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Arefian M, Asgari-Mobarakeh K. Psychoeducational Intervention for Pain, Psychological Distress, Hope, and Post-traumatic Growth Among Breast Cancer Patients During Chemotherapy: A Pilot Randomized Controlled Trial. Pain Manag Nurs 2024:S1524-9042(24)00153-X. [PMID: 38714424 DOI: 10.1016/j.pmn.2024.04.012] [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: 11/27/2023] [Revised: 03/27/2024] [Accepted: 04/07/2024] [Indexed: 05/09/2024]
Abstract
BACKGROUND Chemotherapy is associated with many side effects, including pain and psychological distress, which affect patients' physical and psychological health. AIM The aim of this study was to elucidate the efficacy of a pain management intervention (POLA) to promote pain, psychological distress, hope and post-traumatic growth in breast cancer patients, also, to undertake a preliminary evaluation of the intervention. METHODS A pilot randomized controlled trial was conducted in an Iranian hospital involving 42 breast cancer (BC) patients during chemotherapy. The intervention group received a 6-week group therapy (90 minutes per session) administered by a psychologist. Meanwhile, the comparison group received standard care. patients' Pain, psychological distress, hope and post-traumatic growth were measured at 3 time points (baseline, week 6, and 12 weeks postintervention). RESULTS The study design was found to be feasible, with a recruitment rate of 61.64% and an attrition rate of 6.66%. Compared to the control group, the intervention group showed a significant reduction in pain, psychological distress, depression, anxiety, and stress, as well as a notable improvement in hope and post-traumatic growth (p < .01). These differences remained significant at follow-up (p < 0.05). The study population found the intervention acceptable, as evidenced by a high attendance rate of 90% and adherence rate of 90.47%. CONCLUSION Psychoeducational intervention positively affects the pain, psychological distress, hope and post-traumatic growth of BC patients during chemotherapy.
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Affiliation(s)
- Mohsen Arefian
- Faculty of Education and Psychology, University of Isfahan, Isfahan, Iran.
| | - Karim Asgari-Mobarakeh
- Department of Psychology, Faculty of Education and Psychology, University of Isfahan, Isfahan, Iran
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Cho H, You SB, Hodgson N, Massimo L, Demiris G. Characteristics of Telehealth Interventions for Adult Patients with Chronic Pain and Family Care Partners. Telemed J E Health 2024; 30:1239-1261. [PMID: 38112565 DOI: 10.1089/tmj.2023.0514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023] Open
Abstract
Objectives: This review aimed to assess characteristics of telehealth in pain management for adult patients with chronic pain and their family care partners and review current evidence of the effectiveness of telehealth for pain management. Based on the Revised Symptom Management model, this review identified types of chronic pain management strategies and symptom management outcomes delivered by telehealth. Methods: We conducted a systematic review of four electronic databases, PubMed, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, and Embase, using combinations of keywords, including "telehealth," "caregivers," and "pain." Only interventions delivered online, including websites, mobile applications, phone calls, and videoconferencing, were included. To accurately characterize the features of each telehealth pain intervention, we employed a standardized checklist. Additionally, a summary table of the evidence was created. Results: We analyzed 17 studies that met the inclusion criteria, of which 14 were randomized controlled trials, 1 was a cohort study, and 2 were qualitative cohort studies. We grouped interventions based on content of the intervention for pain management (education, psychotherapy, reporting and consultation, and multicomponent intervention). The quality rating of studies was mostly moderately strong. Findings of interventions' effectiveness were showing heterogenous effects on variables, possibly due to different pain measurements and varying follow-up times. Significance of Results: Telehealth interventions can potentially increase access to care for patients with chronic pain and their families in a limited resource area. Telehealth technology is a feasible tool that may enhance clinicians' pain management efforts for patients with chronic pain and their family care partners. The results of this review can be used to guide telehealth pain assessment and evaluation for care partners, clinicians, and researchers and inform the design of future telehealth systems.
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Affiliation(s)
- Hannah Cho
- NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sang Bin You
- NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nancy Hodgson
- NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lauren Massimo
- NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - George Demiris
- NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine Philadelphia, Philadelphia, Pennsylvania, USA
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Dural G, Çitlik Saritaş S. The Effect of the Neuman Systems Model-Based Training and Follow-up on Self-Efficacy and Symptom Control in Patients Undergoing Chemotherapy. Nurs Sci Q 2024; 37:154-165. [PMID: 38491883 DOI: 10.1177/08943184231224453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2024]
Abstract
In this article, the authors aimed to determine the effect of the training and follow-up based on the Neuman systems model provided to patients undergoing chemotherapy on their self-efficacy and symptom control. The study was carried out with a randomized controlled experimental study model design. The sample consisted of 102 patients including 52 in the experimental group and 50 in the control group. The data were collected using the Patient Information Form, the Cancer Behavior Inventory-Brief (CBI-B), and the Edmonton Symptom Assessment Scale (ESAS). A personal training program prepared according to the Neuman systems model was applied to the experimental group patients. In the intergroup comparison of the experimental and control group patients, there was an increase in the posttest CBI-B scores and a decrease in the ESAS scores in the experimental group compared to the control group, and the intergroup difference was statistically significant (p < .05). According to the results, to improve the self-efficacy and symptom control in patients undergoing chemotherapy, using this education and follow-up program is recommended.
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Affiliation(s)
- Gül Dural
- Department of Internal Medicine Nursing, Faculty of Health Sciences, Fırat University, Elazığ, Turkey
| | - Seyhan Çitlik Saritaş
- Department of Internal Medicine Nursing, Faculty of Health Sciences, Malatya Turgut Ozal University, Malatya, Turkey
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Chen J, Liu L, Wang Y, Qin H, Liu C. Effects of psychotherapy interventions on anxiety and depression in patients with gastrointestinal cancer: A systematic review and network meta-analysis. J Psychosom Res 2024; 179:111609. [PMID: 38394712 DOI: 10.1016/j.jpsychores.2024.111609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 02/05/2024] [Accepted: 02/10/2024] [Indexed: 02/25/2024]
Abstract
OBJECTIVE Various psychological interventions have been demonstrated to be effective at preventing anxiety and depression symptoms in patients with gastrointestinal (GI) cancer. However, it remains unclear which intervention is the best option. This study aimed to evaluate the impact of various psychological interventions on anxiety and depression in symptomatic patients with GI cancer. METHODS The PubMed, Cochrane Library, Embase, CNKI, WanFang Data, and VIP databases were systematically searched from inception to June 2023 to identify randomized controlled trials (RCTs). The primary outcomes were anxiety and depression levels. Two reviewers independently selected the studies, extracted the data based on prespecified criteria, and evaluated the risk of bias using the Cochrane Collaboration risk of bias tool. Stata 14.0 was used to conduct network meta-analysis. RESULTS Thirty-two RCTs (2453 patients) involving 9 psychological interventions were included. The results of the network meta-analysis showed that cognitive-behavioral therapy (CBT; mean difference [MD] = -4.98, 95% CI (-7.04, -2.93), relaxation therapy (MD = -4.39, 95% CI (-7.90, -0.88), reminiscence therapy (MD = -5.01, 95% CI (-8.20, -1.81)), and narrative nursing (MD = -4.89, 95% CI (-8.54, -1.23)) significantly reduced anxiety levels, and CBT (MD = -2.15, 95% CI (-4.28, -0.02), reminiscence therapy (MD = -7.20, 95% CI (-10.48, -3.91), and narrative nursing (MD = -7.20, 95% CI (-10.48, -3.91)) significantly reduced depression levels in patients with GI cancer compared with conventional nursing care. CONCLUSION The findings of this network meta-analysis revealed that CBT, reminiscence therapy and narrative nursing can be actively considered as part of sequential therapy to reduce anxiety and depression levels in patients with GI cancer.
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Affiliation(s)
- Jianwen Chen
- Department of Nursing, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Dongfengdong Road, 510060 Guangzhou, Guangdong Province, China.
| | - Li Liu
- Department of Nursing, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Dongfengdong Road, 510060 Guangzhou, Guangdong Province, China
| | - Yalan Wang
- Department of Nursing, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Dongfengdong Road, 510060 Guangzhou, Guangdong Province, China
| | - Huiying Qin
- Department of Nursing, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Dongfengdong Road, 510060 Guangzhou, Guangdong Province, China.
| | - Chengjiang Liu
- Department of General Medicine, Affiliated Anqing First People's Hospital of Anhui Medical University, 246000 Anqing, Anhui Province, China.
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Yıldız M, Terzioğlu C, Ayhan F. Psychosocial interventions aimed at family members caring for patients with cancer in the palliative period: A systematic review. Int J Nurs Knowl 2024; 35:136-151. [PMID: 36999895 DOI: 10.1111/2047-3095.12423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 03/14/2023] [Indexed: 04/01/2023]
Abstract
AIM The purpose of this systematic review is to examine evidence-based psychosocial intervention research aimed at family members caring for patients with cancer in the palliative period. METHOD In this systematic review, randomized controlled psychosocial intervention studies for the family member caring for patients with cancer published between January 1, 2016 and July 30, 2021 were reviewed. PubMed (including MEDLINE), Cochrane, APA PsycNet, ProQuest, Science Direct, TR Index, and Wiley Online Library databases were scanned. Eight publications were identified following a database review for English language articles published from 2016 to 2021. Sample, methods, content, and outcomes of included interventions are summarized. RESULTS Only eight of the 4652 articles examined met the inclusion criteria. Psychosocial interventions such as mindfulness exercises, stress management, acceptance and commitment therapy, cognitive behavioral intervention, and meaning-centered psychotherapy for cancer caregivers were applied for relatives caring for patients with cancer in the palliative period. CONCLUSION Psychosocial interventions applied to family members caring for patients with cancer during the palliative period lead to improvements in depressive symptoms, stress levels, the caregiver burden, quality of life, self-efficacy, coping skills, and awareness levels.
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Affiliation(s)
- Manolya Yıldız
- Gulhane Institute of Health Science, University of Health science, Ankara, Turkey
| | - Candan Terzioğlu
- Department of Nursing, Division of Mental Health and Psychiatric Nursing, Faculty of Health Sciences, Alanya Alaaddin Keykubat University, Alanya, Antalya, Turkey
| | - Fatma Ayhan
- Department of Nursing, Division of Mental Health and Psychiatric Nursing, Faculty of Health Science, Batman University, Batman, Turkey
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Asakitogum DA, Nutor JJ, Pozzar R, Hammer M, Miaskowski C. Systematic Review of the Literature on Multiple Co-occurring Symptoms in Patients Receiving Treatment for Gynecologic Cancers. Semin Oncol Nurs 2024; 40:151572. [PMID: 38246840 DOI: 10.1016/j.soncn.2023.151572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 11/23/2023] [Accepted: 12/07/2023] [Indexed: 01/23/2024]
Abstract
OBJECTIVE Patients with gynecologic cancers experience a very high symptom burden that has a negative impact on their quality of life. This systematic review aims to identify the common co-occurring symptoms, the prevalence of common symptoms, common instruments used to measure symptoms, associated risk factors, and the symptom burden in patients with gynecologic cancers. DATA SOURCES A search of four databases (ie, PubMed, Embase, Web of Science, and CINAHL) was done from January 1, 2012, through September 5, 2022. A qualitative synthesis of the extant literature was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines (PRISMA 2020). CONCLUSION A total of 118 studies met the prespecified inclusion criteria. Ninety-six symptoms were assessed across these studies. The top six symptoms and their grand mean prevalence rates were lack of energy (64.4%), fatigue (62.1%), abdominal pain (53.3%), depression (52.6%), concentration dysfunction (52.0%), and drowsiness (51.9%). Numerous methodologic challenges were evident across studies. Future research needs to develop a disease-specific symptom assessment measure, evaluate for risk factors associated with a higher symptom burden, and determine the impact of multiple symptoms on patient outcomes. IMPLICATION FOR NURSING PRACTICE The results are relevant for oncology clinicians to assess patients with gynecologic cancers for the presence of common symptoms and risk factors for higher symptom burden in the patients and to offer effective management interventions.
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Affiliation(s)
- David Ayangba Asakitogum
- Doctoral student, Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco, CA.
| | - Jerry John Nutor
- Assistant Professor, Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco, CA
| | - Rachel Pozzar
- Nurse Scientist and Instructor, Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, MA
| | - Marilyn Hammer
- Nurse Scientist and Instructor, Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, MA; Director, Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, MA
| | - Christine Miaskowski
- Professor, Departments of Physiological Nursing and Anesthesia, School of Nursing and Medicine, University of California, San Francisco, CA
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Chen D, Liu Q, Zhang L, Qian H. Effectiveness of Dyadic Psychoeducational Intervention on Cancer Patients and Their Caregivers: A Systematic Review and Meta-analysis. Cancer Nurs 2023:00002820-990000000-00197. [PMID: 38011076 DOI: 10.1097/ncc.0000000000001307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
BACKGROUND Dyadic psychoeducational intervention targets the dyads of cancer patients and caregivers as active participants in partnership, which can potentially address the needs and challenges faced by patients with cancer and their caregivers. However, there is insufficient evidence on the effectiveness of the intervention on psychological health and illness-related outcomes among the dyads. OBJECTIVE To systematically examine the dyadic psychoeducational intervention of cancer patients and their caregivers on psychological health and illness-related outcomes. METHODS Cochrane Library, EMBASE, CINAHL, PsycINFO, PubMed, Web of Science, and 4 Chinese databases were searched from inception to May 29, 2022. Two investigators independently extracted data and evaluated methodological quality. RevMan 5.4 was used for meta-analysis; heterogeneity was evaluated using Higgins' I2 (%). Standardized mean difference (SMD) with a 95% confidence interval (CI) was used to assess the effects. RESULTS Eight randomized controlled trials that involved 1234 dyads were collected. Meta-analysis showed that the intervention was effective in reducing the dyadic depression (patients' SMD, -0.41 [95% CI, -0.78 to -0.04; P = .03]; caregivers' SMD, -0.70 [95% CI, -1.31 to -0.09; P = .03]). It also improved caregivers' quality of life (SMD, -0.29 [95% CI, -0.56 to -0.03; P = .03]), whereas no significant effect was found on patients' quality of life. Dyadic results including anxiety, self-efficacy, disease communication, and appraisals of illness/caregiving were observed. CONCLUSION Dyadic psychoeducational intervention reduced the dyadic depression. It also improved caregivers' quality of life. IMPLICATIONS FOR PRACTICE Nurses can apply dyadic psychoeducational intervention in clinical practice. More studies are needed to draw higher-quality conclusions and investigate the effects on psychological health and illness-related outcomes in cancer patients and caregivers.
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Affiliation(s)
- Daoming Chen
- Author Affiliations: Department of Operating Room, The Affiliated Hospital of Xuzhou Medical University (Ms Chen), Xuzhou; and School of Nursing, Medical College, Soochow University (Ms Liu and Dr Zhang); and Department of Respiratory, The First Affiliated Hospital of Soochow University (Ms Qian), Suzhou, Jiangsu, People's Republic of China
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Garavand A, Aslani N, Behmanesh A, Khara R, Ehsanzadeh SJ, Khodaveisi T. Features of teleoncology in lung cancer: A scoping review. PATIENT EDUCATION AND COUNSELING 2023; 114:107831. [PMID: 37295044 DOI: 10.1016/j.pec.2023.107831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 05/17/2023] [Accepted: 05/27/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVES There are several challenges in providing healthcare services for lung cancer patients. Using teleoncology is an effective solution to meet such challenges. Given this, we in this study aimed to identify the features of teleoncology in lung cancer. METHODS We conducted this scoping review in 2023. We first searched scientific databases including PubMed, Scopus, ISI Web of Sciences, and Science Direct by combining related keywords for the past 12 years (2012-2023). RESULTS After reviewing 860 articles, we selected 39 studies for the purpose of this study. The interventions of teleoncology for lung cancer patients have four main categories, namely: monitoring of symptoms, monitoring the process of treatment and rehabilitation of patients, self-management and patient empowerment, and providing consultation for patients. CONCLUSION The appropriate implementation of teleoncology systems improves the patient's condition and reduces lung cancer complications by improving the availability of different health services. PRACTICE IMPLICATIONS More attention should be paid to the evaluation of telemedicine systems from the perspective of patients and health service providers. Also, the latest platforms, including mobile phone-based software, should be used to implement such systems.
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Affiliation(s)
- Ali Garavand
- Department of Health Information Technology, School of Allied Medical Sciences, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Nasim Aslani
- Department of Health Information Technology, School of Allied Medical Sciences, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Ali Behmanesh
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | | | - Seyed Jafar Ehsanzadeh
- English Language Department, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Taleb Khodaveisi
- Department of Health Information Technology, School of Allied Medical Sciences, Hamadan University of Medical Sciences, Hamadan, Iran.
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Mooney K, Whisenant MS, Wilson CM, Coombs LA, Lloyd J, Alekhina N, Sloss EA, Steinbach M, Moraitis AM, Berry P, Iacob E, Donaldson G. Technology-Assisted mHealth Caregiver Support to Manage Cancer Patient Symptoms: A Randomized Controlled Trial. J Pain Symptom Manage 2023; 66:33-43. [PMID: 36889453 DOI: 10.1016/j.jpainsymman.2023.02.320] [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: 01/12/2023] [Revised: 02/24/2023] [Accepted: 02/26/2023] [Indexed: 03/08/2023]
Abstract
CONTEXT Caregivers managing symptoms of family members with cancer during home hospice care, often feel ill-prepared and need patient care coaching. OBJECTIVES This study tested the efficacy of an automated mHealth platform that included caregiver coaching on patient symptom care and nurse notifications of poorly controlled symptoms. The primary outcome was caregiver perception of patients' overall symptom severity throughout hospice care and at weeks one, two, four, and eight. Secondary outcomes compared individual symptom severity. METHODS Caregivers (n = 298) were randomly assigned to the Symptom Care at Home (SCH) intervention (n = 144) or usual hospice care (UC) (n = 154). All caregivers placed daily calls to the automated system that assessed the presence and severity of 11 end-of-life patient physical and psychosocial symptoms. SCH caregivers received automated coaching on symptom care based on reported patient symptoms and their severity. Moderate-to-severe symptoms were also relayed to the hospice nurse. RESULTS The SCH intervention produced a mean overall symptom reduction benefit, over UC, of 4.89 severity points (95% CI 2.86-6.92) (P < 0.001), with a moderate effect size (d = 0.55). The SCH benefit also occurred at each timepoint (P < 0.001- 0.020). There was a 38% reduction in days reporting moderate-to-severe patient symptoms compared to UC (P < 0.001) with 10/11 symptoms significantly reduced in SCH compared to UC. CONCLUSION Automated mHealth symptom reporting by caregivers, paired with tailored caregiver coaching on symptom management and nurse notifications, reduces cancer patients' physical and psychosocial symptoms during home hospice, providing a novel and efficient approach to improving end-of-life care.
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Affiliation(s)
- Kathi Mooney
- College of Nursing and Huntsman Cancer Institute (KM, JL, MS) University of Utah, Salt Lake City, Utah, USA.
| | - Meagan S Whisenant
- Cizik School of Nursing (M.S.W.), University of Texas Health Science Center, Houston, Texas, USA
| | - Christina M Wilson
- School of Nursing (C.M.W.), University of Alabama, Birmingham, Alabama, USA
| | - Lorinda A Coombs
- School of Nursing (L.A.C.), University of North Carolina, Chapel Hill, North Carolina, USA
| | - Jennifer Lloyd
- College of Nursing and Huntsman Cancer Institute (KM, JL, MS) University of Utah, Salt Lake City, Utah, USA
| | - Natalya Alekhina
- College of Nursing (N.A., E.A.S., A.M.M., P.B., E.I.), University of Utah, Salt Lake City, Utah, USA
| | - Elizabeth A Sloss
- College of Nursing (N.A., E.A.S., A.M.M., P.B., E.I.), University of Utah, Salt Lake City, Utah, USA
| | - Mary Steinbach
- College of Nursing and Huntsman Cancer Institute (KM, JL, MS) University of Utah, Salt Lake City, Utah, USA
| | - Ann Marie Moraitis
- College of Nursing (N.A., E.A.S., A.M.M., P.B., E.I.), University of Utah, Salt Lake City, Utah, USA
| | - Patricia Berry
- College of Nursing (N.A., E.A.S., A.M.M., P.B., E.I.), University of Utah, Salt Lake City, Utah, USA
| | - Eli Iacob
- College of Nursing (N.A., E.A.S., A.M.M., P.B., E.I.), University of Utah, Salt Lake City, Utah, USA
| | - Gary Donaldson
- School of Medicine (G.D.), University of Utah, Salt Lake City, Utah, USA
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Wang XY, Wang J, Zhang S. Analysis of load status and management strategies of main caregivers of patients with malignant tumors of digestive tract. World J Gastrointest Oncol 2023; 15:973-978. [PMID: 37389114 PMCID: PMC10302986 DOI: 10.4251/wjgo.v15.i6.973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 04/12/2023] [Accepted: 04/23/2023] [Indexed: 06/14/2023] Open
Abstract
Caregiver load refers to the subjective and objective negative impact of caregivers in the care of patients, and excessive load will have a serious impact on patients and caregivers themselves and can reduce their quality of life. For the main caregivers, it not only needs to care for the patients in life and daily life, but also needs to pay the cost of treatment for the patients, coupled with the need to carry out their own original work, life, etc. excessive life pressure, economic pressure, work pressure, emotional pressure, etc. lead to heavy load of the main caregivers, which can easily cause caregivers to have different degrees of psychological problems, which will cause serious adverse effects on the caregivers themselves and cancer patients, not conducive to the construction of a harmonious family and society. This article analyzes the current situation of primary caregiver burden in patients with gastrointestinal malignant tumors, analyzes its influencing factors, and specifies specific treatment strategies. It is hoped to provide scientific guidance for later related research and application.
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Affiliation(s)
- Xiao-Yan Wang
- Emergency Department, West China Hospital of Sichuan University, Chengdu 610000, Sichuan Province, China
| | - Jing Wang
- ENT (Ear-Nose-Throat) Department, Chengdu Hospital of Combination of Chinese Traditional and Western Medicine, Chengdu 610000, Sichuan Province, China
| | - Shu Zhang
- Emergency Department, West China Hospital of Sichuan University, Chengdu 610000, Sichuan Province, China
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Lei F, Lee E, Shin J, Lee SY. Non-pharmacological interventions on anxiety and depression in lung cancer patients' informal caregivers: A systematic review and meta-analysis. PLoS One 2023; 18:e0282887. [PMID: 36913399 PMCID: PMC10010534 DOI: 10.1371/journal.pone.0282887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 02/26/2023] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND Lung cancer is one of the common cancers and the leading cause of death. Tremendous caregiving burden of informal caregivers of lung cancer causes psychological disorders, such as anxiety and depression. Interventions for informal caregivers of patients with lung cancer to improve their psychological health, which ultimately leads to patients' positive health outcomes, are crucial. A systematic review and meta-analysis was conducted to: 1) evaluate the effect of non-pharmacological interventions on the outcomes of depression and anxiety for lung cancer patients' informal caregivers; and 2) compare the effects of interventions with differing characteristics (i.e. intervention types, mode of contact, and group versus individual delivery). METHODS Four databases were searched to identify relevant studies. Inclusion criteria for the articles were peer-reviewed non-pharmacological intervention studies on depression and anxiety in lung cancer patients' informal caregivers published between January 2010 and April 2022. Systematic review procedures were followed. Data analysis of related studies was conducted using the Review Manager Version 5.4 software. Intervention effect sizes and studies' heterogeneity were calculated. RESULTS Eight studies from our search were eligible for inclusion. Regarding total effect for the caregivers' levels of anxiety and depression, results revealed evidence for significant moderate effects of intervention on anxiety (SMD -0.44; 95% CI, -0.67, -0.21; p = 0.0002) and depression (SMD -0.46; 95% CI, -0.74, -0.18; p = 0.001). Subgroup analyses for both anxiety and depression of informal caregivers revealed moderate to high significant effects for specific intervention types (cognitive behavioral and mindfulness combined with psycho-education interventions), mode of contact (telephone-based interventions), and group versus individual delivery. CONCLUSION This review provides evidence that cognitive behavioral and mindfulness-based, telephone-based, individual or group-based interventions were effective for informal caregivers of lung cancer patients. Further research is needed to develop the most effective intervention contents and delivery methods across informal caregivers with larger sample size in randomized controlled trials.
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Affiliation(s)
- Fang Lei
- School of Nursing, University of Minnesota, Twin Cities, MN, United States of America
| | - Eunice Lee
- School of Nursing, University of California, Los Angeles, Los Angeles, CA, United States of America
| | - Joosun Shin
- School of Nursing, University of California, San Francisco, San Francisco, CA, United States of America
| | - Shin-Young Lee
- Department of Nursing, Chosun University, Gwangju, Republic of Korea
- * E-mail:
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Burns MF, Secinti E, Johns SA, Wu W, Helft PR, Turk AA, Loehrer PJ, Sehdev A, Al-Hader AA, Mosher CE. Impact of acceptance and commitment therapy on physical and psychological symptoms in advanced gastrointestinal cancer patients and caregivers: Secondary results of a pilot randomized trial. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2023; 27:107-115. [PMID: 37064761 PMCID: PMC10100868 DOI: 10.1016/j.jcbs.2023.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Patients with advanced gastrointestinal cancer often experience high symptom burden, which is associated with heightened distress in both patients and their family caregivers. Few interventions have been tested to jointly address patient and caregiver symptoms in advanced gastrointestinal cancer. In a randomized pilot trial, telephone-based, dyadic acceptance and commitment therapy (ACT) was found to be feasible in this population. The present secondary analyses examined the impact of this intervention on patient and caregiver physical and psychological symptoms. Patients and caregivers (N = 40 dyads) were recruited from clinics in Indianapolis, Indiana and randomized to either six weeks of telephone-based ACT or education/support, an attention control condition. Outcomes were assessed at baseline and at 2 weeks and 3 months post-intervention. Study group differences in outcomes were not statistically significant. However, when examining within-group change, only ACT patients experienced moderate reductions in pain severity and interference at 2 weeks post-intervention (effect size [ES]=-0.47; -0.51) as well as moderate reductions in depressive symptoms at 2 weeks (ES=-0.42) and 3 months (ES=-0.41) post-intervention. ACT caregivers experienced moderate reductions in sleep disturbance (ES=-0.56; -0.49) and cognitive concerns (ES=-0.61; -0.85) across follow-ups. Additionally, caregivers in both conditions experienced moderate reductions in fatigue (ES=-0.38 to -0.70) and anxiety (ES=-0.40 to -0.49) across follow-ups. Findings suggest that ACT may improve certain symptoms in dyads coping with advanced gastrointestinal cancer and warrant replication in a larger trial.
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Affiliation(s)
- Marcia F. Burns
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 North Blackford Street, LD 124, Indianapolis, IN, 46202, USA
| | - Ekin Secinti
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 North Blackford Street, LD 124, Indianapolis, IN, 46202, USA
| | - Shelley A. Johns
- Indiana University School of Medicine, Center for Health Services Research, Regenstrief Institute, 1101 W. 10th Street, Indianapolis, IN, 46202, USA
| | - Wei Wu
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 North Blackford Street, LD 124, Indianapolis, IN, 46202, USA
| | - Paul R. Helft
- Indiana University School of Medicine, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indiana Cancer Pavilion, 535 Barnhill Drive, Suite 473, Indianapolis, IN, 46202, USA
| | - Anita A. Turk
- Indiana University School of Medicine, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indiana Cancer Pavilion, 535 Barnhill Drive, Suite 473, Indianapolis, IN, 46202, USA
| | - Patrick J. Loehrer
- Indiana University School of Medicine, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indiana Cancer Pavilion, 535 Barnhill Drive, Suite 473, Indianapolis, IN, 46202, USA
| | - Amikar Sehdev
- Indiana University School of Medicine, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indiana Cancer Pavilion, 535 Barnhill Drive, Suite 473, Indianapolis, IN, 46202, USA
| | - Ahmad A. Al-Hader
- Indiana University School of Medicine, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indiana Cancer Pavilion, 535 Barnhill Drive, Suite 473, Indianapolis, IN, 46202, USA
| | - Catherine E. Mosher
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 North Blackford Street, LD 124, Indianapolis, IN, 46202, USA
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13
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Shin J, Kober K, Wong ML, Yates P, Miaskowski C. Systematic review of the literature on the occurrence and characteristics of dyspnea in oncology patients. Crit Rev Oncol Hematol 2023; 181:103870. [PMID: 36375635 DOI: 10.1016/j.critrevonc.2022.103870] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 10/31/2022] [Accepted: 11/10/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Dyspnea is a common and distressing symptom for oncology patients.However, dyspnea is not well-characterized and often underestimated by clinicians. This systematic review summarizes the prevalence, intensity, distress, and impact of dyspnea in oncology patients and identifies research gaps. METHODS A search of all of the relevant databases was done from 2009 to May 2022. A qualitative synthesis of the extant literature was performed using established guidelines. RESULTS One hundred-seventeen studies met inclusion criteria. Weighted grand mean prevalence of dyspnea in patients with advanced cancer was 58.0%. Intensity of dyspnea was most common dimension evaluated, followed by the impact and distress. Depression and anxiety were the most common symptoms that co-occurred with dyspnea. CONCLUSION Numerous methodologic challenges were evident across studies. Future studies need to use valid and reliable measures; evaluate the impact of dyspnea; and determine biomarkers for dyspnea.
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Affiliation(s)
- Joosun Shin
- School of Nursing, University of California, San Francisco, CA, USA.
| | - Kord Kober
- School of Nursing, University of California, San Francisco, CA, USA; Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
| | - Melisa L Wong
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA; Division of Hematology/Oncology, Division of Geriatrics, University of California, San Francisco, CA, USA
| | - Patsy Yates
- Cancer & Palliative Outcomes Centre, Centre for Health Transformation, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia; School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Christine Miaskowski
- School of Nursing, University of California, San Francisco, CA, USA; School of Medicine, University of California, San Francisco, CA, USA; Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
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14
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Kizza IB, Muliira JK, Al Jabri KA, Al-Kindi SN. Family Caregivers of Adult Cancer Patients in Oman: Predictors of Caregivers' Self-efficacy for Cancer Pain and Related Symptom Management at Home. Cancer Nurs 2022; Publish Ahead of Print:00002820-990000000-00084. [PMID: 36729792 DOI: 10.1097/ncc.0000000000001181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Family caregivers (FCGs) contribute significantly to the management of pain and other symptoms experienced by their family member with cancer and may not receive preparation to meet the changing patient needs. OBJECTIVE The aim of this study was to identify the predictors of FCG self-efficacy (SE) for pain and related symptom management of adult family members with cancer. METHODS Data were collected from 165 Omani FCGs. The questionnaire comprised the caregiver cancer pain and related symptom management SE scale, the Katz index, Caregiver Reaction Assessment, and Family Pain Questionnaire. Electronic medical records provided data on patients' cancer diagnosis, pain, and symptoms. Predictors of SE were examined using linear regression analysis. RESULTS Most FCGs were female (58.2%) and children of the patient (53.9%). Most patients were on chemotherapy or palliative care (82.4%) and had at least stage 3 cancer (58.8%). Family caregivers reported average SE. The predictors of SE were as follows: patients' functional status (β = 40.90, P = .001), patients' pain intensity (β = -15.10, P = .036), FCGs' confidence in controlling the patients' pain (β = 28.80, P = .000), FCGs' self-rated health (β = -25.90, P = .038), and interaction of FCGs' knowledge level with patients' pain intensity (β = -1.31, P = .008), caregiving hours (β = -0.10, P = .025), and impact of caregiving on FCGs' physical health (β = 1.29, P = .031). CONCLUSION Family caregivers' health status, knowledge, caregiving demands, patient functional status, and pain intensity have a significant effect on caregivers' symptom management. IMPLICATIONS FOR PRACTICE A deliberate model of care that includes supportive interventions to enhance the abilities of FCGs with symptom management is needed in Oman.
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Affiliation(s)
- Irene B Kizza
- Author Affiliations: School of Nursing, University of Wisconsin, Madison (Ms Kizza); School of Nursing, Ball State University, Muncie, Indiana (Dr Muliira); and National Oncology Centre, Royal Hospital (Ms Al Jabri); College of Nursing, Sultan Qaboos University (Ms Al-Kindi), Muscat, Oman
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15
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Otto AK, Ketcher D, Reblin M, Terrill AL. Positive Psychology Approaches to Interventions for Cancer Dyads: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13561. [PMID: 36294142 PMCID: PMC9602591 DOI: 10.3390/ijerph192013561] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 10/14/2022] [Accepted: 10/16/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE Positive psychology approaches (PPAs) to interventions focus on developing positive cognitions, emotions, and behavior. Benefits of these interventions may be compounded when delivered to interdependent dyads. However, dyadic interventions involving PPAs are relatively new in the cancer context. This scoping review aimed to provide an overview of the available research evidence for use of dyadic PPA-based interventions in cancer and identify gaps in this literature. METHODS Following PRISMA guidelines, we conducted a scoping review of intervention studies that included PPAs delivered to both members of an adult dyad including a cancer patient and support person (e.g., family caregiver, intimate partner). RESULTS Forty-eight studies, including 39 primary analyses and 28 unique interventions, were included. Most often (53.8%), the support person in the dyad was broadly defined as a "caregiver"; the most frequent specifically-defined role was spouse (41.0%). PPAs (e.g., meaning making) were often paired with other intervention components (e.g., education). Outcomes were mostly individual well-being or dyadic coping/adjustment. CONCLUSIONS Wide variability exists in PPA type/function and their targeted outcomes. More work is needed to refine the definition/terminology and understand specific mechanisms of positive psychology approaches.
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Affiliation(s)
- Amy K. Otto
- University of Minnesota Medical School, Duluth Campus, Duluth, MN 55812, USA
| | - Dana Ketcher
- University of Minnesota Medical School, Duluth Campus, Duluth, MN 55812, USA
| | - Maija Reblin
- College of Medicine, University of Vermont, Burlington, VT 05405, USA
| | - Alexandra L. Terrill
- Department of Occupational & Recreational Therapies, University of Utah, Salt Lake City, UT 84112, USA
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Mosher CE, Secinti E, Wu W, Kashy DA, Kroenke K, Bricker JB, Helft PR, Turk AA, Loehrer PJ, Sehdev A, Al-Hader AA, Champion VL, Johns SA. Acceptance and commitment therapy for patient fatigue interference and caregiver burden in advanced gastrointestinal cancer: Results of a pilot randomized trial. Palliat Med 2022; 36:1104-1117. [PMID: 35637615 PMCID: PMC9396957 DOI: 10.1177/02692163221099610] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Fatigue often interferes with functioning in patients with advanced cancer, resulting in increased family caregiver burden. Acceptance and commitment therapy, a promising intervention for cancer-related suffering, has rarely been applied to dyads coping with advanced cancer. AIM To examine the feasibility, acceptability, and preliminary efficacy of acceptance and commitment therapy for patient-caregiver dyads coping with advanced gastrointestinal cancer. Primary outcomes were patient fatigue interference and caregiver burden. DESIGN In this pilot trial, dyads were randomized to six weekly sessions of telephone-delivered acceptance and commitment therapy or education/support, an attention control. Outcomes were assessed at baseline and at 2 weeks and 3 months post-intervention. SETTING/PARTICIPANTS Forty patients with stage III-IV gastrointestinal cancer and fatigue interference and family caregivers with burden or distress were recruited from two oncology clinics and randomized. RESULTS The eligibility screening rate (54%) and retention rate (81% at 2 weeks post-intervention) demonstrated feasibility. At 2 weeks post-intervention, acceptance and commitment therapy participants reported high intervention helpfulness (mean = 4.25/5.00). Group differences in outcomes were not statistically significant. However, when examining within-group change, acceptance and commitment therapy patients showed moderate decline in fatigue interference at both follow-ups, whereas education/support patients did not show improvement at either follow-up. Acceptance and commitment therapy caregivers showed medium decline in burden at 2 weeks that was not sustained at 3 months, whereas education/support caregivers showed little change in burden. CONCLUSIONS Acceptance and commitment therapy showed strong feasibility, acceptability, and promise and warrants further testing. TRIAL REGISTRATION ClinicalTrials.gov NCT04010227. Registered 8 July 2019, https://clinicaltrials.gov/ct2/show/NCT04010227?term=catherine+mosher&draw=2&rank=1.
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Affiliation(s)
- Catherine E Mosher
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Ekin Secinti
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Wei Wu
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | | | - Kurt Kroenke
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jonathan B Bricker
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, USA
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Paul R Helft
- Indiana University School of Medicine, Indiana Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN, USA
| | - Anita A Turk
- Indiana University School of Medicine, Indiana Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN, USA
| | - Patrick J Loehrer
- Indiana University School of Medicine, Indiana Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN, USA
| | - Amikar Sehdev
- Indiana University School of Medicine, Indiana Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN, USA
| | - Ahmad A Al-Hader
- Indiana University School of Medicine, Indiana Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN, USA
| | | | - Shelley A Johns
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
- Regenstrief Institute Center for Health Services Research, Indianapolis, IN, USA
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17
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Sak-Dankosky N, Sherwood P, Vehviläinen-Julkunen K, Kvist T. Interventions improving well-being of adult cancer patients' caregivers: A systematic review. J Adv Nurs 2022; 78:2747-2764. [PMID: 35696332 DOI: 10.1111/jan.15320] [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: 05/09/2021] [Revised: 03/23/2022] [Accepted: 05/01/2022] [Indexed: 11/30/2022]
Abstract
AIM The aim of this study was to determine what kind of psychosocial interventions aimed at improving the well-being of adult cancer patient caregivers were developed, and to describe the methodological characteristics and clinical effectiveness of the interventions which could be included in the nursing care plans. DESIGN Systematic review DATA SOURCES: A systematic search of three databases (PubMed, CINAHL, and PsycINFO) was conducted to identify peer-reviewed papers published between years 2004-2019. REVIEW METHODS The review was guided by the Joanna Briggs Institute manual for systematic reviews. Data were extracted and appraised by three reviewers using standardized checklists. Narrative synthesis was used to analyse the data. RESULTS A total of 37 studies underwent analysis. Most of the studies described psychoeducational interventions, designed for patient-caregiver dyads, delivered face-to-face. There was a great variety in caregiver outcomes and measurement tools used. Even though most studies used a randomized controlled design and standardized intervention protocols, many reported problems with recruitment and attrition. Most studies reported that the intervention improved caregiver outcomes, yet the majority of them failed to report effect sizes. CONCLUSION There are currently a plethora of successful interventions available for cancer patient caregivers which can be included to the nursing care plan. Psychoeducational online interventions which include a social support component may have the best potential in supporting caregivers. It is important to address specific caregiver needs at different cancer stages rather than general needs of caregivers in future interventions. IMPACT This review suggests that despite a large number of different interventions which can be included in the nursing care plan to improve the support offered to caregivers, some issues should be addressed while designing an intervention study. The emphasis should be placed on reporting effect sizes, focusing on specific caregiver needs and improving recruitment, retention strategies and sustainability of caregiver interventions.
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Affiliation(s)
| | - Paula Sherwood
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Katri Vehviläinen-Julkunen
- Department of Nursing Science, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - Tarja Kvist
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
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Pinnock H, Murphie P, Vogiatzis I, Poberezhets V. Telemedicine and virtual respiratory care in the era of COVID-19. ERJ Open Res 2022; 8:00111-2022. [PMID: 35891622 PMCID: PMC9131135 DOI: 10.1183/23120541.00111-2022] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 05/04/2022] [Indexed: 11/05/2022] Open
Abstract
The World Health Organization defines telemedicine as “an interaction between a health care provider and a patient when the two are separated by distance”. The COVID-19 pandemic has forced a dramatic shift to telephone and video consulting for follow up and routine ambulatory care for reasons of infection control. Short Message Service (“text”) messaging has proved a useful adjunct to remote consulting allowing transfer of photographs and documents. Maintaining non-communicable diseases care is a core component of pandemic preparedness and telemedicine has developed to enable (for example) remote monitoring of sleep apnoea, telemonitoring of chronic obstructive pulmonary disease, digital support for asthma self-management, remote delivery of pulmonary rehabilitation. There are multiple exemplars of telehealth instigated rapidly to provide care for people with COVID-19, to manage the spread of the pandemic, or to maintain safe routine diagnostic or treatment services.Despite many positive examples of equivalent functionality and safety, there remain questions about the impact of remote delivery of care on rapport and the longer-term impact on patient/professional relationships. Although telehealth has the potential to contribute to universal health coverage by providing cost-effective accessible care, there is a risk of increasing social health inequalities if the “digital divide” excludes those most in need of care. As we emerge from the pandemic, the balance of remote versus face-to-face consulting, and the specific role of digital health in different clinical and healthcare contexts will evolve. What is clear is that telemedicine in one form or another will be part of the “new norm”.
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19
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Nurse-led telehealth interventions for symptom management in patients with cancer receiving systemic or radiation therapy: a systematic review and meta-analysis. Support Care Cancer 2022; 30:7119-7132. [PMID: 35420331 PMCID: PMC9008678 DOI: 10.1007/s00520-022-07052-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 04/06/2022] [Indexed: 11/16/2022]
Abstract
Purpose Patients receiving cancer treatments experience many treatment-related symptoms. Telehealth is increasingly being used to support symptom management. The overall aim was to determine the effectiveness of nurse-led telehealth symptom management interventions for patients with cancer receiving systemic or radiation therapy compared to usual care on health service use, quality of life, and symptom severity. Methods A systematic review was conducted following the Cochrane Handbook and PRISMA reporting guidelines. Five electronic databases were searched. Two independent reviewers screened articles and extracted data. Meta-analysis was performed if data were clinically and methodologically homogeneous. Subanalysis was conducted on reactive and scheduled telehealth interventions. Results Of 7749 citations screened, 10 studies were included (8 randomized control trials, 2 quasi-experimental). Five were reactive telehealth interventions with patient-initiated contact and five evaluated scheduled telehealth interventions initiated by nurses. Compared to usual care (typically patient-initiated calls), nurse-led telehealth interventions for symptom management showed no statistically significant difference in hospitalizations, emergency department visits, or unscheduled clinic visits. Two of three studies of reactive telehealth interventions showed improved quality of life. All telehealth interventions showed reduction in the severity of most symptoms. Pain severity was significantly reduced (standard mean difference − 0.54; 95% CI − 0.88, − 0.19). Significant heterogeneity prevented meta-analysis for most outcomes. Conclusion Few studies evaluated nurse-led telehealth interventions for cancer symptom management. Compared to usual care, patients exposed to telehealth interventions had reduced symptom severity and no difference in health services use. Future research should focus on better reporting intervention characteristics and consistently measuring outcomes. Supplementary Information The online version contains supplementary material available at 10.1007/s00520-022-07052-z.
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20
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Smith TO, Pearson M, Smith MJ, Fletcher J, Irving L, Lister S. Effectiveness of caregiver interventions for people with cancer and non-cancer-related chronic pain: a systematic review and meta-analysis. Br J Pain 2022; 16:71-83. [PMID: 35111316 PMCID: PMC8801680 DOI: 10.1177/20494637211022771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND People with chronic pain frequently have difficulties in completing everyday tasks to maintain independence and quality of life. Informal caregivers may provide support to these individuals. However, the effectiveness of interventions to train and support these individuals in caregiving remains unclear. The purpose of this study was to systematically review the evidence to determine the effectiveness of caregiver interventions to support informal caregivers of people with chronic pain. METHODS A systematic review of published and unpublished literature databases was undertaken (9 April 2021). Trials reporting clinical outcomes of caregiver interventions to train informal caregivers to support community-dwelling people with chronic pain were included. Meta-analysis was undertaken and each outcome was assessed using Grading of Recommendations, Assessment, Development and Evaluation. RESULTS Twenty-seven studies were eligible (N = 3427 patients). Twenty-four studies assessed patients with cancer pain and three with musculoskeletal pain. No other patient groups were identified. There was very low-quality evidence that caregiver interventions were beneficial for caregiver health-related quality of life (standardised mean difference = 0.26, 95% confidence interval = 0.01 to 0.52; N = 231). There was moderate-quality evidence that caregiving interventions were effective in reducing pain in the short-term (standardised mean difference = 0.16, 95% confidence interval = -0.29 to -0.03). There was low-quality evidence that caregiving interventions had no beneficial effect over usual care for psychological outcomes, fatigue, coping or physical function in the long-term. CONCLUSION Caregiving interventions may be effective for patients and caregivers but only in the shorter-term and for a limited number of outcomes. There is insufficient evidence examining the effectiveness of caregiver interventions for people with non-cancer-related pain.
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Affiliation(s)
- Toby O. Smith
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Matthew Pearson
- Dynamic Health, Cambridgeshire Community Services, Huntingdon, UK
| | | | - Jessica Fletcher
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Lisa Irving
- Physiotherapy Department, Sunderland Royal Hospital, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK
| | - Sarah Lister
- Physiotherapy Department, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
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21
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Su Z, Li X, McDonnell D, Fernandez AA, Flores BE, Wang J. Technology-Based Interventions for Cancer Caregivers: Concept Analysis. JMIR Cancer 2021; 7:e22140. [PMID: 34783664 PMCID: PMC8663574 DOI: 10.2196/22140] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 12/01/2020] [Accepted: 10/13/2021] [Indexed: 01/16/2023] Open
Abstract
Background Cancer is a taxing chronic disease that demands substantial care, most of which is shouldered by informal caregivers. As a result, cancer caregivers often have to manage considerable challenges that could result in severe physical and psychological health consequences. Technology-based interventions have the potential to address many, if not all, of the obstacles caregivers encounter while caring for patients with cancer. However, although the application of technology-based interventions is on the rise, the term is seldom defined in research or practice. Considering that the lack of conceptual clarity of the term could compromise the effectiveness of technology-based interventions for cancer caregivers, timely research is needed to bridge this gap. Objective This study aims to clarify the meaning of technology-based interventions in the context of cancer caregiving and provide a definition that can be used by cancer caregivers, patients, clinicians, and researchers to facilitate evidence-based research and practice. Methods The 8-step concept analysis method by Walker and Avant was used to analyze the concept of technology-based interventions in the context of cancer caregiving. PubMed, PsycINFO, CINAHL, and Scopus were searched for studies that examined technology-based interventions for cancer caregivers. Results The defining attributes of technology-based interventions were recognized as being accessible, affordable, convenient, and user-friendly. On the basis of insights gained on the defining attributes, antecedents to, and consequences of technology-based interventions through the concept analysis process, technology-based interventions were defined as the use of technology to design, develop, and deliver health promotion contents and strategies aimed at inducing or improving positive physical or psychological health outcomes in cancer caregivers. Conclusions This study clarified the meaning of technology-based interventions in the context of cancer caregiving and provided a clear definition that can be used by caregivers, patients, clinicians, and researchers to facilitate evidence-based oncology practice. A clear conceptualization of technology-based interventions lays foundations for better intervention design and research outcomes, which in turn have the potential to help health care professionals address the needs and preferences of cancer caregivers more cost-effectively.
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Affiliation(s)
- Zhaohui Su
- Center on Smart and Connected Health Technologies, School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Xiaoshan Li
- Program of Public Relations and Advertising, Beijing Normal University-Hong Kong Baptist University United International College, Zhuhai, China
| | - Dean McDonnell
- Department of Humanities, Institute of Technology, Carlow, Ireland
| | - Andrea A Fernandez
- School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Bertha E Flores
- School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Jing Wang
- Florida State University College of Nursing, Tallahassee, FL, United States
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Komariah M, Maulana S, Platini H, Pahria T. A Scoping Review of Telenursing's Potential as a Nursing Care Delivery Model in Lung Cancer During the COVID-19 Pandemic. J Multidiscip Healthc 2021; 14:3083-3092. [PMID: 34754196 PMCID: PMC8572116 DOI: 10.2147/jmdh.s337732] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 10/19/2021] [Indexed: 12/28/2022] Open
Abstract
This review aims to investigate the potential of telenursing as a nursing care delivery model for lung cancer throughout the COVID-19 pandemic using a scoping review. The Preferred Reporting Item for Systematic Reviews and Meta-analysis for Scoping Review (PRISMA-ScR) were used in this study. The topic was thoroughly researched in PubMed, CINAHL, and Science Direct. Based on the initial search, there were eight relevant studies out of 432. Websites, phone calls, and lifestream were among the telenursing models discovered in the care of lung cancer patients. The delivery care provided includes monitoring vital signs, symptoms, chemotherapy toxicity, support care, education, and postoperative rehabilitation. Telenursing is considered appropriate for lung cancer patients because it has been shown to help with symptom management, functional status, quality of life, and diminishing the demand for care support. Therefore, telenursing can be used to deliver care for lung cancer throughout the COVID-19 pandemic.
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Affiliation(s)
- Maria Komariah
- Department of Fundamental Nursing, Faculty of Nursing, Universitas Padjadjaran, Bandung, Indonesia
| | - Sidik Maulana
- Faculty of Nursing, Universitas Padjadjaran, Bandung, Indonesia
| | - Hesti Platini
- Department of Medical-Surgical Nursing, Faculty of Nursing, Universitas Padjadjaran, Bandung, Indonesia
| | - Tuti Pahria
- Department of Medical-Surgical Nursing, Faculty of Nursing, Universitas Padjadjaran, Bandung, Indonesia
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Song L, Qan'ir Y, Guan T, Guo P, Xu S, Jung A, Idiagbonya E, Song F, Kent EE. The Challenges of Enrollment and Retention: A Systematic Review of Psychosocial Behavioral Interventions for Patients With Cancer and Their Family Caregivers. J Pain Symptom Manage 2021; 62:e279-e304. [PMID: 33933618 PMCID: PMC8419067 DOI: 10.1016/j.jpainsymman.2021.04.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/21/2021] [Accepted: 04/21/2021] [Indexed: 02/06/2023]
Abstract
CONTEXT Psychosocial behavioral interventions (PBIs) that target patients with cancer and their caregivers face challenges in participant enrollment and retention. OBJECTIVES 1) Describe characteristics of the patient-caregiver PBI studies; 2) examine participant enrollment and retention rates; 3) identify factors influencing participant enrollment and retention rates; and 4) explore the strategies to promote enrollment and retention rates. METHODS We identified randomized controlled trials that tested PBIs among adult patients with cancer and caregivers in five electronic databases. We conducted narrative and quantitative analyses to synthesize our findings. RESULTS Among 55 qualified studies reviewed, most tested the efficacy of PBIs (n = 42) and used two study arms (n = 48). In-person meeting was the most common PBI delivery mode. The primary outcomes included quality of life, physical health, and symptoms. The average of enrollment rates of patient-caregiver dyads was 33% across studies (range 8%-100%; median = 23%). The average retention rate at the end of follow-ups was 69% (range 16%-100%; median = 70%). The number of study arms, recruitment method, type of patient-caregiver relationship, and intervention duration influenced enrollment rates. Study design (efficacy vs. pilot), follow-up duration, mode of delivery, type of relationship, and intervention duration influenced retention rates. Sixteen studies reported retention strategies, including providing money/gift cards upon study completion and/or after follow-up survey, and excluding patients with advanced cancer. CONCLUSION Researchers need to incorporate effective strategies to optimize enrollment and retention in patient-caregiver PBI trials. Researchers need to report detailed study processes and PBI information to improve research transparency and increase consistency.
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Affiliation(s)
- Lixin Song
- University of North Carolina at Chapel Hill, School of Nursing, Chapel Hill, North Carolina, USA; University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA.
| | - Yousef Qan'ir
- University of North Carolina at Chapel Hill, School of Nursing, Chapel Hill, North Carolina, USA
| | - Ting Guan
- University of North Carolina at Chapel Hill, School of Social Work, Chapel Hill, North Carolina, USA
| | - Peiran Guo
- University of North Carolina at Chapel Hill, School of Nursing, Chapel Hill, North Carolina, USA
| | - Shenmeng Xu
- University of North Carolina at Chapel Hill, School of Nursing, Chapel Hill, North Carolina, USA
| | - Ahrang Jung
- University of North Carolina at Chapel Hill, School of Nursing, Chapel Hill, North Carolina, USA
| | - Eno Idiagbonya
- University of North Carolina at Chapel Hill, School of Nursing, Chapel Hill, North Carolina, USA
| | - Fengyu Song
- West Coast University, General Education, Anaheim, California, USA
| | - Erin Elizabeth Kent
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
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Cochrane A, Reid O, Woods S, Gallagher P, Dunne S. Variables associated with distress amongst informal caregivers of people with lung cancer: A systematic review of the literature. Psychooncology 2021; 30:1246-1261. [PMID: 33945184 DOI: 10.1002/pon.5694] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/30/2021] [Accepted: 04/01/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Informal caregivers of people with lung cancer often experience a substantial care burden and associated negative consequences due to the often-contracted course of the disease. The objective of this review was to systematically examine the evidence on the factors associated with lung cancer caregiver distress. METHODS Five databases (MEDLINE, CINAHL, EMBASE, PsychINFO and Web of Science) were searched for studies investigating factors associated with distress amongst caregivers of people with lung cancer. Empirical studies published up to July 2020 were included if they measured distress using a valid and reliable measure and examined its association with at least one other factor, with a sample of 50 or more caregivers. RESULTS Thirty publications describing 27 studies (16 cross-sectional; 6 prospective; 8 intervention) involving 3744 caregivers (primarily spouse or adult child) were included. A narrative synthesis of the findings is presented due to heterogeneity in study design, variables measured and analyses conducted. Patient variables associated with greater distress included: stage of cancer and quality of spousal relationship. Caregiver variables associated with higher distress included: social support, coping strategies and self-efficacy. CONCLUSIONS Several variables were associated with distress amongst lung cancer caregivers. Understanding these variables could inform the development of interventions that will enable caregivers to care effectively while maintaining their own well-being. Screening for distress among caregivers may identify those caregivers who would benefit from early intervention.
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Affiliation(s)
- Andy Cochrane
- School of Psychology, Dublin City University, Dublin 9, Ireland
| | - Olivia Reid
- School of Psychology, Dublin City University, Dublin 9, Ireland
| | - Siobhan Woods
- School of Psychology, Dublin City University, Dublin 9, Ireland
| | | | - Simon Dunne
- School of Psychology, Dublin City University, Dublin 9, Ireland
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Mosher CE, Secinti E, Kroenke K, Helft PR, Turk AA, Loehrer PJ, Sehdev A, Al-Hader AA, Champion VL, Johns SA. Acceptance and commitment therapy for fatigue interference in advanced gastrointestinal cancer and caregiver burden: protocol of a pilot randomized controlled trial. Pilot Feasibility Stud 2021; 7:99. [PMID: 33879253 PMCID: PMC8056101 DOI: 10.1186/s40814-021-00837-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 04/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Fatigue interference with activities, mood, and cognition is one of the most prevalent and bothersome concerns of advanced gastrointestinal (GI) cancer patients. As fatigue interferes with patient functioning, family caregivers often report feeling burdened by increasing responsibilities. Evidence-based interventions jointly addressing cancer patient fatigue interference and caregiver burden are lacking. In pilot studies, acceptance and commitment therapy (ACT) has shown promise for addressing symptom-related suffering in cancer patients. The current pilot trial seeks to test a novel, dyadic ACT intervention for both advanced GI cancer patients with moderate-to-severe fatigue interference and their family caregivers with significant caregiving burden or distress. METHODS A minimum of 40 patient-caregiver dyads will be randomly assigned to either the ACT intervention or an education/support control condition. Dyads in both conditions attend six weekly 50-min telephone sessions. Outcomes are assessed at baseline as well as 2 weeks and 3 months post-intervention. We will evaluate the feasibility, acceptability, and preliminary efficacy of ACT for improving patient fatigue interference and caregiver burden. Secondary outcomes include patient sleep interference and patient and caregiver engagement in daily activities, psychological flexibility, and quality of life. We will also explore the effects of ACT on patient and caregiver physical and mental health service use. DISCUSSION Findings will inform a large-scale trial of intervention efficacy. Results will also lay the groundwork for further novel applications of ACT to symptom interference with functioning and caregiver burden in advanced cancer. TRIAL REGISTRATION ClinicalTrials.gov , NCT04010227 . Registered 8 July 2019.
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Affiliation(s)
- Catherine E. Mosher
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 North Blackford Street, LD 124, Indianapolis, IN 46202 USA
| | - Ekin Secinti
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 North Blackford Street, LD 124, Indianapolis, IN 46202 USA
| | - Kurt Kroenke
- Indiana University School of Medicine, Center for Health Services Research, Regenstrief Institute, 1101 W. 10th Street, Indianapolis, IN 46202 USA
| | - Paul R. Helft
- Indiana University School of Medicine, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indiana Cancer Pavilion, 535 Barnhill Drive, Suite 473, Indianapolis, IN 46202 USA
| | - Anita A. Turk
- Indiana University School of Medicine, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indiana Cancer Pavilion, 535 Barnhill Drive, Suite 473, Indianapolis, IN 46202 USA
| | - Patrick J. Loehrer
- Indiana University School of Medicine, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indiana Cancer Pavilion, 535 Barnhill Drive, Suite 473, Indianapolis, IN 46202 USA
| | - Amikar Sehdev
- Indiana University School of Medicine, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indiana Cancer Pavilion, 535 Barnhill Drive, Suite 473, Indianapolis, IN 46202 USA
| | - Ahmad A. Al-Hader
- Indiana University School of Medicine, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indiana Cancer Pavilion, 535 Barnhill Drive, Suite 473, Indianapolis, IN 46202 USA
| | - Victoria L. Champion
- Indiana University School of Nursing, 1111 Middle Drive, NU 340G, Indianapolis, IN 46202 USA
| | - Shelley A. Johns
- Indiana University School of Medicine, Center for Health Services Research, Regenstrief Institute, 1101 W. 10th Street, Indianapolis, IN 46202 USA
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Reblin M, Ketcher D, McCormick R, Barrios-Monroy V, Sutton SK, Zebrack B, Wells KJ, Sahebjam S, Forsyth P, Byrne MM. A randomized wait-list controlled trial of a social support intervention for caregivers of patients with primary malignant brain tumor. BMC Health Serv Res 2021; 21:360. [PMID: 33865382 PMCID: PMC8052543 DOI: 10.1186/s12913-021-06372-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 04/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Informal family caregivers constitute an important and increasingly demanding role in the cancer healthcare system. This is especially true for caregivers of patients with primary malignant brain tumors based on the rapid progression of disease, including physical and cognitive debilitation. Informal social network resources such as friends and family can provide social support to caregivers, which lowers caregiver burden and improves overall quality of life. However, barriers to obtaining needed social support exist for caregivers. To address this need, our team developed and is assessing a multi-component caregiver support intervention that uses a blend of technology and personal contact to improve caregiver social support. METHODS We are currently conducting a prospective, longitudinal 2-group randomized controlled trial which compares caregivers who receive the intervention to a wait-list control group. Only caregivers directly receive the intervention, but the patient-caregiver dyads are enrolled so we can assess outcomes in both. The 8-week intervention consists of two components: (1) The electronic Social Network Assessment Program, a web-based tool to visualize existing social support resources and provide a tailored list of additional resources; and (2) Caregiver Navigation, including weekly phone sessions with a Caregiver Navigator to address caregiver social support needs. Outcomes are assessed by questionnaires completed by the caregiver (baseline, 4-week, 8-week) and the cancer patient (baseline, and 8-week). At 8 weeks, caregivers in the wait-list condition may opt into the intervention. Our primary outcome is caregiver well-being; we also explore patient well-being and caregiver and patient health care utilization. DISCUSSION This protocol describes a study testing a novel social support intervention that pairs a web-based social network visualization tool and resource list (eSNAP) with personalized caregiver navigation. This intervention is responsive to a family-centered model of care and calls for clinical and research priorities focused on informal caregiving research. TRIAL REGISTRATION clinicaltrials.gov , Registration number: NCT04268979 ; Date of registration: February 10, 2020, retrospectively registered.
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Affiliation(s)
- Maija Reblin
- Department of Health Outcomes & Behavior, Moffitt Cancer Center, 12902 Magnolia Dr, Tampa, FL, 33612, USA.
| | - Dana Ketcher
- Department of Health Outcomes & Behavior, Moffitt Cancer Center, 12902 Magnolia Dr, Tampa, FL, 33612, USA
| | - Rachael McCormick
- Department of Health Outcomes & Behavior, Moffitt Cancer Center, 12902 Magnolia Dr, Tampa, FL, 33612, USA
| | - Veronica Barrios-Monroy
- Department of Health Outcomes & Behavior, Moffitt Cancer Center, 12902 Magnolia Dr, Tampa, FL, 33612, USA
| | - Steven K Sutton
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, FL, USA
| | - Bradley Zebrack
- School of Social Work, University of Michigan, Ann Arbor, MI, USA
| | - Kristen J Wells
- Department of Psychology, San Diego State University, San Diego, CA, USA
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Solmaz Sahebjam
- Department of Neuro-Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Peter Forsyth
- Department of Neuro-Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Margaret M Byrne
- Department of Health Outcomes & Behavior, Moffitt Cancer Center, 12902 Magnolia Dr, Tampa, FL, 33612, USA
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Thomas Hebdon MC, Coombs LA, Reed P, Crane TE, Badger TA. Self-efficacy in caregivers of adults diagnosed with cancer: An integrative review. Eur J Oncol Nurs 2021; 52:101933. [PMID: 33799022 DOI: 10.1016/j.ejon.2021.101933] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 03/03/2021] [Accepted: 03/04/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE Cancer caregivers experience health challenges related to their caregiving role, and self-efficacy can contribute to health outcomes through behavioral, environmental, and personal factors. The purpose of this integrative review was to examine self-efficacy in caregivers of adults diagnosed with cancer, including its association with health factors. METHOD A systematic search of PubMed, CINAHL, and PsychInfo yielded 560 articles. Following duplicate removal, 232 articles were screened for inclusion criteria with 71 articles remaining for final review. RESULTS Studies were generally quantitative (n = 67), with predominantly female (n = 55), White (n = 36) caregivers, between the ages of 45-60 (n = 48). Self-efficacy was significantly associated with quality of life, caregiver function, social support, hope, depression, anxiety, and burden as a predictor, mediator, and outcome. Physical health and social determinants of health (social support and financial well-being) were addressed among fewer studies than mental and emotional health outcomes. CONCLUSIONS Addressing self-efficacy in diverse populations and within physical, mental, and social health contexts will enhance understanding of how self-efficacy impacts caregivers of adults diagnosed with cancer. Nurses and other health care professionals can then effectively address supportive needs of caregivers in the personal, behavioral, and environmental domains.
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Affiliation(s)
| | - Lorinda A Coombs
- University of North Carolina Chapel Hill, School of Nursing, Lineberger Comprehensive Cancer Center, USA.
| | - Pamela Reed
- University of Arizona College of Nursing, 1305 N. Martin Ave., Tucson, AZ, 85721, USA.
| | - Tracy E Crane
- University of North Carolina Chapel Hill, School of Nursing, Lineberger Comprehensive Cancer Center, USA.
| | - Terry A Badger
- University of North Carolina Chapel Hill, School of Nursing, Lineberger Comprehensive Cancer Center, USA.
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Khamboon T, Pakanta I. Intervention for Symptom Cluster Management of Fatigue, Loss of Appetite, and Anxiety among Patients with Lung Cancer undergoing Chemotherapy. Asia Pac J Oncol Nurs 2021; 8:267-275. [PMID: 33850960 PMCID: PMC8030596 DOI: 10.4103/2347-5625.311003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 12/17/2020] [Indexed: 12/02/2022] Open
Abstract
Objective: Patients with lung cancer can experience various distressing symptoms. The present study aims to use symptom cluster management intervention based on symptom management theory to moderate the severity of symptom clusters, including fatigue, loss of appetite, and anxiety, in patients with lung cancer undergoing chemotherapy. Methods: A quasi-experimental study was conducted using historical controls to assess and compare the effect of a novel symptom cluster management intervention on the severity of fatigue, loss of appetite, and anxiety in patients with lung cancer undergoing chemotherapy. Lung cancer patients were recruited from an outpatient chemotherapy unit at a university hospital in Thailand. Eighty participants were assigned equally to the experimental and control groups. The study outcomes, including fatigue, loss of appetite, and anxiety, were assessed with the Edmonton Symptom Assessment System at baseline and days 7, 14, and 28 postintervention. Repeated-measures ANOVA was analyzed to determine mean differences between groups across time. Results: Overall, anxiety decreased gradually on days 7, 14, and 28 (P < 0.001 for all time points) in the experimental group. Fatigue and loss of appetite also declined after days 14 (P < 0.001) and 28 (P < 0.001) compared to baseline. The significant effects of the interaction terms time × group (P < 0.001) for all symptoms within the cluster indicate the benefit of the intervention over time. Conclusions: The pattern of changes in the symptom cluster across the study period was significantly different between the two study groups. Patients in the experimental group reported an improvement in fatigue, loss of appetite, and anxiety over time after receiving the intervention. The results suggested that the symptom cluster management intervention provided a promising approach for the simultaneous treatment of multiple symptoms within a cluster.
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Affiliation(s)
- Thidarat Khamboon
- Department of Nursing, Faculty of Nursing, Naresuan University, Phitsanulok, Thailand
| | - Intira Pakanta
- Department of Nursing, Faculty of Nursing, Naresuan University, Phitsanulok, Thailand
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Su Z, McDonnell D, Liang B, Kue J, Li X, Šegalo S, Advani S, Flores BE, Wang J. Technology-based health solutions for cancer caregivers to better shoulder the impact of COVID-19: a systematic review protocol. Syst Rev 2021; 10:43. [PMID: 33526095 PMCID: PMC7849615 DOI: 10.1186/s13643-021-01592-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 01/15/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Cancer patients are particularly vulnerable to COVID-19, partially owing to their compromised immune systems and curbed or cut cancer healthcare services caused by the pandemic. As a result, cancer caregivers may have to shoulder triple crises: the COVID-19 pandemic, pronounced healthcare needs from the patient, and elevated need for care from within. While technology-based health interventions have the potential to address unique challenges cancer caregivers face amid COVID-19, limited insights are available. Thus, to bridge this gap, we aim to identify technology-based interventions designed for cancer caregivers and report the characteristics and effects of these interventions concerning cancer caregivers' distinctive challenges amid COVID-19. METHODS A systematic search of the literature will be conducted in PubMed, PsycINFO, CINAHL, and Scopus from the database inception to the end of March 2021. Articles that center on technology-based interventions for cancer caregivers will be included in the review. The search strategy will be developed in consultation with an academic librarian who is experienced in systematic review studies. Titles, abstracts, and full-text articles will be screened against eligibility criteria developed a priori. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses procedures will be followed for the reporting process. CONCLUSIONS COVID-19 has upended cancer care as we know it. Findings of this study can shed light on evidence-based and practical solutions cancer caregivers can utilize to mitigate the unique challenges they face amid COVID-19. Furthermore, results of this study will also offer valuable insights for researchers who aim to develop interventions for cancer caregivers in the context of COVID-19. In addition, we also expect to be able to identify areas for improvement that need to be addressed in order for health experts to more adequately help cancer caregivers weather the storm of global health crises like COVID-19 and beyond. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42020196301.
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Affiliation(s)
- Zhaohui Su
- School of Nursing, Center on Smart and Connected Health Technologies, Mays Cancer Center, UT Health San Antonio, San Antonio, TX 78229 USA
| | - Dean McDonnell
- Department of Humanities, Institute of Technology Carlow, Carlow, R93 V960, Ireland
| | - Bin Liang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 10010 China
| | - Jennifer Kue
- School of Nursing, Ohio State University, Columbus, USA
| | - Xiaoshan Li
- Program of Public Relations and Advertising, Beijing Normal University-Hong Kong Baptist University United International College, Zhuhai, China
| | - Sabina Šegalo
- Department of Microbiology, Faculty of Medicine, University of Sarajevo, 71000 Sarajevo, Bosnia and Herzegovina
| | - Shailesh Advani
- Terasaki Institute of Biomedical Innovation, Los Angeles, CA 21100 USA
| | - Bertha E. Flores
- School of Nursing, UT Health San Antonio, San Antonio, TX 78229 USA
| | - Jing Wang
- School of Nursing, Center on Smart and Connected Health Technologies, Mays Cancer Center, UT Health San Antonio, San Antonio, TX 78229 USA
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30
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Su Z, McDonnell D, Liang B, Kue J, Li X, Šegalo S, Advani S, Flores BE, Wang J. Technology-based Health Solutions for Cancer Caregivers to Better Shoulder the Impact of COVID-19: A Systematic Review Protocol. RESEARCH SQUARE 2021:rs.3.rs-66218. [PMID: 32908975 PMCID: PMC7480034 DOI: 10.21203/rs.3.rs-66218/v1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Cancer patients are particularly vulnerable to COVID-19, partially owing to their compromised immune systems and curbed or cut cancer healthcare services caused by the pandemic. As a result, cancer caregivers may have to shoulder triple crises: the COVID-19 pandemic, pronounced healthcare needs from the patient, and elevated need for care from within. While technology-based health interventions have the potential to address unique challenges cancer caregivers face amid COVID-19, limited insights are available. Thus, to bridge this gap, we aim to identify technology-based interventions designed for cancer caregivers and report the characteristics and effects of these interventions concerning cancer caregivers' distinctive challenges amid COVID-19. METHODS A systematic search of the literature will be conducted in PubMed, PsycINFO, CINAHL, and Scopus from the database inception to the end of March, 2021. Articles that center on technology-based interventions for cancer caregivers will be included in the review. The search strategy will be developed in consultation with an academic librarian who is experienced in systematic review studies. Titles, abstracts, and full-text articles will be screened against eligibility criteria developed a priori. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses procedures will be followed for the reporting process. CONCLUSIONS COVID-19 has upended cancer care as we know it. Findings of this study can shed light on evidence-based and practical solutions cancer caregivers can utilize to mitigate the unique challenges they face amid COVID-19. Furthermore, results of this study will also offer valuable insights for researchers who aim to develop interventions for cancer caregivers in the context of COVID-19. In addition, we also expect to be able to identify areas for improvement that need to be addressed in order for health experts to more adequately help cancer caregivers weather the storm of global health crises like COVID-19 and beyond. STUDY PROTOCOL REGISTRATION PROSPERO CRD42020196301.
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Affiliation(s)
- Zhaohui Su
- University of Texas Health Science Center at San Antonio
| | | | - Bin Liang
- Chinese Academy of Medical Sciences and Peking Union Medical College
| | | | - Xiaoshan Li
- Beijing Normal University-Hong Kong Baptist University United International College
| | | | | | | | - Jing Wang
- University of Texas Health Science Center at San Antonio
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Beks H, King O, Clapham R, Alston L, Glenister K, McKinstry C, Quilliam C, Wellwood I, Williams C, Wong Shee A. Community health programs delivered through information and communications technology in high-income countries: a scoping review (Preprint). J Med Internet Res 2020; 24:e26515. [PMID: 35262498 PMCID: PMC8943572 DOI: 10.2196/26515] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 04/15/2021] [Accepted: 11/18/2021] [Indexed: 11/13/2022] Open
Abstract
Background The COVID-19 pandemic has required widespread and rapid adoption of information and communications technology (ICT) platforms by health professionals. Transitioning health programs from face-to-face to remote delivery using ICT platforms has introduced new challenges. Objective The objective of this review is to scope for ICT-delivered health programs implemented within the community health setting in high-income countries and rapidly disseminate findings to health professionals. Methods The Joanna Briggs Institute’s scoping review methodology guided the review of the literature. Results The search retrieved 7110 unique citations. Each title and abstract was screened by at least two reviewers, resulting in 399 citations for full-text review. Of these 399 citations, 72 (18%) were included. An additional 27 citations were identified through reviewing the reference lists of the included studies, resulting in 99 citations. Citations examined 83 ICT-delivered programs from 19 high-income countries. Variations in program design, ICT platforms, research design, and outcomes were evident. Conclusions Included programs and research were heterogeneous, addressing prevalent chronic diseases. Evidence was retrieved for the effectiveness of nurse and allied health ICT-delivered programs. Findings indicated that outcomes for participants receiving ICT-delivered programs, when compared with participants receiving in-person programs, were either equivalent or better. Gaps included a paucity of co-designed programs, qualitative research around group programs, programs for patients and carers, and evaluation of cost-effectiveness. During COVID-19 and beyond, health professionals in the community health setting are encouraged to build on existing knowledge and address evidence gaps by developing and evaluating innovative ICT-delivered programs in collaboration with consumers and carers.
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Affiliation(s)
- Hannah Beks
- School of Medicine, Deakin University, Geelong, Australia
| | | | - Renee Clapham
- St Vincents Health Australia, Melbourne, Australia
- Ballarat Health Services, Ballarat, Australia
| | - Laura Alston
- School of Medicine, Deakin University, Geelong, Australia
- Colac Area Health, Colac, Australia
- Global Obesity Centre, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Kristen Glenister
- Department of Rural Health, University of Melbourne, Wangaratta, Australia
- Department of Rural Health, University of Melbourne, Shepparton, Australia
| | - Carol McKinstry
- La Trobe Rural Health School, La Trobe University, Bendigo, Australia
| | - Claire Quilliam
- Department of Rural Health, University of Melbourne, Wangaratta, Australia
| | - Ian Wellwood
- Faculty of Health Sciences, Australian Catholic University, Ballarat, Australia
| | | | - Anna Wong Shee
- School of Medicine, Deakin University, Geelong, Australia
- Ballarat Health Services, Ballarat, Australia
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Mosher CE, Krueger E, Hirsh AT, Miller KD, Ballinger TJ, Storniolo AM, Schneider BP, Newton EV, Champion VL, Johns SA. Protocol of a randomized trial of acceptance and commitment therapy for fatigue interference in metastatic breast cancer. Contemp Clin Trials 2020; 98:106168. [PMID: 33038501 DOI: 10.1016/j.cct.2020.106168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 10/01/2020] [Accepted: 10/04/2020] [Indexed: 11/28/2022]
Abstract
Fatigue interference with activities, mood, and cognition is one of the most prevalent and distressing concerns of metastatic breast cancer patients. To date, there are no evidence-based interventions for reducing fatigue interference in metastatic breast cancer and other advanced cancer populations. In pilot studies, Acceptance and Commitment Therapy (ACT) has shown potential for reducing symptom-related suffering in cancer patients. The current Phase II trial seeks to more definitively examine the efficacy of telephone-based ACT for women with metastatic breast cancer who are experiencing fatigue interference. In this trial, 250 women are randomly assigned to either the ACT intervention or an education/support control condition. Women in both conditions attend six weekly 50-min telephone sessions. The primary aim of this study is to test the effect of telephone-based ACT on fatigue interference. Secondary outcomes include sleep interference, engagement in daily activities, and quality of life. Outcomes are assessed at baseline, 2 weeks post-intervention, and 3 and 6 months post-intervention. This trial also examines whether increases in psychological flexibility, defined as full awareness of the present moment while persisting in behaviors aligned with personal values, account for the beneficial effect of ACT on fatigue interference. After demonstrating ACT's efficacy, the intervention can be widely disseminated to clinicians who care for metastatic breast cancer patients. Our findings will also inform future ACT trials with various cancer populations and functional outcomes.
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Affiliation(s)
- Catherine E Mosher
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 North Blackford Street, LD 124, Indianapolis, IN 46202, USA.
| | - Ellen Krueger
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 North Blackford Street, LD 124, Indianapolis, IN 46202, USA.
| | - Adam T Hirsh
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 North Blackford Street, LD 124, Indianapolis, IN 46202, USA.
| | - Kathy D Miller
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indiana Cancer Pavilion, 535 Barnhill Drive, Suite 473, Indianapolis, IN 46202, USA.
| | - Tarah J Ballinger
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indiana Cancer Pavilion, 535 Barnhill Drive, Suite 473, Indianapolis, IN 46202, USA.
| | - Anna Maria Storniolo
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indiana Cancer Pavilion, 535 Barnhill Drive, Suite 473, Indianapolis, IN 46202, USA.
| | - Bryan P Schneider
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indiana Cancer Pavilion, 535 Barnhill Drive, Suite 473, Indianapolis, IN 46202, USA.
| | - Erin V Newton
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indiana Cancer Pavilion, 535 Barnhill Drive, Suite 473, Indianapolis, IN 46202, USA.
| | - Victoria L Champion
- Indiana University School of Nursing, 1111 Middle Drive, NU 340G, Indianapolis, IN 46202, USA.
| | - Shelley A Johns
- Indiana University School of Medicine, Center for Health Services Research, Regenstrief Institute, 1101 W. 10(th) Street, Indianapolis, IN 46202, USA.
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Pang L, Liu Z, Lin S, Liu Z, Liu H, Mai Z, Liu Z, Chen C, Zhao Q. The effects of telemedicine on the quality of life of patients with lung cancer: a systematic review and meta-analysis. Ther Adv Chronic Dis 2020; 11:2040622320961597. [PMID: 33101621 PMCID: PMC7549184 DOI: 10.1177/2040622320961597] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 09/01/2020] [Indexed: 12/20/2022] Open
Abstract
Background and aims: Lung cancer patients suffer from deterioration in their physical and
psychological function, which exerts a negative influence on their quality
of life (QOL). Telemedicine has been proven to be an effective intervention
for patients with several chronic diseases. The aim of this systematic
review and meta-analysis was to investigate the efficacy of telemedicine in
improving QOL in lung cancer patients. Methods: PubMed, Cochrane Library, EMBASE, Web of Science and Scopus databases were
searched for randomized controlled trials that investigated the
effectiveness of telemedicine in lung cancer patients. Review Manager 5.3
and Stata 15.1 were used to perform data analysis. Results: Our meta-analysis included eight clinical trials with a total of 635 lung
cancer patients. The results showed that the telemedicine group had
significantly higher QOL than the usual care group [standard mean difference
(SMD) 0.96, 95% confidence interval (CI) 0.29–1.63,
I2 = 91%]. In addition, the telemedicine
group had lower anxiety (SMD −0.44, 95% CI −0.66 to −0.23,
I2 = 3%) and depression scores (SMD −0.48,
95% CI −0.91 to −0.05, I2 = 66%) than the usual
care group. However, no significant differences were found in fatigue and
pain outcomes between the two groups. Conclusion: Telemedicine may be an effective method of improving QOL in lung cancer
patients and the further development and use of telemedicine care is
recommended.
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Affiliation(s)
- Lanlan Pang
- Department of Intensive Care Unit, Sun Yat-sen University Cancer Centre, State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangzhou, China
| | - Zefu Liu
- Department of Urology, Sun Yat-sen University Cancer Centre, State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangzhou, China
| | - Sheng Lin
- Department of pulmonary and critical care medicine, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, Fujian, China
| | - Zhidong Liu
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Hengyu Liu
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Zihang Mai
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Zhuowei Liu
- Department of Urology, Sun Yat-sen University Cancer Centre, State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangzhou, China
| | - Chongxiang Chen
- Department of Intensive Care Unit, Sun Yat-sen University Cancer Centre, State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Dongfeng East Road 651, Guangzhou 510060, China
| | - Qingyu Zhao
- Department of Intensive Care Unit, Sun Yat-sen University Cancer Centre, State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangzhou 510060, China
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Kochovska S, Ferreira DH, Luckett T, Phillips JL, Currow DC. Earlier multidisciplinary palliative care intervention for people with lung cancer: a systematic review and meta-analysis. Transl Lung Cancer Res 2020; 9:1699-1709. [PMID: 32953543 PMCID: PMC7481603 DOI: 10.21037/tlcr.2019.12.18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Lung cancer is the most common cancer and leading cause of cancer mortality globally. Lung cancer is associated with significant morbidity, with symptoms often being poorly managed, causing significant symptom burden for both patients and their family caregivers. In people with life-limiting illnesses including advanced cancer, palliative care has been effective in improving symptom control, physical and mental wellbeing, quality of life, and survivorship; with benefits extending to caregivers while in the role and subsequently. Earlier integration of palliative care within oncology may be associated with improved patient outcomes, and has been supported by two Lancet commissions and national guidelines. The evidence for its effectiveness, however, has been mixed across the cancer spectrum. The aim of this review was to evaluate the current evidence for the effectiveness of early integrated palliative care in improving outcomes for people with lung cancer and their caregivers. Meta-analyses were performed where studies used the same measure. Otherwise, synthesis used a narrative approach. Similar to other types of advanced cancer, this review reveals mixed evidence for the effectiveness of early referral to palliative care and for the effectiveness of individual palliative interventions for people with lung cancer and their caregivers. Evidence that on-demand palliative care is equally, if not more effective than palliative care that is routinely provided, raises the question whether initiation and provision of palliative care as part of multidisciplinary lung cancer care ought to be guided by an early referral or need-based referral. Better understanding of what constitutes palliative care when delivered to people with lung cancer and their caregivers will help delineate the correlation with reported outcomes for these populations.
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Affiliation(s)
- Slavica Kochovska
- IMPACCT, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Diana H Ferreira
- Discipline Palliative and Supportive Services, Flinders University, Adelaide, SA, Australia
| | - Tim Luckett
- IMPACCT, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Jane L Phillips
- IMPACCT, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - David C Currow
- IMPACCT, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia.,Wolfson Palliative Care Research Centre, University of Hull, Hull, UK
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Milbury K, Li Y, Durrani S, Liao Z, Tsao AS, Carmack C, Cohen L, Bruera E. A Mindfulness-Based Intervention as a Supportive Care Strategy for Patients with Metastatic Non-Small Cell Lung Cancer and Their Spouses: Results of a Three-Arm Pilot Randomized Controlled Trial. Oncologist 2020; 25:e1794-e1802. [PMID: 32621630 DOI: 10.1634/theoncologist.2020-0125] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 06/12/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Although mindfulness-based interventions have been widely examined in patients with nonmetastatic cancer, the feasibility and efficacy of these types of programs are largely unknown for those with advanced disease. We pilot-tested a couple-based meditation (CBM) relative to a supportive-expressive (SE) and a usual care (UC) arm targeting psychospiritual distress in patients with metastatic lung cancer and their spousal caregivers. PATIENTS AND METHODS Seventy-five patient-caregiver dyads completed baseline self-report measures and were then randomized to one of the three arms. Couples in the CBM and SE groups attended four 60-minute sessions that were delivered via videoconference. All dyads were reassessed 1 and 3 months later. RESULTS A priori feasibility benchmarks were met. Although attendance was high in both groups, dyads in the CBM group indicated greater benefit of the sessions than those in the SE group (patients, CBM mean = 2.63, SE mean = 2.20, p = .003; spouses, CBM mean = 2.71, SE mean = 2.00, p = .005). Compared with the UC group, patients in the CBM group reported significantly lower depressive symptoms (p = .05; d = 0.53) and marginally reduced cancer-related stress (p = .07; d = 0.68). Medium effect sizes in favor of the CBM compared with the SE group for depressive symptoms (d = 0.59) and cancer-related stress (d = 0.54) were found. Spouses in the CBM group reported significantly lower depressive symptoms (p < .01; d = 0.74) compared with those in the UC group. CONCLUSION It seems feasible and possibly efficacious to deliver dyadic interventions via videoconference to couples coping with metastatic lung cancer. Mindfulness-based interventions may be of value to managing psychological symptoms in the palliative care setting. Clinical trial identification number. NCT02596490 IMPLICATIONS FOR PRACTICE: The current randomized controlled trial has established that a mindfulness approach to the management of patients' and spouses' psychospiritual concerns is acceptable and subjectively deemed more beneficial than a supportive-expressive treatment for patients with metastatic non-small cell lung cancer (NSCLC). We also revealed that videoconference delivery, here FaceTime, is an acceptable approach even for geriatric patients with metastatic NSCLC and that patients and their spousal caregivers prefer a dyadic delivery of this type of supportive care strategy. Lastly, this trial has laid the foundation for the role of mindfulness-based interventions in the palliative care setting supporting patients with advanced NSCLC and their spousal caregivers.
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Affiliation(s)
- Kathrin Milbury
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Yisheng Li
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sania Durrani
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Zhongxing Liao
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Anne S Tsao
- Department of Head and Neck/Thoracic Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Cindy Carmack
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Lorenzo Cohen
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Ream E, Hughes AE, Cox A, Skarparis K, Richardson A, Pedersen VH, Wiseman T, Forbes A, Bryant A. Telephone interventions for symptom management in adults with cancer. Cochrane Database Syst Rev 2020; 6:CD007568. [PMID: 32483832 PMCID: PMC7264015 DOI: 10.1002/14651858.cd007568.pub2] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND People with cancer experience a variety of symptoms as a result of their disease and the therapies involved in its management. Inadequate symptom management has implications for patient outcomes including functioning, psychological well-being, and quality of life (QoL). Attempts to reduce the incidence and severity of cancer symptoms have involved the development and testing of psycho-educational interventions to enhance patients' symptom self-management. With the trend for care to be provided nearer patients' homes, telephone-delivered psycho-educational interventions have evolved to provide support for the management of a range of cancer symptoms. Early indications suggest that these can reduce symptom severity and distress through enhanced symptom self-management. OBJECTIVES To assess the effectiveness of telephone-delivered interventions for reducing symptoms associated with cancer and its treatment. To determine which symptoms are most responsive to telephone interventions. To determine whether certain configurations (e.g. with/without additional support such as face-to-face, printed or electronic resources) and duration/frequency of intervention calls mediate observed cancer symptom outcome effects. SEARCH METHODS We searched the following databases: the Cochrane Central Register of Controlled Trials (CENTRAL; 2019, Issue 1); MEDLINE via OVID (1946 to January 2019); Embase via OVID (1980 to January 2019); (CINAHL) via Athens (1982 to January 2019); British Nursing Index (1984 to January 2019); and PsycINFO (1989 to January 2019). We searched conference proceedings to identify published abstracts, as well as SIGLE and trial registers for unpublished studies. We searched the reference lists of all included articles for additional relevant studies. Finally, we handsearched the following journals: Cancer, Journal of Clinical Oncology, Psycho-oncology, Cancer Practice, Cancer Nursing, Oncology Nursing Forum, Journal of Pain and Symptom Management, and Palliative Medicine. We restricted our search to publications published in English. SELECTION CRITERIA We included randomised controlled trials (RCTs) and quasi-RCTs that compared one or more telephone interventions with one other, or with other types of interventions (e.g. a face-to-face intervention) and/or usual care, with the stated aim of addressing any physical or psychological symptoms of cancer and its treatment, which recruited adults (over 18 years) with a clinical diagnosis of cancer, regardless of tumour type, stage of cancer, type of treatment, and time of recruitment (e.g. before, during, or after treatment). DATA COLLECTION AND ANALYSIS We used Cochrane methods for trial selection, data extraction and analysis. When possible, anxiety, depressive symptoms, fatigue, emotional distress, pain, uncertainty, sexually-related and lung cancer symptoms as well as secondary outcomes are reported as standardised mean differences (SMDs) with 95% confidence intervals (CIs), and we presented a descriptive synthesis of study findings. We reported on findings according to symptoms addressed and intervention types (e.g. telephone only, telephone combined with other elements). As many studies included small samples, and because baseline scores for study outcomes often varied for intervention and control groups, we used change scores and associated standard deviations. The certainty of the evidence for each outcome was interpreted using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. MAIN RESULTS Thirty-two studies were eligible for inclusion; most had moderate risk of bias,often related to blinding. Collectively, researchers recruited 6250 people and studied interventions in people with a variety of cancer types and across the disease trajectory, although many participants had breast cancer or early-stage cancer and/or were starting treatment. Studies measured symptoms of anxiety, depression, emotional distress, uncertainty, fatigue, and pain, as well as sexually-related symptoms and general symptom intensity and/or distress. Interventions were primarily delivered by nurses (n = 24), most of whom (n = 16) had a background in oncology, research, or psychiatry. Ten interventions were delivered solely by telephone; the rest combined telephone with additional elements (i.e. face-to-face consultations and digital/online/printed resources). The number of calls delivered ranged from 1 to 18; most interventions provided three or four calls. Twenty-one studies provided evidence on effectiveness of telephone-delivered interventions and the majority appeared to reduce symptoms of depression compared to control. Nine studies contributed quantitative change scores (CSs) and associated standard deviation results (or these could be calculated). Likewise, many telephone interventions appeared effective when compared to control in reducing anxiety (16 studies; 5 contributed quantitative CS results); fatigue (9 studies; 6 contributed to quantitative CS results); and emotional distress (7 studies; 5 contributed quantitative CS results). Due to significant clinical heterogeneity with regards to interventions introduced, study participants recruited, and outcomes measured, meta-analysis was not conducted. For other symptoms (uncertainty, pain, sexually-related symptoms, dyspnoea, and general symptom experience), evidence was limited; similarly meta-analysis was not possible, and results from individual studies were largely conflicting, making conclusions about their management through telephone-delivered interventions difficult to draw. Heterogeneity was considerable across all trials for all outcomes. Overall, the certainty of evidence was very low for all outcomes in the review. Outcomes were all downgraded due to concerns about overall risk of bias profiles being frequently unclear, uncertainty in effect estimates and due to some inconsistencies in results and general heterogeneity. Unsubstantiated evidence suggests that telephone interventions in some capacity may have a place in symptom management for adults with cancer. However, in the absence of reliable and homogeneous evidence, caution is needed in interpreting the narrative synthesis. Further, there were no clear patterns across studies regarding which forms of interventions (telephone alone versus augmented with other elements) are most effective. It is impossible to conclude with any certainty which forms of telephone intervention are most effective in managing the range of cancer-related symptoms that people with cancer experience. AUTHORS' CONCLUSIONS Telephone interventions provide a convenient way of supporting self-management of cancer-related symptoms for adults with cancer. These interventions are becoming more important with the shift of care closer to patients' homes, the need for resource/cost containment, and the potential for voluntary sector providers to deliver healthcare interventions. Some evidence supports the use of telephone-delivered interventions for symptom management for adults with cancer; most evidence relates to four commonly experienced symptoms - depression, anxiety, emotional distress, and fatigue. Some telephone-delivered interventions were augmented by combining them with face-to-face meetings and provision of printed or digital materials. Review authors were unable to determine whether telephone alone or in combination with other elements provides optimal reduction in symptoms; it appears most likely that this will vary by symptom. It is noteworthy that, despite the potential for telephone interventions to deliver cost savings, none of the studies reviewed included any form of health economic evaluation. Further robust and adequately reported trials are needed across all cancer-related symptoms, as the certainty of evidence generated in studies within this review was very low, and reporting was of variable quality. Researchers must strive to reduce variability between studies in the future. Studies in this review are characterised by clinical and methodological diversity; the level of this diversity hindered comparison across studies. At the very least, efforts should be made to standardise outcome measures. Finally, studies were compromised by inclusion of small samples, inadequate concealment of group allocation, lack of observer blinding, and short length of follow-up. Consequently, conclusions related to symptoms most amenable to management by telephone-delivered interventions are tentative.
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Affiliation(s)
- Emma Ream
- School of Health Sciences, University of Surrey, Guildford, UK
| | | | - Anna Cox
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Katy Skarparis
- Department of Nursing, Midwifery & Health, Northumbria University, Newcastle, UK
| | - Alison Richardson
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Vibe H Pedersen
- Florence Nightingale School of Nursing and Midwifery, King's College London, London, UK
| | - Theresa Wiseman
- Health Services Research, The Royal Marsden NHS Foundation Trust, London, UK
| | - Angus Forbes
- Florence Nightingale School of Nursing and Midwifery, King's College London, London, UK
| | - Andrew Bryant
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
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Penagos Castro RV, Vargas Escobar LM. Efectividad de una intervención de enfermería para modificar la autoeficacia y la sobrecarga del cuidador del paciente hemato- oncológico. REVISTA CUIDARTE 2020. [DOI: 10.15649/cuidarte.867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introducción: El paciente hemato-oncológico va a requerir de un cuidador que lo ayude en el control de síntomas físicos, terapéuticas prescritas, apoyo emocional, entre otros. El cuidador debe prepararse, fortalecer su confianza y motivación a través de la autoeficacia de su rol ya que, si se siente eficaz para cuidar, podrá desarrollar su rol adecuadamente, disminuyendo las posibilidades de presentar sobrecarga. Materiales y Métodos: Estudio cuantitativo, cuasi experimental, con dos grupos, pre y pos prueba. El objetivo fue establecer la efectividad de una intervención de enfermería al compararla con la intervención estándar, en la modificación de la autoeficacia y la sobrecarga del rol de cuidador del paciente hemato-oncológico. Para la medición se usó la Escala General de Autoeficacia y la Escala de Zarit. Resultados: La intervención es efectiva para modificar la autoeficacia del cuidador, lo cual se evidencia en la comparación entre el grupo control y experimental posterior a la intervención pasando de 25,8 a 29,8 (p=0.00) en la escala de autoeficacia, así como al interior del grupo experimental pasando de 25,5 a 26,3 (p=0.00). No se observaron diferencias significativas respecto a la sobrecarga del rol de cuidador del paciente hemato-oncológico posterior a la intervención. Discusión: Se aporta una intervención efectiva desde la teoría de enfermería de Resnick para la práctica. Se requieren nuevos estudios que comprueben la efectividad de la intervención en otros contextos. Conclusiones: Las intervenciones educativas de enfermería con enfoque motivacional, son relevantes en la práctica y la investigación, para modificar la autoeficacia del cuidador del paciente hemato-oncológico.
Como citar este artículo: Penagos Castro Rodmar Vanessa, Vargas-Escobar Lina María. Efectividad de una intervención de enfermería para modificar la autoeficacia y la sobrecarga del cuidador del paciente hemato- oncológico. Revista Cuidarte. 2020; 11(2): e867. http://dx.doi.org/10.15649/cuidarte.867
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Jadalla A, Ginex P, Coleman M, Vrabel M, Bevans M. Family Caregiver Strain and Burden: A Systematic Review of Evidence-Based Interventions When Caring for Patients With Cancer. Clin J Oncol Nurs 2020; 24:31-50. [DOI: 10.1188/20.cjon.31-50] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Li Y, Ling L, Zhanyu P. Effect of Wellness Education on Quality of Life of Patients With Non-Small Cell Lung Cancer Treated With First-Line Icotinib and on Their Family Caregivers. Integr Cancer Ther 2019; 18:1534735419842373. [PMID: 31043093 PMCID: PMC6498762 DOI: 10.1177/1534735419842373] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Objective: To examine the effects of a wellness-education intervention on quality of life (QOL) of patients with NSCLC treated with icotinib and on their caregivers. Methods: This feasibility study was a prospective pilot randomized controlled trial to evaluate a wellness-education intervention in NSCLC patients and caregivers undergoing icotinib treatment. The participants in the wellness-education group were provided with well-being information over 8 weeks. The Family Environment Scale (FES), Functional Assessment of Cancer Therapy–Lung (FACT-L), Caregiver QOL Index–Cancer Scale (CQOLC), and Hospital Anxiety and Depression Scale (HADS) were measured at baseline prior to randomization and after 8 weeks. Patients completed the FACT-L and HADS, caregivers completed the CQOLC and FES. Results: 67 patients/caregivers in the wellness-education group and 71 in the control group could be analyzed. Feasibility targets were the following: (1) >70% study enrollment of eligible patients; (2) >90% of participants completing this study; (3) <10% missing data. Wellness-education group had better change scores at 8 weeks for the emotional well-being subscale of FACT-L (12.8 vs 15.6, P = .014), anxiety subscale of HADS (6.1 vs 6.7, P = .030), adaptation (66.0 vs 54.7, P = .037) and financial subscales of CQOLC (70.8 vs 69.8, P = .044), and the cohesion (7.3 ± 1.8 vs 5.7 ± 1.7, P= .021) and conflict (3.4 ± 1.9 vs 4.5 ± 1.7, P = .031) subscales of the FES. Conclusion: Wellness-education in patients/caregivers with NSCLC treated with icotinib are feasible and could improve patients’ QOL and their relationship with caregivers.
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Affiliation(s)
- Yanwei Li
- 1 Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Li Ling
- 1 Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Pan Zhanyu
- 1 Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
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Kedia SK, Collins A, Dillon PJ, Akkus C, Ward KD, Jackson BM. Psychosocial interventions for informal caregivers of lung cancer patients: A systematic review. Psychooncology 2019; 29:251-262. [DOI: 10.1002/pon.5271] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 10/19/2019] [Accepted: 10/20/2019] [Indexed: 01/08/2023]
Affiliation(s)
- Satish K. Kedia
- Division of Social and Behavioral Sciences, School of Public Health University of Memphis Memphis Tennessee
| | - Andy Collins
- Division of Social and Behavioral Sciences, School of Public Health University of Memphis Memphis Tennessee
| | - Patrick J. Dillon
- School of Communication Studies Kent State University at Stark North Canton Ohio
| | - Cem Akkus
- Division of Social and Behavioral Sciences, School of Public Health University of Memphis Memphis Tennessee
| | - Kenneth D. Ward
- Division of Social and Behavioral Sciences, School of Public Health University of Memphis Memphis Tennessee
| | - Bianca M. Jackson
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis Tennessee
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Mosher CE, Secinti E, Hirsh AT, Hanna N, Einhorn LH, Jalal SI, Durm G, Champion VL, Johns SA. Acceptance and Commitment Therapy for Symptom Interference in Advanced Lung Cancer and Caregiver Distress: A Pilot Randomized Trial. J Pain Symptom Manage 2019; 58:632-644. [PMID: 31255586 PMCID: PMC6754796 DOI: 10.1016/j.jpainsymman.2019.06.021] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 06/20/2019] [Accepted: 06/21/2019] [Indexed: 11/24/2022]
Abstract
CONTEXT Advanced lung cancer patients typically have a poor prognosis and many symptoms that interfere with functioning, contributing to high rates of emotional distress in both patients and family caregivers. There remains a need for evidence-based interventions to improve functional outcomes and distress in this population. OBJECTIVES This pilot trial examined the feasibility and preliminary efficacy of telephone-based Acceptance and Commitment Therapy (ACT) for symptomatic, advanced lung cancer patients and their distressed family caregivers. Primary outcomes were patient symptom interference with functioning and patient and caregiver distress. METHODS Symptomatic, advanced lung cancer patients and distressed caregivers (n = 50 dyads) were randomly assigned to six sessions of ACT or an education/support condition. Patients completed measures of symptom interference and measures assessing the severity of fatigue, pain, sleep disturbance, and breathlessness. Patients and caregivers completed measures of distress and illness acceptance and struggle. RESULTS The eligibility screening rate (51%) and retention rate (76% at six weeks postintervention) demonstrated feasibility. No group differences were found with respect to patient and caregiver outcomes. Both groups showed a small, significant decrease in struggle with the illness over the study period, but did not show meaningful change in other outcomes. CONCLUSION Findings suggest that telephone-based ACT is feasible for many advanced lung cancer patients and caregivers, but may not substantially reduce symptom interference and distress. Low baseline levels of certain symptoms may have contributed to null findings. Next steps include applying ACT to specific, clinically meaningful symptom interference and varying intervention dose and modality.
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Affiliation(s)
- Catherine E Mosher
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA.
| | - Ekin Secinti
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA
| | - Adam T Hirsh
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA
| | - Nasser Hanna
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Lawrence H Einhorn
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Shadia I Jalal
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA; Richard L. Roudebush VAMC, Indianapolis, Indiana, USA
| | - Gregory Durm
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | | - Shelley A Johns
- Indiana University School of Medicine, Center for Health Services Research, Regenstrief Institute, Indianapolis, Indiana, USA
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Nightingale CL, Steffen LE, Tooze JA, Petty W, Danhauer SC, Badr H, Weaver KE. Lung Cancer Patient and Caregiver Health Vulnerabilities and Interest in Health Promotion Interventions: An Exploratory Study. Glob Adv Health Med 2019; 8:2164956119865160. [PMID: 31360617 PMCID: PMC6637827 DOI: 10.1177/2164956119865160] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 06/14/2019] [Accepted: 06/28/2019] [Indexed: 12/20/2022] Open
Abstract
Introduction Lung cancer patients and their caregivers are at risk for negative health behaviors and poor psychosocial functioning, but few interventions exist that target this population. To inform intervention development, we explored potential targets and interest and concordance in health promotion interventions among lung cancer patients and their caregivers. Methods Lung cancer patients (n = 18) with a smoking history and their caregivers (n = 15) participated in a cross-sectional, observational survey study (an average of 1 month postdiagnosis) to assess health behaviors, psychosocial functioning, and interest in health promotion interventions. Fisher’s exact and Wilcoxon rank-sum tests examined factors associated with intervention interest. McNemar’s test examined concordance in interest. Results Many caregivers (40%) reported providing care at least 4 days per week, and over half (53.3%) reported a smoking history. Patients reported high cancer self-blame (mean = 3.1, standard deviation = 0.9, range = 1–4). Patients (55.6%) and caregivers (60%) reported clinically significant depressive symptoms. There was high interest and concordance in interest in cancer education (patients, 77.8%; caregivers, 86.7%) and diet and exercise (patients, 66.7%; caregivers, 80%) interventions. Significantly more caregivers were interested in stress reduction (patients, 53.3%; caregivers, 73.3%; P = .05) and yoga (patients, 16.7%; caregivers, 50%; P = .03) than patients. Caregivers interested in stress reduction interventions had higher levels of distress than those not interested. Discussion Health promotion interventions are needed and of interest to lung cancer patients and caregivers. Shared interests in interventions suggest dyadic interventions may be appropriate, yet interventions should also address distinct patient and caregiver needs.
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Affiliation(s)
- Chandylen L Nightingale
- Department of Social Sciences & Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Laurie E Steffen
- Department of Social Sciences & Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Janet A Tooze
- Department of Biostatistical Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - William Petty
- Section on Hematology and Oncology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Suzanne C Danhauer
- Department of Social Sciences & Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Hoda Badr
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Kathryn E Weaver
- Department of Social Sciences & Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina
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Xiu D, Fung YL, Lau BHP, Wong DFK, Chan CHY, Ho RTH, So TH, Lam TC, Lee VHF, Lee AWM, Chow SF, Lim FM, Tsang MW, Chan CLW, Chow AYM. Comparing dyadic cognitive behavioral therapy (CBT) with dyadic integrative body-mind-spirit intervention (I-BMS) for Chinese family caregivers of lung cancer patients: a randomized controlled trial. Support Care Cancer 2019; 28:1523-1533. [PMID: 31280363 DOI: 10.1007/s00520-019-04974-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 06/28/2019] [Indexed: 12/24/2022]
Abstract
PURPOSE The study adopted a randomized controlled trial to compare the effect of culturally compatible psychosocial interventions on multiple aspects of quality of life (QoL) for family caregivers of lung cancer patients. METHODS 157 Chinese informal caregivers of lung cancer patients were recruited together with the family members for whom they were providing care, and randomly assigned to either integrative body-mind-spirit intervention (I-BMS) or cognitive behavioral therapy (CBT). Patient-caregiver dyads attended the same arm of intervention in separate groups for 8 weeks. Assessments of generic QoL, anxiety, depression, perceived stress, insomnia, and caregiving burden were measured before intervention (T0), within 1-week (T1), 8-week (T2), and 16-week (T3) post-intervention. RESULTS Adopting the intention-to-treat analysis, family caregivers in receipt of both I-BMS and CBT exhibited a statistically significant improvement in generic QoL immediately following intervention and at follow-up assessments, with moderate effect size. Improvement of insomnia was found at T1 for both modes, which deteriorated at follow-up; both modes reduced anxiety and perceived stress at follow-up. No intervention effect was observed in depression and domains of caregiving burden. There was no significant interaction effect between intervention type and time. No main or interaction effect between sample background variables and intervention type was found to predict symptomatic changes at T1 and T3. CONCLUSIONS Culturally attuned I-BMS and CBT exhibited equivalent effectiveness in improving psychological distress and generic QoL for family caregivers of lung cancer patients. To improve the evaluation of outcomes, future study could benefit from incorporating a usual care control.
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Affiliation(s)
- Daiming Xiu
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong
| | - Yat-Lui Fung
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong
| | - Bobo Hi-Po Lau
- Department of Counselling and Psychology, Hong Kong Shue Yan University, North Point, Hong Kong
| | - Daniel F K Wong
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong
| | - Celia H Y Chan
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong
| | - Rainbow T H Ho
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong
| | - Tsz-Him So
- Department of Clinical Oncology, The University of Hong Kong, Pokfulam, Hong Kong
| | - Tai-Chung Lam
- Department of Clinical Oncology, The University of Hong Kong, Pokfulam, Hong Kong
| | - Victor Ho-Fun Lee
- Department of Clinical Oncology, The University of Hong Kong, Pokfulam, Hong Kong
| | - Anne W M Lee
- Department of Clinical Oncology, The University of Hong Kong, Pokfulam, Hong Kong
| | | | | | | | - Cecilia L W Chan
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong
| | - Amy Y M Chow
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong.
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Irwin MM, Dudley W, Northouse L, Berry DL, Mallory GA. Oncology Nurses' Knowledge, Confidence, and Practice in Addressing Caregiver Strain and Burden. Oncol Nurs Forum 2019; 45:187-196. [PMID: 29466346 DOI: 10.1188/18.onf.187-196] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To describe nurses' practices, confidence, and knowledge of evidence-based interventions for cancer caregiver strain and burden and to identify factors that contribute to these aspects.
. SAMPLE & SETTING 2,055 Oncology Nursing Society members completed an emailed survey.
. METHODS & VARIABLES Pooled analysis of survey results. Variables included the baseline nursing assessment, intervention, confidence, knowledge, strategies used, and barriers encountered.
. RESULTS Nurses tend to overestimate the strength of evidence for interventions not shown to be effective and have moderate confidence in assessing and intervening with caregivers. Having been an informal caregiver and having received care from an informal caregiver were associated with higher reported practice and confidence. Major strategies used were referral to social workers and others. Barriers reported were financial, caregiver emotional responses, and distance.
. IMPLICATIONS FOR NURSING An opportunity exists to increase nurses' knowledge and confidence in assessment and intervention with caregivers. Greater use of technology may help nurses overcome some barriers to working with caregivers. Findings can be used to plan continuing education, develop clinical processes, and identify resources nurses need to address strain and burden among informal caregivers.
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Treanor CJ, Santin O, Prue G, Coleman H, Cardwell CR, O'Halloran P, Donnelly M. Psychosocial interventions for informal caregivers of people living with cancer. Cochrane Database Syst Rev 2019; 6:CD009912. [PMID: 31204791 PMCID: PMC6573123 DOI: 10.1002/14651858.cd009912.pub2] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Increasingly, cancer is recognised as a chronic condition with a growing population of informal caregivers providing care for cancer patients. Informal caregiving can negatively affect the health and well-being of caregivers. We need a synthesised account of best evidence to aid decision-making about effective ways to support caregivers for individuals 'living with cancer'. OBJECTIVES To assess the effectiveness of psychosocial interventions designed to improve the quality of life (QoL), physical health and well-being of informal caregivers of people living with cancer compared with usual care. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, PsycINFO, ProQuest, Open SIGLE, Web of Science from inception up to January 2018, trial registries and citation lists of included studies. SELECTION CRITERIA We included randomised and quasi-randomised controlled trials comparing psychosocial interventions delivered to adult informal caregivers of adults affected by cancer on a group or individual basis with usual care. Psychosocial interventions included non-pharmacological interventions that involved an interpersonal relationship between caregivers and healthcare professionals. We included interventions delivered also to caregiver-patient dyads. Interventions delivered to caregivers of individuals receiving palliative or inpatient care were excluded. Our primary outcome was caregiver QoL. Secondary outcomes included patient QoL, caregiver and patient depression, anxiety, psychological distress, physical health status and intervention satisfaction and adverse effects. DATA COLLECTION AND ANALYSIS Pairs of review authors independently screened studies for eligibility, extracted data and conducted 'Risk of bias' assessments. We synthesised findings using meta-analysis, where possible, and reported remaining results in a narrative synthesis. MAIN RESULTS Nineteen trials (n = 3, 725) were included in the review. All trials were reported in English and were undertaken in high-income countries. Trials targeted caregivers of patients affected by a number of cancers spanning newly diagnosed patients, patients awaiting treatment, patients who were being treated currently and individuals post-treatment. Most trials delivered interventions to caregiver-patient dyads (predominantly spousal dyads) and there was variation in intervention delivery to groups or individual participants. There was much heterogeneity across interventions though the majority were defined as psycho-educational. All trials were rated as being at 'high risk of bias'.Compared to usual care, psychosocial interventions may improve slightly caregiver QoL immediately post intervention (standardised mean difference (SMD) 0.29, 95% confidence interval (CI) 0.04 to 0.53; studies = 2, 265 participants) and may have little to no effect on caregiver QoL at 12 months (SMD 0.14, 95% CI - 0.11 to 0.40; studies = 2, 239 participants) post-intervention (both low-quality evidence).Psychosocial interventions probably have little to no effect on caregiver depression immediately to one-month post-intervention (SMD 0.01, 95% CI -0.14 to 0.15; studies = 9, 702 participants) (moderate-quality evidence). Psychosocial interventions may have little to no effect on caregiver anxiety immediately post-intervention (SMD -0.12, 95 % CI -0.33 to 0.10; studies = 5, 329 participants), depression three-to-six months (SMD 0.03, 95% CI -0.33 to 0.38; studies = 5. 379 participants) post-intervention and patient QoL six to 12 months (SMD -0.05, 95% CI -0.37 to 0.26; studies = 3, 294 participants) post-intervention (all low-quality evidence). There was uncertainty whether psychosocial interventions improve patient QoL immediately (SMD -0.03, 95 %CI -0.50 to 0.44; studies = 2, 292 participants) or caregiver anxiety three-to-six months (SMD-0.25, 95% CI -0.64 to 0.13; studies = 4, 272 participants) post-intervention (both very low-quality evidence). Two studies which could not be pooled in a meta-analysis for caregiver physical health status found little to no effect immediately post-intervention and a small intervention effect 12 months post-intervention. Caregiver or patient satisfaction or cost-effectiveness of interventions were not assessed in any studies. Interventions demonstrated good feasibility and acceptability.Psychosocial interventions probably have little to no effect on patient physical health status immediately post-intervention (SMD 0.17, 95 % CI -0.07 to 0.41; studies = 4, 461 participants) and patient depression three to six months post-intervention (SMD-0.11, 95% CI -0.33 to 0.12; studies = 6, 534 participants) (both moderate-quality evidence).Psychosocial interventions may have little to no effect on caregiver psychological distress immediately to one-month (SMD -0.08, 95% CI -0.42 to 0.26; studies = 3, 134 participants), and seven to 12 months (SMD 0.08, 95% CI -0.42 to 0.58; studies = 2, 62 participants) post-intervention; patient depression immediately (SMD -0.12, 95% CI -0.31 to 0.07; studies = 9, 852 participants); anxiety immediately (SMD -0.13, 95% CI -0.41 to 0.15;studies = 4, 422 participants), and three to six months (SMD -0.22, 95% CI -0.45 to 0.02; studies = 4, 370 participants); psychological distress immediately (SMD -0.02, 95% CI -0.47 to 0.44; studies = 2, 74 participants) and seven to 12 months (SMD -0.27, 95% CI -0.78 to 0.24; studies = 2, 61 participants); and physical health status six to 12 months (SMD 0.06, 95% CI -0.18 to 0.30; studies = 2, 275 participants) post-intervention (all low-quality evidence).Three trials reported adverse effects associated with the interventions, compared with usual care, including higher distress, sexual function-related distress and lower relationship satisfaction levels for caregivers, higher distress levels for patients, and that some content was perceived as insensitive to some participants.Trials not able to be pooled in a meta-analysis did not tend to report effect size and it was difficult to discern intervention effectiveness. Variable intervention effects were reported for patient and caregiver outcomes. AUTHORS' CONCLUSIONS Heterogeneity across studies makes it difficult to draw firm conclusions regarding the effectiveness of psychosocial interventions for this population. There is an immediate need for rigorous trials with process evaluations and clearer, detailed intervention descriptions. Cost-effectiveness studies should be conducted alongside future trials.
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Affiliation(s)
- Charlene J Treanor
- Queen's University BelfastCentre for Public HealthInstitute of Clinical Sciences Block B, Royal Victoria Hospital SiteGrosvenor RoadBelfastNorthern IrelandUKBT12 6BJ
| | - Olinda Santin
- Queen's University BelfastSchool of Nursing and Midwifery97 Lisburn RoadBelfastUKBT9 7BL
| | - Gillian Prue
- Queen's University BelfastSchool of Nursing and Midwifery97 Lisburn RoadBelfastUKBT9 7BL
| | - Helen Coleman
- Queen's University BelfastCentre for Public HealthInstitute of Clinical Sciences Block B, Royal Victoria Hospital SiteGrosvenor RoadBelfastNorthern IrelandUKBT12 6BJ
| | - Chris R Cardwell
- Queen's University BelfastCentre for Public HealthInstitute of Clinical Sciences Block B, Royal Victoria Hospital SiteGrosvenor RoadBelfastNorthern IrelandUKBT12 6BJ
| | - Peter O'Halloran
- Queen's University BelfastSchool of Nursing and Midwifery97 Lisburn RoadBelfastUKBT9 7BL
| | - Michael Donnelly
- Queen's University BelfastCentre for Public HealthInstitute of Clinical Sciences Block B, Royal Victoria Hospital SiteGrosvenor RoadBelfastNorthern IrelandUKBT12 6BJ
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Corry M, Neenan K, Brabyn S, Sheaf G, Smith V. Telephone interventions, delivered by healthcare professionals, for providing education and psychosocial support for informal caregivers of adults with diagnosed illnesses. Cochrane Database Syst Rev 2019; 5:CD012533. [PMID: 31087641 PMCID: PMC6516056 DOI: 10.1002/14651858.cd012533.pub2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Maintaining care for ill persons in the community is heavily dependent on support from unpaid caregivers. Many caregivers, however, find themselves in a caring role for which they are ill prepared and may require professional support. The telephone is an easily accessible method of providing support irrespective of geographical location. OBJECTIVES The objective of this review was to evaluate the effectiveness of telephone support interventions, delivered by healthcare professionals, when compared to usual care or non-telephone-based support interventions for providing education and psychosocial support for informal caregivers of people with acute and chronic diagnosed illnesses, and to evaluate the cost-effectiveness of telephone interventions in this population. SEARCH METHODS We searched the following databases from inception to 16 November 2018: the Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; Embase; PsycINFO; ProQuest Dissertations and Theses A&I; and CINAHL Complete. We also searched 11 caregiver-specific websites, three conference links, and two clinical trial registries. SELECTION CRITERIA We included randomised controlled trials (RCTs) (including cluster-RCTs) and quasi-RCTs. We excluded cross-over trials because of the high risk of carry-over effects from one intervention to another. DATA COLLECTION AND ANALYSIS Two authors independently screened citations against the review's inclusion criteria, extracted data, and assessed the included studies using the Cochrane 'Risk of bias' tool. The review's prespecified primary (quality of life and burden) and secondary outcomes (skill acquisition, psychological health, knowledge, health status and well-being, family functioning, satisfaction, and economic outcomes), where reported, were assessed at the end of intervention delivery and at short-term (≤ 3 months), medium-term (> 3 to ≤ 6 months) and longer-term time points (> 6 to 12 months) following the intervention. Where possible, meta-analyses were conducted, otherwise results were reported narratively. MAIN RESULTS We included 21 randomised studies involving 1,690 caregivers; 19 studies compared telephone support interventions and usual care, of which 18 contributed data to the analyses. Two studies compared telephone and non-telephone professional support interventions. Caregiver ages ranged from 19 years to 87 years across studies. The majority of participants were female (> 70.53%), with two trials including females only. Most caregivers were family members, educated beyond secondary or high school level or had the equivalent in years of education. All caregivers were based in the community. Overall risk of bias was high for most studies.The results demonstrated that there is probably little or no difference between telephone support interventions and usual care for the primary outcome of quality of life at the end of intervention (SMD -0.02, 95% CI -0.24 to 0.19, 4 studies, 364 caregivers) (moderate-certainty evidence) or burden at the end of intervention (SMD -0.11, 95% CI -0.30 to 0.07, 9 studies, 788 caregivers) (low-certainty evidence). For one study where quality of life at the end of intervention was reported narratively, the findings indicated that a telephone support intervention may result in slightly higher quality of life, compared with usual care. Two further studies on caregiver burden were reported narratively; one reported that telephone support interventions may decrease burden, the other reported no change in the intervention group, compared with usual care.We are uncertain about the effects of telephone support interventions on caregiver depression at the end of intervention (SMD -0.37, 95% CI -0.70 to -0.05, 9 studies, 792 caregivers) due to very low-certainty evidence for this outcome. Depression was reported narratively for three studies. One reported that the intervention may reduce caregiver depression at the end of intervention, but this effect was not sustained at short-term follow-up. The other two studies reported there may be little or no difference between telephone support and usual care for depression at the end of intervention. Six studies measured satisfaction with the intervention but did not report comparative data. All six reported high satisfaction scores with the intervention. No adverse events, including suicide or suicide ideation, were measured or reported by any of the included studies.Our analysis indicated that caregiver anxiety may be slightly reduced (MD -6.0, 95% CI -11.68 to -0.32, 1 study, 61 caregivers) and preparedness to care slightly improved (SMD 0.37, 95% CI 0.09 to 0.64, 2 studies, 208 caregivers) at the end of intervention, following telephone-only support interventions compared to usual care. Findings indicated there may be little or no difference between telephone support interventions and usual care for all of the following outcomes at the end of intervention: problem-solving, social activity, caregiver competence, coping, stress, knowledge, physical health, self-efficacy, family functioning, and satisfaction with supports (practical or social). There may also be little or no effect of telephone support interventions for quality of life and burden at short-term follow-up or for burden and depression at medium-term follow-up.Litttle or no difference was found between groups for any of the reported outcomes in studies comparing telephone and non-telephone professional support interventions. We are uncertain as to the effects of telephone support interventions compared to non-telephone support interventions for caregiver burden and depression at the end of intervention. No study reported on quality of life or satisfaction with the intervention and no adverse events were reported or noted in the two studies reporting on this comparison. AUTHORS' CONCLUSIONS Although our review indicated slight benefit may exist for telephone support interventions on some outcomes (e.g. anxiety and preparedness to care at the end of intervention), for most outcomes, including the primary outcomes, telephone-only interventions may have little or no effect on caregiver outcomes compared to usual care. The findings of the review were mainly based on studies with overall high risk of bias, and few participants. Further high-quality trials, with larger sample sizes are required.
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Affiliation(s)
- Margarita Corry
- Trinity College DublinSchool of Nursing and MidwiferyDublinIreland
| | - Kathleen Neenan
- Trinity College DublinSchool of Nursing and MidwiferyDublinIreland
| | - Sally Brabyn
- University of YorkDepartment of Health SciencesHeslingtonYorkUKYO10 5DD
| | - Greg Sheaf
- The Library of Trinity College DublinCollege StreetDublinIreland
| | - Valerie Smith
- Trinity College DublinSchool of Nursing and MidwiferyDublinIreland
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Milbury K, Liao Z, Shannon V, Mallaiah S, Nagarathna R, Li Y, Yang C, Carmack C, Bruera E, Cohen L. Dyadic yoga program for patients undergoing thoracic radiotherapy and their family caregivers: Results of a pilot randomized controlled trial. Psychooncology 2019; 28:615-621. [PMID: 30659739 DOI: 10.1002/pon.4991] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 01/08/2019] [Accepted: 01/11/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Thoracic radiotherapy (TRT) may result in toxicities that are associated with performance declines and poor quality of life (QOL) for patients and their family caregivers. The purpose of this randomized controlled trial was to establish feasibility and preliminary efficacy of a dyadic yoga (DY) intervention as a supportive care strategy. METHODS Patients with stage I to III non-small cell lung or esophageal cancer undergoing TRT and their caregivers (N = 26 dyads) were randomized to a 15-session DY or a waitlist control (WLC) group. Prior to TRT and randomization, both groups completed measures of QOL (SF-36) and depressive symptoms (CES-D). Patients also completed the 6-minute walk test (6MWT). Dyads were reassessed on the last day of TRT and 3 months later. RESULTS A priori feasibility criteria were met regarding consent (68%), adherence (80%), and retention (81%) rates. Controlling for relevant covariates, multilevel modeling analyses revealed significant clinical improvements for patients in the DY group compared with the WLC group for the 6MWT (means: DY = 473 m vs WLC = 397 m, d = 1.19) and SF-36 physical function (means: DY = 38.77 vs WLC = 30.88; d = .66) and social function (means: DY = 45.24 vs WLC = 39.09; d = .44) across the follow-up period. Caregivers in the DY group reported marginally clinically significant improvements in SF-36 vitality (means: DY = 53.05 vs WLC = 48.84; d = .39) and role performance (means: DY = 52.78 vs WLC = 48.59; d = .51) relative to those in the WLC group. CONCLUSIONS This novel supportive care program appears to be feasible and beneficial for patients undergoing TRT and their caregivers. A larger efficacy trial with a more stringent control group is warranted.
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Affiliation(s)
- Kathrin Milbury
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Zhongxing Liao
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Vickie Shannon
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Smitha Mallaiah
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Yisheng Li
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Chunyi Yang
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Cindy Carmack
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Eduardo Bruera
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Lorenzo Cohen
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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The Meaning of Self-efficacy for Symptom Management in the Acute Phase of Hematopoietic Stem Cell Transplantation. Cancer Nurs 2019; 43:E113-E120. [PMID: 30676398 DOI: 10.1097/ncc.0000000000000685] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hematopoietic stem cell transplantation (HSCT) is an intensive treatment that offers the potential for longer life or cure for some types of cancer. Hematopoietic stem cell transplant is associated with decreased quality of life and functional status and distressing symptoms. Self-efficacy for symptom management (SESM) is a person's belief in his/her ability to implement behaviors to manage these symptoms. Presence of SESM can affect symptom distress, healthcare utilization, and posttransplantation outcomes. OBJECTIVE The aim of this study was to explore the meaning of SESM in adults during the acute phase of HSCT. METHODS Interviews were conducted before and at 30 days after transplantation. Descriptive thematic analysis was performed on verbatim interview transcripts. RESULTS Themes of confidence, being responsible, and caring for mind, body, and spirit were identified, with subthemes of self-confidence, confidence in others, confidence and symptom level, vigilance, self-advocacy, and normalcy. Participants reported having high SESM before transplantation and having much less or no SESM when symptom distress was the most severe. CONCLUSIONS This is the first study to examine the patient's perspective of self-efficacy in the acute phase of HSCT. This contributes to existing literature on the concept of symptom management and expands nursing knowledge of SESM in patients undergoing HSCT. IMPLICATIONS FOR PRACTICE Nurses can assess SESM before transplantation and implement interventions to enhance SESM when symptoms are at their most distressing after HSCT. The findings from this study can provide the basis for creating behavioral interventions to enhance self-efficacy for symptom management in HSCT patients.
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Hu Y, Liu T, Li F. Association between dyadic interventions and outcomes in cancer patients: a meta-analysis. Support Care Cancer 2019; 27:745-761. [PMID: 30604008 DOI: 10.1007/s00520-018-4556-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 11/13/2018] [Indexed: 01/22/2023]
Abstract
PURPOSE Patient-caregiver dyadic interventions are when "interventions are offered to cancer patients and their family caregivers together as the unit of care." The purpose of the present study was to determine the association of dyadic intervention for cancer patients and their family caregivers with quality of life (QOL), and other outcomes for people with cancer. METHODS Literature searches were conducted using the electronic databases to identify all randomized clinical trials on cancer patient-caregiver dyads. Meta-analysis was used to analyze data. RESULTS Twenty-three RCTs provided data on 2317 patient-caregiver dyads. In the meta-analysis, at the 0- to 3-month follow-up, dyadic intervention was associated with statistically and clinically significant improvements in patient total QOL (standardized mean difference [SMD], 0.25; 95% confidence interval [CI], 0.01-0.50); the total spiritual aspect of QOL (SMD, 0.28; 95% CI, 0.06-0.50); the emotional (SMD, 0.16; 95% CI, 0.02-0.29), social (SMD, 0.21; 95% CI, 0.07-0.36), and mental (SMD, 0.26; 95% CI, 0.07-0.46) aspects of QOL; depression (SMD, - 0.35; 95% CI, - 0.65 to - 0.05); anxiety (SMD, - 0.42; 95% CI, - 0.70 to - 0.13); relatedness (SMD, 0.18; 95% CI, 0.04-0.32); and marital functioning (SMD, 1.01; 95% CI, 0.05-1.97). At the 3.1- to 6-month follow-up, dyadic intervention was associated with significant improvements in patient social aspect (SMD, 0.19; 95% CI, 0.03-0.35) and depression (SMD, - 0.29; 95% CI, - 0.56 to - 0.03). There was no association between dyadic interventions and the patient functional and physical aspects of QOL. Dyadic intervention was associated consistently with no improvements in hopelessness, pain, fatigue, and survival. CONCLUSIONS In this review, dyadic interventions for caregivers and cancer patients were associated with improvements in multiple psychosocial aspects of patient outcomes.
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Affiliation(s)
- Yanli Hu
- School of Nursing, Jilin University, Changchun, China
| | - Tao Liu
- Medical Research Center, Second Teaching Hospital, University of Jilin School of Medicine, Changchun, China
| | - Fan Li
- School of Nursing, Jilin University, Changchun, China.
- School of Nursing, The Key Laboratory of Zoonosis, Chinese Ministry of Education, College of Basic Medical Science, Jilin University, No. 126 Xinmin Street, Changchun, 130021, China.
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Kwekkeboom K, Zhang Y, Campbell T, Coe CL, Costanzo E, Serlin RC, Ward S. Randomized controlled trial of a brief cognitive-behavioral strategies intervention for the pain, fatigue, and sleep disturbance symptom cluster in advanced cancer. Psychooncology 2018; 27:2761-2769. [PMID: 30189462 PMCID: PMC6279506 DOI: 10.1002/pon.4883] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 08/27/2018] [Accepted: 08/29/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Patients receiving treatment for advanced cancer suffer significant symptom burden, including co-occurring pain, fatigue, and sleep disturbance. There is limited evidence for effective interventions targeting this common symptom cluster. METHODS A randomized controlled trial of a brief cognitive-behavioral strategies (CBS) intervention was conducted. A sample of 164 patients with advanced cancer receiving chemotherapy practiced imagery, relaxation, and distraction exercises or listened to cancer education recordings (attention-control) to manage co-occurring pain, fatigue, and sleep disturbance over a 9-week period. Symptom cluster severity, distress, and interference with daily life were measured at baseline and 3, 6, and 9 weeks. We also evaluated the moderating influence of imaging ability and number of concurrent symptoms, and mediating effects of changes in stress, anxiety, outcome expectancy, and perceived control over symptoms. RESULTS Compared with the cancer education condition, participants receiving the CBS intervention reported less symptom cluster distress at week 6 (M = 1.82 vs 2.15 on a 0-4 scale, P < .05). No other group differences were statistically significant. The number of concurrent symptoms moderated the intervention effect on symptom cluster interference. Changes in stress, outcome expectancy, and perceived control mediated the extent of intervention effects on symptom outcomes, primarily at weeks 6 and 9. CONCLUSIONS The brief CBS intervention had limited effects in this trial. However, findings regarding potential mediators affirm hypothesized mechanisms and provide insight into ways to strengthen future interventions to reduce the suffering associated with co-occurring pain, fatigue, and sleep disturbance.
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Affiliation(s)
| | - Yingzi Zhang
- School of Nursing, University of Wisconsin-Madison, Madison, WI, USA
| | - Toby Campbell
- School of Nursing, University of Wisconsin-Madison, Madison, WI, USA
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Christopher L Coe
- Department of Psychology, College of Letters and Science, University of Wisconsin-Madison, Madison, WI, USA
| | - Erin Costanzo
- Department of Psychiatry, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Ronald C Serlin
- Department of Educational Psychology, School of Education, University of Wisconsin-Madison, Madison, WI, USA
| | - Sandra Ward
- School of Nursing, University of Wisconsin-Madison, Madison, WI, USA
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