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Zhang R, Pu C, Cui X, Zhang N, Li X, Zheng F. Burden in primary family caregivers caring for uremic patients on maintenance peritoneal dialysis. Perit Dial Int 2020; 40:556-562. [PMID: 32735160 DOI: 10.1177/0896860820942628] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Managing the burden of care for patients with chronic debilitating diseases is an important issue. Herein, we assessed the burden in primary family members caring for uremic patients on maintenance peritoneal dialysis. METHODS One hundred seventy caregivers and 170 patients were recruited. Self-perceived scoring along the Zarit Caregiver Burden Scale (ZCBS), World Health Organization Five-item Well-Being Index (WHO-5), and Warwick-Edinburgh Mental Well-being Scale (WEMWBS) were determined for caregivers. RESULTS There was an inverse relationship between ZCBS and WHO-5 or WEMWBS scores in caregivers, suggesting that the higher the burden, the lesser the self-perceived well-being. One hundred two of 170 caregivers (60%) reported mild to moderate burden, indicating a common presence of mild to moderate caring-related mental and physical stress. Moreover, 31 caregivers (18.2%) reported moderate to severe burden. Several patient disease factors, including diabetes and frailty, increased caregiver burden, while insurance coverage and out-of-pocket medical costs were also positively correlated. Caregivers who lived with patients and spent longer hours in caring-related activities had higher burden scores, while regular exercise seemed to partially alleviate the burden. CONCLUSION Our study clearly showed that caring for patients with maintenance peritoneal dialysis caused physical, mental, and social burden in family caregivers, with the extent of the stress being influenced by patients' disease severity and other demographic factors in both patients and caregivers.
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Affiliation(s)
- Rongzhi Zhang
- Department of Nephrology, Hemodialysis Center, Dalian Medical University, China
| | - Congshan Pu
- Nursing Administrative Department, 540418The Second Hospital, Dalian Medical University, China
| | - Xiaohui Cui
- Advanced Institute for Medical Sciences, Dalian Medical University, China
| | - Ning Zhang
- Department of Nephrology, Hemodialysis Center, Dalian Medical University, China
| | - Xue Li
- Department of Nephrology, Hemodialysis Center, Dalian Medical University, China
| | - Feng Zheng
- Department of Nephrology, Hemodialysis Center, Dalian Medical University, China.,Advanced Institute for Medical Sciences, Dalian Medical University, China
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Gray NA, Zuo L, Hong D, Smyth B, Jun M, De Zoysa J, Vo K, Howard K, Wang J, Lu C, Liu Z, Cass A, Perkovic V, Jardine M. Quality of life in caregivers compared with dialysis recipients: The Co-ACTIVE sub-study of the ACTIVE dialysis trial. Nephrology (Carlton) 2019; 24:1056-1063. [PMID: 30723975 DOI: 10.1111/nep.13530] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2018] [Indexed: 02/05/2023]
Abstract
AIM To compare quality of life (QOL) of caregivers of dialysis patients with the cared for patients and population norms. METHODS The ACTIVE Dialysis study randomized participants to extended (median 24 h/week) or standard (median 12 h/week) haemodialysis hours for 12 months. A subgroup of participants and their nominated caregivers completed QOL questionnaires including the EuroQOL-5 Dimension-3 Level (EQ5D-3 L), short form-36 (SF-36, also allowing estimation of the SF-6D), as well as a bespoke questionnaire and the personal wellbeing index (PWI). Caregiver QOL was compared with dialysis patient QOL and predictors of caregiver QOL were determined using multivariable regression. RESULTS There were 54 patients and caregiver pairs, predominantly from China. Caregivers mean (SD) age was 53.4 (11.3) years, 60% were female, 71% cared for their spouse/partner, and 36% were educated to university level. Caregivers had better physical but similar mental QOL compared with dialysis patients (mean SF-36 physical component summary: 46.9 ± 8.7 vs 40.4 ± 10.2, P < 0.001; mental component summary: 47.8 ± 9.7 vs 49.6 ± 12.0, P = 0.84). Health utility measured with EQ5D-3 L was not significantly different between caregivers and dialysis patients (mean 0.869 ± 0.185 vs 0.798 ± 0.227, P = 0.083). Caregiver PWI was 43.7 ± 15.5, significantly lower than the Chinese population norm (68.2 ± 14.2, P < 0.001). Higher physical and mental QOL among caregivers was predicted by university education but not age, gender or daily hours caring. CONCLUSION Caregivers have higher physical and equivalent mental QOL to dialysis patients but poorer personal well-being than the Chinese population. University education predicts better QOL and may be a surrogate for socioeconomic or other factors. (NCT00649298).
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Affiliation(s)
- Nicholas A Gray
- Department of Nephrology, Sunshine Coast University Hospital, Birtinya, Queensland, Australia
- The University of Queensland, Sunshine Coast Clinical School, Birtinya, Queensland, Australia
| | - Li Zuo
- Department of Nephrology, Peking University People's Hospital, Beijing, China
| | - Daqing Hong
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- Renal Department, Sichuan Provincial People's Hospital, Chengdu, China
- University of Electronic Science and Technology of China Medical School, Chengdu, China
| | - Brendan Smyth
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Min Jun
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Janak De Zoysa
- Renal Service, North Shore Hospital, Waitemata DHB, Auckland, New Zealand
- Department of Medicine, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Kha Vo
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- Bureau of Health Information, NSW Health, Sydney, New South Wales, Australia
| | - Kirsten Howard
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Jing Wang
- Department of Nephrology, First Affiliated Hospital of Dalain Medical University, Dalain, China
| | - Chunlai Lu
- Department of Nephrology, Shanghai 85th Hospital, Shanghai, China
| | - Zhangsuo Liu
- Department of Nephrology, First Affiliated Hospital of Zhengzhou University, China
| | - Alan Cass
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Vlado Perkovic
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Meg Jardine
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- Department of Renal Medicine, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
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Kang A, Yu Z, Foo M, Chan CM, Griva K. Evaluating Burden and Quality of Life among Caregivers of Patients Receiving Peritoneal Dialysis. Perit Dial Int 2019; 39:176-180. [DOI: 10.3747/pdi.2018.00049] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Peritoneal dialysis (PD) is advocated as treatment of choice for most end-stage renal disease (ESRD) patients, including elderly and frail patients. It typically requires caregiver involvement to support care at home. The purpose of this study was to examine changes in burden and quality of life (QOL) in caregivers of prevalent PD patients over 12 months. Data were collected in 44 caregivers of PD patients (mean age 38.4 ± 6.3 years; 60% female) in Singapore at baseline and 12 months. Measures included demographics, the Lay Care-Giving for Adults Receiving Dialysis (LC-GAD), Zarit Burden Interview (ZBI), and the World Health Organization Quality of Life instrument (WHOQOL-BREF). Paired t-tests indicate a significant decrease in task-related aspects of caregiving ( p = 0.04), particularly in relation to personal hygiene ( p < 0.01), over time. Cognitive aspects of caregiving remained unchanged. Perceived burden, however, significantly increased ( p < 0.01), with significantly more caregivers reporting moderate to severe caregiver burden at follow-up (28%) relative to baseline (13%; p < 0.01). There was a significant reduction in psychological health (under WHOQOL) ( p = 0.01). Study findings indicate an increase in caregiver burden and a reduction in psychological health despite a reduction in task-related aspects of caregiving, supporting a further exploration of the “wear-and-tear” hypothesis among this population. Intervention strategies are needed.
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Affiliation(s)
- Augustine Kang
- Department of Psychology Brown University School of Public Health Providence, RI, USA
- National University of Singapore, Singapore Department of Behavioral and Social Sciences Brown University School of Public Health Providence, RI, USA
| | - Zhenli Yu
- Department of Psychology Brown University School of Public Health Providence, RI, USA
| | - Marjorie Foo
- Department of Renal Medicine Singapore General Hospital, Singapore
| | - Choong Meng Chan
- Department of Renal Medicine Singapore General Hospital, Singapore
| | - Konstadina Griva
- Department of Psychology Brown University School of Public Health Providence, RI, USA
- Center for Population Health Sciences Imperial College London & Nanyang Technological University, Singapore
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Progressive exhaustion: A qualitative study on the experiences of Iranian family caregivers regarding patients undergoing hemodialysis. Int J Nurs Sci 2018; 5:193-200. [PMID: 31406824 PMCID: PMC6626230 DOI: 10.1016/j.ijnss.2018.01.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 10/29/2017] [Accepted: 01/11/2018] [Indexed: 11/23/2022] Open
Abstract
Objective The aim of this study was to explore the burden of care for patients undergoing hemodialysis from the experiences of family caregivers. Methods In this qualitative study, a content analysis approach was used for data collection and analysis. Participants were 16 family caregivers selected through purposive sampling from four medical education centers affiliated with Ahvaz Jundishapur University of Medical Sciences, Iran. Semi-structured interviews were held to collect data. Results Four categories were developed as follows: ‘care challenges’, ‘psychological vulnerabilities’, ‘the chronic nature of care ’and “care in the shade”. The categories led to the development of the main theme of ‘progressive exhaustion’ experienced by the family caregivers during the provision of care to patients undergoing hemodialysis. Conclusion Family caregivers have a significant role in the process of patient care, and this role leads them to progressive exhaustion; therefore, the overall health of the caregivers should be taken into account and more attention should be paid to their quality of life, social welfare, and satisfaction level.
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Walker RC, Hanson CS, Palmer SC, Howard K, Morton RL, Marshall MR, Tong A. Patient and Caregiver Perspectives on Home Hemodialysis: A Systematic Review. Am J Kidney Dis 2015; 65:451-63. [DOI: 10.1053/j.ajkd.2014.10.020] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 10/19/2014] [Indexed: 11/11/2022]
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Baillie J, Lankshear A. Patient and family perspectives on peritoneal dialysis at home: findings from an ethnographic study. J Clin Nurs 2014; 24:222-34. [DOI: 10.1111/jocn.12663] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Jessica Baillie
- School of Healthcare Sciences; Cardiff University; Cardiff UK
| | - Annette Lankshear
- Cardiff School of Healthcare Sciences; Cardiff University; Cardiff UK
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Noble H, Kelly D, Hudson P. Experiences of carers supporting dying renal patients managed without dialysis. J Adv Nurs 2012; 69:1829-39. [PMID: 23167619 DOI: 10.1111/jan.12049] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2012] [Indexed: 11/28/2022]
Abstract
AIM To explore the impact of being a family carer to patients with stage 5 chronic kidney disease managed without dialysis. BACKGROUND Increasing numbers of patients with renal disease worldwide are making the decision not to embark on dialysis. This group has significant physical and psychological symptom burdens similar to or greater than those in advanced cancer patients. Little is known about the impact on family carers. DESIGN Exploratory, qualitative design. METHODS The study was undertaken with 19 carers caring for patients managed in a Renal Supportive Care Service in the UK between 2006-2008. Sixty-one semi-structured interviews and detailed field notes inform the analysis. FINDINGS 'Caring from diagnosis to death' was the overarching theme illustrated by three sub-themes: (i) Caregiver's plight - making sense of the disease and potential deterioration; (ii) Having to care indefinitely; and (iii) Avoiding talk of death. 'Caring from diagnosis to death' coincides with an original concept analysis of renal supportive care, which is considered an adjunct to the management of patients with renal disease at all stages of their illness. CONCLUSION There is a clear need for further research internationally and theory-based nursing interventions to support carers of patients managed without dialysis. The development of a holistic, integrated care pathway based on carer perspectives, which includes identification of information needs related to original diagnosis, associated comorbidities, treatment options, prognosis, and assistance in developing strategies to manage communication with patients as the end of life approaches, is required.
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Affiliation(s)
- Helen Noble
- Health Services Research, School of Nursing and Midwifery, Queen's University Belfast, Medical Biology Centre, UK.
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Baillie J, Lankshear A, Featherstone K. Perspectives on peritoneal dialysis at home: implications for the management of a chronic condition. A study protocol. J Adv Nurs 2011; 68:1847-57. [DOI: 10.1111/j.1365-2648.2011.05907.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Fex A, Flensner G, Ek AC, Söderhamn O. Living with an adult family member using advanced medical technology at home. Nurs Inq 2011; 18:336-47. [PMID: 22050619 DOI: 10.1111/j.1440-1800.2011.00535.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Living with an adult family member using advanced medical technology at home An increased number of chronically ill adults perform self-care while using different sorts of advanced medical technology at home. This hermeneutical study aimed to gain a deeper understanding of the meaning of living with an adult family member using advanced medical technology at home. Eleven next of kin to adults performing self-care at home, either using long-term oxygen from a cylinder or ventilator, or performing peritoneal or haemodialysis, were interviewed. The qualitative interviews were analysed using a Gadamerian methodology. The main interpretation explained the meaning as rhythmical patterns of connectedness versus separation, and of sorrow versus reconciliation. Dependence on others was shown in the need for support from healthcare professionals and significant others. In conclusion, next of kin took considerable responsibility for dependent-care. All next of kin were positive to the idea of bringing the technology home, even though their own needs receded into the background, while focusing on the best for the patient. The results were discussed in relation to dependent-care and transition, which may have an influence on the self-care of next of kin and patients. The study revealed a need for further nursing attention to next of kin in this context.
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Low J, Smith G, Burns A, Jones L. The impact of end-stage kidney disease (ESKD) on close persons: a literature review. NDT Plus 2008; 1:67-79. [PMID: 28656996 PMCID: PMC5477906 DOI: 10.1093/ndtplus/sfm046] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2007] [Accepted: 12/13/2007] [Indexed: 11/14/2022] Open
Affiliation(s)
- Joseph Low
- Marie Curie Palliative Care Research Unit, Department of Mental Health Sciences, Royal Free & University College Medical School, London NW3 2PF
| | - Glenn Smith
- Division of Medicine, Imperial College London, London
| | - Aine Burns
- Centre for Nephrology, The Royal Free Hampstead NHS Trust, London NW3 2QG, UK
| | - Louise Jones
- Marie Curie Palliative Care Research Unit, Department of Mental Health Sciences, Royal Free & University College Medical School, London NW3 2PF
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Abstract
The bulk of care provided to elderly people living in the community and needing assistance is provided informally by family and friends. This paper investigates themes from an interpretation of interviews with informal caregivers about their experiences of caring for a frail, ill, or disabled elderly person at home. These themes include mobility, routine, and inter-relationships of scale. The caregivers' narratives illustrate the interconnected nature of physical, material and social, emotional aspects of care, and the profound spatial and social impact of providing informal care to a family member on their everyday lives. These are often at odds with political and social constructions of what it means to care at home. Concepts of space, place, and time are shown to be a helpful framework through which to understand issues and experiences of caring. The social and the physical aspects of the many interconnected scales and places which caregivers negotiate on an everyday basis both shape and are shaped by caregiving.
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Affiliation(s)
- Janine Wiles
- School of Geography and Geosciences, University of St Andrews, KY16 9AL St Andrews, UK.
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Wiles J. Informal caregivers' experiences of formal support in a changing context. HEALTH & SOCIAL CARE IN THE COMMUNITY 2003; 11:189-207. [PMID: 12823424 DOI: 10.1046/j.1365-2524.2003.00419.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
As the location of long-term care of elderly people moves to homes and communities, and responsibility for care shifts to families, understanding the experience of people in this situation is necessary to ensure that support is appropriate, accessible and effective. The present paper explores informal caregivers' and recipients' relationships with formal support, drawing on thematic and narrative analysis of 30 in-depth interviews with self-identified family caregivers conducted over a year in a mid-size city in Ontario, Canada. All but six of these caregivers had had some interaction with formal support. The semistructured interviews explored caregivers' knowledge about, and perceptions and experiences of accessing and using formal support. Interpretation reveals how confusion and lack of knowledge about services, the inflexibility and lack of availability of services, and increasing pressure on the quantity and quality of publicly funded community-based resources combine to impact negatively on the experience of accessing and using formal support. Different ideas about the relative roles and responsibilities of seniors, informal caregivers and 'family' in general, and the state both shape and are shaped by policies and the situated realities of the provision of formal support. Providing care at home creates both opportunities and constraints for caregivers in their interactions with formal support. Lastly, this paper highlights the difficulties of interacting with publicly funded formal support as the costs of care are moved away from the state and onto families and individuals.
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Affiliation(s)
- Janine Wiles
- Health Geography, School of Geography and Geosciences, University of St Andrews, St Andrews, UK.
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