Family Caregivers of Liver Transplant Recipients: Coping Strategies Associated With Different Levels of Post-traumatic Growth

The perceptions and experiences of caregivers of patients with dysphagia: A qualitative meta-synthesis

AIMS

To understand the perceptions and experiences of family caregivers of adult patients with dysphagia.

BACKGROUND

Dysphagia is a common symptom and burdens caregivers greatly. There is a growing body of studies concentrating on caregivers and caregiving experiences. However, no qualitative meta-synthesis has been conducted to explore the perceptions and experiences of family caregivers.

DESIGN

A qualitative meta-ethnography.

METHODS

A search was conducted for relevant articles in six electronic databases (PubMed, Web of Science, CINAHL, Ovid, Cochrane Library, ProQuest) and two Chinese databases (CNKI, Wanfang Data) from inception to February 2023. The Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI) was used to evaluate study quality. The meta-ethnographic method was used to synthesize data from qualitative studies. The study was reported according to EQUATOR guidelines.

RESULTS

Eleven studies were included and three themes emerged: (1) emotion and perception, (2) change and challenge (3) adaption and coping.

CONCLUSION

This review highlighted the challenges and positive coping experienced by caregivers. Findings directly inform the development and implementation of supportive interventions to reduce caregivers' stress and promote adaptive coping.

RELEVANCE TO CLINICAL PRACTICE

Pay attention to the needs of family caregivers of dysphagia. Family caregivers' perceived severity of dysphagia requires assessment. Caregivers need knowledge, support, and guidance to reduce their burden and fulfill their role.

Caregiver Burden in Adult Solid Organ Transplantation

The informal caregiver plays a critical role in supporting patients with various end-stage diseases throughout the solid organ transplantation journey. Caregiver responsibilities include assistance with activities of daily living, medication management, implementation of highly specialized treatments, transportation to appointments and treatments, and health care coordination and navigation. The demanding nature of these tasks has profound impacts across multiple domains of the caregiver's life: physical, psychological, financial, logistical, and social. Few interventions targeting caregiver burden have been empirically evaluated, with the majority focused on education or mindfulness-based stress reduction techniques. Further research is urgently needed to develop and evaluate interventions to improve caregiver burden and outcomes for the patient-caregiver dyad.

Post-traumatic growth in caregivers of children hospitalized in the PICU due to traffic accident: a qualitative study

BACKGROUND

Globally, tens of millions of children are hospitalized every year for non-fatal traffic accident injuries, being confronted with an injured child can be extremely stressful for parents. Understandably, a significant level of psychological distress may ensue. Traumatic losses may lead parents to find new insights in life and develop a greater sense of spirituality and strength.

METHOD

Semi-structured interviews were conducted with caregivers of children who were hospitalized in the pediatric intensive care unit (PICU) with traffic accident injuries at children's hospitals in China between January and June 2022. Caregivers were selected using a purposive sampling method until no new data were generated (n = 24).

RESULTS

We identified eleven sub-themes and four higher-order themes based on these sub-themes: (1) changes in their life philosophy, (2) personal strength enhancement, (3) relationship improvements, and (4) effective responses. The findings of our research contribute to a better understanding of the psychological status of the caregivers of children injured by traffic accidents.

CONCLUSION

Professionals should guide caregivers from a positive perspective, stimulate their strengths and potential, increase personnel support and communication, promote positive coping, formulate targeted management countermeasures to improve the PTG level of caregivers, and develop strategies to maintain stable mental health and well-being.

PTSD and PTG in French and American Firefighters: A Comparative Study

Studies show that experiencing traumatic events can lead to positive psychological change, or posttraumatic growth (PTG). In the hope of promoting PTG, authors have been focusing on identifying the factors that may foster PTG. Despite these attempts, the literature shows inconsistencies, making it difficult to know which variables may be involved in the process of growth. Indeed, authors seem to disagree on the nature of the relationship between PTSD and PTG, time since the event, social support, intrusive rumination, and sociodemographics. Thus, this study aims to clarify these discrepancies, and verify whether the processes involved are the same across two different cultural groups, both of which are confronted with traumatic events regularly: 409 American firefighters, and 407 French firefighters. Results indicate that, in both samples, PTG is positively related to PTSD, subjective perceptions of the event, stress during the event, disruption of core-beliefs, and deliberate rumination; and unrelated to social support, core-self evaluations, and socio-demographic variables (age, gender, relationship status, etc.). However, time since the event and the number of years on the job only predicted PTG in the American sample, while colleague and emotional support only predicted PTG in the French sample. Additionally, American firefighters reported more growth, more social support, more positive self-perceptions, more intrusive rumination, and more neuroticism than French firefighters. These results suggest that the process of growth, as defined by Tedeschi and Calhoun, is relatively stable among firefighters, but that some differences do exist between cultural groups.

[The Caring Experience of Family Caregivers for Patients of Living Donor Liver Transplantation from the Family Members]

PURPOSE

The purpose of the study was to understand the care experiences of the family of living donor liver transplantation (LDLT) patients where the donation had occurred within the family.

METHODS

Participants were eight family caregivers who cared for recipients and donors of LDLT. Data were collected through individual in-depth interviews from November, 2020 to April, 2021. Data analysis was performed through a cyclical process of data collection and analysis by applying Giorgi's phenomenological research method.

RESULTS

The five main components extracted from the experiences of the family caregivers were: "A double-edged choice to save the family", "The harsh daily life of liver transplantation care", "The yoke of double care on both shoulders", "The power to withstand the adversity of caring", and "The recovery and growth of life pursued by trusting each other".

CONCLUSION

The participants tried to do their best in their daily lives, while providing reassurance and care to the LDLT patients in the family; however, they expressed some worry and hardship while doing so. The results of this study provide a deeper understanding of the caring experience of the family caregivers, which may contribute to the development of nursing interventions that will aid these caregivers in providing care to their LDLT family members. Furthermore, the development and application of an integrated management program for LDLT patients in the family is required.

Racial and socioeconomic status differences in stress, posttraumatic growth, and mental health in an older adult cohort during the COVID-19 pandemic

Background

The COVID-19 pandemic has disproportionately impacted the most vulnerable and widened the health disparity gap in both physical and mental well-being. Consequentially, it is vital to understand how to best support elderly individuals, particularly Black Americans and people of low socioeconomic status, in navigating stressful situations during the COVID-19 pandemic and beyond. The aim of this study was to investigate perceived levels of stress, posttraumatic growth, coping strategies, socioeconomic status, and mental health between Black and non-Hispanic, White older adults, the majority over the age of 70. Additionally, we investigated which variables, if any, were associated with posttraumatic growth in these populations.

Methods

One hundred seventy-six community dwelling older adults (mean age = 76.30 ±8.94), part of two observational studies (The Harvard Aging Brain Study and Instrumental Activities of Daily Living Study) in Massachusetts, US, were included in this cross-sectional study. The survey, conducted from March 23, 2021 to May 13, 2021, measured perceived stress, behavioral coping strategies, posttraumatic growth, and mental health during the COVID-19 pandemic. We investigated associations with post-traumatic growth in a multiple linear regression model and examined their differences by race with t-tests, Wilcoxon rank-sum tests, and Fisher's exact tests. A second multiple linear regression model was used to examine which coping strategies were associated with posttraumatic growth.

Findings

Our results indicated no significant difference between the groups in terms of mental health or stress. However, Black participants showed significantly greater posttraumatic growth compared to non-Hispanic, White participants. Additionally, the coping strategies of religion and positive reframing were found to be significantly associated with posttraumatic growth. Furthermore, even with the effects of stress and coping strategies controlled for, race remained significantly associated with posttraumatic growth.

Interpretation

The COVID-19 pandemic has differentially impacted Black and non-Hispanic White older adults. These results may help encourage further analysis on geriatric psychiatry as well as understanding how cultural values and adaptations impact posttraumatic growth and mental health in diverse populations.

Funding

The Harvard Aging Brain Study (HABS) has been funded by NIH-NIA P01 AG036694 (PI: Reisa Sperling). The IADL study is funded by the National Institute on Aging (R01 AG053184, PI: Gad A. Marshall).

Factors related to the use of religious coping by informal caregivers: an integrative review

OBJECTIVES

to identify the factors related to the use of religious coping in informal caregivers.

METHODS

integrative literature review carried out through a search in the databases LILACS, PubMed, Scopus, Web of Science, and CINAHL, in addition to the Virtual Health Library and SciELO. The study selected primary articles in English, Portuguese, and Spanish, using the descriptors Coping Behavior, Caregivers, Spirituality, and Religion, which were combined with each other and with synonyms. There was no time limit for the publications.

RESULTS

nine articles were selected. Factors related to the use of religious coping in informal caregivers included: having an advanced age, experiencing traumatic situations, being under overload, being a spouse or mother, caring for hospitalized individuals, or for those with chronic diseases and high degrees of dependence.

CONCLUSIONS

the factors related to the use of religious coping are multifaceted and involve physical, psychological, psychosocial, and situational aspects.

Post-Traumatic Growth Experiences among COVID-19 Confirmed Cases in China: A Qualitative Study

COVID-19 infection can cause psychological distress and profoundly impact patients' lives, but it can also lead to positive changes and post-traumatic growth (PTG), or positive psychological change in response to challenging life circumstances. Current research on the influence of COVID-19 infection has mainly focused on its negative effects. Therefore, the aim of this study was to investigate whether patients with COVID-19 in China experienced PTG and, if so, what changed for them during the process of PTG. We used a qualitative descriptive approach to conduct this study. Using the purposive sampling recruitment method, patients with a confirmed COVID-19 diagnosis were recruited from a COVID-19 designated hospital in Shanghai, China, from April to July 2020. Data were collected using semi-structured, in-depth interviews conducted via cell phone or in person while social distancing to prevent the spread of COVID-19. Forty confirmed COVID-19 patients (19-68 years old) were recruited. Several prominent themes and subthemes were extracted from the interview responses regarding participants' experiences of PTG. The following are among the positive changesthat occurred for these participants after their diagnosis of COVID-19: (1) Reevaluation of their life priorities, which included a greater appreciation of being alive and re-evaluating their values and goals, (2) Improved relationships within their social circles, which included establishing or maintaining closer relationships with family and friends and a greater willingness to help others, and (3) Perceived changes regarding themselves, which included personal growth and increased awareness of the importance of their health. The study identified potential positive impacts of COVID-19 on patients, which could be helpful in the implementation of interventions to facilitate PTG among COVID-19 survivors.

Unmet Care Needs and Related Factors of Spouses of Liver or Kidney Transplant Recipients

This study aimed to (1) explore the unmet care needs of spouses of liver or kidney transplant recipients, (2) compare the unmet care needs, depression, and anxiety levels of transplant recipients and their spouses, and (3) identify factors related to spouses' unmet care needs. A cross-sectional study was conducted using purposive sampling from transplant outpatient departments at a medical center. Ninety-one liver or kidney transplant recipient-spouse dyads were recruited. Most unmet needs for dyads were involved in the psychological needs and health system and service needs domains. Spouses had significantly higher unmet needs, anxiety, and depression than recipients did. The significant factors related to the spouses' unmet needs included being male, having higher anxiety, and whose partners had higher unmet needs. Health care professionals must attend to the needs of both recipients and spouses. Providing disease-specific information and resources to spouses who potentially had higher unmet needs is strongly suggested.

Impact of psychosocial status on liver transplant process

Liver transplant candidates and recipients are at high risk of psychological distress. Social, psychological and psychiatric patterns seem to influence morbidity and mortality of patients before and after transplant. An accurate organ allocation is mandatory to guarantee an optimal graft and recipient survival. In this context, the pre-transplant social, psychological and psychiatric selection of potential candidates is essential for excluding major psychiatric illness and for estimating the patient compliance. Depression is one of the most studied psychological conditions in the field of organ transplantation. Notably, an ineffectively treated depression in the pre-transplant period has been associated to a worst long-term recipient survival. After transplant, personalized psychological intervention might favor recovery process, improvement of quality of life and immunosuppressant adherence. Active coping strategy represents one of the most encouraging ways to positively influence the clinical course of transplanted patients. In conclusion, multidisciplinary team should act in three directions: prevention of mood distress, early diagnosis and effective treatment. Active coping, social support and multidisciplinary approach might improve the clinical outcome of transplanted patients.

Approaches to Assessing Burden in Caregivers of Patients with Cirrhosis

Background and Aims: Being a caregiver for a patient with chronic liver disease (CLD) can be burdensome mentally, emotionally financially, and physically. The aim of this study was to systemically review the available tools and propose tools that can comprehensively evaluate caregiver burden for individuals caring for patients with CLD. Methods: We searched the PubMed database for all studies on the impact of patients with CLD on caregiver burden without timeframe restriction. Eligible studies included cohort studies, review studies, or cross-sectional studies. The number of patients and caregivers was isolated from each paper. Studies in the same categories were isolated and statistically compared. Results: A total of 13 studies meeting our inclusion criteria as stated in the methods sections were included. In total, 2528 caregivers were taking care of 2003 patients with CLD. Women made up the majority of caregivers at 78.2%, 95.7% of whom identified as the patient's spouse. Caregiver strain index is one of the most comprehensive tools; however, the questions are very general and do not fully elucidate financial strain. Beck depression and anxiety were correlated (p=0.0001), and both depression and anxiety were correlated with perceived caregiver burden (PCB) and Zarit Burden Interview (ZBI) (p=0.002). Depression scale correlated with Interpersonal Support Evaluation - Short Form, and Model for End-Stage Liver Disease score correlated with ZBI and PCB (total and in most domains; p=0.001). Patient's poorer cognitive performance correlated with higher ZBI and PCB (employed patients had higher cognitive performance and lower ZBI and PCB). Conclusions: Caregiver burden remains poorly understood due to the lack of uniformity in the assessment tools used to evaluate caregiver burden. None of the tools used to evaluate caregiver burden are comprehensive; however, most tools correlate statistically in the ability to identify caregiver burden. A comprehensive tool is lacking for identifying caregiver burden in patients with CLD.

Caregiver Patient Reported Outcomes Measurement Information System (PROMIS) profiles in patients undergoing total joint arthroplasty and spine surgery: a prospective observational cohort study

BACKGROUND/OBJECTIVE

The role of caregiver psychosocial characteristics and their relation to postsurgical caregiving capability remains unclear. The objective of this study was to explore caregiver psychosocial variables following surgery of patients undergoing total joint arthroplasty and spine surgery.

METHODS

A prospective observational study was conducted where questionnaires were administered to caregivers preoperatively and 1 week/2 weeks/1 month postoperatively. Measures included demographics, caregiver activities and National Institutes of Health Patient Reported Outcomes Measurement Information System (NIH PROMIS) item banks. Bivariate analysis assessed differences between participants reporting baseline pain and those reporting no baseline pain. Generalized estimating equation models examined PROMIS T-scores across time.

RESULTS

190 caregivers were enrolled and completed surveys. 18% of caregivers reported experiencing a painful condition where they experienced pain during most days of the week. Across all time points, the majority of caregivers reported no worse than mild impairment across PROMIS scores. Compared with baseline, caregivers reported lower PROMIS satisfaction with social roles across all postoperative time points (p<0.001) and higher depression and fatigue at postoperative day 7 (p=0.002) and 14 (p=0.006). PROMIS sleep disturbance was only higher at day 7 (p=0.01). Caregivers reporting a baseline pain condition reported PROMIS scores indicative of higher anxiety (p=0.02), depression (p=0.003), sleep disturbances (p<0.001) and fatigue (p<0.001) and lower levels of satisfaction with social roles (p=0.002) compared with those caregivers without baseline pain.

CONCLUSION

While there were transient worsening in PROMIS scores, it is unclear whether these were clinically meaningful. Postsurgical caregivers reporting baseline pain were characterized by worse functioning across all PROMIS scales.

The Relationship between Self-Perceived Burden and Posttraumatic Growth among Colorectal Cancer Patients: The Mediating Effects of Resilience

At present, the influence factors of posttraumatic growth (PTG) in colorectal cancer (CRC) patients and the relationship between PTG, self-perceived burden (SPB), and resilience are not completely clear. Thus, the present study examined whether resilience and SPB could predict PTG in CRC patients. The role of resilience as a potential mediator was also assessed. Using a cross-sectional design, a convenience sample of 157 CRC patients was selected as subjects, from July to December 2016 in a third-grade hospital. It was found that the main influencing factors for the total PTG score of CRC patients included work status, affordability for medical expenses, and duration of illness. Resilience was positively correlated with PTG, SPB was negatively correlated with PTG, and resilience played an intermediary role. Our findings remind clinicians to treat the psychosocial response of CRC patients from multiple perspectives, with a focus on their positive aspects. By increasing resilience and reducing the patient's SPB, clinicians might enhance the patient's PTG and quality of life.