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Health professionals are expected to support family caregivers of patients requiring palliative care. However, there is a dearth of empirical evidence to help clinicians identify caregivers who might be at risk of poor psychosocial functioning. Purpose This secondary analysis of baseline data from a larger study sought to determine if it was possible to predict the psychosocial functioning of family caregivers who were supporting a relative with advanced incurable cancer. Method Data from 35 primary family caregivers obtained at the start of home-based palliative care services and five weeks later was used in the analysis. Instruments to measure caregiver preparedness, competence, mastery, social support, anxiety, and self-efficacy were used. Results Cluster and logistic analyses revealed that self-reported “anxiety” and “competence” subscale total scores at time of commencement of home-based palliative care services were associated with caregivers at risk of lower levels of psychosocial functioning five weeks later. Conclusions This study suggests that it may be possible to identify family caregivers who are at risk for poorer psychosocial functioning. However, replication in a larger sample is required before this screening approach can be recommended for clinical use.
Collapse
Affiliation(s)
- Peter L. Hudson
- Centre for Palliative Care, St. Vincent's Health and University of Australia, Melbourne
| | - Karla Hayman-White
- Centre for Psychiatric Nursing Research and Practice, School of Nursing, University of Melbourne
| | - Sanchia Aranda
- Peter MacCallum Cancer Centre and School of Nursing, University of Melbourne, Melbourne, Victoria
| | - Linda J. Kristjanson
- Office of Research and Development, Curtin University of Technology, Western Australia, Australia
| |
Collapse
|
26
|
Hagedoorn EI, Keers JC, Jaarsma T, van der Schans CP, Luttik MLA, Paans W. The association of collaboration between family caregivers and nurses in the hospital and their preparedness for caregiving at home. Geriatr Nurs 2019; 41:373-380. [PMID: 30867090 DOI: 10.1016/j.gerinurse.2019.02.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 02/11/2019] [Accepted: 02/15/2019] [Indexed: 11/13/2022]
Abstract
Family caregivers of an older person who was recently hospitalized often feel unprepared for their new or expanded tasks. Quality and continuity of care for older people is expected to improve when nurses collaborate with family caregivers as partners in care. The aim of this study was to explore the unique contribution of collaboration between family caregivers of older patients and hospital nurses as a possible predictor for preparedness of caregiving after hospital discharge. With a cross sectional design, a postal survey was sent to 777 family caregivers of home-dwelling hospitalized patients (≥70 years). Regression analyses were used to test the association between collaboration and preparedness for caregiving. In total, 506 (68%) family caregivers responded of whom 281 (38%) were eligible. Their mean (SD) age was 65 (13) and 71% were female. Family caregivers' level of collaboration with nurses was significantly associated with their preparedness for caregiving.
Collapse
Affiliation(s)
- Ellen I Hagedoorn
- Research Group Healthy Ageing Allied Health Care and Nursing, Hanze University of Applied Sciences, P.O. Box 3109, 9701 DC, Groningen, the Netherlands; University of Groningen, University Medical Center, Department of Health Psychology, A. Deusinglaan 1, 9713 AV, Groningen, the Netherlands; Research Group Nursing Diagnostics, Hanze University of Applied Sciences, P.O. Box 3109, 9701 DC, Groningen, the Netherlands.
| | - Joost C Keers
- Research Group Healthy Ageing Allied Health Care and Nursing, Hanze University of Applied Sciences, P.O. Box 3109, 9701 DC, Groningen, the Netherlands; Martini Hospital, Groningen, the Netherlands.
| | - Tiny Jaarsma
- Department of Social and Welfare Studies (ISV), Linköping University, SE-581 83, Linköping, Sweden.
| | - Cees P van der Schans
- Research Group Healthy Ageing Allied Health Care and Nursing, Hanze University of Applied Sciences, P.O. Box 3109, 9701 DC, Groningen, the Netherlands; University of Groningen, University Medical Center, Department of Health Psychology, A. Deusinglaan 1, 9713 AV, Groningen, the Netherlands; University of Groningen, University Medical Center, Department of Rehabilitation, A. Deusinglaan 1, 9713 AV, Groningen, the Netherlands.
| | - Marie Louise A Luttik
- Research Group Nursing Diagnostics, Hanze University of Applied Sciences, P.O. Box 3109, 9701 DC, Groningen, the Netherlands.
| | - Wolter Paans
- Research Group Nursing Diagnostics, Hanze University of Applied Sciences, P.O. Box 3109, 9701 DC, Groningen, the Netherlands.
| |
Collapse
|
27
|
Dellafiore F, Buck HG, Pucciarelli G, Barbaranelli C, Paturzo M, Alvaro R, Vellone E. Psychometric characteristics of the mutuality scale in heart failure patients and caregivers. Heart Lung 2018; 47:553-561. [DOI: 10.1016/j.hrtlng.2018.05.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 05/23/2018] [Indexed: 12/28/2022]
|
28
|
Halkett GKB, Lobb EA, Miller L, Shaw T, Moorin R, Long A, King A, Clarke J, Fewster S, Nowak AK. Feasibility Testing and Refinement of a Supportive Educational Intervention for Carers of Patients with High-Grade Glioma - a Pilot Study. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2018; 33:967-975. [PMID: 28190236 DOI: 10.1007/s13187-017-1175-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The aim of this pilot study was to test the feasibility and acceptability of a family carer intervention for carers of patients with high-grade glioma (HGG). The intervention consisted of: (1) an initial telephone assessment of carer needs; (2) a personalised tabbed resource file; (3) nurse-led home visit; and (4) ongoing telephone support. Two consumer representatives reviewed the intervention resources. The intervention was then piloted with participants who were the primary carer for patients undergoing treatment for HGG in Western Australia. Two consumers provided feedback on the resource, and 10 carers participated in the pilot. Positive feedback was received about the resource manual and intervention. Suggestions were also made for changes which were implemented into the trial. The surveys were shortened based on feedback. Participants identified a large range of issues during nursing assessments which would not otherwise be identified or addressed for carers receiving routine care. As a result of providing the intervention, the nurse was able to make referrals to address needs that were identified. This pilot study enabled us to refine and test the Care-IS intervention and test the feasibility and acceptability of proposed survey instruments. We were also able to estimate recruitment and retention and the overall study timeline required for the randomised controlled trial we are now conducting. It has also demonstrated the role of the nurse who delivered the intervention and allowed us to refine communication and referral pathways.
Collapse
Affiliation(s)
- Georgia K B Halkett
- Faculty of Health Sciences, School of Nursing, Midwifery and Paramedicine, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia.
| | - Elizabeth A Lobb
- Calvary Health Care Kogarah and Cunningham Centre for Palliative Care, Sydney, New South Wales, Australia
- School of Medicine, The University of Notre Dame, Sydney, New South Wales, Australia
| | - Lisa Miller
- Department of Psychiatry, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
- Department of Health WA, WA Cancer and Palliative Care Network, Perth, Western Australia, Australia
| | - Thérèse Shaw
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Rachael Moorin
- School of Public Health, Curtin University, Perth, Western Australia, Australia
- School of Population Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Anne Long
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Anne King
- Department of Health WA, WA Cancer and Palliative Care Network, Perth, Western Australia, Australia
| | - Jenny Clarke
- Faculty of Health Sciences, School of Nursing, Midwifery and Paramedicine, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia
| | | | - Anna K Nowak
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
- School of Medicine, University of Western Australia, Nedlands, Western Australia, Australia
| |
Collapse
|
29
|
Carter G, McLaughlin D, Kernohan WG, Hudson P, Clarke M, Froggatt K, Passmore P, Brazil K. The experiences and preparedness of family carers for best interest decision-making of a relative living with advanced dementia: A qualitative study. J Adv Nurs 2018; 74:1595-1604. [PMID: 29603347 DOI: 10.1111/jan.13576] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2018] [Indexed: 11/29/2022]
Abstract
AIM To explore the experience and the preparedness of family carers in their caregiving role as best interest decision-makers of a relative living with advanced dementia. BACKGROUND The prevalence of dementia is a global issue. The role of being a carer of a relative living with dementia does not necessarily lessen once they are admitted to a nursing home. Best interest decision-making including end-of-life care decisions need to be made and reaching these choices can be challenging. The preparedness of family carers in this role needs greater understanding. DESIGN Descriptive qualitative study. METHODS During 2015 twenty semi-structured interviews were conducted of family carers of nursing home residents living with advanced dementia, then analysed using Braun and Clarke's thematic analysis. RESULTS Three themes were identified: (1) Caring for someone living with dementia. The impact on the carer's holistic well-being and their experience of being a best interest decision-maker; (2) Accessing support. The influential nature of formal and informal networks; (3) Perceived knowledge and understanding of the dementia trajectory of carers and nursing staff. CONCLUSION The experiences and preparedness of informal carers is a reflection of their personal response, but the distress experienced highlights the significant need of adequate support availability and of enhancing nursing staffs' dementia expertise to maximize their role in facilitating best interest decision-making. This has significant implications for nursing practice and for service user and nursing staff education. Considering the global impact of dementia, our findings have international relevance to similar nursing homes across the world.
Collapse
Affiliation(s)
- Gillian Carter
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Dorry McLaughlin
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | | | - Peter Hudson
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK.,St Vincent's Hospital, University of Melbourne, Melbourne, Australia
| | - Mike Clarke
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Katherine Froggatt
- International Observatory on End of Life Care, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Peter Passmore
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Kevin Brazil
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| |
Collapse
|
30
|
Forbat L, Robinson R, Bilton-Simek R, Francois K, Lewis M, Haraldsdottir E. Distance education methods are useful for delivering education to palliative caregivers: A single-arm trial of an education package (PalliativE Caregivers Education Package). Palliat Med 2018; 32:581-588. [PMID: 28604233 DOI: 10.1177/0269216317712849] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Face-to-face/group education for palliative caregivers is successful, but relies on caregivers travelling, being absent from the patient, and rigid timings. This presents inequities for those in rural locations. AIM To design and test an innovative distance-learning educational package (PrECEPt: PalliativE Caregivers Education Package). DESIGN Single-arm mixed-method feasibility proof-of-concept trial (ACTRN12616000601437). The primary outcome was carer self-efficacy, with secondary outcomes focused on caregiver preparedness and carer tasks/needs. Analysis focused on three outcome measures (taken at baseline and 6 weeks) and feasibility/acceptability qualitative data. SETTING AND PARTICIPANTS A single specialist palliative care service. Eligible informal caregivers were those of patients registered with the outpatient or community service, where the patient had a prognosis of ⩾12 weeks, supporting someone with nutrition/hydration and/or pain management needs, proficient in English and no major mental health diagnosis. RESULTS Two modules were developed and tested (nutrition/hydration and pain management) with 18 caregivers. The materials did not have a statistically significant impact on carer self-efficacy. However, statistically significant improvements were observed on the two subsidiary measures of (1) caregiving tasks, consequences and needs ( p = 0.03, confidence interval: 0.72, 9.4) and (2) caregiver preparedness ( p = 0.001, confidence interval: -1.22, -0.46). The study determined that distance learning is acceptable and feasible for both caregivers and healthcare professionals. CONCLUSION Distance education improves caregiver preparedness and is a feasible and acceptable approach. A two-arm trial would determine whether the materials benefitted caregivers and patients compared to a control group not receiving the materials. Additional modules could be fruitfully developed and offered.
Collapse
Affiliation(s)
- Liz Forbat
- 1 Australian Catholic University, Canberra, ACT, Australia.,2 Calvary Public Hospital Bruce, Canberra, ACT, Australia
| | - Rowena Robinson
- 1 Australian Catholic University, Canberra, ACT, Australia.,2 Calvary Public Hospital Bruce, Canberra, ACT, Australia
| | | | - Karemah Francois
- 1 Australian Catholic University, Canberra, ACT, Australia.,2 Calvary Public Hospital Bruce, Canberra, ACT, Australia
| | | | - Erna Haraldsdottir
- 4 St Columba's Hospice, Edinburgh, UK.,5 Queen Margaret University, Edinburgh, UK
| |
Collapse
|
31
|
Aslakson RA, Dy SM, Wilson RF, Waldfogel J, Zhang A, Isenberg SR, Blair A, Sixon J, Lorenz KA, Robinson KA. Patient- and Caregiver-Reported Assessment Tools for Palliative Care: Summary of the 2017 Agency for Healthcare Research and Quality Technical Brief. J Pain Symptom Manage 2017; 54:961-972.e16. [PMID: 28818633 DOI: 10.1016/j.jpainsymman.2017.04.022] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 04/11/2017] [Accepted: 04/13/2017] [Indexed: 12/21/2022]
Abstract
CONTEXT Assessment tools are data collection instruments that are completed by or with patients or caregivers and which collect data at the individual patient or caregiver level. OBJECTIVES The objectives of this study are to 1) summarize palliative care assessment tools completed by or with patients or caregivers and 2) identify needs for future tool development and evaluation. METHODS We completed 1) a systematic review of systematic reviews; 2) a supplemental search of previous reviews and Web sites, and/or 3) a targeted search for primary articles when no tools existed in a domain. Paired investigators screened search results, assessed risk of bias, and abstracted data. We organized tools by domains from the National Consensus Project Clinical Practice Guidelines for Palliative Care and selected the most relevant, recent, and highest quality systematic review for each domain. RESULTS We included 10 systematic reviews and identified 152 tools (97 from systematic reviews and 55 from supplemental sources). Key gaps included no systematic review for pain and few tools assessing structural, cultural, spiritual, or ethical/legal domains, or patient-reported experience with end-of-life care. Psychometric information was available for many tools, but few studies evaluated responsiveness (sensitivity to change) and no studies compared tools. CONCLUSION Few to no tools address the spiritual, ethical, or cultural domains or patient-reported experience with end-of-life care. While some data exist on psychometric properties of tools, the responsiveness of different tools to change and/or comparisons between tools have not been evaluated. Future research should focus on developing or testing tools that address domains for which few tools exist, evaluating responsiveness, and comparing tools.
Collapse
Affiliation(s)
- Rebecca A Aslakson
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland, USA; Department of Oncology, Palliative Care Program, Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland, USA.
| | - Sydney M Dy
- Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Renee F Wilson
- Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Julie Waldfogel
- Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Allen Zhang
- Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Sarina R Isenberg
- Department of Health, Behavior and Society, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Alex Blair
- Department of Surgery, The Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Joshua Sixon
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
| | - Karl A Lorenz
- VA Palo Alto Health Care System, Palo Alto, California; Stanford School of Medicine, Department of Medicine, Palo Alto, California
| | - Karen A Robinson
- Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, Maryland, USA; Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland, USA; Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| |
Collapse
|
32
|
Petruzzo A, Paturzo M, Buck HG, Barbaranelli C, D'Agostino F, Ausili D, Alvaro R, Vellone E. Psychometric evaluation of the Caregiver Preparedness Scale in caregivers of adults with heart failure. Res Nurs Health 2017; 40:470-478. [DOI: 10.1002/nur.21811] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Accepted: 06/23/2017] [Indexed: 01/10/2023]
Affiliation(s)
- Antonio Petruzzo
- Department of Biomedicine and Prevention; University of Rome Tor Vergata; Rome Italy
| | - Marco Paturzo
- Department of Biomedicine and Prevention; University of Rome Tor Vergata; Rome Italy
| | - Harleah G. Buck
- College of Nursing; University of South Florida; Tampa Florida
| | | | - Fabio D'Agostino
- Department of Biomedicine and Prevention; University of Rome Tor Vergata; Rome Italy
| | - Davide Ausili
- Department of Medicine and Surgery; University of Milan-Bicocca; Milan Italy
| | - Rosaria Alvaro
- Department of Biomedicine and Prevention; University of Rome Tor Vergata; Rome Italy
| | - Ercole Vellone
- Department of Biomedicine and Prevention; University of Rome Tor Vergata; Rome Italy
| |
Collapse
|
33
|
Karlstedt M, Fereshtehnejad SM, Winnberg E, Aarsland D, Lökk J. Psychometric properties of the mutuality scale in Swedish dyads with Parkinson's disease. Acta Neurol Scand 2017; 136:122-128. [PMID: 27781261 DOI: 10.1111/ane.12706] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2016] [Indexed: 01/17/2023]
Abstract
OBJECTIVES The 15-item mutuality scale (MS) has been used in several neurological conditions assessing the quality of relationship associations with negative effects of the caregiving situation. The aim of this study was to translate the original MS into Swedish and assess its psychometric properties in Parkinson's disease (PD). MATERIALS AND METHODS Following the forward-backward translation method, the scale was evaluated regarding linguistic correctness at a conceptual level and user-friendliness. The scale was filled out by a sample of 50 care dyads where one was having PD. Scale assumptions and scale structure were evaluated using floor/ceiling effect and principal component analyses (PCA) with promax rotation. Internal consistency was evaluated using Cronbach's alpha and mean inter-item correlation coefficients. RESULTS The Swedish MS was evaluated as user-friendly and relevant by the participants. The scale demonstrated no floor/ceiling effect and showed high internal consistency (α≥0.93) with a mean inter-item correlation coefficient of ≥0.5. Through the PCA, a two factor solution emerged, which accounted for 67% and 64% of the variance of the MS score by PD-partners and PD-patients, respectively. However, some variables were complex and discarded in the final solution. CONCLUSION Our findings provide initial support of the Swedish MS as a user-friendly and useful instrument with acceptable psychometric properties even though more research is needed to evaluate the existence of subscales.
Collapse
Affiliation(s)
- M. Karlstedt
- Division of Clinical Geriatrics; Department of Neurobiology, Care Sciences and Society; Karolinska Institutet; Huddinge Sweden
| | - S. M. Fereshtehnejad
- Division of Clinical Geriatrics; Department of Neurobiology, Care Sciences and Society; Karolinska Institutet; Huddinge Sweden
| | - E. Winnberg
- Department of Health Care Sciences; Ersta Sköndal University College; Stockholm Sweden
| | - D. Aarsland
- Division of Neurogeriatrics; Department of Neurobiology, Care Sciences and Society; Karolinska Institutet; Huddinge Sweden
| | - J. Lökk
- Division of Clinical Geriatrics; Department of Neurobiology, Care Sciences and Society; Karolinska Institutet; Huddinge Sweden
| |
Collapse
|
34
|
Sawatzky R, Russell L, Friberg F, Carlsson EK, Pettersson M, Öhlén J. Longitudinal person-centered measurement: A psychometric evaluation of the Preparedness for Colorectal Cancer Surgery Questionnaire (PCSQ). PATIENT EDUCATION AND COUNSELING 2017; 100:827-835. [PMID: 27955903 DOI: 10.1016/j.pec.2016.11.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Revised: 10/28/2016] [Accepted: 11/14/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE The Preparedness for Colorectal Cancer Surgery Questionnaire (PCSQ) was previously developed in Swedish to assess patients' knowledge seeking and sense making capabilities. Aiming to measure preparedness at different phases during the pre-surgery and recovery period, the objectives were to (a) evaluate psychometric properties of the longitudinal PCSQ, (b) establish measurement invariance over time, and (c) describe change in preparedness. METHODS Elective colorectal cancer surgery patients completed a questionnaire at five time points from pre-surgery until 6 months post-surgery (n=250). The longitudinal PCSQ consists of 23 items measuring four domains: Searching for and making use of information, Understanding and involvement in care, Making sense of recovery, Support and access to care. Psychometric analyses, including confirmatory factor analysis, were applied to evaluate internal consistency reliability and ascertain invariance over time of the measurement structure and parameters. RESULTS The psychometric analyses revealed good fit of the measurement models, high internal consistency reliability (≥.94), and support for configural, metric and scalar measurement invariance of the four PCSQ domains. Patients reported lower levels of preparedness after surgery than pre-surgery. CONCLUSION The adapted version of the PCSQ can be used for longitudinal analyses. PRACTICE IMPLICATIONS The measurement of preparedness is important for evaluating person-centred outcomes before and during recovery from colorectal cancer surgery.
Collapse
Affiliation(s)
- Richard Sawatzky
- School of Nursing, Trinity Western University, 7600 Glover Road, Langley, BC, V2Y 1Y1, Canada; Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, 588-1081 Burrard Street, St. Paul's Hospital, Vancouver, BC, V6Z 1Y6, Canada.
| | - Lara Russell
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, 588-1081 Burrard Street, St. Paul's Hospital, Vancouver, BC, V6Z 1Y6, Canada; School of Nursing, University of Victoria, P.O. Box 1700 STN CSC, Victoria, BC, V8W 2Y2, Canada.
| | - Febe Friberg
- Department of Health Studies, Faculty of Social Sciences, University of Stavanger, 4036 Stavanger, Norway.
| | - Eva K Carlsson
- University of Gothenburg Centre for Person-Centred Care, P.O. Box 457, SE-40539 Gothenburg, Sweden; Institute of Health and Care Sciences, Sahlgrenska Academy at the University of Gothenburg, P.O. Box 457, SES-49539 Gothenburg, Sweden; Department of Colorectal Surgery, Sahlgrenska University Hospital/East, SE_41685 Gothenburg, Sweden.
| | - Monica Pettersson
- University of Gothenburg Centre for Person-Centred Care, P.O. Box 457, SE-40539 Gothenburg, Sweden; Institute of Health and Care Sciences, Sahlgrenska Academy at the University of Gothenburg, P.O. Box 457, SES-49539 Gothenburg, Sweden; Department of Vascular Surgery, Sahlgrenska University Hospital, SE-41345 Gothenburg, Sweden.
| | - Joakim Öhlén
- University of Gothenburg Centre for Person-Centred Care, P.O. Box 457, SE-40539 Gothenburg, Sweden; Institute of Health and Care Sciences, Sahlgrenska Academy at the University of Gothenburg, P.O. Box 457, SES-49539 Gothenburg, Sweden.
| |
Collapse
|
35
|
Development and validation of the preparedness for Colorectal Cancer Surgery Questionnaire: PCSQ-pre 24. Eur J Oncol Nurs 2016; 25:24-32. [DOI: 10.1016/j.ejon.2016.09.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 08/24/2016] [Accepted: 09/06/2016] [Indexed: 02/04/2023]
|
36
|
Pucciarelli G, Buck HG, Barbaranelli C, Savini S, Simeone S, Juarez-Vela R, Alvaro R, Vellone E. Psychometric Characteristics of the Mutuality Scale in Stroke Patients and Caregivers. THE GERONTOLOGIST 2016; 56:e89-98. [DOI: 10.1093/geront/gnw083] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 03/30/2016] [Indexed: 11/14/2022] Open
|
37
|
Michels CTJ, Boulton M, Adams A, Wee B, Peters M. Psychometric properties of carer-reported outcome measures in palliative care: A systematic review. Palliat Med 2016; 30:23-44. [PMID: 26407683 PMCID: PMC4708617 DOI: 10.1177/0269216315601930] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Informal carers face many challenges in caring for patients with palliative care needs. Selecting suitable valid and reliable outcome measures to determine the impact of caring and carers' outcomes is a common problem. AIM To identify outcome measures used for informal carers looking after patients with palliative care needs, and to evaluate the measures' psychometric properties. DESIGN A systematic review was conducted. The studies identified were evaluated by independent reviewers (C.T.J.M., M.B., M.P.). Data regarding study characteristics and psychometric properties of the measures were extracted and evaluated. Good psychometric properties indicate a high-quality measure. DATA SOURCES The search was conducted, unrestricted to publication year, in the following electronic databases: Applied Social Sciences Index and Abstracts, Cumulative Index to Nursing and Allied Health Literature, The Cochrane Library, EMBASE, PubMed, PsycINFO, Social Sciences Citation Index and Sociological Abstracts. RESULTS Our systematic search revealed 4505 potential relevant studies, of which 112 studies met the inclusion criteria using 38 carer measures for informal carers of patients with palliative care needs. Psychometric properties were reported in only 46% (n = 52) of the studies, in relation to 24 measures. Where psychometric data were reported, the focus was mainly on internal consistency (n = 45, 87%), construct validity (n = 27, 52%) and/or reliability (n = 14, 27%). Of these, 24 measures, only four (17%) had been formally validated in informal carers in palliative care. CONCLUSION A broad range of outcome measures have been used for informal carers of patients with palliative care needs. Little formal psychometric testing has been undertaken. Furthermore, development and refinement of measures in this field is required.
Collapse
Affiliation(s)
- Charlotte T J Michels
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Mary Boulton
- Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Astrid Adams
- Sir Michael Sobell House, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Bee Wee
- Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK Sir Michael Sobell House, Oxford University Hospitals NHS Trust, Oxford, UK Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Michele Peters
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| |
Collapse
|
38
|
Hudson PL, Girgis A, Mitchell GK, Philip J, Parker D, Currow D, Liew D, Thomas K, Le B, Moran J, Brand C. Benefits and resource implications of family meetings for hospitalized palliative care patients: research protocol. BMC Palliat Care 2015; 14:73. [PMID: 26654721 PMCID: PMC4676140 DOI: 10.1186/s12904-015-0071-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 12/03/2015] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Palliative care focuses on supporting patients diagnosed with advanced, incurable disease; it is 'family centered', with the patient and their family (the unit of care) being core to all its endeavours. However, approximately 30-50% of carers experience psychological distress which is typically under recognised and consequently not addressed. Family meetings (FM) are recommended as a means whereby health professionals, together with family carers and patients discuss psychosocial issues and plan care; however there is minimal empirical research to determine the net effect of these meetings and the resources required to implement them systematically. The aims of this study were to evaluate: (1) if family carers of hospitalised patients with advanced disease (referred to a specialist palliative care in-patient setting or palliative care consultancy service) who receive a FM report significantly lower psychological distress (primary outcome), fewer unmet needs, increased quality of life and feel more prepared for the caregiving role; (2) if patients who receive the FM experience appropriate quality of end-of-life care, as demonstrated by fewer hospital admissions, fewer emergency department presentations, fewer intensive care unit hours, less chemotherapy treatment (in last 30 days of life), and higher likelihood of death in the place of their choice and access to supportive care services; (3) the optimal time point to deliver FM and; (4) to determine the cost-benefit and resource implications of implementing FM meetings into routine practice. METHODS Cluster type trial design with two way randomization for aims 1-3 and health economic modeling and qualitative interviews with health for professionals for aim 4. DISCUSSION The research will determine whether FMs have positive practical and psychological impacts on the family, impacts on health service usage, and financial benefits to the health care sector. This study will also provide clear guidance on appropriate timing in the disease/care trajectory to provide a family meeting. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12615000200583.
Collapse
Affiliation(s)
- Peter L Hudson
- Centre for Palliative Care St Vincent's Hospital, University of Melbourne, Melbourne, Australia.
- Queens University, Belfast, UK.
| | - Afaf Girgis
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, UNSW Medicine, The University of New South Wales, Sydney, Australia.
| | | | - Jenny Philip
- Centre for Palliative Care St Vincent's Hospital, University of Melbourne, Melbourne, Australia.
| | - Deborah Parker
- Centre for Applied Nursing Research, Ingham Institute for Applied Medical Research, School of Nursing and Midwifery, Western Sydney University, Sydney, Australia.
| | - David Currow
- Discipline, Palliative and Supportive Services, Flinders University, Adelaide, South Australia.
| | - Danny Liew
- Melbourne EpiCentre, University of Melbourne and Melbourne Health, Melbourne, Australia.
| | - Kristina Thomas
- Centre for Palliative Care St Vincent's Hospital, University of Melbourne, Melbourne, Australia.
| | - Brian Le
- Palliative & Supportive Care Melbourne Health & University of Melbourne, Melbourne, Australia.
| | - Juli Moran
- Palliative Care Austin Health, Melbourne, Australia.
| | - Caroline Brand
- Melbourne EpiCentre, University of Melbourne and Melbourne Health, Melbourne, Australia.
- Department of Epidemiology and Preventive Medicine, Monash University Melbourne, Melbourne, Australia.
| |
Collapse
|
39
|
Leroy T, Fournier E, Penel N, Christophe V. Crossed views of burden and emotional distress of cancer patients and family caregivers during palliative care. Psychooncology 2015; 25:1278-1285. [DOI: 10.1002/pon.4056] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 10/22/2015] [Accepted: 11/13/2015] [Indexed: 11/12/2022]
Affiliation(s)
- Tanguy Leroy
- Social Psychology Research Group (GRePS EA 4163); Université Lumière Lyon 2; Bron France
- UDL3, SCALAB UMR CNRS 9193; Université de Lille; Villeneuve d'Ascq France
| | | | - Nicolas Penel
- Department of General Oncology; Centre Oscar Lambret; Lille France
- UDL2, EA 2694 Public Health: Epidemiology and Quality of Care; Université de Lille; Lille France
| | - Véronique Christophe
- UDL3, SCALAB UMR CNRS 9193; Université de Lille; Villeneuve d'Ascq France
- SIRIC ONCOLille; Lille France
| |
Collapse
|
40
|
Halkett GKB, Lobb EA, Miller L, Phillips JL, Shaw T, Moorin R, Long A, King A, Clarke J, Fewster S, Hudson P, Agar M, Nowak AK. Protocol for the Care-IS Trial: a randomised controlled trial of a supportive educational intervention for carers of patients with high-grade glioma (HGG). BMJ Open 2015; 5:e009477. [PMID: 26503395 PMCID: PMC4636639 DOI: 10.1136/bmjopen-2015-009477] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 09/11/2015] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION High-grade glioma (HGG) is a rapidly progressive and debilitating disease. Primary carers experience significant levels of distress which impacts on their experience of caregiving, the quality of care received and the community in terms of the increased reliance on healthcare due to the potential development of complicated grief. This paper describes the protocol for testing the efficacy and feasibility of an intervention for primary carers of patients with HGG in order to improve preparedness to care and reduce carer distress. METHODS Randomised controlled trial. The target population is carers of patients with HGG who are undergoing combined chemoradiotherapy. The intervention consists of 4 components: (1) initial telephone assessment of unmet needs of the carer, (2) tailoring of a personalised resource folder, (3) home visit, (4) ongoing monthly telephone contact and support for 12 months. The control arm will receive usual care. PRIMARY HYPOTHESIS This intervention will improve preparedness for caring and reduce carer psychological distress. SECONDARY HYPOTHESIS This intervention will reduce carer unmet needs. The longer term aim of the intervention is to reduce patient healthcare resource utilisation and, by doing so, reduce costs. Assessments will be obtained at baseline, 8 weeks post intervention, then 4, 6 and 12 months. Participants will also complete a healthcare utilisation checklist and proxy performance status which will be assessed at baseline and monthly. 240 carers will be recruited. The sample size is 180. Multilevel mixed effects regression models will be applied to test the effect of the intervention. ETHICS Ethics approval has been gained from Curtin University and the participating sites. DISSEMINATION Results will be reported in international peer-reviewed journals. TRIAL REGISTRATION NUMBER Australian and New Zealand Clinical Trials Registration (ACTRN)12612001147875.
Collapse
Affiliation(s)
- Georgia K B Halkett
- Faculty of Health Sciences, School of Nursing and Midwifery, Curtin University, Bentley, Perth, Western Australia, Australia
| | - Elizabeth A Lobb
- Calvary Health Care Kogarah and Cunningham Centre for Palliative Care, Sydney, New South Wales, Australia School of Medicine, The University of Notre Dame, Sydney, New South Wales, Australia
| | - Lisa Miller
- Department of Psychiatry, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia Department of Health WA, WA Cancer and Palliative Carer Network, Perth, Western Australia, Australia
| | - Jane L Phillips
- Faculty of Health, Centre for Cardiovascular and Chronic Care, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Thérése Shaw
- Telethon Kids Institute, Perth, Western Australia, Australia
| | - Rachael Moorin
- School of Public Health, Curtin University, Perth, Western Australia, Australia School of Population Health, The University of Western Australia, Perth, Western Australia, Australia Department of Research, Silver Chain Group, Perth, Western Australia, Australia
| | - Anne Long
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Anne King
- Department of Health WA, WA Cancer and Palliative Carer Network, Perth, Western Australia, Australia
| | - Jenny Clarke
- Faculty of Health Sciences, School of Nursing and Midwifery, Curtin University, Bentley, Perth, Western Australia, Australia
| | | | - Peter Hudson
- Centre for Palliative Care St Vincent's Hospital Melbourne, Victoria, Australia Department of Nursing, University of Melbourne, Melbourne, Victoria, Australia School of Nursing and Midwifery, Queen's University Belfast, Northern Ireland, United Kingdom
| | - Meera Agar
- Department of Palliative Care, Braeside Hospital, Prairiewood, New South Wales, Australia
| | - Anna K Nowak
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia School of Medicine and Pharmacology, University of Western Australia, Nedlands, Western Australia, Australia
| |
Collapse
|
41
|
Holm M, Årestedt K, Carlander I, Fürst CJ, Wengström Y, Öhlen J, Alvariza A. Short-term and long-term effects of a psycho-educational group intervention for family caregivers in palliative home care - results from a randomized control trial. Psychooncology 2015; 25:795-802. [PMID: 26449934 DOI: 10.1002/pon.4004] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 09/11/2015] [Accepted: 09/17/2015] [Indexed: 11/06/2022]
Abstract
BACKGROUND Family caregivers in cancer and palliative care often face heavy responsibilities and feel insufficiently prepared for the situation as caregivers. This study evaluates short-term and long-term effects of a psycho-educational group intervention aiming to increase preparedness for family caregiving in specialized palliative home care. METHODS The study design was a randomized control trial where family caregivers were allocated either to an intervention or control group. The intervention was delivered as a program including three sessions by health professionals (physician, nurse, and social worker/priest). Family caregivers from 10 specialized palliative home care settings were included. Questionnaires with validated instruments at baseline, upon completion, and 2 months following the intervention were used to measure effects of the intervention. The primary outcome was preparedness for caregiving in family caregivers. RESULTS In total, 21 intervention programs were delivered, and 119 family caregivers completed all three measurements. The intervention group had significantly increased their preparedness for caregiving in both the short-term and long-term follow-up compared with the control group. The intervention group also reported significantly increased competence for caregiving in short-term but not long. No effects of the intervention were found on rewards for caregiving, caregiver burden, health, anxiety, or depression. CONCLUSIONS The psycho-educational intervention has the potential to be used by health professionals to improve preparedness for caregiving among family caregivers in palliative care both in short and long terms. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- Maja Holm
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Palliative Research Centre and Department of Health Care Sciences, Ersta Sköndal University College, Stockholm, Sweden
| | - Kristofer Årestedt
- Center for Collaborative Palliative Care, Linnaeus University, Kalmar, Sweden
| | - Ida Carlander
- Palliative Research Centre and Department of Health Care Sciences, Ersta Sköndal University College, Stockholm, Sweden.,Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Carl-Johan Fürst
- Department of Clinical Science and the Institute for Palliative Care, Lund University, Lund, Sweden
| | - Yvonne Wengström
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,School of Health and Medical Sciences, Örebro University, Örebro, Sweden
| | - Joakim Öhlen
- Palliative Research Centre and Department of Health Care Sciences, Ersta Sköndal University College, Stockholm, Sweden.,Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anette Alvariza
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Palliative Research Centre and Department of Health Care Sciences, Ersta Sköndal University College, Stockholm, Sweden.,Capio Palliative care unit, Dalens Hospital, Stockholm, Sweden
| |
Collapse
|
42
|
Limardi S, Stievano A, Rocco G, Vellone E, Alvaro R. Caregiver resilience in palliative care: a research protocol. J Adv Nurs 2015; 72:421-33. [PMID: 26442644 DOI: 10.1111/jan.12829] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2015] [Indexed: 12/22/2022]
Abstract
AIM To describe a research protocol designed to formulate a conceptual framework of informal caregiver resilience in palliative care. BACKGROUND Resilience is the ability to adapt or to improve one's own conditions following experiences of adversity. The end-of-life care provided by informal caregivers is a form of adversity because it entails objective difficulties, emotional involvement and deep levels of introspection that have been stimulated by the death event. Resilience has not yet been addressed in association with end-of-life care. DESIGN This is a multicentre cross-sectional study. METHODS We will administer a questionnaire to a sample of informal end-of-life caregivers to collect data about the main psychological, behavioural and healthcare factors that impact resilience. Data analysis will include descriptive and correlational statistical techniques, multiple linear regressions and structural equation modelling. Data will be collected in multiple palliative care centres and statistical analysis will be carried out using software: SPSS version 19.0 and MPlus version 7.3. The study is supported by a grant from the Centre of Excellence for Nursing Scholarship in Italy (Research Grant number 2.13.10) that was awarded in March 2013. DISCUSSION The study seeks to identify the predictive, mediating and moderating roles of select variables: caregivers' self-efficacy, burdens of caregiving, depression and resilience. The results of this analysis will impact the theoretical study of resilience in palliative care and will have practical implications for interventions aimed at supporting caregivers through healthcare teams.
Collapse
Affiliation(s)
- Stefano Limardi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Italy
| | | | - Gennaro Rocco
- Centre of Excellence for Nursing Scholarship, Rome, Italy
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Italy
| | - Rosaria Alvaro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Italy
| |
Collapse
|
43
|
Henriksson A, Hudson P, Öhlen J, Thomas K, Holm M, Carlander I, Hagell P, Årestedt K. Use of the Preparedness for Caregiving Scale in Palliative Care: A Rasch Evaluation Study. J Pain Symptom Manage 2015; 50:533-41. [PMID: 26004399 DOI: 10.1016/j.jpainsymman.2015.04.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 04/08/2015] [Accepted: 04/19/2015] [Indexed: 11/22/2022]
Abstract
CONTEXT Studies have shown that family carers who feel more prepared for the caregiver role tend to have more favorable experiences. Valid and reliable methods are needed to identify family carers who may be less prepared for the role of supporting a person who needs palliative care. OBJECTIVES The aim of this study was to evaluate the measurement properties of the original English version and a Swedish version of the Preparedness for Caregiving Scale (PCS). METHODS The sample (n = 674) was taken from four different intervention studies from Australia and Sweden, all focused on improving family carers' feelings of preparedness. Family carers of patients receiving palliative home care were selected, and baseline data were used. The measurement properties of the PCS were evaluated using the Rasch model. RESULTS Both the English and Swedish versions of the PCS exhibit sound measurement properties according to the Rasch model. The items in the PCS captured different levels of preparedness. The response categories were appropriate and corresponded to the level of preparedness. No significant differential item functioning for age and sex was detected. Three items demonstrated differential item functioning by language but did not impact interpretation of scores. Reliability was high (>0.90) according to the Person Separation Index. CONCLUSION The PCS is valid for use among family carers in palliative care. Data provide support for its use across age and gender groups as well as across the two language versions.
Collapse
Affiliation(s)
- Anette Henriksson
- Palliative Research Centre and Department of Health Care Sciences, Ersta Sköndal University College, Stockholm, Sweden.
| | - Peter Hudson
- Centre for Palliative Care, St. Vincent's Hospital and Collaborative Centre of The University of Melbourne, Fitzroy, Victoria, Australia
| | - Joakim Öhlen
- Palliative Research Centre and Department of Health Care Sciences, Ersta Sköndal University College, Stockholm, Sweden
| | - Kristina Thomas
- Centre for Palliative Care, St. Vincent's Hospital and Collaborative Centre of The University of Melbourne, Fitzroy, Victoria, Australia
| | - Maja Holm
- Palliative Research Centre and Department of Health Care Sciences, Ersta Sköndal University College, Stockholm, Sweden
| | - Ida Carlander
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Peter Hagell
- The PRO-CARE Group, School of Health and Society, Kristianstad University, Kristianstad, Sweden
| | - Kristofer Årestedt
- Center for Collaborative Palliative Care, Linnaeus University, Kalmar, Sweden
| |
Collapse
|
44
|
Toye C, Moorin R, Slatyer S, Aoun SM, Parsons R, Hegney D, Maher S, Hill KD. Protocol for a randomised controlled trial of an outreach support program for family carers of older people discharged from hospital. BMC Geriatr 2015; 15:70. [PMID: 26108207 PMCID: PMC4479237 DOI: 10.1186/s12877-015-0065-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 05/28/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Presentations to hospital of older people receiving family care at home incur substantial costs for patients, families, and the health care system, yet there can be positive carer outcomes when systematically assessing/addressing their support needs, and reductions in older people's returns to hospital attributed to appropriate discharge planning. This study will trial the Further Enabling Care at Home program, a 2-week telephone outreach initiative for family carers of older people returning home from hospital. Hypotheses are that the program will (a) better prepare families to sustain their caregiving role and (b) reduce patients' re-presentations/readmissions to hospital, and/or their length of stay; also that reduced health system costs attributable to the program will outweigh costs of its implementation. METHODS/DESIGN In this randomised controlled trial, family carers of older patients aged 70+ discharged from a Medical Assessment Unit in a Western Australian tertiary hospital, plus the patients themselves, will be recruited at discharge (N = 180 dyads). Carers will be randomly assigned (block allocation, assessors blinded) to receive usual care (control) or the new program (intervention). The primary outcome is the carer's self-reported preparedness for caregiving (Preparedness for Caregiving Scale administered within 4 days of discharge, 2-3 weeks post-discharge, 6 weeks post-discharge). To detect a clinically meaningful change of two points with 80 % power, 126 carers need to complete the study. Patients' returns to hospital and subsequent length of stay will be ascertained for a minimum of 3 months after the index admission. Regression analyses will be used to determine differences in carer and patient outcomes over time associated with the group (intervention or control). Data will be analysed using an Intention to Treat approach. A qualitative exploration will examine patients' and their family carers' experiences of the new program (interviews) and explore the hospital staff's perceptions (focus groups). Process evaluation will identify barriers to, and facilitators of, program implementation. A comprehensive economic evaluation will determine cost consequences. DISCUSSION This study investigates a novel approach to identifying and addressing family carers' needs following discharge from hospital of the older person receiving care. If successful, the program has potential to be incorporated into routine post-discharge support. TRIAL REGISTRATION Australian and New Zealand Clinical Trial Registry: ACTRN12614001174673 .
Collapse
Affiliation(s)
- Christine Toye
- School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia. .,Centre for Nursing Research, Sir Charles Gairdner Hospital, Perth, WA, 6009, Australia.
| | - Rachael Moorin
- School of Public Health, Curtin University, Perth, WA, 6845, Australia. .,School of Population Health, The University of Western Australia, Perth, WA, 6009, Australia. .,Department of Research, Silver Chain Group, Osborne Park, Perth, WA, 6017, Australia.
| | - Susan Slatyer
- School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia. .,Centre for Nursing Research, Sir Charles Gairdner Hospital, Perth, WA, 6009, Australia.
| | - Samar M Aoun
- School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia.
| | - Richard Parsons
- School of Pharmacy, Curtin University, Perth, WA, 6845, Australia.
| | - Desley Hegney
- School of Nursing and Midwifery, The University of Southern Queensland, Toowoomba, QLD, 4350, Australia. .,School of Nursing, The University of Adelaide, Adelaide, South Australia, 5005, Australia.
| | - Sean Maher
- Department of Rehabilitation and Aged Care, Sir Charles Gairdner Hospital, Perth, WA, 6009, Australia.
| | - Keith D Hill
- School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, 6845, Australia.
| |
Collapse
|
45
|
Hendrix CC, Bailey DE, Steinhauser KE, Olsen MK, Stechuchak KM, Lowman SG, Schwartz AJ, Riedel RF, Keefe FJ, Porter LS, Tulsky JA. Effects of enhanced caregiver training program on cancer caregiver's self-efficacy, preparedness, and psychological well-being. Support Care Cancer 2015; 24:327-336. [PMID: 26062925 DOI: 10.1007/s00520-015-2797-3] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 06/02/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE We examined the effects of an enhanced informal caregiver training (Enhanced-CT) protocol in cancer symptom and caregiver stress management to caregivers of hospitalized cancer patients. METHODS We recruited adult patients in oncology units and their informal caregivers. We utilized a two-armed, randomized controlled trial design with data collected at baseline, post-training, and at 2 and 4 weeks after hospital discharge. Primary outcomes were self-efficacy for managing patients' cancer symptoms and caregiver stress and preparedness for caregiving. Secondary outcomes were caregiver depression, anxiety, and burden. The education comparison (EDUC) group received information about community resources. We used general linear models to test for differences in the Enhanced-CT relative to the EDUC group. RESULTS We consented and randomized 138 dyads: Enhanced-CT = 68 and EDUC = 70. The Enhanced-CT group had a greater increase in caregiver self-efficacy for cancer symptom management and stress management and preparation for caregiving at the post-training assessment compared to the EDUC group but not at 2- and 4-week post-discharge assessments. There were no intervention group differences in depression, anxiety, and burden. CONCLUSION An Enhanced-CT protocol resulted in short-term improvements in self-efficacy for managing patients' cancer symptoms and caregiver stress and preparedness for caregiving but not in caregivers' psychological well-being. The lack of sustained effects may be related to the single-dose nature of our intervention and the changing needs of informal caregivers after hospital discharge.
Collapse
Affiliation(s)
- Cristina C Hendrix
- Duke University School of Nursing, 307 Trent Drive, DUMC 3322, Room 3080, Durham, NC, 27710, USA.,Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs Medical GRECC, 508 Fulton St. Durham VA Medical Center, Durham, NC, 27705, USA.,Center for the Study of Aging and Human Development, Duke University, Box 3003 DUMC, Room 3502 Busse Building, Blue Zone, Duke South Durham, NC, 27710, USA
| | - Donald E Bailey
- Duke University School of Nursing, 307 Trent Drive, DUMC 3322, Room 3080, Durham, NC, 27710, USA.,Center for the Study of Aging and Human Development, Duke University, Box 3003 DUMC, Room 3502 Busse Building, Blue Zone, Duke South Durham, NC, 27710, USA
| | - Karen E Steinhauser
- Center of Excellence for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, 508 Fulton Street, Durham, NC, 27705, USA.,Duke Palliative Care, Duke University Health System, DUMC 2706, Durham, NC, 27710, USA.,Department of Medicine, Duke University School of Medicine, DUMC 2706, Durham, NC, 27710, USA
| | - Maren K Olsen
- Center of Excellence for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, 508 Fulton Street, Durham, NC, 27705, USA.,Department of Medicine, Duke University School of Medicine, DUMC 2706, Durham, NC, 27710, USA
| | - Karen M Stechuchak
- Center of Excellence for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, 508 Fulton Street, Durham, NC, 27705, USA
| | - Sarah G Lowman
- Department of Medicine, Duke University School of Medicine, DUMC 2706, Durham, NC, 27710, USA
| | - Abby J Schwartz
- Center for the Study of Aging and Human Development, Duke University, Box 3003 DUMC, Room 3502 Busse Building, Blue Zone, Duke South Durham, NC, 27710, USA.
| | - Richard F Riedel
- Division of Medical Oncology, Duke University Medical Center, DUMC 3198, Durham, NC, 27710, USA
| | - Francis J Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, DUMC 3159, Durham, NC, 27710, USA
| | - Laura S Porter
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, DUMC 3159, Durham, NC, 27710, USA
| | - James A Tulsky
- Duke Palliative Care, Duke University Health System, DUMC 2706, Durham, NC, 27710, USA.,Department of Medicine, Duke University School of Medicine, DUMC 2706, Durham, NC, 27710, USA
| |
Collapse
|
46
|
Pucciarelli G, Savini S, Byun E, Simeone S, Barbaranelli C, Vela RJ, Alvaro R, Vellone E. Psychometric properties of the Caregiver Preparedness Scale in caregivers of stroke survivors. Heart Lung 2014; 43:555-60. [PMID: 25239706 DOI: 10.1016/j.hrtlng.2014.08.004] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Revised: 08/19/2014] [Accepted: 08/19/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To evaluate the psychometric characteristics of the Caregiver Preparedness Scale (CPS) in caregivers of stroke survivors. BACKGROUND Caregiver preparedness can have an important impact on both the caregiver and the stroke survivor. The validity and reliability of the CPS has not been tested for the stroke-caregiver population. METHODS We used a cross-sectional design to study a sample of 156 caregivers of stroke survivors. Construct validity of the CPS was evaluated by confirmatory factor analysis (CFA). Internal consistency and test-retest reliability were also evaluated. RESULTS Caregivers were, on average, 54 year old (SD = 13.2) and most were women (64.7%). CFA supported the unidimensionality of the scale (comparative fit index = 0.98). Reliability was also supported: item-reliability index and item-total correlations above 0.30; composite reliability index = 0.93; Cronbach's alpha = 0.94; factor score determinacy = 0.97; and test-retest reliability = 0.92. CONCLUSION The CPS is valid and reliable in caregivers of stroke survivors. Scores on this scale may assist health-care providers in identifying caregivers with less preparedness to provide specific interventions.
Collapse
Affiliation(s)
- Gianluca Pucciarelli
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
| | - Serenella Savini
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
| | - Eeeseung Byun
- Department of Family Health Care Nursing, University of California San Francisco School of Nursing, San Francisco, CA, USA
| | - Silvio Simeone
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
| | | | - Raúl Juárez Vela
- Faculty of Health Sciences, University San Jorge, Zaragoza, Spain
| | - Rosaria Alvaro
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy.
| |
Collapse
|
47
|
Factors associated with feelings of reward during ongoing family palliative caregiving. Palliat Support Care 2014; 13:505-12. [DOI: 10.1017/s1478951514000145] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjective:Of the few studies that have paid attention to feelings of reward in family palliative caregiving, most are retrospective and examine the experiences of bereaved family caregivers. Although feeling rewarded has been described as an influence that may facilitate the way family caregivers handle the caregiving situation, no study has sought to identify the factors associated with feelings of reward while providing ongoing family palliative care. The aim of this study, therefore, was to identify influential factors in feelings of reward experienced by family palliative caregivers.Method:Our study had a correlational cross-sectional design. Family caregivers (n = 125) of patients receiving specialized palliative care were consecutively recruited from four settings. These caregivers answered a questionnaire that included the Rewards of Caregiving Scale (RCS). This questionnaire included questions about demographic background and scales to measure preparedness for caregiving, feelings of hope, perceived health, and symptoms of anxiety and depression. Correlation and regression analyses were conducted to identify factors associated with rewards.Results:The results demonstrated that the more prepared caregivers with higher levels of hope felt more rewarded, while caregivers with higher levels of anxiety and those in a spousal relationship with the patient felt less rewarded by caregiving.Significance of results:It seems reasonable that feeling rewarded can be a significant contributor to the overall experience of providing ongoing palliative care. The situation of family caregivers has been shown to be multifaceted and complex, and such covariant factors as preparedness, anxiety, hope, and being in a spousal relationship with the patient to influence this experience.
Collapse
|
48
|
Thomas K, Hudson P, Trauer T, Remedios C, Clarke D. Risk factors for developing prolonged grief during bereavement in family carers of cancer patients in palliative care: a longitudinal study. J Pain Symptom Manage 2014; 47:531-41. [PMID: 23969327 DOI: 10.1016/j.jpainsymman.2013.05.022] [Citation(s) in RCA: 96] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 04/29/2013] [Accepted: 05/04/2013] [Indexed: 11/29/2022]
Abstract
CONTEXT Family carers of palliative care patients report high levels of psychological distress throughout the caregiving phase and during bereavement. Palliative care providers are required to provide psychosocial support to family carers; however, determining which carers are more likely to develop prolonged grief (PG) is currently unclear. OBJECTIVES To ascertain whether family carers reporting high levels of PG symptoms and those who develop PG disorder (PGD) by six and 13 months postdeath can be predicted from predeath information. METHODS A longitudinal study of 301 carers of patients receiving palliative care was conducted across three palliative care services. Data were collected on entry to palliative care (T1) on a variety of sociodemographic variables, carer-related factors, and psychological distress measures. The measures of psychological distress were then readministered at six (T2; n=167) and 13 months postdeath (T3; n=143). RESULTS The PG symptoms at T1 were a strong predictor of both PG symptoms and PGD at T2 and T3. Greater bereavement dependency, a spousal relationship to the patient, greater impact of caring on schedule, poor family functioning, and low levels of optimism also were risk factors for PG symptoms. CONCLUSION Screening family carers on entry to palliative care seems to be the most effective way of identifying who has a higher risk of developing PG. We recommend screening carers six months after the death of their relative to identify most carers with PG.
Collapse
Affiliation(s)
- Kristina Thomas
- Centre for Palliative Care, St. Vincent's Hospital, Melbourne, Victoria, Australia; Collaborative Centre of The University of Melbourne, Melbourne, Victoria, Australia.
| | - Peter Hudson
- Centre for Palliative Care, St. Vincent's Hospital, Melbourne, Victoria, Australia; Collaborative Centre of The University of Melbourne, Melbourne, Victoria, Australia; Queen's University, Belfast, United Kingdom
| | - Thomas Trauer
- Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia; School of Psychology and Psychiatry, Monash University, Melbourne, Victoria, Australia; St. Vincent's Hospital Mental Health Service, Melbourne, Victoria, Australia
| | - Cheryl Remedios
- Centre for Palliative Care, St. Vincent's Hospital, Melbourne, Victoria, Australia; Collaborative Centre of The University of Melbourne, Melbourne, Victoria, Australia
| | - David Clarke
- School of Psychology and Psychiatry, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
49
|
Foreva G, Assenova R. Hidden patients: the relatives of patients in need of palliative care. J Palliat Med 2013; 17:56-61. [PMID: 24320120 DOI: 10.1089/jpm.2013.0333] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND When identifying patients for palliative care, medical specialists find it necessary to disclose "hidden" patients: the patient's relatives. The issue has been discussed sporadically in Bulgaria; the present study was part of a larger investigation that examined the opinion of medical specialists, patients, and their relatives. METHOD The study protocol was explained to participants who gave written informed consent. Patients (n=211) were followed up on by their general practitioners (GPs) (n=42) during one year. All relatives were invited, and 173 (82%) agreed and participated. A questionnaire created by the authors was used. The data were analyzed by frequency distribution (descriptive statistics) and nonparametric tests (Pearson's χ(2)) and statistically processed using SPSS 17.0 (SPSS Inc., Chicago, IL). RESULTS Relatives providing care were predominantly women, two-thirds over 60 years of age. There was a one-to-one ratio between caregivers for oncological and nononcological patients. The duration of care was more than one year in 53% of cases. Most relatives reported their loved ones found physical suffering "very hard to bear" (53%), while approximately 17% could not assess the extent of psychological suffering. The vast majority stated that they had difficulties in providing care, and 68% had financial problems in that respect. CONCLUSION Including relatives as users and part of the palliative care team has been discussed in the literature. In Bulgaria, participation is solely due to the lack of organized services for palliative care. Relatives participate in activities that are performed by trained staff in countries with developed palliative care; these activities, along with negative emotional experiences and economic difficulties, overburden these caregiving relatives significantly.
Collapse
Affiliation(s)
- Gergana Foreva
- General Practice Section, Medical University Plovdiv , Plovdiv, Bulgaria
| | | |
Collapse
|
50
|
Abstract
AbstractObjectives:Palliative family caregivers appear to experience the rewards of caregiving concurrent with burdens and negative feelings. Relatively few studies have attended to the positive and rewarding aspects in palliative family caregiving. In addition, most studies on rewards are retrospective and examine the experiences of bereaved family caregivers. The present study aimed at describing feelings of reward among family caregivers during ongoing palliative care. A further aim was to compare the experience of rewards in relation to sex and age.Methods:The sample consisted of 125 family caregivers and took place in three specialist palliative care units and one hematology unit. Participants answered a questionnaire including demographic background questions and the Rewards of Caregiving Scale (RCS). Descriptive statistics were employed to describe characteristics of the participants and the level of rewards. A Mann–Whitney U test was used to compare differences between groups of different sex and age.Results:Palliative family caregivers reported general high levels of reward. The greatest source of rewards involved feelings of being helpful to patients. This was closely followed by giving something to patients that brought them happiness and being there for them. The smallest sources of rewards were related to personal growth, self-satisfaction, and personal meaning. There was also an association between rewards and age but not between men and women.Significance of results:Family caregivers experienced the rewards of caregiving during ongoing palliative care despite their unique and stressful situation. Feelings of reward seem to be about handling a situation in a satisfying way, feeling competent and confident to take care of the patient and thereby feeling proud. Support could preferably be designed to improve a family caregiver's ability to care and to facilitate the positive aspects and rewards of caregiving and focus on strengths and resources.
Collapse
|