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Wen FH, Hsieh CH, Su PJ, Shen WC, Hou MM, Chou WC, Chen JS, Chang WC, Tang ST. Factors Associated With Family Surrogate Decisional-Regret Trajectories. J Pain Symptom Manage 2024; 67:223-232.e2. [PMID: 38036113 DOI: 10.1016/j.jpainsymman.2023.11.013] [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: 07/05/2023] [Revised: 10/09/2023] [Accepted: 11/17/2023] [Indexed: 12/02/2023]
Abstract
CONTEXT/OBJECTIVES The scarce research on factors associated with surrogate decisional regret overlooks longitudinal, heterogenous decisional-regret experiences and fractionally examines factors from the three decision-process framework stages: decision antecedents, decision-making process, and decision outcomes. This study aimed to fill these knowledge gaps by focusing on factors modifiable by high-quality end-of-life (EOL) care. METHODS This observational study used a prior cohort of 377 family surrogates of terminal-cancer patients to examine factors associated with their membership in the four preidentified distinct decisional-regret trajectories: resilient, delayed-recovery, late-emerging, and increasing-prolonged trajectories from EOL-care decision making through the first two bereavement years by multinomial logistic regression modeling using the resilient trajectory as reference. RESULTS Decision antecedent factors: Financial sufficiency and heavier caregiving burden increased odds for the delayed-recovery trajectory. Spousal loss, higher perceived social support during an EOL-care decision, and more postloss depressive symptoms increased odds for the late-emerging trajectory. More pre- and postloss depressive symptoms increased odds for the increasing-prolonged trajectory. Decision-making process factors: Making an anticancer treatment decision and higher decision conflict increased odds for the delayed-recovery and increasing-prolonged trajectories. Making a life-sustaining-treatment decision increased membership in the three more profound trajectories. Decision outcome factors: Greater surrogate appraisal of quality of dying and death lowered odds for the three more profound trajectories. Patient receipt of anticancer or life-sustaining treatments increased odds for the late-emerging trajectory. CONCLUSION Surrogate membership in decisional-regret trajectories was associated with decision antecedent, decision-making process, and decision outcome factors. Effective interventions should target identified modifiable factors to address surrogate decisional regret.
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Affiliation(s)
- Fur-Hsing Wen
- Department of International Business (F.H.W.), Soochow University, Taipei, Taiwan
| | - Chia-Hsun Hsieh
- College of Medicine (C.H.H., W.C.C., J.S.C., W.C.C.), Chang Gung University, Tao-Yuan, Taiwan; Division of Hematology-Oncology (C.H.H.), Department of Internal Medicine, New Taipei Municipal TuCheng Hospital, New Taipei City, Taiwan
| | - Po-Jung Su
- Division of Hematology-Oncology (P.J.S., W.C.S., M.M.H., W.C.C., J.S.C., W.C.C., S.T.T.), Chang Gung Memorial Hospital, Tao-Yuan, Taiwan
| | - Wen-Chi Shen
- Division of Hematology-Oncology (P.J.S., W.C.S., M.M.H., W.C.C., J.S.C., W.C.C., S.T.T.), Chang Gung Memorial Hospital, Tao-Yuan, Taiwan
| | - Ming-Mo Hou
- Division of Hematology-Oncology (P.J.S., W.C.S., M.M.H., W.C.C., J.S.C., W.C.C., S.T.T.), Chang Gung Memorial Hospital, Tao-Yuan, Taiwan
| | - Wen-Chi Chou
- College of Medicine (C.H.H., W.C.C., J.S.C., W.C.C.), Chang Gung University, Tao-Yuan, Taiwan; Division of Hematology-Oncology (P.J.S., W.C.S., M.M.H., W.C.C., J.S.C., W.C.C., S.T.T.), Chang Gung Memorial Hospital, Tao-Yuan, Taiwan
| | - Jen-Shi Chen
- College of Medicine (C.H.H., W.C.C., J.S.C., W.C.C.), Chang Gung University, Tao-Yuan, Taiwan; Division of Hematology-Oncology (P.J.S., W.C.S., M.M.H., W.C.C., J.S.C., W.C.C., S.T.T.), Chang Gung Memorial Hospital, Tao-Yuan, Taiwan
| | - Wen-Cheng Chang
- College of Medicine (C.H.H., W.C.C., J.S.C., W.C.C.), Chang Gung University, Tao-Yuan, Taiwan; Division of Hematology-Oncology (P.J.S., W.C.S., M.M.H., W.C.C., J.S.C., W.C.C., S.T.T.), Chang Gung Memorial Hospital, Tao-Yuan, Taiwan
| | - Siew Tzuh Tang
- Division of Hematology-Oncology (P.J.S., W.C.S., M.M.H., W.C.C., J.S.C., W.C.C., S.T.T.), Chang Gung Memorial Hospital, Tao-Yuan, Taiwan; School of Nursing, Medical College (S.T.T.), Chang Gung University, Tao-Yuan, Taiwan; Department of Nursing (S.T.T.), Chang Gung Memorial Hospital at Kaohsiung, Taiwan; Department of Nursing (S.T.T.), Chang Gung University of Science and Technology, Tao-Yuan, Taiwan.
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Hirayama K, Kuribara T, Oshikiri M. Experiences of the older spousal caregivers of patients with cancer during palliative chemotherapy: a qualitative descriptive study. BMC Palliat Care 2023; 22:188. [PMID: 37993823 PMCID: PMC10666444 DOI: 10.1186/s12904-023-01313-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 11/17/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Several studies have characterized the experiences of family members caring for patients undergoing chemotherapy; however, information about the experiences of older spousal caregivers with intensive caregiving burdens is unclear. Recently, more older patients have been diagnosed with cancer due to the aging population worldwide. Therefore, this study evaluated the patterns in the experiences of older spousal caregivers of patients undergoing palliative chemotherapy for advanced cancer. METHODS Qualitative research using semi-structured interviews was used in this study involving 10 older spousal caregivers of patients undergoing palliative chemotherapy at a hospital providing advanced cancer care in Japan. The data obtained were analyzed qualitatively and inductively using thematic analysis by Braun and Clarke. RESULTS Four themes were identified from the narratives of the participants in this study. The first theme was "getting used to living with the disease," indicating that the older spouses gradually became accustomed to living with the patient through continued caregiving. The second theme was "deepening view of life and death," indicating that the older spouses' views of life and death were deepened by being confronted with patients' quality of life until death. The third theme was "anxious about the future," indicating the fear regarding the patient's progressive diseases and anxiety pertaining to continuing care for the patient while dealing with their health problems. The final theme was "desire for a better rest of life," indicating that the couple felt their bond was strengthened through caregiving and wishes to live well for the rest of their lives. CONCLUSIONS The patterns in the experience of older spousal caregivers caring for patients undergoing palliative chemotherapy indicated an aspect of rebuilding their lives as they became accustomed to caregiving, while strengthening their marital bond. The caregiving process involved a mix of emotions, including anxiety about the spousal caregiver's health problems worsening. However, the caregivers recognized the value of their remaining time. Therefore, they had deep concern for the patient's comfort, concealing their feelings so that the patient would feel comfortable. This study can contribute to understanding the challenges faced and support needed by older spousal caregivers.
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Affiliation(s)
- Kengo Hirayama
- School of Nursing, Sapporo City University, Kita 11, Nishi 13, Chuo-ku, Sapporo, Japan.
| | - Tomoki Kuribara
- School of Nursing, Sapporo City University, Kita 11, Nishi 13, Chuo-ku, Sapporo, Japan
| | - Miho Oshikiri
- Department of Nursing, Sapporo Sato Hospital, 4-10-15, Fushiko 2, Higashi-ku, Sapporo, Japan
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Mohamed Hussin NA, Mohd Sabri NS. A qualitative exploration of the dynamics of guilt experience in family cancer caregivers. Support Care Cancer 2023; 31:659. [PMID: 37889352 PMCID: PMC10611882 DOI: 10.1007/s00520-023-08060-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 09/21/2023] [Indexed: 10/28/2023]
Abstract
Caregiving for cancer patients can cause stress among family caregivers. Caregiving stress is also associated with guilt as they cannot provide adequate care for cancer patients. However, guilt among family caregivers of cancer patients is poorly understood. This qualitative study aimed to explore the dynamics of guilt feelings in families that care for cancer patients. This study involved 45 family caregivers of cancer patients. Thematic data analysis was conducted. There were six themes emerging. Caregiving can be challenging, guilt and blame, guilt due to lack of self-capacity, guilt for neglecting others, no guilt at all, and discussion of guilt and blame as a caregiver. This study offers insight into social workers regarding the challenges and experiences faced by family caregivers of cancer patients. Appropriate health interventions and support should be provided to family caregivers of cancer patients to improve their well-being.
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Ghezeljeh TN, Seyedfatemi N, Bolhari J, Kamyari N, Rezaei M. Effects of family-based dignity intervention and expressive writing on anticipatory grief in family caregivers of patients with cancer: a randomized controlled trial. BMC Psychiatry 2023; 23:220. [PMID: 37005577 PMCID: PMC10068160 DOI: 10.1186/s12888-023-04715-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 03/23/2023] [Indexed: 04/04/2023] Open
Abstract
Family caregivers of dying cancer patients may suffer from grief experiences and bereavement complications. Previous studies have proposed some psycho-emotional interventions for the management of these complications. However, little attention has been given to family-based dignity intervention and expressive writing. This study was conducted to examine the effects of family-based dignity intervention and expressive writing, combined and alone, on anticipatory grief in family caregivers of dying cancer patients. This was a randomized controlled trial, in which 200 family caregivers of dying cancer patients were randomly assigned to four intervention groups: family-based dignity intervention (n = 50), expressive writing intervention (n = 50), combined family-based single dignity intervention and expressive writing (n = 50), and control group (n = 50). In three times (baseline, 1 week, and 2 weeks after the interventions), anticipatory grief was assessed by a 13-item anticipatory grief scale (AGS). Finally, we found a significant reducing effect of family-based dignity intervention on AGS (-8.12 ± 1.53 vs. -1.57 ± 1.52, P = 0.01) and its subscales including behavioral (-5.92 ± 0.97 vs. -2.17 ± 0.96, P = 0.04) and emotional (-2.38 ± 0.78 vs. 0.68 ± 0.77, P = 0.03) subscales compared to the control group. However, no significant effect was seen for expressive writing intervention and combined interventions of expressive writing and family-based dignity intervention. In conclusion, family-based dignity intervention may be a safe intervention for relieving anticipatory grief among family caregivers of dying cancer patients. Additional clinical trials are needed to confirm our findings. Registration number: IRCT20210111050010N1. Trial registration date:2021-02-06.
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Affiliation(s)
- Tahereh Najafi Ghezeljeh
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Naima Seyedfatemi
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Jafar Bolhari
- Spiritual Health Research Center, School of Behavioral Sciences and Mental Health, University of Medical Sciences, Tehran, Iran
| | - Naser Kamyari
- Department of Public Health, School of Health, Abadan University of Medical Sciences, Abadan, Iran
| | - Masoud Rezaei
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran.
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Weiss CR, Baker C, Gillespie A, Jones J. Ambiguous loss in family caregivers of loved ones with cancer, a synthesis of qualitative studies. J Cancer Surviv 2023; 17:484-498. [PMID: 36396909 DOI: 10.1007/s11764-022-01286-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: 06/07/2022] [Accepted: 10/24/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE The purpose of this synthesis of qualitative studies is to explore manifestations of ambiguous loss within the lived experiences of family caregivers (FCG) of loved ones with cancer. Grief and loss are familiar companions to the family caregivers of loved ones with cancer. Anticipatory loss, pre-loss grief, complicated grief, and bereavement loss have been studied in this caregiver population. It is unknown if family caregivers also experience ambiguous loss while caring for their loved ones along the uncertain landscape of the cancer illness and survivorship trajectory. METHODS We conducted a four-step qualitative meta-synthesis of primary qualitative literature published in three databases between 2008 and 2021. Fourteen manuscripts were analyzed using a qualitative appraisal tool and interpreted through thematic synthesis and reciprocal translation. RESULTS Five themes were derived, revealing FCGs appreciate change in their primary relationship with their loved ones with cancer, uncertainty reconciling losses, an existence that is static in time, living with paradox, and disenfranchised grief. The results of this synthesis of qualitative studies complement the descriptors of ambiguous loss presented in previous research. CONCLUSIONS The results of this synthesis of qualitative studies complement the descriptors of ambiguous loss presented in previous theoretical and clinical research. By understanding ambiguous loss as a complex and normal human experience of cancer FCGs, oncology and palliative care healthcare providers can introduce interventions and therapeutics to facilitate caring-healing and resiliency. IMPLICATIONS FOR CANCER SURVIVORS Untreated ambiguous loss can result in a decrease in wellbeing, loss of hope, and loss of meaning in life. It is imperative that cancer FCGs experiencing ambiguous loss are recognized and supported so that they may live well in the family disease of cancer.
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Affiliation(s)
- Charlotte R Weiss
- College of Nursing, University of Colorado, Denver-Anschutz Medical Campus, Denver, CO, USA.
- , Wilmington, USA.
| | - Christina Baker
- College of Nursing, University of Colorado, Denver-Anschutz Medical Campus, Denver, CO, USA
| | - Anne Gillespie
- College of Nursing, University of Colorado, Denver-Anschutz Medical Campus, Denver, CO, USA
| | - Jacqueline Jones
- College of Nursing, University of Colorado, Denver-Anschutz Medical Campus, Denver, CO, USA
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Shoults CC, Rutherford MW, Kemp AS, Addicott MA, Brown A, Greene CJ, Hayes CJ, Gan JM, Larson-Prior LJ, Bona JP. Analysis of Caregiver Burden Expressed in Social Media Discussions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1933. [PMID: 36767297 PMCID: PMC9915402 DOI: 10.3390/ijerph20031933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/16/2023] [Accepted: 01/18/2023] [Indexed: 06/18/2023]
Abstract
Almost 40% of US adults provide informal caregiving, yet research gaps remain around what burdens affect informal caregivers. This study uses a novel social media site, Reddit, to mine and better understand what online communities focus on as their caregiving burdens. These forums were accessed using an application programming interface, a machine learning classifier was developed to remove low information posts, and topic modeling was applied to the corpus. An expert panel summarized the forums' themes into ten categories. The largest theme extracted from Reddit's forums discussed the personal emotional toll of being a caregiver. This was followed by logistic issues while caregiving and caring for parents who have cancer. Smaller themes included approaches to end-of-life care, physical equipment needs when caregiving, and the use of wearables or technology to help monitor care recipients. The platform often discusses caregiving for parents which may reflect the age of Reddit's users. This study confirms that Reddit forums are used for caregivers to discuss the burdens associated with their role and the types of stress that can result from informal caregiving.
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Affiliation(s)
- Catherine C. Shoults
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Michael W. Rutherford
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Aaron S. Kemp
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Merideth A. Addicott
- Department of Physiology and Pharmacology, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
| | - Aliza Brown
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Carolyn J. Greene
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Corey J. Hayes
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
- VA HSR&D COIN Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock, AR 72205, USA
| | - Jennifer M. Gan
- Department of Medical Humanities and Bioethics, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Linda J. Larson-Prior
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
- Department of Neurobiology and Developmental Sciences, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Jonathan P. Bona
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
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Khan KI, Sabir QUA, Shafqat A, Aslam M. Exploring the psychological and religious perspectives of cancer patients and their future financial planning: a Q-methodological approach. Palliat Care 2022; 21:186. [PMID: 36253745 PMCID: PMC9578276 DOI: 10.1186/s12904-022-01079-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 10/05/2022] [Accepted: 10/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cancer patients are often hesitant to talk about their mental health, religious beliefs regarding the disease, and financial issues that drain them physically and psychologically. But there is a need to break this taboo to understand the perceptions and behaviours of the patients. Previous studies identified many psychological factors that are bothering cancer patients. However, it still requires exploring new elements affecting their mental and physical health and introducing new coping strategies to address patients' concerns. METHODS The current study aims to identify cancer patients' perceived attitudes towards the severity of illness, understand their fears, tend towards religion to overcome the disease, and future financial planning by using a Q-methodological approach. Data were collected in three steps from January-June 2020, and 51 cancer patients participated in the final stage of Q-sorting. RESULTS The findings of the study are based on the principal component factor analysis that highlighted three essential factors: (1) feelings, (2) religious beliefs about the acceptance of death, and (3) their future personal and financial planning. Further, the analysis shows that the patients differ in their beliefs, causes and support that they received as a coping mechanism. CONCLUSION This study explains cancer patients' psychological discomfort and physical pain but cannot relate it to co-morbidities. Q methodology allows the contextualization of their thoughts and future planning in different sets, like acceptance of death, combating religion's help, and sharing experiences through various platforms. This study will help health professionals derive new coping strategies for treating patients and financial managers to design insurance policies that help them to share their financial burdens.
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Affiliation(s)
- Kanwal Iqbal Khan
- Management Sciences Department, New Campus, University of Engineering and Technology, Kala Shah Kaku, Pakistan
| | - Qurat Ul An Sabir
- School of Statistics, Minhaj University Lahore, Lahore, Pakistan.,Biofluids and Biosystems Modelling Lab (BBML), Department of Engineering, Faculty of Agriculture, Dalhousie University, Nova, Scotia, Canada
| | - Ambreen Shafqat
- Department of Basic Sciences, School of Mathematics and Statistics, Riphah International University, Islamabad, Pakistan
| | - Muhammad Aslam
- Department of Statistics, Faculty of Science, King Abdulaziz University, 21551, Jeddah, Saudi Arabia.
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Family Caregivers' Experiences of Caring for Advanced Cancer Patients: A Qualitative Systematic Review and Meta-synthesis. Cancer Nurs 2022:00002820-990000000-00028. [PMID: 35482525 DOI: 10.1097/ncc.0000000000001104] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Advanced cancers qualify as severe stressors to family caregivers (FCGs), which can negatively impact caregivers' psychological and physical well-being because of their association with high symptom burden, distress, and poor prognosis. OBJECTIVE This review aims to synthesize FCGs' experiences of caring for advanced cancer patients using a qualitative systematic review method. METHODS A comprehensive search was conducted in 7 databases from inception until July 2020. Two reviewers independently screened and assessed each study using Joanna Briggs Institute instruments and subsequently undertook the meta-aggregation approach to synthesize findings. RESULTS A total of 26 studies were included, refined to 37 findings, and integrated into 9 categories and 5 synthesized findings. When a loved one with advanced cancer faced deterioration near the end of their life, FCGs showed a tremendous sense of responsibility for care and concerted great efforts to alleviate their loved one's suffering while lacking effective professional support. Cultural beliefs had a great impact on FCGs' responsibility and role recognition. Ultimately, the caregiving helped FCGs achieve personal transcendence inherent in their unique experience. CONCLUSIONS Caring for advanced cancer patients is a unique, culture-specific experience marked by struggle. Effective professional support, including early palliative care, should be considered to improve the FCGs' experience of caring for advanced cancer patients. Cultural beliefs should be considered to understand and develop appropriate strategies to support FCGs. IMPLICATIONS FOR PRACTICE Healthcare providers need to ensure that individualized, multifaceted interventions considering FCGs' needs are delivered at the optimal time with the appropriate approach.
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Kogan N, Tolley M, Cohen R. Family caregivers support their patient's decision to participate in a phase 1 clinical trial: Weighing the pros and cons, bearing the costs. Psychooncology 2022; 31:1374-1380. [PMID: 35460308 DOI: 10.1002/pon.5942] [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: 11/03/2021] [Revised: 02/24/2022] [Accepted: 04/06/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVES When patients with advanced cancer pursue phase 1 clinical trials, family caregivers are impacted as they adopt new roles and responsibilities in time-pressured, uncertain circumstances. This study explored the nature of the caregivers' participation in patients' decision to pursue phase 1 clinical trials and the early impact of the decision on the caregiver. METHODS Semi-structured interviews were conducted with 19 family caregivers of advanced cancer patients who had agreed to participate in phase 1 clinical trials. They were coded for information about the caregiver's relationship with the patient, typical style of decision-making together, understanding of the patient's prognosis and trial, contributions to decision-making and the initial impacts of the trial on the caregiver. Codes illuminating the research questions were grouped into categories and themes, compared across transcripts and examined against the literature. RESULTS Caregivers unequivocally supported the patients' decision to pursue the phase 1 trial as they hoped that the patient would derive medical benefit from the trial. They withheld their opinions and fears about the trial from the patients to support patient autonomy during the decision-making process. The patient's decision to participate increased the caregivers' burdens and deprived them of time spent on pleasurable activities at end of life. CONCLUSIONS Respecting the patients' personal autonomy, caregivers supported the trial, despite the complex caregiving required. As the success of phase 1 trials relies on caregiver involvement, it is imperative that healthcare professionals be sensitized to the support needs of these caregivers.
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Affiliation(s)
- Naomi Kogan
- Louise Granofsky Psychosocial Oncology Program, Segal Cancer Centre, Sir Mortimer B. Davis Jewish General Hospital, Montreal, Quebec, Canada
| | | | - Robin Cohen
- Departments of Oncology and Medicine, McGill University, and Lady Davis Research Institute, Sir Mortimer B. Davis Jewish General Hospital, Montreal, Quebec, Canada
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Poor E, Chan YN, Iadonisi K, Tan K, Leak Bryant A. Exploring Experiences of Bereaved Caregivers of Older Adult Patients With Acute Myeloid Leukemia. Clin J Oncol Nurs 2022; 26:135-139. [PMID: 35302558 DOI: 10.1188/22.cjon.135-139] [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: 01/19/2023]
Abstract
Caregivers of older adults with acute myeloid leukemia (AML) are requiring more support now that novel, nonintensive therapies, such as hypomethylating agents and venetoclax, are shifting the burden of care to the outpatient setting. Early findings from a larger study describe supportive care needs from the perspective of bereaved caregivers that align with existing research, informing the development of best practices for oncology nurses who support caregivers of older adults with AML.
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Affiliation(s)
| | | | | | - Kelly Tan
- University of North Carolina at Chapel Hill
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11
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Abstract
Informal caregivers invest a significant amount of time and effort to provide cancer patients with physical, psychological, information, and social support. These challenging tasks can harm their own health and well-being, while a series of social-ecological factors may also influence the outcomes of cancer caregiving. Several instruments have been developed to help clinicians and researchers understand the multi-dimensional needs and concerns of caregivers. A growing body of evidence indicates that supportive interventions including psychoeducation, skills training, and therapeutic counseling can help improve the burden, information needs, coping strategies, physical functioning, psychological well-being, and quality of life of caregivers. However, there is difficulty in translating research evidence into practice. For instance, some supportive interventions tested in clinical trial settings are regarded as inconsistent with the actual needs of caregivers. Other significant considerations are the lack of well-trained interdisciplinary teams for supportive care provision and insufficient funding. Future research should include indicators that can attract decision-makers and funders, such as improving the efficient utilization of health care services and satisfaction of caregivers. It is also important for researchers to work closely with key stakeholders, to facilitate evidence dissemination and implementation, to benefit caregivers and the patient.
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Epstein RM. Facing epistemic and complex uncertainty in serious illness: The role of mindfulness and shared mind. PATIENT EDUCATION AND COUNSELING 2021; 104:2635-2642. [PMID: 34334265 DOI: 10.1016/j.pec.2021.07.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 07/15/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Epistemic uncertainty refers to situations in which available evidence is insufficient or unreliable, often accompanied by complexity due to novel contexts, multifactorial causation, and emerging options (the "unknowable unknown"). It stands in contrast to aleatory uncertainty where probabilities are known, and potential benefits and harms can be calculated and presented graphically (the "knowable unknown"). DISCUSSION Epistemic uncertainty is common, and encompasses uncertainty about the nature of the illness, whom to entrust with one's care, and one's ability to adapt and cope. Communication about the "unknowable unknown" occurs infrequently and ineffectively, and there is little research on improving communication in the face of epistemic and complex uncertainty. Terror Management Theory (TMT) predicts that in encountering serious illness, people engage in "worldview defense" - suppressing death-related thoughts, affiliating with like-minded others, and developing cognitive rigidity and intolerance of information that challenges their worldview. Mindfulness is associated with diminished defensive worldview reactions and cognitive rigidity, and greater tolerance of ambiguity. Shared mind encompasses shared understanding and affective attunement. CONCLUSION For clinicians and seriously ill patients facing epistemic uncertainty, psychologically-informed interventions that promote mindfulness and shared mind offer promise in promoting open discussions regarding prognostic uncertainty, advance care planning, and treatment decision-making.
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Affiliation(s)
- Ronald M Epstein
- Center for Communication and Disparities Research, Department of Family Medicine, and Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
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13
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Seyedfatemi N, Ghezeljeh TN, Bolhari J, Rezaei M. Effects of family-based dignity intervention and expressive writing on anticipatory grief of family caregivers of patients with cancer: a study protocol for a four-arm randomized controlled trial and a qualitative process evaluation. Trials 2021; 22:751. [PMID: 34711262 PMCID: PMC8552199 DOI: 10.1186/s13063-021-05718-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 10/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Family caregivers of dying cancer patients are affected by grief experiences and bereavement complications. Several approaches such as psycho-emotional care and an increase in spirituality have been suggested to diminish these complications. However, the knowledge about the effects of family-based dignity intervention and expressive writing on anticipatory grief in family caregivers of dying cancer patients is limited. This is a study protocol describing a hospital-based mixed-methods study on the effects of family-based dignity intervention and expressive writing on anticipatory grief in family caregivers of dying cancer patients. METHODS This mixed-methods study will be done in an embedded explanatory design with two quantitative and qualitative phases. In the first phase (quantitative), a randomized clinical trial will be done, in which 200 family caregivers of dying cancer patients will be randomly assigned to one of the four groups: family-based single dignity intervention (group 1), expressive writing intervention (group 2), combined family-based single dignity intervention and expressive writing (group 3), and control (group 4). At baseline, 1 week and 2 weeks after the interventions, anticipatory grief will be assessed by a 13-item anticipatory grief scale. After the quantitative phase, the qualitative phase will be conducted through the conventional content analysis approach of Granheim and Lundman, in which an individual semi-structured interview will be taken from participants in the first phase to collect data on their experiences on interventions. Finally, data from the quantitative and qualitative phases will be analyzed and discussed. DISCUSSION Family caregivers of dying cancer patients usually experience depression, anxiety, and psychological distress due to isolation and inadequate social support. Psychological interventions such as dignity and expressive writing interventions may help caregivers to obtain a better understanding of themselves and to increase their abilities to cope with caregiving difficulties. Therefore, there is a need for a comprehensive study confirming the effects of mentioned interventions on family caregivers of dying cancer patients. TRIAL REGISTRATION Iranian Registry of Clinical Trials ( www.irct.ir ) identifier: IRCT20210111050010N1. Date of trial registration: Feb 6, 2021. This is the first version of this protocol.
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Affiliation(s)
- Naima Seyedfatemi
- Nursing Care Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Tahereh Najafi Ghezeljeh
- Nursing Care Research Center, Iran University of Medical Sciences, Tehran, Iran.,Nursing Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Jafar Bolhari
- Spiritual Health Research Center, School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran
| | - Masoud Rezaei
- Nursing Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran.
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14
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Dealing with Family Conflicts in Decision-making in End-of-Life Care of Advanced Cancer Patients. Curr Oncol Rep 2021; 23:124. [PMID: 34448971 DOI: 10.1007/s11912-021-01122-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE OF REVIEW The family plays a significant role in end-of-life care and decision-making with advanced cancer patients. This non-systematic review aims to summarize the family role and possible emerging conflicts and problems related to family involvement in decisions with advanced cancer patients. RECENT FINDINGS Four important domains were identified: (1) discordance between patients and caregivers' understanding of prognosis and goals of care; (2) internal family conflicts; (3) cultural differences regarding the role of the family in end-of life decision-making; (4) the burden on caregivers through caring for cancer patients. Based on the findings, we formulated some implications to consider for clinical practice. We suggest to involve the family in decision-making, to ascertain patients' wish for family involvement and if necessary, taking a mediator role between patients and their caregivers; to be aware of "invisible" family influence on patients' decisions; to assess systematically family burden and needs; to provide timely information, psychological support interventions and palliative care.
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15
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Abstract
PURPOSE OF REVIEW Our goal was to provide healthcare professionals (HCPs) with evidence-based data about what can be done to handle prognostic discussions with empathy. RECENT FINDINGS First, disclosing prognosis involves a good reason to do so and making sure that the patient will be able to process the discussion. Second, communication tips are given for the three dimensions of empathy: "establishing rapport with the patient," which should not be overlooked; the emotional dimension, which involves an accurate understanding of the patient and communication skills; and the "active/positive" dimension which is about giving hope, explaining things clearly and helping patients take control with shared decision-making and a planned future. Although communication tips are helpful, empathy training should be based more on the development of HCPs' emotional skills, in order to help them regulate their emotions and thus be more comfortable with those of patients and families. Furthermore, research into empathy toward minorities and relatives is needed.
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Affiliation(s)
- Sophie Lelorain
- Univ. Lille, CNRS, UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives, F-59000, Lille, France.
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16
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Fox JA, Rosenberg J, Ekberg S, Langbecker D. Palliative care in the context of immune and targeted therapies: A qualitative study of bereaved carers' experiences in metastatic melanoma. Palliat Med 2020; 34:1351-1360. [PMID: 32338133 DOI: 10.1177/0269216320916154] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Immune and targeted therapies continue to transform treatment outcomes for those with metastatic melanoma. However, the role of palliative care within this treatment paradigm is not well understood. AIM To explore bereaved carers' experiences of immune and targeted therapy treatment options towards end of life for patients with metastatic melanoma. DESIGN An interpretive, qualitative study using a social constructivist framework was utilised. Interviews were recorded, transcribed and analysed using grounded theory methods. SETTING/PARTICIPANTS Participants (n = 20) were bereaved carers of patients who had received some form of immune and/or targeted therapy at one of three Australian metropolitan melanoma treatment centres. RESULTS Carers struggled to reconcile the positive discourse around the success of immune and targeted therapies in achieving long-term disease control, and the underlying uncertainty in predicting individual responses to therapy. Expectations that immune and targeted therapies necessarily provide longer-term survival were evident. Difficulty in prognostication due to clinical uncertainty and a desire to maintain hope resulted in lack of preparedness for treatment failure and end of life. CONCLUSION Immune and targeted therapies have resulted in increased prognostic challenges. There is a need to engage, educate and support patients and carers to prepare and plan amid these challenges. Educational initiatives must focus on improving communication between patients, carers and clinicians; the differences between palliative and end-of-life care; and increased competency of clinicians in having goals-of-care discussions. Clinicians must recognise and communicate the benefit of collaborative palliative care to meet patient and family needs holistically and comprehensively.
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Affiliation(s)
- Jennifer A Fox
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - John Rosenberg
- University of the Sunshine Coast, Caboolture, QLD, Australia
| | - Stuart Ekberg
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, QLD, Australia
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17
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Soto-Rubio A, Valero-Moreno S, Díaz JL, Andreu Y, Pérez-Marín M. COPD at the end of life: Predictors of the emotional distress of patients and their family caregivers. PLoS One 2020; 15:e0240821. [PMID: 33064747 PMCID: PMC7567384 DOI: 10.1371/journal.pone.0240821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 10/02/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Few studies have focused on patients' emotional distress with end-stage chronic obstructive pulmonary disease (COPD) and their main family caregivers. METHODS Cross-sectional data about emotional, functional, and burden-related variables were collected from 85 patients with end-stage COPD and their 85 respective main family caregivers to determine the variables that could predict their emotional well-being. Descriptive analyses, comparison of means, hierarchical regression models, and comparative quali-quantitative analyses were carried out. RESULTS Data show that the great majority of patients with COPD spend years with this diagnosis, and have been admitted to the hospital several times in advance stage of illness the previous year of the moment of end-of-life stage. Furthermore, only a tiny percentage of the patients were functionally independent in the advanced stage of illness. CONCLUSIONS The emotional distress and the burden of the family caregiver play an essential role in the distress of the patient, in conjunction with the patient's own functional independence and the time living with the disease, and comorbidity. On the other hand, variables of the patient, such as time since diagnosis, number of hospital admissions, comorbidity, functional dependence, and emotional distress, play an important role in the family caregiver's emotional distress and burden. Understanding how these variables are related is key to designing appropriate programs to reduce the emotional distress the patients with COPD at the end of life and their family caregivers.
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Affiliation(s)
- Ana Soto-Rubio
- Personality, Assessment, and Psychological Treatments Department, Faculty of Psychology, University of Valencia, Valencia, Spain
| | - Selene Valero-Moreno
- Personality, Assessment, and Psychological Treatments Department, Faculty of Psychology, University of Valencia, Valencia, Spain
| | - José Luis Díaz
- Air Liquide Healthcare, Valencia, Spain
- Respiratory Care Unit, Hospital Clínico Universitario de Valencia, Valencia, Spain
- International University of Valencia (VIU), Valencia, Spain
| | - Yolanda Andreu
- Personality, Assessment, and Psychological Treatments Department, Faculty of Psychology, University of Valencia, Valencia, Spain
| | - Marián Pérez-Marín
- Personality, Assessment, and Psychological Treatments Department, Faculty of Psychology, University of Valencia, Valencia, Spain
- * E-mail:
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18
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Abstract
OBJECTIVES Forecasting survival in cancer is a particularly challenging facet of oncological work and can involve complex interactions with patients and their families. While there is considerable research on patient experiences of being provided with, or becoming aware of, their prognosis, there has been much less emphasis placed on the experiences of caregivers. The aim of this paper was to examine caregivers' experiences of prognosis. DESIGN This study used semistructured interviews; transcripts were analysed thematically using the framework approach. These data are part of a larger research project focused on experiences of cancer survivorship. SETTING Recruitment was from two metropolitan hospitals in Queensland, Australia. PARTICIPANTS 50 caregivers of patients living with cancer and receiving treatment at two metropolitan hospitals (32% male, 68% female) participated in this study. RESULTS Four main themes were identified: (1) caregivers' uncertainty around the meaning and implications of prognosis, (2) caregivers' sense of exclusion in prognostic conversations, (3) the practice of situating prognosis within a context of hope and (4) the precarious balance between realism, optimism and strategic 'ignorance'. CONCLUSIONS Caregivers are in many respects the unseen third party of prognostic communication. Developing a better understanding of caregivers' perceptions of prognosis, including how this may be challenged, accepted or otherwise, is important in engaging caregivers in the process of communicating prognostic information. Facilitating greater participation by caregivers in prognostic conversations could potentially address evident complexities and even improve the experiences of all stakeholders in cancer care settings.
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Affiliation(s)
- Sophie Lewis
- Centre for Social Research in Health, The University of New South Wales, Sydney, New South Wales, Australia
| | - Alex Broom
- School of Social and Political Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Katherine Kenny
- School of Social and Political Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Emma Kirby
- Centre for Social Research in Health, The University of New South Wales, Sydney, New South Wales, Australia
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19
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Loh KP, Soto Pérez de Celis E, Duberstein PR, Culakova E, Epstein RM, Xu H, Kadambi S, Flannery M, Magnuson A, McHugh C, Trevino KM, Tuch G, Ramsdale E, Yousefi-Nooraie R, Sedenquist M, Liu JJ, Melnyk N, Geer J, Mohile SG. Patient and caregiver agreement on prognosis estimates for older adults with advanced cancer. Cancer 2020; 127:149-159. [PMID: 33036063 PMCID: PMC7736110 DOI: 10.1002/cncr.33259] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 07/06/2020] [Accepted: 08/07/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Disagreements between patients and caregivers about treatment benefits, care decisions, and patients' health are associated with increased patient depression as well as increased caregiver anxiety, distress, depression, and burden. Understanding the factors associated with disagreement may inform interventions to improve the aforementioned outcomes. METHODS For this analysis, baseline data were obtained from a cluster-randomized geriatric assessment trial that recruited patients aged ≥70 years who had incurable cancer from community oncology practices (University of Rochester Cancer Center 13070; Supriya G. Mohile, principal investigator). Patient and caregiver dyads were asked to estimate the patient's prognosis. Response options were 0 to 6 months, 7 to 12 months, 1 to 2 years, 2 to 5 years, and >5 years. The dependent variable was categorized as exact agreement (reference), patient-reported longer estimate, or caregiver-reported longer estimate. The authors used generalized estimating equations with multinomial distribution to examine the factors associated with patient-caregiver prognostic estimates. Independent variables were selected using the purposeful selection method. RESULTS Among 354 dyads (89% of screened patients were enrolled), 26% and 22% of patients and caregivers, respectively, reported a longer estimate. Compared with dyads that were in agreement, patients were more likely to report a longer estimate when they screened positive for polypharmacy (β = 0.81; P = .001), and caregivers reported greater distress (β = 0.12; P = .03). Compared with dyads that were in agreement, caregivers were more likely to report a longer estimate when patients screened positive for polypharmacy (β = 0.82; P = .005) and had lower perceived self-efficacy in interacting with physicians (β = -0.10; P = .008). CONCLUSIONS Several patient and caregiver factors were associated with patient-caregiver disagreement about prognostic estimates. Future studies should examine the effects of prognostic disagreement on patient and caregiver outcomes.
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Affiliation(s)
- Kah Poh Loh
- Division of Hematology/Oncology, Department of Medicine, James P Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York
| | - Enrique Soto Pérez de Celis
- Department of Geriatrics, Salvador Zubiran National Institute of Medical Sciences and Nutrition, Mexico City, Mexico
| | - Paul R Duberstein
- Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, Piscataway, New Jersey
| | - Eva Culakova
- Division of Hematology/Oncology, Department of Medicine, James P Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York
| | - Ronald M Epstein
- Division of Hematology/Oncology, Department of Medicine, James P Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York.,Department of Family Medicine, University of Rochester Medical Center, Rochester, New York.,Department of Psychiatry, University of Rochester Medical Center, Rochester, New York.,Department of Medicine, Palliative Care, University of Rochester Medical Center, Rochester, New York
| | - Huiwen Xu
- Division of Hematology/Oncology, Department of Medicine, James P Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York.,Department of Surgery, Cancer Control, University of Rochester Medical Center, Rochester, New York
| | - Sindhuja Kadambi
- Division of Hematology/Oncology, Department of Medicine, James P Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York
| | - Marie Flannery
- School of Nursing, University of Rochester Medical Center, Rochester, New York
| | - Allison Magnuson
- Division of Hematology/Oncology, Department of Medicine, James P Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York
| | - Colin McHugh
- Division of Hematology/Oncology, Department of Medicine, James P Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York
| | - Kelly M Trevino
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Gina Tuch
- Department of Aged Care, Alfred Health, Melbourne, Victoria, Australia
| | - Erika Ramsdale
- Division of Hematology/Oncology, Department of Medicine, James P Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York
| | - Reza Yousefi-Nooraie
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, New York
| | - Margaret Sedenquist
- SCOREboard Advisory Group, University of Rochester Medical Center, Rochester, New York
| | - Jane Jijun Liu
- Heartland National Cancer Institute Community Oncology Research Program (NCORP), Decatur, Illinois
| | | | - Jodi Geer
- Metro-Minnesota NCORP, St Paul, Minnesota
| | - Supriya G Mohile
- Division of Hematology/Oncology, Department of Medicine, James P Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York
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