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Rapelli G, Giusti EM, Tarquinio C, Varallo G, Franceschini C, Musetti A, Gorini A, Castelnuovo G, Pietrabissa G. Psychological couple-oriented interventions for patients with heart disease and their partners: a scoping review and guidelines for future interventions. Front Psychol 2023; 14:1194767. [PMID: 37842689 PMCID: PMC10570454 DOI: 10.3389/fpsyg.2023.1194767] [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: 03/27/2023] [Accepted: 08/21/2023] [Indexed: 10/17/2023] Open
Abstract
Objective This scoping review aims to provide an accessible summary of available evidence on the efficacy of psychological couple-based interventions among patients with heart disease and their partners focusing on specific aspects and strategies by assessing different emotional and physical cardiac-related outcome measures. Methods A literature search was performed in PubMed, Scopus, Medline, PsycINFO, and Web of Science databases using the keywords "heart diseases" and "couple-based intervention." A literature search using systematic methods was applied. Data were extracted to address the review aims and were presented as a narrative synthesis. Results The database search produced 11 studies. Psychological couple-based interventions varied in terms of the type of intervention, personnel, format (group or individual, phone or in person), number of sessions, and duration. Most of the contributions also lacked adequate details on the training of professionals, the contents of the interventions, and the theoretical models on which they were based. Finally, although partners were involved in all the treatment, in most studies, the psychological strategies and outcomes were focused on the patient. Conclusion The variability of the psychological couple-based interventions of included studies represents a challenge in summarizing the existing literature. Regarding their impact, psychological interventions for patients with cardiovascular disease and their partners were found to moderately improve patients' and partners' outcomes.
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Affiliation(s)
- Giada Rapelli
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Emanuele Maria Giusti
- EPIMED Research Center, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Claudia Tarquinio
- Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
| | - Giorgia Varallo
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Alessandro Musetti
- Department of Humanities, Social Sciences and Cultural, University of Parma, Parma, Italy
| | - Alessandra Gorini
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Istituti Clinici Scientifici Maugeri IRCCS, Milan, Italy
| | - Gianluca Castelnuovo
- Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
- Istituto Auxologico Italiano IRCCS, Psychology Research Laboratory, Milan, Italy
| | - Giada Pietrabissa
- Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
- Istituto Auxologico Italiano IRCCS, Psychology Research Laboratory, Milan, Italy
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Purcell C, Dibben G, Hilton Boon M, Matthews L, Palmer VJ, Thomson M, Smillie S, Simpson SA, Taylor RS. Social network interventions to support cardiac rehabilitation and secondary prevention in the management of people with heart disease. Cochrane Database Syst Rev 2023; 6:CD013820. [PMID: 37378598 PMCID: PMC10305790 DOI: 10.1002/14651858.cd013820.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
BACKGROUND Globally, cardiovascular diseases (CVD, that is, coronary heart (CHD) and circulatory diseases combined) contribute to 31% of all deaths, more than any other cause. In line with guidance in the UK and globally, cardiac rehabilitation programmes are widely offered to people with heart disease, and include psychosocial, educational, health behaviour change, and risk management components. Social support and social network interventions have potential to improve outcomes of these programmes, but whether and how these interventions work is poorly understood. OBJECTIVES: To assess the effectiveness of social network and social support interventions to support cardiac rehabilitation and secondary prevention in the management of people with heart disease. The comparator was usual care with no element of social support (i.e. secondary prevention alone or with cardiac rehabilitation). SEARCH METHODS: We undertook a systematic search of the following databases on 9 August 2022: CENTRAL, MEDLINE, Embase, and the Web of Science. We also searched ClinicalTrials.gov and the WHO ICTRP. We reviewed the reference lists of relevant systematic reviews and included primary studies, and we contacted experts to identify additional studies. SELECTION CRITERIA: We included randomised controlled trials (RCTs) of social network or social support interventions for people with heart disease. We included studies regardless of their duration of follow-up, and included those reported as full text, published as abstract only, and unpublished data. DATA COLLECTION AND ANALYSIS Using Covidence, two review authors independently screened all identified titles. We retrieved full-text study reports and publications marked 'included', and two review authors independently screened these, and conducted data extraction. Two authors independently assessed risk of bias, and assessed the certainty of the evidence using GRADE. Primary outcomes were all-cause mortality, cardiovascular-related mortality, all-cause hospital admission, cardiovascular-related hospital admission, and health-related quality of life (HRQoL) measured at > 12 months follow-up. MAIN RESULTS: We included 54 RCTs (126 publications) reporting data for a total of 11,445 people with heart disease. The median follow-up was seven months and median sample size was 96 participants. Of included study participants, 6414 (56%) were male, and the mean age ranged from 48.6 to 76.3 years. Studies included heart failure (41%), mixed cardiac disease (31%), post-myocardial infarction (13%), post-revascularisation (7%), CHD (7%), and cardiac X syndrome (1%) patients. The median intervention duration was 12 weeks. We identified notable diversity in social network and social support interventions, across what was delivered, how, and by whom. We assessed risk of bias (RoB) in primary outcomes at > 12 months follow-up as either 'low' (2/15 studies), 'some concerns' (11/15), or 'high' (2/15). 'Some concerns' or 'high' RoB resulted from insufficient detail on blinding of outcome assessors, data missingness, and absence of pre-agreed statistical analysis plans. In particular, HRQoL outcomes were at high RoB. Using the GRADE method, we assessed the certainty of evidence as low or very low across outcomes. Social network or social support interventions had no clear effect on all-cause mortality (risk ratio (RR) 0.75, 95% confidence interval (CI) 0.49 to 1.13, I2 = 40%) or cardiovascular-related mortality (RR 0.85, 95% CI 0.66 to 1.10, I2 = 0%) at > 12 months follow-up. The evidence suggests that social network or social support interventions for heart disease may result in little to no difference in all-cause hospital admission (RR 1.03, 95% CI 0.86 to 1.22, I2 = 0%), or cardiovascular-related hospital admission (RR 0.92, 95% CI 0.77 to 1.10, I2 = 16%), with a low level of certainty. The evidence was very uncertain regarding the impact of social network interventions on HRQoL at > 12 months follow-up (SF-36 physical component score: mean difference (MD) 31.53, 95% CI -28.65 to 91.71, I2 = 100%, 2 trials/comparisons, 166 participants; mental component score MD 30.62, 95% CI -33.88 to 95.13, I2 = 100%, 2 trials/comparisons, 166 participants). Regarding secondary outcomes, there may be a decrease in both systolic and diastolic blood pressure with social network or social support interventions. There was no evidence of impact found on psychological well-being, smoking, cholesterol, myocardial infarction, revascularisation, return to work/education, social isolation or connectedness, patient satisfaction, or adverse events. Results of meta-regression did not suggest that the intervention effect was related to risk of bias, intervention type, duration, setting, and delivery mode, population type, study location, participant age, or percentage of male participants. AUTHORS' CONCLUSIONS: We found no strong evidence for the effectiveness of such interventions, although modest effects were identified in relation to blood pressure. While the data presented in this review are indicative of potential for positive effects, the review also highlights the lack of sufficient evidence to conclusively support such interventions for people with heart disease. Further high-quality, well-reported RCTs are required to fully explore the potential of social support interventions in this context. Future reporting of social network and social support interventions for people with heart disease needs to be significantly clearer, and more effectively theorised, in order to ascertain causal pathways and effect on outcomes.
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Affiliation(s)
- Carrie Purcell
- Faculty of Wellbeing, Education and Language Studies, The Open University in Scotland, Edinburgh, UK
| | - Grace Dibben
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Michele Hilton Boon
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Lynsay Matthews
- School of Health and Life Sciences, University of the West of Scotland, Glasgow, UK
| | - Victoria J Palmer
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Meigan Thomson
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Susie Smillie
- School of Social and Political Sciences, University of Glasgow, Glasgow, UK
| | - Sharon A Simpson
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Rod S Taylor
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
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Rouch SA, Fields BE, Alibrahim HA, Rodakowski J, Leland NE. Evidence for the Effectiveness of Interventions for Caregivers of People With Chronic Conditions: A Systematic Review. Am J Occup Ther 2021; 75:12528. [PMID: 34780615 DOI: 10.5014/ajot.2021.042838] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Caregivers are pivotal in supporting the growing population of people with chronic conditions. Yet, engaging in the caregiver role involves the risk of poor outcomes. Caregiver interventions are needed that address poor outcomes while fostering engagement in role-related activities. OBJECTIVE To evaluate the evidence for interventions to support caregivers of adults with chronic conditions. DATA SOURCES Five databases were searched for studies of interventions for caregivers and patient-caregiver dyads published between 1995 and 2019. Study Selection and Data Collection: We reviewed the titles, abstracts, and full-text articles of the initial search results (N = 12,216 studies) according to a predetermined protocol. FINDINGS Forty-eight studies met the inclusion criteria. Psychoeducation and education with skills training were the two caregiver intervention themes. Studies evaluating psychoeducation (n = 28) provided low strength of evidence for improved psychosocial outcomes. Within this theme, problem-solving and coping skills training were common intervention components associated with significant improvements in depression and quality of life. Studies evaluating education with skills training (n = 20) provided moderate strength of evidence for improved knowledge and low strength of evidence for improved psychosocial outcomes. Dyadic self-management education and hands-on training were common components associated with significant improvements in knowledge, quality of life, and burden or strain. CONCLUSIONS AND RELEVANCE We found low strength of evidence to support the use of psychoeducation and education with skills training. Within these approaches, problem-solving and coping skills training, dyadic self-management education, and hands-on training show promise for improving caregiver outcomes. What This Article Adds: Findings of this systematic review are inconclusive with respect to psychoeducation and education with skills training leading to improved caregiver well-being. Within these broad approaches, the findings support the use of problem-solving and coping skills training, dyadic self-management education, and hands-on training to improve knowledge and well-being among caregivers of people with chronic conditions.
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Affiliation(s)
- Stephanie A Rouch
- Stephanie A. Rouch, MOT, OTR/L, is Graduate Student Researcher, Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA;
| | - Beth E Fields
- Beth E. Fields, PhD, OTR/L, is Assistant Professor, Department of Kinesiology, University of Wisconsin-Madison
| | - Hussain A Alibrahim
- Hussain A. Alibrahim, MsOT, OTR/L, is Occupational Therapist, Saudi Ministry of Higher Education, Riyadh, Saudi Arabia
| | - Juleen Rodakowski
- Juleen Rodakowski, OTD, MS, OTR/L, is Assistant Professor, Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA
| | - Natalie E Leland
- Natalie E. Leland, PhD, OTR/L, BCG, FAOTA, FGSA, is Associate Professor and Vice Chair for Research, Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA
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Backman C, Chartrand J, Crick M, Devey Burry R, Dingwall O, Shea B. Effectiveness of person- and family-centred care transition interventions on patient- oriented outcomes: A systematic review. Nurs Open 2021; 8:721-754. [PMID: 33570290 PMCID: PMC7877224 DOI: 10.1002/nop2.677] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 08/31/2020] [Accepted: 10/21/2020] [Indexed: 11/22/2022] Open
Abstract
AIM The aim was to critically analyse the body of evidence regarding the effectiveness of PFCC transition interventions on the quality of care and the experience of patients. DESIGN We conducted a systematic review using the Cochrane Handbook's guidelines and adhered to a standardized reporting format: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). METHODS Four databases and grey literature were searched. Following a two-step screening process, data from the eligible studies were extracted. Risk of bias and quality of the studies were also assessed. Narrative synthesis and vote counting were used for the data analysis. RESULTS A total of 28 articles met our inclusion criteria. Interventions varied in regards to the extent of the PFCC focus and the comprehensiveness of the transition of care. Educating patients to promote self-management was the most commonly included component and it was described in all 28 interventions.
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Affiliation(s)
- Chantal Backman
- School of NursingFaculty of Health SciencesUniversity of OttawaOttawaCanada
- Clinical Epidemiology ProgramOttawa Hospital Research InstituteOttawaCanada
- Bruyère Research InstituteOttawaCanada
| | - Julie Chartrand
- School of NursingFaculty of Health SciencesUniversity of OttawaOttawaCanada
| | - Michelle Crick
- School of NursingFaculty of Health SciencesUniversity of OttawaOttawaCanada
| | - Robin Devey Burry
- School of NursingFaculty of Health SciencesUniversity of OttawaOttawaCanada
| | - Orvie Dingwall
- Neil John Maclean Health Sciences LibraryUniversity of ManitobaWinnipegManitobaCanada
| | - Beverley Shea
- Clinical Epidemiology ProgramOttawa Hospital Research InstituteOttawaCanada
- Bruyère Research InstituteOttawaCanada
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Draper O, Goh I, Huang C, Kibblewhite T, Le Quesne P, Smith K, Gray E, Skinner M. Psychosocial interventions to optimize recovery of physical function and facilitate engagement in physical activity during the first three months following CABG surgery: a systematic review. PHYSICAL THERAPY REVIEWS 2020. [DOI: 10.1080/10833196.2020.1832714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Owen Draper
- School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Isaiah Goh
- School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Cong Huang
- School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | | | - Poppy Le Quesne
- School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Kate Smith
- School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Emily Gray
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Margot Skinner
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
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Bjørnnes AK, Moons P, Parry M, Halvorsen S, Tønnessen T, Lie I. Experiences of informal caregivers after cardiac surgery: a systematic integrated review of qualitative and quantitative studies. BMJ Open 2019; 9:e032751. [PMID: 31719093 PMCID: PMC6858143 DOI: 10.1136/bmjopen-2019-032751] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 09/10/2019] [Accepted: 10/10/2019] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES To provide a comprehensive synthesis of informal caregivers' experiences of caring for a significant other following discharge from cardiac surgery. DESIGN Systematic integrated review without meta-analysis. DATA SOURCES A bibliographic search for publications indexed in six databases (Cochrane Library, CINAHL, MEDLINE, EMBASE, AMED and PsycINFO), including a scan of grey literature sources (GreyNet International, Google Scholar, Web of Science, WorldCat and the Clinical Trials Registry) was conducted in October 2018. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Studies were included if they described views and perspectives of informal caregivers of cardiac surgery patients (non-intervention studies (qualitative and quantitative)), and the effectiveness of interventions to evaluate support programme for informal caregivers of cardiac surgery patients (intervention studies). RESULTS Of the 4912 articles identified in searches, 42 primary research studies were included in a narrative synthesis with 5292 participants, including 3231 (62%) caregivers of whom 2557 (79%) were women. The median sample size across studies was 96 (range 6-734). Three major themes emerged from the qualitative study data: (1) caregiver information needs; (2) caregiver work challenges and (3) caregivers adaption to recovery. Across the observational studies (n=22), similar themes were found. The trend across seven intervention studies focused on caregiver information needs related to patient disease management and symptom monitoring, and support for caregivers to reduce symptoms of emotional distress. CONCLUSION Informal caregivers want to assist in the care of their significant others after hospital discharge postcardiac surgery. However, caregivers feel insecure and overwhelmed and they lack clear/concise discharge information and follow-up support during the early at-home recovery period. The burden of caregiving has been recognised and reported since the early 1990s, but there remains a limited number of studies that assesses the effectiveness of caregiver interventions. PROSPERO REGISTRATION NUMBER CRD42018096590.
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Affiliation(s)
- Ann Kristin Bjørnnes
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Philip Moons
- KU Leuven Department of Public Health and Primary Care, KU Leuven-University, Leuven, Belgium
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Monica Parry
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Sigrun Halvorsen
- Department of Cardiology, Division of Medicine, Oslo University Hospital Ullevål, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Theis Tønnessen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Cardiothoracic Surgery, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital Ullevaal, Oslo, Norway
| | - Irene Lie
- Department of Cardiothoracic Surgery, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital Ullevaal, Oslo, Norway
- Center for Patient-centered Heart and Lung Research, Department of Cardiothoracic Surgery, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Oslo, Norway
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Copanitsanou P, Sourtzi P, Cano S, Cabrera E, Charalambous A, Katajisto J, Leino-Kilpi H, Papastavrou E, Valkeapää K, Zabalegui A, Lemonidou C. Empowering education of arthroplasty patients' significant others in three Southern European countries. Int J Older People Nurs 2018; 13:e12193. [DOI: 10.1111/opn.12193] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 02/05/2018] [Indexed: 11/26/2022]
Affiliation(s)
| | | | - Sara Cano
- Universitat Jaume I; Castellón Spain
| | - Esther Cabrera
- School of Health Sciences TecnoCampus; University Pompeu Fabra; Mataró Barcelona Spain
| | - Andreas Charalambous
- Faculty of Nursing; Cyprus University of Technology; Limassol Cyprus
- University of Turku; Turku Finland
| | - Jouko Katajisto
- Department of Statistics; University of Turku; Turku Finland
| | - Helena Leino-Kilpi
- Department of Nursing Science; University of Turku; Turku Finland
- Turku University Hospital; Turku Finland
| | | | - Kirsi Valkeapää
- Department of Nursing Science; University of Turku; Turku Finland
- Lahti University of Applied Sciences; Lahti Finland
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Parry M, Bjørnnes AK, Victor JC, Ayala AP, Lenton E, Clarke H, Harvey P, Lalloo C, McFetridge-Durdle J, McGillion MH, Price J, Stinson J, Watt-Watson J. Self-Management Interventions for Women With Cardiac Pain: A Systematic Review and Meta-analysis. Can J Cardiol 2018; 34:458-467. [PMID: 29477931 DOI: 10.1016/j.cjca.2017.12.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 12/01/2017] [Accepted: 12/08/2017] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Cardiac pain is considered the primary indicator of coronary artery disease (CAD). Existing reviews lack appropriate numbers of women or sex-based subgroup analyses, or both; thus, the benefits of self-management (women with cardiac pain actively participating in their own care and treatment) remain uncertain. METHODS Using methods described by the Evidence for Policy and Practice Information and Co-ordinating Centre at the Institute of Education, 7 databases were systematically searched to examine and synthesize the evidence on self-management interventions for women with cardiac pain and cardiac pain equivalents, such as fatigue, dyspnea, and exhaustion. RESULTS Our search yielded 22,402 article titles and abstracts. Of these, 57 randomized controlled trials were included in a final narrative synthesis, comprising data from 13,047 participants, including 5299 (41%) women. Self-management interventions targeting cardiac pain in women compared with a control population reduced (1) cardiac pain frequency and cardiac pain proportion (obstructive and nonobstructive CAD), (2) fatigue at 12 months, and (3) dyspnea at 2 months. There was no evidence of group differences in postprocedural (percutaneous coronary intervention or cardiac surgery) pain. Results indicated that self-management interventions for cardiac pain were more effective if they included a greater proportion of women (standardized mean difference [SMD], -0.01; standard error, 0.003; P = 0.02), goal setting (SMD, -0.26; 95% confidence interval [CI], -0.49 to -0.03), and collaboration/support from health care providers (SMD, -0.57; 95% CI, -1.00 to -0.14). CONCLUSIONS The results of this review suggest that self-management interventions reduce cardiac pain and cardiac pain equivalents.
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Affiliation(s)
- Monica Parry
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.
| | - Ann Kristin Bjørnnes
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada; Institute of Nursing and Health Promotion, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - J Charles Victor
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Ana Patricia Ayala
- Gerstein Science Information Centre, University of Toronto, Toronto, Ontario, Canada
| | - Erica Lenton
- Gerstein Science Information Centre, University of Toronto, Toronto, Ontario, Canada
| | - Hance Clarke
- Pain Research Unit, University Health Network, Toronto, Ontario, Canada
| | - Paula Harvey
- Department of Medicine, Women's College Hospital, Toronto, Ontario, Canada
| | - Chitra Lalloo
- The Hospital for Sick Children, The Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada
| | | | | | - Jennifer Price
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Jennifer Stinson
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada; The Hospital for Sick Children, The Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada
| | - Judy Watt-Watson
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
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Berry E, Davies M, Dempster M. Exploring the effectiveness of couples interventions for adults living with a chronic physical illness: A systematic review. PATIENT EDUCATION AND COUNSELING 2017; 100:1287-1303. [PMID: 28228340 DOI: 10.1016/j.pec.2017.02.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 02/09/2017] [Accepted: 02/11/2017] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Partners have a significant role in a person's ability to adjust to a chronic physical illness, which warrants their inclusion in couples interventions. However to deliver more specific, tailored support it is necessary to explore which types of couples interventions are most effective across certain chronic illness populations and outcomes. METHODS Five databases were searched using selected terms. Thirty-five articles met the eligibility criteria for inclusion. RESULTS The majority of studies were from the US, and most interventions targeted cancer populations. Couples interventions fell into two categories according to therapeutic approach; Cognitive Behavioural Skills Training (CBST) and Relationship Counselling (RC). When compared with a patient-only intervention or controls, CBST interventions effectively targeted behavioural, physical/somatic and cognitive outcomes, while RC more effectively targeted interpersonal outcomes. CONCLUSION Couples interventions can be more effective than patient-only interventions or controls across various patient and partner outcomes. Couples interventions tend to favour a skills-based or a relationship-based approach, which strongly influences the types outcomes effectively targeted. PRACTICE IMPLICATIONS Our findings suggest it could be therapeutically useful to integrate these two approaches to more holistically support couples living with chronic illness. We also identify the need to target understudied illness groups and ethnicities.
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Affiliation(s)
- Emma Berry
- Queen's University Belfast, School of Psychology, Northern Ireland.
| | - Mark Davies
- Department of Clinical Psychology, Belfast Health & Social Care Trust, Northern Ireland.
| | - Martin Dempster
- Queen's University Belfast, School of Psychology, Northern Ireland.
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Clinical effectiveness of individual patient education in heart surgery patients: A systematic review and meta-analysis. Int J Nurs Stud 2017; 65:44-53. [DOI: 10.1016/j.ijnurstu.2016.11.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 11/01/2016] [Accepted: 11/04/2016] [Indexed: 11/19/2022]
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Bernabeu-Mora R, García-Guillamón G, Montilla-Herrador J, Escolar-Reina P, García-Vidal JA, Medina-Mirapeix F. Rates and predictors of depression status among caregivers of patients with COPD hospitalized for acute exacerbations: a prospective study. Int J Chron Obstruct Pulmon Dis 2016; 11:3199-3205. [PMID: 28008245 PMCID: PMC5167454 DOI: 10.2147/copd.s118109] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Hospitalization is common for acute exacerbation of COPD, but little is known about its impact on the mental health of caregivers. OBJECTIVE The aim of this study was to determine the rates and predictors of depressive symptoms in caregivers at the time of hospitalization for acute exacerbation of COPD and to identify the probability and predictors of subsequent changes in depressive status 3 months after discharge. MATERIALS AND METHODS This was a prospective study. Depression symptoms were measured in 87 caregivers of patients hospitalized for exacerbation at hospitalization and 3 months after discharge. We measured factors from four domains: context of care, caregiving demands, caregiver resources, and patient characteristics. Univariate and multivariate multiple logistic regressions were used to determine the predictors of depression at hospitalization and subsequent changes at 3 months. RESULTS A total of 45 caregivers reported depression at the time of hospitalization. After multiple adjustments, spousal relationship, dyspnea, and severe airflow limitation were the strongest independent predictors of depression at hospitalization. Of these 45 caregivers, 40% had a remission of their depression 3 months after discharge. In contrast, 16.7% of caregivers who were not depressive at hospitalization became depressive at 3 months. Caregivers caring >20 hours per week for patients with dependencies had decreased odds of remission, and patients having dependencies after discharge increased the odds of caregivers becoming depressed. CONCLUSION Depressive symptoms are common among caregivers when patients are hospitalized for exacerbation of COPD. Although illness factors are determinants of depression at hospitalization, patient dependence determines fluctuations in the depressive status of caregivers.
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Affiliation(s)
- Roberto Bernabeu-Mora
- Division of Pneumology, Hospital Morales Meseguer; Department of Physical Therapy, University of Murcia; Physiotherapy and Disability Research Group, Instituto Murciano de Investigación Biosanitaria Virgen de la Arrixaca (IMIB), Murcia, Spain
| | | | - Joaquina Montilla-Herrador
- Department of Physical Therapy, University of Murcia; Physiotherapy and Disability Research Group, Instituto Murciano de Investigación Biosanitaria Virgen de la Arrixaca (IMIB), Murcia, Spain
| | - Pilar Escolar-Reina
- Department of Physical Therapy, University of Murcia; Physiotherapy and Disability Research Group, Instituto Murciano de Investigación Biosanitaria Virgen de la Arrixaca (IMIB), Murcia, Spain
| | | | - Francesc Medina-Mirapeix
- Department of Physical Therapy, University of Murcia; Physiotherapy and Disability Research Group, Instituto Murciano de Investigación Biosanitaria Virgen de la Arrixaca (IMIB), Murcia, Spain
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Effectiveness of a psychoeducation program on the quality of life in patients with coronary heart disease: A clinical trial. Appl Nurs Res 2016; 33:36-41. [PMID: 28096020 DOI: 10.1016/j.apnr.2016.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 09/05/2016] [Accepted: 09/09/2016] [Indexed: 11/21/2022]
Abstract
AIM The present study was conducted to evaluate effectiveness of a psychoeducation program (PEP) on the quality of life in patients with coronary heart disease (CHD). BACKGROUND CHD affects patients' quality of life. PEPs may be useful to help patients reach maximum functional health. METHODS A pretest-posttest controlled clinical trial was conducted on a study population of 70 CHD patients, who were selected through convenience sampling and randomly allocated to either the intervention or the control group. The MacNew Quality of Life Questionnaire in heart disease was completed by participants twice: first as a pretest, and then in a follow-up posttest. RESULTS After the intervention, the quality of life (QOL) score was 157.97±25.51 in the intervention group and 105.03±8.38 in the control group, making for a significant difference (p<0. 05). CONCLUSION Based on the findings, PEPs helped CHD patients improve their quality of life through reducing tension, relieving their negative emotions, and improving their social relationships.
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Berthelsen CB, Kristensson J. The SICAM-trial: evaluating the effect of spouses' involvement through case management in older patients' fast-track programmes during and after total hip replacement. J Adv Nurs 2016; 73:112-126. [PMID: 27488572 DOI: 10.1111/jan.13091] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2016] [Indexed: 11/29/2022]
Abstract
AIM The aim of this study was to evaluate the effect of spouses' involvement in older patients' care trajectories, using case management as intervention in total hip replacement through fast-track programmes. BACKGROUND Patients need their spouses to be involved in their fast-track programmes and this involvement is often associated with improvements in patient outcomes. However, the effect of spouses' involvement in older patients' fast-track programmes has not yet been investigated. DESIGN A two-group quasi-experimental design with pre-test and repeated post-test measures was conducted in an orthopaedic ward of a Danish Regional Hospital from February 2014-June 2015. Spouse-patient dyads were initially recruited for the control group (n = 14), receiving usual care; dyads for the intervention group (n = 15) were recruited afterwards, receiving case management intervention elements before, during and after admission. METHODS Face-to-face interviews on questionnaires were conducted with spouses and patients at baseline, 2 weeks and 3 months after discharge, measuring spouses' caregiver satisfaction, difficulties and level of anxiety and patients' functional and nutritional status, pain and level of depression. RESULTS The results showed that there were no differences between the groups with regard to any of the outcome measures. However, statistically significant improvements were found in the patient groups on functional status, pain and depression and in the groups of spouses on caregiver satisfaction. CONCLUSION The case management intervention seemed to have an effect in patient and spousal groups; however, this improvement could also have been caused by the effect of fast-track treatment.
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Affiliation(s)
- Connie Bøttcher Berthelsen
- Department of Orthopaedic Surgery, Zealand University Hospital, Køge, Denmark.,Section of Nursing, Aarhus University, Copenhagen, Denmark
| | - Jimmie Kristensson
- Department of Health Sciences, Lund University, Sweden.,Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden
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14
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Abstract
The purpose of this trial was to determine the effectiveness of advanced practice nursing support on cardiac surgery patients’ during the first 5 weeks following hospital discharge. Patients ( N = 200) were randomly allocated to two groups: (a) an intervention group who received telephone calls from an advanced practice nurse (APN) familiar with their clinical condition and care needs, twice during the first week following discharge then weekly thereafter for 4 weeks, and (b) a usual care group. Measures of health-related quality of life (HRQL), symptom distress, satisfaction with recovery care, and unexpected health care contacts were obtained at 5 weeks following discharge. There were no significant group differences in HRQL, unexpected contacts with the health care system, or symptom distress. The provision of APN support via telephone followup after cardiac surgery is feasible. However, further randomized trials of single and multicomponent APN interventions are needed to prove effectiveness.
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Leino-Kilpi H, Gröndahl W, Katajisto J, Nurminen M, Suhonen R. Participation of family members and quality of patient care - the perspective of adult surgical patients. J Clin Nurs 2016; 25:2242-50. [PMID: 27334560 DOI: 10.1111/jocn.13262] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2016] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES The aim of this study is to describe the participation of family members in the care of Finnish adult surgical patients and the connection of the participation with the quality of patient care as perceived by surgical patients. BACKGROUND The family members of adult surgical patients are important. Earlier studies vary concerning the nature of participation, its meaning and the connection of participation with patient-centred quality of care. In this study, we aim to produce new knowledge about adult surgical patients whose family members have participated in their care. DESIGN This was a cross-sectional descriptive survey study. METHODS The data were collected among adult surgical patients (N = 481) before being discharged home from hospital with two instruments: the Good Nursing Care scale and the Received Knowledge of Hospital Patients. RESULTS Based on the results, most adult surgical patients report that family members participate in their care. Participation was connected with received knowledge and preconditions of care, which are components of the quality of patient care. CONCLUSIONS In future, testing of different solutions for improving the participation of surgical patients' family members in patient care should be implemented. Furthermore, the preconditions of family members' participation in care and the concept of participation should be analysed to emphasise the active role of family members. RELEVANCE TO CLINICAL PRACTICE The results emphasised the importance of family members for the patients in surgical care. Family members' participation is connected with the quality of patient care.
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Affiliation(s)
| | | | | | - Matti Nurminen
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Riitta Suhonen
- Department of Nursing Science, University of Turku, Turku, Finland
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Morrow EM, Nicholson C. Carer engagement in the hospital care of older people: an integrative literature review. Int J Older People Nurs 2016; 11:298-314. [DOI: 10.1111/opn.12117] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 01/08/2016] [Indexed: 12/13/2022]
Affiliation(s)
| | - Caroline Nicholson
- Florence Nightingale Faculty of Nursing and Midwifery; King's College London; London UK
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17
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The content, dissemination and effects of case management interventions for informal caregivers of older adults: A systematic review. Int J Nurs Stud 2015; 52:988-1002. [DOI: 10.1016/j.ijnurstu.2015.01.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 01/06/2015] [Accepted: 01/10/2015] [Indexed: 11/23/2022]
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18
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Berthelsen CB, Kristensson J. Spouses’ involvement in older patients’ fast-track programmes during total hip replacement using case management intervention. A study protocol of the SICAM-trial. J Adv Nurs 2015; 71:1169-80. [DOI: 10.1111/jan.12602] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Connie Bøttcher Berthelsen
- Orthopaedic Department; Regional Hospital of Køge; Denmark
- Section of Nursing; Institute of Public Health; Aarhus University; Denmark
| | - Jimmie Kristensson
- Department of Health Sciences; Lund University; Sweden
- The Swedish Institute for Health Sciences; Lund University; Sweden
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19
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Gaeeni M, Farahani MA, Seyedfatemi N, Mohammadi N. Informational support to family members of intensive care unit patients: the perspectives of families and nurses. Glob J Health Sci 2014; 7:8-19. [PMID: 25716373 PMCID: PMC4796373 DOI: 10.5539/gjhs.v7n2p8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 07/08/2014] [Accepted: 08/04/2014] [Indexed: 12/02/2022] Open
Abstract
Introduction: The receiving information about the patients hospitalized in the intensive care unit is classified among the most important needs of the family members of such patients. Meeting the informational needs of families is a major goal for intensive care workers. Delivering honest, intelligible and effective information raises specific challenges in the stressful setting of the intensive care unit (ICU). The aim of this qualitative study was to explain perspectives of families of Intensive Care Unit patients and nurses about informational support. Method: Using a conventional content analysis approach, semi-structured interviews were conducted with participants to explore their perspectives of providing informational support to families of ICU patients. A purposeful sampling method was used to recruit nineteen family members of thirteen patients hospitalized in the ICU and twelve nurses from three teaching hospitals. In general, 31 persons participated in this study. Data collection continued to achieve data saturation. Findings: A conventional content analysis of the data produced three categories and seven sub-categories. The three main categories were as followed, a) providing information, b) handling information and c) using information. Providing information had three sub-categories consisting of “receiving admission news”, “receiving truthful and complete information” and receiving general information. Handling information had two sub-categories consisting ‘keeping information” and “gradual revelation”. Lastly, using information has two sub-categories consisting of “support of patient” and “support of family members”. Conclusion: The results of this study revealed perspectives of families of Intensive Care Unit patients and nurses about informational support. It also determines the nurses’ need to know more about the influence of their supportive role on family’s ICU patients informing. In addition, the results of present study can be used as a basis for further studies and for offering guidelines about informational support to the families of the patients hospitalized in the ICU.
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Caregivers' perceived roles in caring for patients with heart failure: what do clinicians need to know? J Card Fail 2014; 20:731-738. [PMID: 25084216 DOI: 10.1016/j.cardfail.2014.07.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 07/08/2014] [Accepted: 07/22/2014] [Indexed: 11/21/2022]
Abstract
BACKGROUND Poor self-management of heart failure (HF) is an essential contributor to poor outcomes. Caregivers are involved in the care of HF patients, but caregiver interventions intended to improve the outcomes of patients have been largely unsuccessful. Improved knowledge of caregivers' desired roles in care may improve future interventions. METHODS AND RESULTS This qualitative study of 20 caregivers of HF patients recruited from an academic medical center used a general inductive approach, with insights from role theory, to analyze the data. Caregivers perceived themselves as health care managers and care plan enforcers, advocates for quality of life, and experts in the lived experience of HF at home. However, they encountered role strain (expectations of role exceed ability to perform role) and role conflict (incompatible or contradictory roles) when it seemed that these roles were incompatible with those that they felt the health care system saw them in. This resulted in expressions of anger and distrust towards the health care system. CONCLUSIONS Clinicians caring for patients with HF can seek to better empower and enable this care. Involving caregivers in disease management research and assessing their roles before intervention may hold promise for enabling and empowering caregivers to improve outcomes of HF patients.
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21
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Keeping-Burke L, Purden M, Frasure-Smith N, Cossette S, McCarthy F, Amsel R. Bridging the transition from hospital to home: effects of the VITAL telehealth program on recovery for CABG surgery patients and their caregivers. Res Nurs Health 2013; 36:540-53. [PMID: 24242195 DOI: 10.1002/nur.21571] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2013] [Indexed: 11/10/2022]
Abstract
The purpose of this randomized trial was to determine whether coronary artery bypass graft surgery patients and their caregivers who received telehealth follow-up had greater improvements in anxiety levels from pre-surgery to 3 weeks after discharge than did those who received standard care. Secondary outcomes included changes in depressive symptoms and patients' contacts with physicians. No group differences were noted in changes in patients' anxiety and depressive symptoms, but patients in the telehealth group had fewer physician contacts (p = .04). Female caregivers in the telehealth group had greater decreases in anxiety than those in standard care (p < .001), and caregivers of both genders in the telehealth group had greater decreases in depressive symptoms (p = .03).
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Affiliation(s)
- Lisa Keeping-Burke
- Department of Nursing & Health Sciences, University of New Brunswick, PO Box 5050, Saint John, New Brunswick, E2L 4L5, Canada; Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
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22
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23
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Reid J, Ski CF, Thompson DR. Psychological interventions for patients with coronary heart disease and their partners: a systematic review. PLoS One 2013; 8:e73459. [PMID: 24039950 PMCID: PMC3764157 DOI: 10.1371/journal.pone.0073459] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Accepted: 07/21/2013] [Indexed: 11/20/2022] Open
Abstract
Objectives Despite evidence that patients with coronary heart disease (CHD) and their partners report significant psychological distress, and suggestions that involving partners in interventions alleviates such distress, no systematic reviews have examined this. The objective of this study was to systematically review evidence on the effectiveness of psychological interventions for patients with CHD and their partners. Methods CENTRAL, Medline, EMBASE, CINAHL and PsycINFO databases were searched through October 2012. Randomized controlled trials evaluating psychological interventions for patients with CHD and their partners were included. Selection of studies, study appraisal, data extraction and analysis were undertaken using standard methods. Results Seven studies comprising 673 dyads (patient and partner) were included. Psychological interventions result in modest improvements in patients' health-related quality of life, blood pressure, knowledge of disease and treatment, and satisfaction with care, and in partners' anxiety, knowledge and satisfaction. There was a non-significant trend for improvements in anxiety for patients, and depressive symptoms for both patients and partners. There was no evidence of a significant effect on mortality, morbidity or other cardiovascular risk factors for patients, or social support for patients and partners. Conclusions Psychological interventions for patients with CHD and their partners were found to improve health-related quality of life, blood pressure, knowledge, and satisfaction with care for patients, and anxiety, knowledge, and satisfaction with care for partners. However, as the overall quality of the evidence was low, these results should be interpreted with caution.
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Affiliation(s)
- Jane Reid
- Cardiovascular Research Centre, Australian Catholic University, Melbourne, Victoria, Australia
| | - Chantal F. Ski
- Cardiovascular Research Centre, Australian Catholic University, Melbourne, Victoria, Australia
| | - David R. Thompson
- Cardiovascular Research Centre, Australian Catholic University, Melbourne, Victoria, Australia
- * E-mail:
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24
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Carroll DL. Antecedents to the integration process for recovery in older patients and spouses after a cardiovascular procedure. Int J Nurs Pract 2013; 20:97-105. [PMID: 24580980 DOI: 10.1111/ijn.12127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Diane L Carroll
- Institute for Patient Care; Massachusetts General Hospital; Boston Massachusetts USA
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25
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Thomson P, Niven CA, Peck DF, Eaves J. Patients' and partners' health-related quality of life before and 4 months after coronary artery bypass grafting surgery. BMC Nurs 2013; 12:16. [PMID: 23829859 PMCID: PMC3744164 DOI: 10.1186/1472-6955-12-16] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Accepted: 07/03/2013] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Patients having coronary artery bypass grafting (CABG) often depend on their partners for assistance before and after surgery. Whilst patients' physical and mental health usually improves after surgery little is known about the partners' health-related quality of life (HRQoL) in CABG. If the partners' physical and emotional health is poor this can influence their caregiving role and ability to support the patient. This study aimed: to increase understanding of patients' and partners' HRQoL before and after CABG; to explore whether patients' and partners' pre-operative socio-demographics and HRQoL predict their own, and also partners' HRQoL 4 months after CABG. METHODS This prospective study recruited 84 dyads (patients 84% males, aged 64.5 years; partners 94% females, aged 61.05 years). Patients' and partners' perceived health status was assessed using the Short-Form 12 Health Survey. Patients' physical limitation, angina symptoms and treatment satisfaction were assessed using the Seattle Angina Questionnaire. Partners' emotional, physical and social functioning was assessed using the Quality of Life of Cardiac Spouses Questionnaire. Data were analysed using hierarchical multiple (logistic) regressions, repeated measures analysis of variance, paired t test and Chi square. RESULTS Patients most likely to have poorer physical health post-operatively were associated with partners who had poorer pre-operative physical health. Partners most likely to have poorer emotional, physical and social functioning post-operatively were associated with patients who had poorer pre-operative mental health. Patients" and partners' poorer post-operative HRQoL was also explained by their poorer pre-operative HRQoL. CONCLUSION The partners' involvement should be considered as part of patients' pre-operative assessment. Special attention needs be paid to patients' pre-operative mental health since it is likely to impact on their post-operative mental health and the partner's emotional, physical and social functioning.
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Affiliation(s)
- Patricia Thomson
- School of Nursing, Midwifery and Health, BG Bomont Building, University of Stirling, Stirling FK9 4LA, Scotland
| | - Catherine A Niven
- School of Nursing, Midwifery and Health, BG Bomont Building, University of Stirling, Stirling FK9 4LA, Scotland
| | - David F Peck
- School of Nursing, Midwifery and Health, BG Bomont Building, University of Stirling, Stirling FK9 4LA, Scotland
| | - Jennifer Eaves
- School of Nursing, Midwifery and Health, BG Bomont Building, University of Stirling, Stirling FK9 4LA, Scotland
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26
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Li H, Powers BA, Melnyk BM, McCann R, Koulouglioti C, Anson E, Smith JA, Xia Y, Glose S, Tu X. Randomized controlled trial of CARE: an intervention to improve outcomes of hospitalized elders and family caregivers. Res Nurs Health 2012; 35:533-49. [PMID: 22736271 PMCID: PMC3442140 DOI: 10.1002/nur.21491] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2012] [Indexed: 11/09/2022]
Abstract
In this randomized controlled trial we tested the efficacy of an intervention program (CARE: Creating Avenues for Relative Empowerment) for improving outcomes of hospitalized older adults and their family caregivers (FCGs). FCG-patient dyads (n = 407) were randomized into two groups. The CARE group received a two-session empowerment-educational program 1-2 days post-admission and 1-3 days pre-discharge. The attention control group received a generic information program during the same timeframe. Follow-up was at 2 weeks and 2 months post-discharge. There were no statistically significant differences in patient or FCG outcomes. However, inconsistent evidence of role outcome differences suggests that CARE may benefit certain FCG subgroups instead of being a one-size-fits-all intervention strategy. Closer examination of CARE's mechanisms and effects is needed.
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Affiliation(s)
- Hong Li
- School of Nursing, University of Rochester, Rochester, NY
| | | | | | - Robert McCann
- School of Medicine and Dentistry, University of Rochester, Rochester, NY
| | | | | | - Joyce A. Smith
- School of Nursing, University of Rochester, Rochester, NY
| | - Yinglin Xia
- School of Medicine and Dentistry, University of Rochester, Rochester, NY
| | - Susan Glose
- School of Nursing, University of Rochester, Rochester, NY
| | - Xin Tu
- School of Medicine and Dentistry, University of Rochester, Rochester, NY
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Serious complications in connection with cardiac surgery--next of kin's views on information and support. Intensive Crit Care Nurs 2011; 27:331-7. [PMID: 22055397 DOI: 10.1016/j.iccn.2011.10.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2011] [Revised: 10/07/2011] [Accepted: 10/08/2011] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Next of kin (NoK) to patients undergoing cardiac surgery expect successful outcomes but sometimes serious complications occur and this affects their NoK. To describe NoK's experiences of information and support when serious complications occur during the first 30 days after cardiac surgery. METHODS A qualitative, critical incident technique was used. Forty-two NoK were asked to describe their experiences of information and support. RESULTS Three main areas emerged from the analysis. The first main area, Confidence during the waiting period, described how NoK could not participate in the forthcoming operation and how the NoK were informed. The second main area, Involvement during the hospital stay, described how the NoK feel trust in the healthcare professionals and dissatisfaction with the care in relation to the operation. The third main area, Sense of abandonment, described problems with the rehabilitation. CONCLUSIONS These findings show the importance of pre- and post operative contacts between healthcare professionals, patients and NoK. When the NoK and the patients are well informed it constitutes a basis for fruitful conversations between them and the healthcare professionals, and everyone can be better prepared if complications occur.
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Thomson P, Molloy GJ, Chung ML. The effects of perceived social support on quality of life in patients awaiting coronary artery bypass grafting and their partners: testing dyadic dynamics using the Actor-Partner Interdependence Model. PSYCHOL HEALTH MED 2011; 17:35-46. [PMID: 21678197 DOI: 10.1080/13548506.2011.579988] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Patients awaiting coronary artery bypass grafting (CABG) need support from their partners or family caregivers to manage their self care successfully and to maximise quality of life. Partners need social support to help overcome the stressful tasks of an unexpected caregiving role. It is not known whether the individual's perceived social support contributes to their own, as well as their partner's quality of life. The aims of this study were to assess differences in social support and quality of life in patients and partners awaiting CABG, and to examine whether patients' and partners' perceived social support predicted their own, as well as their partner's quality of life before CABG. This cross-sectional study recruited 84 dyads (patients 84% males, aged 64.5 years and partners 94% females, aged 61.05 years). Perceived social support was assessed using the Medical Outcomes Study Social Support survey, with sub-scales for informational/emotional support, affectionate support, tangible support and positive social interaction. Quality of life was assessed using the Short-Form 12 Health Survey. Dyadic data were analysed using the Actor-Partner Interdependence Model, with distinguishable dyad regression. Results revealed the patients' informational/emotional support exhibited an actor effect on their own mental health (ß = 0.19, p = 0.001); indicating those with low informational/emotional support had poorer mental health. There was a partner effect of the patients' informational/emotional support on their partner's mental health (ß = 0.14, p = 0.024), indicating the patients' informational/emotional support was associated with the partner's mental health. None of the other types of social support exhibited an actor effect or a partner effect on the patient's or the partner's mental or physical health. More research into the relationship between social support and mental health is needed to help inform the design of interventions that target the dyad.
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Affiliation(s)
- Patricia Thomson
- School of Nursing, Midwifery & Health, BG Bomont Building, University of Stirling, Stirling FK9 4LA, Scotland, UK.
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Martire LM, Schulz R, Helgeson VS, Small BJ, Saghafi EM. Review and meta-analysis of couple-oriented interventions for chronic illness. Ann Behav Med 2011; 40:325-42. [PMID: 20697859 DOI: 10.1007/s12160-010-9216-2] [Citation(s) in RCA: 258] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Evidence continues to build for the impact of the marital relationship on health as well as the negative impact of illness on the partner. Targeting both patient and partner may enhance the efficacy of psychosocial or behavioral interventions for chronic illness. PURPOSE The purpose of this report is to present a cross-disease review of the characteristics and findings of studies evaluating couple-oriented interventions for chronic physical illness. METHODS We conducted a qualitative review of 33 studies and meta-analyses for a subset of 25 studies. RESULTS Identified studies focused on cancer, arthritis, cardiovascular disease, chronic pain, HIV, and Type 2 diabetes. Couple interventions had significant effects on patient depressive symptoms (d = 0.18, p < 0.01, k = 20), marital functioning (d = 0.17, p < 0.01, k = 18), and pain (d = 0.19, p < 0.01, k = 14) and were more efficacious than either patient psychosocial intervention or usual care. CONCLUSIONS Couple-oriented interventions have small effects that may be strengthened by targeting partners' influence on patient health behaviors and focusing on couples with high illness-related conflict, low partner support, or low overall marital quality. Directions for future research include assessment of outcomes for both patient and partner, comparison of couple interventions to evidence-based patient interventions, and evaluation of mechanisms of change.
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Affiliation(s)
- Lynn M Martire
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA 16802, USA.
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McKenzie LH, Simpson J, Stewart M. A systematic review of pre-operative predictors of post-operative depression and anxiety in individuals who have undergone coronary artery bypass graft surgery. PSYCHOL HEALTH MED 2010; 15:74-93. [PMID: 20391226 DOI: 10.1080/13548500903483486] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
In addition to the physical benefits, another important objective of coronary artery bypass graft (CABG) surgery is improvement of health-related quality of life. The aim of this systematic review is to provide an overview of the literature relating to the pre-operative prediction of post-operative depression and anxiety in individuals who have undergone CABG surgery. Forty-six studies were identified through a literature search of electronic databases conducted using explicit inclusion and exclusion criteria. The study characteristics, methodological features, and psychometric and clinical outcomes were summarised in a systematic manner. Collective appraisal of the studies indicated that symptoms of depression and anxiety exhibited after CABG surgery are best predicted by pre-operative measures of functioning in that area. Papers were inconclusive with respect to the predictive qualities of gender and age. Further research is required to clarify the predictive values of these and other factors, including pre-morbid ill health and socio-economic status. The findings of this review indicate a range of pre-operative predictors of post-operative depression and anxiety in patients with CABG. Chief among these are pre-operative depression and anxiety. These findings have clinical implications concerning the importance of pre and post-operative psychological assessment and intervention for individuals at risk of poor psychological recovery.
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Affiliation(s)
- Louise H McKenzie
- Division of Health Research, School of Health and Medicine, Lancaster University, Lancaster, UK.
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31
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Utriyaprasit K, Moore SM, Chaiseri P. Recovery after coronary artery bypass surgery: effect of an audiotape information programme. J Adv Nurs 2010; 66:1747-59. [DOI: 10.1111/j.1365-2648.2010.05334.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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McKenzie LH, Simpson J, Stewart M. The impact of depression on activities of daily living skills in individuals who have undergone coronary artery bypass graft surgery. PSYCHOL HEALTH MED 2010; 14:641-53. [DOI: 10.1080/13548500903254234] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Expectations, anxiety, depression, and physical health status as predictors of recovery in open-heart surgery patients. J Cardiovasc Nurs 2010; 24:454-64. [PMID: 19858954 DOI: 10.1097/jcn.0b013e3181ac8a3c] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVES Recovery after open-heart surgery is a complex process that presents psychosocial and physical challenges that continue well after discharge. The purpose of this study was to examine the relationship among expectations, anxiety, depression, and physical health status (PHS) and to determine predictors of postoperative PHS in open-heart surgery patients. PARTICIPANTS AND METHODS A convenience sample (N = 54) was recruited from 2 hospitals in rural regions from 2 different mid-Atlantic states. The sample included participants who underwent coronary artery bypass graft or valve replacement surgery for the first time. The study used a longitudinal design, and data were collected preoperatively in the hospital or surgeons' offices and 4 weeks postoperatively by telephone interviews. Participants were interviewed using the following questionnaires: the Future Expectations Regarding Life with Heart Disease scale, the Hospital Anxiety and Depression scale, and the Medical Outcomes Study 36-Item Short Form Health Survey. Repeated-measures analysis of variance, Pearson product-moment correlations, and multiple regression were used for data analyses. RESULTS AND CONCLUSIONS Statistical analysis revealed that anxiety (P = .002) and depression (P = .026) scores decreased postoperatively. Significant relationships were found among the preoperative and postoperative variables: expectations, anxiety, depression, and PHS. Analyses also found that preoperative expectations, anxiety, depression, and PHS contributed 38% of the variance of postoperative PHS (P < .001). However, the postoperative variables were not significant predictors of postoperative PHS (P = .075). The findings support the need for interventions to assist patients in developing realistic expectations and for clinicians to screen patients for anxiety and depression before and after surgery. Future research needs to measure PHS at various times postoperatively to identify continued limitations after surgery.
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Rantanen A, Tarkka MT, Kaunonen M, Tarkka M, Sintonen H, Koivisto AM, Astedt-Kurki P. Health-related quality of life after coronary artery bypass grafting. J Adv Nurs 2009; 65:1926-36. [PMID: 19694856 DOI: 10.1111/j.1365-2648.2009.05056.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM The purpose of this study was to monitor changes in health-related quality of life and to identify associated factors among patients having coronary artery bypass grafting and their significant others. BACKGROUND Heart disease and its treatment affects the lives of both patients and their significant others, and the early stage of recovery from surgery causes particular anxiety for both. METHOD In this longitudinal study, three sets of questionnaire data were collected 1, 6 and 12 months after coronary artery bypass grafting surgery from patients and significant others at one university hospital in Finland in 2001-2005. We recruited all patients who had been admitted for elective coronary artery bypass grafting surgery during the period specified. The data consisted of the responses from those patients and significant others who had completed all three questionnaires and for whom patient-significant other pairs existed (n = 163). FINDINGS Patients' and their significant others' health-related quality of life was at its lowest one month after the operation and improved during follow-up. The change in the mean health-related quality of life score differed between patients and significant others; the improvement in the patients' health-related quality of life was greater than that in the significant others. Neither the background variables used in the study nor social support were associated with change in health-related quality of life. CONCLUSION Further research is needed to identify factors explaining the change in health-related quality of life to develop interventions to support patients and significant others.
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Affiliation(s)
- Anja Rantanen
- Department of Nursing Science, University of Tampere, Finland.
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Agren S, Frisman GH, Berg S, Svedjeholm R, Strömberg A. Addressing spouses' unique needs after cardiac surgery when recovery is complicated by heart failure. Heart Lung 2009; 38:284-91. [PMID: 19577699 DOI: 10.1016/j.hrtlng.2008.10.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2008] [Revised: 08/28/2008] [Accepted: 10/04/2008] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cardiac surgery places extensive stress on spouses who often are more worried than the patients themselves. Spouses can experience difficult and demanding situations when the partner becomes critically ill. OBJECTIVES To identify, describe, and conceptualize the individual needs of spouses of patients with complications of heart failure after cardiac surgery. METHODS Grounded theory using a mix of systematic coding, data analysis, and theoretical sampling was performed. Spouses, 10 women and 3 men between 39 and 85 years, were interviewed. RESULTS During analysis, the core category of confirmation was identified as describing the individual needs of the spouses. The core category theoretically binds together three underlying subcategories: security, rest for mind and body, and inner strength. Confirmation facilitated acceptance and improvement of mental and physical health among spouses. CONCLUSIONS By identifying spouses' needs for security, rest for mind and body, and inner strength, health care professionals can confirm these needs throughout the caring process, from the critical care period and throughout rehabilitation at home. Interventions to confirm spouses' needs are important because they are vital to the patients' recovery.
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Affiliation(s)
- Susanna Agren
- Department of Cardiothoracic Surgery, Linköping University Hospital and Department of Medical and Health Sciences, Division of Nursing Sciences, Linköping University, Linköping S-58185, Sweden.
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Miller C, Zimmerman L, Barnason S, Nieveen J. Impact of an early recovery management intervention on functioning in postoperative coronary artery bypass patients with diabetes. Heart Lung 2008; 36:418-30. [PMID: 18005803 DOI: 10.1016/j.hrtlng.2007.02.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2005] [Accepted: 02/15/2007] [Indexed: 11/26/2022]
Abstract
BACKGROUND Approximately 30% of patients undergoing coronary artery bypass graft (CABG) procedures have diabetes and, as such, are at increased risk for postoperative complications and a lengthy recovery. OBJECTIVE To test the feasibility of an in-home early recovery management intervention to improve physical and psychosocial functioning in the diabetic CABG population. METHODS This pilot study was a 2-group, randomized, experimental study. The 6-week in-home early recovery intervention was delivered by way of a device called the Health Buddy (Health Hero Network, Redwood City, CA). Subjects were 49 diabetic patients who had undergone a first-time CABG procedure. RESULTS Although no statistical differences between groups were found, descriptively, the intervention group's baseline means on Medical Outcomes Study Short Form-36 subscales measuring physical functioning were lower but improved to levels comparable with that of the control group. Improvements in psychosocial functioning were comparable between the 2 groups. CONCLUSION This in-home telehealth intervention may have promise for improving functioning outcomes in high-risk CABG patients with diabetes. However, weaknesses of the intervention and the need for a more focused, directive intervention were identified.
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Affiliation(s)
- Connie Miller
- College of Nursing, University of Nebraska Medical Center, Omaha, Nebraska 68198-5330, USA
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Factors Associated With Caregiver Depressive Symptoms, Outcomes, and Perceived Physical Health After Coronary Artery Bypass Surgery. J Cardiovasc Nurs 2007; 22:508-15. [DOI: 10.1097/01.jcn.0000297388.21626.6c] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Halm MA, Treat-Jacobson D, Lindquist R, Savik K. Caregiver burden and outcomes of caregiving of spouses of patients who undergo coronary artery bypass graft surgery. Heart Lung 2007; 36:170-87. [PMID: 17509424 DOI: 10.1016/j.hrtlng.2006.08.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2006] [Revised: 07/12/2006] [Accepted: 08/07/2006] [Indexed: 11/25/2022]
Abstract
BACKGROUND Patients who undergo coronary artery bypass graft surgery often rely on spouses for care during recovery. Although often meaningful, caregiving may be stressful and affect spouses' ability to provide care to the patient. OBJECTIVES The purpose of this study was to compare burden and caregiving outcomes across three groups of spouses. Spouse groups varied by the interval of time between surgery and follow-up, which may have been 3, 6, or 12 months. METHODS This cross-sectional comparative study recruited a convenience sample of 166 spouses on the basis of a power analysis. A total of 166 spouses completed caregiver surveys on burden and other caregiving outcomes. RESULTS Total, objective, and subjective burden levels were low to moderate. Although no burden differences were found between groups, men had higher total burden but more positive caregiving outcomes. Future outlook and social activities were less positive in the 6-month group. Burden levels were not lower, nor were caregiving outcomes higher, in the 12-month group, suggesting a steady caregiving demand across the first year after coronary artery bypass graft surgery. CONCLUSION Longitudinal investigations are needed to understand burden and caregiving outcomes over time and the impact of burden on spousal and patient recovery outcomes.
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Abstract
OBJECTIVE This qualitative study explored the kinds of worry that family caregivers experience when their older relatives are hospitalized. BACKGROUND Little is known about what kinds of worries family caregivers may have in association with the hospitalizations of older relatives. An understanding of the different patterns of family worry may help health care teams intervene more effectively to meet family caregiver's needs by reducing their anxiety. DESIGN A qualitative descriptive design with Loftland and Loftland (1984) approach for the study of a phenomenon occurring in a social setting was used. METHOD A purposeful sample of 10 participants was obtained that included six family caregivers and four nurses. Participants were recruited from two hospitals in the northwest US. Intensive interviews and participant observations were used for data collection, and Loftland and Loftland's (1984) qualitative approach was used for data analysis. RESULTS Family worry was defined as family caregivers' felt difficulty in fulfilling their roles because of worry. Four categories of family worry were identified as a result of this study: (i) worry about the patient's condition; (ii) worry about the patient's care received from the health care team; (iii) worry about future care for the patient provided by the family caregiver; and (iv) worry about finances. CONCLUSIONS The findings of this pilot study provide nurses with the initial knowledge of the typology of family worry associated with elderly relatives' hospitalizations. RELEVANCE TO CLINICAL PRACTICE The findings of this study may sensitize the nurses to more precisely evaluate family caregivers' worry about their hospitalized elders and provide more effective nursing interventions to improve outcomes of both patients and their family caregivers.
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Affiliation(s)
- Hong Li
- School of Nursing, University of Rochester, Rochester, New York 14642, USA.
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Martire LM, Lustig AP, Schulz R, Miller GE, Helgeson VS. Is it beneficial to involve a family member? A meta-analysis of psychosocial interventions for chronic illness. Health Psychol 2005; 23:599-611. [PMID: 15546228 DOI: 10.1037/0278-6133.23.6.599] [Citation(s) in RCA: 254] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Links between chronic illness and family relationships have led to psychosocial interventions targeted at the patient's closest family member or both patient and family member. The authors conducted a meta-analytic review of randomized studies comparing these interventions with usual medical care (k=70), focusing on patient outcomes (depression, anxiety, relationship satisfaction, disability, and mortality) and family member outcomes (depression, anxiety, relationship satisfaction, and caregiving burden). Among patients, interventions had positive effects on depression when the spouse was included and, in some cases, on mortality. Among family members, positive effects were found for caregiving burden, depression, and anxiety; these effects were strongest for nondementing illnesses and for interventions that targeted only the family member and that addressed relationship issues. Although statistically significant aggregate effects were found, they were generally small in magnitude. These findings provide guidance in developing future interventions in this area.
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Affiliation(s)
- Lynn M Martire
- University of Pittsburgh, Department of Psychiatry and University Center for Social and Urban Research, Pittsburgh, PA 15260, USA.
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Abstract
Achieving optimum patient outcomes has always been the primary focus of healthcare providers. The degree to which any healthcare discipline can impact outcomes varies since patient outcomes are multiple and diverse. As the measurement and reporting of outcomes has moved into the arena of public reporting, it has become essential for disciplines to be able to identify which outcomes they can either partially or completely influence. The focus of this article is to (1) identify what specific nursing-sensitive outcomes have been measured or monitored on cardiac surgery patients in the past and then (2) suggest potential next generation outcomes.
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Affiliation(s)
- Gayle R Whitman
- School of Nursing, University of Pittsburgh, Pittsburgh, PA 15261, USA.
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Cameron JI, Shin JL, Williams D, Stewart DE. A brief problem-solving intervention for family caregivers to individuals with advanced cancer. J Psychosom Res 2004; 57:137-43. [PMID: 15465067 DOI: 10.1016/s0022-3999(03)00609-3] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/10/2003] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate a brief problem-solving intervention for family caregivers to individuals with advanced cancer. METHOD Family caregivers were recruited through oncology clinics of a large tertiary care hospital in Canada. Those providing informed consent completed a baseline survey, received a brief problem-solving intervention, received a detailed home care guide, and completed a follow-up survey over the telephone 4 weeks after receiving the intervention. RESULTS Thirty-four family caregivers completed all aspects of the study. Sixty-eight percent of caregivers were women, 73.5% were married to the care recipient, and their average age was 53.6 years. This brief intervention resulted in improvements in emotional tension (P<.03), caregiving confidence (P<.06), and positive problem-solving orientation (P<.06). CONCLUSION These findings suggest that even a brief problem-solving intervention may be beneficial for family caregivers to individuals with advanced cancer.
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Affiliation(s)
- Jill I Cameron
- Uniiversity Health Network Women's Health Program, 657 University Avenue, ML 2-004, Toronto, Ontario, Canada M5G 2N2.
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Watt-Watson J, Stevens B, Katz J, Costello J, Reid GJ, David T. Impact of preoperative education on pain outcomes after coronary artery bypass graft surgery. Pain 2004; 109:73-85. [PMID: 15082128 DOI: 10.1016/j.pain.2004.01.012] [Citation(s) in RCA: 109] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2003] [Revised: 12/30/2003] [Accepted: 01/12/2004] [Indexed: 11/28/2022]
Abstract
Cardiovascular diseases cause more disability and economic loss in industrialized nations than any other group of diseases. In previous work [Nurs Res 49 (2000a) 1], most coronary artery bypass graft patients (CABG, N=225 ) reported unrelieved pain and received inadequate analgesics. This study proposed to evaluate a preadmission education intervention to reduce pain and related activity interference after CABG surgery. Patients (N=406) were randomly assigned to (a) standard care or (b) standard care+pain booklet group. Data were examined at the preadmission clinic and across days 1-5 after surgery. Outcomes were pain-related interference (BPI-I), pain (MPQ-SF), analgesics (chart), concerns about taking analgesics (BQ-SF), and satisfaction (American Pain Society-POQ). The impact of sex was explored related to primary and secondary outcomes. The intervention group did not have better overall pain management although they had some reduction in pain-related interference in activities ( t(355)=2.54, P<0.01) and fewer concerns about taking analgesics ( F(1,313)=2.7, P<0.05) on day 5. Despite moderate 24-h pain intensity across 5 days, patients in both groups received inadequate analgesics (i.e. 33% prescribed dose). Women reported more pain and pain-related interference in activities than men. The booklet was rated as helpful, particularly by women. In conclusion, the intervention did not result in a clinically significant improvement in pain management outcomes. In future, an intervention that considers sex-specific needs and also involves educating the health professionals caring for these patients may influence these results.
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Affiliation(s)
- Judy Watt-Watson
- Faculty of Nursing and Centre for the Study of Pain, University of Toronto, 50 St George Street, Toronto, Ont., Canada M5S 3H4.
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Li H, Melnyk BM, McCann R, Chatcheydang J, Koulouglioti C, Nichols LW, Lee MD, Ghassemi A. Creating avenues for relative empowerment (CARE): a pilot test of an intervention to improve outcomes of hospitalized elders and family caregivers. Res Nurs Health 2003; 26:284-99. [PMID: 12884417 DOI: 10.1002/nur.10091] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The purpose of this pilot study was to evaluate the effectiveness of a family caregiver-focused intervention program (CARE) on the outcomes of hospitalized elders and their family caregivers. A randomized clinical trial was conducted with 49 family caregivers of hospitalized elders in a university medical center in upstate New York. Driven by self-regulation and role theories, the two-phase CARE program consisted of: (a). a mutual agreement consisting of family caregiving activities during hospitalization; and (b). audiotaped information regarding emotional responses and possible complications associated with an elderly patient's hospitalization as well as instructions for effectively participating in the elder's hospital care. The comparison program consisted of information about hospital services and policies. CARE elders had fewer incidents of acute confusion reported by family caregivers during hospitalization and fewer depressive symptoms at 2 weeks and 2 months posthospitalization than did the comparison group. CARE family caregivers participated more in the care of their hospitalized elders and had higher scores on role rewards prior to hospital discharge. Findings from this study support the need for further testing of the CARE intervention with family caregivers to determine its effectiveness on outcomes of hospitalized elders and their family caregivers.
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Affiliation(s)
- Hong Li
- School of Nursing, University of Rochester, Rochester, NY 14642, USA
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Hartford K, Wong C, Zakaria D. Randomized controlled trial of a telephone intervention by nurses to provide information and support to patients and their partners after elective coronary artery bypass graft surgery: effects of anxiety. Heart Lung 2002; 31:199-206. [PMID: 12011810 DOI: 10.1067/mhl.2002.122942] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the effectiveness of an information and support telephone intervention for reducing anxiety in patients who have undergone coronary artery bypass graft surgery and their partners. DESIGN The study is a randomized controlled trial. Intervention began at discharge; 6 telephone calls were made to patients and partners over 7 weeks. Primary outcome was Beck Anxiety Inventory measured at baseline in hospital, at home on day 3, week 4, and week 8. SAMPLE The subjects were 131 patients who have undergone elective coronary artery bypass graft surgery and their partners. RESULTS Patients' anxiety was moderate to severe the day before discharge. It was significantly lower in the treatment group than in the control group at day 2 at home. Partners always had lower anxiety than patients. A more sustained decrease in anxiety in the partner treatment group was found at both day 2 and week 4. CONCLUSION Intervention effect is in the early period after discharge-- the time most affected by reduced lengths of stay.
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Affiliation(s)
- Kathleen Hartford
- Lawson Health Research Institute, 375 South Street, Room NRC218, London, Ontario, Canada N6A 4G5
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