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Marshall KH, Riddiford-Harland DL, Meller AE, Caplan GA, Naganathan V, Cullen J, Gonski P, Zwar NA, O’Keeffe JA, Krysinska K, Rhee JJ. Feasibility and Acceptability of Facilitated Advance Care Planning in Outpatient Clinics: A Qualitative Study of Patient and Caregivers Experiences. J Appl Gerontol 2024; 43:339-348. [PMID: 37949095 PMCID: PMC10875901 DOI: 10.1177/07334648231206742] [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: 05/10/2023] [Revised: 09/19/2023] [Accepted: 09/21/2023] [Indexed: 11/12/2023] Open
Abstract
Guidelines recommend advance care planning (ACP) for people with advanced illness; however, evidence supporting ACP as a component of outpatient care is lacking. We sought to establish the feasibility and acceptability of a facilitated ACP intervention for people attending tertiary outpatient clinics. Data from 20 semi-structured interviews with patient (M = 79.3 ± 7.7, 60% male) and caregiver (M = 68.1 ± 11.0, 60% female) participants recruited as part of a pragmatic, randomized controlled trial (RCT) were analyzed using qualitative descriptive methodology. Patients were randomized to intervention (e.g., facilitated support) or control (e.g., standard care). Intervention patients expressed high satisfaction, reporting the facilitated ACP session was clear, straightforward, and suited to their needs. Intervention caregivers did not report any significant concerns with the facilitated ACP process. Control participants reported greater difficulty completing ACP compared to intervention participants. Embedding facilitated ACP into tertiary outpatient care appears feasible and acceptable for people with advanced illnesses.
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Affiliation(s)
- Kate H. Marshall
- UNSW Academic General Practice Network, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | | | - Anne E. Meller
- Advance Care Planning Services, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Gideon A. Caplan
- Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
- Department of Geriatric Medicine, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Vasi Naganathan
- Centre for Education and Research on Ageing (CERA), Department of Geriatric Medicine, Concord Repatriation General Hospital, Sydney, NSW, Australia
- Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - John Cullen
- Centre for Education and Research on Ageing (CERA), Department of Geriatric Medicine, Concord Repatriation General Hospital, Sydney, NSW, Australia
- Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Peter Gonski
- Southcare Aged and Extended Community Care, Sutherland Hospital, Sydney, NSW, Australia
| | - Nicholas A. Zwar
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Julie-Ann O’Keeffe
- Aged, Chronic Care and Rehabilitation, Sydney Local Health District, Sydney, NSW, Australia
| | - Karolina Krysinska
- Centre for Primary Health Care and Equity, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Joel J. Rhee
- UNSW Academic General Practice Network, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
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Hart NH, Crawford-Williams F, Crichton M, Yee J, Smith TJ, Koczwara B, Fitch MI, Crawford GB, Mukhopadhyay S, Mahony J, Cheah C, Townsend J, Cook O, Agar MR, Chan RJ. Unmet supportive care needs of people with advanced cancer and their caregivers: a systematic scoping review. Crit Rev Oncol Hematol 2022; 176:103728. [PMID: 35662585 DOI: 10.1016/j.critrevonc.2022.103728] [Citation(s) in RCA: 67] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 05/24/2022] [Accepted: 05/26/2022] [Indexed: 01/11/2023] Open
Abstract
Examining and addressing unmet care needs is integral to improving the provision and quality of cancer services. This review explored the prevalence of unmet supportive care needs, and factors associated with unmet need, in adults with advanced cancers (solid and hematological malignancies) and their caregivers. Electronic databases (PubMed, CINAHL, EMBASE) were searched, producing 85 papers representing 81 included studies. People with advanced cancer reported the highest unmet needs in financial, health system and information, psychological, and physical and daily living domains, whereas caregivers reported the highest unmet needs in psychological, and patient care and support domains. Distress, depression, and anxiety were associated with higher unmet needs across all unmet need domains for people with advanced cancer and their caregivers. Substantial heterogeneity in study populations and methods was observed. Findings from this review can inform targeted strategies and interventions to address these unmet needs in people with advanced cancer.
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Affiliation(s)
- Nicolas H Hart
- Caring Futures Institute, College of Nursing and Health Science, Flinders University, SA, Australia; Exercise Medicine Research Institute, School of Medical and Health Sciences, Edith Cowan University, WA, Australia; Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, QLD, Australia; Institute for Health Research, University of Notre Dame Australia, WA, Australia.
| | - Fiona Crawford-Williams
- Caring Futures Institute, College of Nursing and Health Science, Flinders University, SA, Australia; Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, QLD, Australia
| | - Megan Crichton
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, QLD, Australia; Nutrition and Dietetics Research Group, Bond University, QLD, Australia
| | - Jasmine Yee
- Centre for Medical Psychology and Evidence-Based Decision-Making, Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - Thomas J Smith
- Division of General Internal Medicine, John Hopkins Medical Institutions, Baltimore, MD, USA
| | - Bogda Koczwara
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, SA, Australia; Flinders Cancer and Innovation Centre, Flinders Medical Centre, SA, Australia
| | - Margaret I Fitch
- School of Graduate Studies, Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Gregory B Crawford
- Discipline of Medicine, University of Adelaide, SA, Australia; Northern Adelaide Local Health Network, SA, Australia
| | - Sandip Mukhopadhyay
- Burdwan Medical College, West Bengal, Kolkata, India; Indian Council of Medical Research, National Institute of Cholera and Enteric Diseases, Kolkata, India
| | | | - Chan Cheah
- Internal Medicine, UWA Medical School, University of Western Australia, WA, Australia; Department of Haematology, Sir Charles Gairdner Hospital, WA, Australia; Department of Haematology, Hollywood Private Hospital, WA, Australia
| | | | - Olivia Cook
- McGrath Foundation, NSW, Australia; School of Nursing and Midwifery, Monash University, VIC, Australia
| | - Meera R Agar
- IMPACCT Centre, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Raymond J Chan
- Caring Futures Institute, College of Nursing and Health Science, Flinders University, SA, Australia; Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, QLD, Australia
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Lowers J, Scardaville M, Hughes S, Preston NJ. Comparison of the experience of caregiving at end of life or in hastened death: a narrative synthesis review. BMC Palliat Care 2020; 19:154. [PMID: 33032574 PMCID: PMC7545566 DOI: 10.1186/s12904-020-00660-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 09/29/2020] [Indexed: 12/15/2022] Open
Abstract
Background End-of-life caregiving frequently is managed by friends and family. Studies on hastened death, including aid in dying or assisted suicide, indicate friends and family also play essential roles before, during, and after death. No studies have compared the experiences of caregivers in hastened and non-hastened death. The study aim is to compare end-of-life and hastened death caregiving experience using Hudson’s modified stress-coping model for palliative caregiving. Method Narrative synthesis of qualitative studies for caregivers at end of life and in hastened death, with 9946 end-of life and 1414 hastened death qualitative, peer-reviewed research articles extracted from MEDLINE, CINAHL, Web of Science, and PsycINFO, published between January 1998 and April 2020. Results Forty-two end-of-life caregiving and 12 hastened death caregiving articles met inclusion criteria. In both end-of-life and hastened death contexts, caregivers are motivated to ease patient suffering and may put their own needs or feelings aside to focus on that priority. Hastened death caregivers’ expectation of impending death and the short duration of caregiving may result in less caregiver burden. Acceptance of the patient’s condition, social support, and support from healthcare professionals all appear to improve caregiver experience. However, data on hastened death are limited. Conclusion Caregivers in both groups sought closeness with the patient and reported satisfaction at having done their best to care for the patient in a critical time. Awareness of anticipated death and support from healthcare professionals appear to reduce caregiver stress. The modified stress-coping framework is an effective lens for interpreting caregivers’ experiences at end of life and in the context of hastened death.
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Affiliation(s)
- Jane Lowers
- Emory University, Palliative Care Center, 1821 Clifton Road, Suite 1016, Atlanta, GA, 30329, USA.
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Hearson B, McClement S, McMillan DE, Harlos M. Sleeping with One Eye Open: The Sleep experience of Family Members Providing Palliative Care at Home. J Palliat Care 2018. [DOI: 10.1177/082585971102700202] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: To empirically describe the sleep experience of family caregivers (n=13) of advanced cancer patients. Method: Mixed methodology using: family interviews; Epworth Sleepiness Scale (ESS); Pittsburgh Sleep Quality Index (PSQI); and actigraphy measurement. Qualitative data analysis utilized constant comparative content techniques. Actiware for the actigraphy data and the Statistical Package for the Social Sciences-15 (SPSS-15) generated descriptive and correlation statistics. Findings: The over arching theme “sleeping with one eye open” captures the vigilant nature of caregivers’ sleep experiences. Caregiver narratives were validated by quantitative findings: 5 of the family caregivers (38.5 percent) had an ESS score ≥ 11 indicative of excessive daytime sleepiness, all caregivers had a PSQI global score > 5 indicative of moderate to severe sleep problems, and actigraphy scores — including total sleep time, sleep efficiency, and time awake after sleep onset — fell beyond normal values documented in the literature. Conclusion: Impeccable assessment of the patient's and family's sleep status, sleep education, intervention strategies, and high-quality respite services are critical in community-based palliative care.
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Affiliation(s)
- Brenda Hearson
- B Hearson (corresponding author) Winnipeg Regional Health Authority Palliative Care Program, and Canadian Virtual Hospice, 10 Doral Way, Headingly, Manitoba, Canada R4H 1J4
| | - Susan McClement
- Faculty of Nursing, University of Manitoba, and Manitoba Palliative Care Research Unit, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Diana E. McMillan
- Faculty of Nursing, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Michael Harlos
- Faculty of Medicine, University of Manitoba, and Palliative Care Program, Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada
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Fjose M, Eilertsen G, Kirkevold M, Grov EK. "Non-palliative care" - a qualitative study of older cancer patients' and their family members' experiences with the health care system. BMC Health Serv Res 2018; 18:745. [PMID: 30268149 PMCID: PMC6162914 DOI: 10.1186/s12913-018-3548-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 09/18/2018] [Indexed: 12/26/2022] Open
Abstract
Background Among all cancer patients in the palliative phase, ¾ have reached the age of 65. An aging population will increase the number of people afflicted with cancer, and create challenges for patients, family members and health services. Nevertheless, limited research has focused explicitly on the experiences and needs of older cancer patients in the palliative phase and their families. Therefore, the aim of this study is to explore what older home dwelling cancer patients in the palliative phase and their close family members, as individuals and as a family, experience as important and difficult when facing the health services. Methods We used a qualitative descriptive design. Data was collected through family group interviews with 26 families. Each interview consisted of an older home dwelling cancer patient and one to four family members with different relationships to the patient (e.g. spouse, adult children and/or children-in-law). Data was analysed by qualitative content analysis. Results The main theme is “Non-palliative care” – health care services in the palliative phase not tailored to family needs. Three themes are revealed: 1) exhausting cancer follow-up, 2) a cry for family involvement, and 3) fragmented care. Conclusion The health services seem poorly organised for meeting the demands of palliative care for older home dwelling cancer patients in the palliative phase and their family members. Close family members would like to contribute but health services lack systems for involving them in the follow-up of the patient.
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Affiliation(s)
- Marianne Fjose
- Faculty of Health and Social Sciences, Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Postboks 7030, 5020, Bergen, Norway.
| | - Grethe Eilertsen
- Faculty of Health and Social Sciences, Department of Nursing and Health Sciences, University College of Southeast Norway, Drammen, Norway
| | - Marit Kirkevold
- Faculty of Medicine, Department of Nursing Science, University of Oslo, Oslo, Norway
| | - Ellen Karine Grov
- Faculty of Health Sciences, Institute of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
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Wang T, Molassiotis A, Chung BPM, Tan JY. Unmet care needs of advanced cancer patients and their informal caregivers: a systematic review. BMC Palliat Care 2018; 17:96. [PMID: 30037346 PMCID: PMC6057056 DOI: 10.1186/s12904-018-0346-9] [Citation(s) in RCA: 335] [Impact Index Per Article: 55.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 06/25/2018] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND This systematic review aimed to identify the unmet care needs and their associated variables in patients with advanced cancer and informal caregivers, alongside summarizing the tools used for needs assessment. METHODS Ten electronic databases were searched systematically from inception of each database to December 2016 to determine eligible studies. Studies that considered the unmet care needs of either adult patients with advanced cancer or informal caregivers, regardless of the study design, were included. The Mixed Methods Appraisal Tool was utilized for quality appraisal of the included studies. Content analysis was used to identify unmet needs, and descriptive analysis was adopted to synthesize other outcomes. RESULTS Fifty studies were included, and their methodological quality was generally robust. The prevalence of unmet needs varied across studies. Twelve unmet need domains were identified in patients with advanced cancer, and seven among informal caregivers. The three most commonly reported domains for patients were psychological, physical, and healthcare service and information. The most prominent unmet items of these domains were emotional support (10.1-84.4%), fatigue (18-76.3%), and "being informed about benefits and side-effects of treatment" (4-66.7%). The most commonly identified unmet needs for informal caregivers were information needs, including illness and treatment information (26-100%) and care-related information (21-100%). Unmet needs of patients with advanced cancer were associated with their physical symptoms, anxiety, and quality of life. The most commonly used instruments for needs assessment among patients with advanced cancer were the Supportive Care Needs Survey (N = 8) and Problems and Needs in Palliative Care questionnaire (N = 5). The majority of the included studies investigated unmet needs from the perspectives of either patients or caregivers with a cross-sectional study design using single time-point assessments. Moreover, significant heterogeneity, including differences in study contexts, assessment methods, instruments for measurement, need classifications, and reporting methods, were identified across studies. CONCLUSION Both advanced cancer patients and informal caregivers reported a wide range of context-bound unmet needs. Examining their unmet needs on the basis of viewing patients and their informal caregivers as a whole unit will be highly optimal. Unmet care needs should be comprehensively evaluated from the perspectives of all stakeholders and interpreted by using rigorously designed mixed methods research and longitudinal studies within a given context.
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Affiliation(s)
- Tao Wang
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Alex Molassiotis
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Betty Pui Man Chung
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Jing-Yu Tan
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
- College of Nursing and Midwifery, Charles Darwin University, Darwin, Australia
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Reckrey JM, Brody AA, McCormick ET, DeCherrie LV, Zhu CW, Ritchie CS, Siu AL, Egorova NN, Federman AD. Rationale and design of a randomized controlled trial of home-based primary care versus usual care for high-risk homebound older adults. Contemp Clin Trials 2018; 68:90-94. [PMID: 29588167 DOI: 10.1016/j.cct.2018.03.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 03/12/2018] [Accepted: 03/19/2018] [Indexed: 11/18/2022]
Affiliation(s)
- Jennifer M Reckrey
- Department of Geriatrics and Palliative Medicine, Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
| | - Abraham A Brody
- Hartford Institute of Geriatric Nursing, Rory Meyers College of Nursing, New York University, New York, NY, United States; Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Geriatrics Research, Education, and Clinical Center (GRECC), James J. Peters VA Medical Center, Bronx, NY, United States
| | - Elizabeth T McCormick
- Department of Geriatrics and Palliative Medicine, Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Linda V DeCherrie
- Department of Geriatrics and Palliative Medicine, Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Carolyn W Zhu
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Geriatrics Research, Education, and Clinical Center (GRECC), James J. Peters VA Medical Center, Bronx, NY, United States
| | - Christine S Ritchie
- Department of Medicine, University of California San Francisco, School of Medicine, San Francisco, CA, United States
| | - Albert L Siu
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Geriatrics Research, Education, and Clinical Center (GRECC), James J. Peters VA Medical Center, Bronx, NY, United States
| | - Natalia N Egorova
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Alex D Federman
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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8
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Caregivers needing care: the unmet needs of the family caregivers of end-of-life cancer patients. Support Care Cancer 2017; 26:759-766. [PMID: 28952034 DOI: 10.1007/s00520-017-3886-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 09/11/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Family caregivers play a significant role in the care of cancer patients, especially in their end of life. Identifying and meeting the needs of these caregivers is essential to improving their quality of patient care. This study was conducted to identify the unmet needs of the caregivers of end-of-life cancer patients. METHODS A total of 18 semi-structured interviews were held with the family caregivers of end-of-life cancer patients using purposive sampling. The interviews were recorded, transcribed, and analyzed using qualitative content analysis. RESULTS The analysis of the data led to the formation of three main categories, including social needs, cognitive needs, and psychological needs. The social needs category comprised of the subcategories of support for care, effective communication and financial support. The cognitive needs category comprised of educational support and support in decision-making. The psychological needs category comprised of support for psychological trauma, preparation to confront the reality of the death of a loved one, and support for mourning. CONCLUSIONS The family caregivers of end-of-life cancer patients take on the responsibility of many aspects of care for their patient, but many of their own needs remain unmet. The findings of this study can be used for healthcare policy planning and the development of palliative interventions, particularly for the family caregivers of end-of-life cancer patients.
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Delalibera M, Presa J, Barbosa A, Leal I. [Burden of caregiving and its repercussions on caregivers of end-of-life patients: a systematic review of the literature]. CIENCIA & SAUDE COLETIVA 2017; 20:2731-47. [PMID: 26331505 DOI: 10.1590/1413-81232015209.09562014] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Caring for a family member with an advanced and/or terminal illness can be a great emotional, physical and financial burden that has an impact on the quality of life of the caregivers. The scope of this study was to conduct a systematic review of the literature on the burden of caregiving, related factors and the consequences for family caregivers of advanced stage cancer patients or patients in end-of-life or palliative care. A search for scientific papers published in the EBSCO, Web of Knowledge and BIREME databases was conducted since records on this topic began in the databases through March 2014. Of the 582 articles found, only 27 were selected. The majority of the articles found that family caregivers were overburdened. Some studies found that the care-giving burden was associated with characteristics of the patients and their illnesses while, in other studies, it was associated with poor health of the caregiver, greater psychopathological symptoms (anxiety, depression, emotional distress) and with the development of complications in the grieving process. However, hope, social support, the ability of the caregiver to attribute meaning to the experience of caring and feeling comfortable with the tasks of caring were associated with lower levels of burden.
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Affiliation(s)
| | - Joana Presa
- Unidade de Medicina Paliativa, Centro Hospitalar Lisboa Norte, PT
| | - António Barbosa
- Unidade de Medicina Paliativa, Centro Hospitalar Lisboa Norte, PT
| | - Isabel Leal
- Instituto Superior de Psicologia Aplicada, Lisboa, PT,
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Sagha Zadeh R, Eshelman P, Setla J, Sadatsafavi H. Strategies to Improve Quality of Life at the End of Life: Interdisciplinary Team Perspectives. Am J Hosp Palliat Care 2017; 35:411-416. [PMID: 28571497 DOI: 10.1177/1049909117711997] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
This ethnographic study draws on the experiences of members of interdisciplinary care teams working with end-of-life care patients to identify strategies to improve quality of life through care practices. We surveyed 133 staff and volunteers (physicians, physician assistants, nurse practitioners, registered nurses, social workers, chaplains, administrators, and volunteers) who provide end-of-life care to patients in both home and institutional settings for 4 organizations in 2 counties in Upstate New York. Survey responses were analyzed using qualitative content analysis. The results identified numerous strategies to enhance and safeguard quality of life for end-of-life care patients and their family members. These strategies can be categorized into 6 domains: organization philosophy and mission; organizational policies; caregivers' behaviors and practices; symptom management; facility design, operation and management; and patient, family member, and caregiver experience. The diverse list of identified strategies indicates that improving care to address the unique, complex, multilayered dimensions of quality of life at the end of life requires a multidisciplinary approach and consistency among care providers, including administration, clinical management, front-line caregivers, and support staff. When all of these strategies are used in harmony, care can truly be enhanced.
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Affiliation(s)
- Rana Sagha Zadeh
- 1 Department of Design and Environmental Analysis, Cornell University, Ithaca, NY, USA
| | - Paul Eshelman
- 1 Department of Design and Environmental Analysis, Cornell University, Ithaca, NY, USA
| | - Judith Setla
- 2 Hospice of Central New York, Liverpool, NY, USA
- 3 SUNY Upstate Medical University, Syracuse, NY, USA
| | - Hessam Sadatsafavi
- 1 Department of Design and Environmental Analysis, Cornell University, Ithaca, NY, USA
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11
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Robinson CA, Bottorff JL, McFee E, Bissell LJ, Fyles G. Caring at home until death: enabled determination. Support Care Cancer 2016; 25:1229-1236. [PMID: 27924357 DOI: 10.1007/s00520-016-3515-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 11/25/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE The importance of family caregivers in providing palliative care at home and in supporting a home death is well supported. Gaining a better understanding of what enables palliative family caregivers to continue caring at home for their family members until death is critical to providing direction for more effective support. The purpose of the study was to describe the experiences of bereaved family caregivers whose terminally ill family members with advanced cancer were successful in achieving a desired home death. METHOD A qualitative interpretive descriptive approach was used. Data were collected using semi-structured, audio-recorded interviews conducted in-person or via telephone in addition to field notes and reflective journaling. The study took place in British Columbia, Canada, and included 29 bereaved adult family caregivers who had provided care for a family member with advanced cancer and experienced a home death. RESULTS Four themes captured the experience of caring at home until death: context of providing care, supportive antecedents to providing care, determination to provide care at home, and enabled determination. Factors that enabled determination to achieve a home death included initiation of formal palliative care, asking for and receiving help, augmented care, relief or respite, and making the healthcare system work for the ill person. CONCLUSIONS Clarifying caregiving goals and supporting the factors that enable caregiver determination appear to be critical in enhancing the likelihood of a desired home death.
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Affiliation(s)
- Carole A Robinson
- School of Nursing, University of British Columbia, ART 132, 1147 Research Road, Kelowna, BC, V1V 1V7, Canada.
| | - Joan L Bottorff
- School of Nursing, University of British Columbia, ART 223A, 1147 Research Road, Kelowna, BC, V1V 1V7, Canada
| | - Erin McFee
- School of Nursing, University of British Columbia, Kelowna, BC, Canada
| | - Laura J Bissell
- College of Graduate Studies, University of British Columbia, EME 2121, 1137 Alumni Avenue, Kelowna, BC, V1V 1V7, Canada
| | - Gillian Fyles
- British Columbia Cancer Agency, Sindi Ahluwalia Hawkins Centre for the Southern Interior, 399 Royal Avenue, Kelowna, BC, V1Y 5L3, Canada
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12
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Wajnberg A, Soones TN, Smith KL, Russell D, Ross JS, Federman A. Identifying Sociodemographic Characteristics Associated With Burden Among Caregivers of the Urban Homebound: The Importance of Racial and Relationship Differences. Gerontol Geriatr Med 2016; 2:2333721416667878. [PMID: 28913372 PMCID: PMC5590692 DOI: 10.1177/2333721416667878] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 05/16/2016] [Accepted: 08/01/2016] [Indexed: 11/30/2022] Open
Abstract
Limited research has explored whether the burden associated with caring for homebound patients varies across racial groups or by relationship status. We examined these variations for this vulnerable population. Patients self-identified informal caregivers and caregiver burden/depression were assessed using the Zarit Caregiver Burden Scale and the Center for Epidemiologic Studies–Depression scale (CES-D). Forty-nine informal caregivers completed the interview. Mean age was 58 (SD = 14), 78% were female, 37% Black, 35% Hispanic, and 46% had completed high school. Over 60% of caregivers had moderate or severe caregiver burden and 30% had significant depression. White caregivers had greater burden than Black and Hispanic caregivers (p = .02). Mean caregiver burden was higher among spouse/partner caregivers, versus those who identified as children or other family or friends (p = .004). Additional research is needed to better understand the experience of racial and ethnic minorities and spouses in providing informal care to homebound adults.
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Affiliation(s)
| | | | | | - David Russell
- Center for Home Care Policy & Research, Visiting Nurse Services of New York, NY, USA
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13
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Rokach A, Matalon R, SaFarov A, Bercovitch M. The Dying, Those Who Care for Them, and How They Cope With Loneliness. Am J Hosp Palliat Care 2016; 24:399-407. [DOI: 10.1177/1049909107305652] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This study compares the manner in which the dying, their caregivers, and the general population cope with loneliness. The patients were recruited in an oncological hospice in Israel and, despite being on their deathbed, agreed to participate. Thirty-seven cancer-stricken patients, 78 caregivers, and 128 participants From the general population volunteered to take part. The participants anonymously answered a 34-item questionnaire and were asked to endorse those items that described their strategies oF successFully coping with loneliness. Results suggested the dying patient, his or her caregiver, and the general population cope with loneliness diFFerently. Dying patients scored signiFicantly lower than the general population on the social support network and increased activity sub-scales, with a reversed trend For religion and Faith. This may be the First study to examine the manner in which the dying and their caregivers cope with loneliness. Thus, more research is needed to replicate the study using larger samples.
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Affiliation(s)
- Ami Rokach
- Institute For the Study and Treatment oF Psychosocial Stress, Toronto, Ontario, Canada,
| | - Raan Matalon
- Institute For the Study and Treatment oF Psychosocial Stress, Toronto, Ontario, Canada
| | - Artem SaFarov
- Institute For the Study and Treatment oF Psychosocial Stress, Toronto, Ontario, Canada
| | - Michaela Bercovitch
- Palliative Care Department, Sheba Medical Center, Tel Aviv University, Israel
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Abstract
BACKGROUND With the research focus on family caregiving shifting from the individual to the dyadic level, there is a need to develop a conceptual framework that focused on caregiver-patient dyads. OBJECTIVE The aim of this study was to develop a preliminary conceptual framework for cancer couple dyads, to "Live With Love." METHODS A literature search was conducted among 4 electronic databases to identify couple-based intervention studies related to couples coping with cancer. This report differs from a traditional literature review in that we synthesized the models or frameworks used in these studies rather than the outcomes of the studies. A preliminary Live With Love Conceptual Framework (P-LLCF) for cancer couple dyads was developed based on the conceptual frameworks adopted in related literature on spousal caregiving for patients with cancer. RESULTS This P-LLCF contains 3 domains: event situation, dyadic mediators, and caregiver-patient dyads (appraisal, coping, and adjustment/outcomes). The various components in this P-LLCF will work together to benefit the positive dyadic adjustment/outcomes of the spousal caregiver-patient dyads in the cancer dyads' journey of coping with cancer. CONCLUSIONS This P-LLCF sheds new light on the study of cancer couple dyads. It will be potentially valuable for guiding the related research and development of interventions on cancer couple dyads. IMPLICATIONS FOR PRACTICE Future research is needed to assess the outcome of interventions that focus on different components. It is also needed to develop measurements to assess dyadic adjustment/outcomes in nursing practice.
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Ewing G, Austin L, Grande G. The role of the Carer Support Needs Assessment Tool in palliative home care: A qualitative study of practitioners' perspectives of its impact and mechanisms of action. Palliat Med 2016. [PMID: 26199133 DOI: 10.1177/0269216315596662] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The importance of supporting family carers is well recognised in healthcare policy. The Carer Support Needs Assessment Tool is an evidence-based, comprehensive measure of carer support needs to facilitate carer support in palliative home care. AIM To examine practitioner perspectives of the role of the Carer Support Needs Assessment Tool intervention in palliative home care to identify its impact and mechanisms of action. DESIGN Qualitative - practitioner accounts of implementation (interviews, focus groups, reflective audio diaries) plus researcher field notes. SETTING/PARTICIPANTS A total of 29 staff members from two hospice home-care services - contrasting geographical locations, different service sizes and staff composition. A thematic analysis was conducted. RESULTS Existing approaches to identification of carer needs were informal and unstructured. Practitioners expressed some concerns, pre-implementation, about negative impacts of the Carer Support Needs Assessment Tool on carers and expectations raised about support available. In contrast, post-implementation, the Carer Support Needs Assessment Tool provided positive impacts when used as part of a carer-led assessment and support process: it made support needs visible, legitimised support for carers and opened up different conversations with carers. The mechanisms of action that enabled the Carer Support Needs Assessment Tool to make a difference were creating space for the separate needs of carers, providing an opportunity for carers to express support needs and responding to carers' self-defined priorities. CONCLUSION The Carer Support Needs Assessment Tool delivered benefits through a change in practice to an identifiable, separate assessment process for carers, facilitated by practitioners but carer-led. Used routinely with all carers, the Carer Support Needs Assessment Tool has the potential to normalise carer assessment and support, facilitate delivery of carer-identified support and enable effective targeting of resources.
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Affiliation(s)
- Gail Ewing
- Centre for Family Research, University of Cambridge, Cambridge, UK
| | - Lynn Austin
- School of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK
| | - Gunn Grande
- School of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK
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16
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Experiences of Parents and General Practitioners with End-of-Life Care in Adolescents and Young Adults with Cancer. J Adolesc Young Adult Oncol 2016; 5:64-8. [DOI: 10.1089/jayao.2015.0009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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17
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Bužgová R, Špatenková N, Fukasová-Hajnová E, Feltl D. Assessing needs of family members of inpatients with advanced cancer. Eur J Cancer Care (Engl) 2016; 25:592-9. [DOI: 10.1111/ecc.12441] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2015] [Indexed: 10/22/2022]
Affiliation(s)
- R. Bužgová
- Department of Nursing and Midwifery; Faculty of Medicine; University of Ostrava; Ostrava Czech Republic
| | - N. Špatenková
- Department of Nursing and Midwifery; Faculty of Medicine; University of Ostrava; Ostrava Czech Republic
| | - E. Fukasová-Hajnová
- Department of Nursing and Midwifery; Faculty of Medicine; University of Ostrava; Ostrava Czech Republic
- Clinic of Oncology; University Hospital Ostrava; Ostrava Czech Republic
| | - D. Feltl
- Department of Imaging Methods; University of Ostrava; Ostrava Czech Republic
- Clinic of Oncology; University Hospital Ostrava; Ostrava Czech Republic
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Arias Rojas M, García-Vivar C. The transition of palliative care from the hospital to the home: a narrative review of experiences of patients and family caretakers. INVESTIGACION Y EDUCACION EN ENFERMERIA 2015; 33:482-491. [PMID: 28569956 DOI: 10.17533/udea.iee.v33n3a12] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 04/15/2015] [Indexed: 06/07/2023]
Abstract
OBJECTIVE This work sought to identify, analyze, and synthesize the qualitative studies published on the experiences of patients and family caretakers during the transition of palliative care from the hospital to the home. METHODOLOGY A narrative review was conducted on the PubMed, Cochrane Central, ScienceDirect, Ovid Nursing, CINALH, Scielo, and Bireme databases, from 2000 to 2014. RESULTS After the analysis and comparison of the data, the results were grouped into six themes: (1) the dyad and its knowledge regarding the diagnosis and prognosis; (2) emotions experienced by the family caretaker and the patient during discharge; (3) effective communication among those involved with the care; (4) education for the care of the person at home; (5) continuous support to the dyad at home, and (6) care overload: social support for the family caretaker. CONCLUSION Patients and relatives in palliative care experience a broad range of needs during the transition process from the hospital to the home, which are often not covered by healthcare professionals. This review evidences the need to research further on the experiences of these families, especially during the stage prior to the transfer to the domicile.
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LeSeure P, Chongkham-Ang S. The Experience of Caregivers Living with Cancer Patients: A Systematic Review and Meta-Synthesis. J Pers Med 2015; 5:406-39. [PMID: 26610573 PMCID: PMC4695863 DOI: 10.3390/jpm5040406] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 11/10/2015] [Accepted: 11/12/2015] [Indexed: 11/16/2022] Open
Abstract
The objectives of this meta-synthesis were to: (1) explore the experience of caregivers who were caring for cancer patients, including their perceptions and responses to the situation; and (2) describe the context and the phenomena relevant to the experience. Five databases were used: CINAHL, MEDLINE, Academic Search, Science Direct, and a Thai database known as the Thai Library Integrated System (ThaiLIS). Three sets of the context of the experience and the phenomena relevant to the experience were described. The contexts were (1) having a hard time dealing with emotional devastation; (2) knowing that the caregiving job was laborious; and (3) knowing that I was not alone. The phenomenon showed the progress of the caregivers’ thoughts and actions. A general phenomenon of the experience—balancing my emotion—applied to most of the caregivers; whereas, more specific phenomenon—keeping life as normal as possible and lifting life above the illness—were experienced by a lesser number of the caregivers. This review added a more thorough explanation of the issues involved in caregiving for cancer patients. A more comprehensive description of the experience of caregiving was described. The findings of this review can be used to guide clinical practice and policy formation in cancer patient care.
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Affiliation(s)
- Peeranuch LeSeure
- McCormick Faculty of Nursing, Payap University, Chiang Mai 50000, Thailand.
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20
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Hou WK, Lau KM, Ng SM, Lee TMC, Cheung HYS, Shum TCY, Cheng ACK. Psychological detachment and savoring in adaptation to cancer caregiving. Psychooncology 2015; 25:839-47. [PMID: 26514926 DOI: 10.1002/pon.4019] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 08/11/2015] [Accepted: 09/29/2015] [Indexed: 11/08/2022]
Abstract
BACKGROUND Recovery experience including psychological detachment from caregiving and savoring positive moments in life could be complementary coping processes for cancer caregivers. This study aims to examine the nature of their associations with caregiving burden and anxiety and depressive symptoms among Chinese cancer caregivers in Hong Kong. METHODS A total of 155 Chinese caregivers of recently diagnosed cancer patients (mean time since diagnosis = 42.57 days, SD = 39.25) were recruited from two major government-funded hospitals and administered a questionnaire assessing psychological detachment, savoring, caregiving burden, anxiety and depressive symptoms, and demographics. RESULTS Controlling for demographic and medical covariates, structural equation modeling revealed significant associations of detachment, savoring, and their interaction term with caregiving burden and anxiety and depressive symptoms. Detachment and savoring were inversely associated with caregiving burden only when the other was at lower/medium levels. Detachment was inversely associated with anxiety and depressive symptoms at lower/medium levels of savoring, but savoring was inversely associated with anxiety and depressive symptoms across all levels of detachment. CONCLUSIONS Detachment and savoring could overshadow the positive impact of the other on caregiving burden if either one is at higher levels, while they could demonstrate concurrent positive impact on burden when both are at lower/medium levels. Savoring could have a prioritized role in ameliorating caregivers' anxiety and depressive symptoms, supplemented by detachment. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Wai Kai Hou
- Department of Psychological Studies, The Hong Kong Institute of Education, Hong Kong.,Laboratory of Psychobiology of Emotion and Stress (LoPES), The Hong Kong Institute of Education, Hong Kong.,Centre for Psychosocial Health, The Hong Kong Institute of Education, Hong Kong
| | - Kam Man Lau
- Department of Psychological Studies, The Hong Kong Institute of Education, Hong Kong.,Laboratory of Psychobiology of Emotion and Stress (LoPES), The Hong Kong Institute of Education, Hong Kong
| | - Sin Man Ng
- Department of Psychological Studies, The Hong Kong Institute of Education, Hong Kong.,Laboratory of Psychobiology of Emotion and Stress (LoPES), The Hong Kong Institute of Education, Hong Kong
| | - Tatia Mei Chun Lee
- Department of Psychology, The University of Hong Kong, Hong Kong.,Laboratory of Neuropsychology, The University of Hong Kong, Hong Kong
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21
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Test Construction of Caregiver Collusion Questionnaire. PSYCHOLOGICAL STUDIES 2014. [DOI: 10.1007/s12646-014-0273-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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22
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Dean S, Libby K, McAuley WJ, Van Nostrand J. Access to bereavement services in hospice. OMEGA-JOURNAL OF DEATH AND DYING 2014; 69:79-92. [PMID: 25084710 DOI: 10.2190/om.69.1.e] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Hospice bereavement services, though often overlooked in hospice research, are an important area of study due not only to the potential value of bereavement support but also the emphasis placed on such services by the Centers for Medicare and Medicaid Services. Moreover, access to these services is seldom understood or researched. Therefore, using the patient public use file of the 2007 National Home and Hospice Care Survey, we explored the relationships between patient, informal caregiver, and agency characteristics as well as discharges from hospice to gain perspective into bereavement service access to informal caregivers. Findings suggested that death at discharge from hospice may be an important moderator variable between access to hospice bereavement support and many other factors. However, even under controls for death at discharge, two agency characteristics remain significantly associated with access. Bereavement access tends to be more likely in agencies that provide only hospice care as opposed to other services, and in micropolitan agencies. Furthermore, death at discharge is less likely among African Americans, suggesting the value of enhanced culturally-appropriate and more targeted hospice care and hospice bereavement support for this population. Future research should explore the strategies used to effectively deliver bereavement services and how these strategies may benefit from targeted and culturally sensitive approaches.
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Yoo JS, Lee J, Chang SJ. Family Experiences in End-of-Life Care: A Literature Review. Asian Nurs Res (Korean Soc Nurs Sci) 2014; 2:223-34. [PMID: 25029960 DOI: 10.1016/s1976-1317(09)60004-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2008] [Revised: 09/12/2008] [Accepted: 11/21/2008] [Indexed: 10/21/2022] Open
Abstract
PURPOSE The purpose of this study was to summarize and analyze families' experiences of end-of-life care by conducting a systematic review of peer reviewed journals both in Korea and abroad. BACKGROUND Families play an increasingly important role in care and medical treatment, acting as caregivers or decision makers rather than just being passive observers. It is necessary to understand the experiences of family members in order to provide appropriate care for them. METHODS A systematic search of the literature was performed using the Cumulative Index for Nursing and Allied Health Literature (CINAHL) and the Korea Education & Research Information Service (KERIS) for the period of January 1990 through to December 2006. A total of 35 studies met the inclusion criteria. RESULTS Seventeen studies used a quantitative design, while 18 studies used qualitative methods. Quantitative studies reported that the family's quality of life was relatively low when the patient was in need of high medical/nursing services. The perceived burden levels were moderately high, and depression levels were high among family caregivers. Various concepts emerged from the 18 qualitative studies, including psychological issues, physical problems, burdens, needs and interpersonal relationships. CONCLUSION This study found that most previous research findings were focused on negative and neutral experiences. A few studies identified positive experiences. Based on the study results, we suggest that nurses need to be more aware of the experiences of patients' families and their potential needs.
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Affiliation(s)
- Ji-Soo Yoo
- Professor, Nursing Policy Research Institute, College of Nursing, Yonsei University, Seoul, Korea
| | - JuHee Lee
- Assistant Professor, Nursing Policy Research Institute, College of Nursing, Yonsei University, Seoul, Korea
| | - Soo Jung Chang
- Ph.D. candidate, Department of Nursing, Graduate school, Yonsei University
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"A True Human Interaction": Comparison of Family Caregiver and Hospice Nurse Perspectives On Needs of Family Hospice Caregivers. J Hosp Palliat Nurs 2014; 16:282-290. [PMID: 31007623 DOI: 10.1097/njh.0000000000000066] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Context Home hospice providers are concerned with family caregiver perceptions about the quality of care and support offered. More research is needed to understand experiences of family caregivers and what "support" means to these family members. Objective We compared perceptions of caregiver needs from the family caregiver and the nurse case manager. Methods Former family caregivers and hospice nurses participated in focus groups. Discussions were audio-recorded, transcribed, inductively coded and qualitatively analyzed to describe patterns and themes. Results Both groups described information, honesty, trust, respect, and control as important to caregivers feeling supported, and to the development of positive relationships between hospice and family. Caregivers and nurses, however, talked about the concepts of caregiver needs, relationship building, and effective support differently, which suggested two themes that captured these contrasts while highlighting the importance of relationship-building to both groups: "Breaking it down to build it up" and "Doing to, doing for, doing with". Conclusion Caregivers and nurses cited similar elements necessary for successful relationships between caregivers and the hospice team, but how they described them differed and these differences shape perceptions of support. Greater understanding of similarities and differences could inform and improve training and education programs for hospice teams.
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Michael N, O'Callaghan C, Baird A, Hiscock N, Clayton J. Cancer caregivers advocate a patient- and family-centered approach to advance care planning. J Pain Symptom Manage 2014; 47:1064-77. [PMID: 24144996 DOI: 10.1016/j.jpainsymman.2013.07.009] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Revised: 07/19/2013] [Accepted: 07/23/2013] [Indexed: 11/29/2022]
Abstract
CONTEXT Cancer caregivers have important roles in delivering practical, emotional, and end-of-life support to patients; however, they express multiple unmet needs, particularly information on future care planning. Early regular communication and decision making may improve access to timely information, alleviate anxiety, reduce uncertainty, and improve coping strategies. OBJECTIVES This study examines how cancer caregivers view advance care planning (ACP) to inform an ACP program in an Australian cancer center. METHODS This study used a qualitative descriptive design with grounded theory overtones. Eighteen caregivers of patients from lung and gastrointestinal tumor streams participated in focus groups or semistructured interviews, which incorporated the vignette technique. RESULTS Caregivers believe that, although confronting, ACP discussions can be helpful. Conversations are sometimes patient initiated, although caregivers may intend to sensitively broach conversations over time. Findings highlight the impact of caregiver hierarchies, adaptive family decision-making styles, and complex cultural influences on decision making. Some caregivers may develop subsidiary care intentions, based on "knowing" or overriding patients' desires. Hindrances on caregivers supporting patients' ACPs include limited information access, patient or caregiver resistance to engage in conversations, and ACPs association in oncology with losing hope. Many caregivers wanted professional support and further opportunities to obtain information, develop subsidiary plans, and help patients engage in ACP discussions. CONCLUSION Findings highlight the influence of cancer caregivers and family dynamics over ACP decisions and actualization of future care plans. A patient- and family-centered care approach to ACP, promoting shared decision making and caregiver support, is recommended. Given that caregivers may override and, plausibly, misinterpret patients' desires, caregivers' subsidiary planning warrants further investigation.
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Affiliation(s)
- Natasha Michael
- Department of Pain and Palliative Care, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
| | - Clare O'Callaghan
- Department of Pain and Palliative Care, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Departments of Oncology and Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Angela Baird
- Department of Pain and Palliative Care, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Nathaniel Hiscock
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Josephine Clayton
- Hammond Care Palliative and Supportive Care Service, Greenwich Hospital, Sydney, New South Wales, Australia; Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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Ventura AD, Burney S, Brooker J, Fletcher J, Ricciardelli L. Home-based palliative care: a systematic literature review of the self-reported unmet needs of patients and carers. Palliat Med 2014; 28:391-402. [PMID: 24292156 DOI: 10.1177/0269216313511141] [Citation(s) in RCA: 117] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND There have been many studies on the unmet needs of palliative care patients and carers from the perspective of bereaved caregivers. However, the unmet needs of palliative care patients and carers from the perspective of current patients and their carers have received little research attention. AIM As home-based services have become one of the main delivery models of palliative care, the aim of this review was to describe, evaluate and summarise the literature on the unmet needs of palliative home care patients and carers. DESIGN The systematic review of qualitative and quantitative studies was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. DATA SOURCES PubMed, CINAHL, Embase, MEDLINE, PsycINFO, AMED and CareSearch were searched to find empirical studies on the self-reported unmet needs of palliative home care patients and carers. RESULTS Nine qualitative studies, three quantitative studies and three mixed-design studies were identified. The most frequently reported unmet need was effective communication with health-care professionals, the lack of which negatively impacted on the care received by patients and carers. Physical care needs were met, which indicates that the examined palliative home care services were delivering satisfactory care in this domain, but lacking in other areas. CONCLUSIONS The focus therefore should be on improving other aspects of patient care, including communication by health professionals to prevent or reduce suffering in areas such as psychosocial domains. Valid and reliable quantitative measures of unmet needs in palliative care are needed to examine this area more rigorously.
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Williams AM, Wang L, Kitchen P. Differential impacts of care-giving across three caregiver groups in Canada: end-of-life care, long-term care and short-term care. HEALTH & SOCIAL CARE IN THE COMMUNITY 2014; 22:187-196. [PMID: 24172162 PMCID: PMC4255295 DOI: 10.1111/hsc.12075] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/19/2013] [Indexed: 05/28/2023]
Abstract
Using data from Statistic Canada's General Social Survey Cycle 21 (GSS 2007), this study explores whether differences exist in the impacts of care-giving among three groups of caregivers providing informal care either in the caregiver's or recipient's home, or in other locations within the community: (i) those providing end-of-life (EOL) care (n = 471); (ii) those providing long-term care (more than 2 years) for someone with a chronic condition or long-term illness (n = 2722); and (iii) those providing short-term care (less than 2 years) for someone with a chronic condition or long-term illness (n = 2381). This study lays out the variation in sociodemographic characteristics across the three caregiver groups while also building on our understanding of the differential impacts of care-giving through an analysis of determinants. All three groups of caregivers shared a number of sociodemographic characteristics, including being female, married, employed and living in a Census Metropolitan Area (CMA). With respect to health, EOL caregivers were found to have significantly higher levels of 'fair or poor' self-assessed health than the other two groups. Overall, the findings suggest that EOL caregivers are negatively impacted by the often additional role of care-giving, more so than both short-term and long-term caregivers. EOL caregivers experienced a higher proportion of negative impacts on their social and activity patterns. Furthermore, EOL caregivers incurred greater financial costs than the other two types of informal caregivers. The impacts of EOL care-giving also negatively influence employment for caregivers when compared with the other caregiver groups. Consequently, EOL caregivers, overall, experienced greater negative impacts, including negative health outcomes, than did long-term or short-term caregivers. This provides the evidence for the assertion that EOL care-giving is the most intense type of care-giving, potentially causing the greatest caregiver burden; this is shown through the greater negative impacts experienced by the EOL caregivers when compared with the short-term and long-term caregivers.
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Affiliation(s)
- Allison M Williams
- School of Geography and Earth Sciences, McMaster University, Hamilton, Ontario, Canada
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Williams A, Duggleby W, Eby J, Cooper RD, Hallstrom LK, Holtslander L, Thomas R. Hope against hope: exploring the hopes and challenges of rural female caregivers of persons with advanced cancer. BMC Palliat Care 2013; 12:44. [PMID: 24341372 PMCID: PMC3878500 DOI: 10.1186/1472-684x-12-44] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 11/29/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This paper focuses on the qualitative component of a study evaluating a hope intervention, entitled Living with Hope Program (LWHP), designed to foster hope in female caregivers of family members living with advanced cancer. The purpose of this research is to share, in the form of a story, the experiences of rural female caregivers caring for family members with advanced cancer, focusing on what fosters their hope. Hope is a psychosocial and spiritual resource that has been found to help family caregivers live through difficult transitions and challenges. METHODS Twenty-three participants from rural Western Canada completed daily journal entries documenting their hopes and challenges. Cortazzi's (2001) method of narrative analysis was used to analyze the data, which was then transcribed into a narrative entitled 'hope against hope.' RESULTS The journal entries highlighted: the caregivers' hopes and what fostered their hope; the various challenges of caregiving; self-care strategies, and; their emotional journey. Hope was integrated throughout their entire experience, and 'hope against hope' describes how hope persists even when there is no hope for a cure. CONCLUSIONS This research contributes to the assessment of caregiver interventions that impact hope and quality of life, while illustrating the value of a narrative approach to both research and practice. Journaling may be particularly valuable for rural caregivers who are isolated, and may lack direct professional and peer support. There is an opportunity for health professionals and other providers to foster a relationship of trust with family caregivers, in which their story can be told openly and where practitioners pay closer attention to the psychosocial needs of caregivers.
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Affiliation(s)
- Allison Williams
- School of Geography and Earth Sciences, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4 K1, Canada
| | - Wendy Duggleby
- Nursing Research Chair Aging and Quality of Life, Level 3, Edmonton Clinic Health Academy, 11405 87 Avenue, University of Alberta, Edmonton, AB T6G 1C9, Canada
| | - Jeanette Eby
- School of Geography and Earth Sciences, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4 K1, Canada
| | - Reverend Dan Cooper
- Palliative Care Services, Regina Qu'Appelle Health Region, 410w Dewdney Ave, Regina, SK S4T 1A5, Canada
| | - Lars K Hallstrom
- Alberta Centre for Sustainable Rural Communities (ACSRC), Political Studies (Augustana Faculty) and REES (ALES), University of Alberta, 2-135 Augustana Forum, Edmonton, AB T4V 2R3, Canada
| | - Lorraine Holtslander
- College of Nursing, University of Saskatchewan, Office Rm 343 Ellis Hall, 107 Wiggins Rd, Saskatoon SK S7N5E5, Canada
| | - Roanne Thomas
- Qualitative Health Research with Marginalized Populations, School of Rehabilitation Sciences, 451 Smyth Road (3068), Ottawa, ON K1H 8 M5, Canada
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Ando M, Ninosaka Y, Okamura K, Ishi Y. Difficulties in caring for a patient with cancer at the end of life at home and complicated grief. Am J Hosp Palliat Care 2013; 32:173-7. [PMID: 24301084 DOI: 10.1177/1049909113514626] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The present study aimed to investigate difficulties in caring for a patient with cancer at the end of life at home and to examine relationships between difficulties with care and complicated grief. The 45 bereaved family members completed the Family Difficulty Scale (FDS) and the Inventory of Complicated Grief (ICG). The FDS score for "Patient's pain and condition" was the highest, followed by "Caregivers did not want home care" and "No support from others." There was a significant relationship between FDS and ICG scores. These results suggest that the condition of the patient, the view of the caregiver on home care, and the absence of other support are important factors contributing to difficulties of family caregivers, and that these difficulties may lead to complicated grief.
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Affiliation(s)
- Michiyo Ando
- Faculty of Nursing, St Mary's College, Kurume City, Fukuoka, Japan
| | | | | | - Yoko Ishi
- Nasu Red Cross Hospital, Otawara, Tochigi, Japan
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Abstract
AbstractObjectives:Palliative family caregivers appear to experience the rewards of caregiving concurrent with burdens and negative feelings. Relatively few studies have attended to the positive and rewarding aspects in palliative family caregiving. In addition, most studies on rewards are retrospective and examine the experiences of bereaved family caregivers. The present study aimed at describing feelings of reward among family caregivers during ongoing palliative care. A further aim was to compare the experience of rewards in relation to sex and age.Methods:The sample consisted of 125 family caregivers and took place in three specialist palliative care units and one hematology unit. Participants answered a questionnaire including demographic background questions and the Rewards of Caregiving Scale (RCS). Descriptive statistics were employed to describe characteristics of the participants and the level of rewards. A Mann–Whitney U test was used to compare differences between groups of different sex and age.Results:Palliative family caregivers reported general high levels of reward. The greatest source of rewards involved feelings of being helpful to patients. This was closely followed by giving something to patients that brought them happiness and being there for them. The smallest sources of rewards were related to personal growth, self-satisfaction, and personal meaning. There was also an association between rewards and age but not between men and women.Significance of results:Family caregivers experienced the rewards of caregiving during ongoing palliative care despite their unique and stressful situation. Feelings of reward seem to be about handling a situation in a satisfying way, feeling competent and confident to take care of the patient and thereby feeling proud. Support could preferably be designed to improve a family caregiver's ability to care and to facilitate the positive aspects and rewards of caregiving and focus on strengths and resources.
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Ewing G, Brundle C, Payne S, Grande G. The Carer Support Needs Assessment Tool (CSNAT) for use in palliative and end-of-life care at home: a validation study. J Pain Symptom Manage 2013; 46:395-405. [PMID: 23245452 DOI: 10.1016/j.jpainsymman.2012.09.008] [Citation(s) in RCA: 106] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Revised: 09/06/2012] [Accepted: 09/19/2012] [Indexed: 11/29/2022]
Abstract
CONTEXT Family carers need to be supported in their central role of caring for patients at the end of life, but brief practical tools to assess their support needs have been missing. To address this gap, we developed a brief evidence-based Carer Support Needs Assessment Tool (CSNAT) suitable for everyday practice. OBJECTIVES To assess face, content, and criterion validity of the CSNAT and measure sensitivity to change over time. METHODS Participants were 225 adult carers of patients from six U.K. Hospice Home Care services. Carers were surveyed at baseline and at four-week follow-up using self-completed questionnaires, including CSNAT, standard measures (distress, strain, positive appraisals, preparedness, and global health), help provided with activities of daily living, and patients' symptom levels. Qualitative feedback on CSNAT was sought through 10 pilot carer interviews and professional and carer advisory group input. RESULTS The CSNAT has good face, content, and criterion validity. CSNAT domains comprehensively covered carer support needs. CSNAT scores showed clear and consistent positive correlations with strain and distress and negative correlations with preparedness for caregiving and global health. There also were clear correlations with help with activities of daily living and some relationships with positive appraisals and symptom burden. The CSNAT's sensitivity to change in relevant domains was similar to other measures. CONCLUSION The CSNAT is a valid tool for the direct measurement of carers' support needs. It combines comprehensiveness of content with feasibility of administration and has utility both as a research tool and a tool for everyday palliative care practice.
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Affiliation(s)
- Gail Ewing
- Centre for Family Research, University of Cambridge, Cambridge, United Kingdom.
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Casey V, Crooks VA, Snyder J, Turner L. "You're dealing with an emotionally charged individual...": an industry perspective on the challenges posed by medical tourists' informal caregiver-companions. Global Health 2013; 9:31. [PMID: 23889860 PMCID: PMC3733688 DOI: 10.1186/1744-8603-9-31] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 07/03/2013] [Indexed: 11/29/2022] Open
Abstract
Background Patients engage in medical tourism when they privately obtain a medical care abroad. Previous research shows that many medical tourists travel abroad with friends and family members who provide support and assistance. Meanwhile, very little is known about this important stakeholder group, referred to here as caregiver-companions. In this article we examine the challenges that can be posed by caregiver-companions and the overall practice of informal caregiving in medical tourism from an industry perspective. Specifically, we report on the findings of interviews conducted with international patient coordinators (IPCs) who work at destination facilities. IPCs come into regular contact with caregiver-companions in their professional positions and thus are ideally suited to comment on trends they have observed among this stakeholder group as well as the challenges they can pose to medical tourists, health workers, and facilities. Methods We conducted 20 semi-structured interviews with 21 IPCs from 16 different facilities across nine countries. Topics probed in the interviews included caregiver-companion roles, IPCs’ and others’ interaction with caregiver-companions, and potential health and safety risks posed to medical tourists and caregiver-companions. Thematic analysis of the verbatim transcripts was employed. Results Although most participants encouraged medical tourists to travel with a caregiver-companion, many challenges associated with caregiver-companions were identified. Three themes best characterize the challenges that emerged: (1) caregiver-companions require time, attention and resources; (2) caregiver-companions can disrupt the provision of quality care; and (3) caregiver-companions can be exposed to risks. IPCs pointed out that caregiver-companions may, for example, have a negative impact on the patient through cost of accompaniment or inadequate care provision. Caregiver-companions may also create unanticipated or extra work for IPCs, as additional clients and by ignoring established organizational rules, routines, and expectations. Furthermore, caregiver-companions may be susceptible to stresses and health and safety risks, which would further deteriorate their own abilities to offer the patient quality care. Conclusions Although caregiver-companions can pose challenges to medical tourists, health workers, and medical tourism facilities, they can also assist in enhancing best care and offering meaningful support to medical tourists. If caregiver-companions are open to collaboration with IPCs, and particularly in the form of information sharing, then their experience abroad can be safer and less stressful for themselves and, by extension, for the accompanied patients and facility staff.
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Affiliation(s)
- Victoria Casey
- Department of Geography, Simon Fraser University, 8888 University Drive, Burnaby, Canada.
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Li Q, Loke AY. The positive aspects of caregiving for cancer patients: a critical review of the literature and directions for future research. Psychooncology 2013; 22:2399-407. [DOI: 10.1002/pon.3311] [Citation(s) in RCA: 121] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Revised: 03/06/2013] [Accepted: 04/24/2013] [Indexed: 11/07/2022]
Affiliation(s)
- Qiuping Li
- School of Nursing; The Hong Kong Polytechnic University; Hung Hom Kowloon Hong Kong China
- Wuxi Medical School; Jiangnan University; Wuxi Jiangsu China
| | - Alice Yuen Loke
- School of Nursing; The Hong Kong Polytechnic University; Hung Hom Kowloon Hong Kong China
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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.
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Affiliation(s)
- Gail Ewing
- Centre for Family Research, University of Cambridge, Cambridge, UK.
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Ishii Y, Miyashita M, Sato K, Ozawa T. A family's difficulties in caring for a cancer patient at the end of life at home in Japan. J Pain Symptom Manage 2012; 44:552-62. [PMID: 22575721 DOI: 10.1016/j.jpainsymman.2011.10.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Revised: 09/30/2011] [Accepted: 10/10/2011] [Indexed: 11/24/2022]
Abstract
CONTEXT Most people hoped for home care at the end of life and death at home in Japan. However, the rate for death at home from cancer in Japan is less than 10% of the total deaths of cancer patients. OBJECTIVES The aim of this study was to investigate circumstances, difficulties, and correlated factors for family caregivers who provided care at home for a family member with terminal cancer. METHODS The Family's Difficulty Scale for end-of-life home care questionnaire was sent to 395 bereaved family caregivers who had cared for a terminal cancer patient with the assistance of home services. RESULTS We obtained 306 responses for a response rate of 81%. The results showed that family caregivers had a high rate of difficulties related to "Patient's pain and condition" (64%~90%) and "Burden of care" (61%~78%). A logistic regression analysis was performed on the data to examine factors related to the difficulties. More difficulties occurred for male caregivers (odds ratio [OR]=0.39, P=0.04) who did not prefer for the patient to die at home (OR=0.42, P=0.01). CONCLUSION This study indicates that it is important for home care providers to introduce services to reduce care burden. In addition, a thorough explanation of the patient's symptoms and condition is necessary to reduce distress and anxiety for family caregivers.
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Affiliation(s)
- Yoko Ishii
- Ohtawara Red Cross Hospital, 2-7-3 Sumiyoshi-chou, Ohtawara-shi, Tochigi, Japan.
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Naruse T, Taguchi A, Kuwahara Y, Nagata S, Murashima S. Effects of Nonnursing Assistance on Home Visit Nurses’ Time Spent In Japan: One Group Repeated Pretest-Posttest Trial. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2012. [DOI: 10.1177/1084822312458920] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To determine means of improving the efficiency of home nursing services, we conducted an experimental pretest-posttest study to compare the time spent by home visiting nurses (HVNs) on providing care with or without assistance. HVNs’ job-related satisfaction levels were also compared. Forty-four clients in six visiting nursing offices in Fukuoka prefecture were selected for this study, which was conducted between July 2009 and January 2010. With assistance, HVNs’ total care time and time spent performing trivial tasks decreased and time spent on communicating or teaching increased. Furthermore, HVNs were more satisfied with providing care than with their usual visits. We conclude that introduction of a skill mix might improve home visiting nursing service efficiency through shortening the HVNs’ length of stay at a client’s home.
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Keesing S, Rosenwax L, McNamara B. 'Doubly deprived': a post-death qualitative study of primary carers of people who died in Western Australia. HEALTH & SOCIAL CARE IN THE COMMUNITY 2011; 19:636-644. [PMID: 21585581 DOI: 10.1111/j.1365-2524.2011.01005.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
This paper explores the daily experiences and occupational needs of family carers of people who were dying, with particular reference to their daily routines and ability to undertake other varied activities during the period of care. The impact of the caring experience on these occupations was then examined to determine how, and if, these occupational needs were addressed in the community using potential and available services. An exploratory approach using grounded theory was employed to examine these experiences. Participants were recruited from metropolitan (n = 10) and rural (n = 4) locations across Western Australia between February and June 2009, using a purposive sampling method. A semi-structured interview guide was developed following consultation with the literature, expert opinion and piloting. Interviews were conducted in participants' homes and questions were asked about their experiences as a carer including routines, engagement in usual activities and the impact of the caring role on their daily life during and after the period of care. Each interview was transcribed verbatim and analysed to determine potential themes. Two important themes were identified: (1) Carers experienced disengagement and deprivation from their usual occupations during and after the period of care; and (2) Participants described significant disempowerment in their role as carer. Carers are 'doubly disadvantaged' as a result of their caring role; they are unable to participate in their usual occupations and they are not recognised for their contributions as carers. Carers experienced disengagement and deprivation from their usual occupations, contributing to physical, psychological and emotional difficulties and this may result in long term consequences for health and well-being. In addition, the current services and support available for carers in the community are deemed inadequate; placing further stress on a health care system which needs to cope with increasing demands as a result of the ageing population in Australia.
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Affiliation(s)
- Sharon Keesing
- School of Occupational Therapy and Social Work, Curtin Health and Innovation Research Institute, Curtin University.
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Where do our patients die? A review of the place of death of cancer patients in Cape Town, South Africa. Palliat Support Care 2011; 9:31-41. [PMID: 21352616 DOI: 10.1017/s1478951510000520] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE A 3-year review of the place of death of patients from a private oncology unit in Cape Town explores the length of time patients spent in acute care hospital beds, under the oncologist's care, prior to their death. Implications for improved staff training, patient support, and family education are identified. METHOD This is an exploratory quantitative study that captures details of place of death and particulars of length of acute care hospital stay for cancer patients of a private oncology unit. Data was gathered from 424 patient files, from January 2006 to December 2008, and is interpreted using simple descriptive statistics. RESULTS Of the 424 recorded deaths, the average age at death was 66.09 years, with lung and bronchial cancer accounting for the leading diagnosis at death (23.82%). Most of patient deaths recorded (42.92%) occurred at home, with death under the oncologist's care in an acute medical ward comprising the second largest category (34.20%). The majority of the patients who died in this ward (38%) died within 3 days of admission. SIGNIFICANCE OF RESULTS Although medical and community support for end-of-life care at home are not uniformly available to all South Africans, the patients and families in this study had good access to hospice care, and achieved a higher "death at home" rate than that seen in several more developed countries. The review of place of death and length of hospitalization prior to death highlights the need for staff at private oncology units to be trained in and comfortable with palliative care. Attention is also drawn to the very real needs of carers and family members of patients, if death is planned to occur in the patient's home.
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Williams AM, Eby JA, Crooks VA, Stajduhar K, Giesbrecht M, Vuksan M, Cohen SR, Brazil K, Allan D. Canada's Compassionate Care Benefit: is it an adequate public health response to addressing the issue of caregiver burden in end-of-life care? BMC Public Health 2011; 11:335. [PMID: 21592383 PMCID: PMC3123207 DOI: 10.1186/1471-2458-11-335] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2010] [Accepted: 05/18/2011] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND An increasingly significant public health issue in Canada, and elsewhere throughout the developed world, pertains to the provision of adequate palliative/end-of-life (P/EOL) care. Informal caregivers who take on the responsibility of providing P/EOL care often experience negative physical, mental, emotional, social and economic consequences. In this article, we specifically examine how Canada's Compassionate Care Benefit (CCB)--a contributory benefits social program aimed at informal P/EOL caregivers--operates as a public health response in sustaining informal caregivers providing P/EOL care, and whether or not it adequately addresses known aspects of caregiver burden that are addressed within the population health promotion (PHP) model. METHODS As part of a national evaluation of Canada's Compassionate Care Benefit, 57 telephone interviews were conducted with Canadian informal P/EOL caregivers in 5 different provinces, pertaining to the strengths and weaknesses of the CCB and the general caregiving experience. Interview data was coded with Nvivo software and emerging themes were identified by the research team, with such findings published elsewhere. The purpose of the present analysis was identified after comparing the findings to the literature specific to caregiver burden and public health, after which data was analyzed using the PHP model as a guiding framework. RESULTS Informal caregivers spoke to several of the determinants of health outlined in the PHP model that are implicated in their burden experience: gender, income and social status, working conditions, health and social services, social support network, and personal health practises and coping strategies. They recognized the need for improving the CCB to better address these determinants. CONCLUSIONS This study, from the perspective of family caregivers, demonstrates that the CCB is not living up to its full potential in sustaining informal P/EOL caregivers. Effort is required to transform the CCB so that it may fulfill the potential it holds for serving as one public health response to caregiver burden that forms part of a healthy public policy that addresses the determinants of this burden.
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Affiliation(s)
- Allison M Williams
- Department of Geography and Earth Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Jeanette A Eby
- Department of Geography and Earth Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Valorie A Crooks
- Department of Geography, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Kelli Stajduhar
- School of Nursing and Centre On Aging, University of Victoria, Victoria, British Columbia, Canada
| | - Melissa Giesbrecht
- Department of Geography, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Mirjana Vuksan
- Department of Geography and Earth Sciences, McMaster University, Hamilton, Ontario, Canada
| | - S Robin Cohen
- Department of Oncology, McGill University, Montreal, Québec, Canada
| | - Kevin Brazil
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Diane Allan
- Centre On Aging, University of Victoria, Victoria, British Columbia, Canada
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Schmidt KL, Gentry A, Monin JK, Courtney KL. Demonstration of facial communication of emotion through telehospice videophone contact. Telemed J E Health 2011; 17:399-401. [PMID: 21492032 DOI: 10.1089/tmj.2010.0190] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE The purpose of this study was to demonstrate the range of emotional expressions that can be displayed by nurse and family caregiver during a telehospice videophone consultation. We hypothesized that a nurse providing telehospice care via videophone would gain access to rich nonverbal emotional signals from the caregiver and communicate her own social presence to the caregiver, to potentially enhance the building of empathy between nurse and caregiver. METHODOLOGY Videorecording of a case exemplar of videophone contact was obtained using the Beamer, a commercially available product that allows display of both caller and receiver on an available television through standard telephone lines. Nonverbal communication through facial expressions of emotion was quantified using detailed coding of facial movement and expression (facial action coding system). RESULTS In this study, we demonstrated the presence of visual nonverbal information in the form of facial expressions of emotion during a videophone interaction between nurse and family caregiver. Over the course of a typical after-hours telehospice call, a variety of facial expressions of emotion were displayed by both nurse and family caregiver. Expression of positive and negative emotions, as well as mixed emotions, was apparent. Through detailed analysis of this case of videophone interaction, we have demonstrated the potential value of videophone contact for providing access to visual nonverbal emotional communication.
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Affiliation(s)
- Karen L Schmidt
- Department of Oral Biology, University of Pittsburgh School of Dental Medicine, Pittsburgh, PA, USA.
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Claessens P, Menten J, Schotsmans P, Broeckaert B. Development and validation of a modified version of the Edmonton Symptom Assessment Scale in a Flemish palliative care population. Am J Hosp Palliat Care 2011; 28:475-82. [PMID: 21398268 DOI: 10.1177/1049909111400724] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Palliative cancer patients are faced with multiple symptoms that threaten their quality of life. To manage these symptoms, a reliable and valid way of registration is crucial. In this study, the Edmonton Symptom Assessment Scale (ESAS) has been translated, modified, and tested on content, face, criterion, construct validity, and internal consistency for patients admitted to Flemish palliative care units. These aspects are tested in a descriptive, comparative, longitudinal study based on 3 convenience samples. The first consisted of 8 palliative care experts. The second sample checked the face validity and consisted of 4 patients, 5 family members, and 5 nurses. The last sample involved 23 patients admitted to 3 Flemish palliative care units. Heedful of the "new-wave" vision on validity, the translated and altered ESAS seemed a suitable instrument for the symptom assessment of patients with cancer admitted to a palliative care unit.
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Affiliation(s)
- Patricia Claessens
- Centre for Biomedical Ethics and Law, Catholic University Leuven, Belgium.
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Stenberg U, Ruland CM, Miaskowski C. Review of the literature on the effects of caring for a patient with cancer. Psychooncology 2011; 19:1013-25. [PMID: 20014159 DOI: 10.1002/pon.1670] [Citation(s) in RCA: 530] [Impact Index Per Article: 40.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To adequately help family caregivers (FCs) of cancer patients, clinicians need to understand the complexity of the problems and responsibilities associated with cancer patients illness that FCs experience. METHODS This systematic review identified the types of problems and burdens that FCs of cancer patients experience during the patient's illness. We also analyzed the language caregivers use to communicate their problems and responsibilities related to caregiving for the cancer patient. RESULTS Of 2845 titles identified, 192 articles met the inclusion criteria and are included in this review. Of these, 164 were research-based. In addition to FC responsibilities and the impact of being a caregiver on daily life, a number of other physical, social, and emotional problems related to caregiving for these FCs were identified. CONCLUSION A substantial evidence base supports the conclusion that FCs experience many difficult problems and increased responsibilities during and after the patient is undergoing treatment and rehabilitation for cancer. The insights gained from this review will help researchers and clinicians to understand the complexity of problems and responsibilities FCs experience. This understanding may encourage them to include support for FCs as part of total or holistic patient care. However, more research is needed to better understand the variations in caregiving experiences over time; how the caregiving perspective is influenced by different cultural, ethnic, or socioeconomic backgrounds as well as gender and age; and how problems and responsibilities related to caregiving interfere with daily life.
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Affiliation(s)
- Una Stenberg
- Center for Shared Decision Making and Nursing Research, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
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Clark PG, Brethwaite DS, Gnesdiloff S. Providing support at time of death from cancer: results of a 5-year post-bereavement group study. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2011; 7:195-215. [PMID: 21895437 DOI: 10.1080/15524256.2011.593156] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Despite advances in the quality and availability of hospice and palliative care for people with end stage cancers, research addressing the psychosocial needs of family members and concerned others during the dying process has been limited primarily to caregivers. In addition, many of these studies focused on the recently bereaved. In this study, the authors sought to broaden that perspective by examining the psychosocial needs of secondary survivors, a term that applies to caregivers, family members, and others who felt a caring bond with a dying person. A qualitative exploration of needs expressed by secondary survivors following the conclusion of a structured 8-week psychoeducational grief group experience revealed that secondary cancer survivors experience a sense of isolation and powerlessness that is often unrecognized by physicians, nurses, oncology social workers, or other health care professionals. Furthermore, these secondary survivors needed support that extends well beyond activities that are traditionally associated with the physical and emotional care of the dying. Social work intervention strategies directed toward helping secondary survivors assert personal needs, develop greater proximity with the health care team, and prepare for the processes associated with end-of-life may be helpful later during bereavement.
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Affiliation(s)
- Paul G Clark
- Department of Social Work, George Mason University, 4400 University Drive, Fairfax, VA 22030, USA.
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Northfield S, Nebauer M. The Caregiving Journey for Family Members of Relatives With Cancer. Clin J Oncol Nurs 2010; 14:567-77. [DOI: 10.1188/10.cjon.567-577] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Funk L, Stajduhar K, Toye C, Aoun S, Grande G, Todd C. Part 2: Home-based family caregiving at the end of life: a comprehensive review of published qualitative research (1998-2008). Palliat Med 2010; 24:594-607. [PMID: 20576673 DOI: 10.1177/0269216310371411] [Citation(s) in RCA: 207] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Family caregivers are crucial for supporting home death. We reviewed published qualitative research on home-based family caregiving at end of life (1998-2008), synthesizing key findings and identifying gaps where additional research is needed. Multiple databases were searched and abstracts reviewed for a focus on family caregiving and palliative care; full articles were reviewed to extract data for this review. In total, 105 articles were included. Findings are presented in the following areas: the caregiving experience and contextual features; supporting family caregivers at end of life; caregiving roles and decision-making; and rewards, meaning and coping. We noted a lack of definitional clarity; a reliance on interview methods and descriptive, thematic analyses, and a relative lack of diversity of patient conditions. Research needs are identified in several areas, including the bereavement experience, caregiver ambivalence, access to services, caregiver meaning-making, and relational and contextual influences on family caregiving at end of life.
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Affiliation(s)
- L Funk
- Centre on Aging, University of Victoria, British Columbia, Canada.
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McConigley R, Halkett G, Lobb E, Nowak A. Caring for someone with high-grade glioma: a time of rapid change for caregivers. Palliat Med 2010; 24:473-9. [PMID: 20123944 DOI: 10.1177/0269216309360118] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Patients diagnosed with high-grade gliomas have a poor prognosis and limited life expectancy, and often experience rapid decline in function. Caring for a patient with high-grade glioma is particularly stressful because caregivers are faced not only with cancer-related caregiving issues, but also issues relating to caring for someone with cognitive impairment. This study aimed to articulate the experiences of family caregivers of people diagnosed with high-grade glioma and to describe their information and support needs. A grounded theory method was adopted. Twenty-one family caregivers of people with high-grade glioma were interviewed using a semi-structured interview guide. A constant comparison method of data analysis was employed. A central theme, A Time of Rapid Change and two sub-themes, Renegotiating Relationships and Learning to be a Caregiver, emerged to describe the experiences of participants. Caregiving was characterised by numerous role and life changes from the moment of diagnosis. Caregivers in this study reported experiences similar to those described by caregivers of people with other cancers. What differed for this group was the rapidity of change and the need for immediate information and support to assist with caring for a person with high-grade glioma.
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Affiliation(s)
- Ruth McConigley
- Western Australian Centre for Cancer and Palliative Care and Curtin Health Innovation Research Institute, Curtin University of Technology, Perth, Australia.
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Wittenberg-Lyles E, Parker Oliver D, Demiris G, Baldwin P. The ACTive Intervention in Hospice Interdisciplinary Team Meetings: Exploring family caregiver and hospice team communication. JOURNAL OF COMPUTER-MEDIATED COMMUNICATION : JCMC 2010; 15:465-481. [PMID: 20543889 PMCID: PMC2882300 DOI: 10.1111/j.1083-6101.2010.01502.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
This paper presents the theoretical framework and rationale for the ACTive intervention which proposes the use of video technology to facilitate patient and family participation in hospice interdisciplinary team meetings where plans of care are determined. It is surmised that patient and family involvement will improve communication and compliance in hospice care. An analysis of data from a pilot project of the ACTive intervention was conducted to explore active participation among family caregivers and the hospice team. Through the use of videophone technology caregivers participated in video-recorded team meetings. The actual communication behaviors of caregivers and team members were analyzed for active participation. Findings revealed that team-prompted caregiver participation was most common, however, team use of supportive talk in this context was considerably less frequent. The study also found that the team's use of active participation behaviors elicits caregiver active participation behaviors. The results of this study suggest the intervention was an effective way to involve family caregivers as active participants in the designing of care for their loved one. Findings also suggest that hospice staff would benefit from education and training on best practices for communicating with caregivers in the team meeting setting.
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Affiliation(s)
- Elaine Wittenberg-Lyles
- Department of Communication Studies, University of North Texas P. O. Box 305268 Denton TX 76203-5268 Phone: 940-565-2588 Fax: 940-565-3630
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Currow DC, Wheeler JL, Glare PA, Kaasa S, Abernethy AP. A framework for generalizability in palliative care. J Pain Symptom Manage 2009; 37:373-86. [PMID: 18809276 DOI: 10.1016/j.jpainsymman.2008.03.020] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2007] [Revised: 03/28/2008] [Accepted: 04/03/2008] [Indexed: 12/11/2022]
Abstract
Palliative medicine has only recently joined the ranks of evidence-based medical subspecialties. Palliative medicine is a rapidly evolving field, which is quickly moving to redress its historical paucity of high-quality research evidence. This burgeoning evidence base can help support the application of evidence-based principles in palliative and hospice clinical care and service delivery. New knowledge is generally taken into practice relatively slowly by established practitioners. At present, the translation of evidence into palliative and hospice care clinical practice lags behind emerging research evidence in palliative care at even greater rates for three critical reasons: 1) the application of research results to specific clinical subpopulations is complicated by the heterogeneity of palliative care study subpopulations and by the lack of a recognized schema for describing populations or services; 2) definitional issues in service provision are, at best, confusing; and 3) fundamental research concepts (e.g., external validity, effect size, generalizability, applicability) are difficult to apply meaningfully in palliative care. This article provides a suggested framework for classifying palliative care research subpopulations and the clinical subpopulations to which the research findings are being applied to improve the ability of clinicians, health planners, and funders to interpret and apply palliative care research in real-world settings. The framework has five domains: patients and caregivers; health professionals; service issues; health and social policy; and research.
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Affiliation(s)
- David C Currow
- Department of Palliative and Supportive Services, Flinders University, Adelaide, Australia.
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Place of death of adolescents and young adults with cancer: First study in a French population. Palliat Support Care 2009; 7:27-35. [DOI: 10.1017/s1478951509000054] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
ABSTRACTObjective:To improve the palliative care and more effectively meet the needs of young patients and their families at the end of life, the authors investigated the place of death of adolescents and young adults treated in their institution and identified some of the factors influencing the choice of place of death.Methods:The parents and/or partners of adolescents and young adults (15 to 25 years old) who died at Institut Curie (cancer center) between 2000 and 2003 were contacted. Twenty-one families agreed to participate in the interview between October 2005 and April 2006. Analysis of the interviews comprised a descriptive part and a thematic part.Results:Nineteen out of 21 (90%) families declared that they did not really choose their child's place of death due to lack of time. However, all families said that they preferred the hospital. No family attended a bereavement group after their child's death and only 3 families (14%) consulted a mental health care professional. Thematic analysis showed that representations and beliefs concerning life and death at least partly determined the family's capacity to discuss the place of death with their child.Significance of results:Although progress has been made over recent years in France, there is still considerable room for improvement of palliative care to more effectively meet the needs of young patients and their families at the end of life.
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