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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 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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2
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Song Y, Wang M, Zhu M, Wang N, He T, Wu X, Shi Z, Chen M, Ji T, Shen Y. Benefit finding among family caregivers of patients with advanced cancer in a palliative treatment: a qualitative study. BMC Nurs 2024; 23:397. [PMID: 38862930 PMCID: PMC11165861 DOI: 10.1186/s12912-024-02055-z] [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: 02/23/2024] [Accepted: 05/31/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND Benefit finding is the search for positive meaning from traumatic events, such as cancer. It can help caregivers have a positive experience in the caregiving process, relieve negative emotions, and reduce caregiving stress. The aim of this study was to explore benefit finding among caregivers of patients with advanced cancer in their palliative caregiving journey. METHODS An exploratory qualitative design of phenomenology was used. Semistructured interviews were conducted with 19 caregivers of palliative care patients with advanced cancer. The Colaizzi 7-step analysis was used to analyse, summarize, and extract themes from the interview data. RESULTS The study identified five themes of caregiver benefit finding in the caregiving process: personal growth, strengthened relationships with patients, adjustment and adaptation, perceived social support, and perceived meaning in life. Most caregivers reported a closer, more dependent relationship with the patient, and only one caregiver did not report any positive changes. CONCLUSIONS Caregivers of palliative care patients with advanced cancer can have positive experiences in their care. Healthcare professionals should focus on supporting caregivers and helping them find positive experiences to cope with the challenges of caregiving and improve their quality of life.
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Affiliation(s)
- Yuanyi Song
- Department of Breast and Urological Oncology, Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, Hubei, China
| | - Min Wang
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, Hubei, China
| | - Meina Zhu
- Department of Breast and Urological Oncology, Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, Hubei, China
| | - Na Wang
- Department of Breast and Urological Oncology, Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, Hubei, China
| | - Ting He
- Department of Breast and Urological Oncology, Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, Hubei, China
| | - Xu Wu
- Department of Breast and Urological Oncology, Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, Hubei, China
| | - Zhihui Shi
- Department of Breast and Urological Oncology, Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, Hubei, China
| | - Mengye Chen
- Department of Breast and Urological Oncology, Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, Hubei, China
| | - Tian Ji
- Department of Breast and Urological Oncology, Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, Hubei, China
| | - Ying Shen
- Department of Breast and Urological Oncology, Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, Hubei, China.
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Christodoulou L, Parpottas P, Petkari E. Psychological interventions to enhance positive outcomes in adult cancer caregivers: A systematic review. J Health Psychol 2024; 29:747-769. [PMID: 38439520 DOI: 10.1177/13591053241236254] [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: 03/06/2024] Open
Abstract
This systematic review aims to examine the characteristics of psychological interventions that aim to enhance positive outcomes, such as wellbeing, post-traumatic growth, or hope in cancer caregivers. Studies published until December 2023 were searched on PubMed, Scopus, PsycINFO, WOS, PsycARTICLES and were included when examining interventions targeting positive outcomes with adult cancer caregivers. Of the 1424 articles retrieved through the databases, 16 studies were eligible for inclusion in this review, targeting 908 caregivers (70.2% female; Mage = 53.5). A narrative synthesis was used to describe the interventions, which were based on a variety of approaches such as psychoeducation, mindfulness, or Existential Behavioral Therapy, and reported positive gains for the positive outcomes. The results show few randomized controlled trials published to date, highlight the contrast between the focus shift towards these outcomes and the need for systematic testing of the interventions, to be able to inform evidence-based service delivery.
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Wang B, Wang C, Yu J, Lin Y, Wen H, Wu Y, Hu R. How adult children experience and cope with their parents' diagnosis of multiple myeloma: A qualitative exploration. Eur J Oncol Nurs 2024; 70:102604. [PMID: 38795442 DOI: 10.1016/j.ejon.2024.102604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 03/29/2024] [Accepted: 05/01/2024] [Indexed: 05/28/2024]
Abstract
PURPOSE The aim of this study was to understand and explore the caregiving experience of adult children of patients with multiple myeloma (MM) during diagnosis and initial treatment based in Chinese filial piety culture. METHODS A descriptive phenomenology study was conducted to investigate semi-structured interview responses from the adult children (N = 22) of MM patients within three months after diagnosis. Colaizzi's descriptive analysis framework was employed to analyze data. This study was reported following the COREQ checklist. RESULTS Four themes and twelve subthemes were identified from the interviews. (1) Commitment to filial piety. Participants subconsciously fulfilled their commitment to filial piety by supporting their parents, obeying their wishes, providing emotional comfort, and protecting them from harm. (2) Experiencing multiple dilemmas. They faced challenges such as difficult treatment decisions, insufficient caregiving preparation, emotional distress, and role conflict. (3) Benefiting from setbacks. The caregiving experience allowed participants to cherish the present more and to establish a new view of life. (4) Adaptive coping. Family supports and self-adaptation are effective coping strategies to achieve their good psychosocial adaptation. CONCLUSIONS Our study provides a culturally sensitive perspective on the caregiving experience of adult children of patients with MM. This study found that Chinese culture, especially filial piety culture, influenced the experiences and coping strategies of MM caregivers. Healthcare providers should focus on the challenges faced by adult children and develop various strategies to help them cushion the burden and adjust to caregiving roles, such as supportive care programs, meaning-centered psychotherapy, and family-centered medical communication interventions.
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Affiliation(s)
- Binbin Wang
- School of Nursing, Fujian Medical University, Fuzhou, China
| | - Chunfeng Wang
- School of Nursing, Fujian Medical University, Fuzhou, China
| | - Jiejie Yu
- School of Nursing, Fujian Medical University, Fuzhou, China
| | - Yanfang Lin
- Department of Hematology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Hongmei Wen
- School of Nursing, Fujian Medical University, Fuzhou, China
| | - Yong Wu
- Department of Hematology, Fujian Medical University Union Hospital, Fuzhou, China.
| | - Rong Hu
- School of Nursing, Fujian Medical University, Fuzhou, China.
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Fang W, Chen C, Zhang X, Li J, Li X, Fan X. Association Between Benefit Finding and Self-care Management in Heart Failure Patient-Caregiver Dyads: The Mediating Role of Mutuality. J Cardiovasc Nurs 2024; 39:E93-E102. [PMID: 37563755 DOI: 10.1097/jcn.0000000000001034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
BACKGROUND Inadequate self-care management has been reported in patients with heart failure (HF) and their family caregivers. However, evidence on the influencing factors and corresponding action paths for self-care management within a dyadic context is limited. OBJECTIVE The aim of this study was to examine dyadic associations between benefit finding and self-care management in HF patient-caregiver dyads and the mediating role of mutuality in these associations. METHODS This cross-sectional study was conducted in China, and a convenience sample of 253 HF patient-caregiver dyads was included in the analysis. Dyadic benefit finding and mutuality, patients' self-care management, and caregivers' contributions to self-care management were measured using self-reported questionnaires. The actor-partner interdependence model and actor-partner interdependence mediation model were adopted to analyze the data. RESULTS Patients' benefit finding had an actor effect on their own self-care management (β = 0.134, P < .05) and a partner effect on caregivers' contributions to self-care management (β = 0.130, P < .05). Similarly, caregivers' benefit finding had an actor effect on their contributions to self-care management (β = 0.316, P < .01) and a partner effect on patients' self-care management (β = 0.187, P < .01). Moreover, patients' mutuality completely mediated the actor effect of their benefit finding on self-care management (β = 0.127; 95% confidence interval, 0.032-0.233), and caregivers' mutuality partially mediated the actor effect of their benefit finding on contributions to self-care management (β = 0.060; 95% confidence interval, 0.012-0.124). In addition, caregivers' mutuality completely mediated the partner effect of patients' benefit finding on caregivers' contributions to self-care management (β = 0.036; 95% confidence interval, 0.009-0.081). CONCLUSIONS The findings revealed the importance of benefit finding and mutuality, 2 modifiable factors positively associated with dyadic HF self-care management. Dyadic interventions targeting on enhancing benefit finding and mutuality should be designed and implemented to improve HF self-care management.
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McLachlan LM, Engster S, Winger JG, Haupt A, Levin-Decanini T, Decker M, Noll RB, Yu JA. Self-Reported Well-Being of Family Caregivers of Children with Medical Complexity. Acad Pediatr 2024:S1876-2859(24)00145-1. [PMID: 38609015 DOI: 10.1016/j.acap.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 03/08/2024] [Accepted: 04/06/2024] [Indexed: 04/14/2024]
Abstract
OBJECTIVE Provide an in-depth and psychometrically rigorous profile of the emotional well-being and sleep-related health of family caregivers of children with medical complexity (CMC). METHODS Cross-sectional survey study of family caregivers of CMC receiving care from a pediatric complex care center between May 2021 and March 2022. Patient Reported Outcomes Measurement Information System Short-Forms (PROMIS-SF) assessed global mental health, emotional distress (anxiety, depression, anger), psychological strengths (self-efficacy, emotional regulation, meaning and purpose), and sleep-related health (fatigue, sleep-related impairment). Student's t-tests compared the sample's mean T-scores to US population norms. Pearson's correlation coefficient (ρ) examined associations between measures of psychological strengths and emotional distress. Unadjusted linear regression analyses explored relationships between well-being outcomes and child and caregiver characteristics. RESULTS Compared to US population norms, caregivers of CMC (n = 143) reported significantly lower global mental health and emotional regulation ability as well as elevated symptoms of anxiety, depression, anger, fatigue, and sleep-related impairment (all P < .01). Whereas participants reported a significantly higher sense of meaning and purpose (P < .05), levels of self-efficacy were not significantly different from population norms. We observed moderate-to-strong inverse relationships between psychological strengths and emotional distress (ρ range, -0.39 to -0.69); with the strongest inverse associations found between emotional regulation ability and emotional distress. In exploratory analyses, caregiver race and ethnicity, socioeconomic status, and child health insurance type were significantly associated with caregiver well-being. CONCLUSION Family caregivers of CMC report poor well-being, most notably, increased symptoms of anxiety and reduced global mental health and sleep-related health.
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Affiliation(s)
| | - Stacey Engster
- Jose F. Alvarado and Associates (S Engster), Salisbury, Md
| | - Joseph G Winger
- Department of Psychiatry and Behavioral Sciences (JG Winger), Duke University School of Medicine, Durham, NC; Duke Cancer Institute (JG Winger), Duke University Health System, Durham, NC
| | - Alicia Haupt
- Complex Care Center (A Haupt and M Decker), UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pa; Department of Pediatrics (A Haupt, M Decker, and RB Noll), University of Pittsburgh School of Medicine, Pittsburgh, Pa
| | - Tal Levin-Decanini
- Complex Care Center (T Levin-Decanini), General Academic Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pa
| | - Michael Decker
- Complex Care Center (A Haupt and M Decker), UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pa; Department of Pediatrics (A Haupt, M Decker, and RB Noll), University of Pittsburgh School of Medicine, Pittsburgh, Pa
| | - Robert B Noll
- Department of Pediatrics (A Haupt, M Decker, and RB Noll), University of Pittsburgh School of Medicine, Pittsburgh, Pa
| | - Justin A Yu
- Divisions of Pediatric Supportive and Palliative Care and Hospital Medicine (JA Yu), University of Pittsburgh School of Medicine and UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pa.
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7
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Applebaum AJ, Schofield E, Kastrinos A, Gebert R, Behrens M, Loschiavo M, Shaffer KM, Levine M, Dannaoui A, Bellantoni C, Miller MF, Zaleta AK. A randomized controlled trial of a distress screening, consultation, and targeted referral system for family caregivers in oncologic care. Psychooncology 2024; 33:e6301. [PMID: 38363002 PMCID: PMC11250988 DOI: 10.1002/pon.6301] [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: 12/18/2023] [Revised: 01/16/2024] [Accepted: 01/27/2024] [Indexed: 02/17/2024]
Abstract
OBJECTIVE Distress screening is standard practice among oncology patients, yet few routine distress screening programs exist for cancer caregivers. The objective of this study was to demonstrate the feasibility, acceptability, and preliminary efficacy of Cancer Support Source-CaregiverTM (CSS-CG, 33-item), an electronic distress screening and automated referral program with a consultation (S + C) to improve caregiver unmet needs, quality of life, anxiety, depression, and distress relative to Enhanced Usual Care (EUC; access to educational materials). METHOD 150 caregivers of patients with varying sites/stages of cancer were randomized to S + C or EUC and completed assessments at baseline, 3-months post-baseline, and 6-months post-baseline. A subset of participants (n = 10) completed in-depth qualitative interviews. RESULTS S + C was feasible: among 75 caregivers randomized to S + C, 66 (88%) completed CSS-CG and consultation. Top concerns reported were: (1) patient's pain and/or physical discomfort; (2) patient's cancer progressing/recurring; and (3) feeling nervous or afraid. Differences between groups in improvements on outcomes by T2 and T3 were modest (ds < 0.53) in favor of S + C. Qualitative data underscored the helpfulness of S + C in connecting caregivers to support and helping them feel cared for and integrated into cancer care. CONCLUSIONS S + C is feasible, acceptable, and yields more positive impact on emotional well-being than usual care. Future studies will examine programmatic impact among caregivers experiencing higher acuity of needs, and benefits of earlier integration of S + C on caregiver, patient, and healthcare system outcomes.
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Affiliation(s)
- Allison J. Applebaum
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center
| | - Elizabeth Schofield
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center
| | - Amanda Kastrinos
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center
| | - Rebecca Gebert
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center
| | - Mia Behrens
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center
| | - Morgan Loschiavo
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center
| | - Kelly M. Shaffer
- Center for Behavioral Health and Technology, University of Virginia
| | - Marcia Levine
- Department of Nursing, Memorial Sloan Kettering Cancer Center
| | - Aimee Dannaoui
- Department of Nursing, Memorial Sloan Kettering Cancer Center
| | | | - Melissa F. Miller
- Research and Training Institute, Cancer Support Community, Philadelphia, PA
| | - Alexandra K. Zaleta
- Research and Training Institute, Cancer Support Community, Philadelphia, PA
- Current affiliation: CancerCare, New York, NY
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Mroz EL, Kastrinos A, Bacharz K, Fisher CL, Applebaum AJ. "A little bit different now": Impacts of caregiving for parent with cancer on psychosocial development in emerging and young adulthood. DEATH STUDIES 2024:1-12. [PMID: 38293809 PMCID: PMC11289163 DOI: 10.1080/07481187.2024.2309488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
Serving as a family caregiver for, and ultimately losing, a parent with advanced cancer in emerging and young adulthood has substantial, life phase-specific implications for psychosocial development. This qualitative study characterizes domains of psychosocial development impacted by cancer caregiving and parental death in this life phase. As part of a larger study, 33 bereaved emerging/young adult caregivers of parents who died following advanced cancer completed semi-structured interviews. A thematic analysis leveraging the constant comparative method was conducted by two coders and generated three themes, which described impacts of caregiving on: identity, life path, and relational intimacy and roles. Analyses also defined specific outcomes within these domains. Findings suggest that cancer caregiving-loss experiences can greatly influence developmental pursuits in this life phase. Findings validate a range of possible psychosocial impacts these caregivers may experience and can guide development of supportive resources for this growing subgroup of bereaved family caregivers.
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Affiliation(s)
- Emily L Mroz
- Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Amanda Kastrinos
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Kelsey Bacharz
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Carla L Fisher
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Allison J Applebaum
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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McAndrew NS, Gray TF, Wallace L, Calkins K, Guttormson J, Harding ES, Applebaum AJ. Existential distress in family caregivers: scoping review of meaning-making interventions. BMJ Support Palliat Care 2024; 13:e676-e685. [PMID: 37604657 PMCID: PMC11040498 DOI: 10.1136/spcare-2023-004448] [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: 06/18/2023] [Accepted: 08/03/2023] [Indexed: 08/23/2023]
Abstract
OBJECTIVES Family and friend caregivers often feel overwhelmed by and ill-prepared for their responsibilities. Many feel helpless living with uncertainty about the outcome of the patient's illness, which leads to existential distress. Supportive care interventions that address existential distress by promoting meaning and purpose buffer the negative effects of caregiver burden and promote resilience and growth. The purpose of this scoping review is to describe the depth and breadth of available interventions targeting caregiver existential distress. METHODS We followed the Joanna Briggs Institute's scoping review methods and applied the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension checklist. SCOPUS, Ovid MEDLINE and PsycINFO databases were searched for interventions that targeted existential distress by promoting meaning-making, spiritual well-being, post-traumatic growth and/or benefit finding for caregivers of seriously ill adult patients. RESULTS We screened 1377 titles/abstracts and 42 full-text articles. Thirty-one articles (28 unique studies) met inclusion criteria. Most interventions were designed for caregivers supporting patients with cancer (n=14) or patients receiving palliative care (n=9). Promising interventions included Meaning-Centered Psychotherapy for Cancer Caregivers, Meaning-Based Intervention for Patients and their Partners, Legacy Intervention for Family Enactment, Family Participatory Dignity Therapy and Existential Behavioural Therapy. More than half of the studies (n=20, 64%) were in the feasibility/acceptability/pilot stage of intervention testing. CONCLUSION Large randomised controlled trials with more diverse samples of caregivers are needed. Future research should explore the impact of delivering meaning-making interventions to caregivers throughout the illness trajectory. Developing strategies for scaling up and conducting cost analyses will narrow the research and practice gap for meaning-making interventions.
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Affiliation(s)
- Natalie S McAndrew
- School of Nursing, College of Health Professions & Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
- Department of Patient Care Research, Froedtert & the Medical College of Wisconsin, Froedtert Hospital, Milwaukee, Wisconsin, USA
| | - Tamryn F Gray
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Lyndsey Wallace
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Kelly Calkins
- College of Nursing, Marquette University, Milwaukee, Wisconsin, USA
| | - Jill Guttormson
- College of Nursing, Marquette University, Milwaukee, Wisconsin, USA
| | - Eric S Harding
- Medical College of Wisconsin Libraries, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Allison J Applebaum
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Psychiatry, Weill Cornell Medicine, New York, New York, USA
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10
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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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11
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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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12
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Fava M, Sorg E, Jacobs JM, Leadbetter R, Guidi J. Distinguishing and treating demoralization syndrome in cancer: A review. Gen Hosp Psychiatry 2023; 85:185-190. [PMID: 37950966 DOI: 10.1016/j.genhosppsych.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 08/22/2023] [Accepted: 10/08/2023] [Indexed: 11/13/2023]
Abstract
IMPORTANCE Demoralization, characterized by a persistent inability to cope, as well as helplessness, hopelessness, and despair, is highly prevalent in oncology, with between 36% to 52% of patients exhibiting demoralization syndrome. Given established evidence linking demoralization in patients with cancer to physical symptom burden, quality of life, sleep disturbance, and suicidality, assessment and treatment of demoralization syndrome is critical for optimizing clinical and psychosocial outcomes. OBSERVATIONS The term "demoralization" is highly relevant to the care of patients with cancer facing life-limiting illnesses. Indeed, demoralization can be conceptualized as a feeling state characterized by the perception of being unable to cope with some pressing problems and/or of lack of adequate support from others. Despite a considerable overlap in symptoms, demoralization and depression should be regarded as distinct and independent clinical syndromes. Patients who are demoralized but not clinically depressed often describe a sense of subjective incompetence and do not report anhedonia (i.e., loss of interest and inability to enjoy things). Although the definition of demoralization is now included as a distinct syndrome in the International Classification of Diseases (ICD)-11, it has been neglected by the current U.S. official nosology in psychiatry, such as the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR). As such, demoralization syndrome may be under- or misdiagnosed and treated ineffectively in the oncology setting, potentially prolonging suffering and influencing cancer outcomes. CONCLUSIONS AND RELEVANCE Optimization of methods to diagnose and assess demoralization syndrome is critical to underpin rigorous studies evaluating the efficacy of psychotherapeutic and pharmacological interventions for patients with cancer experiencing demoralization. Our review supports the use of specific diagnostic criteria for demoralization in cancer patients, introduces methodological considerations relevant to treatment studies, and presents a novel measurement approach to the assessment of demoralization severity with the Clinical Interview for Demoralization (CIDE).
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Affiliation(s)
- Maurizio Fava
- Department of Psychiatry, Massachusetts General Hospital, Bulfinch 351 - 55 Fruit Street, Boston, MA 02114, United States of America.
| | - Emily Sorg
- Center for Psychiatric Oncology & Behavioral Sciences, Department of Psychiatry & Mass General Cancer Center, Massachusetts General Hospital, 55 Fruit Street, Yawkey Center for Outpatient Care, Suite 10B, Boston, MA 02114, United States of America
| | - Jamie M Jacobs
- Center for Psychiatric Oncology & Behavioral Sciences, Department of Psychiatry & Mass General Cancer Center, Massachusetts General Hospital, 55 Fruit Street, Yawkey Center for Outpatient Care, Suite 10B, Boston, MA 02114, United States of America
| | - Robert Leadbetter
- Reset Pharmaceuticals, Massachusetts General Hospital MA United States of America
| | - Jenny Guidi
- Department of Psychology "Renzo Canestrari", University of Bologna, Viale Berti Pichat 5, 40127 Bologna, Italy
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Rosario-Ramos L, Peña-Vargas C, Torres-Blasco N. Acceptance of Caregiver-Patient Support to Latinx Coping with Advanced Cancer (CASA) Intervention: A Caregiver Case Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4996. [PMID: 36981903 PMCID: PMC10049334 DOI: 10.3390/ijerph20064996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/09/2023] [Accepted: 03/10/2023] [Indexed: 06/18/2023]
Abstract
Latinos frequently assume caregiver roles when the need arises in their social nucleus. Because of their active role, caregivers are heavily involved in their family member's cancer trajectory. Therefore, there is a need for culturally adapted interventions that integrate the caregiver and cancer patient. The objective is to present a case study of a former caregiver's experience and acceptance of the cultural adaptation of Caregiver-Patient Support to Latinx Coping with Advanced Cancer (CASA) intervention. We conducted a case study with a male caregiver between the ages of 20 and 30. A male caregiver expressed his experience and acceptance of a psychosocial intervention. He conveyed moderate to high acceptance of intervention components through anecdotes and opinions based on his experiences as a caregiver for multiple family members. Finally, he reported distress, but he presented little to no symptoms of caregiver burden, depression, anxiety, and hopelessness. It is crucial to culturally adapt interventions that integrate caregivers when they play a big part in their loved one's cancer journey. Integrating their perspective when adapting an intervention may assist in providing essential information that will benefit the patient and caregiver.
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Affiliation(s)
- Lianel Rosario-Ramos
- School of Behavioral and Brain Sciences, Ponce Health Sciences University, Ponce 00716, Puerto Rico
| | - Cristina Peña-Vargas
- Ponce’s Research Institute, Ponce Health Sciences University, Ponce 00716, Puerto Rico
| | - Normarie Torres-Blasco
- School of Behavioral and Brain Sciences, Ponce Health Sciences University, Ponce 00716, Puerto Rico
- Ponce’s Research Institute, Ponce Health Sciences University, Ponce 00716, Puerto Rico
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