The burden of filial piety: A qualitative study on caregiving motivations amongst family caregivers of patients with cancer in Singapore

Motivation in caregiving among mothers of children with intellectual and developmental disabilities in Iran: A qualitative study

BACKGROUND

The motivation of caregivers plays a crucial role in the treatment, follow-up, and care of children with intellectual and developmental disabilities. Previous studies have focused on the older people and end-stage diseases, while giving less attention to the motivation of mothers caring for children with special needs. This study aimed to explore the motivations of mothers caring for children with intellectual and developmental disabilities in Iran.

METHODS

This study employed a qualitative approach, guided by the Self-Determination Theory. Purposeful sampling was initially used, followed by theoretical sampling until data saturation was achieved. Data were collected through semi-structured interviews with 26 mothers of children with intellectual and developmental disabilities. Mayring's seven-step directed content analysis approach was utilized for coding and categorization. The research adhered to ethical standards and ensured data trustworthiness through credibility, dependability, confirmability, and transferability measures.

RESULTS

The findings revealed that mothers' caregiving motivations could be classified into four main categories: (I) intrinsic, (II) identified-extrinsic, (III) introjected-extrinsic, and (IV) external-extrinsic. Additionally, twelve sub-categories were identified within these four main categories.

CONCLUSION

The findings revealed that mothers demonstrated varying levels of intrinsic and extrinsic motivations in caring for children with intellectual and developmental disabilities. By recognizing and enhancing the diverse sources of motivation, healthcare providers and policymakers can better support mothers in their caregiving roles, ultimately contributing to improved outcomes for both the mothers and their children.

Protocol for a telephonic mixed methods study to understand needs and find solutions for bereaved dementia caregivers

INTRODUCTION

Most caregivers of people living with dementia will experience bereavement within 10 years, but study of and support for their needs rarely persists following the death of their care recipients. A single model that leverages theoretical insights as well as observation from lived experience might help identify who will have greater difficulty following dementia-related bereavement and suggest core mechanisms to target to relieve clinical and subclinical consequences. The millions of existing bereaved dementia caregivers likely have considerable insight into ways to improve experience. Rather than creating interventions from scratch, researchers might leverage those insights to more rapidly improve the lives of bereaved dementia caregivers.

METHODS AND ANALYSIS

This study uses a transformative mixed methods approach to explore the needs of caregivers for individuals with Alzheimer's disease (AD) and AD-related dementias, incorporating both quantitative surveys (n=400) and qualitative semistructured interviews (n=45) across diverse subgroups. The study described in this protocol aims to quantitatively test a new model based on self-determination theory to help understand when and why bereaved dementia caregivers experience better and worse outcomes following bereavement. The study also aims to qualitatively explore the ways that bereaved dementia caregivers might meet their needs to inform future interventions.

ETHICS AND DISSEMINATION

The study adheres to institutional guidelines, ensuring participant consent and minimising risks through verbal consent procedures and the removal of personal identifiers from survey responses. The study team will share findings widely through academic publications, conferences and targeted outreach to advocacy groups and healthcare professionals, while also providing concise summaries of results to participants and making them accessible through the lab's website.

Stress and Loneliness Among Family Caregivers of Older Persons With Cognitive Impairment: The Mediating Role of Social Isolation and the Moderating Role of Personal Mastery

OBJECTIVES

Relatively little attention has been paid to the underlying processes and conditions leading to loneliness among caregivers of older persons with cognitive impairment (PCI). Drawing upon the caregiver stress-process model and the social relationship expectations framework, this study examined the mediating role of social isolation and the moderating role of caregiver personal mastery in the association between PCI memory and behavioral problems and caregiver loneliness.

METHODS

Structural equation modeling was applied to cross-sectional data from 266 caregivers in Singapore.

RESULTS

Caregiver-reported PCI memory and behavioral problems were associated with increased levels of caregiver loneliness. Caregiver social isolation partially mediated the association and caregiver personal mastery moderated the association.

DISCUSSION

Caregivers with low mastery were more likely to experience loneliness due in part to social isolation resulting from their PCI's memory and behavioral problems. Tailored interventions should address caregiver social isolation and foster caregiver personal mastery.

More competent informal caregivers reduce advanced cancer patients' unplanned healthcare use and costs

BACKGROUND

Patients with metastatic cancer experience high healthcare use and costs, most of which are unplanned. We aimed to assess whether patients with more competent informal caregivers have lower unplanned healthcare use and costs.

METHODS

This study used data from a prospective cohort of patients with solid metastatic cancer. Patients and their informal family caregivers were surveyed every 3 months until patients' death. Patients' unplanned healthcare use/costs were examined through hospital records. Caregivers responded to the 4-item Caregiver Competence Scale. First, in a deceased subsample of patients and their caregivers, we used patients' last 2 years of data (226 dyads) to assess the association between caregivers' competency (independent variable) and patients' unplanned healthcare use/costs (outcomes). Next, in a prospective sample of patient-caregiver dyads (up to 15 surveys), we assessed whether patients' functional well-being and psychological distress moderated the association between caregivers' competency and unplanned healthcare use/costs (311 dyads).

RESULTS

In the deceased subsample, during last 2 years of patients' life, caregivers' higher competency lowered the odds of patients' unplanned healthcare use [OR (CI) = 0.86 (0.75, 0.98), p = 0.03], and was associated with a significant reduction in unplanned healthcare costs [Coeff (CI) = -0.19 (-0.36, -0.01), p = 0.03]. In the prospective sample, patients' functional well-being and psychological distress moderated the association between caregivers' competency and patients' unplanned healthcare use/costs.

CONCLUSION

With deterioration in patients' condition and an increase in caregiving demands, improving caregivers' competency can reduce patients' unplanned healthcare use and costs. This should be further tested in future trials.

Validating interRAI Chinese self-reported carer needs (SCaN) assessment and predicting caregiving distress among informal Chinese caregivers of older adults

BACKGROUND

This study aims to (1) determine the reliability and validity of the interRAI Chinese Self-reported Carer Needs (SCaN) assessment among informal Chinese caregivers of older adults, (2) identify predictors of caregiving distress in Asian regions with long-standing Confucian values of filial piety and family responsibility.

METHODS

This cross-sectional study recruited 531 informal Chinese caregivers of older adults in Hong Kong, Shanghai, Taiwan, and Singapore. The scale reliability was examined using Cronbach's alphas (α) and McDonald's omega coefficient (ω). The concurrent validity and discriminant validity were assessed using Spearman rank correlations (rho). To examine the predictors of caregiving distress among informal caregivers of older adults, we employed hierarchical linear regression analyses informed by the Model of Carer Stress and Burden and categorized the predictors into six domains.

RESULTS

Results revealed good internal consistency reliability (α = 0.83-0.96) and concurrent validity (rho = 0.45-0.74) of the interRAI Chinese SCaN assessment. Hierarchical linear regression analysis revealed that entering the background factors, primary stressors, secondary stressors, appraisal, and exacerbating factors all significantly enhanced the model's predictability, indicating that the source of caregiving distress is multidimensional. In the full model, caregivers with longer informal care time, lack of support from family and friends, have unmet needs, experience role overload, have sleep problems, and low IADL functioning are at a higher risk of caregiving distress.

CONCLUSIONS

The interRAI Chinese SCaN Assessment was found to be a reliable and valid tool among the Chinese informal caregivers of older adults. It would be useful for determining family caregivers' strengths, needs, and challenges, and tailoring interventions that address the potentially modifiable factors associated with caregiving distress and maximize support. Healthcare providers working in home and community settings should be aware of the early identification of caregiving distress and routine assessment of their needs and empower them to continue taking care of their needs and providing adequate care to the care recipient.

The family caregiving; A Rogerian concept analysis of Muslim perspective & Islamic sources

Despite the numerous concepts of caregiving discussed in the literature, there is still no agreed definition and concept of family caregiving from the perspective of Islam. This study aims to comprehensively define family caregiving from Islamic religious and Muslim cultural perspectives. Rodger's evolutionary model was used to generate content by analyzing and redefining concepts. A thorough examination of the relevant literature using Scopus, PubMed, Medline, and CINAHL databases also trusted sources offered a total of 52 articles and 8 books to be reviewed. Our study reveals that family caregiving is viewed as God's gift as important as an essential religious and cultural obligation in Islam, where humans are expected to deliver care for their families although they are unprepared. This can be motivated by aspirations for respect, love, responsibility, and a desire to recompense parents, as well as the belief that by doing so they will be rewarded in the hereafter. The provision of family caregiving leads to positive consequences such as living with hope, gaining rewards and achievement, but at the same time, it also causes devastated life. This research contributes to a new discourse on family caregiving based on Islamic literature which helps in the comprehension of the practices of Muslim communities worldwide.

Filial piety and older adult caregiving among Chinese and Chinese-American families in the United States: a concept analysis

BACKGROUND

The culturally sensitive nursing practice has not embedded filial piety as a cultural value and stance pertaining to caregiving among aging Chinese and Chinese-American (CCA) families in the United States, yet it is critical for healthy aging among CCAs.

PURPOSE

To understand filial piety when caring for aging CCAs and conceptualize an operational definition and framework.

METHODS

A systematic search was conducted in CINAHL, PubMed, Scopus, and PsycINFO databases. Analysis of the concept of filial piety among CCAs used Walker and Avant's methods. Twenty-six studies were selected in the final full-text analysis.

FINDINGS

Synthesis of evidence identified four antecedents: (a) filial obligation as a 'cultural gene', (b) sense of altruism, (c) familial solidarity, and (d) societal expectation of 'birth right'. Attributes included familial material and emotional support, obedience, pious reverence, and societal norms. Consequences were related to caregiver burden, psychological and physical well-being, quality of life, and health equity.

CONCLUSION

Filial piety is an intrinsic desire to support aging parents and an extrinsic desire to adhere to Chinese societal moral tenets. The proposed operational framework "Caregiving for aging CCAs in the United States" merits further study.

Exploring the Lived Experiences of Caregiving for Older Family Members by Young Caregivers in Singapore: Transition, Trials, and Tribulations

Amidst population ageing trends and epidemiological transitions, there has been a growing emergence of young family caregivers, about whom most studies have been conducted in Western countries. Their subjective experiences and perceptions toward caregiving remain underexplored in Asia. This qualitative study explored the lived experiences of caregiving for older family members by young caregivers in Singapore. Interpretative phenomenological analysis was employed to collect and analyse data from semi-structured, in-depth interviews with six young adult caregivers aged between 23 and 29. Interviews were supplemented with photo-elicitation techniques to deepen interview discussions and uncover experiential significance. Findings illustrated transitions into caregiving, challenges across role conflicts and expectations amidst developmental tasks and transitions, and navigation of intergenerational conflicts and ambivalence. Although no definitive conclusions can be reached from this small-scale study, the findings offer important insights into the convergence and intensity of young caregivers' experiences. Given that caregiving challenges are likely to continue amidst Singapore's rapidly ageing population, these necessitate further in-depth research efforts. Implications for policy and practice across multiple stakeholders interfacing with youth and older adults are presented. A whole-of-society approach is called for to enable young caregivers to realise their full potential while contributing to their ageing families and nation.

Randomized controlled trials on promoting self-care behaviors among informal caregivers of older patients: a systematic review and meta-analysis

BACKGROUND

Informal caregivers of older patients often neglect their self-care, despite the mental and physical health effects of caregiving. Randomized controlled trials (RCTs) on self-care interventions for informal caregivers are lacking, making it difficult to determine effective strategies. This systematic review explored the definition and categories of self-care RCTs for informal caregivers and a meta-analysis was conducted to determine the effectiveness of these interventions.

METHODS

Seven databases (Scopus, Web of Science, MEDLINE, PubMed, ProQuest, CINAHL, and Embase) were searched for articles in English reporting on self-care intervention outcomes for informal caregivers of patients aged 60 years or older. Standardized mean differences (SMD) with 95% confidence intervals (CI) were calculated using a random-effects model. Subgroup, sensitivity, and publication bias analyses were conducted.

RESULTS

Eighteen studies were included in the systematic review, of which fifteen studies were included in the meta-analysis. RCTs lacked a clear definition of self-care, mainly focused on promoting physical and mental health and individual capacity, and neglected disease prevention. The interventions focused on self-management for health and individual agency, with less attention on health literacy, decision-making capacity, self-monitoring for health status, and linkage to the health system. Meta-analysis results showed that RCTs had a small effect on reducing anxiety (SMD = -0.142, 95% CI [-0.302, 0.017], p = .081) but a significant effect on reducing depression (SMD = -0.214, 95% CI [-0.353, -0.076], p = .002). Country and type of caregiver significantly contributed to the effect of reducing caregivers' depression in subgroup analysis.

CONCLUSIONS

Studies on caregiver-centered self-care interventions are limited, resulting in a lack of a clear definition and comprehensive intervention. RCTs indicated a small effect on informal caregivers' mental health, and interventions should consider both mental and physical health. More evidence is needed on the effectiveness of self-care interventions for informal caregivers' anxiety and physical health.

Biographical continuation: recovery of stroke survivors and their family caregivers in Taiwan

AIM

To explore the experiences pertaining to long-term care services from the perspectives of dyads of stroke survivors and their family caregivers in indigenous and non-indigenous communities.

BACKGROUND

Stroke occurrence is a life-changing event associated with quality of life for stroke survivors and their families, especially those who provide primary support. Indigenous people are more likely to experience a stroke at a younger age and have a higher likelihood of hospitalisation and death due to health disparities. Few studies have investigated family dyads or indigenous populations to understand their experiences of coping with changed body-self and to contextualise their reintegration into communities post-stroke.

METHODS

Ethnographic fieldwork over nine months in 2018-2019 with indigenous, urban-based, and non-indigenous populations, resulting in 48 observations and 24 interviews with 12 dyads in three geo-administrative communities.

FINDINGS

The post-stroke recovery trajectory is illuminated, delineating the dyads' life transitions from biographical disruption to biographical continuation. The trajectory is shaped by seven states involving four mindsets and three status passages. The four mindsets are sense of loss and worry, sense of interdependence, sense of independence, and wellbeing state. The status passages identified in this study are acceptance, alteration, and identification. A community-based and family-centred long-term care system, aligning with medical healthcare and community resources, underpinned each dyad's biographical continuation by: (1) providing rehabilitation that afforded time and space for recovery adaptation; (2) acknowledging the individuality of family caregivers and helping to alleviate their multitasking; and (3) reintegrating stroke survivors into their communities. Key to determining the quality of recovery for the indigenous participants was their reintegration into their native community and regaining of identity. Therefore, integrating post-stroke care into various care contexts and incorporating indigenous-specific needs into policymaking can support dyads in adapting to their communities.

Engagement in Physical Activity and Quality of Life Among Informal Caregivers of Older Adults

OBJECTIVES

This study examined (1) the association of caregiver engagement in physical activity (PA) with their quality of life (QoL) and (2) the moderating effect of caregiver engagement in PA on the relationship between several caregiving stressors and their QoL, among informal caregivers of older adults.

METHODS

Multivariable regression was applied to data from 278 adult caregivers, aged 23-90 years, in Singapore.

RESULTS

Engagement in PA by caregivers was positively associated with psychological, social relationships, and environment domains of their QoL. Caregiver engagement in PA also mitigated the negative association between care-recipient mood impairment and QoL of caregivers in the physical health and social relationships domains.

DISCUSSION

QoL of caregivers may be improved or protected by their regular engagement in PA, especially when their care-recipients have mood impairment. Policymakers and practitioners should encourage caregivers to engage in PA and provide them with the necessary support to do so.

Caregiver burden for adults with epilepsy in Malaysian families: A qualitative study

BACKGROUND

Caregivers of adults with epilepsy (AWE) play an important role in the healthcare pathway of AWE and are described as the "co-client." Being caregivers can be stressful and the negative impacts might accumulate over time, affecting their quality of life and well-being.

OBJECTIVES

This qualitative study aimed to explore the lived experience of caregivers of AWE in Malaysian families and understand their caregiving challenges. Individual semi-structured interviews were held with 12 primary caregivers of AWE. Interpretative Phenomenological Approach (IPA) was used. The interview transcripts were analyzed using NVivo12 software.

RESULTS

Primary caregivers of AWE were parents or siblings, with ages ranging from 56 to 80 years old and years of caregiving from 24 to 40 years. Most AWE (58%) were intellectually disabled and fully dependent on ADL needs. Two categories of themes emerged, including four themes on caregiver burden, i.e., physical, emotional, and social burdens, and challenges in future planning of care, and two themes on coping strategies (problem- or emotional-focused). In future planning of care, most caregivers especially parents carried a burden of responsibility and were reluctant to depend on others or institutional services.

CONCLUSION

The caregiving burden among caregivers for adult AWE was not confined to current burdens only but also challenges in future planning. A better understanding of the caregiving burden for AWE and coping strategies is needed to provide tailored psychoeducation or psychosocial intervention to support this population.

Does covid-19 pandemic tell us something about time and space to meet our being, belonging and becoming needs?

BACKGROUND

People's perceptions of events like a pandemic are shaped by individual experiences within their socio-cultural context. Attributing negative or positive meanings to an experience may influence the sense of Being, Belonging and Becoming.

AIM AND OBJECTIVES

To investigate the impact of the isolation/social distancing measures on people's sense of Being, Belonging, Becoming and overall sense of Occupational Wholeness compared to the time before the Covid-19 Pandemic as it is perceived by an Iranian population.

METHODS

The Model of Occupational Wholeness used to inform the theoretical basis of this study and development of the survey questions. An internet-based survey using a convenient and snowball sampling method was conducted. A self-administered questionnaire was published using a software named Porsline. A sample of 1624 members of the general population in Iran (67% response rate) completed the questionnaire within the first four weeks of the isolation/social distancing period starting on 18 March 2020. The Data was analysed by the SPSS 22.

RESULTS

The participants showed a more positive perceived level of Being and Belonging as well as an overall sense of Occupational Wholeness, and no difference in the perceived sense of Becoming during the isolation/social distancing period compared to the time before the Covid 19 pandemic.

CONCLUSIONS

The findings show that the isolation/social distancing measures were perceived by participants as an opportunity to meet some of their Being, and Belonging needs that contribute to an overall sense of OccupationalWholeness.This highlights the role that Occupational science and Occupational therapy may have in helping people in situations when they need to rethink and replan for what they Do and the way they attribute meaning to their experiences.

Issues of Elder Care among Migrant Workers in Contemporary Rural China: Filial Piety Redefined from a Foucauldian Perspective

This article reports on research that explored rural migrant workers' experiences of returning to their hometown to provide care for elderly parents diagnosed with cancer. The authors used a culturally integrated approach to Foucauldian discourse analysis to consider how 24 participants narrated their experiences of care in China. The discourse of care demonstrated a strong commitment to filial piety despite their unique care challenges, and this commitment was bolstered by discourses that emphasized how much parents had sacrificed, as well as by a persistent forgetting of experiences or background details that suggested any lack of parental sacrifice in recent Chinese history. Policy implications related to enhancing filial care are discussed.

Does willingness to care fluctuate over time? A weekly diary study among informal caregivers

OBJECTIVE

Informal caregivers are expected to be willing to care for relatives with care needs. Little is known about whether and how willingness to care changes over time. Using a weekly diary study, we examined changes in the willingness of 955 caregivers from nine countries. Caregivers provided information on their caregiving context, relationship type, and relationship satisfaction with the care recipient.

METHODS AND MEASURES

For 24 consecutive weeks, caregivers evaluated willingness to care as it was 'right now'.

RESULTS

Willingness differs from one caregiver to another (68% between-level variability) but also fluctuates in the same caregiver from week to week (32% within-level variability), with a decrease over 6 months (intercept = 8.55; slope = -0.93; p < .001). Regardless of individual differences in average willingness to care based on caregiving context and relationship satisfaction, caregivers reported decreases in willingness. Caregivers who presented one or more health conditions themselves reported higher weekly fluctuations in willingness than caregivers with no health conditions.

CONCLUSION

Willingness is not a stable attitude because it decreases and caregivers experience fluctuations from week to week. A clearer understanding of weekly processes is optimal for monitoring the caregivers' well-being and tailoring interventions in line with weekly individual variations.

Spiritual growth, sense of coherence and self-efficacy of family caregivers of people with disabilities

OBJECTIVE

Analyze the spiritual growth of family caregivers of people with severe disabilities who reside in the Metropolitan District of Quito and identify the cognitive-affective factors, bio-sociocultural characteristics and care characteristics that model it.

METHOD

Cross-sectional study, carried out during the second semester of 2021, probabilistic sample of 223 caregivers residing in Quito-Ecuador. Descriptive statistics, correlation coefficients and regression were applied.

RESULTS

49.8% perceived a high spiritual growth. This correlated with the manageability dimension of the sense of coherence and with the self-efficacy of care. Some cognitive-affective factors, bio-sociocultural characteristics and care characteristics explained 25% of its variation.

CONCLUSION

The results showed a frequent practice of actions that promote spiritual growth, self-efficacy of care is highlighted as an important protective factor, these results can serve as a basis for planning interventions towards the evaluation and development of spiritual growth in search of a healthy lifestyle. in this vulnerable population.

A prospective study of psychological distress among patients with advanced cancer and their caregivers

BACKGROUND

Cancer can impact the psychological well-being of both patients and their informal caregivers. We investigated the joint trajectories of psychological distress among Singaporean advanced cancer patients-caregiver dyads. We also examined predictors of trajectory group membership.

METHODS

This study utilised data from 299 patients with advanced solid cancer and their caregivers over 33 months (12 times points). Group-based trajectory modelling was used to examine the joint trajectories of patient anxiety, patient depression, caregiver anxiety and caregiver depression scores using the Hospital Anxiety and Depression Scale.

RESULTS

Four joint trajectory groups were found: (1) Patient-caregiver low distress (27%), (2) patient-caregiver increasing distress (28.5%), (3) patient low- caregiver borderline distress (25%), (4) patient-caregiver high distress (19.5%). Dyads where the patient is below 50 years of age were more likely to be in Group 4. Dyads where caregiver-patient emotional closeness was low were more likely to be in Groups 2 or 4 where dyads reported increasing/high distress. Dyads that reported financial inadequacy were more likely to be in Groups 2, 3 and 4, while dyads with caregivers who were employed were more likely to be in group 3.

CONCLUSIONS

A substantial proportion of patients and caregivers reported anxiety and/or depression that lasted or increased throughout the study duration. We found significant heterogeneity in how dyads experienced psychological distress, suggesting that efforts should consider dyadic differences when providing psychological support. Particular focus should be placed on identifying dyads that are at risk and who require additional support.

Relationship of Psychological Flexibility and Mindfulness to Caregiver Burden, and Depressive and Anxiety Symptoms in Caregivers of People with Dementia

Caregivers of People with dementia (PwD) commonly experience burdens and other mental health issues, e.g., depression and anxiety. At present, there are limited studies that examine the relationships between caregiver psychological factors and caregiver burden, and depressive and anxiety symptoms. Therefore, this study's objectives were to examine the relationships between psychological flexibility and mindfulness in caregivers of PwD, and to determine the predictors of these three outcomes. This was a cross-sectional study conducted in the geriatric psychiatry clinic of Kuala Lumpur Hospital, Malaysia, and the sample (n = 82) was recruited via a universal sampling method over three months. The participants completed a questionnaire that consisted of the sociodemographics of the PwD and caregivers, illness characteristics of the PwD, Acceptance and Action Questionnaire-II (AAQ-II), Mindful Attention Awareness Scale (MAAS), Zarit Burden Interview Scale (ZBI), Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7). The results show that despite significant relationships between psychological flexibility and mindfulness and lower levels of caregiver burden, and depressive and anxiety symptoms (p < 0.01), only psychological inflexibility (p < 0.01) remained as a significant predictor of the three outcomes. Therefore, in conclusion, intervention programs that target the awareness of the caregiver's psychological inflexibility should be implemented to alleviate these adverse outcomes in dementia caregivers.

Understanding Occupations of Terminally Ill Chinese Adults and Their Caregivers: A Scoping Review

This scoping review explored the occupations of terminally ill Chinese adults and their caregivers. Seven databases were searched for peer-reviewed journal articles published in English or Chinese before June 2020. Of the 16 studies that met the selection criteria, only one directly used the term "occupations" while the other 15 studies contained descriptions of occupations. Eight themes were extracted and compared with existing literature. The top two reported themes were occupations surrounding life roles and tasks and those surrounding food and eating. More study is required about the occupational engagement of this client group.

Development and validation of caregiver stress and support scale for caregivers of individuals with disabilities in Singapore

PURPOSE

Few available measures include culturally salient stressors and support systems for caregivers of offspring with disabilities in Asia. The purpose of this study was to develop and validate a self-report measure that included relevant stressors and sources of support for caregivers of offspring with disabilities.

MATERIALS AND METHODS

Open-ended interviews with eight caregivers in Singapore, along with existing measures were used to develop items. The original 34 items were administered to caregivers of offspring with disabilities in Singapore (n = 234, 85% mothers). Based on an examination of factor loadings, internal consistency, and feedback from professionals, the scale was revised and administered to 370 caregivers (78% mothers), along with other measures of stress, support, depression, and well-being.

RESULTS

Exploratory factor analysis of the original 34-item scale yielded two factors, Sources of Stress and Sources of Support. After scale revision, confirmatory factor analysis showed that a two-factor structure demonstrated a fair fit. The subscales showed adequate internal consistency and test-retest reliability, and significant associations in expected directions with other measures of stress and support, as well as with depressive symptoms and well-being.

CONCLUSIONS

The measure has adequate reliability and validity, with implications for use by local service providers.Implications for rehabilitationCaregivers face unique challenges, such as stressors associated with caregiving, with varying support systems available to reduce the stress.A psychometrically-sound measure can be used to assess sources of stress and support, monitor services, and address service gaps for caregivers.The Sources of Caregiver Stress and Support Scale is a contextually-sensitive self-report measure for caregivers of people with disabilities in Singapore.

A qualitative meta-synthesis of the caregiving experiences of adult children providing care for cancer patients in China: Implications for multidisciplinary healthcare teams

Qualitative meta-synthesis is a coherent approach to answering an overarching research question by synthesising past qualitative studies so as to create new meanings from their results. We conducted a qualitative meta-synthesis to systematically evaluate and integrate the caregiving experiences of adult children providing care for an elderly parent with cancer. The search was conducted in the databases Web of Science, PubMed, Embase, MEDLINE, Cochrane Library, Grew Literature in the Health Sciences, CNKI, WanFang Data, VIP, SINOMED and China Academic Journals as well as Chinese grey literature databases (China Academic Conference Literature Database/, National Science and Technology Library) from inception to June 9, 2021. Thirteen studies were included in the final synthesis. The caregiver experiences they describe are synthesised into three primary themes: care needs, care burden and care gains, with numerous secondary themes. Besides our findings that seem to align with those from studies focused on other cultures, we have highlighted three main discoveries from the synthesis that stand out in the Chinese context: (1) many sub-themes related to specific caregiving skills; (2) a strong expectation for health professionals to improve their communication skills with family caregivers; (3) the negative and positive influences of filial piety in caregiving experiences. Our findings can help multidisciplinary healthcare teams in China support adult children as caregivers in their emphasis on improving caregiver education and training, ways of making the most of potential care gains, and ways of easing care burdens.

Exploring the Motivations of Family Caregivers Caring for Older Persons in Urban Poor Accra, Ghana

There is a general paucity of studies on family caregivers' motivations for providing care to older persons in the urban poor context in Ghana. This study seeks to explore family caregivers' motivations for providing care to older persons in urban poor Accra, Ghana. A qualitative descriptive design was used and in-depth interviews were conducted with thirty-one family caregivers. The QSR NVivo 10 software was used to analyze the data thematically. We found that autonomous motivation inspired family caregivers to provide care. Empathy and affection intrinsically motivated some caregivers to provide care to their care recipients, while others were extrinsically motivated by filial responsibility, reciprocity, and obligation to provide care. These findings showed that family caregivers were autonomously motivated to provide care to older persons. We recommend the need for future studies to explore changes in family caregivers' motivations to provide care over time.

How Culture Shapes Informal Caregiver Motivations: A Meta-Ethnographic Review

The provision of informal care presents a significant global challenge. To better understand how cultural factors underpin and shape motivations and willingness to provide informal care for adults, an in-depth qualitative synthesis was conducted. Six electronic databases and a wide range of additional sources were searched. Following meta-ethnographic guidelines, 37 qualitative studies were synthesised. Six main concepts were identified: cultural self-identity, which appeared as an overarching explanatory concept; cultural duty and obligations; cultural values; love and emotional attachments; repayment and reciprocity; and competing demands and roles. These concepts informed a model of cultural caregiving motivations, offering an inductive-based exploration of key cultural motivators and highlighting implications for theory development, future research, policy and practice. The model holds implications for the actual exchange of care. Caregiver motivations should not be taken for granted by healthcare or social care professionals involved in assessment and support planning, educational endeavours at a population level may support caregiving, and support should be sensitive to cultural caregiving motivations.

Challenges of Help-Seeking in Iranian Family Caregivers of Patients with Cancer: A Qualitative Study

Background: The nature of cancer is such that it causes several problems for patients and caregivers. As a vital source of support for patients with cancer, family caregivers must seek assistance and make use of available resources to overcome these issues and offer better care for the patient. Objectives: This study aimed at exploring the challenges of seeking help in Iranian family caregivers of patients with cancer from supportive sources. Methods: This qualitative study was conducted from 2019 to 2021 on 15 family caregivers with a wide variety of caring experiences and 13 health professionals (i.e. nurse, physician, social worker, clergyman, and family counselor who were engaged with services for the patient and caregiver) via purposive sampling and semi-structured in-depth interviews in a central cancer care hospital in Isfahan. Graneheim and Lundman's conventional qualitative content analysis approach was used to analyze the data. To assess data trustworthiness, Lincoln and Guba's criteria were used. Data management was performed using MAXQDA (v. 10) software. Results: Four main categories were identified consisted of (1) being strained by social desirability; (2) stigmatizing attitudes toward help-seeking; (3) reactive self-forgetfulness; and (4) resistance to change. Conclusions: The need to develop and implement interventions geared to enhance family caregivers' preferred attitudes and personal skills in order to overcome socio-cultural obstacles to help-seeking behaviors was underlined in this research. Both health care professionals and the community should be prepared to make support services more accessible and usable for family caregivers.

Development and Validation of Filial Piety Representations at Parents’ End of Life Scale

Filial piety has a long historical standing in Chinese communities. However, the filial piety practices of adult children at the end of a parent’s life are under-explored. This study aims to develop a measurement for filial piety representations of the adult children of Macao Chinese, whose parents are at the stage of end of life. By adopting a scale development and validation framework, a 19-item Filial Piety Representations at Parents’ End of Life Scale (FPR-EoL) was formulated based on a Dual Filial Piety Model and literature, through procedures of item identification, panel review, cognitive interviews, and pre-test. The FPR-EoL was examined on 274 individuals. Factor analysis showed four factors in the scale; respect and comfort, acceptance of death, spending final days, and disclosing bad news. The Cronbach’s alpha of FPR-EoL was 0.73, and the four factors were 0.73, 0.66, 0.58 and 0.77, respectively. Discriminant validity was examined between FPR-EoL, the Good Death Inventory (GDI) and the Filial Piety Scale (FPS). The results suggested that there were differences between the three scales. FPR-EoL is found to be a reliable, valid and novel measure of filial piety representations among Macao Chinese. It may be a potential tool to probe and achieve good death among older persons of Chinese ethnicity in clinical settings.

Care v. Caring: Obligation, Duty, and Love Among Latino Alzheimer's Family Caregivers

The number of Latinos living with Alzheimer's disease is projected to grow. Latinos currently make one-fifth of U.S. family caregivers. In this paper, we explore the cultural scripts and gendered practice of care in Latino families in relation to the underutilization of services to persons with Alzheimer's disease and related dementias. We conducted interviews with 24 Latino caregivers in Miami-Dade, Florida representing six Latin American countries of origin. Interviews were analyzed using a grounded theory approach. We critically examined the concept of familism in order to better understand in-depth experiences of diverse Latino caregivers and concluded that an ethics of care model better elucidates the complexities of the care experience. Our analysis illustrates the ambivalence, contradictions, and changes in the beliefs and practice of care. These findings can help advance understanding among researchers and providers to develop a formal support system that is responsive to Latino caregiver needs.

Why do they care? A qualitative systematic review and meta-synthesis of personal and relational motivations for providing informal care

Informal caregiving is crucial to the sustainability of health and social care systems globally. With ageing populations and a rising prevalence of acute and chronic health conditions, the need for informal care is growing, making it important to understand what motivates individuals to care and to continue caring. This paper reports findings of a systematic review which examined determinants of motivations and willingness to provide informal care. A systematic search was conducted using six electronic databases and a wide range of additional sources. 105 qualitative studies published before August 2019 were included with 103 of them reporting on personal and relational motivations, and the contextual factors underpinning these. Grounded theory-based, thematic synthesis was applied to synthesise the literature. This meta-synthesis reports on findings from across the world spanning three decades, with data from over 2500 caregivers across a range of health conditions. This paper presents the relational, personal and contextual themes. It highlights the significance of reciprocity, affection, family values and caregiving obligations. Personal characteristics, finding meaning, illness perceptions, situational and temporal aspects of caregiving are also identified as important in shaping motivations and willingness to care and to continue caring. Implications for theory, research, policy and practice are discussed.

Perceptions of Stakeholders Toward "Hospital at Home" Program in Singapore: A Descriptive Qualitative Study

OBJECTIVE

Hospital at Home (HaH) programs have been shown to improve quality of care and patient satisfaction, and reduce bed occupancy rate in hospitals. Despite the prevalence of HaH in Western countries, studies in Asia are limited and the perception of HaH remains underexplored in Asian context. Understanding the perceptions of stakeholders is vital before implementing HaH in any new settings. Thus, the aim of this study is to explore the perceptions of referring physicians, care providers, patients, and caregivers on HaH programs in a multiracial country such as in Singapore.

METHODS

This study used a descriptive qualitative design. Participants from 2 tertiary hospitals in Singapore, including 13 referring physicians, 10 care providers, 15 patients, and 3 caregivers, were interviewed between June 2020 and September 2020. Data were analyzed using inductive thematic analysis.

RESULTS

The overarching theme titled "The stakeholders' perception on HaH" was pillared by 4 main themes: (1) patients suitable for HaH; (2) perceived advantages and benefits of HaH; (3) perceived risks, anxiety, and concerns about HaH; and (4) potential enablers of HaH. Overall, the findings reported that most of the stakeholders embraced HaH. Timely medical interventions and support from care providers were reportedly important factors to maintain patient safety and quality of care. The importance of having adequate resources and sound financing mechanisms to develop a successful HaH program was also highlighted.

CONCLUSIONS

This study offered insights into HaH from the perspectives of stakeholders in Singapore and facilitate the planning of future HaH pilot programs in multiracial Singapore and other Asian countries.

Factors associated with family caregiver burden among frail older persons with multimorbidity

Introduction

Singapore is facing an ageing population and the care needs of the population will increase in tandem. A segment of this population would be living with multimorbidity and frailty. Frailty is defined as an age-related state characterised by reduced strength and physiologic malfunctioning. Multimorbidity refers to the coexistence of multiple chronic conditions in an individual. Older adults are more likely to have frailty and multimorbidity, and this would increase the burden of their caregiver. Our study aimed to determine the prevalence of caregiver burden for primary family caregivers of frail older adults with multimorbidity. We also investigated the factors that were associated with primary family caregiver burden.

Methods

This was an interviewer-administered, cross-sectional study of primary family caregivers of frail older patients with multimorbidity that was conducted in two National Healthcare Group polyclinics. Convenience sampling was used. The 12-item Zarit Burden Index (ZBI) was used to assess primary family caregiver burden. The scores of the ZBI range from 0 to 48, with a score of 10 or above indicating that the primary family caregiver perceives burden. Descriptive statistics were used to provide information regarding the caregivers and the care recipients. Multivariable logistic regression was used to investigate the factors affecting primary family caregiver burden.

Results

One hundred eighty-eight family caregivers were interviewed and 71.8% of them perceived burden on the ZBI. 59.6% were caregivers to their parents and 18.1% of them had multimorbidity. Almost two-thirds of the caregivers interviewed were female. After adjusting for other factors via multivariable analysis, the ethnicity of the caregiver and the increase in time spent caregiving per week were the two factors positively associated with family caregiver burden. A Chinese primary family caregiver had almost three times the odds of perceiving burden when compared to a non-Chinese primary family caregiver.

Conclusion

Caregiver burden was high amongst primary family caregivers of frail older adults with multimorbidity. Being a Chinese primary family caregiver compared to non-Chinese ethnic groups as well as being a primary family caregiver who spent increased time caregiving per week were the two factors positively associated with family caregiver burden. Further exploratory, qualitative studies can be done to find out the reasons to Chinese primary family caregivers being more burdened compared to the non-Chinese primary family caregivers. In addition, the specific factors related to increased time caregiving per week and family caregiver burden can also be studied.

Cultural and societal motivations for being informal caregivers: a qualitative systematic review and meta-synthesis

Informal caregiving constitutes the mainstay of a society's care supply. Motivations for caring and continuing to provide care are crucial to understanding the nature of caregiver experiences and their relationship with the person/people they support. This systematic review of qualitative evidence examines determinants of motivations and willingness to provide informal care. 105 qualitative studies published before August 2019 and fitting the inclusion criteria were identified, 84 of them pertaining to cultural and societal motivations for caregiving. Grounded theory-based, thematic synthesis was conducted. Cultural and societal factors strongly underpinned motivations and willingness for informal caregiving. The main cultural motives for caregiving were cultural values and beliefs encompassing the ethnocultural context of the caregiving role, culture-specific norms, cultural and spiritual beliefs, illness beliefs and socialisation. Societal norms and perceived expectations, such as gendered roles, norms and expectations of caregiving, and perceptions of health and social care services further shaped caregiver motivations and willingness to provide care. These meta-synthesis findings contribute towards novel understandings about the cultural and societal aspects shaping informal care provision. These findings bear important implications for theory, research, policy and practice; all of which contributing to the issue of the sustainability of informal care from a 'macro' perspective.

Experiences and needs of the caregivers of stroke survivors in Malaysia-A phenomenological exploration

Introduction

Informal caregivers play a crucial role in supporting the activities of daily living, rehabilitation, and the road to recovery for stroke survivors. However, these informal caregivers are often reported as experiencing neglect and lack of recognition despite their primary contribution to stroke recovery. This study investigated the experiences of the caregivers of stroke survivors and access to stroke care in Malaysia.

Method

This qualitative study with a phenomenological approach utilized in-depth interviews, including ten primary caregivers, one formal caregiver, and stroke healthcare providers as the participants. The interviews were done until the data saturation was achieved, and the data was analyzed using thematic analysis.

Result

Three primary themes and 14 subthemes were identified from the interviews. The role of primary caregivers of stroke survivors had tremendous physical, mental and social impact on the caregivers. Caregivers had two primary needs. The need for information about comprehensive stroke care at home and the need for psychological support to themselves. The key internal driver for providing care was identified to be the motivation level of the stroke survivor and the external driver was identified to be the societal support with access to comprehensive stroke care.

Conclusion

The role of informal caregivers becomes critical for continuum of stroke care. As caregivers take up the roles and responsibilities of those who contribute to stroke rehabilitation single-handedly soon after hospital discharge. Results of this study highlights the needs for providing systematic support to caregivers for engaging them in effective stroke care, particularly in the community. Stroke service providers, policy makers and program planners must be sensitized to empower caregivers of stroke survivors in effectively supporting stroke survivor in their family on the road of recovery.

The relationship between filial piety and caregiver burden among adult children: A systematic review and meta-analysis

INTRODUCTION

Filial piety is an important cultural value in aging societies. However, mixed findings were identified regarding its influence on caregiver burden. The purpose of this meta-analysis was to clarify the relationships between filial concepts and caregiver burden.

METHOD

Twelve databases on filial piety, filial obligation, and caregiver burden among adult children prior to January, 2020 were systematically cross-culturally reviewed.

RESULTS

Twelve studies were finalized for analysis. Fixed effect models indicated that stronger filial piety was significantly correlated (r = -.23) or associated with (β = -.27) less caregiver burden. However, no significant relationship between filial obligation and caregiver burden was revealed by random effect models.

CONCLUSION

Stronger filial piety may lessen caregiver burden. Therefore, filial piety should be assessed and supported in adult child caregivers, particularly in Eastern cultures. However, the concept of filial piety and its tools should be updated transculturally. PROSPERO Registration Number: CRD42020161969.

Older adult and family caregiver experiences with prescription medication labels and their suggestions for label improvement

Background

Prescription medication labels (PMLs) are an important source of written medication information for patients. However, real-world PMLs do not entirely conform with available labelling best practices and guidelines. Given this disconnect, older adults remain particularly at risk of misinterpreting their PMLs. Past studies have commonly assessed hypothetical PMLs, warranting studies that explore the lived experiences of older adults with real-world PMLs. Furthermore, the perspective of family caregivers of older adults is yet to be studied.

Objective(s)

This qualitative study documented the challenges faced by older adults and their family caregivers in using real-world PMLs, their strategies to cope with these challenges, and their suggestions to improve existing PMLs.

Methods

We conducted two focus group discussions (n = 17) and 30 in-depth interviews with older adults (n = 20; including those who can read in English and those with limited English proficiency) and caregivers (n = 10) in Singapore. The data were systematically assigned to codes that were continuously refined to accommodate emergent themes.

Results

Challenges, coping strategies and suggested improvements were related to the comprehensibility, availability, readability and consistency of medication information on PMLs.

Conclusions

Real-world PMLs continue to pose challenges for older adults and their caregivers, necessitating them to seek unique and personal coping strategies. The identified PML improvements, desired by older adults and their caregivers, urge healthcare systems to implement improved PMLs. Future research should explore system-level logistical, financial, and administrative barriers (or opportunities) that hinder (or facilitate) this implementation.

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Older adults and caregivers still face challenges with English medicine labels.

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Small font and lack of desired information were also enduring challenges.

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Inconsistency in label format and content confused older adults and caregivers.

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Caregivers and pharmacy staff adopted unique strategies to help older adults.

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Challenges and ad-hoc strategies necessitate real-world, systemic change to labels.

Older cancer survivors living with financial hardship in China: A qualitative study of family perspectives

OBJECTIVE

Financial hardship among older cancer survivors has not been well-studied, despite its debilitating effects on their health and well-being. The purpose of this study was to describe the lived experiences of Chinese older cancer survivors who have experienced financial hardship following a cancer diagnosis.

METHODS

A qualitative study was conducted. Data was collected using in-depth interviews with 21 older cancer survivors (aged ≥ 60) with financial hardship and 20 family caregivers in Shandong Province, China between August 2020 and January 2021. Data were analyzed using Colaizzi's phenomenological method.

RESULTS

Four main themes emerged: (1) older survivors have insufficient ability to address cancer-related costs; (2) financial transfers from adult children to older parents became prevalent after a cancer diagnosis; (3) cancer-related financial worries and stress extended into children's families; (4) coping and adjustment strategies were used by the extended family. Traditional Confucian culture and the Chinese health care system considerably impacted the interpretation of financial hardship.

CONCLUSION

Both older cancer survivors and their adult children experienced financial distress impacted by filial piety in China. Strategies adapted to Confucian family values and the health care system are needed to address cancer-related financial hardships.

Types of Caregiving Experience and Their Association With Caregiver Depressive Symptoms and Quality of Life

ObjectiveThis study examines distinct types of caregiving experience, each formed by varied combinations of caregiving burden and benefits, and their association with caregiver depressive symptoms and quality of life. Methods: We apply latent profile analysis and multivariable regression to data on 278 caregivers participating in the Caregiving Transitions among Family Caregivers of Elderly Singaporeans (TraCE) study in 2019-2020. Results: We identify four caregiving experience types: (1) balanced (low burden and moderate benefits, 40% of caregivers), (2) satisfied (low burden and high benefits, 33%), (3) intensive (high burden and high benefits, 17%), and (4) dissatisfied (moderate burden and low benefits, 10%). Caregivers with dissatisfied and intensive caregiving experience tend to report higher depressive symptoms and lower quality of life compared to those with satisfied caregiving experience. Discussion: A person-centered approach helps capture the heterogeneity in caregiving experience. Policymakers should develop tailored interventions by caregiving experience types for promoting caregiver well-being.

What Makes Chinese Adult Children Behave Differently during Parents' End of Life: A Discriminant Analysis of Macao Chinese

The daily practice of filial piety (FP) is well prescribed under the traditional filial norms in the Chinese community. However, exploration of FP practices at the end of parents' lives is limited. The current study explored the FP representation and good death preferences of Macao Chinese. A cross-sectional web-based survey was conducted and discriminant analysis was used to identify possible predictors of FP representation in the context of parents' end of life. Results showed that Macao Chinese were inclined to perform most of the filial duties in the last journey of their parents. Among 705 participants, 150 (21.3%) tended to practice authoritarian FP, and 555 (78.7%) tended to practice reciprocal FP. Age, education, religion, and good death preferences were identified as predictors of different FP representation groups. The findings could help clinicians to obtain a preliminary perception of FP representation of Chinese patients and to determine the appropriate approach for end-of-life care from a family perspective.

Motivations and willingness to provide care from a geographical distance, and the impact of distance care on caregivers' mental and physical health: a mixed-method systematic review protocol

INTRODUCTION

Distance caregivers (DCGs) are a growing population with substantial contribution to informal care. While a reasonable amount is known on the determinants of motives and willingness to provide local informal care, and the local caregiver outcomes, reports for the distance caregiving population are lacking. An evidence synthesis of what motivates and makes DCGs willing to care from a distance and the impact of that care on their mental and physical health would highlight any gaps or consensus in knowledge. This would guide the research needed towards the development of tailored interventions, in order to support DCGs and promote the sustainability of distance care.

METHODS AND ANALYSIS

This protocol adheres to Preferred Items for Reporting of Systematic Reviews and Meta-Analyses Protocols guidelines and the Joanna Briggs Institute (JBI) Methodology for mixed-method reviews. A comprehensive search strategy will be conducted in four electronic databases (CINAHL, MEDLINE, PubMed and PsycINFO). Grey literature will also be assessed to minimise publication bias. Two independent reviewers will assess each study for inclusion and any discrepancies will be resolved with the consultation of a third reviewer. Eligible studies for inclusion will be English language studies exploring the motives and willingness to care for a care recipient with a chronic disease, disability or frailty from a geographical distance; or studies focusing on the mental and physical health outcomes of DCGs. Qualitative and quantitative data will be integrated in a single qualitative synthesis following the JBI convergent integrated approach. Study quality will be assessed using the Mixed Methods Appraisal Tool version 2018.

ETHICS AND DISSEMINATION

Ethical approval is not required for this study as no primary data will be collected. Findings will be disseminated through peer-reviewed publication and presentations at academic conferences and lay summaries for various stakeholders.

PROSPERO REGISTRATION NUMBER

CRD42020156350.

"He Just Doesn't Want to Get Out of the Chair and Do It": The Impact of Apathy in People with Dementia on Their Carers

Apathy, defined as a lack of motivation, is a prevalent and persistent behavioural and psychological symptom of dementia. Limited research suggests that apathy is associated with increased carer burden, but there are no studies investigating carers’ subjective experiences of apathy. This study aimed to fill this gap and explore the lived experience of apathy in dementia from the perspectives of the people with dementia and their carers. This article reports on the carers’ perspectives. Six dyads of people with dementia and carers participated in semi-structured interviews, which were analysed using interpretative phenomenological analysis. Three superordinate themes were identified: (1) achieving a balance of conflicting emotions—the challenges of apathy led to feelings of guilt, acceptance, and frustration; (2) new roles imposed by caring, which involved taking on new responsibilities and promoting remaining interests of person with dementia; and (3) having a life of one’s own—coping with apathy by talking to others, and spending time away from the caring role. This study highlighted that carers are caught in a struggle between wanting to involve the person with dementia in decisions and finding that they cannot if they want to overcome the hurdle of apathy. Implications of this study suggest that a wider understanding of apathy at a societal level could lead to the provision of a helpful forum for carers to share their experiences.

Burden of caregivers who care for oldest-old parents with disability: A cross-sectional study

OBJECTIVE

To describe the characteristics of oldest-old Chinese with disability and their adult-child caregivers, and the extent to which these characteristics were associated with caregiver burden.

METHODS

The study was based on 168 pairs of disabled oldest-old adults and their adult-child caregivers, derived from the Chinese Longitudinal Healthy Longevity Survey. Descriptive analyses of care recipients' and caregivers' characteristics were conducted respectively, in reference to caregiver burden. Statistically significant characteristics identified in these bivariate analyses were then jointly evaluated in multiple linear regression models with caregiver burden as the outcome.

RESULTS

Care recipients positive emotion status [(β = -0.227 (-0.412, -0.042)], multiple chronic disease [(β = 0.513 (0.081, 0.945)], and caregivers spent more caregiving time [(β = 0.225 (0.061, 0.389)] were main factors associated with caregiver burden.

CONCLUSION

Adult-children caregivers perceived heavier burden if care recipients had low positive emotions, had multiple chronic diseases, and caregivers spent more time caregiving.

Measuring the Burden on Family Caregivers of People With Cancer: Cross-cultural Translation and Psychometric Testing of the Caregiver Reaction Assessment-Indonesian Version

Supplemental digital content is available in the text.

Background

The Caregiver Reaction Assessment (CRA) is considered one of the well-developed instruments for measuring the multidimensional burden of family caregivers. To date, there is no available validated instrument to assist healthcare professionals in measuring the caregiver’s burden in Indonesia.

Objective

To translate the CRA from English into Indonesian and to conduct psychometric testing of this CRA–Indonesian version (CRA-ID) with family caregivers of patients with cancer.

Methods

Cross-cultural translation and psychometric testing were conducted. Confirmatory factor analysis and exploratory factor analysis were performed to check, explore, and confirm the best model for the CRA-ID; internal consistency was also measured.

Results

A total of 451 respondents participated, of whom 40 were involved in the feasibility testing. Confirmatory factor analysis with the original factors of the CRA revealed that the fit was not satisfactory, and adaptation was needed. Through exploratory factor analysis, the best model fit was developed, and confirmatory factor analysis was performed again. Five factors from the original instrument were confirmed with an explained variance of 54.89%. Almost all items in the CRA-ID appeared to have a similar structure as the original version. Cronbach's α's ranged between .64 and .81.

Conclusions

The CRA-ID appeared to be feasible, valid, and reliable for measuring the burden of family caregivers of patients with cancer in Indonesia.

Implications for Practice

Nurses can use the CRA-ID to measure family caregivers’ burden. Its availability in the Indonesian language enhances the opportunity to conduct international comparisons of family caregiver burden using the same instrument.

The experience of bereavement on family caregivers of people with dementia in China

BACKGROUND AND OBJECTIVES

Despite many studies on 'life after care' for family caregivers with dementia in Western societies, little is known about the bereavement experiences of family caregivers in China. The aim of this study was to explore the experience of bereavement on family members of people with dementia in China. It also hopes to inform end-of-life care within communities, providing a theoretical basis for improving the quality of life of bereaved family caregivers.

METHODS

Interpretative phenomenological analysis approach was adapted for this study. Purposive sampling was used to recruit former family caregivers of people with dementia. Semi-structured in-depth interviews with 12 bereaved family caregivers were collected. Thematic analysis was used for data analysis.

FINDINGS

Five themes were identified: recalling the past life, lack of support, uncertainty of the future, social withdrawal and acceptance and release.

CONCLUSION

The experiences of bereavement on family members of people with dementia in China are socially and culturally complex. This article recommends that bereavement should be supported throughout the palliative process of community services and healthcare services. Providing all-round support and education on death and dying can help the family caregivers to pass through grief and help them to maintain their normal life.

Caregiver burden among informal caregivers in the largest specialized palliative care unit in Malaysia: a cross sectional study

BACKGROUND

Informal caregivers (IC) are often overshadowed by the attention required by the terminally ill. This study aims to reveal the estimated proportion of caregiver burden, psychological manifestations and factors associated with caregiver burden among IC in the largest specialized Palliative Care Unit (PCU) in Malaysia.

METHODS

This was a cross-sectional study involving IC attending a PCU. Caregiver burden and psychological manifestations were measured using previously translated and validated Zarit Burden Interview and DASS-21 questionnaires respectively. Two hundred forty-nine samples were selected for analysis.

RESULT

The mean ZBI score was 23.33 ± 13.7. About half of the population 118(47.4%) was found to experienced caregiver burden whereby majority have mild to moderate burden 90(36.1%). The most common psychological manifestation among IC is anxiety 74(29.7%) followed by depression 51(20.4%) and stress 46(18.5%). Multiple logistic regression demonstrated that women who are IC to patients with non-malignancy were less likely to experience caregiver burden. IC who were highly educated and spent more than 14 h per day caregiving were at least twice likely to experience caregiver burden. Finally, those with symptoms of depression and anxiety were three times more likely to suffer from caregiver burden.

CONCLUSION

Caregiver burden among IC to palliative patients is prevalent in this population. IC who are men, educated, caregiving for patients with malignancy, long hours of caregiving and have symptoms of depression and anxiety are at risk of developing caregiver burden. Targeted screening should be implemented and IC well-being should be given more emphasis in local policies.

Caring for home-dwelling parents with dementia: A qualitative study of adult-child caregivers' motivation

Aim

To explore adult children's motivation in caregiving for their home-dwelling parents with dementia.

Design

Qualitative design with a phenomenological approach.

Methods

Semi-structured individual interviews with 21 adult sons and daughters who were caregivers for a parent with dementia. Data were analysed using systematic text condensation.

Results

Inspired by self-determination theory, three categories were identified in the empirical data representing the main motivational drivers for adult-child caregivers: relatedness (to the parent with dementia, the parent's spouse, other persons), competence (in handling dementia, in the parent's need) and autonomy (freedom of choice, innate values and tasks). Caregivers report relatedness as their key motivational driver.These results imply that nurses and other health professionals should value the importance of relatedness when interacting with dementia caregivers and establish belonging support structures. Further research should generate more knowledge of the positive motivational drivers, including interventions to improve relatedness, competence and autonomy.

Burden, quality of life, anxiety, and depressive symptoms among caregivers of hemodialysis patients: The role of social support

OBJECTIVE

The purpose of this study was to determine how burden and quality of life predict anxiety and depressive symptoms among caregivers of hemodialysis patients. Social support was included in the model as a proposed moderator in the above relationships.

METHODS

This cross-sectional study involved 340 caregivers of chronic kidney patients undergoing hemodialysis. The setting was in Terengganu, Malaysia. The caregivers completed the measures of caregiving burden, quality of life, social support, and symptoms of anxiety and depression.

RESULTS

About 28.8% and 52.4% of caregivers showed clinically moderate levels of anxiety and depressive symptoms, respectively. Furthermore, 35.9% and 3.8% of them showed clinically high levels of anxiety and depressive symptoms, respectively. Analyses showed that general quality of life was a significant predictor of both anxiety and depressive symptoms. Burden and psychological domains of quality of life significantly predicted anxiety. In addition, a lack of social support was a determinant of depressive symptoms. Evidence suggested that social support moderated the burden-anxiety relationship. Specifically, caregivers with low levels of social support showed more elevated levels of anxiety symptoms when their burden was higher.

CONCLUSION

There is an urgent need for early detection to initiate prompt treatment in this population. The study provides some important insights into offering comprehensive intervention to help caregivers cope more effectively through the provision of sufficient social support to buffer the effects of caregiving burden and improve mental health.

Blessings or burdens: an Interpretative Phenomenological Analysis (IPA) study on the motivations and their impact on end-of-life caregiving among Asian family caregivers

BACKGROUND

While the impact of family caregiving has been well-documented, many of such studies center on investigating external factors such as socioeconomic status, accessibility to resources and availability of social support as the primary causation of caregiver wellbeing outcomes. This paper explores the motivations that drive family caregivers in supporting their family members at the end-of-life, and critically examines how internal appraisal processes of such motivations can both positively and negatively impact their wellbeing.

METHODS

This study adopted an interpretative phenomenological analysis (IPA) to investigate the motivations and internal appraisal processes of Asian family caregivers in Singapore who were tending to a dying family member. Qualitative dyadic interview data (N = 20) was drawn from a larger Randomized Controlled Trial for a novel Family Dignity Intervention (FDI) for palliative care patients and their families. The sampling population consisted of participants aged 21 and above who were identified to be the primary caregivers of older palliative care patients with a prognosis of less than 12 months. Data collection was conducted in the homes of patients and family caregivers.

RESULTS

Findings revealed six themes that could either nurture or diminish caregiver wellbeing: 1) Honoring Fidelity (caregivers were motivated to commit to their caregiving roles in order to avoid regret), 2) Alleviating Suffering (caregivers were motivated to relieve their family member's pain), 3) Enduring Attachment (caregivers were motivated to spend time together with their family member), 4) Preserving Gratitude (caregivers were motivated to express their appreciation to their family member by caregiving), 5) Navigating Change (caregivers were motivated to adapt accordingly to changes in the illness trajectory) and 6) Reconciling with Mortality (caregivers were motivated to respond accordingly to their family member's prognosis). The final theme of the Wellbeing Determinant is posited as an indication of self-determination, and is conjectured to influence how caregiving motivations are appraised by the caregiver.

CONCLUSION

Fulfilling and enhancing one's sense of self-determination appears central to infusing one's caregiving motivations with positive meaning, and consequently nurturing one's wellbeing in the end-of-life caregiving journey. These findings are discussed with recommendations for healthcare professionals working with family caregivers of palliative care patients.

Validation of the Needs Assessment of Family Caregivers-Cancer scale in an Asian population

BACKGROUND

The Needs Assessment of Family Caregivers- Cancer (NAFC-C) scale is shown to have adequate psychometric properties in assessing family caregiver needs during the cancer journey and its psychometric properties have been studied only in Western populations. This study sought to validate the NAFC-C in an Asian population for wider applicability.

METHODS

Participants (n = 363) completed questions on sociodemographics, the Depression Anxiety Stress Scale, the Zarit Burden Interview, the Caregiver Quality of Life Index-Cancer scale, and the NAFC-C.

RESULTS

Results revealed good internal consistency, test-retest reliability, and concurrent validity of the NAFC-C. Confirmatory factor analysis did not demonstrate a good fit of the NAFC-C in our sample. Exploratory factor analysis revealed a similar factor structure in this study's population. Further reliability and validity analyses with the EFA factor structure demonstrated similar reliability and validity assessments.

CONCLUSIONS

The NAFC-C is shown to be applicable in an Asian population. It would be a useful instrument for determining family caregivers' needs and to inform future interventions to address those needs and improve or maintain quality of life in both patients and their caregivers.

Factors Associated With Resilience Among Primary Caregivers of Patients With Advanced Cancer Within the First 6 Months Post-Treatment in Taiwan: A Cross-Sectional Study

PURPOSE

To identify factors associated with resilience in primary caregivers of patients with advanced oral cavity cancer within the first 6 months post-treatment.

DESIGN

A cross-sectional study.

METHODS

We recruited patient-primary caregiver dyads from the outpatient radiation department of a medical center in Northern Taiwan. Patients were assessed using a set of structured questionnaires to measure performance status and demographic and clinical characteristics. Primary caregivers were measured in their social support, resilience, and care characteristics.

RESULTS

Of the 148 dyads surveyed, 33.8% of primary caregivers reported moderately low to moderate resilience, and 61.5% reported low resilience. Greater resilience of primary caregivers was associated with the primary caregiver factors of younger age, lower educational level, and more affectionate social support; and greater resilience was associated with the patient factors of better performance status and older age. These factors explained 40.4% of the variance in resilience.

CONCLUSIONS

Patients' performance status and primary caregivers' affectionate social support strongly influence overall resilience and each domain of resilience.

CLINICAL RELEVANCE

Providing primary caregivers with sufficient social resources and a support group can help them cope with the demands of caregiving for loved ones with oral cavity cancer.