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Moreno PI, Worch SM, Thomas JL, Nguyen RL, Medina HN, Penedo FJ, Moskowitz JT, Yanez B, Kircher SM, Kundu SD, Flury SC, Cheung EO. Quality of Life in Patients and Their Spouses and Cohabitating Partners in the Year Following a Cancer Biopsy (the Couples Cope Study): Protocol for a Prospective Observational Study. JMIR Res Protoc 2024; 13:e52361. [PMID: 38889402 PMCID: PMC11220434 DOI: 10.2196/52361] [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: 08/31/2023] [Revised: 03/11/2024] [Accepted: 03/12/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Receiving a diagnosis of cancer is a profound and often very stressful experience. Few studies have prospectively recruited patients prior to receiving a new diagnosis of cancer and included spouses or partners. OBJECTIVE The aim of the Couples Cope Study is to understand the impact of undergoing a diagnostic biopsy and receiving a new cancer diagnosis on quality of life (QoL) in both patients and their spouses or partners, as well as on the quality of their relationship. This protocol paper describes the study design and assesses the feasibility of recruitment and retention. METHODS Study staff reviewed the schedules of collaborating physicians using specific encounter codes to identify patients scheduled for breast or prostate biopsies. Potential participants were prescreened via the electronic health record and sent a recruitment letter at least 2 to 3 weeks prior to their biopsy procedure. Patients subsequently underwent a phone screening to determine eligibility. Patients who enrolled provided study staff with contact information for their spouses or partners. All consent forms were completed online. Surveys were completed online prior to receiving the biopsy results (baseline), and at 1, 3, 6, and 9 months after the biopsy. Study staff engaged in ongoing, personalized contact with participants and sent assessment completion reminders via phone and email. RESULTS A total of 2294 patients undergoing a breast or prostate biopsy were identified and 69% (n=1582) were eligible for phone screening following electronic health record prescreening. Of the 431 patients who underwent phone screening, 75% (n=321) were eligible to participate. Of the eligible patients, 72% (n=231) enrolled and 82% (n=190) of enrolled patients had an accompanying partner or spouse who also enrolled. A total of 77% (34/44) of patients who received a cancer diagnosis and 72% (26/36) of their spouses or partners were retained through 9 months, while 80% (53/66) of patients who received a benign diagnosis and 68% (42/62) of their partners were retained. CONCLUSIONS Prospective recruitment of patients undergoing diagnostic biopsy and their partners is feasible and requires both strategic collaboration with providers and concerted prescreening and recruitment efforts by study staff. Importantly, this study was able to conduct all study activities online without disrupting clinical workflow and without requiring patients and their spouses or partners to come into the laboratory. Consideration should be given to the ratio of biopsies to cancer diagnoses, which can vary significantly by cancer type. Prospective studies are needed and can inform our ability to provide effective support earlier to couples facing a possible cancer diagnosis. Future studies should examine other tumor types that have received less attention in QoL studies, include behavioral and neurobiological assessments beyond self-report measures, and follow couples beyond 9 months in order to examine long-term effects on QoL. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/52361.
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Affiliation(s)
- Patricia I Moreno
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Sarah M Worch
- Department of Psychology, Lynn University, Boca Raton, FL, United States
| | - Jessica L Thomas
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Rebecca L Nguyen
- Department of Psychology, University of Maryland, Baltimore County, Baltimore, MD, United States
| | - Heidy N Medina
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Frank J Penedo
- Departments of Medicine & Psychology, University of Miami, Miami, FL, United States
| | - Judith T Moskowitz
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Betina Yanez
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Sheetal M Kircher
- Division of Hematology and Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Shilajit D Kundu
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Sarah C Flury
- Department of Urology, Vanderbilt University School of Medicine, Nashville, TN, United States
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Genderson MW, Thomson MD, Siminoff LA. Where you begin is not necessarily where you end: the mental and physical health trajectories of cancer caregivers over time. Support Care Cancer 2024; 32:233. [PMID: 38499880 DOI: 10.1007/s00520-024-08437-y] [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: 10/30/2023] [Accepted: 03/12/2024] [Indexed: 03/20/2024]
Abstract
PURPOSE Cancer caregiving, a critical component in the cancer-care model, has deleterious effects on the caregiver's physical and mental health. The degree to which these negative effects are uniformly experienced by caregivers is unclear; effects may be exacerbated at the end of life when caregiving is intensified. Not all caregivers have the support of an additional involved support person (secondary caregiver). The impact of the secondary caregiver's absence on the primary caregiver's well-being is understudied. METHODS Terminal cancer patient-caregiver dyads (n = 223) were recruited from oncology clinics and followed for six months or until patient death. Longitudinal latent growth models were used to characterize the heterogeneity of caregiver physical health and depressive symptoms; characteristics associated with these trajectories are examined. RESULTS Caregivers were majority female (74%), white (55%) and patient spouses (60%). Two physical health (moderate, stable; initially good, declining) and two depressive symptom (moderate, stable; high, increasing) trajectories were identified. Declining physical health was more likely among caregivers who were healthiest at baseline, had higher levels of education, lower subjective burden, fewer depressive symptoms, cared for patients with fewer functional limitations and reported fewer caregiving tasks rendered by a secondary caregiver. Those with increasing depressive symptoms were more likely to be white, patient's wife, have higher subjective caregiver burden, lower physical health, and care for a patient with greater functional limitations. CONCLUSIONS Decreasing physical health was evident among caregivers who were initially healthier and reported less assistance from secondary caregivers. Increasing depression was seen in white, female spouses with higher subjective burden. Sample heterogeneity revealed hidden groups unexpectedly at risk in the primary cancer caregiver role to which the oncology care team should be alert.
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Affiliation(s)
- Maureen Wilson Genderson
- College of Public Health, Social and Behavioral Sciences, Temple University, 1700 N Broad St, 4th fl Suite 417, Philadelphia, PA, 19122, USA
| | - Maria D Thomson
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, 830 East Main Street Richmond, Richmond, VA, 23219, USA
| | - Laura A Siminoff
- College of Public Health, Social and Behavioral Sciences, Temple University, 1700 N Broad St, 4th fl Suite 417, Philadelphia, PA, 19122, USA.
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Wilson-Genderson M, Thomson MD, Siminoff LA. Where you begin is not necessarily where you end: the mental and physical health trajectories of cancer caregivers over time. RESEARCH SQUARE 2023:rs.3.rs-3513142. [PMID: 37986993 PMCID: PMC10659542 DOI: 10.21203/rs.3.rs-3513142/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
Purpose Cancer caregiving, a critical component in the cancer-care model, has deleterious effects on the caregiver's physical and mental health. The degree to which these negative effects are uniformly experienced by caregivers is unclear. The impact of the secondary caregiver's absence on the primary caregivers' well-being is understudied. Methods Terminal cancer patient-caregiver dyads (n = 223) were recruited from oncology clinics and followed for six months or until patient death. Longitudinal latent growth models were used to characterize the heterogeneity of caregiver physical health and depressive symptoms; characteristics associated with these trajectories are examined. Results Caregivers were majority female (74%), white (55%) and patient spouses (60%). Two physical health (moderate, stable; initially good, declining) and two depressive symptom (moderate, stable; high, increasing) trajectories were identified. Declining physical health was more likely among caregivers who were healthiest at baseline, had higher levels of education, lower subjective burden, fewer depressive symptoms, cared for patients with fewer functional limitations and reported fewer caregiving tasks rendered by a secondary caregiver. Those with increasing depressive symptoms were more likely to be white, patient's wife, have higher subjective caregiver burden, lower physical health, and care for a patient with greater functional limitations. Conclusions Decreasing physical health was evident among caregivers who were initially healthier and reported less assistance from secondary caregivers. Increasing depression was seen in white, female spouses with higher subjective burden. Sample heterogeneity revealed hidden groups unexpectedly at risk in the primary cancer caregiver role to which the oncology care team should be alert.
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Carlozzi NE, Choi SW, Wu Z, Sen S, Troost J, Lyden AK, Miner JA, Graves C, Sander AM. The reliability and validity of the TBI-CareQOL system in four diverse caregiver groups. J Patient Rep Outcomes 2023; 7:57. [PMID: 37358716 DOI: 10.1186/s41687-023-00602-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 06/04/2023] [Indexed: 06/27/2023] Open
Abstract
PURPOSE Establishing the psychometric reliability and validity of new measures is an ongoing process. More work is needed in to confirm the clinical utility of the TBI-CareQOL measurement development system in both an independent cohort of caregivers of traumatic brain injury (TBI), as well as in additional caregiver groups. METHODS An independent cohort of caregivers of people with TBI (n = 139), as well as three new diverse caregiver cohorts (n = 19 caregivers of persons with spinal cord injury, n = 21 caregivers for persons with Huntington disease, and n = 30 caregivers for persons with cancer), completed 11 TBI-CareQOL measures (caregiver strain; caregiver-specific anxiety; anxiety; depression; anger; self-efficacy; positive affect and well-being; perceived stress; satisfaction with social roles and activities; fatigue; sleep-related impairment), as well as two additional measures to examine convergent and discriminant validity (PROMIS Global Health; the Caregiver Appraisal Scale). RESULTS Findings support the internal consistency reliability (all alphas > 0.70 with the vast majority being > 0.80 across the different cohorts) of the TBI-CareQOL measures. All measures were free of ceiling effects, and the vast majority were also free of floor effects. Convergent validity was supported by moderate to high correlations between the TBI-CareQOL and related measures, while discriminant validity was supported by low correlations between the TBI-CareQOL measures and unrelated constructs. CONCLUSION Findings indicate that the TBI-CareQOL measures have clinical utility in caregivers of people with TBI, as well as in other caregiver groups. As such, these measures should be considered as important outcome measures for clinical trials aiming to improve caregiver outcomes.
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Affiliation(s)
- Noelle E Carlozzi
- Department of Physical Medicine and Rehabilitation, University of Michigan, North Campus Research Complex, 2800 Plymouth Road, Building NCRC B14, Room G216, Ann Arbor, MI, 48109-2800, USA.
| | - Sung Won Choi
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Zhenke Wu
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, USA
- Michigan Institute for Data Science, University of Michigan, Ann Arbor, MI, USA
| | - Srijan Sen
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Jonathan Troost
- Michigan Institute for Data Science, University of Michigan, Ann Arbor, MI, USA
| | - Angela K Lyden
- Clinical Trials Support Office, University of Michigan, Ann Arbor, MI, USA
| | - Jennifer A Miner
- Department of Physical Medicine and Rehabilitation, University of Michigan, North Campus Research Complex, 2800 Plymouth Road, Building NCRC B14, Room G216, Ann Arbor, MI, 48109-2800, USA
| | - Christopher Graves
- Department of Physical Medicine and Rehabilitation, University of Michigan, North Campus Research Complex, 2800 Plymouth Road, Building NCRC B14, Room G216, Ann Arbor, MI, 48109-2800, USA
| | - Angelle M Sander
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine/Harris Health System, Houston, TX, USA
- Brain Injury Research Center, TIRR Memorial Hermann, Houston, TX, USA
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Reblin M, Iacob E, Tay DL, Li H, Hebdon MCT, Beck A, Donaldson G, Cloyes KG, Ellington L. Family Caregiver Reports of Their Own and Patient Symptoms in Cancer Home Hospice Approaching End-of-Life. Am J Hosp Palliat Care 2023; 40:508-516. [PMID: 35689339 PMCID: PMC9734284 DOI: 10.1177/10499091221108119] [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] [Indexed: 12/14/2022] Open
Abstract
Context: Family caregivers assume the primary responsibility of assessing and managing hospice cancer patient symptoms while simultaneously managing their own wellbeing and symptoms. Objectives: Describe caregivers' assessment of hospice cancer patient and their own symptoms during the last 60 days of patient life, and assess the relationship between patient and caregiver symptoms over time. Methods: Caregiver symptom report of self and cancer home hospice patient symptom data were collected via telephone in the final 60 days of patient life. Descriptive data on symptom severity and prevalence were summarized. Exploratory Factor Analysis was used to group individual symptoms. Factors representing patient symptoms, caregiver symptoms, and caregiver outlook were analyzed using mixed-effects analysis to determine relationships between factors and change in relationship between factors over time. Results: Data from 61 patient-caregiver dyads are presented. At least 1 day of moderate-to-severe symptoms were reported in the majority of dyads. Significant auto-regressive associations were found, namely previous factor scores for an individual positively predicted the next factor scores for that individual. Previous caregiver report of patient symptoms was also positively associated with the next report of caregiver symptoms; previous caregiver report of their own symptoms were negatively associated with their next report of patient symptoms. Patient and caregiver symptoms and caregiver outlook worsened over time and the relationship between patient and caregiver symptoms strengthened closer to death. Conclusion: Our findings may guide hospice care team responses to caregiver and patient symptoms to promote individual level and unit level functioning.
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Affiliation(s)
- Maija Reblin
- School of Medicine, University of Vermont, Burlington, VT, USA
| | - Eli Iacob
- College of Nursing, University of Utah, Salt Lake City, UT, USA
| | - Djin L. Tay
- College of Nursing, University of Utah, Salt Lake City, UT, USA
| | - Hui Li
- College of Nursing, University of Utah, Salt Lake City, UT, USA
| | | | - Anna Beck
- Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Gary Donaldson
- College of Nursing, University of Utah, Salt Lake City, UT, USA
| | | | - Lee Ellington
- College of Nursing, University of Utah, Salt Lake City, UT, USA
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Barben J, Billa O, Collot J, Collot T, Manckoundia P, Bengrine-Lefevre L, Dabakuyo-Yonli TS, Quipourt V. Quality of life and perceived burden of the primary caregiver of patients aged 70 and over with cancer 5 years after initial treatment. Support Care Cancer 2023; 31:147. [PMID: 36729239 PMCID: PMC9892678 DOI: 10.1007/s00520-023-07594-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 01/14/2023] [Indexed: 02/03/2023]
Abstract
PURPOSE Long-term effects of being the primary caregiver of an older patient with cancer are not known. This study aimed to assess health-related quality of life (HRQoL) in primary caregivers of patients aged 70 and older with cancer, 5 years after initial treatment. Secondly, to compare the HRQoL between former primary caregivers whose caregiving relationship had ceased (primary caregiver no longer directly assisting the patient because of patient death or removal to another city or admission to an institution) and current caregivers, and to determine the perceived burden of the primary caregivers. METHODS Prospective observational study including primary caregivers of patients aged 70 and older with cancer. HRQoL and perceived burden were assessed using the SF-12 and Zarit Burden Interview (ZBI) at baseline and 5 years after initial treatment. RESULTS Ninety-six caregivers were initially included; at 5 years, 46 caregivers completed the SF-12 and ZBI between June 15 and October 26, 2020. Primary caregiver's HRQoL scores had significantly decreased over time for physical functioning (mean difference = -10, p=0.04), vitality (MD= -10.5, p=0.02), and role emotional (MD= -8.1, p=0.01) dimensions. The comparison at 5 years according to caregiving status showed no difference for all HRQoL dimensions. There was no decrease in perceived burden at 5 years. CONCLUSION Some dimensions of HRQoL decreased at 5 years with a stable low perceived burden. TRIAL REGISTRATION NCT04478903.
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Affiliation(s)
- Jérémy Barben
- Department of Geriatrics and Internal Medicine, Hospital of Champmaillot, University Hospital, Dijon, France. .,Geriatric Oncology Coordination Unit in Burgundy, University Hospital, Dijon, France. .,Breast and Gynaecological Cancer Registry, Centre George François Leclerc, Dijon, France. .,National Clinical Research Platform for Quality of Life in Oncology, Dijon, France. .,UMR INSERM U1231, University of Burgundy, Dijon, France.
| | - Oumar Billa
- Breast and Gynaecological Cancer Registry, Centre George François Leclerc, Dijon, France ,National Clinical Research Platform for Quality of Life in Oncology, Dijon, France ,UMR INSERM U1231, University of Burgundy, Dijon, France
| | - Julie Collot
- Department of Geriatrics and Internal Medicine, Hospital of Champmaillot, University Hospital, Dijon, France
| | - Thomas Collot
- Medical Oncology Department, Centre George François Leclerc, Dijon, France
| | - Patrick Manckoundia
- Department of Geriatrics and Internal Medicine, Hospital of Champmaillot, University Hospital, Dijon, France ,UMR INSERM U1093, University of Burgundy, Dijon, France
| | - Leila Bengrine-Lefevre
- Geriatric Oncology Coordination Unit in Burgundy, University Hospital, Dijon, France ,Medical Oncology Department, Centre George François Leclerc, Dijon, France
| | - Tienhan Sandrine Dabakuyo-Yonli
- Breast and Gynaecological Cancer Registry, Centre George François Leclerc, Dijon, France ,National Clinical Research Platform for Quality of Life in Oncology, Dijon, France ,UMR INSERM U1231, University of Burgundy, Dijon, France
| | - Valérie Quipourt
- Department of Geriatrics and Internal Medicine, Hospital of Champmaillot, University Hospital, Dijon, France ,Geriatric Oncology Coordination Unit in Burgundy, University Hospital, Dijon, France
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How Caregivers Cope and Adapt When a Family Member Is Diagnosed With a Hematologic Malignancy: Informing Supportive Care Needs. Cancer Nurs 2022; 45:E849-E855. [PMID: 35120021 DOI: 10.1097/ncc.0000000000001063] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Informal family caregivers (FCs) of adults with various diseases including hematologic malignancy (HM) experience low quality of life and psychological well-being. Although HMs are life-threatening cancers associated with high mortality, numerous symptoms, and lengthy hospitalizations and are therefore likely to be challenging for FCs to cope with, there is scant research exploring FC experiences. OBJECTIVE The aim of this study was to describe the coping and adaptation of FCs of patients during diagnosis and treatment of HM. METHODS This study used a qualitative descriptive design to analyze semi-structured interview responses from FCs (N = 28) within 3 months of the patients' HM diagnosis. A content analysis was conducted to generate common themes. RESULTS Family caregivers endorsed adaptive and maladaptive coping. Adaptive strategies included taking one day at a time, spirituality, engaging in pastimes, and utilizing emotional and instrumental family and community support. Maladaptive coping included wishful thinking, harmful habits, avoidance, and lacking or being unable to accept family and community support. CONCLUSIONS Findings highlight the complexities of caregiver burden as they support their loved ones with HM. IMPLICATIONS FOR PRACTICE Family caregivers would benefit from receiving an interdisciplinary family-centered approach as their HM person is initiating treatment. Nurses should consider assessing the FCs' psychosocial needs to help facilitate appropriate services, such as palliative care consultations, social work referrals, support groups, and/or counseling.
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Alnajar M, Mosleh S, Almalik M, Darawad M. Psychological predictors of quality of life among Jordanian cancer patients' caregivers. Psychooncology 2022; 31:1886-1894. [PMID: 36250593 DOI: 10.1002/pon.6054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 09/08/2022] [Accepted: 09/14/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The caregivers who provide care for patients with cancer often experience emotional and psychological stressors and burdens that could be influenced by several factors, including the cultural context. This study examines the level of emotional distress and burden and their effect on the quality of life (QOL) of Jordanian cancer patients' caregivers. METHODS A cross-sectional survey was conducted among 257 family caregivers of patients at various stages of cancer. RESULTS The average age of caregivers was 37.5 years (SD = 12.2). Most caregivers (145; 59.2%) were female and married (168; 68.6%). About a quarter were partners (32.2%) and lived with their patients (137; 55.9%). Caregivers with a reduced overall Caregiver Quality of Life Index-Cancer (CQOLC) score were more likely to be older, the parents of the patients, and living with patients in the same house. A significant negative relationship was found between caregivers' CQOLC and Zarit Burden Interview (r = -0.7, p = 0.001), anxiety (r = -0.69, p = 0.001), and depression (r = -0.42, p = 0.03) scores. Multiple linear regression analysis revealed that burden, anxiety, and depression scores were independent predictors and explained 63% of the variance in the total CQOLC score of caregivers. CONCLUSION Cancer caregivers are at elevated risk of poor QOL. Despite participants' low perception of the burden level, this study provides preliminary results for policymakers and medical practitioners to foster a comprehensive platform supporting cancer caregivers. Moreover, identifying the caregivers' readiness to provide the needed care and the availability of supportive resources, as a clinical routine, is strongly recommended.
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Affiliation(s)
- Malek Alnajar
- College of Nursing, The University of Utah, Salt Lake, Utah, USA
| | - Sultan Mosleh
- Faculty of Nursing, Mutah University, Mu'tah, Jordan.,Higher Collages of Technology, Faculty of Health Science, Fujairah, United Arab Emirates
| | - Mona Almalik
- Faculty of Nursing, Mutah University, Mu'tah, Jordan
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Mitchell HR, Kim Y, Llabre MM, Ironson G. Four-symptom model of medical-related posttraumatic stress among adult cancer patients. Health Psychol 2022; 41:492-501. [PMID: 35587888 PMCID: PMC10710860 DOI: 10.1037/hea0001187] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Four symptoms of posttraumatic stress (PTSS: intrusion, avoidance, alterations in arousal and reactivity, and negative alterations in cognitions and mood) were put forth by the Diagnostic and Statistical Manual of Mental Disorder (DSM-5). Patients with chronic major medical illness and their family caregivers often perceive the illness experience as traumatic, yet DSM-5 criteria precludes medical illness as a potential traumatic exposure. In this article, we address the applicability of the four symptoms to a medical population. METHOD Adult patients with colorectal cancer (n = 130, M = 55.83 years old, 60.0% female, 46.9% Hispanic) and their family caregivers (n = 160, M = 51.01 years old, 72.5% female, 49.0% Hispanic) completed questionnaires around the time of cancer diagnosis and treatment initiation (Time 1 [T1]), and 1- (Time 2 [T2]) and 2- (Time 3 [T3]) year postdiagnosis. Intrusion, avoidance, and alterations in arousal and reactivity symptoms were assessed using the Impact of Events Scale-Revised and negative alterations in cognitions and mood were quantified with selected conceptually congruent items from various psychosocial measures. RESULTS Confirmatory factor analysis revealed good fit of the four-symptom model of PTSS for caregivers at all three times and for patients at T2. Factor loadings of the four symptoms were high, ranging from .47-.97 and .62-.96 among patients and caregivers, respectively. CONCLUSIONS Findings extend the application of the four posttraumatic stress symptoms to patients with chronic major medical illness (cancer) and their family caregivers. Assessment and treatment of subclinical, yet substantial psychological distress precipitated by major medical illness like cancer are warranted. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Leggett A, Koo HJ, Park B, Choi H. The Changing Tides of Caregiving During the COVID-19 Pandemic: How Decreasing and Increasing Care Provision Relates to Caregiver Well-Being. J Gerontol B Psychol Sci Soc Sci 2022; 77:S86-S97. [PMID: 35032387 PMCID: PMC9122649 DOI: 10.1093/geronb/gbac002] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES Pandemic-specific changes to the caregiving context (e.g., attempts to reduce exposure, physical distancing requirements) may lead to changes in care provision. This study uses the 2020 National Health and Aging Trends Study Family Members and Friends coronavirus disease 2019 (COVID-19) questionnaire to explore changes in the amount of care provision during COVID-19 and associations with stress process outcomes of caregiving. METHODS The sample includes 1,020 caregivers who provided care for an older adult during COVID-19. Caregivers indicated whether their hours of care decreased, stayed stable, or increased during the pandemic. We describe reasons for change in care and compare changes in care by demographic and care-related characteristics using chi-squares and analyses of variance, and relate changes in care with stress process outcomes (e.g., overload, COVID-related anxiety) using multivariable linear regression. RESULTS Caregivers were 60.7 years old on average, 69.3% were female, and 18.6% were non-White. While most caregivers reported no change, 30.5% reported an increase and 11.5% reported a decrease in the amount of pandemic care provided. Relative to maintaining stable care provision, an increase was associated broadly with worse mental health and care-related stress, whereas a decrease was associated with greater emotional difficulty related to care and lower levels of positive affectivity. DISCUSSION Those who changed their care provision during the pandemic predominantly did so to protect their care recipient from COVID-19 exposure. Increasing one's care provision was strongly associated with worse mental health and well-being. Supports for caregivers who take on additional care tasks during the pandemic could have great public health benefit.
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Affiliation(s)
- Amanda Leggett
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Hyun Jung Koo
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Bona Park
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - HwaJung Choi
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
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Lavers G, Andriessen K, Krysinska K. A Systematic Review of the Experiences and Support Needs of Informal Caregivers for People Who Have Attempted Suicide or Experienced Suicidal Ideation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095181. [PMID: 35564578 PMCID: PMC9102006 DOI: 10.3390/ijerph19095181] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 04/16/2022] [Accepted: 04/21/2022] [Indexed: 02/04/2023]
Abstract
Informal caregivers include family, friends, and significant others who provide important support for people who have attempted suicide or experienced suicidal ideation. Despite the prevalence of suicidal behaviour worldwide, they remain an understudied population. This review aimed to synthesise the literature on the experiences and support needs of informal caregivers of people who have attempted suicide or experienced suicidal ideation. We conducted a systematic review according to PRISMA guidelines. Searches of peer-reviewed literature in Medline, Emcare, Embase, EBM Reviews, and PsycINFO identified 21 studies (4 quantitative and 17 qualitative), published between 1986 and 2021. Informal carers commonly reported symptoms of depression and anxiety, for which they receive little assistance. They also expressed a desire for more involvement and education in the professional care of suicidality. Together, the studies indicated a need to improve the way informal caregiving is managed in professional healthcare settings. This review identified potential avenues for future research, as well as broad areas which require attention in seeking to improve the care of suicidal people and their caregivers.
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Affiliation(s)
- George Lavers
- Melbourne Medical School, The University of Melbourne, Parkville, VIC 3010, Australia;
| | - Karl Andriessen
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC 3010, Australia;
| | - Karolina Krysinska
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC 3010, Australia;
- Correspondence:
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12
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The presence of a secondary caregiver differentiates primary cancer caregiver well-being. Support Care Cancer 2022; 30:1597-1605. [PMID: 34546455 PMCID: PMC8732324 DOI: 10.1007/s00520-021-06544-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 09/04/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Informal caregivers play a fundamental role in the care of hematological cancer patients, but less is known about how secondary caregivers are involved. We assessed the presence or absence of a secondary caregiver, the types of caregiving activities performed by primary and secondary caregivers, and examined whether the presence of a secondary caregiver was associated with primary caregiver characteristics and well-being over time. METHODS A case series of hematological cancer patient-caregiver dyads (n = 171) were recruited from oncology clinics in Virginia and Pennsylvania and followed for 2 years. Multilevel models were developed to examine the associations between the presence of a secondary caregiver and the primary caregivers' well-being. RESULTS Most (64.9%) primary caregivers reported having secondary caregivers. Multilevel models showed primary caregivers without help had higher baseline mental and physical health, but experienced deteriorating physical health over time, compared to supported primary caregivers. Supported primary caregivers reported improvements in mental health over time that was associated with improvements in physical health. CONCLUSIONS Primary caregivers in good physical and mental health at the beginning of their caregiving journey but who have the least assistance from others may be at greatest risk for detrimental physical health effects long term. Attention to the arrangement of caregiving roles (i.e., who provides what care) over time is needed to ensure that caregivers remain healthy and well supported.
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Lee LJ, Kim Y, Shamburek R, Ross A, Yang L, Bevans MF. Caregiving stress and burden associated with cardiometabolic risk in family caregivers of individuals with cancer. Stress 2022; 25:258-266. [PMID: 35727023 PMCID: PMC9380420 DOI: 10.1080/10253890.2022.2037548] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Chronic stress is a well-established risk factor for cardiometabolic disease. Caregiving for individuals with cancer is perceived as a chronic stressor yet research on the risk for cardiometabolic disease in this population, opposed to the elderly and those with Alzheimer's disease, is limited. Additionally, few studies have explored the early physiological changes that occur in family caregivers suggesting an elevated risk for illness. This cross-sectional study was designed to examine levels of cardiometabolic risk biomarkers and their correlates in caregivers of patients with colorectal cancer. Caregivers completed questionnaires that measure exposures to stress and vulnerability factors, psychological distress, and health habits as potential correlates. Traditional lipid and nontraditional lipoprotein particle biomarkers (e.g. concentration and size for all lipoprotein classes) were assayed from blood serum. Caregivers (N = 83, mean age = 49.8, 73% female) displayed levels of cardiometabolic biomarkers that suggest an elevated risk for cardiometabolic disease. Caregivers who were Hispanic, married, highly educated, employed, reported more hours spent caregiving daily, experienced higher caregiver burden associated with the lack of family support and impact on schedule, and psychological distress, demonstrated an elevated risk for cardiometabolic disease; primarily determined by nontraditional lipid biomarkers - large TRL-P, LDL-P, small HDL-P, large HDL-P, TRL-Z, LDL-Z and HDL-Z. These findings suggest that traditional lipid biomarkers may not be robust enough to detect early physiological changes associated with cardiometabolic disease risk in family caregivers. Moreover, findings reiterate the importance of assessing caregiver burden and providing evidence-based interventions to manage caregiving stress with the potential to improve caregivers' cardiometabolic health.
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Affiliation(s)
- Lena J. Lee
- Translational Biobehavioral and Health Disparities, National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Youngmee Kim
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | | | - Alyson Ross
- Translational Biobehavioral and Health Disparities, National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Li Yang
- Translational Biobehavioral and Health Disparities, National Institutes of Health Clinical Center, Bethesda, MD, USA
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14
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Pan YC, Lin YS. Systematic Review and Meta-Analysis of Prevalence of Depression Among Caregivers of Cancer Patients. Front Psychiatry 2022; 13:817936. [PMID: 35633789 PMCID: PMC9133351 DOI: 10.3389/fpsyt.2022.817936] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 03/03/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Caregivers of cancer patients commonly experience depressive symptoms due to the heavy burden of caregiving responsibility. OBJECTIVE This meta-analysis examined the prevalence of depression among caregivers of cancer patients. METHODS We included 85 studies covering 23,317 participants published between 2001 and 2021 (25 countries) that reported the prevalence of depression among caregivers of cancer patients. We examined the pooled prevalence of depression and hypothesized moderators, including year, age, sex, geographic regions, percentage of spousal caregivers, depression measures, and cancer stage. RESULTS All 85 effect sizes included 6,077 caregivers of patients with depression. The weighted average prevalence of depression was 25.14% (95% CI, 21.42-29.27%) among caregivers. The prevalence rates were moderated by geographic region, patients' cancer stage, and measures for depression. The prevalence rates also varied among the different measures assessing depression. The prevalence rate decreased with the mean age of the caregivers and the percentage of spousal caregivers. CONCLUSIONS This study revealed a high prevalence of depression among caregivers of cancer patients. The prevalence rates also varied with the study design, demographics of caregivers, and patients' medical information. These findings highlight that psychological support and intervention may be crucial for patients and their caregivers in clinical practice.
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Affiliation(s)
- Yuan-Chien Pan
- Department of Psychology, National Taiwan University, Taipei, Taiwan
| | - Yaw-Sheng Lin
- Department of Psychology, National Taiwan University, Taipei, Taiwan
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15
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Carlozzi NE, Choi SW, Wu Z, Miner JA, Lyden AK, Graves C, Wang J, Sen S. An App-Based Just-in-Time Adaptive Self-management Intervention for Care Partners (CareQOL): Protocol for a Pilot Trial. JMIR Res Protoc 2021; 10:e32842. [PMID: 34889775 PMCID: PMC8704108 DOI: 10.2196/32842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 10/07/2021] [Accepted: 10/07/2021] [Indexed: 12/02/2022] Open
Abstract
Background Care partners (ie, informal family caregivers) of individuals with health problems face considerable physical and emotional stress, often with a substantial negative impact on the health-related quality of life (HRQOL) of both care partners and care recipients. Given that these individuals are often overwhelmed by their caregiving responsibilities, low-burden self-management interventions are needed to support care partners to ensure better patient outcomes.
Objective The primary objective of this study is to describe an intensive data collection protocol that involves the delivery of a personalized just-in-time adaptive intervention that incorporates passive mobile sensor data feedback (sleep and activity data from a Fitbit [Fitbit LLC]) and real time self-reporting of HRQOL via a study-specific app called CareQOL (University of Michigan) to provide personalized feedback via app alerts.
Methods Participants from 3 diverse care partner groups will be enrolled (care partners of persons with spinal cord injury, care partners of persons with Huntington disease, and care partners of persons with hematopoietic cell transplantation). Participants will be randomized to either a control group, where they will wear the Fitbit and provide daily reports of HRQOL over a 3-month (ie, 90 days) period (without personalized feedback), or the just-in-time adaptive intervention group, where they will wear the Fitbit, provide daily reports of HRQOL, and receive personalized push notifications for 3 months. At the end of the study, participants will complete a feasibility and acceptability questionnaire, and metrics regarding adherence and attrition will be calculated.
Results This trial opened for recruitment in November 2020. Data collection was completed in June 2021, and the primary results are expected to be published in 2022.
Conclusions This trial will determine the feasibility and acceptability of an intensive app-based intervention in 3 distinct care partner groups: care partners for persons with a chronic condition that was caused by a traumatic event (ie, spinal cord injury); care partners for persons with a progressive, fatal neurodegenerative disease (ie, Huntington disease); and care partners for persons with episodic cancer conditions that require intense, prolonged inpatient and outpatient treatment (persons with hematopoietic cell transplantation).
Trial Registration ClinicalTrials.gov NCT04556591; https://clinicaltrials.gov/ct2/show/NCT04556591
International Registered Report Identifier (IRRID) DERR1-10.2196/32842
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Affiliation(s)
- Noelle E Carlozzi
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, United States
| | - Sung Won Choi
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, United States
| | - Zhenke Wu
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Jennifer A Miner
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, United States
| | - Angela K Lyden
- Clinical Trials Support Office, University of Michigan, Ann Arbor, MI, United States
| | - Christopher Graves
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, United States
| | - Jitao Wang
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Srijan Sen
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
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16
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Wallis CJD, Joyce DD, Klaassen Z, Luckenbaugh AN, Laviana AA, Penson D, Dusetzina SB, Barocas DA. Out-of-pocket costs for commercially insured patients with localized prostate cancer. Urol Oncol 2021; 39:797-805. [PMID: 34600803 DOI: 10.1016/j.urolonc.2021.08.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 08/09/2021] [Accepted: 08/30/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE Financial toxicity is an underappreciated component of cancer survivorship. Treatment-specific out-of-pocket costs for patients undergoing localized prostate cancer treatment have not, to date, been described and may influence patient's decision making. METHODS We performed a retrospective cohort study among commercially-insured patients in the United States with incident prostate cancer from 2013 to 2018. We captured out-of-pocket and total costs in the year following diagnosis and compared these between patients receiving radical prostatectomy, radiotherapy, and no local treatment using propensity-score weighting adjusting for patient demographics and pre-diagnosis health utilization costs. RESULTS Among 30,360 included men [median age 59 years, 83% Charlson score 0], 15,854 underwent surgery, 5,265 radiotherapy, and 9,241 no local therapy in the year following diagnosis. In the 6-months preceding diagnosis, median overall and out-of-pocket health care costs were $2022 (interquartile range $3778) and $466 (interquartile range $781), respectively. Following propensity-score weighting, out-of-pocket costs were significantly lower for patients who received no active treatment (adjusted cost $1746, 95% confidence interval [CI] $1704-1788), followed by those who underwent surgery ($2983, 95% CI $2832-3142, P < 0.001), and those who underwent radiation ($3139, 95% CI $2939-3353, P < 0.001) in the 6-months following diagnosis. Similar patterns were seen with out-of-pocket costs 6 to 12 months following index, with overall costs, and with costs attributable to inpatient, outpatient medical, and outpatient pharmacy services. CONCLUSIONS Among commercially insured men with incident prostate cancer, active treatment with surgery or radiotherapy was associated with significantly higher out-of-pocket costs versus those who received no treatment, with little difference observed between treatment approaches.
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Affiliation(s)
| | - Daniel D Joyce
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
| | - Zachary Klaassen
- Department of Surgery, Section of Urology, Medical College of Georgia - Augusta University, Augusta, GA
| | - Amy N Luckenbaugh
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
| | - Aaron A Laviana
- Department of Surgery and Perioperative Care, Dell Medical School, Austin, TX
| | - David Penson
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
| | - Stacie B Dusetzina
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN
| | - Daniel A Barocas
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
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Thompson T, Ketcher D, Gray TF, Kent EE. The Dyadic Cancer Outcomes Framework: A general framework of the effects of cancer on patients and informal caregivers. Soc Sci Med 2021; 287:114357. [PMID: 34500320 DOI: 10.1016/j.socscimed.2021.114357] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 08/24/2021] [Accepted: 08/28/2021] [Indexed: 01/22/2023]
Abstract
It is widely acknowledged that cancer affects not only patients but also their friends and family members who provide informal, and typically unpaid, care. Given the dual impact that cancer often has on patients and their informal caregivers (i.e., family members, partners, or friends), an expanded dyadic framework that encompasses a range of health and psychosocial outcomes and includes primary caregivers with a range of relationships to the patients is critically needed. Moreover, an emphasis on the role of social and contextual factors may help the framework resonate with a broader range of patient-caregiver relationships and allow for the development of more effective dyadic interventions. This article describes the development of the Dyadic Cancer Outcomes Framework, which was created to guide future research and intervention development. Using an iterative process, we conducted a conceptual review of currently used dyadic and/or caregiving models and frameworks and developed our own novel dyadic framework. Our novel Dyadic Cancer Outcomes Framework highlights individual- and dyad-level predictors and outcomes, as well as incorporating the disease trajectory and the social context. This framework can be used in conjunction with statistical approaches including the Actor Partner Interdependence Model to evaluate outcomes for different kinds of partner-caregiver dyads. This flexible framework can be used to guide intervention development and evaluation for cancer patients and their primary caregivers, with the ultimate goal of improving health, psychosocial, and relationship outcomes for both patients and caregivers. Future research will provide valuable information about the framework's effectiveness for this purpose.
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Affiliation(s)
- Tess Thompson
- Washington University in St. Louis, Brown School of Social Work, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA.
| | - Dana Ketcher
- Moffitt Cancer Center, Department of Health Outcomes and Behavior, Tampa, FL, USA
| | - Tamryn F Gray
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Institute, Boston, MA, USA; Phyllis F. Cantor Center for Research in Nursing & Patient Care Services, Dana-Farber Cancer Institute, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Erin E Kent
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, USA; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, USA
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18
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Mathew A, Doorenbos AZ, Vincent C. Symptom Management Theory: Analysis, Evaluation, and Implications for Caring for Adults With Cancer. ANS Adv Nurs Sci 2021; 44:E93-E112. [PMID: 33394585 PMCID: PMC10960233 DOI: 10.1097/ans.0000000000000347] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A detailed analysis of Symptom Management Theory (SMT) along with its extent of use and implications for adults with cancer as demonstrated in 20 oncology research studies is reported. SMT provides useful guidance for adult oncology research and nursing practice. Theory dimension most researched in cancer was symptom experience. Although theory assertions were demonstrated in 80% of the studies, it was used to an adequate extent only in 35% of them. Comparisons between cancer-related clinical outcomes with and without use of SMT, certain theory modifications, and future SMT-based studies involving longitudinal designs in this population are warranted.
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Affiliation(s)
- Asha Mathew
- College of Nursing, University of Illinois, Chicago (Ms Mathew and Drs Doorenbos and Vincent); College of Nursing, Christian Medical College, Vellore, Tamil Nadu, India (Ms Mathew); and University of Illinois Cancer Center, Chicago (Dr Doorenbos)
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19
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Shani P, Raeesi K, Walter E, Lewis K, Wang W, Cohen L, Yeh GY, Lengacher CA, Wayne PM. Qigong mind-body program for caregivers of cancer patients: design of a pilot three-arm randomized clinical trial. Pilot Feasibility Stud 2021; 7:73. [PMID: 33741070 PMCID: PMC7976717 DOI: 10.1186/s40814-021-00793-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 02/08/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Informal caregivers, often family and friends, experience significant psychological and physical distress leading to reductions in health and quality of life (QOL). Mind-body interventions focused on caregivers are often limited and do not address multiple barriers, including caregivers' economic, geographic, and time constraints. Translation of in-person, community-based interventions to Internet-based delivery may offer greater accessibility for caregivers, leading to increased adherence. METHODS Caring for Caregivers with Mind-Body implements a three-arm, pilot, randomized controlled trial to evaluate the feasibility of delivering a Qigong intervention (Eight Brocades) to cancer caregivers. A total of 54 cancer caregivers will be randomized into one of three 12-week programs: (1) community-based Qigong, (2) Internet-based Qigong, or (3) a self-care control group. Study-specific aims include (1) modify intervention content for online delivery, (2) evaluate the feasibility of recruiting and retaining cancer caregivers into a 12-week clinical trial, and (3) evaluate the feasibility of collecting and managing data, and the suitability of questionnaires for this population. Several outcomes will be assessed, including caregiver QOL, caregiver burden, caregiver distress, perceived social support, physical function, and cognitive function. A 6-month follow-up will also assess longer-term changes in QOL and psychosocial well-being. DISCUSSION Findings will be used to inform the design and conduct of a large-scale comparative effectiveness trial evaluating caregivers who received Qigong training delivered through community-based vs Internet-based programs. A finding that either or both programs are effective would inform care and options for caregivers. TRIAL REGISTRATION NCT04019301 ; registered on July 15, 2019; clinicaltrials.gov.
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Affiliation(s)
- Pinky Shani
- University of Houston, College of Nursing, Houston, TX, USA.
| | - Kristin Raeesi
- Texas Woman's University, College of Nursing, Houston, TX, USA
| | - Eli Walter
- University of Houston, College of Nursing, Houston, TX, USA
| | - Kai Lewis
- Houston Martial Arts Academy, Houston, TX, USA
| | - Wanyi Wang
- Texas Woman's University, College of Nursing, Houston, TX, USA
| | - Lorenzo Cohen
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Gloria Y Yeh
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Osher Center for Integrative Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA, USA
| | | | - Peter M Wayne
- Osher Center for Integrative Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA, USA
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20
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El-Jawahri A, Greer JA, Park ER, Jackson VA, Kamdar M, Rinaldi SP, Gallagher ER, Jagielo AD, Topping CEW, Elyze M, Jones B, Temel JS. Psychological Distress in Bereaved Caregivers of Patients With Advanced Cancer. J Pain Symptom Manage 2021; 61:488-494. [PMID: 32882355 PMCID: PMC7914132 DOI: 10.1016/j.jpainsymman.2020.08.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 08/23/2020] [Accepted: 08/25/2020] [Indexed: 12/23/2022]
Abstract
CONTEXT Individuals caring for patients with advanced cancer (caregivers) experience psychological distress during the patient's illness course. However, data on the prevalence of bereaved caregivers' psychological distress and its relationship with the quality of patient's end of life (EOL) care are limited. OBJECTIVES To describe rates of depression and anxiety symptoms in bereaved caregivers of patients with advanced cancer and to understand the relationship between these outcomes and patient distress at the EOL. METHODS We conducted a secondary analysis of 168 caregivers enrolled in a supportive care trial for patients with incurable lung and gastrointestinal cancers and their caregivers. We used the Hospital Anxiety and Depression Scale to assess caregivers' depression and anxiety symptoms at three months after the patient's death. Caregivers also rated the patient's physical and psychological distress in the last week of life on a 10-point scale three months after the patient death. We used linear regression adjusting for caregiver age, sex, randomization, and cancer type to explore the relationship between bereaved caregivers' depression and anxiety symptoms and their ratings of physical and psychological distress in patients at the EOL. RESULTS Of the 168 bereaved caregivers, 30.4% (n = 51) and 43.4% (n = 73) reported clinically significant depression and anxiety symptoms, respectively. Caregiver ratings of worse physical (B = 0.32; P = 0.009) and psychological (B = 0.50; P < 0.001) distress experienced by the patient at the EOL were associated with worse depression symptoms in bereaved caregivers. Only caregiver rating of worse psychological distress experienced by the patient at the EOL (B = 0.42; P < 0.001) was associated with worse bereaved caregivers' anxiety symptoms. CONCLUSION Many bereaved caregivers of patients with advanced cancer experience symptoms of depression and anxiety, which are associated with their perceptions of distress in their loved ones at the EOL.
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Affiliation(s)
- Areej El-Jawahri
- Division of Hematology & Oncology, Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA.
| | - Joseph A Greer
- Division of Hematology & Oncology, Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - Elyse R Park
- Division of Hematology & Oncology, Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - Vicki A Jackson
- Harvard Medical School, Boston, Massachusetts, USA; Division of Palliative Care, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Mihir Kamdar
- Harvard Medical School, Boston, Massachusetts, USA; Division of Palliative Care, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Simone P Rinaldi
- Division of Palliative Care, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Emily R Gallagher
- Division of Hematology & Oncology, Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Annemarie D Jagielo
- Division of Hematology & Oncology, Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Carlisle E W Topping
- Division of Hematology & Oncology, Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Madeleine Elyze
- Division of Hematology & Oncology, Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Bailey Jones
- Division of Hematology & Oncology, Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Jennifer S Temel
- Division of Hematology & Oncology, Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
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21
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Singer J, Shrout MR, Papa A. Rates and prospective psychosocial correlates of pre-loss grief in cancer and dementia family members. J Health Psychol 2021; 27:1547-1555. [DOI: 10.1177/1359105321995945] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This study examined changes in Pre-Loss Grief (PLG) among individuals whose family member has a life limiting illness and how baseline psychosocial factors predicted PLG. This two-wave study recruited family members of advanced cancer ( N = 100) and dementia ( N = 38) patients. A subsample completed 1-month follow-up (Cancer = 33; Dementia = 28). Higher caregiver burden and female participants predicted greater PLG at follow-up, accounting for baseline PLG. Family members of dementia patients (10.5%) were significantly more likely than family members of cancer patients (2.1%) to be in the “severe PLG” group. Findings demonstrate psychosocial factors related to PLG, informing interventions aimed at reducing PLG.
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22
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Rozwadowski M, Dittakavi M, Mazzoli A, Hassett AL, Braun T, Barton DL, Carlozzi N, Sen S, Tewari M, Hanauer DA, Choi SW. Promoting Health and Well-Being Through Mobile Health Technology (Roadmap 2.0) in Family Caregivers and Patients Undergoing Hematopoietic Stem Cell Transplantation: Protocol for the Development of a Mobile Randomized Controlled Trial. JMIR Res Protoc 2020; 9:e19288. [PMID: 32945777 PMCID: PMC7532463 DOI: 10.2196/19288] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/26/2020] [Accepted: 07/14/2020] [Indexed: 12/18/2022] Open
Abstract
Background Cancer patients who undergo allogeneic hematopoietic stem cell transplantation are among the most medically fragile patient populations with extreme demands for caregivers. Indeed, with earlier hospital discharges, the demands placed on caregivers continue to intensify. Moreover, an increased number of allogeneic hematopoietic stem cell transplantations are being performed worldwide, and this expensive procedure has significant economic consequences. Thus, the health and well-being of family caregivers have attracted widespread attention. Mobile health technology has been shown to deliver flexible, and time- and cost-sparing interventions to support family caregivers across the care trajectory. Objective This protocol aims to leverage technology to deliver a novel caregiver-facing mobile health intervention named Roadmap 2.0. We will evaluate the effectiveness of Roadmap 2.0 in family caregivers of patients undergoing hematopoietic stem cell transplantation. Methods The Roadmap 2.0 intervention will consist of a mobile randomized trial comparing a positive psychology intervention arm with a control arm in family caregiver-patient dyads. The primary outcome will be caregiver health-related quality of life, as assessed by the PROMIS Global Health scale at day 120 post-transplant. Secondary outcomes will include other PROMIS caregiver- and patient-reported outcomes, including companionship, self-efficacy for managing symptoms, self-efficacy for managing daily activities, positive affect and well-being, sleep disturbance, depression, and anxiety. Semistructured qualitative interviews will be conducted among participants at the completion of the study. We will also measure objective physiological markers (eg, sleep, activity, heart rate) through wearable wrist sensors and health care utilization data through electronic health records. Results We plan to enroll 166 family caregiver-patient dyads for the full data analysis. The study has received Institutional Review Board approval as well as Code Review and Information Assurance approval from our health information technology services. Owing to the COVID-19 pandemic, the study has been briefly put on hold. However, recruitment began in August 2020. We have converted all recruitment, enrollment, and onboarding processes to be conducted remotely through video telehealth. Consent will be obtained electronically through the Roadmap 2.0 app. Conclusions This mobile randomized trial will determine if positive psychology-based activities delivered through mobile health technology can improve caregiver health-related quality of life over a 16-week study period. This study will provide additional data on the effects of wearable wrist sensors on caregiver and patient self-report outcomes. Trial Registration ClinicalTrials.gov NCT04094844; https://www.clinicaltrials.gov/ct2/show/NCT04094844 International Registered Report Identifier (IRRID) PRR1-10.2196/19288
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Affiliation(s)
- Michelle Rozwadowski
- Department of Pediatrics, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Manasa Dittakavi
- Department of Pediatrics, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Amanda Mazzoli
- Department of Pediatrics, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Afton L Hassett
- Department of Anesthesia, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Thomas Braun
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Debra L Barton
- School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | - Noelle Carlozzi
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Srijan Sen
- Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Muneesh Tewari
- Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - David A Hanauer
- Department of Pediatrics, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Sung Won Choi
- Department of Pediatrics, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
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23
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Bloom RD, Reblin M, Chou WYS, Beck SL, Wilson A, Ellington L. Online social support for cancer caregivers: alignment between requests and offers on CaringBridge. J Psychosoc Oncol 2020; 39:118-134. [PMID: 32835649 DOI: 10.1080/07347332.2020.1806174] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Exploring CaringBridge, we describe types of social support caregivers requested, types of social support offered, and the alignment between the two. RESEARCH APPROACH A retrospective, longitudinal, descriptive approach. SAMPLE Twenty public CaringBridge sites. METHODOLOGICAL APPROACH The Social Support Behavior Code system was adapted and applied to cancer-caregiver journal entries (n = 389) and guestbook posts (n = 2,466) to identify types of support (emotional, esteem, informational, network, tangible, and no support requested/offered). Matches between requests and offers were examined. FINDINGS Cancer caregivers requested different types of support from their guests, most commonly emotional support. However, in most posts, caregivers did not request any support (n = 238, 61.18%). Guests offered all support types, but predominately offered emotional support (n = 2,353, 95%). When support was requested, 66.67% of requests received a matched offer within 24 hours. INTERPRETATION Social media platforms may provide all types of support to caregivers.
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Affiliation(s)
- Rosaleen Duggan Bloom
- St David's School of Nursing, Texas State University, Round Rock, Texas, USA.,College of Nursing, The University of Utah, Salt Lake City, Utah, USA
| | - Maija Reblin
- H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Wen-Ying Sylvia Chou
- Health Communication and Informatics Research Branch, National Cancer Institute, Rockville, Maryland, USA
| | - Susan L Beck
- College of Nursing, The University of Utah, Salt Lake City, Utah, USA
| | - Andrew Wilson
- College of Nursing, The University of Utah, Salt Lake City, Utah, USA
| | - Lee Ellington
- College of Nursing, The University of Utah, Salt Lake City, Utah, USA
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Junkins CC, Kent E, Litzelman K, Bevans M, Cannady RS, Rosenberg AR. Cancer across the ages: a narrative review of caregiver burden for patients of all ages. J Psychosoc Oncol 2020; 38:782-798. [DOI: 10.1080/07347332.2020.1796887] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Courtney C. Junkins
- Center for Clinical and Translational Research, Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Erin Kent
- Gillings School of Global Public Health, Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kristin Litzelman
- Department of Human Development and Family Studies, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Margaret Bevans
- Office of Research on Women’s Heath, National Institutes of Health, Bethesda, Maryland, USA
| | - Rachel S. Cannady
- Cancer Control Department, American Cancer Society, Atlanta, Georgia, USA
| | - Abby R. Rosenberg
- Center for Clinical and Translational Research, Seattle Children’s Research Institute, Seattle, Washington, USA
- Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Research Institute, Seattle, Washington, USA
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
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25
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Kang E, Keam B, Lee NR, Kang JH, Kim YJ, Shim HJ, Jung KH, Koh SJ, Ryu H, Lee J, Choo J, Yoo SH, Yun YH. Impact of family caregivers' awareness of the prognosis on their quality of life/depression and those of patients with advanced cancer: a prospective cohort study. Support Care Cancer 2020; 29:397-407. [PMID: 32372177 DOI: 10.1007/s00520-020-05489-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 04/20/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE A caregiver's prognostic awareness can affect clinical decisions for the patient. The purpose of this study was to examine the impact of family caregivers' prognostic awareness on the quality of life (QOL) and emotional state of both patients with advanced cancer and their caregivers. METHODS This prospective cohort study was conducted from December of 2016 to January of 2018. A total of 159 patients with advanced cancer and an equal number of caregivers participated. The investigation tools used include the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C15-Palliative, the McGill Quality of Life Questionnaire, and the Patient Health Questionnaire-9, and evaluation was performed at baseline, 3 months, and 6 months. Covariance analysis with a general linear modeling was used to compare changes in quality of life scores according to the caregivers' awareness of the prognosis. RESULTS Mean patient overall QOL score increased in the group of caregivers who were aware of prognosis and decreased in the caregivers who were not aware of the prognosis (p = 0.018). The changes over time in the patients' QOL scores associated with symptoms improved with caregiver awareness (pain, p = 0.017; dyspnea, p = 0.048; appetite loss, p = 0.045). The percentage of depressed patients was smaller after 3 months in the group with caregivers aware of the prognosis (baseline to 3 months p = 0.028). Caregivers who did not understand their patients' prognosis exhibited better existential well-being (p = 0.036), and the incidence of depression was lower in this group at 3 months (p = 0.024). CONCLUSION Caregivers' prognostic awareness may improve the quality of life and mood in patients with advanced cancer; however, this awareness may harm the quality of life and mood of the caregivers. These results may aid in developing in-depth interventions regarding prognosis for both patients and their caregivers.
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Affiliation(s)
- EunKyo Kang
- Department of Family Medicine, Seoul National University Hospital, Seoul, South Korea.,Institute for Public Health and Medical Service, Seoul National University Hospital, Seoul, South Korea
| | - Bhumsuk Keam
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Na-Ri Lee
- Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, South Korea
| | - Jung Hun Kang
- Department of Internal Medicine, Gyeongsang University Hospital, Jinju, South Korea
| | - Yu Jung Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Hyun-Jeong Shim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - Kyung Hae Jung
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Su-Jin Koh
- Department of Hematology and Oncology, Ulsan University Hospital, Ulsan University College of Medicine, Ulsan, South Korea
| | - Hyewon Ryu
- Internal Medicine, Chungnam National University College of Medicine, Chungnam, South Korea
| | - Jihye Lee
- Department of Medical Informatics, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, South Korea
| | - Jiyeon Choo
- Department of Medical Informatics, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, South Korea
| | - Shin Hye Yoo
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Young Ho Yun
- Department of Family Medicine, Seoul National University Hospital, Seoul, South Korea. .,Department of Medical Informatics, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, South Korea.
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26
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Vieira AC, Cunha MLDR. My role and responsibility: mothers' perspectives on overload in caring for children with cancer. Rev Esc Enferm USP 2020; 54:e03540. [PMID: 32187307 DOI: 10.1590/s1980-220x2018034603540] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 04/11/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To understand the experience of maternal overload in caring for children with cancer from the mother's perspective. METHOD Symbolic Interactionism was adopted as a theoretical framework and the Grounded Theory as methodological framework. The study was conducted in a public hospital, which is reference in pediatric oncology. Data was collected from six mothers through semi-structured interviews in the second semester of 2017. RESULTS Mothers of children with cancer attributed meaning to the care experience when trying to cope with the emotional, social, physical, financial, family-related, information and moral overload. Maternal overload arises as a dynamic inter-relation process between the many types of overload. CONCLUSION The maternal figure is the main person involved in care and experiences overload in caring for their sick child, facing limitations and responsibilities. The research acted as a key element to broaden the analysis and intervention of the family nurse, not only contributing to the theoretical construct related to maternal overload, but also and mainly to the scope of practice in patient care.
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Affiliation(s)
- Aretuza Cruz Vieira
- Programa de Mestrado Profissional em Enfermagem, Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, SP, Brazil
| | - Mariana Lucas Da Rocha Cunha
- Programa de Mestrado Profissional em Enfermagem, Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, SP, Brazil
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27
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Kocaçal E, Karadağ E. Nursing diagnoses and NIC interventions in adult males undergoing radical prostatectomy. Rev Esc Enferm USP 2020; 54:e03541. [PMID: 32187316 DOI: 10.1590/s1980-220x2018038003541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 04/23/2019] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To determine NANDA-I nursing diagnoses and NIC nursing interventions in patients who underwent radical prostatectomy. METHOD A cross-sectional and descriptive study was conducted in a research and teaching hospital in western Turkey between June 2016 and June 2017. The sample included adult patients diagnosed with prostate cancer in the immediate postoperative period of radical prostatectomy. Data collection was performed using Gordon's Functional Health Patterns, NANDA-International and Nursing Interventions Classification Taxonomy Systems. RESULTS Participants were 54 adult patients. The main nursing diagnoses were in the classes of "physical injury", "self-care", "hydration" and "physical comfort". Some nursing diagnoses were identified in all patients, namely: "risk for deficient fluid volume", "risk for imbalanced fluid volume", "impaired urinary elimination". The most selected NIC interventions were in the classes of "risk management", "elimination management", "coping assistance", "tissue perfusion management" and "self-care facilitation". CONCLUSION future studies with larger populations are needed to explore the nursing diagnoses and effects of nursing interventions on patients who underwent radical prostatectomy.
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Affiliation(s)
- Elem Kocaçal
- İzmir Demokrasi University, Faculty of Health Sciences, Department of Fundamentals of Nursing, İzmir, Turkey
| | - Ezgi Karadağ
- Dokuz Eylül University Faculty of Nursing, Department of Oncology Nursing, İzmir, Turkey
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28
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Gouin JP, Wrosch C, McGrath J, Booij L. Interpersonal capitalization moderates the associations of chronic caregiving stress and depression with inflammation. Psychoneuroendocrinology 2020; 112:104509. [PMID: 31744782 DOI: 10.1016/j.psyneuen.2019.104509] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 09/17/2019] [Accepted: 11/06/2019] [Indexed: 01/16/2023]
Abstract
Chronic stress and depression can enhance chronic low-grade inflammation. Interpersonal factors may buffer the impact of stress and depression on inflammation. Interpersonal capitalization is a social support process in which one discloses positive personal events and experiences to close others. Greater capitalization may attenuate the deleterious impact of chronic stress and depression. The goal of the current study was to assess whether interpersonal capitalization is associated with inflammation and whether it moderates the association of chronic stress and depression with inflammation. In this cross-sectional study of chronic caregiving stress, 222 caregiving mothers of adolescents with developmental disabilities or comparison mothers of typically developing adolescents completed a self-reported daily diary assessment of capitalization, the Center for Epidemiological Study-Depression scale, and provided blood samples to assess interleukin-6, tumor necrosis factor-α, and C-reactive protein, three circulating inflammatory markers. Regression analysis indicated that there was no main effect of capitalization on inflammation, p = .24, R2 = .006. However, there was a significant three-way interaction among capitalization, chronic caregiving stress, and depressive symptoms, p = .01, R2 = .02. Among participants with lower capitalization, greater depressive symptoms were associated with higher inflammation in the caregiving group, but not in the comparison group. Among participants with higher capitalization, greater depressive symptoms were no longer significantly associated with higher inflammation among caregivers, but were marginally related to inflammation in the comparison group. Capitalization may thus be an interpersonal process mitigating the effects of chronic stress and depression on inflammation.
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Affiliation(s)
- J P Gouin
- Department of Psychology, Concordia University, Montreal, Canada.
| | - C Wrosch
- Department of Psychology, Concordia University, Montreal, Canada
| | - J McGrath
- Department of Psychology, Concordia University, Montreal, Canada
| | - L Booij
- Department of Psychology, Concordia University, Montreal, Canada
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29
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Mittendorfer-Rutz E, Rahman S, Tanskanen A, Majak M, Mehtälä J, Hoti F, Jedenius E, Enkusson D, Leval A, Sermon J, Taipale H, Tiihonen J. Burden for Parents of Patients With Schizophrenia-A Nationwide Comparative Study of Parents of Offspring With Rheumatoid Arthritis, Multiple Sclerosis, Epilepsy, and Healthy Controls. Schizophr Bull 2019; 45:794-803. [PMID: 30184197 PMCID: PMC6581137 DOI: 10.1093/schbul/sby130] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND The study aimed to (1) compare the risk of health care use, adverse health status, and work productivity loss of parents of patients with schizophrenia to parents of patients with multiple sclerosis (MS), rheumatoid arthritis (RA), epilepsy, and healthy controls; and (2) evaluate such outcome measures while considering disease severity of schizophrenia. METHODS Based on linkage of Swedish registers, at least one parent was included (n = 18215) of patients with schizophrenia (information 2006-2013, n = 10883). Similarly, parental information was linked to patients with MS, RA, epilepsy, and matched healthy controls, comprising 11292, 15516, 34715, and 18408 parents, respectively. Disease severity of schizophrenia was analyzed. Different regression models yielding odds ratios (OR), hazard ratios (HR), or relative risks (RR) with 95% confidence intervals (CI) were run. RESULTS Psychiatric health care use, mainly due to anxiety and affective disorders, showed a strongly increasing trend for parents of patients with schizophrenia throughout the observation period. During the follow-up, these parents had an up to 2.7 times higher risk of specialized psychiatric health care and receipt of social welfare benefits than other parents. Parents of the moderately severely ill patients with schizophrenia had higher risk estimates for psychiatric health care (RR: 1.12; 95% CI: 1.07-1.17) compared with parents of least severely ill patients. CONCLUSIONS Parents of patients with schizophrenia have a considerably higher risk of psychiatric health care and social welfare benefit receipt than other parents. Psychiatric health care use worsens over time and with increasing disease severity of the offspring.
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Affiliation(s)
- Ellenor Mittendorfer-Rutz
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden,To whom correspondence should be addressed; tel: +46-8-524-820-25, fax: +46-8-524-832-05, e-mail:
| | - Syed Rahman
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Antti Tanskanen
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden,Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland,The Impact Assessment Unit, National Institute for Health and Welfare, Helsinki, Finland
| | | | | | | | | | | | - Amy Leval
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | | | - Heidi Taipale
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden,School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Jari Tiihonen
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden,Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland
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30
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Kepic M, Randolph A, Hermann‐Turner KM. Care for Caregivers: Understanding the Need for Caregiver Support. ADULTSPAN JOURNAL 2019. [DOI: 10.1002/adsp.12068] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Marcela Kepic
- Department of Counseling and Human DevelopmentGeorge Washington University
| | - Amber Randolph
- Department of Clinical Mental Health CounselingJudson University
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31
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Shaffer KM, Nightingale CL. Comparison of Healthcare Utilization Between Informal Caregivers and Non-Caregivers: An Analysis of the Health Information National Trends Survey. J Aging Health 2019; 32:453-461. [PMID: 30793639 DOI: 10.1177/0898264319830262] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: The demands of providing unpaid care for someone with a disabling health condition (i.e., informal caregiving) can limit attention to one's own health needs. Using a nationally representative survey, this study examines whether caregivers report different healthcare utilization relative to non-caregivers. Method: Participants in the Health Information National Trends Survey 5, Cycle 1 reported whether they provided unpaid care and healthcare utilization outcomes. Logistic regressions and chi-square tests with jackknife variance estimation were used. Results: Caregivers (N = 391) did not differ from non-caregivers (N = 2,894) in time since routine checkup or number of healthcare appointments in the past year (p values > .25). Among caregivers, number of healthcare appointments differed according to caregivers' relationship to the care recipient (p = .04). Discussion: Findings suggest that informal caregivers access routine healthcare at a frequency similar to non-caregivers. Further research should determine whether this utilization is optimal, or whether increased utilization during caregiving might help attenuate caregivers' longer term morbidity.
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Affiliation(s)
- Kelly M Shaffer
- University of Virginia School of Medicine, Charlottesville, USA.,Memorial Sloan Kettering Cancer Center, New York, NY, USA
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32
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Liu H, Lou VWQ. Transitioning into spousal caregiving: contribution of caregiving intensity and caregivers' multiple chronic conditions to functional health. Age Ageing 2019; 48:108-114. [PMID: 29982336 DOI: 10.1093/ageing/afy098] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 06/14/2018] [Indexed: 11/12/2022] Open
Abstract
Background both caregiving intensity and caregivers' multiple chronic conditions (MCCs) are important aspects of caregiving that might affect the health and well-being of older spousal caregivers, but few investigations have simultaneously modelled their impact during the transition into spousal caregiving. Objective to examine the differential effects of caregiving intensity and caregivers' MCCs on functional health over time among individuals entering the spousal caregiver role. Methods a total of 1,866 non-caregivers at the baseline were followed over a 4-year period (2011-2015). The effects of transitioning into caregiving (transitioned into low-intensity and transitioned into high-intensity versus never-caregiver) and caregivers' MCCs (reported before and during the transitioning period versus no MCCs) on functional health at the follow-up were estimated using mixed-effects regression models. Results transitioning into spousal caregiving was associated with a decline in functional health, particularly for those transitioned into high-intensity caregiving, and for those who reported MCCs when transitioning into the caregiver role. The association between transitioning into spousal caregiving and functional decline was strongest for high-intensity caregivers reporting MCCs when transitioning into caregiving, followed by low-intensity caregivers reporting MCCs when transitioning into caregiving. Conclusion the results highlight the contribution of transitioning into high-intensity caregiving and caregivers' MCCs to the functional health decline of spousal caregivers. Caregiver support interventions should target spousal caregivers who have newly entered a demanding caregiving role; clinical attention should be emphasised for the development of caregivers' own MCCs coinciding with the transitioning period.
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Affiliation(s)
- Huiying Liu
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, China
| | - Vivian W Q Lou
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, China
- Department of Social Work and Social Administration, Sau Po Center on Ageing, University of Hong Kong, Hong Kong, China
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33
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Shaffer KM, Chow PI, Cohn WF, Ingersoll KS, Ritterband LM. Informal Caregivers' Use of Internet-Based Health Resources: An Analysis of the Health Information National Trends Survey. JMIR Aging 2018; 1:e11051. [PMID: 31518244 PMCID: PMC6715019 DOI: 10.2196/11051] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 10/29/2018] [Accepted: 10/30/2018] [Indexed: 01/05/2023] Open
Abstract
Background Informal caregivers express strong interest in technology innovations to help them in their caregiving role; however, divides across sociodemographic characteristics in internet and technology access may preclude the most vulnerable caregivers from accessing such resources. Objective This study aims to examine caregivers’ internet use, both generally and for seeking health-related information, and whether usage differs as a function of caregivers’ characteristics. Methods Data were analyzed from the Health Information National Trends Survey 5 Cycle 1. Participants were included in analyses if they self-identified as providing uncompensated care to a close individual. Caregivers reported internet use factors, age, education, rurality, general health, distress, and objective caregiving burden. We used chi-square tests of independence with jackknife variance estimation to compare whether internet use factors differed by caregivers’ characteristics. Results A total of 77.5% (303/391) caregivers surveyed reported ever using the internet. Of internet users, 88.1% (267/303) accessed from a home computer and 83.2% (252/303) from a mobile device. Most caregivers accessed health information for themselves (286/391, 73.1%) or others (264/391, 67.5%); fewer communicated with a doctor over the Web (148/391, 37.9%) or had a wellness app (171/391, 43.7%). Caregivers reporting younger age, more education, and good health were more likely to endorse any of these activities. Furthermore, two-thirds of caregivers (258/391, 66.0%) endorsed trust in health information from the internet. Conclusions Computers and mobile devices are practical platforms for disseminating caregiving-related information and supportive services to informal caregivers; these modalities may, however, have a more limited reach to caregivers who are older, have less education, and are in poorer health.
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Affiliation(s)
- Kelly M Shaffer
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, United States.,Center for Behavioral Health & Technology, Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, VA, United States
| | - Philip I Chow
- Center for Behavioral Health & Technology, Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, VA, United States
| | - Wendy F Cohn
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, United States
| | - Karen S Ingersoll
- Center for Behavioral Health & Technology, Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, VA, United States
| | - Lee M Ritterband
- Center for Behavioral Health & Technology, Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, VA, United States
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34
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Geng HM, Chuang DM, Yang F, Yang Y, Liu WM, Liu LH, Tian HM. Prevalence and determinants of depression in caregivers of cancer patients: A systematic review and meta-analysis. Medicine (Baltimore) 2018; 97:e11863. [PMID: 30278483 PMCID: PMC6181540 DOI: 10.1097/md.0000000000011863] [Citation(s) in RCA: 218] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Aim of this study was to estimate the prevalence rate of depression in cancer patient caregivers and to identify factors affecting depression and quality of life of cancer caregivers. METHODS Relevant research articles were retrieved after literature search in several electronic databases. Random effects meta-analyses were performed to obtain pooled estimates of the prevalence rates of depression and anxiety; their respective scores, and quality of life scores. Significant relationships between depression and factors related to depression and quality of life reported in individual studies were identified. RESULTS Thirty studies were included. Overall, 21,149 caregivers were appraised in these studies (age 52.65 years [95% CI: 49.65, 55.65]; 31.14% [28.40, 33.89] men). The prevalence of depression and anxiety were 42.30% [33.31, 51.29] % and 46.55% [35.59, 57.52], respectively. Quality of life score, as measured with Caregiver Quality of Life-Cancer scale was 64.55 [47.44, 81.66]. Patient's condition, caregiving burden, duration of caregiving, spouse caregiver, caregiver being unemployed, caregiver with chronic disease, caregiver's sleep quality, caregiver's avoidance, financial problems, and female sex were positively associated with depression whereas overall quality of life of caregiver, pre-loss grief, caregiver's education level, caregiver's age, caregiver's sense of coherence, and caregiver's bondage with patient were negatively associated with depression in caregivers. CONCLUSION A considerably high prevalence of depression is found in cancer patient caregivers. Several factors may affect depression and their quality of life of cancer patient caregivers.
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Affiliation(s)
| | | | | | | | | | - Li-hui Liu
- Department of Nursing, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Hong-mei Tian
- Department of Nursing, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
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