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Willis KD, Reid MP, Fox A, Kleva CS, Sherwood P, Loughan AR. The impact of a primary brain tumor diagnosis on caregivers: Insights from the patients' perspective. Support Care Cancer 2024; 32:595. [PMID: 39160352 PMCID: PMC11333512 DOI: 10.1007/s00520-024-08783-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 08/02/2024] [Indexed: 08/21/2024]
Abstract
PURPOSE The diagnosis of a primary brain tumor (PBT) causes significant distress for the caregiver-patient dyad, warranting increased supportive care intervention. Although researchers have previously assessed caregivers' perceptions of their own supportive care needs, no study to date has identified how patients perceive the caregiving experience and/or patients' recommendations for integrating supportive care of caregivers in neuro-oncology. This qualitative study examined caregiver distress as well as caregiver supportive care needs from the patients' perspective to inform future intervention development. METHODS Adults with PBT (N = 15; Mage = 45; 53% female; 93% White) were divided into four, 90-min focus groups moderated by a clinical neuropsychologist. Patients responded to semi-structured interview questions regarding various supportive care needs throughout the course of disease. Each discussion was transcribed and coded using thematic content analysis and NVivo software. Inter-rater reliability was excellent (MKappa = 0.92, range = 0.85-0.93). RESULTS Seven distinct codes related to PBT caregivers emerged and were classified into two broader themes: Caregiver Impact (47% of coded content) and Caregiver Support (53% of coded content). Caregiver Impact refers to patients' perspective of the practical and emotional demands of caregiving. Under Caregiver Support, patients cited a strong need for increased support of caregivers, including bereavement care, individual psychotherapy, and joint caregiver-patient dyad sessions. CONCLUSION Patients with PBT expressed profound concerns regarding the demands of caregiving and its impact on the well-being of their loved ones. Findings emphasize the need for comprehensive dyadic support in neuro-oncology throughout the disease trajectory to enhance the overall quality-of-life for both patients and their caregivers.
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Affiliation(s)
- Kelcie D Willis
- Department of Psychiatry, Center for Psychiatric Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Morgan P Reid
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Amber Fox
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Christopher S Kleva
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Paula Sherwood
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ashlee R Loughan
- Division of Neuro-Oncology, Department of Neurology, VCU School of Medicine, 1201 East Marshall St, Richmond, VA, 23298, USA.
- Massey Cancer Center, VCU School of Medicine, Richmond, VA, USA.
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Thallner R, Gumbinger C, Hohmann A, Wick A, Wick W, Busetto L. Patient, Relative and Staff Experiences of Clinical Trial Participation in Neurooncology: "Maybe You Can Also Show the Positive, No Matter How It Ends". Cancer Manag Res 2024; 16:663-676. [PMID: 38919873 PMCID: PMC11197948 DOI: 10.2147/cmar.s447407] [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: 11/02/2023] [Accepted: 05/22/2024] [Indexed: 06/27/2024] Open
Abstract
Purpose There is a lack of evidence regarding how patients with malignant brain tumor and their relatives experience participation in neurooncological clinical trials. Similarly, insights from the perspective of trial staff caring for this group of patients are missing. This study aims to investigate patient, relative and trial staff experiences regarding participation in clinical neurooncological trials. Methods Within a qualitative exploratory study, 29 semi-structured interviews with brain tumor patients, relatives and trial staff were conducted and analyzed using reflexive thematic analysis (RTA) by Braun and Clarke. A patient researcher and patient council were involved in data analysis and interpretation. Results Four themes were developed reflecting significant aspects of the trial experience: 1. "It all revolves around hope"; 2. "Trial participation: experiencing unique medical care"; 3. "Everyone's roles are changing"; 4. "Communication as a possible area of conflict". Experiencing trial participation and general medical treatment were found to be interconnected to such a degree that they were often not meaningfully distinguished by patients and relatives. Conclusion In addition to assessing traditional endpoints for patient outcomes, we recommend increased emphasis on investigating the impact of the "soft" components constituting trial participation. Due to the interconnectedness of medical treatment and trial participation, we recommend further investigation in comparison to experiences in regular care. A deeper understanding of trial participation is needed to inform improvements for patient experiences and staff satisfaction alongside medical and scientific progress.
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Affiliation(s)
- Ronja Thallner
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Christoph Gumbinger
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Anja Hohmann
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Antje Wick
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Wolfgang Wick
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Loraine Busetto
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
- Institute for Medical Virology, Goethe University Frankfurt, University Hospital, Frankfurt am Main, Germany
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La IS, Johantgen M, Storr CL, Zhu S, Cagle JG, Ross A. Spirituality moderates the relationship between cancer caregiver burden and depression. Palliat Support Care 2024; 22:470-481. [PMID: 38131143 DOI: 10.1017/s1478951523001785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
OBJECTIVES Cancer has become a chronic disease that requires a considerable amount of informal caregiving, often quite burdensome to family caregivers. However, the influence of spirituality on the caregivers' burden and mental health outcomes has been understudied. This study was to examine how caregiver burden, spirituality, and depression change during cancer treatment and investigate the moderating role of spirituality in the relationship between caregiver burden and depression for a sample of caregivers of persons with cancer. METHODS This secondary analysis used a longitudinal design employing 3 waves of data collection (at baseline, 3 months, and 6 months). Family caregivers completed the Caregiver Reaction Assessment, Spiritual Perspective Scale, and the PROMIS® depression measure. Linear mixed model analyses were used, controlling for pertinent covariates. RESULTS Spirituality, total caregiver burden, and depression remained stable over 6 months. More than 30% of the caregivers had mild to severe depressive symptoms at 3 time points. There was evidence of overall burden influencing depression. Of note was a protective effect of caregivers' spirituality on the relationship between depression and caregiver burden over time (b = -1.35, p = .015). The lower the spirituality, the stronger the relationship between depression and burden, especially regarding subscales of schedule burden, financial burden, and lack of family support. SIGNIFICANCE OF RESULTS Spirituality was a significant resource for coping with caregiving challenges. This study suggests that comprehensive screening and spiritual care for cancer caregivers may improve their cancer caregiving experience and possibly influence the care recipients' health.
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Affiliation(s)
- In Seo La
- College of Nursing Science, Kyung Hee University, Seoul, South Korea
| | - Meg Johantgen
- University of Maryland School of Nursing, Baltimore, MD, USA
| | - Carla L Storr
- University of Maryland School of Nursing, Baltimore, MD, USA
| | - Shijun Zhu
- University of Maryland School of Nursing, Baltimore, MD, USA
| | - John G Cagle
- University of Maryland School of Social Work, Baltimore, MD, USA
| | - Alyson Ross
- Wisdom of the Whole Coaching Academy, Asheville, NC, USA
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Buskbjerg CR, Amidi A, Munk A, Danielsen JT, Henriksen LT, Lukacova S, Haldbo-Classen L, Evald J, Evald L, Lassen-Ramshad Y, Zachariae R, Høyer M, Hasle H, Wu LM. Engaging carers in neuropsychological rehabilitation for brain cancer survivors: The "I'm aware: Patients And Carers Together" (ImPACT) program. Contemp Clin Trials 2024; 138:107419. [PMID: 38142774 DOI: 10.1016/j.cct.2023.107419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 12/11/2023] [Accepted: 12/19/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND Cognitive impairment is a common late effect in child and adult brain cancer survivors (BCS). Still, there is a dearth of research aimed at therapeutic interventions and no standard treatment options for most BCS. OBJECTIVE To describe 1) a novel neuropsychological rehabilitation program for BCS - the "I'm aware: Patients And Carers Together" (ImPACT) program, and 2) two studies that aim to assess the feasibility of the ImPACT program in child and adult BCS, respectively. The program adapts the holistic neuropsychological approach pioneered by Leonard Diller and Yehuda Ben-Yishay to an outpatient setting. METHODS Two feasibility studies are described: 1) A single-armed study with 15 child BCS (10-17 years) (ImPACT Child); and 2) a randomized waitlist-controlled trial with 26 adult BCS (>17 years) (ImPACT Adult). In both studies, patients will undergo an 8-week program together with a cohabiting carer. Primary outcomes (i.e., cognitive and neurobehavioral symptoms), and secondary outcomes (i.e., behavioral and psychological symptoms, e.g., quality of life, fatigue) will be assessed at four time points: pre-, mid-, and post intervention, and 8 weeks follow-up. Adult waitlist controls will be assessed at equivalent time points and will be included in the intervention group after all study assessments. Semi-structured interviews will be conducted at follow-up. EXPECTED OUTCOMES Results will provide feasibility data in support of future larger scale trials. DISCUSSION The findings could potentially improve the management of cognitive impairment in BCS and transform available services. The program can be delivered in-person or remotely and harnesses existing resources in patients' lives.
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Affiliation(s)
- C R Buskbjerg
- Department of Oncology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark; Unit for Psycho-oncology and Health Psychology, Department of Psychology and Behavioural Sciences, Aarhus University, Bartholins Allé, 8000 Aarhus, Denmark
| | - A Amidi
- Unit for Psycho-oncology and Health Psychology, Department of Psychology and Behavioural Sciences, Aarhus University, Bartholins Allé, 8000 Aarhus, Denmark
| | - A Munk
- Department of Oncology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark; Unit for Psycho-oncology and Health Psychology, Department of Psychology and Behavioural Sciences, Aarhus University, Bartholins Allé, 8000 Aarhus, Denmark
| | - J T Danielsen
- Unit for Psycho-oncology and Health Psychology, Department of Psychology and Behavioural Sciences, Aarhus University, Bartholins Allé, 8000 Aarhus, Denmark
| | - L T Henriksen
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - S Lukacova
- Danish Centre for Particle Therapy, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - L Haldbo-Classen
- Department of Oncology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - J Evald
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - L Evald
- Hammel Neurorehabilitation Centre & University Research Clinic, Voldbyvej 15, 8450, Hammel, Denmark
| | - Y Lassen-Ramshad
- Danish Centre for Particle Therapy, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - R Zachariae
- Department of Oncology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark; Unit for Psycho-oncology and Health Psychology, Department of Psychology and Behavioural Sciences, Aarhus University, Bartholins Allé, 8000 Aarhus, Denmark
| | - M Høyer
- Danish Centre for Particle Therapy, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - H Hasle
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - L M Wu
- Department of Oncology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark; Unit for Psycho-oncology and Health Psychology, Department of Psychology and Behavioural Sciences, Aarhus University, Bartholins Allé, 8000 Aarhus, Denmark; Department of Psychology, Reykjavik University, Iceland.
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Quevedo-Blasco R, Díaz-Román A, Vega-García A. Death Anxiety in Caregivers of Chronic Patients. Healthcare (Basel) 2024; 12:107. [PMID: 38201013 PMCID: PMC10871074 DOI: 10.3390/healthcare12010107] [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: 10/25/2023] [Revised: 11/26/2023] [Accepted: 12/22/2023] [Indexed: 01/12/2024] Open
Abstract
This study aimed to determine the extent to which caregivers of patients with chronic illnesses experience death anxiety, and which variables from caregivers and patients might potentially be related to their death anxiety. It also aimed to compare the levels of death anxiety between patients and caregivers. Web of Science, Scopus, PubMed, Psychology Database, Cochrane, and Google Scholar were searched for original studies available until December 2022 that quantitatively addressed death anxiety in family and informal caregivers of individuals with chronic illnesses. The methodological quality of the included studies was assessed, and a meta-analysis was conducted using Hedges' g as the effect size index and the DerSimonian-Laird method to analyze differences between patients and caregivers in death anxiety. The results of the 11 included studies showed moderate levels of death anxiety in caregivers, and the meta-analysis (k = 7; 614 patients and 586 caregivers) revealed non-significant differences between the death anxiety experienced by patients and caregivers (pooled Hedges' g = -0.03, 95% CI = -0.29 to 0.25, p = 0.802). Some sociodemographic and psychological factors (e.g., gender, depression, and anxiety) might be related to the death anxiety experienced, but additional research is necessary to validate these findings.
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Affiliation(s)
- Raúl Quevedo-Blasco
- Mind, Brain and Behavior Research Center (CIMCYC), University of Granada, 18011 Granada, Spain
| | - Amparo Díaz-Román
- Faculty of Psychology and Speech Therapy, University of Málaga, 29010 Málaga, Spain
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Walbaum C, Philipp R, Oechsle K, Ullrich A, Vehling S. Existential distress among family caregivers of patients with advanced cancer: A systematic review and meta-analysis. Psychooncology 2024; 33:e6239. [PMID: 37985531 DOI: 10.1002/pon.6239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 09/13/2023] [Accepted: 10/21/2023] [Indexed: 11/22/2023]
Abstract
OBJECTIVE Caregiving for a loved one is challenging and requires significant resources. Existential distress in family caregivers may include hopelessness, demoralization, fear of death, pre-loss grief, or a sense of not being emotionally prepared. The aim of this systematic review is to synthesize the quantitative literature on existential distress among family caregivers of patients with advanced cancer, focusing on its prevalence, association with mental disorders, as well as with sociodemographic, disease, and treatment-related factors. METHODS We systematically searched electronic databases for quantitative studies of the above-described existential distress concepts in family caregivers of patients with advanced cancer. Two independent reviewers extracted data and evaluated study quality. Data were analyzed using random-effects meta-analysis. RESULTS We retrieved 17.587 records, of which 31 studies fulfilled inclusion criteria. 63% of the studies (n = 20) provided sufficient data for meta-analysis for 5558 patients. We found an overall pooled prevalence of 30.6% for existential distress, 95% CI [24.2-37.0]. For existential distress subconcepts, prevalence rates were 57.0%, 95% CI [37.8-76.2], for death anxiety, 13.9%, 95% CI [10.8-17.0], for demoralization, 24.0%, 95% CI [18.0-30.0], for pre-loss grief, 18.4%, 95% CI [4.0-32.7], for hopelessness, 35.2%, 95% CI [28.2-42.2], for loneliness, and 35.6%, 95% CI [13.0-58.3], for emotional unpreparedness. CONCLUSIONS Approximately one third of the respondents were affected by high levels of existential distress. The review provides evidence for further development of support services that can reduce existential distress, focused on death anxiety, and improve the quality of life for family caregivers of patients with advanced cancer.
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Affiliation(s)
- Charlotte Walbaum
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Rebecca Philipp
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Karin Oechsle
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anneke Ullrich
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sigrun Vehling
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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7
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Sharma A. Palliative Care and Care Partner Support in Neuro-oncology. Continuum (Minneap Minn) 2023; 29:1872-1895. [PMID: 38085902 DOI: 10.1212/con.0000000000001353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
ABSTRACT The journey for a patient with a brain tumor and their loved ones can be extremely challenging due to the high burden of physical symptoms and the emotional distress caused by the diagnosis. Optimizing quality of life by addressing symptoms and reducing this emotional distress can improve treatment tolerance and outcomes and alleviate care partner distress and burden. Symptoms in patients with central nervous system (CNS) tumors can vary in onset and intensity, ranging from headaches, seizures, and focal weakness to emotional distress and cognitive dysfunction. Additionally, care partners may demonstrate distress due to the high burden of care and need appropriate support structures and access to resources to alleviate this stress. Evidence-based recommendations are unfortunately limited given the lack of high-quality research in this area, but patients living with CNS tumors and their loved ones can benefit from early and routine symptom identification and management, compassionate and transparent communication, and practical guidance for the future. These principles are part of palliative care, a field of medicine focused on alleviating suffering in patients with serious, chronic illness. Clinicians involved in the care of patients with CNS tumors must be educated in these important primary palliative care principles. This article focuses on key symptom management, strategies for high-quality communication, a discussion of advance care planning, and an overview of end-of-life care.
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Willis K, Ravyts SG, Lanoye A, Reid MP, Aslanzadeh FJ, Braun SE, Svikis D, Rodin G, Loughan AR. Measuring and understanding death anxiety in caregivers of patients with primary brain tumor. Palliat Support Care 2023; 21:812-819. [PMID: 35975283 PMCID: PMC9935750 DOI: 10.1017/s1478951522001110] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Caregivers of patients with primary brain tumor (PBT) describe feeling preoccupied with the inevitability of their loved one's death. However, there are currently no validated instruments to assess death anxiety in caregivers. This study sought to examine (1) the psychometric properties of the Death and Dying Distress Scale (DADDS), adapted for caregivers (DADDS-CG), and (2) the prevalence and correlates of death anxiety in caregivers of patients with PBT. METHODS Caregivers (N = 67) of patients with PBT completed the DADDS-CG, Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder (GAD-7), Fear of Cancer Recurrence (FCR-7), and God Locus of Health Control (GLHC). Caregivers' sociodemographic information and patients' medical characteristics were also collected. Preliminary examination of the psychometric properties of the DADDS-CG was conducted using exploratory factor analysis, Cronbach's alpha, and correlations. The prevalence and risk factors of death anxiety were assessed using frequencies, pair-wise comparisons, and correlations. RESULTS Factor analysis of the DADDS-CG revealed a two-factor structure consistent with the original DADDS. The DADDS-CG demonstrated excellent internal consistency, convergent validity with the PHQ-9, GAD-7, and FCR-7, and discriminant validity with the GLHC. Over two-thirds of caregivers reported moderate-to-severe symptoms of death anxiety. Death anxiety was highest in women and caregivers of patients with high-grade PBT. SIGNIFICANCE OF RESULTS The DADDS-CG demonstrates sound psychometric properties in caregivers of patients with PBT, who report high levels of death anxiety. Further research is needed to support the measure's value in clinical care and research - both in this population and other caregivers - in order to address this unmet, psychosocial need.
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Affiliation(s)
- Kelcie Willis
- Department of Psychology, Virginia Commonwealth University, Richmond, VA
- Massey Cancer Center, Virginia Commonwealth University, Richmond, VA
| | - Scott G. Ravyts
- Department of Psychology, Virginia Commonwealth University, Richmond, VA
| | - Autumn Lanoye
- Massey Cancer Center, Virginia Commonwealth University, Richmond, VA
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, VA
| | - Morgan P. Reid
- Department of Psychology, Virginia Commonwealth University, Richmond, VA
- Massey Cancer Center, Virginia Commonwealth University, Richmond, VA
| | | | - Sarah Ellen Braun
- Massey Cancer Center, Virginia Commonwealth University, Richmond, VA
- Department of Neurology, Virginia Commonwealth University, Richmond, VA
| | - Dace Svikis
- Department of Psychology, Virginia Commonwealth University, Richmond, VA
| | - Gary Rodin
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Ashlee R. Loughan
- Massey Cancer Center, Virginia Commonwealth University, Richmond, VA
- Department of Neurology, Virginia Commonwealth University, Richmond, VA
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Kroll JL, Jones M, Chen AB, Yang CC, Carmack CL, Cohen L, Bruera E, Milbury K. End-of-Life Care, Symptom Burden, and Quality of Life in Couples Facing Stage IV Lung Cancer: The Role of Patient and Spousal Psychospirituality and Discussions Around Fear of Death and Disease Progression. J Palliat Med 2023; 26:690-696. [PMID: 36856536 PMCID: PMC10150712 DOI: 10.1089/jpm.2022.0376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2023] [Indexed: 03/02/2023] Open
Abstract
Background: As patients live longer with stage IV nonsmall cell lung cancer, correlates of end-of-life (EOL) care and experience are increasingly relevant. Methods: We, therefore, prospectively examined associations among psychospirituality (Center for Epidemiologic Studies Depression Scale, Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being), discussions around fear of death and disease progression, and hospital-based EOL care in patients and caregivers. Patients additionally reported symptom burden (MD Anderson Symptom Inventory-Lung Cancer total) and quality of life (QOL) (quality-of-life at EOL). Results: Of the baseline patients (n = 75), 32% were alive at time of the analyses (mean = 4.6 years postbaseline). Deceased patients (n = 51) were middle aged (mean = 65.3 years) and non-Hispanic White (81%). Caregiver spiritual well-being (r = 0.34, p = 0.02) and depression (r = -0.31, p = 0.03) were associated with EOL care metrics. Patients who "held back" more of their fear of death or disease progression experienced greater symptom burden (r = 0.41, p < 0.001) and poorer QOL (r = -0.44, p < 0.001). Conclusion: For couples facing prolonged metastatic disease, psychospirituality is highly relevant to EOL care with potential sequelae of withholding one's fear regarding death or disease progression.
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Affiliation(s)
- Juliet L. Kroll
- Department of Behavioral Science, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Morgan Jones
- Department of Behavioral Science, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Aileen B. Chen
- Department of Radiation Oncology, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Chunyi Claire Yang
- Department of Radiation Oncology, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Cindy L. Carmack
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Lorenzo Cohen
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kathrin Milbury
- Department of Behavioral Science, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Amonoo HL, Johnson PC, Nelson AM, Clay MA, Daskalakis E, Newcomb RA, Deary EC, Mattera EF, Yang D, Cronin K, Boateng K, Lee SJ, LeBlanc TW, El-Jawahri A. Coping in caregivers of patients with hematologic malignancies undergoing hematopoietic stem cell transplantation. Blood Adv 2023; 7:1108-1116. [PMID: 36398978 PMCID: PMC10111355 DOI: 10.1182/bloodadvances.2022008281] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 08/10/2022] [Accepted: 09/29/2022] [Indexed: 11/21/2022] Open
Abstract
Caregivers of patients with hematologic malignancies undergoing hematopoietic stem cell transplantation (HSCT) must cope with substantial caregiving burden, high rates of psychological distress, and diminished quality of life (QOL). However, data describing coping strategies before HSCT and the association between coping, QOL, and psychological outcomes in this population are lacking. We conducted a secondary analysis of data collected during a multisite randomized clinical trial of a supportive care intervention in HSCT recipients and their caregivers. Caregivers completed the Brief COPE, Hospital Anxiety and Depression Scale, and the Caregiver Oncology Quality of Life Questionnaire to measure coping strategies, psychological distress, and QOL, respectively. We grouped coping into 2 higher-order domains: approach-oriented (ie, emotional support and active coping) and avoidant (ie, self-blame and denial). We used the median split method to describe the distribution of coping and multivariate linear regression models to assess the relationship between coping and caregiver outcomes. We enrolled 170 caregivers, with a median (range) age of 53 (47-64) years. Most were White (87%), non-Hispanic (96%), and female (77%). Approach-oriented coping was associated with less anxiety (β = -0.210, P = .003), depression symptoms (β = -0.160, P = .009), and better QOL (β = 0.526, P = .002). In contrast, avoidant coping was associated with more anxiety (β = 0.687, P<.001), depression symptoms (β = 0.579, P < .001), and worse QOL (β = -1.631, P < .001). Our findings suggest that coping is related to distress and QOL among caregivers of HSCT recipients even before transplant. Hence, caregivers of patients with hematologic malignancies undergoing HSCT may benefit from resources that facilitate adaptive coping with the demands of caregiving.
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Affiliation(s)
- Hermioni L. Amonoo
- Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA
- Harvard Medical School, Boston, MA
| | - P. Connor Johnson
- Harvard Medical School, Boston, MA
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Ashley M. Nelson
- Harvard Medical School, Boston, MA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Madison A. Clay
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | | | - Richard A. Newcomb
- Harvard Medical School, Boston, MA
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Emma C. Deary
- Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA
| | - Elizabeth F. Mattera
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Daniel Yang
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Katherine Cronin
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Kofi Boateng
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Stephanie J. Lee
- Clinical Research Division, Fred Hutchinson Cancer Research Center, and Division of Medical Oncology, University of Washington, Seattle, WA
| | - Thomas W. LeBlanc
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Areej El-Jawahri
- Harvard Medical School, Boston, MA
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA
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11
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Diamond EL. Advances in palliative care in neuro-oncology come in many forms. Neuro Oncol 2023; 25:457-458. [PMID: 36610079 PMCID: PMC10013640 DOI: 10.1093/neuonc/noac287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Indexed: 01/09/2023] Open
Affiliation(s)
- Eli L Diamond
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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12
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Arshinoff R, Roldan C, Balboni T. Spirituality and spiritual distress in neurologic illness. HANDBOOK OF CLINICAL NEUROLOGY 2023; 191:221-234. [PMID: 36599510 DOI: 10.1016/b978-0-12-824535-4.00004-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Neurologic illnesses present multiple challenges to patients and their families from the time of initial diagnosis and throughout their illness trajectory, including challenges related to accepting the diagnosis and its various impacts and anxiety about future living with their illness. Often patients and their families rely on their spirituality to cope with and to maintain meaning and dignity in the midst of disease. As a result, spiritual care provision is a critical component of holistic medical care to patients with neurologic illness. Spiritual care provision follows a generalist-specialist model, which requires all healthcare professionals involved in the care of patients facing serious illness to play a role in recognizing and addressing spiritual needs. This model is characterized by generalist spiritual care providers (e.g., nurses, physicians, social workers) who perform spiritual screenings through history taking. Chaplains function as specialist spiritual care providers and can address spiritual care more deeply. In addition, several developed psychotherapeutic approaches may be useful for patients with neurologic disease, and chaplains are especially trained to offer supportive spiritual care to patients with neurologic illnesses and their families and to work together with physicians and other members of the healthcare team as part of a holistic approach to care.
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Affiliation(s)
- Rena Arshinoff
- Department of Spiritual Care, Baycrest Center for Geriatrics, Division of Palliative Care, University of Toronto, Toronto, ON, Canada.
| | - Claudia Roldan
- Northwestern Feinberg School of Medicine, Chicago, IL, United States
| | - Tracy Balboni
- Departments of Radiation Oncology and of Psychosocial Oncology and Palliative Care, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, MA, United States
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13
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Forst DA, Kaslow-Zieve ER, Hansen A, Mesa M, Landay SL, Quain KM, Sereno I, El-Jawahri A, Greer JA, Temel JS, Jacobs JM. Characterizing Distress and Identifying Modifiable Intervention Targets for Family Caregivers of Patients with Malignant Gliomas. J Palliat Med 2023; 26:17-27. [PMID: 35708587 DOI: 10.1089/jpm.2021.0534] [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: 01/11/2023] Open
Abstract
Background: Individuals caring for patients with malignant gliomas experience high rates of anxiety; however, an in-depth understanding of their distress and evidence-based interventions to target their needs are lacking. Objective: We conducted semistructured interviews with caregivers with elevated anxiety to characterize their drivers of anxiety, identify modifiable intervention targets, and capture their preferences for a psychosocial intervention. Design: From 9/2017 to 3/2019, we conducted semistructured interviews with 21 caregivers of patients with malignant gliomas, at time points following the patient's diagnosis or within one to three months after the patient's death. Setting/Subjects: Eligible caregivers in the United States had clinically significant anxiety as measured by a Hospital Anxiety and Depression Scale-Anxiety score >7. Measurements: Three independent coders employed thematic content analysis to analyze the qualitative data with NVivo 12, achieving high intercoder agreement (Kappa = 0.98). Results: On average, caregivers were 54.81 years old (SD = 10.85) with elevated anxiety (M = 10.90, SD = 3.25). We identified six themes in which caregivers described (1) coping through reassurance seeking or avoidance, (2) changes in their relationship with the patient, (3) challenges with social support, (4) vacillation between certainty and uncertainty regarding the future, (5) devaluation of self-care for the patients' needs, and (6) challenges communicating with the health care team. Caregivers were interested in an intervention soon after the patient's diagnosis, yet expressed concern about finding the time to participate. Conclusions: Emergent themes characterized the distress experienced by caregivers of patients with malignant gliomas and provided insight into their psychosocial intervention preferences. We identified evidence-based intervention components based on the modifiable factors arising from these themes.
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Affiliation(s)
- Deborah A Forst
- Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | | | - Andrea Hansen
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Michelle Mesa
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Kit M Quain
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Areej El-Jawahri
- Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Joseph A Greer
- Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer S Temel
- Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Jamie M Jacobs
- Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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14
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Shlobin NA, Kolcun JPG, Leland BD, Ackerman LL, Lam SK, Raskin JS. Disability or Death: A Focused Review of Informed Consent in Pediatric Neurosurgery. Semin Pediatr Neurol 2022; 45:101030. [PMID: 37003629 DOI: 10.1016/j.spen.2022.101030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 12/04/2022] [Accepted: 12/10/2022] [Indexed: 12/24/2022]
Abstract
The management of pediatric neurosurgical disease often requires families to choose between long-term disability and premature death. This decision-making is codified by informed consent. In practice, decision-making is heavily weighted toward intervening to prevent death, often with less consideration of the realities of long-term disability. We analyze long-term disability in pediatric neurosurgical disease from the perspectives of patients, families, and society. We then present a pragmatic framework and conversational approach for addressing informed consent discussions when the outcome is expected to be death or disability. We performed a focused review of literature regarding informed consent in pediatric neurosurgery by searching PubMed and Google Scholar with search terms including "pediatric neurosurgery," "informed consent," and "disability." The literature was focused on patients with diagnoses including spina bifida, neuro-oncology, trauma, and hydrocephalus. Patient perspective elements were physical/mental disability, lack of autonomy, and role in community/society. The family perspective involves caregiver burden, emotional toll, and financial impact. Societal considerations include the availability of public resources for disabled children, large-scale financial cost, and impacts on global health. Practical conversational steps with patients/caregivers include opening the discussion, information provision and acknowledgement of uncertainty, assessment of understanding and clarifying questions, decision-making, and decision maintenance, all while remaining sensitive to the emotional burden commensurate with these decisions. The "death or disability" paradigm represents a common challenge to informed consent in pediatric neurosurgery. Patient, family, and societal factors that inform surrogate decisions vary and sometimes conflict. Pediatric neurosurgeons must use a comprehensive approach to address the informational and relational needs of caregivers during the informed consent process.
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15
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Applebaum AJ, Baser RE, Roberts KE, Lynch K, Gebert R, Breitbart WS, Diamond EL. Meaning-Centered Psychotherapy for Cancer Caregivers: A pilot trial among caregivers of patients with glioblastoma multiforme. Transl Behav Med 2022; 12:841-852. [PMID: 35852487 PMCID: PMC9385123 DOI: 10.1093/tbm/ibac043] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023] Open
Abstract
Caregivers of patients with glioblastoma multiforme (GBM) are at significant risk for existential distress. Such distress negatively impacts caregivers' quality of life and capacity to serve in their role as healthcare proxies, and ultimately, contributes to poor bereavement outcomes. Our team developed Meaning-Centered Psychotherapy for Cancer Caregivers (MCP-C), the first targeted psychosocial intervention that directly addresses existential distress in caregivers. The purpose of this study was to evaluate the feasibility, acceptability, and preliminary effects of MCP-C among caregivers of patients with GBM via a mixed-method pilot trial. Caregivers were randomized to seven sessions of MCP-C or Enhanced Usual Care (EUC), which included distress screening and the provision of targeted referrals and completed quantitative assessments at baseline (T1), after completion of MCP-C (T2), and at 2-month follow-up (T3). A subset of participants engaged in semistructured interviews at T2. Of 60 caregivers randomized, 55 were evaluable for preliminary efficacy analysis. Constrained linear mixed models indicated the MCP-C arm had statistically significant improvement relative to the EUC arm in the primary outcome of personal meaning and multiple secondary outcomes, including benefit finding, depressive symptomatology, and spiritual wellbeing. MCP-C demonstrated preliminary efficacy in facilitating caregivers' capacity to experience a sense of meaning and purpose despite the challenges and suffering associated with providing care to patients with GBM. Future studies are needed among more diverse samples of caregivers and should include the opportunity for concurrent patient enrollment to allow for a reciprocal and augmented experience of meaning among patient-caregiver dyads.
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Affiliation(s)
| | - Raymond E Baser
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kailey E Roberts
- Clinical Psychology PsyD Program, Ferkauf Graduate School of Psychology, Yeshiva University, New York, NY, USA
| | - Kathleen Lynch
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Rebecca Gebert
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - William S Breitbart
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Eli L Diamond
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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16
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Heinsch M, Cootes H, Wells H, Tickner C, Sampson D, Kay-Lambkin F. "It's Hard, but We Could Kind of Laugh About It": Exploring the Role of Humor in Brain Cancer Caregiving. QUALITATIVE HEALTH RESEARCH 2022; 32:744-754. [PMID: 35152801 DOI: 10.1177/10497323211069339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Research exploring the benefits of humor for caregivers is limited and, to date, no qualitative studies have explored the role of humor in brain cancer caregiving. To address this gap, we analyzed transcripts from twenty-one in-depth telephone interviews conducted with brain cancer caregivers from a strengths perspective. Thematic analysis using Braun and Clarke's method revealed that humor functions as (1) an innate element of the self and relationship, (2) an expression of mutual connection and understanding, (3) a way of managing difficult or awkward moments, (4) a form of avoidance or a welcome distraction, and may be (5) helpful, or unhelpful, depending on where someone is in the brain cancer trajectory. Findings suggest that humor represents an important yet complex individual and family strength for health service providers to identify and build upon.
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Affiliation(s)
- Milena Heinsch
- Centre for Brain and Mental Health Research, 5982University of Newcastle, Callaghan, NSW, Australia
| | - Hannah Cootes
- Centre for Brain and Mental Health Research, 5982University of Newcastle, Callaghan, NSW, Australia
| | - Hannah Wells
- Centre for Brain and Mental Health Research, 5982University of Newcastle, Callaghan, NSW, Australia
| | - Campbell Tickner
- Centre for Brain and Mental Health Research, 5982University of Newcastle, Callaghan, NSW, Australia
| | - Dara Sampson
- Centre for Brain and Mental Health Research, 5982University of Newcastle, Callaghan, NSW, Australia
| | - Frances Kay-Lambkin
- Centre for Brain and Mental Health Research, 5982University of Newcastle, Callaghan, NSW, Australia
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17
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Factors associated with psychological distress in caregivers of patients with malignant gliomas. Support Care Cancer 2022; 30:5811-5820. [DOI: 10.1007/s00520-022-06989-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 03/11/2022] [Indexed: 10/18/2022]
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18
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Benites AC, Arantes de Oliveira-Cardoso É, Dos Santos MA. Spirituality in Brazilian family caregivers of patients with cancer from the end-of-life care to bereavement. DEATH STUDIES 2022; 47:249-258. [PMID: 35300583 DOI: 10.1080/07481187.2022.2051095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Although spirituality can be a source of support during end-of-life and engage a transformative experience after loss, few studies report family members' spiritual and existential needs considering their experiences over time. We conducted a longitudinal interpretative phenomenological analysis from audio-recorded interviews of 10 family caregivers while providing end-of-life care for cancer patients and during bereavement. Participants' spirituality experiences were presented in three superordinate themes: connectedness with religious beliefs and the deceased; re-signifying relationships, life, and loss; suffering and the family caregiver's needs. Finding connection through relationships, greater existential and spiritual suffering post-loss were important issues involved in expressing their spirituality.
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Affiliation(s)
- Andrea Carolina Benites
- Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto, Departamento de Psicologia, Universidade de São Paulo. Ribeirao Preto, Brazil
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Érika Arantes de Oliveira-Cardoso
- Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto, Departamento de Psicologia, Universidade de São Paulo. Ribeirao Preto, Brazil
| | - Manoel Antônio Dos Santos
- Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto, Departamento de Psicologia, Universidade de São Paulo. Ribeirao Preto, Brazil
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19
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Crooms RC, Johnson MO, Leeper H, Mehta A, McWhirter M, Sharma A. Easing the Journey-an Updated Review of Palliative Care for the Patient with High-Grade Glioma. Curr Oncol Rep 2022; 24:501-515. [PMID: 35192120 DOI: 10.1007/s11912-022-01210-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2022] [Indexed: 12/26/2022]
Abstract
PURPOSE OF REVIEW High-grade gliomas (HGG) are rare brain tumors that cause disproportionate suffering and mortality. Palliative care, whose aim is to relieve the symptoms and stressors of serious illness, may benefit patients with HGG and their families. In this review, we summarize the extant literature and provide recommendations for addressing the symptom management and communication needs of brain tumor patients and their caregivers at key points in the illness trajectory: initial diagnosis; during upfront treatment; disease recurrence; end-of-life period; and after death during bereavement. RECENT FINDINGS Patients with HGG experience highly intrusive symptoms, cognitive and functional decline, and emotional and existential distress throughout the disease course. The caregiver burden is also substantial during the patient's illness and after death. There is limited evidence to guide the palliative management of these issues. Palliative care is likely to benefit patients with HGG, yet further research is needed to optimize the delivery of palliative care in neuro-oncology.
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Affiliation(s)
- Rita C Crooms
- Department of Neurology, Icahn School of Medicine at Mount Sinai, 1468 Madison Ave, 1052, NY, 10029, New York, USA.,Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Margaret O Johnson
- Department of Neurosurgery, Duke University Medical Center, Trent Drive 047 Baker House, Durham, NC, 27710, USA.,The Preston Robert Tirsch Brain Tumor Center, Duke University Medical Center, Trent Drive 047 Baker House, NC, 27710, Durham, USA
| | - Heather Leeper
- Neuro-Oncology Branch, National Institutes of Health, National Cancer Institute, 9030 Old Georgetown Rd, Bloch Bldg 82, Bethesda, MD, 20892, USA
| | - Ambereen Mehta
- Palliative Care Program, Division of Medicine, Johns Hopkins School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, 21224, MD, USA.,Division of Medicine, Johns Hopkins School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, 21224, MD, USA
| | - Michelle McWhirter
- Palliative Care Program, Division of Medicine, Johns Hopkins School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, 21224, MD, USA.,Department of Social Work, Johns Hopkins Bayview Medical Center, Baltimore, 21224, MD, USA
| | - Akanksha Sharma
- Department of Translational Neurosciences, Pacific Neuroscience Institute/Saint John's Cancer Institute, 2200 Santa Monica Blvd, Santa Monica, CA, 90404, USA.
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20
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Neuro-oncology and supportive care: the role of the neurologist. Neurol Sci 2022; 43:939-950. [DOI: 10.1007/s10072-021-05862-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 12/28/2021] [Indexed: 11/29/2022]
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21
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A qualitative exploration of the feasibility and acceptability of Meaning-Centered Psychotherapy for Cancer Caregivers. Palliat Support Care 2022; 20:623-629. [PMID: 35078552 PMCID: PMC9314455 DOI: 10.1017/s1478951521002030] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Caregivers of patients with cancer are at significant risk for existential distress. Such distress negatively impacts caregivers' quality of life and capacity to serve in their role as healthcare proxies, and ultimately, contributes to poor bereavement outcomes. Our team developed Meaning-Centered Psychotherapy for Cancer Caregivers (MCP-C), the first targeted psychosocial intervention that directly addresses existential distress in caregivers. METHOD Nine caregivers of patients with glioblastoma multiforme (GBM) enrolled in a pilot randomized controlled trial evaluating the feasibility, acceptability, and effects of MCP-C, and completed in-depth interviews about their experience in the therapy. One focus group with three MCP-C interventionists was also completed. RESULTS Four key themes emerged from interviews: (1) MCP-C validated caregivers' experience of caregiving; (2) MCP-C helped participants reframe their "caregiving identity" as a facet of their larger self-identity, by placing caregiving in the context of their life's journey; (3) MCP-C enabled caregivers to find ways to assert their agency through caregiving; and (4) the structure and sequence of sessions made MCP-C accessible and feasible. Feedback from interventionists highlighted several potential manual changes and overall ways in which MCP-C can help facilitate caregivers' openness to discussing death and engaging in advanced care planning discussions with the patient. SIGNIFICANCE OF RESULTS The overarching goal of MCP-C is to allow caregivers to concurrently experience meaning and suffering; the intervention does not seek to deny the reality of challenges endured by caregivers, but instead to foster a connection to meaning and purpose alongside their suffering. Through in-depth interviews with caregivers and a focus group with MCP interventionists, we have refined and improved our MCP-C manual so that it can most effectively assist caregivers in experiencing meaning and purpose, despite inevitable suffering.
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22
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"You begin to give more value in life, in minutes, in seconds": spiritual and existential experiences of family caregivers of patients with advanced cancer receiving end-of-life care in Brazil. Support Care Cancer 2021; 30:2631-2638. [PMID: 34817692 PMCID: PMC8611251 DOI: 10.1007/s00520-021-06712-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 11/18/2021] [Indexed: 11/18/2022]
Abstract
Purpose Facing the end of life may trigger significant distress in family caregivers of patients with advanced cancer. However, few studies have addressed the spiritual and existential concerns of these family caregivers in their end-of-life care journey. This study aimed to understand the spiritual and existential experience of family caregivers of patients with advanced cancer facing the end of life in Brazil. Methods A purposive sample of 16 family caregivers of hospitalized terminally ill cancer patients in Brazil participated in in-depth interviews. Data collection and analysis were based on interpretative phenomenological analysis. Results Three superordinate themes in their spiritual and existential experience were identified: (i) connectedness through caregiving, personal relationships, and spiritual beliefs; (ii) shifting hope: from death as a possibility to preparation for impending death; (iii) reframing suffering and meaning. For these caregivers, the relationship with the patient and with others, their spiritual beliefs, and hope were significant sources of meaning. Hope was sustained by death avoidance, oscillating with death acceptance and hope that it would occur with comfort. Family caregivers also experienced existential and spiritual suffering in the form of guilt, suppressed emotions, and loneliness. Conclusion Health care providers should address and support caregivers’ spiritual needs and their relationships with the patient and others during end-of-life care and facilitate reflection regarding existential concerns, meaning, and preparation for impending death.
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23
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Crooms RC, Lin HM, Neifert S, Deiner SG, Brallier JW, Goldstein NE, Gal JS, Gelfman LP. Palliative Care Consultation for Hospitalized Patients with Primary and Secondary Brain Tumors at a Single Academic Center. J Palliat Med 2021; 24:1550-1554. [PMID: 34166114 DOI: 10.1089/jpm.2021.0088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Studies addressing palliative care delivery in neuro-oncology are limited. Objectives: To compare inpatients with brain tumors who received palliative care (through referral or trigger) with those receiving usual care. Design: Retrospective cohort study. Setting/Subjects: Inpatients with primary or secondary brain tumors who did or did not receive palliative care at a U.S. medical center. Measurements: Sociodemographic, clinical, and utilization characteristics were compared. Results: Of 1669 brain tumor patients, 386 (23.1%) received palliative care [nontrigger: 246 (14.7%); trigger: 140 (8.4%)] and 1283 (76.9%) received usual care. Nontrigger patients were oldest (mean age 65.0 years; trigger: 61.1 years; usual care: 55.5 years; p < 0.001); sickest at baseline (mean Elixhauser comorbidity index 3.76; trigger: 3.49; usual care: 1.84; p < 0.001); and had highest in-hospital death [34 (13.8%), trigger: 10 (7.1%), usual care: 7 (0.5%); p < 0.001] and hospice discharge [54 (22.0%), trigger: 18 (12.9%), usual care: 14 (1.1%); p < 0.001]. Conclusions: Trigger criteria may promote earlier palliative care referral, yet criteria tailored for neuro-oncology are undeveloped.
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Affiliation(s)
- Rita C Crooms
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Hung-Mo Lin
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Sean Neifert
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Stacie G Deiner
- Dartmouth Hitchcock and Geisel School of Medicine, Lebanon, New Hampshire, USA
| | - Jess W Brallier
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Nathan E Goldstein
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Geriatric Research Education and Clinical Center, James J. Peters VA Medical Center, Bronx, New York, USA
| | - Jonathan S Gal
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Laura P Gelfman
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Geriatric Research Education and Clinical Center, James J. Peters VA Medical Center, Bronx, New York, USA
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24
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Bovero A, Vitiello LP, Botto R, Gottardo F, Cito A, Geminiani GC. Demoralization in End-of-Life Cancer Patients' Family Caregivers: A Cross-Sectional Study. Am J Hosp Palliat Care 2021; 39:332-339. [PMID: 34128389 DOI: 10.1177/10499091211023482] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES The aims of this study were to evaluate the prevalence of demoralization in a sample of end-of-life cancer patients' family caregivers and investigate the association between demoralization and different factors, such as distress, hope, quality of life, and caregiver burden. METHODS The study used a cross-sectional design and 142 participants were sampled. Family caregivers were included if they were caring for a cancer patient in palliative care with a limited life expectancy.Socio-demographic data were gathered, and Italian versions of the following scales were administered: Demoralization Scale (DS), Herth Hope Index (HHI), Caregiver Reaction Assessment (CRA), Short Form-36 Health Survey (SF-36), and Distress Thermometer (DT). RESULTS The average total demoralization score was 29.04 (SD = 13.62). 19.50% of caregivers was the low scorers at DS (0-25th percentile), 27.50% was the middle scorers (25th-75th percentile), and 39.00% was the high scorers (75th-100 percentile). 19.50% of the caregivers showed mild demoralization, 27.50% moderate demoralization, and 39.00% showed severe demoralization. Strong Moderate correlations were found between the total DS score and the Temporality and Future HHI subscale (ρ = .520); the HHI total score (ρ = .528); the Social functioning (ρ = .536) and Mental health (ρ = .675) SF-36 subscales. The HHI total score and the Mental health SF-36 subscale emerged as the main predictors of demoralization. CONCLUSIONS The results show that not only end-of-life patients but also family caregivers may experience demoralization. This demoralization seems to be more associated to spiritual and psychological suffering rather than difficulties relating to caregivers' personal time, social roles, physical states, and financial resources.
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Affiliation(s)
- Andrea Bovero
- Clinical Psychology Unit, Department of Neuroscience, 9314University of Turin, Città della Salute e della Scienza" Hospital, Turin, Italy
| | - Ludovica Panzini Vitiello
- Clinical Psychology Unit, Department of Neuroscience, 9314University of Turin, Città della Salute e della Scienza" Hospital, Turin, Italy
| | - Rossana Botto
- Clinical Psychology Unit, Department of Neuroscience, 9314University of Turin, Città della Salute e della Scienza" Hospital, Turin, Italy
| | - Francesco Gottardo
- Clinical Psychology Unit, Department of Neuroscience, 9314University of Turin, Città della Salute e della Scienza" Hospital, Turin, Italy
| | - Alessandra Cito
- Clinical Psychology Unit, Department of Neuroscience, 9314University of Turin, Città della Salute e della Scienza" Hospital, Turin, Italy
| | - Giuliano Carlo Geminiani
- Clinical Psychology Unit, Department of Neuroscience, 9314University of Turin, Città della Salute e della Scienza" Hospital, Turin, Italy
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25
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Binswanger J, Kohl C, Behling F, Noell S, Hirsch S, Hickmann AK, Tatagiba MS, Tabatabai G, Hippler M, Renovanz M. Neuro-oncological patients' and caregivers' psychosocial burden during the COVID-19 pandemic-A prospective study with qualitative content analysis. Psychooncology 2021; 30:1502-1513. [PMID: 33938076 DOI: 10.1002/pon.5713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/11/2021] [Accepted: 04/12/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The COVID-19 pandemic may reinforce psychosocial distress of neuro-oncological patients. We aimed to (1) differentiate the burden caused by the pandemic versus the tumor and (2) establish topics relevant for brain tumor patients (BTPs) and caregivers. METHODS Patients and caregivers were prospectively assessed from April 2020-July 2020 by a 10-item comprising interview over the phone, including qualitative and quantitative questions. They were quantitatively evaluated i.a. by the distress thermometer (DT, score 1-10). The qualitative questions were analyzed using structured content analysis: The interview questions defined the main categories. Subcategories were derived by an inductive approach assessing the frequency of patients' and caregivers' answers. RESULTS A total of 69 patients and 20 caregivers were interviewed; n = 36 were female (49%), mean age was 53 years (range 32-81). Patients' disease-related DT scores were higher than the COVID-19-related DT scores: the median of the disease-related DT score was 7 (range 2-10) versus median of COVID-19-related distress: 5.0 (range 2-7). Caregivers perceived a higher burden due to the disease (DT median disease: 8; range 2-10 vs. DT pandemic: 3, range 0-10). A total of five main and 21 subcategories were elaborated, most frequently mentioned were "restrictions in public and private affairs" (28%), "changes in the psychological well-being" (23%), "limited social interaction by contact restriction" (25%). Subcategories relevant for caregivers were similar to those of BTPs. CONCLUSION A considerable proportion of patients and caregivers still perceived the brain tumor disease as more burdensome than the pandemic. We established main and subcategories of interview items possibly of great relevance to patients during these difficult times, which could be implemented in the content-related adaption of the psychosocial assessment.
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Affiliation(s)
- Julia Binswanger
- Department of Neurology and Interdisciplinary Neuro-Oncology, University Hospital Tübingen, Hertie Institute for Clinical Brain Research, Eberhard-Karls-University Tübingen, Tübingen, Germany
| | - Carolin Kohl
- Department of Neurology and Interdisciplinary Neuro-Oncology, University Hospital Tübingen, Hertie Institute for Clinical Brain Research, Eberhard-Karls-University Tübingen, Tübingen, Germany
| | - Felix Behling
- Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany.,Department of Neurosurgery, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany
| | - Susan Noell
- Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany.,Department of Neurosurgery, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany
| | - Sophie Hirsch
- Department of Neurology and Interdisciplinary Neuro-Oncology, University Hospital Tübingen, Hertie Institute for Clinical Brain Research, Eberhard-Karls-University Tübingen, Tübingen, Germany.,Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany
| | - Anne-Katrin Hickmann
- Department of Neurosurgery, Universitat St Gallen Bibliothek, St. Gallen, Switzerland
| | - Marcos Soares Tatagiba
- Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany.,Department of Neurosurgery, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany
| | - Ghazaleh Tabatabai
- Department of Neurology and Interdisciplinary Neuro-Oncology, University Hospital Tübingen, Hertie Institute for Clinical Brain Research, Eberhard-Karls-University Tübingen, Tübingen, Germany.,Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany
| | - Melina Hippler
- Department of Neurology and Interdisciplinary Neuro-Oncology, University Hospital Tübingen, Hertie Institute for Clinical Brain Research, Eberhard-Karls-University Tübingen, Tübingen, Germany.,Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany
| | - Mirjam Renovanz
- Department of Neurology and Interdisciplinary Neuro-Oncology, University Hospital Tübingen, Hertie Institute for Clinical Brain Research, Eberhard-Karls-University Tübingen, Tübingen, Germany.,Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany.,Department of Neurosurgery, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany
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Philipp R, Kalender A, Härter M, Bokemeyer C, Oechsle K, Koch U, Vehling S. Existential distress in patients with advanced cancer and their caregivers: study protocol of a longitudinal cohort study. BMJ Open 2021; 11:e046351. [PMID: 33895716 PMCID: PMC8074557 DOI: 10.1136/bmjopen-2020-046351] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION At the end of life, patients with advanced cancer and their informal caregivers may confront multiple existential concerns. Despite the strong potential to alleviate existential distress through psychosocial interventions, existential distress and its impact on healthcare outcomes have not yet been studied systematically. We aim to investigate the frequency, longitudinal trajectory and predictive impact of existential distress on end-of-life outcomes. We further aim to determine patients' and caregivers' specific need for and utilisation of psychosocial support for existential distress. METHODS This longitudinal cohort study will consecutively recruit 500 patients with advanced cancer and 500 caregivers from oncological outpatient and inpatient clinics. Participants will complete self-report questionnaires (sociodemographic and disease-related characteristics, existential distress, end-of-life outcomes, resources and support needs) at five points of assessment (at baseline and after 3, 6, 9 and 12 months). At baseline and 6-month follow-up, we will conduct structured diagnostic interviews to assess mental disorders. Statistical analyses will include descriptive statistics to determine the prevalence of existential distress, mental disorders and end-of-life outcomes; multiple linear and logistic regression analyses to calculate the predictive impact of existential distress on end-of-life outcomes; and growth mixture models to analyse longitudinal trajectories of existential distress. DISCUSSION This study will provide comprehensive knowledge about patients' and caregivers' existential concerns. The longitudinal empirical data will allow for conclusions concerning the frequency and course of existential distress throughout 1 year. This important extension of existing cross-sectional research will contribute to further develop targeted psychosocial interventions. Profiles of existential distress may be applied by clinicians from multiple professions and help to address existential concerns effectively. ETHICS AND DISSEMINATION The study was approved by the institutional research ethics committee (reference number LPEK-0177). Results will be presented at scientific conferences and published in peer-reviewed journals. Other forms of dissemination will include sharing results on the psychometric properties of the structured demoralisation interview with international research groups and communication with healthcare professionals providing psychosocial treatment for patients and caregivers. Following scientific standards, our progress will be regularly updated on ClinicalTrials.gov. TRIAL REGISTRATION NUMBER NCT04600206.
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Affiliation(s)
- Rebecca Philipp
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anna Kalender
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Oncology, Hematology, and Bone Marrow Transplantation with Section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Carsten Bokemeyer
- Department of Oncology, Hematology, and Bone Marrow Transplantation with Section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Karin Oechsle
- Department of Oncology, Hematology, and Bone Marrow Transplantation with Section of Pneumology, Palliative Care Unit, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Uwe Koch
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sigrun Vehling
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Oncology, Hematology, and Bone Marrow Transplantation with Section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Prevalence of post-traumatic stress disorder in caregivers of pediatric neurosurgical patients. Childs Nerv Syst 2021; 37:959-967. [PMID: 33111174 DOI: 10.1007/s00381-020-04938-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 10/20/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Having a child receive a neurosurgical diagnosis creates significant stress and anxiety in caregivers. The stress of these life-threatening and emotionally charged diagnoses may put caregivers at risk for developing post-traumatic stress disorder (PTSD). While PTSD has been studied in a variety of caregivers of pediatric populations, to the best of our knowledge, it has yet to be examined in caregivers commonly seen in general pediatric neurosurgical practices. This study was designed to gain an understanding of the prevalence of PTSD within this population. METHODS A cross-sectional survey method was utilized. Participants completed both a survey to provide demographic information, and the Posttraumatic Stress Checklist for DSM-5 (PCL-5) which is used to make a provisional diagnosis of PTSD. Surveys were distributed both in person and online between December 2018 and April 2019. RESULTS One hundred sixty-eight surveys were included in the study. According to the DSM-5 diagnostic criteria, 44.6% (n = 75) of caregivers screened positively for a provisional diagnosis of PTSD. The specific neurosurgical diagnosis (p = 0.002), number of surgeries (p = 0.008), and category of the last surgery (p = 0.026) impacted the rate of PTSD symptoms in this population. Most caregivers who screened positive for PTSD experience a high level of disturbing memories and physical reactions to the events and avoid reminders of the medical experience. Caregivers also report a loss of interest in activities, feel distant from other people, and have difficulties with concentration and sleep. There was no significant relationship between caregivers who identified having a high level of anxiety before their child was diagnosed and who screened positive for PTSD. CONCLUSION This study has identified a higher number of caregivers screening positive for PTSD within pediatric neurosurgical patients, than previously reported in other populations. Specific neurosurgical diagnosis, number of surgeries, and category of last surgery all impact a positive screen for the condition. Caregivers who avoid remembering events surrounding their child's diagnosis are at a higher risk of having the condition. The results highlight the need to identify ways to decrease the impact of a pediatric neurosurgical diagnosis on the mental health of caregivers. Future research focused on early mental health intervention for caregivers of pediatric neurosurgical patients may be helpful in reducing the long-term impact of this difficult condition.
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Hack TF, Ruether JD, Pitz M, Thiessen B, Degner LF, Chateau D. Impact of consultation recordings on patient-reported outcomes in patients with brain tumors: a parallel randomized controlled trial. Support Care Cancer 2021; 29:5681-5690. [PMID: 33595717 DOI: 10.1007/s00520-021-06038-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 02/02/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE We aimed to determine the impact of a primary treatment consultation recording on perception of being informed, satisfaction with cancer care, satisfaction with the oncologist, and psychological distress in patients with brain tumors. METHODS This was a prospective, double-blind, parallel, randomized controlled trial conducted in 3 Canadian cities, in which patients who had their initial treatment consultation recorded were assigned to either receive their digital recording or not. It was hypothesized that patients who received their recording would realize statistically significant benefit on the outcomes of interest at 1 week, 3 months, and 6 months post-consultation in comparison to patients who did not receive their recording. Outcome measures included the following: Patient Satisfaction with Cancer Scale, Hospital Anxiety and Depression Scale, PrestMan Satisfaction with Doctor Scale, and Perception of Being Informed Scale. RESULTS Of the 246 eligible patients, 133 participated (60.9% male; age M=52.4 years; 53.4% grade IV disease). Of these, 63 received their consultation recording and 70 did not. Intention-to-treat analysis showed that, compared to baseline, patients who received their consultation recording reported being more fully informed about their disease and treatment at 1 week post-consultation than patients who did not receive their recording (p = 0.007), but this finding was no longer significant at 3 and 6 months. There were no statistically significant differences observed between the two groups on the measures of satisfaction with cancer care, satisfaction with the doctor, and depression or anxiety at any assessment time point, though the study was under-powered. CONCLUSION The study findings show that primary treatment consultation recordings may provide limited benefit beyond brain tumor patients' perception of being informed, despite being highly valued by these patients, and high listening rates among their significant others. The lack of statistical power should be considered when interpreting the findings. TRIAL REGISTRATION ClinicalTrials.gov - NCT01866228.
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Affiliation(s)
- Thomas F Hack
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada. .,Research Institute in Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB, Canada. .,St. Boniface Hospital Research Centre, Winnipeg, MB, Canada. .,Asper Clinical Research Institute, Room CR3018, 369 Taché Avenue, Winnipeg, Manitoba, R2H 2A6, Canada.
| | - J Dean Ruether
- Tom Baker Cancer Centre, Calgary, AB, Canada.,Faculty of Medicine, University of Calgary, Calgary, AB, Canada
| | - Marshall Pitz
- Research Institute in Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB, Canada.,Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Brian Thiessen
- Department of Medical Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Lesley F Degner
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Dan Chateau
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
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29
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Benites AC, Rodin G, Leite ACAB, Nascimento LC, Dos Santos MA. 'The experience of spirituality in family caregivers of adult and elderly cancer patients receiving palliative care: A meta-synthesis'. Eur J Cancer Care (Engl) 2021; 30:e13424. [PMID: 33547680 DOI: 10.1111/ecc.13424] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 11/27/2020] [Accepted: 01/11/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Spirituality is a multidimensional aspect of human experience. In the context of palliative care, it is an individual resource that can be used to cope with illness and to assign new meanings to suffering. Qualitative studies that aim to investigate the experience of spirituality and the needs of family caregivers in this context are rare. OBJECTIVE This meta-synthesis aimed to synthesise qualitative studies on the experience of spirituality in family caregivers of adult and elderly cancer patients receiving palliative care. METHODS A systematic review was performed in six databases, and 14 studies were included in this meta-synthesis. RESULTS The results are presented as a thematic synthesis divided into two analytical themes: (1) The interweaving of spirituality with end-of-life care and (2) The dimensions of suffering and spirituality in the dying process of the loved one. Each analytical theme is explained by two descriptive themes. The results showed that family caregivers express their spirituality in a multidimensional way, giving meaning to the care provided and reassessing the meanings of their lives and their suffering. CONCLUSION Investigating the suffering and spiritual needs of family members in this context may be of value to inform comprehensive and multi-professional psychosocial care.
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Affiliation(s)
- Andrea Carolina Benites
- Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto, Departamento de Psicologia, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil.,Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Global Institute of Psychosocial, Palliative and End-of-Life Care (GIPPEC), University of Toronto, Toronto, Ontario, Canada
| | - Gary Rodin
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Global Institute of Psychosocial, Palliative and End-of-Life Care (GIPPEC), University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Ana Carolina Andrade Biaggi Leite
- Escola de Enfermagem de Ribeirão Preto, WHO Collaborating Centre for Nursing Research Development, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Lucila Castanheira Nascimento
- Escola de Enfermagem de Ribeirão Preto, WHO Collaborating Centre for Nursing Research Development, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Manoel Antônio Dos Santos
- Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto, Departamento de Psicologia, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
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30
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Lung EYL, Wan A, Ankita A, Baxter S, Benedet L, Li Z, Mirhosseini M, Mirza RM, Thorpe K, Vadeboncoeur C, Klinger CA. Informal Caregiving for People With Life-Limiting Illness: Exploring the Knowledge Gaps. J Palliat Care 2021; 37:233-241. [PMID: 33467993 PMCID: PMC9109592 DOI: 10.1177/0825859720984564] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background: People with life-limiting illness are increasingly
having more care provided to them by informal caregivers (ICs) such as family
members and friends. Although there is a substantial amount of literature
surrounding informal caregiving, there is a paucity of research from a hospice
palliative care angle. To address this knowledge gap, this scoping review
explored the effects of/challenges to informal caregiving at the end of life in
Canada. Methods: Scoping review of the literature following Arksey
and O’Malley’s framework. Key healthcare and social sciences databases alongside
the gray literature were searched. Relevant scholarly and gray literature
sources from 2005 to 2019 were screened for inclusion criteria, and a thematic
content analysis employed to summarize findings. Results: Of 2,717
initial search results, 257 distinct full text articles were obtained. Following
deduplication and screening, 33 met inclusion criteria. Four major themes were
identified: (1) Physical health challenges, (2) Psycho-socio-spiritual health
challenges, (3) Financial issues, and (4) Health system issues. Gender of ICs
was also found to be an important contributor to the differing effects of
providing support. Conclusions: This review raises awareness toward
ICs regarding the numerous physical, psycho-socio-spiritual, financial, and
health system challenges faced during care for people with life-limiting
illness. The knowledge gained will inform and advance future practice, policy,
and research. Application to interventions (such as caregiver benefits) will
assist to improve informal caregiving experiences and outcomes alongside quality
of life. Further research is required to understand these unique experiences and
the challenges of minority IC populations.
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Affiliation(s)
- Elaine Y L Lung
- Health Studies Program, University of Toronto, Toronto, Ontario, Canada.,National Initiative for the Care of the Elderly (NICE), Toronto, Ontario, Canada
| | - Andrew Wan
- Translational Research Program, University of Toronto, Toronto, Ontario, Canada
| | - Ankita Ankita
- Translational Research Program, University of Toronto, Toronto, Ontario, Canada
| | - Sharon Baxter
- Canadian Hospice Palliative Care Association (CHPCA), Ottawa, Ontario, Canada.,Quality End-of-Life Care Coalition of Canada (QELCCC), Ottawa, Ontario, Canada
| | - Lisa Benedet
- Quality End-of-Life Care Coalition of Canada (QELCCC), Ottawa, Ontario, Canada.,Canadian Home Care Association (CHCA), Mississauga, Ontario, Canada
| | - Zoey Li
- Translational Research Program, University of Toronto, Toronto, Ontario, Canada
| | - Mehrnoush Mirhosseini
- Quality End-of-Life Care Coalition of Canada (QELCCC), Ottawa, Ontario, Canada.,Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Raza M Mirza
- Health Studies Program, University of Toronto, Toronto, Ontario, Canada.,National Initiative for the Care of the Elderly (NICE), Toronto, Ontario, Canada.,Translational Research Program, University of Toronto, Toronto, Ontario, Canada
| | - Karla Thorpe
- Quality End-of-Life Care Coalition of Canada (QELCCC), Ottawa, Ontario, Canada.,Mental Health Commission of Canada (MHCC), Ottawa, Ontario, Canada
| | - Christina Vadeboncoeur
- Quality End-of-Life Care Coalition of Canada (QELCCC), Ottawa, Ontario, Canada.,Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Christopher A Klinger
- Health Studies Program, University of Toronto, Toronto, Ontario, Canada.,National Initiative for the Care of the Elderly (NICE), Toronto, Ontario, Canada.,Translational Research Program, University of Toronto, Toronto, Ontario, Canada.,Quality End-of-Life Care Coalition of Canada (QELCCC), Ottawa, Ontario, Canada
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31
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Fortunato JT, Van Harn M, Haider SA, Phillips J, Walbert T. Caregiver perceptions of end-of-life care in patients with high-grade glioma. Neurooncol Pract 2020; 8:171-178. [PMID: 33898050 DOI: 10.1093/nop/npaa077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Patients dying from high-grade gliomas (HGG) suffer from high symptom burden in the end-of-life (EoL) phase. Family caregivers are most informed about the patient's symptoms and disease course. The aim of this study is to assess caregiver perception on quality of EoL care of HGG patients. Methods Caregivers prospectively participated in the Toolkit After-Death Bereaved Family Member Interview, part of the Toolkit of Instruments to Measure End-of-Life Care (TIME survey). This validated survey assesses EoL care in areas such as physical comfort and emotional support, advance care planning, focus on the individual, attention to family, and coordination of care. The quality of EoL care was measured by domain scores (0 = care was always optimal, 1 = care was always suboptimal) or with a 0-10 scale. Results Of the 55 enrolled family caregivers, 44 completed the interview and rated the overall care high (8.90 ± 1.36/10), perceived that patients' wishes were respected (9.46 ± 0.95) and that they died in dignity (9.65 ± 0.98). Caregivers perceived high satisfaction with information and decision-making (0.18), advance care planning (0.19), focus on the individual (0.16), and care coordination (0.11). Attention to family (0.25) needed improvement. Only 41% of caregivers were confident that they knew what to do at the time of death and 46% felt that the healthcare team did not provide them with someone to turn to in distress. Conclusions Caregivers reported high overall satisfaction with EoL HGG care, though attention to family and communication needed improvement. Focus should therefore be on improved caregiver communication to improve EoL care, caregiver burnout, and bereavement in HGG populations.
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Affiliation(s)
| | - Meredith Van Harn
- Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan
| | | | - Joel Phillips
- Mercy Health Hauenstein Neurosciences, Grand Rapids, Michigan
| | - Tobias Walbert
- Departments of Neurosurgery, Detroit, Michigan.,Neurology, Henry Ford Health System, Detroit, Michigan
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Palliative Care in High-Grade Glioma: A Review. Brain Sci 2020; 10:brainsci10100723. [PMID: 33066030 PMCID: PMC7599762 DOI: 10.3390/brainsci10100723] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 10/02/2020] [Accepted: 10/09/2020] [Indexed: 12/19/2022] Open
Abstract
High-grade glioma (HGG) is characterized by debilitating neurologic symptoms and poor prognosis. Some of the suffering this disease engenders may be ameliorated through palliative care, which improves quality of life for seriously ill patients by optimizing symptom management and psychosocial support, which can be delivered concurrently with cancer-directed treatments. In this article, we review palliative care needs associated with HGG and identify opportunities for primary and specialty palliative care interventions. Patients with HGG and their caregivers experience high levels of distress due to physical, emotional, and cognitive symptoms that negatively impact quality of life and functional independence, all in the context of limited life expectancy. However, patients typically have limited contact with specialty palliative care until the end of life, and there is no established model for ensuring their palliative care needs are met throughout the disease course. We identify low rates of advance care planning, misconceptions about palliative care being synonymous with end-of-life care, and the unique neurologic needs of this patient population as some of the potential barriers to increased palliative interventions. Further research is needed to define the optimal roles of neuro-oncologists and palliative care specialists in the management of this illness and to establish appropriate timing and models for palliative care delivery.
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Feasibility, Safety and Effects of a One-Week, Ski-Based Exercise Intervention in Brain Tumor Patients and Their Relatives: A Pilot Study. J Clin Med 2020; 9:jcm9041006. [PMID: 32252441 PMCID: PMC7231125 DOI: 10.3390/jcm9041006] [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: 03/02/2020] [Revised: 03/23/2020] [Accepted: 04/01/2020] [Indexed: 12/19/2022] Open
Abstract
A brain tumor diagnosis poses a significant psychological burden and it severely impacts quality of life (QOL), both in patients and relatives. However, comprehensive strategies addressing QOL in this setting remain rare. Here, we aim to share our findings of a one-week ski exercise intervention, with emphasis on feasibility, safety, QOL, and physical exercise. The intervention consisted of week-long daily ski sessions with professional ski guides as well as dedicated physicians present. The participants were handed questionnaires, including distress and QOL items before, during, and after the intervention. Using fitness watches, exercise intensity was also tracked at these timepoints. During the intervention, patients were checked for adverse events daily. Fifteen participants, nine patients after multidisciplinary treatment, and six relatives were included in the study. Additionally, 13 children participated in the exercise, but not in the study. All of the participants completed the entire program. No severe adverse events were documented during daily checks. There was a strong increase in quantified activity and QOL with a corresponding decrease in distress during the intervention, and, partly, afterwards. This prospective brain tumor rehabilitation study demonstrates the feasibility and safety of challenging ski exercise in brain tumor patients. The findings also underline the exercise-mediated QOL benefits, emphasizing the need for more comprehensive brain tumor rehabilitation programs.
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Applebaum AJ, Polacek LC, Walsh L, Reiner AS, Lynch K, Benvengo S, Buthorn J, Atkinson TM, Mao JJ, Panageas KS, Diamond EL. The unique burden of rare cancer caregiving: caregivers of patients with Erdheim-Chester disease. Leuk Lymphoma 2020; 61:1406-1417. [PMID: 32090658 DOI: 10.1080/10428194.2020.1719090] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Research examining the experience of informal caregivers (ICs) for patients with rare cancers is limited. This was a mixed-methods pilot study of 14 ICs for patients with Erdheim-Chester disease (ECD), an ultra-rare neoplasm. Participants were predominantly female and over half provided at least 60% of their loved one's care. Participants completed measures of the impact of caregiving, caregiver burden, unmet needs, quality of life, anxiety, and depression. Participants reported substantial impact of caregiving, including limiting (50%) or discontinuing (21%) paid employment, and exhausting financial savings (43%). ICs reported a moderate level of burden with five (38%) reporting risk for burnout. While participants reported anxiety (64%) and depression (14%), their overall quality of life was favorable. Semi-structured interviews highlighted factors related to the distress and isolation of navigating a rare cancer. ECD ICs report burden and distress shaped by the experience of providing care for a patient with a rare cancer.
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Affiliation(s)
- Allison J Applebaum
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Weill Cornell Medical College, New York, NY, USA
| | - Laura C Polacek
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Leah Walsh
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Anne S Reiner
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kathleen Lynch
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Stephanie Benvengo
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Justin Buthorn
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Thomas M Atkinson
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jun J Mao
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Katherine S Panageas
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Eli L Diamond
- Weill Cornell Medical College, New York, NY, USA.,Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Supportive Care Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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35
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Voisin MR, Oliver K, Farrimond S, Chee T, Arzbaecher J, Kruchko C, Maher ME, Tse C, Cashman R, Daniels M, Mungoshi C, Lamb S, Granero A, Lovely M, Baker J, Payne S, Zadeh G. Brain tumors and COVID-19: the patient and caregiver experience. Neurooncol Adv 2020; 2:vdaa104. [PMID: 32989433 PMCID: PMC7499687 DOI: 10.1093/noajnl/vdaa104] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Since the COVID-19 pandemic began, thousands of medical procedures and appointments have been canceled or delayed. The long-term effects of these drastic measures on brain tumor patients and caregivers are unknown. The purpose of this study is to better understand how COVID-19 has affected this vulnerable population on a global scale. METHODS An online 79-question survey was developed by the International Brain Tumour Alliance, in conjunction with the SNO COVID-19 Task Force. The survey was sent to more than 120 brain tumor charities and not-for-profits worldwide and disseminated to pediatric and adult brain tumor patients and caregivers. Responses were collected from April to May 2020 and subdivided by patient versus caregiver and by geographical region. RESULTS In total, 1989 participants completed the survey from 33 countries, including 1459 patients and 530 caregivers. There were no significant differences in COVID-19 testing rates (P = .662) or positive cases for brain tumor patients between regions (P = .1068). Caregivers were significantly more anxious than patients (P ≤ .0001). Patients from the Americas were most likely to have lost their jobs due to the pandemic, practiced self-isolation, and received telehealth services (P ≤ .0001). Patients from Europe experienced the most treatment delays (P = .0031). Healthcare providers, brain tumor charities, and not-for-profits were ranked as the most trusted sources of information. CONCLUSIONS As a result of COVID-19, brain tumor patients and caregivers have experienced significant stress and anxiety. We must continue to provide accessible high-quality care, information, and support in the age of COVID-19.
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Affiliation(s)
- Mathew R Voisin
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Kathy Oliver
- International Brain Tumour Alliance (IBTA), Tadworth, UK
| | | | - Tess Chee
- McMaster University, Hamilton, Ontario, Canada
| | | | - Carol Kruchko
- International Brain Tumour Alliance (IBTA), Tadworth, UK
| | | | - Chris Tse
- International Brain Tumour Alliance (IBTA), Tadworth, UK
| | | | | | | | - Sharon Lamb
- International Brain Tumour Alliance (IBTA), Tadworth, UK
| | - Anita Granero
- International Brain Tumour Alliance (IBTA), Tadworth, UK
| | - Mary Lovely
- International Brain Tumour Alliance (IBTA), Tadworth, UK
| | - Jenifer Baker
- International Brain Tumour Alliance (IBTA), Tadworth, UK
| | - Sally Payne
- International Brain Tumour Alliance (IBTA), Tadworth, UK
| | - Gelareh Zadeh
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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36
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Kuluski K, Peckham A, Gill A, Arneja J, Morton-Chang F, Parsons J, Wong-Cornall C, McKillop A, Upshur REG, Sheridan N. "You've got to look after yourself, to be able to look after them" a qualitative study of the unmet needs of caregivers of community based primary health care patients. BMC Geriatr 2018; 18:275. [PMID: 30419819 PMCID: PMC6233534 DOI: 10.1186/s12877-018-0962-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 10/24/2018] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND There is growing reliance on unpaid caregivers to provide support to people with care needs. Integrated care approaches that aim to coordinate primary care with community care known as community based primary health care (CBPHC) has been a key policy initiative across health systems; however most attention has been paid to the needs of patients and not caregivers. The objective of this paper was to explore the unmet needs of caregivers of older adults with complex care needs receiving CBPHC. METHODS This qualitative descriptive study entailed one-to-one interviews with 80 caregivers from Canada and New Zealand where roles, experiences and needs were explored. Interview text related to unmet need was reviewed inductively and core themes identified. RESULTS Three themes were identified across CBPHC sites: unrecognized role; lack of personal resources; and no breaks even when services are in place. CONCLUSIONS To support caregivers, models of care such as CBPHC need to look beyond the patient to meaningfully engage caregivers, address their needs and recognize the insight they hold. This knowledge needs to be valued as a key source of evidence to inform developments in health and social care.
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Affiliation(s)
- Kerry Kuluski
- Bridgepoint Collaboratory, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Allie Peckham
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Ashlinder Gill
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Jasleen Arneja
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Frances Morton-Chang
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - John Parsons
- School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Cecilia Wong-Cornall
- School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Ann McKillop
- School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Ross E. G. Upshur
- Bridgepoint Collaboratory, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada
- Division of Clinical Public Health, Dalla Lana School of Public Health, Toronto, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - Nicolette Sheridan
- Centre for Nursing and Health Research, School of Nursing, College of Health Te Kura Hauora Tangata, Massey University, Albany, New Zealand
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Vehling S, Kissane DW. Existential distress in cancer: Alleviating suffering from fundamental loss and change. Psychooncology 2018; 27:2525-2530. [DOI: 10.1002/pon.4872] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 08/26/2018] [Indexed: 12/13/2022]
Affiliation(s)
- Sigrun Vehling
- Department of Medical Psychology; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - David W. Kissane
- University of Notre Dame; Sydney Australia
- Cunningham Centre; St Vincent's Hospital; Sydney Australia
- Szalmuk Family Psycho-Oncology Research Unit; Cabrini Health and Monash Partner's Comprehensive Cancer Centre; Melbourne Australia
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Reblin M, Ketcher D, Forsyth P, Mendivil E, Kane L, Pok J, Meyer M, Wu YP, Agutter J. Outcomes of an electronic social network intervention with neuro-oncology patient family caregivers. J Neurooncol 2018; 139:643-649. [PMID: 29808340 PMCID: PMC6126960 DOI: 10.1007/s11060-018-2909-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 05/19/2018] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Informal family caregivers (FCG) are an integral and crucial human component in the cancer care continuum. However, research and interventions to help alleviate documented anxiety and burden on this group is lacking. To address the absence of effective interventions, we developed the electronic Support Network Assessment Program (eSNAP) which aims to automate the capture and visualization of social support, an important target for overall FCG support. This study seeks to describe the preliminary efficacy and outcomes of the eSNAP intervention. METHODS Forty FCGs were enrolled into a longitudinal, two-group randomized design to compare the eSNAP intervention in caregivers of patients with primary brain tumors against controls who did not receive the intervention. Participants were followed for six weeks with questionnaires to assess demographics, caregiver burden, anxiety, depression, and social support. Questionnaires given at baseline (T1) and then 3-weeks (T2), and 6-weeks (T3) post baseline questionnaire. RESULTS FCGs reported high caregiver burden and distress at baseline, with burden remaining stable over the course of the study. The intervention group was significantly less depressed, but anxiety remained stable across groups. CONCLUSIONS With the lessons learned and feedback obtained from FCGs, this study is the first step to developing an effective social support intervention to support FCGs and healthcare providers in improving cancer care.
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Affiliation(s)
- Maija Reblin
- Moffitt Cancer Center, 12902 Magnolia Dr., Tampa, FL, USA.
| | - Dana Ketcher
- Moffitt Cancer Center, 12902 Magnolia Dr., Tampa, FL, USA
| | - Peter Forsyth
- Moffitt Cancer Center, 12902 Magnolia Dr., Tampa, FL, USA
| | | | | | - Justin Pok
- University of Utah, Salt Lake City, UT, USA
| | | | - Yelena P Wu
- University of Utah, Salt Lake City, UT, USA
- Hunstman Cancer Institute, Salt Lake City, UT, USA
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Applebaum AJ, Buda KL, Schofield E, Farberov M, Teitelbaum ND, Evans K, Cowens-Alvarado R, Cannady RS. Exploring the cancer caregiver's journey through web-based Meaning-Centered Psychotherapy. Psychooncology 2017; 27:847-856. [PMID: 29136682 DOI: 10.1002/pon.4583] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 08/23/2017] [Accepted: 10/27/2017] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Psychosocial interventions are historically underutilized by cancer caregivers, but support programs delivered flexibly over the Internet address multiple barriers to care. We adapted Meaning-Centered Psychotherapy for cancer caregivers, an in-person psychotherapeutic intervention intended to augment caregivers' sense of meaning and purpose and ameliorate burden, for delivery in a self-administered web-based program, the Care for the Cancer Caregiver (CCC) Workshop. The present study evaluated the feasibility, acceptability, and preliminary effects of this program. METHODS Eighty-four caregivers were randomized to the CCC Workshop or waitlist control arm. Quantitative assessments of meaning, burden, anxiety, depression, benefit finding, and spiritual well-being were conducted preintervention (T1), within 2-weeks postintervention (T2), and 2- to 3-month follow-up (T3). In-depth semistructured interviews were conducted with a subset of participants. RESULTS Forty-two caregivers were randomized to the CCC Workshop. Attrition was moderate at T2 and T3, with caregiver burden and bereavement as key causes of drop-out. At T2 and T3, some observed mean change scores and effect sizes were consistent with hypothesized trends (eg, meaning in caregiving, benefit finding, and depressive symptomatology), though no pre-post significant differences emerged between groups. However, a longitudinal mixed-effects model found significant differential increases in benefit finding in favor of the CCC arm. CONCLUSIONS The CCC Workshop was feasible and acceptable. Based on effect sizes reported here, a larger study will likely establish the efficacy of the CCC Workshop, which has the potential to address unmet needs of caregivers who underutilize in-person supportive care services.
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Affiliation(s)
- A J Applebaum
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - K L Buda
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - E Schofield
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - M Farberov
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - N D Teitelbaum
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - K Evans
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
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