1
|
Park T, Parillon B, Cruz-Oliver DM, Sloan DH, Reid MC, Czaja S, Adelman R, Dignam R, Phongtankuel V. Pilot Testing Educational Videos for Black Caregivers Receiving Home Hospice Care. J Hosp Palliat Nurs 2024:00129191-990000000-00137. [PMID: 38842308 DOI: 10.1097/njh.0000000000001038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
Black caregivers face distinct challenges in symptom management when providing end-of-life care. Educational interventions may improve caregiver preparedness and competency by providing information on symptom management. This study pilot tested 4 culturally tailored caregiver educational videos about symptom management for Black caregivers receiving home hospice care at a large, urban, nonprofit hospice organization to determine feasibility and acceptability, along with their potential impact on caregiver outcomes. All participants (N = 10) agreed to watch the 4 videos and found the videos to be helpful; 90% (n = 9) shared that they would recommend them to other Black caregivers receiving home hospice care. Total preparedness scores increased from a mean score of 23.5 preintervention to 28.3 postintervention. Caregiver competency scores increased from 13.8 at preintervention to 14.3 at postintervention. Caregivers' comfort and knowledge scores increased from preintervention to postintervention for all 7 end-of-life topics presented in the 4 videos. This study found that it was feasible and acceptable to show Black caregivers culturally tailored educational videos related to issues regarding symptom management. Many found the videos to be helpful and the topics to be relatable. There were trends toward improvement in preparedness and competency. Future studies examining efficacy are needed to determine the impact of this intervention.
Collapse
|
2
|
Starr LT, Washington KT, Jabbari J, Benson JJ, Oliver DP, Demiris G, Cagle JG. Pain Management Education for Rural Hospice Family Caregivers: A Pilot Study With Embedded Implementation Evaluation. Am J Hosp Palliat Care 2024; 41:619-633. [PMID: 37491002 PMCID: PMC11032627 DOI: 10.1177/10499091231191114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Assessing and managing hospice patients' pain is a common source of anxiety among hospice family caregivers (HFCGs), especially caregivers in rural communities who face special challenges including distance, limited access, and concerns about opioid misuse. OBJECTIVE To pilot test Ready2Care, a pain management education intervention for rural HFCGs. We sought to determine whether there was a signal of benefit for clinically-relevant outcomes and to identify contextual factors pertinent to conducting a future randomized clinical trial of Ready2Care. METHODS We conducted a multi-method, single-arm study, enabling completion of paired t-tests comparing pre- and post-intervention measures of caregiver anxiety, pain management self-efficacy, barriers to pain management, and reports of patient pain intensity and corresponding patient and caregiver distress. We concurrently conducted an embedded implementation evaluation via calculation of descriptive statistics (recruitment and retention data) and directed content analysis of brief caregiver interviews. RESULTS Twenty-seven (n = 27) HFCGs participated; 15 completed the study. Among completers, significant improvement was observed in patient pain intensity (average 1.4 points decrease on 0-10 scale) and in overall pain experience. No statistically significant changes were detected in caregiver anxiety, barriers to pain management, or pain management self-efficacy. Facilitators to successful conduct of a future clinical trial included high acceptability of Ready2Care, driven by its perceived clarity and relevance to caregivers' concerns. Barriers included lower-than-anticipated accrual and an attrition rate of nearly 44%. CONCLUSION A multisite clinical trial of Ready2Care is warranted; however, its success may require more effective recruitment and retention strategies for rural caregiver participants.
Collapse
Affiliation(s)
- Lauren T. Starr
- Department of Biobehavioral Health Sciences, NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | | | - JoAnn Jabbari
- Washington University in St Louis School of Medicine, St Louis, MO, USA
- Barnes-Jewish College, Goldfarb School of Nursing, St Louis, MO, USA
| | | | - Debra Parker Oliver
- Washington University in St Louis School of Medicine, St Louis, MO, USA
- Barnes-Jewish College, Goldfarb School of Nursing, St Louis, MO, USA
| | - George Demiris
- Department of Biobehavioral Health Sciences, NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - John G. Cagle
- Center to Advance Chronic Pain Research, University of Maryland, School of Social Work, Baltimore, MD, USA
| |
Collapse
|
3
|
Lowenthal C, Ekwebelem M, Callahan ME, Pike K, Weisblatt S, Silva M, Novas AL, Tucci AS, Reid MC, Shalev D. Mental Health Service Integration in Hospice Organizations: A National Survey of Hospice Clinicians and Medical Leadership. Am J Hosp Palliat Care 2024:10499091241233677. [PMID: 38378452 DOI: 10.1177/10499091241233677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024] Open
Abstract
Background: Unmet mental health needs are associated with a range of negative consequences for individuals at the end of life. Despite the high prevalence of mental health needs among individuals enrolled in hospice, there is a paucity of data describing mental health service integration in hospices in the United States. Objectives: 1. To identify patterns of mental health service integration in hospice organizations nationally; 2. To characterize gaps in mental health service delivery in hospice settings as perceived by hospice clinicians and medical leadership. Methods: A cross-sectional survey querying hospice clinicians and hospice medical leadership nationally. Results: A total of 279 surveys were included. Clinically significant mental health symptoms were common among hospice patients; the most frequently encountered symptom groups were depression, anxiety, dementia, and delirium. A minority of hospices maintained relationships with psychiatrists (23%, n = 60), psychiatric nurse practitioners (22%, n = 56), or psychologists (19%, n = 49). Only 38% (n = 99) of respondents were satisfied with their patients' access to services and only 45% (n = 118) were satisfied with the quality of these services. Common limitations to providing adequate mental health services included lack of specialist services, short length of stay for patients, and reluctance of patients to engage in these services. Conclusions: Significant mental health symptoms are common among hospice patients, and hospice organizations perceive these needs are not being met. Further research is needed to better understand the current treatment landscape and design interventions to address these needs.
Collapse
Affiliation(s)
| | - Maureen Ekwebelem
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Mary E Callahan
- Department of Medicine, Columbia University, New York, NY, USA
| | | | | | - Milagros Silva
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, NY, USA
| | | | - Amy S Tucci
- Hospice Foundation of America, Washington, DC, USA
| | - M Carrington Reid
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Daniel Shalev
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, NY, USA
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA
| |
Collapse
|
4
|
Cruz-Oliver DM, Milner GE, Mensh K, Bugayong M, Blinka MD, Durkin N, Abshire Saylor M, Budhathoki C, Oliver DP. Promising Impact of Telenovela Intervention for Caregivers of Hospice Patients: A Pilot Study. Am J Hosp Palliat Care 2024:10499091241228835. [PMID: 38321708 DOI: 10.1177/10499091241228835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND Hospice family caregivers (HFCGs) support the needs of their loved ones but are at risk of developing distress and anxiety. NOVELA is a four-chapter telenovela-style educational video to support topics related to hospice caregiving. Telehealth visits are scheduled in 4 weekly sessions consisting of a chapter and subsequent discussion with an interventionist. This feasibility pilot study tested NOVELA's effect to change HFCGs' outcomes, session and outcome measure completion (defined a priori as >70%). METHODS This is a single-group pretest-posttest study of HFCGs of care recipients with PPS score >20% from 3 hospices in the U.S. Mid-Atlantic region. At baseline and at final posttest, participants completed a web-based survey assessing 3 outcomes: anxiety, self-efficacy, and satisfaction with intervention. Descriptive, t-test, and chi-square statistics were computed. RESULTS Participants in our study (N = 59) were mainly collage educated, White, female, adult children of home-bound people with a non-cancer diagnosis. Outcomes changed in the expected direction (P > .05) with higher self-efficacy (Cohen's d = -.08 [95% CI -.4 to .2) and lower anxiety (Cohen's d = .2 [95% CI -.1 to .5]) scores from final to baseline, 86% of HFCGs were satisfied or very satisfied with NOVELA, session (33/59) and outcome measure (43/59) completion averaged 68%. CONCLUSION Encouraging trends in NOVELA's estimation of effect suggests that NOVELA may buffer stressful aspects of hospice caregiving. However, further refinement of NOVELA is needed. Supporting HFCGs through supportive educational interventions may reduce distress and anxiety with broad implications for quality improvement.
Collapse
Affiliation(s)
- Dulce M Cruz-Oliver
- Section of Palliative Medicine, Division of General Internal Medicine Department of Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
| | | | - Kelsea Mensh
- Med-Surg Oncology 5A, Sibley Memorial Hospital, Washington, DC, USA
| | - Marielle Bugayong
- Division of General Internal Medicine Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Marcela D Blinka
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Center on Aging and Health, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nowella Durkin
- Division of General Internal Medicine Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | | | - Debra Parker Oliver
- Division of Palliative Medicine, Goldfarb School of Nursing, Barnes Jewish Hospital, Washington University, St. Louis, MO, USA
| |
Collapse
|
5
|
Alshakhs S, Park T, McDarby M, Reid MC, Czaja S, Adelman R, Sweet E, Jedlicka CM, Delgado D, Phongtankuel V. Interventions for Family Caregivers of Patients Receiving Palliative/Hospice Care at Home: A Scoping Review. J Palliat Med 2024; 27:112-127. [PMID: 37582194 PMCID: PMC10790551 DOI: 10.1089/jpm.2023.0160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2023] [Indexed: 08/17/2023] Open
Abstract
There is a need for understanding the breadth of interventions for caregivers of individuals receiving hospice care at home, given the important role caregivers play in caring and the negative outcomes (e.g., depression) associated with their caregiving. Previous reviews were limited in scope to certain types of interventions or patient populations. The objective of this scoping review was to broadly examine the interventions targeting caregivers who provide care to terminally ill patients in home, with the purpose of (1) describing the characteristics of these interventions, (2) discussing key outcomes, limitations, and knowledge gaps, (3) highlighting intervention strengths, and (4) proposing future research directions. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Intervention studies that met the inclusion criteria and that were published up until October 2022 were obtained from the following databases: Ovid MEDLINE, Ovid EMBASE, CINAHL (EBSCO), and The Cochrane Library (Wiley). We analyzed 76 studies describing 55 unique interventions that took place in 14 countries. Interventions were largely delivered by nurses (n = 18, 24%), followed by an interdisciplinary team (n = 16, 21%), a health care provider (n = 10, 13%), research staff (n = 10, 13%), social worker (n = 5, 7%), and others (n = 11, 15%). Six interventions (8%) were self-administered. The most measured outcome was caregiver quality of life (n = 20, 26%), followed by anxiety (n = 18, 24%) and burden (n = 15, 20%). Missing data on patient and caregiver characteristics (i.e., age, gender) were common, and less than half of studies (n = 32, 42%) reported race/ethnicity data. Our review highlighted the current state of interventions for caregivers of patients receiving hospice care at home. Many of the interventions were in the early phases of development, raising the need for future studies to look at efficacy, effectiveness, and the ability to implement interventions in real-world settings.
Collapse
Affiliation(s)
| | | | - Meghan McDarby
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - M. Cary Reid
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Sara Czaja
- Center on Aging and Behavioral Research, Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York, USA
| | | | | | - Caroline M. Jedlicka
- Weill Cornell Medical College, New York, New York, USA
- Robert J. Kibbee Library, Kingsborough Community College, CUNY (City University of New York), New York, New York, USA
| | - Diana Delgado
- Samuel J. Wood Library and C.V. Starr Biomedical Information Center, Weill Cornell Medicine, New York, New York, USA
| | | |
Collapse
|
6
|
Washington KT, Knight A, Pitzer KA, Oliver DP, Devlin SM, Benson JJ, Newland P. Cancer-Related Fatigue in Hospice: A Nudge to Action? J Pain Symptom Manage 2023; 65:e511-e514. [PMID: 36736862 PMCID: PMC10106366 DOI: 10.1016/j.jpainsymman.2023.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 01/20/2023] [Accepted: 01/23/2023] [Indexed: 02/04/2023]
Affiliation(s)
- Karla T Washington
- Department of Medicine, Division of Palliative Medicine (K.T.W., K.A.P., D.P.O., S.M.D., J.J.B.), Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA.
| | - Alyssa Knight
- The Brown School at Washington University in St. Louis (A.K.), St. Louis, Missouri, USA
| | - Kyle A Pitzer
- Department of Medicine, Division of Palliative Medicine (K.T.W., K.A.P., D.P.O., S.M.D., J.J.B.), Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Debra Parker Oliver
- Department of Medicine, Division of Palliative Medicine (K.T.W., K.A.P., D.P.O., S.M.D., J.J.B.), Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Shannon M Devlin
- Department of Medicine, Division of Palliative Medicine (K.T.W., K.A.P., D.P.O., S.M.D., J.J.B.), Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Jacquelyn J Benson
- Department of Medicine, Division of Palliative Medicine (K.T.W., K.A.P., D.P.O., S.M.D., J.J.B.), Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Pamela Newland
- Golfarb School of Nursing at Barnes-Jewish College (P.N.), St. Louis, Missouri, USA
| |
Collapse
|
7
|
Cruz-Oliver DM, Milner GE, Abshire Saylor M, Nelson KE, Blinka MD, Durkin N, Smith TJ, Oliver DP. Recruitment, Retention and Intervention Delivery Experiences With Hospice Family Caregivers. Am J Hosp Palliat Care 2023; 40:409-415. [PMID: 35771204 DOI: 10.1177/10499091221110855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Recruitment and attrition are inherently challenging issues in hospice research. We sought to describe strategies of recruitment, retention, and delivery of NOVELA (short for telenovela), an intervention for hospice family caregivers (HFCG). METHODS Statistics were kept of every referral, consenting participant, visit session, and intervention activity. We used the Social Marketing Mix Framework to describe recruiting strategies employed and lessons learned. RESULTS Two hospices in the U.S. Mid-Atlantic region referred 47 HFCG and N = 20 agreed to participate, out of which 50% (N = 10) completed all 4 sessions with an average of 2.8 sessions per person, each lasting an average duration of 13.5 minutes (range 8.0-25.7). The main reason for missing a session was a patient's death (N = 8). Successful recruitment strategies employed in NOVELA included: (a) intensive start-up hospice engagement, (b) remote recruitment and delivery of NOVELA, and (c) scheduling flexibility to work around caregivers' other demands. CONCLUSION The recruitment and intervention delivery had successes and challenges resulting in the identification of multiple opportunities to strengthen our strategy and inform future studies with HFCGs.
Collapse
Affiliation(s)
- Dulce M Cruz-Oliver
- Palliative Medicine Section, Division of General Internal Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | | | | | - Katie E Nelson
- 15851Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Marcela D Blinka
- Division of Geriatric Medicine and Gerontology, School of Medicine, 1466Johns Hopkins University, Baltimore, MD, USA
| | - Nowella Durkin
- Division of General Internal Medicine, School of Medicine, 1466Johns Hopkins University, Baltimore, MD, USA
| | - Thomas J Smith
- Palliative Medicine Section, Division of General Internal Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Debra Parker Oliver
- Goldfarb School of Nursing, Barnes Jewish HospitalDivision of Palliative Medicine, 7548Washington University, St Louis, MO, USA
| |
Collapse
|
8
|
Oliver DP, Washington K, Benson J, Kruse RL, Popejoy L, Liu J, Smith J, Pitzer K, White P, Demiris G. Access for Cancer Caregivers to Education and Support for Shared Decision Making (ACCESS) intervention: a cluster cross-over randomised clinical trial. BMJ Support Palliat Care 2023:spcare-2022-004100. [PMID: 36863862 PMCID: PMC10474243 DOI: 10.1136/spcare-2022-004100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 01/09/2023] [Indexed: 03/04/2023]
Abstract
OBJECTIVES The purpose of this study was to test an intervention named ACCESS (Access for Cancer Caregivers to Education and Support for Shared Decision Making). The intervention uses private Facebook support groups to support and educate caregivers, preparing them to participate in shared decision-making during web-based hospice care plan meetings. The overall hypothesis behind the study was that family caregivers of hospice patients with cancer would experience lower anxiety and depression as a result of participating in an online Facebook support group and shared decision-making with hospice staff in a web-based care plan meeting. METHODS This is a cluster cross-over randomised three-arm clinical trial where one group participated in both the Facebook group and the care plan team meeting. A second group participated only in the Facebook group and the third group was a control group and received usual hospice care. RESULTS There were 489 family caregivers who participated in the trial. There were no statistically significant differences between the ACCESS intervention group and the Facebook only or the control group on any outcome. The participants in the Facebook only group, however, experienced a statistically significant decrease in depression compared with the enhanced usual care group. CONCLUSIONS While the ACCESS intervention group did not experience significant improvement in outcomes, caregivers assigned to the Facebook only group showed significant improvement in depression scores from baseline as compared with the enhanced usual care control group. Further research is needed to understand the mechanisms of action leading to reduced depression.
Collapse
Affiliation(s)
- Debra Parker Oliver
- Medicine, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
- Goldfarb School of Nursing, Barnes-Jewish College, St Louis, Missouri, USA
| | - Karla Washington
- Medicine, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Jacquelyn Benson
- Medicine, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
- Goldfarb School of Nursing, Barnes-Jewish College, St Louis, Missouri, USA
| | - Robin L Kruse
- Family Medicine, University of Missouri System, Columbia, Missouri, USA
| | - Lori Popejoy
- Sinclair School of Nursing, University of Missouri System, Columbia, Missouri, USA
| | - Jingxia Liu
- Biostatistics, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Jami Smith
- Family Medicine, University of Missouri System, Columbia, Missouri, USA
| | - Kyle Pitzer
- Medicine, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Patrick White
- Medicine, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - George Demiris
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| |
Collapse
|
9
|
Oliver DP, Kruse RL, Pitzer K, Washington KT, Starr LT, Liu J, Smith J, Jorgenson L, Demiris G. Older Adult Engagement With Facebook ® Interventions: A Challenge for Nursing Research. J Gerontol Nurs 2022; 48:10-17. [PMID: 35771068 PMCID: PMC9509659 DOI: 10.3928/00989134-20220606-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Facebook® is a popular platform for older adults, especially as they try to stay in contact with their family around the country. It is also a popular platform for hosting online support groups. The readily available, socially acceptable, and free platform holds many advantages not only for older adults but also for nurse researchers designing and implementing interventions for older adults. The literature is void of proven methods to measure individual engagement with the Facebook platform. The current article describes efforts to develop a measurement process and evaluate the impact that engagement with Facebook has on improved mental health outcomes for older adults. Scores were severely skewed and ranged from no engagement to very high engagement. Engagement differed based on sex, race, and living arrangements with patients. Further work in this area is needed if nurse researchers are to consider the role of engagement in social media interventions. [Journal of Gerontological Nursing, 48(7), 10-17.].
Collapse
Affiliation(s)
| | - Robin L. Kruse
- University of Missouri, Department of Family and Community Medicine, Columbia, Missouri
| | - Kyle Pitzer
- Division of Palliative Medicine, Department of Medicine, Washington University in St. Louis
| | - Karla T. Washington
- Division of Palliative Medicine, Department of Medicine, Washington University in St. Louis
| | - Lauren T. Starr
- NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, PA USA
| | - Jingxia Liu
- Division of Biostatistics, Washington University in St. Louis
| | - Jamie Smith
- University of Missouri, Department of Family and Community Medicine, Columbia, Missouri
| | - Lucas Jorgenson
- Division of Palliative Medicine, Department of Medicine, Washington University in St. Louis
| | - George Demiris
- Department of Biobehavioral and Health Sciences, School of Nursing and Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania
| |
Collapse
|
10
|
Washington KT, Piontek A, Jabbari J, Benson JJ, Demiris G, Tatum PE, Oliver DP. The Lived Experience of Physical Separation for Hospice Patients and Families amid COVID-19. J Pain Symptom Manage 2022; 63:971-979. [PMID: 35192877 PMCID: PMC8856963 DOI: 10.1016/j.jpainsymman.2022.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 02/14/2022] [Accepted: 02/16/2022] [Indexed: 11/30/2022]
Abstract
CONTEXT Many hospice patients were physically separated from family members and healthcare professionals during the early COVID-19 pandemic. OBJECTIVES Researchers sought to describe the lived experience of physical separation for hospice patients and family caregivers who adhered to public health guidelines intended to limit the transmission of COVID-19 in the spring of 2020. METHODS Researchers performed a secondary analysis of qualitative data collected during a multi-site clinical trial of an intervention that incorporated family caregivers into care plan reviews during biweekly hospice interdisciplinary team meetings. Twenty-eight adult family caregivers of hospice patients with cancer participated in at least one care plan review between March 7, 2020 and June 10, 2020. The final analytic dataset included the transcribed content of 60 care plan reviews, which were analyzed via reflexive thematic analysis. RESULTS Hospice patients and their family caregivers experienced physical separation as interrupted care that resulted in the potential for unmet informational, functional, and social and emotional needs. Connection strategies employed to adapt to care interruptions and address patient and caregiver needs were not consistently effective. CONCLUSION Inclusive, innovative connection strategies are needed to ensure that high-quality end-of-life care is provided to hospice patients and their family caregivers when physical presence must be limited.
Collapse
Affiliation(s)
- Karla T Washington
- Washington University in St. Louis, Department of Medicine, Division of Palliative Medicine (K.T.W., J.J.B., P.E.T., D.P.O.), St. Louis, Missouri, USA.
| | - Amy Piontek
- Goldfarb School of Nursing at Barnes-Jewish College (A.P., J.J., D.P.O.), St. Louis, Missouri, USA
| | - JoAnn Jabbari
- Goldfarb School of Nursing at Barnes-Jewish College (A.P., J.J., D.P.O.), St. Louis, Missouri, USA; The Graduate School at Washington University in St. Louis (J.J.), St. Louis, Missouri, USA
| | - Jacquelyn J Benson
- Washington University in St. Louis, Department of Medicine, Division of Palliative Medicine (K.T.W., J.J.B., P.E.T., D.P.O.), St. Louis, Missouri, USA
| | - George Demiris
- Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing (G.D.), Philadelphia, Pennsylvania, USA; Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine (G.D.), Philadelphia, Pennsylvania, USA
| | - Paul E Tatum
- Washington University in St. Louis, Department of Medicine, Division of Palliative Medicine (K.T.W., J.J.B., P.E.T., D.P.O.), St. Louis, Missouri, USA
| | - Debra Parker Oliver
- Washington University in St. Louis, Department of Medicine, Division of Palliative Medicine (K.T.W., J.J.B., P.E.T., D.P.O.), St. Louis, Missouri, USA; Goldfarb School of Nursing at Barnes-Jewish College (A.P., J.J., D.P.O.), St. Louis, Missouri, USA
| |
Collapse
|
11
|
Parker Oliver D, Washington KT, Benson J, White P, Cruz Oliver D, Smith JB, Mazur J, Lakew A, Lewis A, Demiris G. Facebook Online Support Groups for Hospice Family Caregivers of Advanced Cancer Patients: Protocol, Facilitation Skills and Promising Outcomes. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2022; 18:146-159. [PMID: 35282796 PMCID: PMC9262848 DOI: 10.1080/15524256.2022.2046236] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Research has demonstrated a lack of support for hospice caregivers and a higher than average level of self-reported anxiety and depression. While online support groups are gaining popularity, few protocols have been published, little research has demonstrated the skills required to facilitate, and virtually no data has explored the clinical outcomes affiliated with participation in such groups. This paper presents the preliminary experience and results of a clinical trial testing the use of online support groups designed to both educate and provide social support to caregivers of hospice cancer patients. A detailed protocol outlines educational strategies, discussion questions, and a blueprint outlining ways to engage participants. A review of field notes completed by the interventionist reveal specific facilitation skills and strategies used to engage participants. Finally, preliminary analysis of 78 participants shows the group is having a statistically significant impact on the caregiver depression.
Collapse
Affiliation(s)
- Debra Parker Oliver
- Division of Palliative Medicine, Department of Medicine and Goldfar, Goldfarb School of Nursing, Washington University St Louis and Barnes Jewish Hospital, St. Louis, MO, USA
| | - Karla T Washington
- Division of Palliative Medicine, School of Medicine, Washington University St Louis, St. Louis, MO, USA
| | - Jacquelyn Benson
- Department of Human Development and Family Science, University of Missouri, Columbia, MO, USA
| | - Patrick White
- Division of Palliative Medicine, Department of Internal Medicine, School of Medicine, Washington University St Louis, St. Louis, MO, USA
| | - Dulce Cruz Oliver
- General Medicine Section of Palliative Medicine, John Hopkins Hospital, Baltimore, MD, USA
| | - Jamie B Smith
- Department of Family and Community Medicine, University of Missouri, Columbia, MO, USA
| | | | - Abeba Lakew
- Division of Palliative Medicine, Department of Medicine, Washington University St Louis, St. Louis, MO, USA
| | - Alexandra Lewis
- School of Social Work, University of Missouri, Columbia, MO, USA
| | - George Demiris
- Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
12
|
Washington KT, Demiris G, White P, Mathis HC, Forsythe JE, Parker Oliver D. A Goal-Directed Model of Collaborative Decision Making in Hospice and Palliative Care. J Palliat Care 2022; 37:120-124. [PMID: 34787009 PMCID: PMC9106802 DOI: 10.1177/08258597211049138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Hospice and palliative care teams face numerous barriers to the meaningful involvement of patients and families in medical decision making, which limits opportunities for exploration of the very values, preferences, and goals that ideally inform serious illness care. Researchers who develop and test interventions to address these barriers have noted the complementary utility of two existing models in supporting collaborative relationships between hospice and palliative care teams and the patients and families they serve: (1) the social problem-solving model, and (2) the integrative model of shared decision making in medical encounters. This paper describes the integration and extension of these two highly synergistic models, resulting in a goal-directed model of collaborative decision making in hospice and palliative care. Directions for practice innovation and research informed by the model are discussed at length.
Collapse
Affiliation(s)
| | - George Demiris
- Penn Integrates Knowledge (PIK) University Professor, University of Pennsylvania, USA
| | | | | | | | - Debra Parker Oliver
- Washington University in St. Louis, USA
- Barnes-Jewish College, Goldfarb School of Nursing, USA
| |
Collapse
|
13
|
Mixed methods analysis of hospice staff perceptions and shared decision making practices in hospice. Support Care Cancer 2022; 30:2679-2691. [PMID: 34825279 PMCID: PMC9067598 DOI: 10.1007/s00520-021-06631-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 10/16/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Shared decision making has been a long-standing practice in oncology and, despite a lack of research on the subject, is a central part of the philosophical foundation of hospice. This mixed methods study examined the perceptions of staff regarding shared decision making and their use of shared decision elements in hospice interdisciplinary team meetings. METHODS The revised Leeds Attitude to Concordance scale (LatConII) was used to measure the attitudes of hospice staff toward shared decision making. Field notes and transcripts of hospice interdisciplinary team meetings that included family caregivers as participants were coded to identify 9 theory-driven shared decision making elements. The results were mixed in a matrix analysis comparing attitudes with practice. Three transcripts demonstrate the variance in the shared decision making process between hospice teams. RESULTS Hospice staff reported overall positive views on shared decision making; however, these views differed depending on participants' age and position. The extent to which staff views were aligned with the observed use of shared decision making elements in hospice interdisciplinary team meetings varied. CONCLUSION Policy and practice conditions can make shared decision making challenging during hospice interdisciplinary team meetings despite support for the process by staff. TRIAL REGISTRATION This study is a sub-study of a parent study registered with clinicaltrials.gov (NCT02929108).
Collapse
|
14
|
Oliver DP, Benson JJ, Ulrich C, Washington KT, Rolbiecki AJ, White P, Smith JB, Lero C, Landon OJ, Demiris G. Perceived Benefits and Burdens of Participation for Caregivers of Cancer Patients in Hospice Clinical Trials: A Pilot Study. J Pain Symptom Manage 2021; 61:1147-1154. [PMID: 33166583 PMCID: PMC8552226 DOI: 10.1016/j.jpainsymman.2020.10.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 10/21/2020] [Accepted: 10/22/2020] [Indexed: 11/15/2022]
Abstract
CONTEXT Hospice is a service for those with a life expectancy of six months or less. Family caregivers suffer from depression and anxiety as they care for their loved one until they die. Little is known about how research participants decide to consent to participate in clinical trials in the hospice setting. OBJECTIVES This pilot study sought to answer two research questions: 1) In what way do demographic characteristics, mental health, and perceived caregiving experience impact the decision by caregivers to participate in hospice clinical trials? 2) In what ways do the perceived physical, psychological, economic, familial, and social dimensions of caregivers' lives influence their decision to participate in hospice clinical trials? METHODS The characteristics and stated reasons for consent of hospice caregivers participating in a clinical trial were compared with individuals who refused clinical trial consent and only consented to this pilot study. Demographic, mental health, and perceptions of caregiving experience were measured as influencers to the consent decision. Recruitment calls were recorded and coded using framework analysis to identify perceived benefits and burdens impacting the decision to consent to the clinical trial. RESULTS Overall, trial participants were more often adult children to the patient (55% vs. 21%, P = 0.005), younger (56 vs. 63 years, P = 0.04), and employed (47% vs. 24%, P = 0.02) as compared with those who did not consent to participate in the trial. Reported levels of depression, anxiety, and quality of life were not significantly different between those who chose to participate in the clinical trial and those who participated only in this pilot study; however, caregiver burden was higher for those consenting to the clinical trial (4.05 vs. 7.16, P < 0.0001). Perceived benefits expressed by both groups were largely psychological as participants felt positive about contributing to science. Burdens expressed by both groups were predominately physical as they related to hesitation to participate in the intervention because of technology or the burdens of caregiving. CONCLUSION The benefits and burdens model for clinical trial participation is applicable to the caregiver experience in the hospice setting. Understanding the perceptions and dimensions of benefits and burdens to potential study participants is critical to not only the intervention design but also the tailoring of recruitment contacts and informed consent process.
Collapse
Affiliation(s)
- Debra Parker Oliver
- Division of Palliative Medicine, Barnes Jewish College, Goldfarb School of Nursing, Washington University St Louis, Columbia, Missouri, USA.
| | - Jacquelyn J Benson
- Department of Human Development and Family Science, University of Missouri, Columbia, Missouri, USA
| | - Connie Ulrich
- Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Karla T Washington
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri, USA
| | - Abigail J Rolbiecki
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri, USA
| | - Patrick White
- Division of Palliative Medicine, Department of Internal Medicine, Stokes Family Endowed Chair in Palliative Medicine and Supportive Care, Washington University School of Medicine, St Louis, Missouri, USA
| | - Jamie B Smith
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri, USA
| | - Christina Lero
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri, USA
| | - Olivia J Landon
- Department of Human Development and Family Science, University of Missouri, Columbia, Missouri, USA
| | - George Demiris
- Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| |
Collapse
|
15
|
Gaps in Hospice and Palliative Care Research: A Scoping Review of the North American Literature. J Aging Res 2020; 2020:3921245. [PMID: 33204532 PMCID: PMC7661142 DOI: 10.1155/2020/3921245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 09/07/2020] [Accepted: 09/16/2020] [Indexed: 11/17/2022] Open
Abstract
Background The demand for hospice and palliative care is growing as a result of the increase of an aging population, which is most prominent in North America. Despite the importance of the topic and an increase in hospice and palliative care utilization, there still are gaps in research and evidence within the field. Aim To determine what gaps currently exist in hospice and palliative/end-of-life care research within the context of a North American setting to ensure that future directions are grounded in appropriate evidence. Methods Using Arksey and O'Malley's scoping review framework, six peer-reviewed, and four grey electronic literature databases in healthcare and the social sciences were searched in mid-2019. 111 full-text articles were retrieved, with 25 articles and reports meeting the inclusion criteria. Major themes were identified through thematic context analysis: (1) clinical, (2) system access to care, (3) research methodology, and (4) caregiving-related research gaps. Results Findings include strategies for engaging stakeholder organizations and funding agencies, implications for other stakeholder groups such as clinicians and researchers, and highlight implications for policy (e.g., national framework discussion) and practice (e.g., healthcare provider education and training and public awareness). Conclusion Reviewing and addressing targeted research gaps is essential to inform future directions in Canada and beyond.
Collapse
|
16
|
Lindley LC, Keim-Malpass J, Svynarenko R, Cozad MJ, Mack JW, Hinds PS. Pediatric Concurrent Hospice Care: A Scoping Review and Directions for Future Nursing Research. J Hosp Palliat Nurs 2020; 22:238-245. [PMID: 32282559 PMCID: PMC7716801 DOI: 10.1097/njh.0000000000000648] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In 2010, forgoing curative therapies were removed as a hospice eligibility criterion for children through section 2302 of the Patient Protection and Affordable Care Act called Concurrent Care for Children. Given that concurrent care is a federally mandated option for children and their families, no review of the science has been conducted. The purpose of this study was to systematically collect the evidence on concurrent hospice care, critically appraise the evidence, and identify areas for future nursing research. Of the 186 articles identified for review, 14 met the inclusion and exclusion criteria. Studies in this review described concurrent hospice care from a variety of perspectives: policy, legal, and ethics. However, only 1 article evaluated the impact of concurrent hospice care on outcomes, whereas several studies explained clinical and state-level implementation. There is a need for further studies that move beyond conceptualization and generate baseline and outcomes data. Understanding the effectiveness of concurrent hospice care might provide important information for future nursing research. The approaches used to disseminate and implement concurrent hospice care at state, provider, and family levels should be explored.
Collapse
|