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Tungsanga S, Bello AK. Prevention of Chronic Kidney Disease and Its Complications in Older Adults. Drugs Aging 2024; 41:565-576. [PMID: 38926293 DOI: 10.1007/s40266-024-01128-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2024] [Indexed: 06/28/2024]
Abstract
In an era marked by a global demographic shift towards an aging society, there is a heightened prevalence of chronic kidney disease (CKD) among older adults. The burden of CKD spans from kidney-related complications to impacting psychological well-being, giving rise to depressive symptoms and caregiver burnout. This article delves into CKD prevention strategies within the context of aging, contributing to the discourse by exploring its multifaceted aspects. The prevention of CKD in the older adults necessitates a comprehensive approach. Primary prevention is centered on the modification of risk factors, acknowledging the intricate interplay of various comorbidities. Secondary prevention focuses on early CKD identification. Tertiary prevention aims to address factors contributing to CKD progression and complications, emphasizing the importance of timely interventions. This comprehensive strategy aims to enhance the quality of life for individuals affected by CKD, decelerating the deterioration of functional status. By addressing CKD at multiple levels, this approach seeks to effectively and compassionately care for the aging population.
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Affiliation(s)
- Somkanya Tungsanga
- Division of Nephrology and Immunology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
- Division of General Internal Medicine-Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Aminu K Bello
- Division of Nephrology and Immunology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
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Gazaway S, Gutierrez O, Wells R, Nix‐Parker T, Lyas C, Daniel S, Lang‐Lindsey K, Bryant T, Knight R, Odom JN. Exploring the health-related decision-making experiences of people with chronic kidney disease and their caregivers: A qualitative study. Health Expect 2023; 27:e13907. [PMID: 37926914 PMCID: PMC10757106 DOI: 10.1111/hex.13907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 10/21/2023] [Accepted: 10/24/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND This study aimed to explore the decision-making experience of patients with chronic kidney disease (CKD) and their caregivers. METHODS This was a qualitative descriptive study of the decision-making experiences of individuals with stage 3-end-stage CKD and their family caregivers. One-on-one, semistructured interviews were conducted using a guide developed and approved by a community advisory group. Data were analyzed using thematic analysis. RESULTS Three themes were identified: (1) decisions triggered by declining health and broad in scope, (2) challenges to decision-making and (3) factors influencing decision-making. Participants' experiences with health-related decision-making demonstrated that decisions were triggered when health declined. Yet, decisions that impact disease progression were being made in stage 3. Decision-making was made difficult due to lack of information, complex co-morbidities, and poor resource utilization. However, the structure and nature of the medical appointment, supportive caregivers, and resources served to remove challenges. CONCLUSION Decision-support interventions must train patients and caregivers to be empowered participants in answer-seeking behaviours upstream of advanced illness. PUBLIC CONTRIBUTIONS This work was conducted in full collaboration with a community advisory board consisting of patients with CKD, caregivers and clinicians. These members are noted in the acknowledgement section, and those who worked with the team to develop the interview guide, study protocols, and manuscript preparation are included as authors. As part of their role, advisory members met monthly, providing input on recruitment, study progress, inclusion of diverse voices and added relevance to study findings.
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Affiliation(s)
- Shena Gazaway
- Division Family, Commuity, & Health Systems, School of NursingUniversity of Alabama at BirminghamBirminghamAlabamaUSA
- Center for Palliative and Supportive CareUniversity of Alabama at BirminghamBirminghamAlabamaUSA
- Nephrology Training and Research CenterUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Orlando Gutierrez
- Nephrology Training and Research CenterUniversity of Alabama at BirminghamBirminghamAlabamaUSA
- Division of Nephrology, Heersink School of MedicineUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Rachel Wells
- Center for Palliative and Supportive CareUniversity of Alabama at BirminghamBirminghamAlabamaUSA
- Division‐Acute, Chronic & Continuing Care, School of NursingUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Tamara Nix‐Parker
- School of NursingUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Claretha Lyas
- Division of Nephrology, Heersink School of MedicineUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Shawona Daniel
- Division‐Acute, Chronic & Continuing Care, School of NursingUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Katina Lang‐Lindsey
- Department of Social Work, Psychology and CounselingAlabama A&M UniversityHuntsvilleAlabamaUSA
| | | | | | - James N. Odom
- Center for Palliative and Supportive CareUniversity of Alabama at BirminghamBirminghamAlabamaUSA
- Division‐Acute, Chronic & Continuing Care, School of NursingUniversity of Alabama at BirminghamBirminghamAlabamaUSA
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Burden, depression and anxiety effects on family caregivers of patients with chronic kidney disease in Greece: a comparative study between dialysis modalities and kidney transplantation. Int Urol Nephrol 2023; 55:1619-1628. [PMID: 36720745 DOI: 10.1007/s11255-023-03482-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 01/21/2023] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Burden of caregivers is a status that was identified as a consequence of daily care. Anxiety and depression are probably related to complex tasks interwined with the care of a family member suffering from chronic kidney disease (CKD). PURPOSE To examine the experienced burden, anxiety and depression of Greek caregivers of patients with End-Stage CKD on dialysis as well as kidney transplant recipients (TX) in relation to their demographic profile and to compare among the groups. METHODS A total of 396 participants (198 couples of patients and caregivers) were recruited. Structured interviews and self-completed questionnaires were obtained from patients undergoing dialysis modalities as well as TX (28 peritoneal dialysis patients, 137 hemodialysis patients, 33 TX) and their caregivers. Zarit Burden Interview, Beck Depression Inventory and the Generalized Anxiety Disorder-2 scales were used as screening tools. RESULTS The majority of caregivers were females (67.2%), with a median age of 58 years. Total burden was indicated as mild to moderate (Mdn = 36 (24-51)). Caregivers of haemodialysis (HD) patients showed the highest burden (Mdn = 40 (26-53)) followed by peritoneal dialysis(PD) (Mdn = 29 (25-51)) and TX group (Mdn = 28 (21-43)) (p = 0.022). Caregivers' depression and anxiety were related to the type of patients' treatment, as well. Caregivers of HD and PD patients reported significantly higher depression (Mdn = 11 (5-18)) and anxiety scores (Mdn = 3 (2-5)) in comparison to TX caregivers (Mdn = 6 (2-13) and Mdn = 2 (2-4)) (p = 0.045 and p = 0.04, respectively). CONCLUSION Caregivers of TX patients appeared to have less burden, depression and anxiety levels compared with caregivers of patients on dialysis modalities. Caregivers' burden is significantly associated with anxiety, depressive symptoms, gender, duration of caregiving, educational level, financial status and caregivers' age.
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Oberdhan D, Palsgrove AC, Cole JC, Harris T. Caregiver Burden of Autosomal Dominant Polycystic Kidney Disease: A Qualitative Study. Kidney Med 2022; 5:100587. [PMID: 36686593 PMCID: PMC9852954 DOI: 10.1016/j.xkme.2022.100587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Rationale & Objective There is limited published research on how autosomal dominant polycystic kidney disease (ADPKD) impacts caregivers. This study explored how caregivers of individuals with ADPKD perceive the burdens placed on them by the disease. Study Design Qualitative study consisting of focus groups and interviews. Discussions were conducted by trained interviewers using semi-structured interview guides. Setting & Participants The research was conducted in 14 countries in North America, South America, Asia, Australia, and Europe. Eligible participants were greater than or equal to 18 years old and caring for a child or adult diagnosed with ADPKD. Analytical Approach The concepts reported were coded using qualitative research software. Data saturation was reached when subsequent discussions introduced no new key concepts. Results Focus groups and interviews were held with 139 participants (mean age, 44.9 years; 66.9% female), including 25 participants who had a diagnosis of ADPKD themselves. Caregivers reported significant impact on their emotional (74.1%) and social life (38.1%), lost work productivity (26.6%), and reduced sleep (25.2%). Caregivers also reported worry about their financial situation (23.7%). In general, similar frequencies of impact were reported among caregivers with ADPKD versus caregivers without ADPKD, with the exception of sleep (8.0% vs 28.9%, respectively), leisure activities (28.0% vs 40.4% respectively), and work/employment (12.0% vs 29.8%, respectively). Limitations The study was observational and designed to elicit concepts, and only descriptive analyses were conducted. Conclusions These findings highlight the unique burden on caregivers in ADPKD, which results in substantial emotional, social, and professional/financial impact.
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Affiliation(s)
- Dorothee Oberdhan
- Otsuka Pharmaceutical Development & Commercialization, Inc, Rockville, Maryland,Address for Correspondence: Dorothee Oberdhan, Otsuka Pharmaceutical Development & Commercialization, Inc, 2440 Research Blvd, Rockville, MD 20850.
| | - Andrew C. Palsgrove
- Otsuka Pharmaceutical Development & Commercialization, Inc, Rockville, Maryland
| | | | - Tess Harris
- PKD International, London, UK,PKD Charity, London, UK
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Bártolo A, Sousa H, Ribeiro O, Figueiredo D. Effectiveness of psychosocial interventions on the burden and quality of life of informal caregivers of hemodialysis patients: a systematic review. Disabil Rehabil 2022; 44:8176-8187. [PMID: 34913777 DOI: 10.1080/09638288.2021.2013961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE To systematically review the effectiveness of psychosocial interventions developed for informal caregivers of hemodialysis patients. METHODS Relevant studies were identified through five electronic databases: PubMed, Scopus, Web of Science, ProQuest, and the CENTRAL. Randomized controlled trials (RCTs) and quasi-experimental studies describing interventions for informal caregivers of adult in-center hemodialysis patients (≥18 years old) were included and independently appraised by two reviewers using the Joanna Briggs Institute Statistics Assessment and Review Instruments critical appraisal checklists. RESULTS Eleven articles evaluating eight intervention programs were included in this review, covering a total of 729 informal caregivers. Most studies implemented educational or psycho-educational interventions (n = 6). Psycho-educational interventions designed to promote caregivers' ability to care and to cope with the caregiving role had positive effects on burden and/or quality of life. Psychological interventions also had large effects on reducing the burden over time. CONCLUSIONS There are still few interventions available to caregivers of hemodialysis patients. Psychosocial interventions showed great potential in improving the caregiver burden and quality of life. Further research with rigorous designs is needed to achieve stronger evidence on the extent of the current findings. TRIAL REGISTRATION NUMBER CRD42021247916.Implications for rehabilitationPatients with end-stage renal disease (ESRD) undergoing in-center hemodialysis often require emotional and/or practical support from family members or friends.Research has consistently shown that informal caregivers of hemodialysis patients may experience significant burden and a negative impact on their quality of life as a result of their caregiving role during the disease trajectory.This review evidenced that intervention programs involving education and psychological strategies had large positive effects on reducing caregiver burden and improving quality of life.The findings provide valuable evidence to recommend the inclusion of psychosocial programs to family caregivers as part of comprehensive renal care.
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Affiliation(s)
- Ana Bártolo
- Center for Health Technology and Services Research (CINTESIS.UA), Piaget Institute - ISEIT/Viseu, Viseu, Portugal
| | - Helena Sousa
- Department of Education and Psychology, Center for Health Technology and Services Research (CINTESIS.UA), University of Aveiro (Campus Universitário de Santiago), Aveiro, Portugal
| | - Oscar Ribeiro
- Department of Education and Psychology, Center for Health Technology and Services Research (CINTESIS.UA), University of Aveiro (Campus Universitário de Santiago), Aveiro, Portugal
| | - Daniela Figueiredo
- School of Health Sciences, Center for Health Technology and Services Research (CINTESIS.UA), University of Aveiro (Campus Universitário de Santiago), Aveiro, Portugal
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Vart P, Heerspink HJ. Progress and opportunities in measuring the burden of Chronic Kidney Disease. Lancet Reg Health Eur 2022; 20:100447. [PMID: 35781927 PMCID: PMC9241022 DOI: 10.1016/j.lanepe.2022.100447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Priya Vart
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Internal Medicine (Section of Nephrology), University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Corresponding author at: Department Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Hanzeplein 1, 9700 RB Groningen, the Netherlands.
| | - Hiddo J.L. Heerspink
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- The George Institute for Global Health, Sydney, Australia
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Walavalkar A, Craswell A, Gray NA. Experiences of Caregivers of Patients With Conservatively Managed Kidney Failure: A Mixed Methods Systematic Review. Can J Kidney Health Dis 2022; 9:20543581221089080. [PMID: 35450152 PMCID: PMC9016578 DOI: 10.1177/20543581221089080] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 02/07/2022] [Indexed: 11/24/2022] Open
Abstract
Background: Older people with kidney failure often choose conservative kidney care. The
experiences and quality of life (QOL) of caregivers who support them are
incompletely characterized. Objective: To determine the burden, QOL, and understand experiences of caregivers
supporting patients managed conservatively. Design: Systematic review of quantitative and qualitative studies. Sources of information: PubMed, Embase, PsycINFO, CINAHL, and MEDLINE electronic databases were
systematically searched for quantitative and qualitative studies published
between January 2000 and July 2020. Subjects: Caregivers of adults with kidney failure (estimated glomerular filtration
rate < 15 mL/min/1.73 m2) managed conservatively. Methods: Data were extracted by 2 independent reviewers using a prespecified
extraction tool. Study quality was assessed using the Critical Appraisal
Skills Program (CASP) tool. Measurements: Descriptive reports of demographics, measurement scales, and outcomes.
Thematic synthesis of qualitative data. Results: Six studies met inclusion criteria, including 3 quantitative and 3
descriptive qualitative studies. Caregivers of patients receiving
conservative kidney management (CKM) experienced significant caregiver
burden and similar impacts to their QOL as those caring for patients
receiving dialysis. Thematic synthesis revealed 5 themes: Understanding the
concept of CKM, Need for involvement in the decision for CKM, Identifying
available supports, Uncertainty about the future and negotiating
deteriorations and dying, and Burden of care impacting on QOL. Limitations: Low numbers of included studies, data collection and recruitment biases in
qualitative studies and small caregiver numbers in quantitative studies,
limit transferability of findings. Heterogeneity in study design and outcome
measures precluded meta-analysis. Conclusions: Caregivers of patients with conservatively managed kidney failure suffer
significant burden and experience QOL comparable with those caring for
patients on dialysis. Limited understanding and involvement in conservative
management decision making, and a fear of deterioration and dying, result in
anxiety in caregivers. Further research into the experiences of caregivers
will help support both caregivers and the patients who choose conservative
management. Registration: PROSPERO registration number CRD42021209811.
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Affiliation(s)
- Anisha Walavalkar
- Renal Unit, Department of Nephrology, Sunshine Coast University Hospital, Birtinya, Queensland, Australia
| | - Alison Craswell
- University of the Sunshine Coast, Sippy Downs, Queensland, Australia
- Sunshine Coast Health Institute, Birtinya, Queensland, Australia
| | - Nicholas A. Gray
- Renal Unit, Department of Nephrology, Sunshine Coast University Hospital, Birtinya, Queensland, Australia
- University of the Sunshine Coast, Sippy Downs, Queensland, Australia
- Sunshine Coast Health Institute, Birtinya, Queensland, Australia
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Michalopoulos SN, Gauthier-Loiselle M, Aigbogun MS, Serra E, Bungay R, Clynes D, Cloutier M, Kahle E, Guérin A, Farag YM, Wish JB. Patient and Care Partner Burden in CKD With and Without Anemia: A US-Based Survey. Kidney Med 2022; 4:100439. [PMID: 35402892 PMCID: PMC8988003 DOI: 10.1016/j.xkme.2022.100439] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Rationale & Objective Chronic kidney disease (CKD) has a far-reaching impact on both patients and care partners, which can be further compounded by frequent complications such as anemia. This study assessed the burden experienced by patients with CKD and the care partners of patients with CKD, with and without anemia. Study Design Online survey. Setting & Participants Adult patients with CKD and the care partners of adult patients with CKD living in the United States were recruited through the American Association of Kidney Patients and a third-party online panel (January 9, 2020-March 12, 2020). Outcomes Patient and care partner characteristics, care received or provided; health-related quality of life, and work productivity. Analytical Approach Descriptive statistics were reported separately based on the presence or absence of anemia. Results In total, 410 patients (anemia: n=190, no anemia: n=220) and 258 care partners (anemia: n=110, no anemia: n=148) completed the survey. Most patients reported receiving paid or unpaid care because of their health condition (anemia: 58.9%, no anemia: 50.9%), with an overall average of 14.2 and 11.3 h/wk among the anemia and no anemia patients, respectively. The care partners also reported providing numerous hours of care (anemia: 33.6 h/wk, no anemia: 38.0 h/wk), especially care partners living with their care recipient (anemia: 52.6 h/wk, no anemia: 42.8 h/wk). Among the patients, those with anemia reported a numerically lower average health-related quality of life (Functional Assessment of Cancer Therapy-Anemia score, anemia: 110.1; no anemia: 121.6). Most care partners reported a severe or very severe burden (Burden Scale for Family Caregivers-Short Version score≥15, anemia: 69.1%; no anemia: 58.8%). The work productivity impairment was substantial among employed patients (anemia: 44.9%, no anemia: 35.4%) and employed care partners (anemia: 47.9%, no anemia: 40.7%). Limitations The survey results may have been subject to selection and recall biases; moreover, the observational nature of the study does not allow for causal inferences. Conclusions Patients with CKD and the care partners of patients with CKD experience a considerable burden, especially when anemia is present.
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Affiliation(s)
| | - Marjolaine Gauthier-Loiselle
- Analysis Group, Inc., Montréal, Québec, Canada
- Address for Correspondence: Marjolaine Gauthier-Loiselle, PhD, Analysis Group, Inc., 1190 Avenue des Canadiens-de-Montréal, Suite 1500, Montreal, QC H3B 0G7, Canada.
| | | | | | | | - Diana Clynes
- American Association of Kidney Patients, Tampa, FL
| | | | - Erin Kahle
- American Association of Kidney Patients, Tampa, FL
| | | | | | - Jay B. Wish
- Indiana University School of Medicine, Indianapolis, IN
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Coexisting with the Life of Patients with Hemodialysis: Qualitative Meta-Synthesis Study of Life of Caregivers of Patients with Hemodialysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042163. [PMID: 35206351 PMCID: PMC8871738 DOI: 10.3390/ijerph19042163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/04/2022] [Accepted: 02/09/2022] [Indexed: 02/04/2023]
Abstract
As the number of patients with hemodialysis (HD) continues to increase, so too does the number of people depending on caregivers. There is need to pay attention to the lives of caregivers of patients with HD, where sacrifices are forced. This study systematically reviewed and synthesized qualitative studies that explored the experiences of caregivers caring for patients with HD using the meta-synthesis method. We searched literature using four databases (i.e., PubMed, Excerpta Medica dataBASE, Cumulated Index to Nursing and Allied Health Literature, and Web of Science), and finally ten publications were selected. Four themes and nine subtopics were derived from analyzing and synthesizing the research results. The synthesized themes were: “bearing the burden of life as a caregiver,” “reconstructing life to maintain hemodialysis”, “the fading of caregiver’s own life,” and “effort to relieve the burden.” The results of this study can contribute to the development of interventional studies to improve the quality of life of HD patients. These studies provide an integrated and in-depth perspective on the experiences of caregivers who care for HD patients.
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Sharma R, Jafra BS, Tiewsoh K, Kumar K, Kaur N, Sharawat IK, Dawman L. Distress, anxiety, and its correlates among caregivers of children with kidney diseases during COVID-19 pandemic lockdown. Arch Pediatr 2022; 29:243-248. [PMID: 35115218 PMCID: PMC8768425 DOI: 10.1016/j.arcped.2022.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 01/13/2022] [Indexed: 12/12/2022]
Abstract
Background The COVID-19 pandemic has generated a significant amount of psychological burden in the form of stress, anxiety, uncertainty, depression, anger, and helplessness. The caregivers of children with chronic diseases in particular are at a higher risk of mental stress and burden. Material and Methods We conducted an online survey among caregivers of children with kidney diseases to assess the psychosocial impact of COVID-19. The psychosocial impact of COVID-19 pandemic on their mental health was assessed through standardized psychological scales (Peritraumatic Distress Inventory, Insomnia Severity Scale [ISI], Depression Anxiety and Stress Scale [DASS], and Positive and Negative Aspect Scale) and a semi-structured interview was conducted telephonically. Results A total of 200 caregivers participated in the study. The mean age of the participants was 36±5.56 years, and 76% were males. Participants experienced maximum distress in terms of life threat (6.27±4.64), followed by helplessness and anger (2.66 ± 1.65). Among participants, 38% of them exhibited significant distress. The majority scored below the cut-off on positive affect (98%), and thus could not experience positive emotions and interaction, and 37.5% of participants were feeling significant negative affect. On the ISI, 38.5% of participants experienced significant sleep problems. On the DASS, 65% of participants exhibited significant stress, 76% anxiety, and 78.5% depression. Conclusion A high prevalence of stress, anxiety, and depression along with insomnia was detected among the caregivers of children with kidney diseases during the COVID-19 pandemic.
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Affiliation(s)
- Rajni Sharma
- Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Room No. 5120, 5A, Chandigarh 160012, India
| | - Bikramjit Singh Jafra
- Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Room No. 5120, 5A, Chandigarh 160012, India
| | - Karalanglin Tiewsoh
- Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Room No. 5120, 5A, Chandigarh 160012, India
| | - Krishan Kumar
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Navpreet Kaur
- Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Room No. 5120, 5A, Chandigarh 160012, India
| | - Indar Kumar Sharawat
- Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh 249203, India
| | - Lesa Dawman
- Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Room No. 5120, 5A, Chandigarh 160012, India.
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Carswell C, Yaqoob M, Gilbert P, Kuan Y, Laurente G, McGuigan K, McKeaveney C, McVeigh C, Reid J, Rej S, Walsh I, Noble H. Exploration of Caregiver Experiences of Conservatively Managed End-Stage Kidney Disease to Inform Development of a Psychosocial Intervention: The ACORN Study Protocol. Healthcare (Basel) 2021; 9:healthcare9121731. [PMID: 34946457 PMCID: PMC8701309 DOI: 10.3390/healthcare9121731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 12/08/2021] [Accepted: 12/09/2021] [Indexed: 11/16/2022] Open
Abstract
Background: End-stage kidney disease (ESKD) is an overwhelming illness that impacts not just patients, but also their informal carers. Patients who opt for conservative management rather than dialysis experience difficult symptoms and the psychosocial consequences of their condition. Informal carers of patients who choose conservative management can also experience high levels of psychosocial burden, yet there is little guidance on how best to support informal carers, and no evidence on psychosocial interventions to address unmet needs. Aim: The aim of this study is to explore the experiences and unmet needs of informal carers of patients with ESKD receiving conservative management in order to inform the development of a psychosocial intervention. Methods: This qualitative study will consist of three stages: (I) semi-structured interviews with informal carers in England and Northern Ireland, (II) focus groups with healthcare professionals and informal carers, and (III) national workshops to refine the components of a psychosocial intervention. Discussion: Informal carers of patients with ESKD who are receiving conservative management experience a high psychosocial burden, but there is limited evidence on how best to provide support, particularly as the patient nears the end of life. To our knowledge this study will be the first to address this gap by exploring the experiences and unmet needs of informal carers, with the aim of informing the development of a psychosocial intervention to support the health and wellbeing of informal carers.
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Affiliation(s)
- Claire Carswell
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT7 1NN, UK; (G.L.); (K.M.); (C.M.); (C.M.); (J.R.); (H.N.)
- Department of Health Sciences, University of York, York YO10 5DD, UK
- Correspondence:
| | | | - Patricia Gilbert
- Northern Ireland Kidney Patient Association, Belfast BT9 7AB, UK;
| | - Ying Kuan
- Western Health and Social Care Trust, Londonderry BT47 6SB, UK;
| | - Gladys Laurente
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT7 1NN, UK; (G.L.); (K.M.); (C.M.); (C.M.); (J.R.); (H.N.)
- Barts Health NHS Trust, London E1 1BB, UK;
| | - Karen McGuigan
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT7 1NN, UK; (G.L.); (K.M.); (C.M.); (C.M.); (J.R.); (H.N.)
| | - Clare McKeaveney
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT7 1NN, UK; (G.L.); (K.M.); (C.M.); (C.M.); (J.R.); (H.N.)
| | - Clare McVeigh
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT7 1NN, UK; (G.L.); (K.M.); (C.M.); (C.M.); (J.R.); (H.N.)
| | - Joanne Reid
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT7 1NN, UK; (G.L.); (K.M.); (C.M.); (C.M.); (J.R.); (H.N.)
| | - Soham Rej
- Department of Psychiatry, Jewish General Hospital/Lady Davis Institute, McGill University, Montréal, QC H3A 0G4, Canada;
| | - Ian Walsh
- School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast BT7 1NN, UK;
| | - Helen Noble
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT7 1NN, UK; (G.L.); (K.M.); (C.M.); (C.M.); (J.R.); (H.N.)
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Ebadi A, Sajadi SA, Moradian ST, Akbari R. Psychological consequences for family caregivers of patients receiving hemodialysis: threat or opportunity? BMC Psychol 2021; 9:154. [PMID: 34620241 PMCID: PMC8496675 DOI: 10.1186/s40359-021-00667-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 09/30/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Family caregivers of patients receiving hemodialysis experience physical and psychological disorders. They are unfortunately neglected. The aim of this study was to explain the psychological consequences for family caregivers of patients receiving hemodialysis. METHODS This qualitative inductive conventional content analysis research approach was conducted in Tehran, Iran. Nineteen hemodialysis patient caregivers were enrolled via purposive sampling. Data collection was conducted through in-depth and semi-structured interviews until reaching data saturation. All interviews were recorded, transcribed, imported into the Open Code Software, and analyzed using the Graneheim and Lundman methods. RESULTS The results included two main categories: (1) threats to the psychological integrity; (2) development of capabilities. The first main category comprised the sub-categories of "care-related negative feelings and emotions," care-related stress and its behavioral impacts on care, "psychological disorders arising from care provision," and "impaired quality and quantity of sleep." The second main category comprised of the sub-categories of "care-related positive feelings and emotions" and "coping strategies." CONCLUSIONS The present study showed that though caring for hemodialysis patients threatens the caregiver's psychological integrity, it provides the opportunity of development capabilities.
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Affiliation(s)
- Abbas Ebadi
- Behavioral Sciences Research Center, Lifestyle Institute, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Seyedeh Azam Sajadi
- Department of Nursing Management, Faculty of Nursing, Aja University of Medical Sciences, Kaj St., Shariati St, Tehran, Iran.
| | - Seyed Tayeb Moradian
- Atherosclerosis Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Roghayeh Akbari
- Department of Nephrology, School of Medicine, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
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13
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Dong W, Zwi AB, Shen C, Wu Y, Gao J. Exploring the relationship between functional limitations of the older adults and the health-related quality of life of their spouse in Shaanxi Province, China. Health Qual Life Outcomes 2021; 19:209. [PMID: 34461921 PMCID: PMC8404336 DOI: 10.1186/s12955-021-01835-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 08/03/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND With trends towards longer life expectancy, lifetime with disability has also been prolonged. It is increasingly recognized that not only the person with disability but also those around them are affected. The relationship between functional limitation (FL) of the older adults and health-related quality of life (HRQoL) of their spouse is of interest. So too is the determination of the factors aside from FL that influence HRQoL. METHODS The sample was derived from the 2013 National Health Service Survey conducted in Shaanxi Province in China. Married couples aged ≥ 60 years were selected (n = 3463). The European quality of life five dimensions (EQ-5D) and visual analogue scale were used to measure HRQoL. RESULTS Both wife and husband reported lower HRQoL if either the male or female partner had some or serious FLs (P < 0.001). Other factors associated with lower HRQoL of the spouse included age, lower educational level, presence of chronic disease, and lower household economic status. Family size was associated with wife's HRQoL only when the male had no FL and lived with another 1-2 persons, or when the male had some FLs and lived in a larger family (n ≥ 5). Residential status did not relate to the HRQoL of spouses regardless of FL status. CONCLUSIONS Older adults in Shaanxi province who have partners with FLs tend to report poorer EQ-5D, suggesting that couples amongst whom one has FL may be particularly vulnerable to lower HRQoL.
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Affiliation(s)
- Wanyue Dong
- School of Health Economics and Management, Nanjing University of Chinese Medicine, Nanjing, China
| | - Anthony B Zwi
- School of Social Sciences, The University of New South Wales, Sydney, Australia.
| | - Chi Shen
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China
| | - Yue Wu
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China
| | - Jianmin Gao
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China.
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14
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Torres GCS, Sumile EFR, Rebueno MCDR, Parial LLB, Malong-Consolacion CP, Estrada MG, Macindo JRB, Hendrix CC. Exploring the challenges and needs of home caregivers of hemodialysis patients in the Philippines: A mixed methods study. Nurs Forum 2021; 56:823-833. [PMID: 34080194 DOI: 10.1111/nuf.12618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 05/17/2021] [Accepted: 05/20/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Although the importance of home caregivers of chronic kidney disease patients has been increasingly recognized, their perceived caregiving difficulties and requisites remain underexplored. This study investigated the challenges and needs of home caregivers of hemodialysis patients in the Philippines. METHODS We utilized a mixed-method (QUAN + qual), explanatory sequential design. Data were collected from July 2017 to May 2018 from 46 home caregivers of hemodialysis patients. A three-part researcher-made survey were developed from literature search, personal values and cultural context, while some items were generated from a standardized tool that measures caregiver infrastructure and needs of those caring from frail US veterans. The tool developed gathered the participants' profile, caregiving characteristics, and related needs. The tool was validated and pretested for reliability. Fifteen participants were also interviewed to explore caregiving challenges and needs. Descriptive and χ2 statistics were used for quantitative outcomes, while thematic analysis was employed for qualitative data. RESULTS Participants provided moderate assistance to patients, spending an average of 10.65 h/day and 5.08 days/week in caregiving. The most difficult caregiving circumstances were having costly expenses (78.26%); missing work (50.00%); and experiencing negative feelings (47.83%), stress (43.48%), and physical difficulties (34.78%). They also had the lowest confidence in deciding when to contact health providers (x̅ = 3.31, SD = 0.94) and finding patient care services (x̅ = 2.93, SD = 1.08). Qualitative findings further revealed caregiving needs and challenges in cost management, physical and psychological health, assumption of multiple roles, lifestyle adjustment, and reinforcement of carer knowledge, skills, and attitudes. CONCLUSION Supportive strategies are needed to address the challenges encountered by home caregivers of hemodialysis patients. Findings can be utilized in developing appropriate interventions for home caregivers in low-resource settings where home caregiving and healthcare system issues, such as lack of access to resources and social support, are prevalent.
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Affiliation(s)
| | - Earl Francis R Sumile
- College of Nursing, University of Santo Tomas, Manila, Philippines.,Graduate School, Centro Escolar University, Mendiola, Manila, Philippines
| | | | - Laurence Lloyd B Parial
- College of Nursing, University of Santo Tomas, Manila, Philippines.,School of Nursing, Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR
| | | | - Marica G Estrada
- College of Nursing, University of Santo Tomas, Manila, Philippines
| | - John Rey B Macindo
- Division of Nursing Service, AMOSUP Seamen's Hospital, Manila, Philippines
| | - Cristina C Hendrix
- Division of Health Systems and Analytics, Duke University School of Nursing, Durham, North Carolina, USA
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15
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Nagarathnam M, Latheef SAA, Sivakumar V. Factors Influencing Scales of Burden, Coping Mechanisms, and Quality of Life in Caregivers of Hemodialysis Patients in Andhra Pradesh, India. Indian J Palliat Care 2021; 27:62-67. [PMID: 34035619 PMCID: PMC8121241 DOI: 10.4103/ijpc.ijpc_117_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/01/2020] [Accepted: 10/02/2020] [Indexed: 11/04/2022] Open
Abstract
Background: Evaluation of factors influencing scales of burden, coping mechanisms, and quality of life (QOL) in caregivers of hemodialysis (HD) patients may lead to the revision of interventions aimed at the betterment of QOL of caregivers of HD patients. In this study, we investigated the influence of demographic, social, and clinical variables on burden, coping mechanisms, and QOL in caregivers of HD patients. Methods: In this prospective study, 150 caregivers of HD patients were recruited. Assessment of burden, coping strategies, and QOL were made by the Zarit Burden Interview, Revised Ways of Coping, and Short Form-36 QOL. The role of age, gender, and social and clinical variables on these constructs was investigated using multivariate analysis of variance. Results: The mean age was 43.86 ± 1.11 years. Males outnumbered females. Most were Hindu, married, primary school educated, unemployed, spouses, caring the patients, and suffering from chronic diseases for <5 years. In multivariate analysis of variance, effect of age on physical functioning (PF), general health (GH), and physical component summary (PCS) score (P < 0.01); gender on burden, distancing, seeking social support, role limitation due to emotional problem, and pain (P < 0.05); role limitations due to physical health, energy/fatigue (EF), emotional well-being, PCS, and mental component summary (MCS) score (P < 0.01); religion on PF (P < 0.05); marital status on burden and GH (P < 0.05); PF and PCS (P < 0.01); relationship of caregiver with the patient on PCS (P < 0.05); EF and MCS (P < 0.01); and presence of chronic diseases on GH and social functioning (P < 0.01) were observed. Conclusion: The role of demographic, social, and clinical variables should be taken into consideration while initiating therapies for reducing the burden and improving the QOL of caregivers.
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Affiliation(s)
- M Nagarathnam
- Department of Medical and Surgical Nursing, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - S A A Latheef
- Department of Biochemistry, School of Life Sciences, University of Hyderabad, Hyderabad, Telangana, India
| | - V Sivakumar
- Department of Nephrology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
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16
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Sharma R, Kumar K, Pilania R, Dawman L, Kaur N, Sharma R, Tiewsoh K. Alarming rates of psychological problems among caregivers of pediatric kidney patients admitted during the COVID-19 pandemic lockdown. Ind Psychiatry J 2021; 30:84-89. [PMID: 34483529 PMCID: PMC8395558 DOI: 10.4103/ipj.ipj_237_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 03/02/2021] [Accepted: 04/12/2021] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Caregivers of children with comorbidities suffer from various psychological problems. We envisage more such complications during this COVID-19 pandemic. METHODOLOGY A cross-sectional study to assess psychological issues in caregivers of children with kidney diseases, admitted during lockdown period in India was done. Psychological tools including Peritraumatic Distress Inventory (PDI), Insomnia Severity Index, Depression Anxiety Stress Scale (DASS II), Positive and Negative Affect Schedule (PANAS) and a new "COVID Stress Survey Questionnaire" were used. Standard statistical analysis using SPSS Statistic 23 (IBM SPSS Statistics, New York, United States) was done. RESULTS Forty-seven caregivers (33 mothers; 14 fathers) were included. Of these, 33 (70.2%) experienced psychological distress. On PANAS, 45 (95.7%) scored below cut off on a positive affect and 42 (89.4%) scored above cut off on a negative effect. The DASS II score revealed that 38 (80.9%) reported mild stress, 23 (48.9%) severe anxiety, and 37 (78.7%) had moderate depression. Upper middle socioeconomic status caregivers reported more insomnia. Further, parents of children with acute kidney injury (AKI) or prolonged hospital stay scored higher on subjective distress and aversive feelings. CONCLUSION We observed an alarming level of distress, insomnia, and anxiety among caregivers, more so in upper middle socioeconomic status, children with AKI and prolonged hospital stay. We suggest due counseling should be done.
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Affiliation(s)
- Rajni Sharma
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Krishan Kumar
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rakesh Pilania
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Lesa Dawman
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Navpreet Kaur
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rahul Sharma
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Karalanglin Tiewsoh
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Rafati F, Mashayekhi F, Dastyar N. Caregiver Burden and Spiritual Well-being in Caregivers of Hemodialysis Patients. JOURNAL OF RELIGION AND HEALTH 2020; 59:3084-3096. [PMID: 31650381 DOI: 10.1007/s10943-019-00939-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
The number of hemodialysis patients is increasing worldwide, and the caregivers of these patients experience a great burden. This study was conducted to examine the relationship between caregiver burden and spiritual well-being in caregivers of hemodialysis patients in Kerman, Iran. This correlational study was conducted on 382 caregivers of hemodialysis patients. Data were collected using the Caregiver Burden Inventory (24 items) and Ellison and Paloutzian 20-Item Spiritual Well-being Questionnaire. Data were analyzed by descriptive and inferential statistics (t test, ANOVA, Spearman correlation, and linear regression analysis) in SPSS 20 software. The findings showed that 45 (11.8%) caregivers had mild, 214 (56%) moderate, and 123 (32.2%) high caregiver burden. Furthermore, 1 (0.3%) caregiver had mild, 349 (92.4%) moderate, and 32 (8.4%) high spiritual well-being. Also, Spearman correlation test showed a significant reveres relationship between caregiver burden and spiritual well-being scores (p < 0.001, r = - 0.41). Moreover, the results of the regression analysis showed that the patient's income, frequency of patient dialysis per week, and patient's need to receive care and spiritual well-being were predictors of caregiver burden, which explained 41% of the burden in caregivers. The results of this study revealed that spiritual well-being was negatively related to caregiver burden and was one of its predictors. Therefore, spirituality can be used as a low-cost and effective intervention to reduce the caregiver's burden.
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Affiliation(s)
- Foozieh Rafati
- School of Nursing and Midwifery, Jiroft University of Medical Sciences, Sabzevaran Square, PO Box: 7861763730, Jiroft, Iran
| | - Fatemeh Mashayekhi
- Department of Nursing, Nursing and Midwifery School, Jiroft University of Medical Sciences, Sabzevaran Square, PO Box: 7861763730, Jiroft, Iran
| | - Neda Dastyar
- Department of Midwifery, Nursing and Midwifery School, Jiroft University of Medical Sciences, Sabzevaran Square, PO Box: 7861763730, Jiroft, Iran.
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18
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Shukri M, Mustofai MA, Md Yasin MAS, Tuan Hadi TS. Burden, quality of life, anxiety, and depressive symptoms among caregivers of hemodialysis patients: The role of social support. Int J Psychiatry Med 2020; 55:397-407. [PMID: 32216495 DOI: 10.1177/0091217420913388] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
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.
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Affiliation(s)
- Madihah Shukri
- Department of Psychology and Counselling, University Malaysia Terengganu, Terengganu, Malaysia
| | - Mohd Azman Mustofai
- Department of Psychology and Counselling, University Malaysia Terengganu, Terengganu, Malaysia
| | - Md Aris Safree Md Yasin
- Department of Psychology and Counselling, University Malaysia Terengganu, Terengganu, Malaysia
| | - Tuan Sharipah Tuan Hadi
- Department of Psychiatry and Mental Health, Hospital Sultanah Nur Zahirah, Kuala Terengganu, Malaysia
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Matthews M, Reid J, McKeaveney C, Mullan R, Bolton S, Hill C, Noble H. Development of a psychosocial intervention to support informal caregivers of people with end-stage kidney disease receiving haemodialysis. BMC Nephrol 2020; 21:421. [PMID: 32998706 PMCID: PMC7527291 DOI: 10.1186/s12882-020-02075-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 09/18/2020] [Indexed: 12/05/2022] Open
Abstract
Background Patients with end-stage kidney disease, receiving haemodialysis rely increasingly on informal carers to help manage their debilitating chronic disease. Informal carers may experience a negative impact on their quality of life exacting a toll on their physical, social and emotional well-being. Informal carers of patients with end-stage kidney disease receiving haemodialysis have significant unmet needs which may include physical and psychological issues, financial disadvantage and social isolation. Poor experiences of informal carers may also impact the experience of the patients for whom they care. The needs of this group of informal caregivers have been largely neglected, with little emphasis placed on supportive interventions that might assist and support them in their caring role. The aim of this study is therefore to explore the experiences and unmet needs of informal carers of people with end-stage kidney disease receiving haemodialysis and develop a psychosocial intervention to support them in their caring role. Methods This qualitative study will include a systematic review, semi-structured interviews with 30 informal carers and focus groups with renal health care professionals. Perceptions of care provision, caregiving experiences as well as contextual factors impacting the design and delivery of a psychosocial intervention for informal carers of patients with end-stage kidney disease, will be explored and will inform the development of a supportive intervention. Discussion The needs of informal carers of patients with end-stage kidney disease have been neglected with little emphasis placed on supportive interventions that might assist and support this group in their care giving role. This is in contrast to other chronic disease groups such as stroke, cancer and dementia. In these conditions well developed supportive interventions have significantly improved outcomes in regard to informal caregivers’ preparedness, competence, positive emotions and psychological well-being in terms of informal care provision. Support interventions could potentially improve the quality of life of those informal carers who provide care to patients with end-stage kidney disease receiving haemodialysis.
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Affiliation(s)
- Michael Matthews
- School of Nursing and Midwifery, Queen's University, Medical Biology Centre, 97 Lisburn Road, Belfast, BT9 7BL, UK.
| | - Joanne Reid
- School of Nursing and Midwifery, Queen's University, Medical Biology Centre, 97 Lisburn Road, Belfast, BT9 7BL, UK
| | - Clare McKeaveney
- School of Nursing and Midwifery, Queen's University, Medical Biology Centre, 97 Lisburn Road, Belfast, BT9 7BL, UK
| | - Robert Mullan
- Renal Unit, Northern Health and Social Care Trust, 45 Bush Road, Antrim, BT41 2RL, UK
| | - Stephanie Bolton
- Renal Unit, Northern Health and Social Care Trust, 45 Bush Road, Antrim, BT41 2RL, UK
| | - Christopher Hill
- Regional Nephrology Unit, Belfast Health and Social Care Trust, 51 Lisburn Road, Belfast, BT9 7AB, UK
| | - Helen Noble
- School of Nursing and Midwifery, Queen's University, Medical Biology Centre, 97 Lisburn Road, Belfast, BT9 7BL, UK
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20
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Moore C, Carter LA, Mitra S, Skevington S, Wearden A. Quality of life improved for patients after starting dialysis but is impaired, initially, for their partners: a multi-centre, longitudinal study. BMC Nephrol 2020; 21:185. [PMID: 32423378 PMCID: PMC7236460 DOI: 10.1186/s12882-020-01819-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 04/19/2020] [Indexed: 02/07/2023] Open
Abstract
Background Quality of life (QOL) is important to patients with end stage renal disease and their partners. Despite the first 12 weeks being a critical time in the treatment pathway, limited research exists which examines how the transition onto dialysis impacts QOL. In this study we measured QOL in patients and their partners at pre-dialysis and over the first 12 weeks on dialysis to investigate QOL during this crucial period. Methods Patients and their partners, recruited from 10 renal units in England, completed questionnaires at pre-dialysis (n = 166 participants, 83 couples), 6 weeks (n = 90 participants, 45 couples) and 12 weeks (n = 78, 39 couples) after starting dialysis. On each occasion participants completed a QOL questionnaire (WHOQOL-BREF). Multilevel modelling accommodated the nested structure of couples with repeated measures within participants. Three-level random intercept models estimated changes in WHOQOL general QOL and its four domains (Physical, Psychological, Social and Environment). Two-level random intercept models assessed the relationship between baseline clinical and socio-demographic variables with changes in general QOL. Results Patients reported positive changes in general QOL from pre-dialysis to 6 weeks (β = 0.42, p < 0.001, 95% CI 0.19, 0.65) and from pre-dialysis to 12 weeks (β = 0.47, p < 0.001, 95% CI 0.24, 0.71). Partners’ general QOL decreased significantly from pre-dialysis to 6 weeks (β = − 0.24, p = 0.04, 95% CI -0.47, − 0.01) but returned to its original level at 12 weeks. Patients reported improvements in the physical domain between pre-dialysis and 12 weeks (β = 6.56, p < 0.004, 95% CI 2.10, 11.03). No other domains changed significantly in patients or partners. Only in patients were there significant associations between moderator variables and general QOL. High comorbidity risk level and diabetes were associated with poorer QOL at pre-dialysis whereas being female and having an arteriovenous fistula were linked with improvements in general QOL. Conclusions Patients reported significant improvements in their general and physical QOL after starting dialysis. Partners’ general QOL worsened after patients started dialysis but improved by 12 weeks. Both patients and partners may benefit from additional educational and counselling services in the lead up to, and immediately after starting dialysis, which could facilitate the transition onto dialysis and improve QOL in both. Study registration This study was adopted on the NIHR Clinical Research Network (UK). The details of this study are registered on the Research Registry website (www.researchregistry.com). The identifier for this study is researchregistry2574.
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Affiliation(s)
- Currie Moore
- School of Health Sciences, Division of Psychology and Mental Health, Manchester Centre for Health Psychology, University of Manchester, Manchester, UK. .,Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.
| | - Lesley-Anne Carter
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, UK
| | - Sandip Mitra
- Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.,Manchester University NHS Foundation Trust, Manchester, UK.,NIHR Devices for Dignity MedTech Cooperative, Sheffield, UK
| | - Suzanne Skevington
- School of Health Sciences, Division of Psychology and Mental Health, Manchester Centre for Health Psychology, University of Manchester, Manchester, UK.,Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Alison Wearden
- School of Health Sciences, Division of Psychology and Mental Health, Manchester Centre for Health Psychology, University of Manchester, Manchester, UK.,Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
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21
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Al-Rawashdeh S, Alshraifeen A, Alhawamdih S, Ashour A. Wellbeing and quality of life of family caregivers: influence of sleep quality. Br J Community Nurs 2020; 25:70-75. [PMID: 32040366 DOI: 10.12968/bjcn.2020.25.2.70] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Sami Al-Rawashdeh
- Assistant Professor, Department of Community and Mental Health Nursing, Faculty of Nursing, The Hashemite University, Zarqa, Jordan
| | - Ali Alshraifeen
- Assistant Professors, Department of Adult Health Nursing, Faculty of Nursing, The Hashemite University, Zarqa, Jordan
| | - Sajidah Alhawamdih
- Assistant Professor, Nursing Department, Faculty of Nursing, Isra University, Amman, Jordan
| | - Ala Ashour
- Assistant Professors, Department of Adult Health Nursing, Faculty of Nursing, The Hashemite University, Zarqa, Jordan
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Moore C, Skevington S, Wearden A, Mitra S. Impact of Dialysis on the Dyadic Relationship Between Male Patients and Their Female Partners. QUALITATIVE HEALTH RESEARCH 2020; 30:380-390. [PMID: 31478450 DOI: 10.1177/1049732319869908] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The objective of this study was to explore the impact of three early phases of renal dialysis, namely pre-dialysis, starting dialysis, and establishing dialysis, on dyadic relationships. Twenty UK-based dyads (20 male patients and their female partners) participated in semi-structured interviews and discussed the effects of dialysis on themselves and their relationship. Dyadic thematic analysis, facilitated by dyadic-level charting, integrated participants' experiences and enabled identification of patterns across dyads. We found that dialysis had positive and negative influences on identity, social relationships, and mental health, forming the themes: Prioritizing the Patient, Carrying the Burden, and Changing Identities. The final theme, Managing the Relationship, described how dyads prevented dialysis from negatively impacting their relationship. Dyadic-level charting provided a systematic examination of individual and dyadic experiences. These findings indicate that access to informational and support services for dyads as they prepare to start dialysis may minimize negative effects on their relationship.
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Affiliation(s)
- Currie Moore
- School of Health Sciences and Manchester Centre for Health Psychology, The University of Manchester, Manchester, United Kingdom
- Manchester Academic Health Science Centre, United Kingdom
| | - Suzanne Skevington
- School of Health Sciences and Manchester Centre for Health Psychology, The University of Manchester, Manchester, United Kingdom
- Manchester Academic Health Science Centre, United Kingdom
| | - Alison Wearden
- School of Health Sciences and Manchester Centre for Health Psychology, The University of Manchester, Manchester, United Kingdom
- Manchester Academic Health Science Centre, United Kingdom
| | - Sandip Mitra
- Manchester Academic Health Science Centre, United Kingdom
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
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An exploration of symptom burden and its management, in Saudi Arabian patients receiving haemodialysis, and their caregivers: a mixed methods study protocol. BMC Nephrol 2019; 20:250. [PMID: 31288747 PMCID: PMC6617670 DOI: 10.1186/s12882-019-1424-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 06/20/2019] [Indexed: 11/13/2022] Open
Abstract
Background Globally 10% of the population worldwide are affected by chronic kidney disease (CKD), making it one of the most prevalent chronic diseases. Several studies have highlighted that the symptoms of CKD have a significant impact on patients. A number of symptoms, including fatigue and depression, are associated with poor patient health, increased risk of hospitalisation and mortality. Physical and emotional symptoms often remain under-recognised and largely untreated; however, patients often create a variety of self-management strategies to meet the challenges of these symptoms. There is a lack of knowledge regarding symptom burden and the experiences of patients receiving haemodialysis (HD) and their caregivers, particularly in Saudi Arabia, therefore, this study aims to explore symptom burden and its management amongst patients receiving HD in addition to caregiver burden. Method A mixed methods, sequential, explanatory design consisting of two phases: phase 1 involves a cross-sectional study design with a planned convenience sample size of 141 patients who will be recruited from King Khaled hospital, Saudi Arabia. Thirty-two physical and psychological symptoms will be measured using the Chronic Kidney Disease-Symptom Burden Index (CKD-SBI). Additionally, 130 caregivers will complete the Arabic version of the Zarit Burden Interview (ZBI-22) to identify the level of burden in the caregivers of patients on maintenance HD. Phase 2 of the study is a qualitative descriptive design involving semi-structural interviews with 15 eligible patients currently receiving HD. The selection of participants for interviews will be based on the patients’ total CKD-SBI scores with five individuals recruited from the lowest, median and highest percentiles. Additionally, 15 caregivers of the patients to be interviewed, will also be recruited and interviewed. Discussion This study focuses on a wide number of physical and psychological symptoms experienced by patients receiving HD. It will also focus on the effective management strategies patients employ to help reduce their perceived symptoms. Burden in caregivers of patients receiving HD will also be explored. Furthermore, the association between symptom burden and caregiver burden will be investigated. Findings from this study will provide evidence to help health care providers to develop effective interventions to assess and manage symptoms in patients receiving HD.
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Mantulak A. "Best interest" and Pediatric End Stage Kidney Disease: The Case of Baby M. J Pediatr Nurs 2019; 46:e37-e43. [PMID: 30862429 DOI: 10.1016/j.pedn.2019.02.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 02/22/2019] [Accepted: 02/22/2019] [Indexed: 11/25/2022]
Abstract
In everyday clinical practice, health professionals and parents of chronically ill children often rely on the principle of 'best interest' in the development of medically oriented treatment plans. In most cases, such processes are done collaboratively; however, 'best interest' as a standard for decision-making becomes ambiguous in situations wherein parents and health professionals fail to agree on the course of treatment. This paper will explore the potential tensions that can exist in clinical practice when 'best interest' is used for making health care decisions. The discussion will be framed within the case of baby M, a newborn child of Mennonite descent diagnosed at birth with end-stage kidney disease (ESKD). M's parents refused medically-prescribed therapy on behalf of their child because of the uncertainty of the treatment and beliefs regarding quality of life. This case highlights that the application of the 'best interest' principle in the clinical domain can be ambiguously interpreted and subjectively operationalized along a narrowly defined medical understanding of what is in the patient's best interest. In addition, this case serves as an example of how power within the health care system can be used to operationalize a medically-sanctioned definition of 'best interest', often at the expense of the values, beliefs and interests of parental caregivers.
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Affiliation(s)
- Andrew Mantulak
- School of Social Work, King's University College at Western University, London, Ontario, Canada.
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Van Ness PH, MacNeil Vroomen J, Leo-Summers L, Vander Wyk B, Allore HG. Chronic Conditions, Medically Supportive Care Partners, And Functional Disability Among Cognitively Impaired Adults. Innov Aging 2019; 3:igz018. [PMID: 31286072 PMCID: PMC6604743 DOI: 10.1093/geroni/igz018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND OBJECTIVES To assess whether medically supportive care partners modify the associations of symptomatic chronic conditions with the number of functional disabilities in a cohort of multimorbid older adults with cognitive impairment. RESEARCH DESIGN AND METHODS The research design is a prospective study of a nationally representative cohort of Medicare beneficiaries. National Health and Aging Trends Study (NHATS) data were linked with Medicare claims for years 2011-2015. Participants were aged 65 or older and had cognitive impairment with at least 2 chronic conditions (N = 1,003). Annual in-person interviews obtained sociodemographic information at baseline and time-varying variables for caregiving, hospitalization, and 6 activities of daily living (ADL); these variables were merged with Center for Medicare and Medicaid Services data to ascertain 16 time-varying chronic conditions. A care partner was defined as a person who sat with their care recipient during doctor visits in the past year and/or who helped them with prescribed medications in the last month. Chronic condition associations and their potential effect modifications by care partner status were assessed using weighted generalized estimating equations accounting for the complex survey design of the longitudinal analytical sample. RESULTS Chronic kidney disease, depression, and heart failure were associated with an increased number of functional disabilities. Among these, only the association of chronic kidney disease with the number of functional disabilities (interaction p value = .001) was weakened by the presence of a care partner. DISCUSSION AND IMPLICATIONS The presence of care partners showed limited modification of the associations of symptomatic chronic conditions with functional disability.
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Affiliation(s)
- Peter H Van Ness
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Janet MacNeil Vroomen
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Internal Medicine, Section of Geriatric Medicine, Academic University Medical Center, Amsterdam, The Netherlands
| | - Linda Leo-Summers
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Brent Vander Wyk
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Heather G Allore
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
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O'Hare AM, Song MK, Kurella Tamura M, Moss AH. Research Priorities for Palliative Care for Older Adults with Advanced Chronic Kidney Disease. J Palliat Med 2018; 20:453-460. [PMID: 28463635 DOI: 10.1089/jpm.2016.0571] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Older adults with advanced chronic kidney disease (CKD) often have multiple comorbid conditions, a high symptom burden, and limited life expectancy. There is mounting concern that the intensive patterns of care that many of these patients receive at the end of life are discordant with their values and preferences. The nephrology community has recognized that there are significant unmet palliative care needs in this population. In this article, we identify three broad areas of knowledge deficit where more evidence is needed to support the "best care possible" for this population: (1) what matters most to older adults with advanced CKD and their caregivers near the end of life; (2) how the nephrology community can best support older adults with advanced CKD to navigate complex treatment decisions throughout their illness; and (3) how the healthcare system should be reconfigured to promote patient- and family-centered care for older adults with advanced CKD. Research priorities include identifying opportunities for improving the end-of-life experience of older adults with CKD and their caregivers; developing and testing communication interventions before and during dialysis to ensure that treatment decisions reflect patients' preferences; and assessing the effectiveness of palliative care in improving quality of life for patients and caregivers, satisfaction with care, and aligning treatment decisions with patient goals and preferences.
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Affiliation(s)
- Ann M O'Hare
- 1 Department of Medicine, University of Washington and Veterans Affairs Puget Sound Healthcare System , Seattle, Washington
| | - Mi-Kyung Song
- 2 Center for Nursing Excellence in Palliative Care, Nell Hodgson Woodruff School of Nursing, Emory University , Atlanta, Georgia
| | | | - Alvin H Moss
- 4 Sections of Nephrology and Supportive Care, West Virginia University School of Medicine , Morgantown, West Virginia
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Wang V, Vilme H, Maciejewski ML, Boulware LE. The Economic Burden of Chronic Kidney Disease and End-Stage Renal Disease. Semin Nephrol 2018; 36:319-30. [PMID: 27475662 DOI: 10.1016/j.semnephrol.2016.05.008] [Citation(s) in RCA: 177] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The growing prevalence and progression of chronic kidney disease (CKD) raises concerns about our capacity to manage its economic burden to patients, caregivers, and society. The societal direct and indirect costs of CKD and end-stage renal disease are substantial and increase throughout disease progression. There is significant variability in the evidence about direct and indirect costs attributable to CKD and end-stage renal disease, with the most complete evidence concentrated on direct health care costs of patients with advanced to end-stage CKD. There are substantial gaps in evidence that need to be filled to inform clinical practice and policy.
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Affiliation(s)
- Virginia Wang
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC; Health Services Research and Development, Durham VA Medical Center, Durham, NC.
| | - Helene Vilme
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Matthew L Maciejewski
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC; Health Services Research and Development, Durham VA Medical Center, Durham, NC
| | - L Ebony Boulware
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC
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Ahlawat R, Tiwari P, D'Cruz S. Direct Cost for Treating Chronic Kidney Disease at an Outpatient Setting of a Tertiary Hospital: Evidence from a Cross-Sectional Study. Value Health Reg Issues 2017. [PMID: 28648314 DOI: 10.1016/j.vhri.2016.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Chronic kidney disease (CKD) has a high morbidity and mortality in developing countries. And this burden is also increasing rapidly in India. Unaffordability due to high cost of medication and hemodialysis remains one of the major barriers in the successful treatment of CKD. OBJECTIVES To determine the direct cost involved in treating CKD at an outpatient department of a public tertiary care hospital. METHODS This cross-sectional study was carried out at a public tertiary care hospital. Patients diagnosed with CKD by a physician were included in the study after obtaining a written informed consent. All the relevant data were collected on a predesigned case record form. RESULTS The results are based on data obtained from 150 patients. The average age of the patients was 55.7 ± 10.1 years. The average number of drugs per prescription was found to be 6.5 ± 1.7. The annual average costs of treatment for patients on medication only and for patients on hemodialysis plus medication were Rs 25,836 (US $386) and Rs 2,13,144 (US $3181), respectively (Rs = Indian rupee). Treatment cost was found to be statistically significantly higher in patients on hemodialysis, treatment support by employer, patients with a smoking habit, patients with comorbidities, and patients with end-stage renal disease. Calcium tablets, vitamin D sachets, iron supplements, torsemide, and amlodipine were the top five medications prescribed. CONCLUSIONS Reimbursement, patient's dialysis status, habits, and comorbidities were found to have a significant effect on the direct cost of treatment.
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Affiliation(s)
- Rajiv Ahlawat
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research (NIPER), Mohali, Punjab, India
| | - Pramil Tiwari
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research (NIPER), Mohali, Punjab, India.
| | - Sanjay D'Cruz
- Department of General Medicine, Government Medical College and Hospital, Chandigarh, India
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Baek HS, Park KS, Ha IS, Kang HG, Cheong HI, Park YS, Lee JH, Cho HY, Cho MH. Impact of end-stage renal disease in children on their parents. Nephrology (Carlton) 2017; 23:764-770. [PMID: 28612957 DOI: 10.1111/nep.13083] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 05/16/2017] [Accepted: 06/08/2017] [Indexed: 11/29/2022]
Abstract
AIM This study was designed to investigate the impact of paediatric end-stage renal disease (ESRD) on parents, based on the PedsQL Family Impact Module (FIM), and the relationship to the quality of life (QOL) of paediatric ESRD patients measured by PedsQL 3.0 ESRD module. METHODS We performed a cross-sectional study using Korean translations of the PedsQL FIM and the PedsQL 3.0 ESRD module. In all, 79 patients were enrolled, including 47 children receiving dialysis and 32 children who underwent renal transplant. RESULTS FIM scores, analyzed for every category according to treatment modality, were significantly lower in haemodialysis (HD) than in peritoneal dialysis (PD) or renal transplant patients. Mother's age, duration since diagnosis of ESRD and the existence of comorbidity were variables to have significant effects on FIM scores. The correlation between total FIM and QOL scores of paediatric patients were significant, in both parent-proxy and child-self report. CONCLUSIONS The PedsQL FIM appears to be a useful tool for the assessment of family impact on children with ESRD. Further prospective studies focused on the QOL of parents and caregivers should be performed with the goal of improving clinical outcomes for paediatric ESRD patients.
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Affiliation(s)
- Hee Sun Baek
- Department of Pediatrics, Kyungpook National University Hospital, Daegu, Korea
| | - Ki-Soo Park
- Department of Preventive Medicine and Institute of Health Sciences, Gyeongsang National University Hospital, Jinju, Korea
| | - Il Soo Ha
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
| | - Hee Gyung Kang
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
| | - Hae Il Cheong
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
| | - Young Seo Park
- Department of Pediatrics, Asan Medical Center, Seoul, Korea
| | - Joo Hoon Lee
- Department of Pediatrics, Asan Medical Center, Seoul, Korea
| | - Hee Yeon Cho
- Department of Pediatrics, Samsung Medical Center, Seoul, Korea
| | - Min Hyun Cho
- Department of Pediatrics, Kyungpook National University Hospital, Daegu, Korea
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Avşar U, Avşar UZ, Cansever Z, Yucel A, Cankaya E, Certez H, Keles M, Aydınlı B, Yucelf N. Caregiver Burden, Anxiety, Depression, and Sleep Quality Differences in Caregivers of Hemodialysis Patients Compared With Renal Transplant Patients. Transplant Proc 2016; 47:1388-91. [PMID: 26093725 DOI: 10.1016/j.transproceed.2015.04.054] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND We compared the caregivers of hemodialysis (HD) patients and caregivers of patients with renal transplantation (Tx) in terms of anxiety, depression, sleep quality, and caregiver burden. We believe that caregivers of HD have more difficult conditions than caregivers of the patients with Tx. METHODS This cross-sectional study analyzed the psychological status of caregivers of Tx patients compared with those of HD patients with using the Hospital Anxiety and Depression Scale, Zarit Burden Interview, and Pittsburg Sleep Quality Indexes. We recruited 133 caregivers-65 caregivers in the Tx group and 68 in the HD group. RESULTS Mean age was 43.1 ± 8.5 years. The age, sex, income level, and education level were similar between the 2 groups. Caregivers in the HD group had significantly higher rates of anxiety and depression compared with the Tx group (P = .007 and P < .001, respectively). Good sleep quality rates for caregivers in the Tx group and caregivers in the HD group were 92% (n = 60) and 63% (n = 43), respectively. Poor sleep quality was significantly higher in caregivers in the HD group compared with caregivers in the Tx group (P < .001). Caregiver burden scores were significantly higher for caregivers in the HD group compared with caregivers in the Tx group (P < .001). CONCLUSIONS We suggest that Tx is the more appropriate renal replacement therapy for caregivers who undertake the care of patients with end-stage renal disease and chronic kidney disease.
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Affiliation(s)
- U Avşar
- Department of Family Medicine, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - U Z Avşar
- Department of Medical Education, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Z Cansever
- Department of Medical Education, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - A Yucel
- Department of Psychiatry, Faculty of Medicine, Ataturk University, Erzurum, Turkey.
| | - E Cankaya
- Department of Nephrology, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - H Certez
- Department of Nephrology, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - M Keles
- Department of Nephrology, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - B Aydınlı
- Department of General Surgery, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - N Yucelf
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Ataturk University, Erzurum, Turkey
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Alnazly EK. Burden and coping strategies among Jordanian caregivers of patients undergoing hemodialysis. Hemodial Int 2015; 20:84-93. [PMID: 25998798 DOI: 10.1111/hdi.12318] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Recent studies reported hemodialysis patients' sufferings from physical and psychosocial issues, but few studies reported family-caregiver burdens. This study aims to explore the burdens and coping strategies of caregivers of patients receiving hemodialysis. Caregivers of patients undergoing hemodialysis (n = 139) at 3 dialysis units were given 3 forms: Caregiver and Patient Characteristics, Oberst Caregiving Burden Scale Difficulty Subscale, and Ways of Coping Questionnaire. Descriptive statistics, correlational analysis, and multiple regression analysis were performed. The Oberst Caregiving Burden Scale was significantly related to self-controlling (r = 0.20) and seeking social support (r = 0.17). Caregiver burden was positively and significantly correlated with self-controlling coping subscale, with t = 1.10, P = 0.05, and β = 0.25. Living with the patient was the only variable that was a significant predictor of burden, with t = 2.96, P = 0.00, and β = 0.331. Living with patients predicted caregiver burden, and the burden scale correlated with self-controlling. The findings contribute to the evidence on the adverse health effects of caregivers of patients receiving hemodialysis. This study suggests that nursing interventions should target caregiver knowledge for better coping.
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Parham R, Jacyna N, Hothi D, Marks SD, Holttum S, Camic P. Development of a measure of caregiver burden in paediatric chronic kidney disease: The Paediatric Renal Caregiver Burden Scale. J Health Psychol 2014; 21:193-205. [DOI: 10.1177/1359105314524971] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
To inform the development of a measure of caregiver burden for carers of children with chronic kidney disease, interviews were conducted with 16 caregivers and 10 renal healthcare professionals. A pool of 97 items generated from interviews was reduced to 60 items following review. A piloting exercise provided evidence for the usability, readability and relevance of items and informed further adaptations resulting in the 51-item Paediatric Renal Caregiver Burden Scale. Further to assessment of its psychometric properties, it is hoped that that the Paediatric Renal Caregiver Burden Scale will serve as a useful measure of caregiver burden in paediatric chronic kidney disease.
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Affiliation(s)
| | | | - Daljit Hothi
- Great Ormond Street Hospital for Children NHS Foundation Trust, London
| | - Stephen D Marks
- Great Ormond Street Hospital for Children NHS Foundation Trust, London
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Mollaoğlu M, Kayataş M, Yürügen B. Effects on caregiver burden of education related to home care in patients undergoing hemodialysis. Hemodial Int 2012; 17:413-20. [PMID: 23279118 DOI: 10.1111/hdi.12018] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Caring for a patient undergoing hemodialysis is highly stressful and can negatively affect a caregiver's physical and psychological well-being. This study was conducted to examine the effect of educational support concerning caregiver burden and given to the caregivers of hemodialysis patients. This experimental study was performed with 122 caregivers. Patients' data were collected by means of Personal Information Form and Zarit Caregiver Burden Scale (ZCBS). Characteristics of caregivers of hemodialysis patients were analyzed descriptively in terms of frequencies and percentages for categorical data, means, and standard deviations. Mann-Whitney U test, Kruskall-Wallis test, and percentages were used in the data analysis. The mean ZCBS score was 52.1 ± 8.6 (range, 0-88). Among the caregivers, the mean score of the ZCBS was significantly higher in women, single, young, family relatives as "daughter/sister/brother/daughter-in-law and town/district, high educational level (P < 0.05). Moreover, the mean score of the ZCBS was significantly higher in caregivers who have health problems/diseases. In addition, this study explored the educational needs of home-based such as nutrition (35.2%), dialysis (27.8%), fistula care (20.4%), catheter care (18.8%), the information about chronic kidney disease (18.0%), blood pressure (17.2%), weight control (17.2%), hygiene (3.1%), and travel/exercise (6.5%). The post-educational mean scores (55.0 ± 7.6) of caregiver burden were observed to be lower than the pre-educational scores (43.9 ± 5.2), and the difference was found to be statistically significant. The home-based educational program demonstrated a decrease in the burden of hemodialysis caregivers.
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Assessing and improving the health-related quality of life of patients with ESRD. Nat Rev Nephrol 2012; 8:718-24. [DOI: 10.1038/nrneph.2012.238] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Rutkowski B, Rychlik I. Daily hemodialysis and caregivers burden. Nephrol Dial Transplant 2011; 26:2074-6. [PMID: 21708982 DOI: 10.1093/ndt/gfr298] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Bolesław Rutkowski
- Department of Nephrology, Transplantology, and Internal Disease, University Medical of Gdansk, Gdansk, Poland.
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Hedayati SS, Yalamanchili V, Finkelstein FO. A practical approach to the treatment of depression in patients with chronic kidney disease and end-stage renal disease. Kidney Int 2011; 81:247-55. [PMID: 22012131 DOI: 10.1038/ki.2011.358] [Citation(s) in RCA: 168] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Depression is a common, under-recognized, and under-treated problem that is independently associated with increased morbidity and mortality in CKD patients. However, only a minority of CKD patients with depression are treated with antidepressant medications or nonpharmacologic therapy. Reasons for low treatment rates include a lack of properly controlled trials that support or refute efficacy and safety of various treatment regimens in CKD patients. The aim of this manuscript is to provide a comprehensive review of studies exploring depression treatment options in CKD. Observational studies as well as small trials suggest that certain serotonin-selective reuptake inhibitors may be safe to use in patients with advanced CKD and ESRD. These studies were limited by small sample sizes, lack of placebo control, and lack of formal assessment for depression diagnosis. Nonpharmacologic treatments were explored in selected ESRD samples. The most promising data were reported for frequent hemodialysis and cognitive behavioral therapy. Alternative proposed therapies include exercise training regimens, treatment of anxiety, and music therapy. Given the association of depression with cardiovascular events and mortality, and the excessive rates of cardiovascular death in CKD, it becomes imperative to not only investigate whether treatment of depression is efficacious, but also whether it would result in a reduction in morbidity and mortality in this patient population.
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Affiliation(s)
- S Susan Hedayati
- Renal Section, Medical Service, Veterans Affairs North Texas Health Care System, Dallas, Texas, USA.
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The multi-dimensional burden of cirrhosis and hepatic encephalopathy on patients and caregivers. Am J Gastroenterol 2011; 106:1646-53. [PMID: 21556040 PMCID: PMC3989143 DOI: 10.1038/ajg.2011.157] [Citation(s) in RCA: 258] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Cirrhosis and hepatic encephalopathy (HE) can adversely affect survival, but their effect on socioeconomic and emotional burden on the family is not clear. The aim was to study the emotional and socioeconomic burden of cirrhosis and HE on patients and informal caregivers. METHODS A cross-sectional study in two transplant centers (Veterans and University) of cirrhotic patients and their informal caregivers was performed. Demographics for patient/caregivers, model-for-end-stage liver disease (MELD) score, and cirrhosis complications were recorded. Patients underwent a cognitive battery, sociodemographic, and financial questionnaires. Caregivers were given the perceived caregiver burden (PCB; maximum=155) and Zarit Burden Interview (ZBI)-Short Form (maximum=48) and questionnaires for depression, anxiety, and social support. RESULTS A total of 104 cirrhotics (70% men, 44% previous HE, median MELD 12, 49% veterans) and their caregivers (66% women, 77% married, relationship duration 32±14 years) were included. Cirrhosis severely impacted the family unit with respect to work (only 56% employed), finances, and adherence. Those with previous HE had worse unemployment (87.5 vs. 19%, P=0.0001) and financial status (85 vs. 61%, P=0.019) and posed a higher caregiver burden; PCB (75 vs. 65, P=0.019) and ZBI (16 vs. 11, P=0.015) compared with others. Cognitive performance and MELD score were significantly correlated with employment and caregiver burden. Veterans and non-veterans were equally affected. On regression, depression score, MELD, and cognitive tests predicted both PCB and ZBI score. CONCLUSIONS Previous HE and cognitive dysfunction are associated with worse employment, financial status, and caregiver burden. Cirrhosis-related expenses impact the family unit's daily functioning and medical adherence. A multidisciplinary approach to address this burden is required.
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Ekelund ML, Andersson SI. "I need to lead my own life in any case"--a study of patients in dialysis with or without a partner. PATIENT EDUCATION AND COUNSELING 2010; 81:30-36. [PMID: 19962846 DOI: 10.1016/j.pec.2009.10.025] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2009] [Revised: 10/17/2009] [Accepted: 10/24/2009] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To elicit psychological and psychosocial problems existing in patients in dialysis and their partners, its being felt that the diversity involved has important implications for how service in dialysis units is delivered to patients and their partners. METHODS The results of a series of interviews of 39 patients in dialysis and 21 partners of theirs, each interview individual, concerning their ways of thinking and their feelings and the behaviour, were analyzed in qualitative and content-oriented terms. RESULTS Five basic themes could be identified: importance of treatment being individualized, dependency on an apparatus, consequences of the disease and its treatment, hopes for the future, and thoughts concerning life and death. Diversities relating to age, civil status, cultural and gender matters were disclosed. CONCLUSION The interview approach illustrated the importance of extended professional and individualized support in handling psychological and psychosocial disparities and needs in order to make treatment regimes more acceptable to the persons involved. PRACTICE IMPLICATIONS Suggestions are made concerning efforts to improve the care of patients receiving dialysis, and the importance of working with the patients and those closest to them in multidisciplinary teams.
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Health related quality of life and the CKD patient: challenges for the nephrology community. Kidney Int 2009; 76:946-52. [DOI: 10.1038/ki.2009.307] [Citation(s) in RCA: 138] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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