Exploring the associations between spiritual well-being, burden, and quality of life in family caregivers of cancer patients

An intervention module for caregivers of children with acute lymphoblastic leukemia (ALL)

INTRODUCTION

Childhood cancer caregivers report psychological distress and unmet psychosocial needs, affecting outcomes for their children. An experimental study was carried out to measure the effectiveness of an intervention in addressing traumatic stress, depression and anxiety.

METHODS

Caregivers (n = 59) of children with ALL were allocated to both groups (intervention, n = 29; TAU control, n = 30) via the SNOSE method. The intervention is a physical copy of a 2-week psychosocial self-help guidebook. Scores on the PCL-5, BDI and BAI were recorded at baseline, post-intervention and 1-month follow-up.

RESULTS

There was a statistically significant difference in traumatic stress symptoms post intervention (F(1, 57) = 5.760, p = .020, np2 = 0.093) in favor of the intervention group. No statistical significance was found for its effect at one-month follow-up, overall depression and anxiety.

CONCLUSION

A psychosocial module developed for caregivers of children with ALL was found to be effective in reducing symptoms of traumatic stress and potentially depression. However, the maintenance of its effectiveness and the effectiveness on anxiety requires further study.

The effect of psychological resilience and spiritual well-being on the experience of hope in parents of children with cancer

PURPOSE

Hope in pediatric oncology guides parents as an inner guidance compass through their child's challenging journey toward cancer treatment. This study was designed to examine the effects of psychological resilience, spiritual well-being, and some child- and parent-related factors on parents' experience of hope while their child is undergoing cancer treatment.

DESIGN AND METHODS

This cross-sectional, correlational study was conducted between March and July 2022 in the pediatric oncology-hematology ward of a university hospital in Turkey. Parents of 120 children with cancer were included in the study. Data were collected using the child and parent questionnaire, Herth Hope Index, Connor-Davidson Resilience Short Form, and Spiritual Well-Being Scale. Correlation and multiple linear regression analysis were used to analyze the data. In addition, the content analysis method was used to analyze the open-ended structured questions. Ethical approval was obtained for the study.

RESULTS

In the study, 57.5% of the parents who participated were mothers. The mean age of the children was 9.46 ± 5.00 years. 30.8% of the children were diagnosed with Acute Lymphoblastic Leukemia, and the mean duration of treatment was 20.42 ± 13.75 months. According to multiple linear regression analysis, child gender (β = -0.16), number of children (β = -0.16), cancer diagnosis (β = -0.24), resilience (β =0.31), and parental spiritual well-being (β =0.40) were the determinant factors affecting parents' experiences of hope. All these predictors explained 55% of the change in parents' hope levels. In addition, two main themes (increasing and decreasing factors) were identified regarding parents' experiences of hope.

CONCLUSIONS

Insights from this study have the potential to shape interventions specifically designed to maintain parents' hope throughout their child's cancer treatment journey.

IMPLICATIONS FOR PRACTICE

This study may provide insights for the design of intervention programs in pediatric oncology hematology wards aimed at strengthening the hope and improving coping mechanisms of parents with children coping with cancer.

The impact of spiritual care on the psychological health and quality of life of adults with heart failure: a systematic review of randomized trials

Background

Heart failure (HF) brings not only physical pain but also psychological distress. This systematic review investigated the influence of spiritual care on the psychological well-being and quality of life in adults with HF.

Methods

We conducted a systematic literature review following PRISMA guidelines, searching seven electronic databases for relevant randomized controlled studies without language or temporal restrictions. The studies were assessed for quality using the Cochrane Bias Risk tool.

Results

A total of 13 studies (882 participants) were reviewed, investigating interventions such as religion, meditation, mental health, cognitive interventions, and spiritual support. Key factors influencing the effectiveness of spiritual care implementation included integration into routine care, respect for diversity, patient engagement, intervention quality, and alignment with patient beliefs. The majority of the studies indicated that spiritual care has a potentially beneficial impact on the mental health and quality of life of patients with HF.

Conclusion

The findings provide valuable insights for healthcare professionals, highlighting the importance of adopting a spiritual care approach to healthcare for this population.

Determinants of quality of life among Omani family caregivers of adult patients with cancer pain

OBJECTIVES

The study aimed to explore the determinants of quality of life (QoL) among Omani family caregivers (FCGs) of adult patients with cancer pain.

METHODS

A descriptive cross-sectional design, measures of caregiver reaction, knowledge about cancer pain, self-efficacy for cancer pain and other symptom management, QoL, and patient functional status were used to collect data from 165 FCGs and patients. Descriptive, correlation, and regression analyses were performed.

RESULTS

Most patients had intermittent (83%) and severe (50.9%) cancer pain. The FCGs had low QoL (58.44 ± 17.95), and this mostly impacted support and positive adaptation (55.2%). Low QoL was associated with low self-rated health, low confidence in the ability to control the patient's pain, low self-efficacy, high perceived distress due to patient pain, and a high impact of caregiving on physical health. The level of caregiver distress due to the patient's pain (p < 0.01), patient's functional status (p < 0.01), and perceived impact of caregiving on health (p < 0.05) were significant predictors of overall QoL.

CONCLUSION

Omani FCGs of patients with cancer pain suffer a negative impact on their QoL, and this is related to the patient's level of pain and functional status, caregiver's health, and self-efficacy in cancer pain and symptom management. The FCGs' QoL may be enhanced by augmenting their skills and self-efficacy in cancer pain and symptom management and by health promotion programs.

What Aspects of Quality of Life are Important from Palliative Care Patients' Perspectives? A Framework Analysis to Inform Preference-Based Measures for Palliative and End-of-Life Settings

BACKGROUND AND OBJECTIVE

Preference-based outcome measures are commonly applied in economic analyses to inform healthcare resource allocation decisions. Few preference-based outcome measures have been specifically developed for palliative and end-of-life settings. This study aimed to identify which quality-of-life domains are most important to Australians receiving specialised palliative care services to help determine if the development of a new condition-specific preference-based outcome measure is warranted.

METHODS

In-depth face-to-face interviews were conducted with 18 participants recruited from palliative care services in South Australia. Data were analysed using a framework analysis drawing on findings from a systematic review of international qualitative studies investigating the quality-of-life preferences of patients receiving palliation (domains identified included cognitive, emotional, healthcare, personal autonomy, physical, preparatory, social, spiritual). Participants identified missing or irrelevant domains in the EQ-5D and QLU-C10D questionnaires and ranked the importance of domains.

RESULTS

A priori domains were refined into cognitive, environmental, financial, independence, physical, psychological, social and spiritual. The confirmation of the eight important quality-of-life domains across multiple international studies suggests there is a relatively high degree of convergence on the perspectives of patients in different countries. Four domains derived from the interviews are not covered by the EQ-5D and QLU-C10D (cognitive, environmental, financial, spiritual), including one of the most important (spiritual).

CONCLUSIONS

Existing, popular, preference-based outcome measures such as the EQ-5D do not incorporate the most important, patient-valued, quality-of-life domains in the palliative and end-of-life settings. Development of a new, more relevant and comprehensive preference-based outcome measure could improve the allocation of resources to patient-valued services and have wide applicability internationally.

Sexual Function, Religion, Existential Well-being and Mental Health among Iranian Married Women of Reproductive Age

The present study investigates the relationship between sexuality and spirituality with mental health among Iranian married women of reproductive age. It was a cross-sectional, correlational study with a sample size of 120 Iranian married women in 2022. Goldberg general health, Female Sexual Function Index, and Paloutzian and Ellison spiritual health questionnaires were used to collect data. The level of spiritual health scale (SWBS) in more than half of the married women was high (50.8%) and 49.2% at the average level. Sexual dysfunction was reported at 43.3%. Sexual function, religious and existential well-being was predictors of mental health and its dimensions. The risk of sexual dysfunction was 3.33-fold higher in people who had an unfavorable level of SWBS (β = 3.33, CI: 1.558-7.099, P = 0.002) compared to those who had a favorable level of SWBS. Therefore, adhering to sexual health and relying on spirituality are emphasized in preventing mental health problems.

Spiritual Coping Among Families of Children With Cancer: A Qualitative Study

The impact of a childhood cancer diagnosis precipitates caregiver's engagement in spiritual coping. This study aimed to explore spirituality among Malaysian Muslim caregivers of children with acute lymphoblastic leukemia. A total of 13 eligible caregivers participated in this qualitative semi-structured interview via purposive sampling. Each interview was audio recorded, transcribed verbatim, and analyzed using NVivo 12 via thematic analysis. Three main themes revolved around hope through the act of praying and recitation (du'ā' and dhikr), acceptance of God's will (redha), and faith toward God as the Provider of sustenance (rezeki). The findings of this study contribute to a holistic supportive care system in pediatric oncology as it informs health care providers the role of spirituality in mitigating the emotional impact of a cancer diagnosis and promoting psychological adaptation. As a multicultural country, future studies may explore spirituality in other cultures and religion in the country.

Factors related to the quality of life of family cancer caregivers

Background

Cancer caregivers directly affect patient health outcomes. To maintain the function and health of caregivers so that patients can receive efficient care, we must pay more attention to caregivers' quality of life in the process of caring for patients. However, the factors influencing caregivers' quality of life are complex.

Aim

To assess caregivers' quality of life in the process of caring for cancer patients and to explore the factors associated with it.

Design

This was a descriptive correlational study. A self-report questionnaire was used to anonymously collect data from one Chinese cancer hospital. The Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being (FACIT-Sp-12), General Self-efficacy Scale (GSES), Positive and Negative Affect Schedule (PANAS), Connor-Davidson Resilience Scale 10 (CD-RISC-10), 24-item Caregiver Burden Inventory (CBI) and Caregiver Evaluation Questionnaire were used to measure caregivers' spiritual well-being, self-efficacy, affective well-being, resilience, caregiver burden and quality of life. One-way analysis of variance, the Kruskal-Wallis H test and multiple regression analysis were applied to measure the factors influencing caregivers' situations.

Setting and participants

A total of 315 caregivers of cancer patients were selected by convenience sampling. All participants were invited to complete the questionnaire through a one-on-one approach.

Results

The mean score for caregiver quality of life was 204.62 ± 36.61. After controlling for demographic factors, self-efficacy (β' = 0.265, p < 0.01), resilience (β' = 0.287, p < 0.01) and positive affect (β' = 0.103, p < 0.01) were protective factors for caregivers' quality of life. Negative affect (β' = -0.217, p < 0.01) and caregiver burden (β' = -0.219, p < 0.01) were negative factors. Notably, not all of these predictors can predict all dimensions of quality of life.

Conclusion

Caregivers' quality of life needs to be further improved. The results of this study may provide clues to help identify factors influencing caregivers' quality of life and implement targeted strategies to improve their quality of life.

Spiritual Well-Being and Care Burden in Caregivers of Patients with Breast Cancer in Turkey

This research was carried out to identify the relationship between the spiritual well-being and caregiver burden in caregivers of patients with breast cancer. The study was conducted with family caregivers of patients with breast cancer who presented to the oncology clinic of a university hospital for treatment. The study sample included a total of 138 family caregivers who met the criteria for participation and agreed to participate in the study. The data were collected using a participant information form, caregiver burden scale and three-dimensional spiritual well-being scale. The caregivers have a moderate level of caregiver burden and their spiritual well-being was quite high. The caregiver burden of female caregivers was found to be significantly higher than that of male caregivers (p = 0.040). There is a negatively significant relationship between caregiver burden and spiritual well-being (p = 0.000, r =  - 0.357). The caregiver burden is significantly higher among the 24-h caregivers compared to that among the 3-h and 4-6-h caregivers (p = 0.003). The spiritual well-being of the caregivers who provide care between 3 h and 4-6 h a day was significantly higher than that of those who provide 24-h care (p = 0.001). Increasing spiritual well-being may help to reduce caregiver burden in caregivers of those with breast cancer.

Correlations between caregiver competence, burden and health-related quality of life among Chinese family caregivers of elderly adults with disabilities: a cross-sectional study using structural equations analysis

OBJECTIVE

To examine the relationship between caregiver competence and health-related quality of life (HRQoL) among family caregivers of disabled elderly adults, and to evaluate the role of caregiver burden as a potential mediator of that relationship.

DESIGN

Cross-sectional study.

SETTING

Two general hospitals in Shanghai, China.

PARTICIPANTS

Study participants were 135 family caregivers of disabled elderly adults listed on a roster for outpatient and emergency services utilisation from January to March 2022.

DATA ANALYSIS AND OUTCOME MEASURES

We used stratified linear regression and structural equation model analysis. HRQoL was the main outcome, measured using the Medical Outcomes Study 36-Item Short form Health Survey. Caregiver competence was assessed using the Family Caregiver Task Inventory, and caregiver burden was assessed with the Zarit Burden Interview.

RESULTS

Caregivers of moderately and severely disabled elderly adults showed poorer scores in Physical Component Summary (F=20.463, p<0.05) and Mental Component Summary (F=17.062, p<0.05) compared with caregivers of older adults with mild disabilities. At the same time, those caregivers showed higher scores on the caregiving burden (F=19.533, p<0.05) and caregiving difficulties (F=16.079, p<0.05). A structural equation model was performed and successfully adjusted (χ²/df=1.175, p=0.261, NFI=0.970, RFI=0.949, IFI=0.995, CFI=0.995, GFI=0.963, TLI=0.992, AGFI=0.920, RMSEA=0.036). The total effect of Family Caregiver Task Inventory scores on HRQoL scores was -0.980, with a direct effect of -0.645. The mediating effect on HRQoL scores through the intermediate variable of caregiver burden scores was -0.335.

CONCLUSIONS

Family caregivers' HRQoL is closely related to caregiver difficulties and burdens. Early identification and targeted measures are needed to reduce the burden and problems in caregiving.

Health-Related Quality of Life in Primary Caregivers of People Receiving Palliative Home Care

Primary caregivers face constant challenges because of changes in the clinical situation of the person receiving palliative home care. These changes can alter the health-related quality of life and all its dimensions. This study aimed to describe the health-related quality of life of 137 primary caregivers of people enrolled in a palliative home care program in Bogotá, Colombia, applying a quantitative, descriptive, and cross-sectional research design. The Caregiver's Quality of Life Instrument, initially developed by Ferrell, and the sociodemographic characteristics form for caregivers of people with chronic disease, both previously validated in the Colombian population, were used. The results showed that the primary caregivers have a good and adequate overall health-related quality of life; however, they presented some alterations in the physical, psychological, and social dimensions. Therefore, nursing and interdisciplinary palliative care teams should aim their interventions not only at patients but also at primary caregivers during palliative home care.

Instruments to assess the burden of care for family caregivers of adult palliative care patients

BACKGROUND

A primary caregiver shares the illness experience of the patient and undertakes vital care work, alongside managing the patient's emotions, and is actively involved in care process without being paid. When faced with the palliative care patient's needs, caregivers are affected on multiple levels (physical, psychological and socio-economic), thereby experiencing a moderate or severe burden of care.

AIM

To identify assessment instruments for the burden of care for family caregivers that are suitable to be used in clinical practice.

METHOD

A narrative review was conducted using an electronic search in Pubmed, PsychINFO, CINAHL of articles published in English between 2009-2019, using the search terms: 'caregiver/family, caregiver/carer and burden and palliative care/hospice/end of life'. An assessment grid was developed to appraise the clinical use of identified instruments.

RESULTS

Of the 568 articles identified, 40 quantitative studies were selected using 31 instruments to measure the caregiver burden of cancer, noncancer and terminally ill patients. Most instruments 23 (74.11%) evaluate the psycho-emotional and, 22 (70.96%) the social domain, 12 instruments (38.7%) focused on the physical domain, three (9.67%) on the spiritual field and six instruments (19.35%) on economic aspects. For the multidimensional instruments, the assessment grid scored highest for the Burden Scale for Family Caregiver (BSFC).

CONCLUSION

The BSFC is the tool that seems to meet the most requirements, being potentially the most useful tool in clinical practice.

Relationship of Gratitude and Coping Styles with Depression in Caregivers of Children with Special Needs

This is a cross-sectional, descriptive and correlational study aiming to reveal the relationship of gratitude and coping styles with depression in caregivers of children with special needs. As a result of the study, which was conducted with 330 caregivers, it was determined that the caregivers' level of gratitude was high. In this study, it was found that the caregivers used mostly turning to religion, planning, positive reinterpretation, and instrumental social support as coping styles respectively. It was established that there was a significant correlation between caregivers' depression level and gender, education level, level of gratitude, focus on and venting of emotions, substance use, behavioural disengagement, positive reinterpretation, using emotional social support and planning coping styles. The depression disclosure level was found to be 17.8%. For holistic nursing care, the assessment of spiritual care and spiritual needs of caregivers is very important because of its positive effect on mental health.

Dittrichia&nbsp;graveolens (L.) Greuter, a Rapidly Spreading Invasive Plant: Chemistry and Bioactivity

Dittrichia graveolens L. Greuter belonging to the Asteraceae family, is an aromatic herbaceous plant native to the Mediterranean region. This plant species has been extensively studied for its biological activities, including antioxidant, antitumor, antimicrobial, antifungal, anti-inflammatory, anticholinesterase, and antityrosinase, and for its peculiar metabolic profile. In particular, bioactivities are related to terpenes and flavonoids metabolites, such as borneol (40), tomentosin (189), inuviscolide (204). However, D. graveolens is also well known for causing health problems both in animals and humans. Moreover, the species is currently undergoing a dramatic northward expansion of its native range related to climate change, now including North Europe, California, and Australia. This review represents an updated overview of the 52 literature papers published in Scopus and PubMed dealing with expansion, chemistry (262 different compounds), pharmacological effects, and toxicology of D. graveolens up to October 2021. The review is intended to boost further studies to determine the molecular pathways involved in the observed activities, bioavailability, and clinical studies to explore new potential applications.

Empowerment of Women to Provide Home-based Supportive and Palliative Care for Patients with Cancer: Participatory Action Research Protocol

Background: Determining the needs and challenges of women, who care for patients with cancer and providing appropriate strategies to empower them in the design and implementation of appropriate change programs pave the way for the promotion of these women's health and empowerment. Objectives: This study aims at identifying the needs and challenges of women and developing a program to empower women, who care for patients with cancer. Methods: The present study is based on a participatory action research approach and uses the Kemmis and McTaggart model. The participatory action research of this study will be in 4 phases of planning, action, observation, and reflection. In the planning phase, the needs and challenges of female caregivers are examined from the perspective of women and the health team and, then, women's empowerment strategies in providing home-based supportive and palliative care for patients with cancer are determined, using the results of the qualitative phase and review of the literature by using the decision matrix. In the action phase, the selected strategies are implemented with the help of process owners. In the observation phase, combining different methods, data will be collected to measure the results of change. Finally, in the reflection phase, the results of the implementation of the strategies are evaluated and this cycle continues until the intended results are achieved. Discussion: Empowerment of the women, who care for patients with cancer requires awareness, motivation, and active participation of women and the health team. As many cultural and social factors affect the health and participation of these women, participatory research can involve them in promoting their health.

The Role of Family Caregivers in the Care of Older Adults with Cancer

OBJECTIVES

To provide an overview on the role of family caregivers (FCGs) in the care of older adults with cancer and review quality of life needs for FCGs.

DATA SOURCES

Journal articles, research reports, state of the science papers, position papers, and clinical guidelines from professional organizations were used.

CONCLUSION

The high prevalence of multiple comorbidities and the associated burden of geriatric events in older adults have a substantial impact on the quality of life of their FCGs. Practical and efficient models of comprehensive assessment, interventions, and caregiving preparedness support are needed to improve outcomes for both older adults with cancer and their FCGs.

IMPLICATIONS FOR NURSING PRACTICE

Oncology nurses practicing in clinical and research settings have a responsibility to prepare themselves with evidence-based knowledge and resources to include the needs of FCGs in the care provided to older adults with cancer.

The effect of anxiety and spiritual well-being on the care burden of caregivers of cancer patients during the COVID-19 pandemic

Objectives

The COVID-19 pandemic has adversely affected the caregivers of people with all chronic diseases, including people with cancer (PWC). This study was conducted to determine the impact of anxiety and spiritual well-being on the care burden of caregivers of PWC during the COVID-19 pandemic.

Design

This cross-sectional descriptive study included 250 caregivers of hematology and oncology patients registered with a cancer support association. All participants completed the following self-report questionnaires: the Spiritual Well-Being Scale (SWBS), Generalized Anxiety Disorder 7-item scale (GAD-7), and the Zarit Caregiver Burden Interview (ZBI).

Results

Most (82.4%) of the caregivers expressed fear that their patient may contract COVID-19, and 42.0% stated that they had difficulty getting to the hospital. The caregivers’ mean ZBI score was 21.06 ± 14.64, their mean GAD-7 score was 14.51 ± 6.02, and their mean SWBS score was 111.50 ± 16.84. According to the results of regression analysis, SWBS and GAD-7 scores had a significant effect on the ZBI score (p < 0.05).

Conclusion

In this study, anxiety explained most of the care burden during COVID-19. Therefore, during the COVID-19 pandemic, it may be beneficial to implement practices to promote spirituality and reduce anxiety in caregivers of PWC.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00520-021-06611-0.

Religious Involvement, Depressive Symptoms, and Burden in Caregivers of Terminally Ill Patients

Caring for terminally ill patients can be emotionally burdensome. Previous research has demonstrated that caregiving is associated with anxiety and depression. Research on caregivers of terminally ill patients is limited by retrospective studies with small samples. This study aimed to (1) describe religiosity, religious coping, and depressive symptoms in caregivers of persons with amyotrophic lateral sclerosis or advanced cancer; (2) examine the relationship between religiosity and depressive symptoms in caregivers of persons with amyotrophic lateral sclerosis or advanced cancer; (3) examine the relationship between religious coping and depressive symptoms in caregivers of persons with amyotrophic lateral sclerosis or advanced cancer. A descriptive exploratory design was used to analyze data from a larger 5-year National Institutes of Health-funded multisite randomized controlled trial (the TAILORED study). Nearly half of the caregivers screened positive for depressive symptoms, and negative religious coping was associated with higher depressive symptoms (P < .001). Spouse caregivers reported higher depressive symptoms than nonspouse caregivers. Many caregivers experienced depression, which was mitigated by positive religious coping.

Psychometric evaluation of the Persian version of the spiritual well-being scale (SWBS) in Iranian patients with cancer

OBJECTIVE

The spiritual well-being scale (SWBS) is a widely used clinical scale which should be evaluated for Iranian patients with cancer. The aim of this study is to evaluate the psychometric properties of the Persian version of the SWBS in Iranian patients with cancer.

METHOD

This cross-sectional, methodological study was conducted among Iranian patients with cancer (n = 400). The participants were recruited using convenience sampling. The content, construct, convergent and discriminant validity, and reliability of the Persian version of the SWBS were evaluated.

RESULTS

A two-factor structure for the scale was indicated with the factors being: connecting with God and meaningless life that explained 54.18% of the total variance of the concept of spiritual well-being. The results demonstrated the model had a good fit. Cronbach's alpha, McDonald's omega, and the inter-item correlation values of the factors indicated good internal consistency of the scale.

SIGNIFICANCE OF RESULTS

These results suggest that the Persian version of the SWBS is a reliable and valid measure to assess the spiritual well-being of patients with cancer through 16 items related to connecting with God and meaningless life.

Internet-Based Cognitive Behavioral Therapy for Informal Caregivers: Randomized Controlled Pilot Trial

BACKGROUND

Caregiving for a family member can result in reduced well-being for the caregiver. Internet-delivered cognitive behavioral therapy (ICBT) may be one way to support this population. This is especially the case for caregivers in countries with limited resources, but high demand for psychological services.

OBJECTIVE

In this study we evaluated the effects of a therapist-guided 8-week-long ICBT intervention for informal caregivers.

METHODS

In total, 63 participants were recruited online and randomized either to the intervention or to the wait-list control group. The main study outcome was the Caregiver Burden Inventory (CBI). Secondary outcomes included measures of caregiver depression, anxiety, stress, and quality of life.

RESULTS

Moderate between-group effect sizes were observed for the CBI measure, in favor of the intervention group, with a Cohen d=-0.70 for the intention-to-treat analysis. Analyses of the subscales of the CBI showed significant reductions on the subscales of Development and Physical Health. Moderate reductions were found for depression and anxiety scores as indicated by the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) scores. Large between-group effects were observed for reduction in stress and increase in quality of life as indicated by the Perceived Stress Scale-14 (PSS-14), The Brunnsviken Brief Quality of Life Scale (BBQ), and The World Health Organization-Five Well-Being Index (WHO-5). In addition, participants experienced little to no difficulty in using the program and were mostly satisfied with the intervention's platform and the choice of content.

CONCLUSIONS

This is the first internet intervention study for informal caregivers in Lithuania. The results suggest that therapist-guided ICBT can be effective in reducing caregiver burden, anxiety, depression, stress, and improving quality of life.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04052724; https://clinicaltrials.gov/ct2/show/NCT04052724.

CLINICAL VALIDATION OF THE NANDA-I "CAREGIVER ROLE STRAIN" NURSING DIAGNOSIS IN THE CONTEXT OF PALLIATIVE CARE

ABSTRACT Objective: to clinically validate the defining characteristics of the “Caregiver Role Strain” Nursing diagnosis for caregivers of people in a palliative care situation. Method: a cross-sectional, quantitative, descriptive and analytical study. It was developed based on Fehring's Clinical Validation Model and on the diagnostic accuracy measures (sensitivity, specificity, predictive values and Receiver Operating Characteristic curve). The data collection instrument used was a form, applied in 2017 by two nurses to a sample of 111 caregivers of people in a palliative care situation, in Portugal. The caregivers were divided into two groups (with and without the diagnosis), being identified by the simultaneity of three criteria, namely: Zarit Burden Interview values greater than 56; agreement of two nurses about the diagnosis; and caregiver's perception of the presence of signs and symptoms. The defining characteristics were classified as major, secondary and irrelevant, according to the models used. Results: the prevalence of diagnosis was 42.3%. Of the 29 characteristics subjected to the validation process, 9 were considered major, 13 secondary and 7 irrelevant. Ineffective coping, depressive mood, frustration, worsening of previous diseases, stress and fatigue were the characteristics which proved to be more associated with the diagnosis in both analyses. The overall score of the diagnosis was 0.68. Conclusion: the study results contribute to the improvement of the diagnosis, making it more accurate. In addition, they enable better clinical decision in Nursing, allowing nurses to make a diagnostic judgment supported by scientific evidence.

Predictors of Quality of Life in Patients with Heart Disease

Individuals with heart disease have been found to have more negative psychological and physical effects that impact their quality of life (QoL) than the general population. Spiritual well-being is considered a protective factor associated with QoL in people with heart disease. Therefore, the current research seeks to evaluate whether sociodemographic factors and spiritual well-being predict QoL among patients with heart disease. A total of 500 patients who were selected through a convenient sampling method from an Iranian hospital participated in this descriptive-correlational study. Data were collected using the McGill QoL Questionnaire, the Spiritual Well-being Scale, and demographic variables. The data analysis included descriptive and inferential statistics powered by SPSS (v. 23). Following multivariate analyses, findings revealed that those participants with their main source of income derived from family or a government pension and with College or intermediate educational levels were more likely to have higher QoL. Those participants with average or poor socioeconomic status reported higher QoL than those who were more affluent. Furthermore, younger patients (- 0.2, 95% CI - 0.3 to - 0.003, p = 0.016) and those with higher social support (0.7, 95% CI 0.2 to 1.3, p = 0.006) and spiritual well-being (0.2, 95% CI 0.1 to 0.3, p < 0.001) had significantly better QoL. In the current study, spiritual well-being and social support led to reduced negative psychological sequelae and improved QoL in cardiac patients.

Health-related quality of life and its socio-economic and cultural predictors among advanced cancer patients: evidence from the APPROACH cross-sectional survey in Hyderabad-India

Background

Patients with advanced cancer often experience poor health-related quality-of-life (HRQoL) due to cancer and treatment-related side-effects. With India’s palliative care landscape in its infancy, there is a concern that advanced cancer patients, especially individuals who are from disadvantaged populations experience poor HRQoL outcomes. We aim to assess HRQoL of advanced cancer patients in terms of general well-being (physical, functional, emotional, and social/family well-being), pain experiences, psychological state, and spiritual well-being, and determine the relationship between belonging to a disadvantaged group and HRQoL outcomes. We hypothesize that patients from disadvantaged or minority backgrounds, identified in this paper as financially distressed, female, lower years of education, lower social/family support, minority religions, and Non-General Castes, would be associated with worse HRQoL outcomes compared to those who are not from a disadvantaged group.

Methods

We administered a cross-sectional survey to 210 advanced cancer patients in a regional cancer center in India. The questionnaire included standardized instruments for general well-being (FACT-G), pain experiences (BPI), psychological state (HADS), spiritual well-being (FACT-SP); socio-economic and demographic characteristics.

Results

Participants reported significantly lower general well-being (mean ± SD) (FACT-G = 62.4 ± 10.0) and spiritual well-being (FACT-SP = 32.7 ± 5.5) compared to a reference population of cancer patients in the U.S. Patients reported mild to moderate pain severity (3.2 ± 1.8) and interference (4.0 ± 1.6), normal anxiety (5.6 ± 3.1) and borderline depressive symptoms (9.7 ± 3.3). Higher financial difficulty scores predicted most of the HRQoL domains (p ≤ 0.01), and being from a minority religion predicted lower physical well-being (p ≤ 0.05) and higher pain severity (p ≤ 0.05). Married women reported lower social/family well-being (p ≤ 0.05). Pain severity and interference were significant predictors of most HRQoL domains.

Conclusions

Advanced cancer patients, especially those with lower financial well-being and belonging to minority religions, reported low physical, functional, emotional, social/family, and spiritual well-being, and borderline depressive symptoms. Future studies should be directed at developing effective interventions supporting vulnerable groups such as those with financial distress, and those belonging to minority religions.

Current Advances in Palliative & Hospice Care: Problems and Needs of Relatives and Family Caregivers During Palliative and Hospice Care-An Overview of Current Literature

Palliative and hospice care aims to improve quality of life of patients’ relatives, but still little is known about their specific problems and needs. We present a comprehensive literature update. Narrative review to present an expert overview of peer-reviewed, English-written original research publications and reviews on psychosocial and existential problems, supportive needs as well as interventions for relatives during the patients’ disease trajectory published between January 2017 and November 2018. A total of 64 publications were included. Relatives report high rates of psychological and existential distress, burden and psychological morbidity during the total disease trajectory of the patient. In addition, relatives report an alarmingly high number of unmet needs with information being the central issue. Relatives’ problems and needs are part of complex systems influenced by various socio-demographic factors and patient–relatives-interactions and dependency between different psychological phenomena. First support interventions for relatives during disease trajectory have proven feasible and secondary data from randomized studies suggest beneficial effects of providing early palliative care also for relatives. Relatives should be addressed to a still larger extent in the daily practice of palliative and hospice care, thus further research to reveal more detailed systematic information is needed to improve relatives’ psychological burden and quality of life.