1
|
Milberg A, Rydstrand K, Helander L, Friedrichsen M. Participants’ Experiences of a Support Group Intervention for Family Members during Ongoing Palliative Home Care. J Palliat Care 2019. [DOI: 10.1177/082585970502100407] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Anna Milberg
- Division of Geriatrics, Faculty of Health Sciences, Linköping University
| | | | | | - Maria Friedrichsen
- Department of Welfare and Care - palliative care, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| |
Collapse
|
2
|
Miyajima K, Fujisawa D, Yoshimura K, Ito M, Nakajima S, Shirahase J, Mimura M, Miyashita M. Association between Quality of End-of-Life Care and Possible Complicated Grief among Bereaved Family Members. J Palliat Med 2014; 17:1025-31. [DOI: 10.1089/jpm.2013.0552] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Kaya Miyajima
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Daisuke Fujisawa
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
- The Center for Psychiatric Oncology and Behavioral Sciences, Massachusetts General Hospital Cancer Center, Boston, Massachusetts
| | - Kimio Yoshimura
- Department of Health Policy and Management, Keio University School of Medicine, Tokyo, Japan
| | - Masaya Ito
- National Center for Cognitive Behavior Therapy and Research, National Center of Neuropsychiatry and Psychiatry, Tokyo, Japan
| | - Satomi Nakajima
- National Center for Cognitive Behavior Therapy and Research, National Center of Neuropsychiatry and Psychiatry, Tokyo, Japan
| | - Joichiro Shirahase
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan
| |
Collapse
|
3
|
Family stories of end-of-life cancer care when unable to fulfill a loved one's wish to die at home. Palliat Support Care 2014; 13:473-83. [PMID: 24621995 DOI: 10.1017/s1478951514000017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Control over place of death is deemed important, not only in providing a "good death," but also in offering person-centered palliative care. Despite the wish to die at home being endorsed by many, few achieve it. The present study aimed to explore the reasons why this wish is not fulfilled by examining the stories of ten individuals who lost a loved one to cancer. METHOD We adopted a narrative approach, with stories synthesized to create one metastory depicting plot similarities and differences. RESULTS Stories were divided into four chapters: (1) the cancer diagnosis, (2) the terminal stage and advancement of death, (3) death itself, and (4) reflections on the whole experience. Additionally, several reasons for cessation of home care were uncovered, including the need to consider children's welfare, exhaustion, and admission of the loved one by professionals due to a medical emergency. Some participants described adverse effects as a result of being unable to continue to support their loved one's wish to remain at home. SIGNIFICANCE OF RESULTS Reflections upon the accounts are provided with a discussion around potential clinical implications.
Collapse
|
4
|
What family caregivers learn when providing care at the end of life: a qualitative secondary analysis of multiple datasets. Palliat Support Care 2014; 13:425-33. [PMID: 24524561 DOI: 10.1017/s1478951513001168] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Although growing numbers of family members provide end-of-life care for dying persons, caregivers frequently report lacking essential information, knowledge, and skills. This analysis explicates what family members learn during the process of providing end-of-life care. METHOD Four qualitative interview studies of family caregivers to those at the end of life (n = 156) formed the basis of a secondary data analysis. RESULTS Thematic and cross-comparative analyses found three general kinds of learning that were described-knowledge about: (1) the situation and the illness (including what to expect), (2) how to provide care, and (3) how to access help. Learning gaps, preferences, and potential inequities were identified. Further, in some instances, participant talk about "learning" appears to reflect a meaning-making process that helps them accept their situation, as suggested by the phrase "I have had to learn." SIGNIFICANCE OF RESULTS Findings can inform the development of individualized educational programs and interventions for family caregivers.
Collapse
|
5
|
Foreva G, Assenova R. Hidden patients: the relatives of patients in need of palliative care. J Palliat Med 2013; 17:56-61. [PMID: 24320120 DOI: 10.1089/jpm.2013.0333] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND When identifying patients for palliative care, medical specialists find it necessary to disclose "hidden" patients: the patient's relatives. The issue has been discussed sporadically in Bulgaria; the present study was part of a larger investigation that examined the opinion of medical specialists, patients, and their relatives. METHOD The study protocol was explained to participants who gave written informed consent. Patients (n=211) were followed up on by their general practitioners (GPs) (n=42) during one year. All relatives were invited, and 173 (82%) agreed and participated. A questionnaire created by the authors was used. The data were analyzed by frequency distribution (descriptive statistics) and nonparametric tests (Pearson's χ(2)) and statistically processed using SPSS 17.0 (SPSS Inc., Chicago, IL). RESULTS Relatives providing care were predominantly women, two-thirds over 60 years of age. There was a one-to-one ratio between caregivers for oncological and nononcological patients. The duration of care was more than one year in 53% of cases. Most relatives reported their loved ones found physical suffering "very hard to bear" (53%), while approximately 17% could not assess the extent of psychological suffering. The vast majority stated that they had difficulties in providing care, and 68% had financial problems in that respect. CONCLUSION Including relatives as users and part of the palliative care team has been discussed in the literature. In Bulgaria, participation is solely due to the lack of organized services for palliative care. Relatives participate in activities that are performed by trained staff in countries with developed palliative care; these activities, along with negative emotional experiences and economic difficulties, overburden these caregiving relatives significantly.
Collapse
Affiliation(s)
- Gergana Foreva
- General Practice Section, Medical University Plovdiv , Plovdiv, Bulgaria
| | | |
Collapse
|
6
|
Lundberg T, Olsson M, Fürst CJ. The perspectives of bereaved family members on their experiences of support in palliative care. Int J Palliat Nurs 2013; 19:282-8. [PMID: 24151739 DOI: 10.12968/ijpn.2013.19.6.282] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM To explore family members' supportive interactions in palliative care and the emotional experiences that they associate with these interactions. METHODS Qualitative individual interviews were performed with bereaved family members recruited from an urban palliative care service in Sweden. The interviews were analysed using inductive qualitative content analysis. RESULTS Five categories of supportive interactions with staff members were linked with emotional consequences: informational support, supportive encounters, professional focus of staff, a supportive environment, and bereavement support. Having a dialogue with family members nurtured certainty and security, supportive encounters gave a warm and comforting feeling, and bereavement support contributed to feelings of strength. Environmental factors contributed to dignity. CONCLUSION Supportive interactions with staff and within a home-like environment help to build resilience if tailored to the family member's own needs.
Collapse
Affiliation(s)
- Tina Lundberg
- Palliative Research Centre, PO Box 11189, SE-100 61 Stockholm, Sweden.
| | | | | |
Collapse
|
7
|
Stajduhar KI, Funk L, Outcalt L. Family caregiver learning--how family caregivers learn to provide care at the end of life: a qualitative secondary analysis of four datasets. Palliat Med 2013; 27:657-64. [PMID: 23695826 DOI: 10.1177/0269216313487765] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Family caregivers are assuming growing responsibilities in providing care to dying family members. Supporting them is fundamental to ensure quality end-of-life care and to buffer potentially negative outcomes, although family caregivers frequently acknowledge a deficiency of information, knowledge, and skills necessary to assume the tasks involved in this care. AIM The aim of this inquiry was to explore how family caregivers describe learning to provide care to palliative patients. DESIGN Secondary analysis of data from four qualitative studies (n = 156) with family caregivers of dying people. DATA SOURCES Data included qualitative interviews with 156 family caregivers of dying people. RESULTS Family caregivers learn through the following processes: trial and error, actively seeking needed information and guidance, applying knowledge and skills from previous experience, and reflecting on their current experiences. Caregivers generally preferred and appreciated a supported or guided learning process that involved being shown or told by others, usually learning reactively after a crisis. CONCLUSIONS Findings inform areas for future research to identify effective, individualized programs and interventions to support positive learning experiences for family caregivers of dying people.
Collapse
Affiliation(s)
- Kelli I Stajduhar
- School of Nursing, University of Victoria, Victoria, BC V8W 2Y2, Canada.
| | | | | |
Collapse
|
8
|
A separate structured conversation with relatives of patients enrolled for advanced palliative home care: a care development project. Palliat Support Care 2013; 12:107-15. [PMID: 23659694 DOI: 10.1017/s1478951512001022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE One prerequisite for palliative home care is the relatives' participation in the care. The relatives' situation in palliative home care is unique, as they support the sick person and also have a great need for support themselves. The aim of this care development project was to develop and implement separate structured conversations (SSC) with relatives of patients of an advanced palliative home care team (APHCT). METHOD During the project, 61 conversations were held and 55 relatives answered a questionnaire. The questionnaire, eight semistructured interviews with relatives, and three focus-group discussions with nurses constitute the material for the evaluation. RESULTS Relatives have difficulties separating the SSC from the APHCT's care as a whole. They underline that the SSC was a part of an ongoing process. They also emphasize the value of having a conversation of their own in which the patient was absent, and in which the focus was on the relative's situation. For some, the conversation took place at the APHCT premises. The advantages of that were more privacy and the opportunity to walk around the inpatient palliative care units. The main problem during the project was conducting the SSC soon after the patient was enrolled with the APHCT. SIGNIFICANCE OF RESULTS Routinely offering one separate structured conversation with relatives with the intention of answering questions, talking about their willingness to provide care in the home, and mapping out their situation and social network, is a way to support both the relatives and the patients. The common structure of the conversations facilitated the assessment of the relatives' situation but did not hinder individualization according to the relatives' needs. The assumption is that all relatives should be offered a conversation.
Collapse
|
9
|
Ewing G, Grande G. Development of a Carer Support Needs Assessment Tool (CSNAT) for end-of-life care practice at home: a qualitative study. Palliat Med 2013; 27:244-56. [PMID: 22450160 DOI: 10.1177/0269216312440607] [Citation(s) in RCA: 127] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Current end-of-life care policy and guidance recognises the important contribution of family carers, recommending that their needs should be assessed to support them in their caring role. How regular carer assessment is to be achieved is unclear, particularly because there is no evidence-based tool for directly assessing carers' support needs that is suitable for use in end-of-life home care practice. AIMS To obtain carers' perspectives of key aspects of support needed during provision of end-of-life care at home and to develop a carer support needs assessment tool suitable for use in everyday practice. DESIGN Qualitative using focus groups and telephone interviews. Thematic analysis uses a framework approach. SETTING/PARTICIPANTS 75 adult bereaved carers who were family members/friends of patients referred to five Hospice at Home services in the UK. RESULTS Carers' needs fell into two distinct groupings of key support areas or 'domains': support to enable them to provide care for their relative and more direct personal support for themselves. Many aspects of supportive input were common across domains, for example, anticipatory information, explanations or being included in the care process. Therefore, the tool was designed as a screening measure, to identify support needs requiring further detailed assessment. CONCLUSIONS The Carer Support Needs Assessment Tool (CSNAT) is an evidence-based direct measure of carers' support needs in 14 domains. It is short but comprehensive in approach and thus suitable for both end-of-life care research and practice. Further work has been undertaken to test its psychometric properties.
Collapse
Affiliation(s)
- Gail Ewing
- Centre for Family Research, University of Cambridge, Cambridge, UK.
| | | | | |
Collapse
|
10
|
Benkel I, Wijk H, Molander U. Loved Ones Obtain Various Information About the Progression of the Patient’s Cancer Disease Which is Important for Their Understanding and Preparation. Am J Hosp Palliat Care 2012; 29:64-9. [DOI: 10.1177/1049909111412579] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Inger Benkel
- Department of Geriatric Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Helle Wijk
- Department of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Ulla Molander
- Department of Geriatric Medicine, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
11
|
A desire to be seen: family caregivers' experiences of their caring role in palliative home care. Cancer Nurs 2011; 33:28-36. [PMID: 19926979 DOI: 10.1097/ncc.0b013e3181af4f61] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Primary health care is the base of Swedish healthcare, and many terminally ill patients are cared for at home. A dying relative has a profound impact on his/her family members' situation, including negative effects on roles, well-being, and health. The aim of this study was to explore how the informal carers of a dying relative in palliative home care experienced their caring role and support during the patient's final illness and after death. Fourteen family members were selected in 4 primary health care areas in Sweden. Data were collected using open, tape-recorded interviews. A hermeneutic approach was used to analyze the data. The findings revealed that being an informal carer was natural when a relative became seriously ill. More or less voluntarily, the family member took on a caring role of control and responsibility. The informal carers felt left out and had feelings of powerlessness when they did not manage to establish a relationship with the healthcare professionals. For the informal carers to feel seen, it was necessary for them to narrate about their own supporting role.
Collapse
|
12
|
Clayton JM, Hancock KM, Butow PN, Tattersall MHN, Currow DC, Adler J, Aranda S, Auret K, Boyle F, Britton A, Chye R, Clark K, Davidson P, Davis JM, Girgis A, Graham S, Hardy J, Introna K, Kearsley J, Kerridge I, Kristjanson L, Martin P, McBride A, Meller A, Mitchell G, Moore A, Noble B, Olver I, Parker S, Peters M, Saul P, Stewart C, Swinburne L, Tobin B, Tuckwell K, Yates P. Clinical practice guidelines for communicating prognosis and end-of-life issues with adults in the advanced stages of a life-limiting illness, and their caregivers. Med J Aust 2007; 186:S77-S105. [PMID: 17727340 DOI: 10.5694/j.1326-5377.2007.tb01100.x] [Citation(s) in RCA: 164] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2006] [Accepted: 03/18/2007] [Indexed: 11/17/2022]
|
13
|
Hancock K, Clayton JM, Parker SM, Walder S, Butow PN, Carrick S, Currow D, Ghersi D, Glare P, Hagerty R, Tattersall MHN. Discrepant perceptions about end-of-life communication: a systematic review. J Pain Symptom Manage 2007; 34:190-200. [PMID: 17544247 DOI: 10.1016/j.jpainsymman.2006.11.009] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2006] [Revised: 11/08/2006] [Accepted: 11/11/2006] [Indexed: 12/12/2022]
Abstract
Little research has compared the perceptions of health professionals (HPs), patients, and caregivers about the communication of prognostic information. The objectives of this literature review were to determine 1) patient and caregiver perceptions of levels of information received about prognosis and end-of-life (EoL) issues regarding a life-limiting illness; 2) patient perceptions of and factors related to their understanding and awareness of prognosis; 3) HPs' perceptions of patients' wishes about disclosure of prognosis and factors related to their decision whether to disclose; and 4) concordance between HPs and patients/caregivers regarding the information given by HPs about prognostic and EoL issues. Relevant studies meeting the inclusion criteria were identified by searching computerized databases (MEDLINE, EMBASE, CINAHL, PsychINFO, Cochrane Register of Controlled Trials [Central]) up to November 2004. The reference lists of identified studies were hand searched for further relevant studies. Inclusion criteria were studies of any design evaluating communication of prognostic information that included adult patients with an advanced, life-limiting illness; their caregivers; and qualified HPs. Fifty-one studies were identified. There was a large discrepancy between patients/caregivers and HPs regarding the amount of information they believed had been given. Patients' understanding and awareness of information received conflicted with the HPs' perceptions of patients' understanding and awareness of the information that had been given. HPs tended to underestimate patients' need for information and overestimate patients' understanding and awareness of their prognosis and EoL issues. HPs need to repeatedly check patients' understanding and preferences for information.
Collapse
Affiliation(s)
- Karen Hancock
- Medical Psychology Research Unit, NHMRC Clinical Trials Centre, School of Psychology, University of Sydney, Camperdown, New South Wales, Australia
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Parker SM, Clayton JM, Hancock K, Walder S, Butow PN, Carrick S, Currow D, Ghersi D, Glare P, Hagerty R, Tattersall MHN. A systematic review of prognostic/end-of-life communication with adults in the advanced stages of a life-limiting illness: patient/caregiver preferences for the content, style, and timing of information. J Pain Symptom Manage 2007; 34:81-93. [PMID: 17531434 DOI: 10.1016/j.jpainsymman.2006.09.035] [Citation(s) in RCA: 352] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2006] [Accepted: 09/26/2006] [Indexed: 11/30/2022]
Abstract
Evidence-based recommendations concerning how to discuss dying, life expectancy, and likely future symptoms with patients with a limited life expectancy and their families are lacking. The aim of this systematic review was to review studies regarding prognostic/end-of-life communication with adult patients in the advanced stages of a life-limiting illness and their caregivers. Relevant studies meeting the inclusion criteria were identified by searching computerized databases up to November 2004. One hundred twenty-three studies met the criteria for the full review, and 46 articles reported on patient/caregiver preferences for content, style, and timing of information. The majority of the research was descriptive. Although there were individual differences, patients/caregivers in general had high levels of information need at all stages of the disease process regarding the illness itself, likely future symptoms and their management, and life expectancy and information about clinical treatment options. Patient and caregiver information needs showed a tendency to diverge as the illness progressed, with caregivers needing more and patients wanting less information. Patients and caregivers preferred a trusted health professional who showed empathy and honesty, encouraged questions, and clarified each individual's information needs and level of understanding. In general, most patients/caregivers wanted at least some discussion of these topics at the time of diagnosis of an advanced, progressive, life-limiting illness, or shortly after. However, they wanted to negotiate the content and extent of this information.
Collapse
Affiliation(s)
- Sharon M Parker
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Camperdown, New South Wales, Australia
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Milberg A, Strang P. What to do when ‘there is nothing more to do’? A study within a salutogenic framework of family members' experience of palliative home care staff. Psychooncology 2007; 16:741-51. [PMID: 17106866 DOI: 10.1002/pon.1124] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The aim of this study was to develop a theoretical framework of family members' experience of palliative home care staff based on a secondary analysis of four previous studies. A salutogenic framework was used, i.e. with the origin of health in focus. Data had been collected (semi-structured tape-recorded interviews and postal questionnaires with open-ended questions) from 469 family members of mainly cancer patients referred to advanced palliative home care. Walker and Avant's strategies for theory construction were used. The secondary analysis generated three theoretical blocks: (1) general components of staff input (including five generalized resistance resources (GRRs): competence, support, spectrum of services, continuity, and accessibility); (2) specific interactions with staff (including two GRRs: being in the centre and sharing caring); (3) emotional and existential consequences of staff support (including six health-disease continuums: security-insecurity, hope-hopelessness, congruent inner reality-chaos, togetherness-isolation, self-transcendence-feelings of insufficiency and retained everyday life-disrupted everyday life). It seems important that all three aspects of family members' experience of palliative care staff are to be considered in evaluations of palliative care, in goal-setting and in teaching role models. The study is specific to the Swedish model of palliative home care and replication of the work in other countries is recommended.
Collapse
Affiliation(s)
- A Milberg
- Department of Society and Welfare Studies, Linköping University and Unit of Advanced Palliative Home Care, University Hospital, Linköping, Sweden.
| | | |
Collapse
|