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Chase DM, Shukla S, Courcy JD, Ellis H, Piercy J, Taylor-Whiteley T, Golembesky A, Wethington SL. The power of hope: Views of Ovarian Cancer patients on how maintenance therapy Affects their Lives (VOCAL). Future Oncol 2024; 20:83-94. [PMID: 37701998 DOI: 10.2217/fon-2023-0450] [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] [Indexed: 09/14/2023] Open
Abstract
Aim: To assess maintenance preference and trade-offs for patients with advanced epithelial ovarian cancer. Methods: Patients completed a time trade-off exercise ranking five maintenance approaches. Patients' preferred approach was compared with alternatives to determine the progression-free time they would trade off to remain on their preferred approach. Results: Of 152 patients (median age 53 years, 68% White), 56% chose one of four maintenance medications, mostly to feel proactive and 44% chose active surveillance. Compared with their preferred approach, patients were willing to trade a mean progression-free time before switching of 2.3 months for once-daily oral medications, 3.2 months for twice-daily oral medications, 5.5 months for intravenous infusions every 3 weeks (iv. q3), 6.1 months for active surveillance and 7.5 months for iv. q3 and twice-daily oral. Conclusion: Findings highlight the importance of patients' awareness of all maintenance approaches and involving them in the decision-making process.
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Affiliation(s)
- Dana M Chase
- Gynecologic Oncology Division, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-7383, USA
| | - Soham Shukla
- Value Evidence & Outcomes, GSK, Collegeville, PA, USA
| | | | | | | | | | - Amanda Golembesky
- Value Evidence & Outcomes - Oncology, GSK, Research Triangle, NC, USA
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Zaleta AK, Miller MF, Fortune EE, Olson JS, Rogers KP, Hendershot K, Ash-Lee S. CancerSupportSource TM -Caregiver: Development of a distress screening measure for cancer caregivers. Psychooncology 2023; 32:418-428. [PMID: 36604371 DOI: 10.1002/pon.6092] [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: 05/24/2022] [Revised: 11/29/2022] [Accepted: 01/01/2023] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Given the substantial demands of cancer caregiving, practical and psychometrically sound tools to evaluate distress among cancer caregivers are needed. CancerSupportSourceTM -Caregiver is a distress screening, referral, and support program designed to identify the unmet needs of cancer caregivers and link caregivers to desired resources and support. This study refined and finalized the CancerSupportSource-Caregiver screening measure and examined its psychometric properties. METHODS Using an analytic sample of 400 caregivers to people with cancer, we first performed item reduction by assessing exploratory factor analysis, external/internal item quality, and judging theoretical and practical implications of items. Confirmatory factor analysis along with reliability and validity analyses were then conducted to corroborate dimensionality and psychometric properties of the final measure. Nonparametric receiver operating characteristic curve analyses determined scoring thresholds for depression and anxiety risk subscales. RESULTS Scale refinement resulted in an 18-item measure plus one screening item assessing tobacco and substance use. Items represented five domains of caregiver concerns: emotional well-being, patient well-being, caregiving tasks, finances, and healthy lifestyle. Our analyses showed strong internal consistency and test-retest reliability, a replicable factor structure, and adequate convergent, discriminant, and known groups validity. Sensitivity of 2-item depression and 2-item anxiety risk subscales were 0.95 and 0.87, respectively. CONCLUSIONS CancerSupportSource-Caregiver is a reliable and valid multidimensional measure of caregiver distress that also screens for risk for clinically significant depression and anxiety. It can be implemented within a distress screening, referral, and follow-up program to rapidly assess caregivers' unmet needs and enhance caregiver well-being across the care continuum.
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Affiliation(s)
- Alexandra K Zaleta
- Cancer Support Community, Research and Training Institute, Philadelphia, Pennsylvania, USA
| | - Melissa F Miller
- Cancer Support Community, Research and Training Institute, Philadelphia, Pennsylvania, USA
| | - Erica E Fortune
- Cancer Support Community, Research and Training Institute, Philadelphia, Pennsylvania, USA
| | - Julie S Olson
- Cancer Support Community, Research and Training Institute, Philadelphia, Pennsylvania, USA
| | - Kimberly Papay Rogers
- Cancer Support Community, Research and Training Institute, Philadelphia, Pennsylvania, USA
| | | | - Susan Ash-Lee
- Cancer Support Community, Washington, District of Columbia, USA
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3
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Ringborg CH, Wengström Y, Schandl A, Lagergren P. The long-term experience of being a family caregiver of patients surgically treated for oesophageal cancer. J Adv Nurs 2023; 79:2259-2268. [PMID: 36779443 DOI: 10.1111/jan.15580] [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: 06/29/2022] [Revised: 01/10/2023] [Accepted: 01/22/2023] [Indexed: 02/14/2023]
Abstract
AIM This qualitative study aimed to explore the experience of being family caregivers of patients treated for oesophageal cancer 2 years after treatment. To better understand the family caregiver's situation, a conceptual model was used in the analysis. The results of the study can guide future interventions to support family caregivers of patients treated for oesophageal cancer. DESIGN A qualitative descriptive study using semi-structured telephone interviews. An abductive approach was used in the analysis to reach deeper knowledge about the family caregivers' experiences and to better understand deeper patterns. METHODS A qualitative study was conducted and included 13 family caregivers of patients surgically treated for oesophageal cancer in Sweden in 2018 who participated in a population-based nationwide cohort study. Individual telephone interviews were held in 2020, 2 years after the patients' surgery. The analysis of the interviews started with an inductive approach using thematic analysis. Thereafter, a deductive approach was used to interpret the findings in relation to the conceptual model, The Cancer Family Caregiving Experience. RESULTS The most essential/evident stress factors for the family caregivers were distress regarding the patients' nutrition, fear of tumour recurrence and worry about the future. In addition, a transition was experienced, going from a family member to a caregiver, and the many psychosocial aspects of this transition were highlighted during the disease trajectory. CONCLUSION Despite, the long-term survival of the patient, family caregivers were still struggling with psychosocial consequences because of the patient's cancer diagnosis and treatment. Furthermore, there is a need to improve supportive interventions for family caregivers during the whole disease trajectory. IMPACT The current study includes comprehensive information about the family caregivers' experiences when caring for a patient treated for oesophageal cancer. Family caregivers struggle with the psychosocial consequences of the patient's cancer and worry about tumour recurrence even 2 years after surgery. These findings can be useful in the development of supportive interventions, which may facilitate life for family caregivers. PATIENT OR PUBLIC CONTRIBUTION The study was discussed and planned together with our research partnership group including patients and family caregivers. In addition, the manuscript was reviewed by some of the members to cross-check the results and discussed them to avoid misinterpretation.
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Affiliation(s)
- Cecilia H Ringborg
- Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Yvonne Wengström
- Karolinska Comprehensive Cancer Centre, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden.,Department of Neurobiology, Care Science and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden
| | - Anna Schandl
- Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.,Department of Anaesthesiology and Intensive Care, Södersjukhuset, Stockholm, Sweden.,Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden
| | - Pernilla Lagergren
- Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.,Department of Surgery and Cancer, Imperial College London, London, UK
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4
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Kusi G, Atenafu EG, Boamah Mensah AB, Lee CT, Viswabandya A, Puts M, Mayo S. The effectiveness of psychoeducational interventions on caregiver-oriented outcomes in caregivers of adult cancer patients: A systematic review and meta-analysis. Psychooncology 2023; 32:189-202. [PMID: 36251609 DOI: 10.1002/pon.6050] [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: 05/10/2022] [Revised: 09/23/2022] [Accepted: 10/09/2022] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Cancer caregiving can result in increased psychosocial distress and poor health-related quality of life (QOL). Psychoeducation has been shown to be effective in enhancing caregiving-oriented outcomes. A systematic assessment of the overall effect of psychoeducational intervention (PEI) and identification of individual intervention characteristics that may contribute to the effectiveness of PEI is needed. METHODS For this meta-analysis, relevant articles were identified through electronic databases using key search terms and their medical subject heading such as "family caregiver," "cancer," and "psychoeducational intervention." RESULTS Twenty-eight controlled trials with 3876 participants were included. PEIs had beneficial effect on depression (Standardized Mean Difference [SMD] -0.26; 95% CI = -0.50 to -0.01, p < 0.04), anxiety (SMD -0.41; 95% CI = -0.82 to 0.01, p < 0.05), caregiver burden (SMD -0.84; 95% CI = -1.22 to -0.46, p < 0.0001) and QOL (SMD 0.59, 95% CI 0.24-0.93; p < 0.0009) at the immediate post-intervention period. At longer-term follow-up, the effectiveness of PEI was maintained on QOL (SMD 0.39, 95% CI = -0.00 to -0.77, p < 0.05), and anxiety (SMD -0.57; 95% CI = -1.09 to -0.06, p < 0.03). Moderation analysis showed that intervention characteristics such as studies conducted in high-income countries, group intervention and studies that focused on specific and mixed cancers explain some of the high variations observed among the included studies. CONCLUSIONS PEI may benefit caregivers of cancer patients through the significant effects on caregiver burden, QOL, anxiety, and depression. The findings from the moderation analysis may be important for the design of future interventions.
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Affiliation(s)
- Grace Kusi
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.,Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Eshetu G Atenafu
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | | | | | - Auro Viswabandya
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Martine Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.,Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Samantha Mayo
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.,Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
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5
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Badesha M, Thayanantha A, Shune S, Namasivayam-MacDonald A. Caregiver burden interventions in speech-language pathology: A systematic review. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2023. [PMID: 36722020 DOI: 10.1111/1460-6984.12856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 01/11/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Previous research has demonstrated that many caregivers of care recipients with communication and swallowing impairments suffer from caregiver burden. Existing research sheds light on the presence of burden and various predicting factors, but little information on interventions to reduce caregiver burden. AIMS To determine how speech-language pathologists (SLPs) address caregiver burden in clinical practice. METHODS A systematic review was conducted according to PRISMA guidelines and 1898 unique articles were assessed for eligibility from nine electronic databases. Only 11 studies carried out a caregiver burden intervention involving an SLP. Details of the interventions were extracted per the Rehabilitation Treatment Specification System (RTSS) guidelines. MAIN CONTRIBUTION Results of the review revealed that SLP-led caregiver burden interventions can be effective in reducing burden. Multiple aspects of the intervention approaches, such as multidisciplinary care and targeting emotional burden, are discussed. Demographic factors, such as gender and socio-economic status (SES), are also taken into consideration. CONCLUSIONS & IMPLICATIONS This review suggests that SLPs can be effective at reducing caregiver burden through interventions involving caregivers across the lifespan and continuum of care. WHAT THIS PAPER ADDS What is already known on this subject Previous research has demonstrated that many caregivers of care recipients with communication and swallowing impairments suffer from caregiver burden. These caregivers range from parents of young children to spouses of individuals with dementia. However, it is unclear if and how SLPs address caregiver burden in clinical practice. What this paper adds to existing knowledge Using the RTSS, details of various caregiver burden interventions involving SLPs were identified. This review revealed that SLP-led caregiver burden interventions can be effective in reducing emotional and financial burden, as well as play a part in improving care-recipient outcomes. What are the potential or actual clinical implications of this work? This systematic review demonstrates that efforts to reduce caregiver burden within SLP practice may yield benefits for both caregivers and care recipients. It provides clinicians with a preliminary resource to help consider caregiver burden interventions that best suit the needs of the caregivers and their care recipients.
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Affiliation(s)
- Maneetpal Badesha
- School of Rehabilitation Sciences-Speech-Language Pathology, McMaster University, Hamilton, ON, Canada
| | | | - Samantha Shune
- Communication Disorders and Sciences, University of Oregon, Eugene, OR, USA
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6
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Darley A, Coughlan B, Maguire R, McCann L, Furlong E. A bridge from uncertainty to understanding: The meaning of symptom management digital health technology during cancer treatment. Digit Health 2023; 9:20552076231152163. [PMID: 36714543 PMCID: PMC9880573 DOI: 10.1177/20552076231152163] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 01/03/2023] [Indexed: 01/24/2023] Open
Abstract
Objective Digital health technology is valued as a tool to provide person-centred care and improve health outcomes amongst people with cancer and their family caregivers. Although the evidence to date shows encouraging effectiveness, there is limited knowledge regarding the lived experience and personal meaning of using supportive technology during cancer treatment. The aim of this study was to explore the lived experiences of people with colorectal cancer receiving chemotherapy using digital health symptom management technology and their family caregivers. Methods A longitudinal and multi-perspective interpretative phenomenological analytical approach was adopted including three people with newly diagnosed colorectal cancer and four family caregivers. Findings Three superordinate themes and related subthemes were identified. The first theme (The 3 Cs of symptom management technology) centred on the continuity of care that participants felt while using the technology. The second theme (Digital health technology as a psychosocial support) offered insights into the psychological benefits using technology incurred as they navigated their cancer diagnosis including sense of control and psychological safety. The final theme (Impact of digital health technology on family caregivers) details the supportive effect the technology had on family caregivers' role, responsibilities and well-being during the cancer experience. Conclusion Digital health technology can act as a bridge from uncertainty to an understanding regarding a cancer diagnosis and its treatment. Digital health technology can support peoples' understanding of cancer and enhance self-management practices, while being a psychological support in navigating the uncertain and often worrying period of receiving cancer treatment.
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Affiliation(s)
- Andrew Darley
- School of Medicine, University College Dublin, Dublin, Ireland,Andrew Darley, School of Medicine,
University College Dublin, Belfield, Dublin 4, Ireland.
| | - Barbara Coughlan
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Roma Maguire
- Digital Health and Wellness Group, Department of Computing and
Information Sciences, University of Strathclyde, Glasgow, UK
| | - Lisa McCann
- Digital Health and Wellness Group, Department of Computing and
Information Sciences, University of Strathclyde, Glasgow, UK
| | - Eileen Furlong
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
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7
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Cincidda C, Pizzoli SFM, Ongaro G, Oliveri S, Pravettoni G. Caregiving and Shared Decision Making in Breast and Prostate Cancer Patients: A Systematic Review. Curr Oncol 2023; 30:803-823. [PMID: 36661710 PMCID: PMC9857468 DOI: 10.3390/curroncol30010061] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/20/2022] [Accepted: 01/04/2023] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND A cancer diagnosis can impact patients' and caregivers' lives, posing different challenging situations. In particular, breast cancer and prostate cancer are two types of cancer involving families and especially spouses in challenges linked with the diagnosis and treatment process. Caregivers are usually involved in the treatment decision-making (TDM) process concerning patients' clinical pathway, cancer treatment, and ongoing therapies. To date, no contributions provide an exhaustive overview of the role of caregivers in cancer care and their involvement in the TDM process related to the therapies. METHODS We performed a systematic review of caregiver and patients experiences and perceptions of caregiver involvement in cancer TDM. Articles were searched on Public/Publisher MEDLINE (PubMed), Excerpta Medica Database (Embase), Medical Literature Analysis and Retrieval System Online (Medline), and American Psychological Association APA PsycINFO. RESULTS 17 studies were included, 10 on prostate cancer and 7 on breast cancer. According to the reviewed studies, patients and caregivers experienced the cancer diagnosis with a sense of unity. Most patients preferred to have an active or collaborative role with caregivers in TDM, feeling it was important to consult or share the decision made with their caregivers. Caregivers preferred to collaborate with patients or let patients decide by themselves after considering their opinions. Caregiver involvement could have a positive influence on the patient's medical decisions, even if cancer diagnosis and treatments overwhelmed patients and caregivers. CONCLUSIONS These findings highlight the importance of using a perspective that focuses on the relationship between a patient and caregivers when they receive a cancer diagnosis and have to make a treatment decision. Targeting caregiver-patient dyads, rather than individuals, is important since a supported relationship could have a protective effect on psychological distress, quality of life (QOL), and relationship satisfaction. Moreover, dyads may benefit from interventions that focus on the needs of both the patient and caregiver.
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Affiliation(s)
- Clizia Cincidda
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, 20141 Milano, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milano, Italy
| | | | - Giulia Ongaro
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, 20141 Milano, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milano, Italy
| | - Serena Oliveri
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, 20141 Milano, Italy
| | - Gabriella Pravettoni
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, 20141 Milano, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milano, Italy
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8
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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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Nissim RS, Hales S. Caring for the Family Caregiver: Development of a Caregiver Clinic at a Cancer Hospital as Standard of Care. J Clin Psychol Med Settings 2022; 30:111-118. [PMID: 35699840 PMCID: PMC9195392 DOI: 10.1007/s10880-022-09891-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2022] [Indexed: 11/27/2022]
Abstract
Family caregivers make significant contributions to the overall care of cancer patients and are the “invisible backbone” of the health care system. Family caregivers experience a wide range of challenges and can be considered patients in their own right, requiring support and dedicated attention, which may benefit them, the patients they are caring for, and the health care system. Despite consistent evidence on caregiver distress and unmet needs, most cancer care is organized around the patient as the target of care and caregiver distress is not screened for or addressed systematically. This article describes the development of a novel clinical, educational, and research program dedicated to supporting family caregivers at the Princess Margaret Cancer Center, Toronto, Canada and presents a model for a brief psychosocial intervention for caregivers. The objective of this article is to assist others in developing services to address the needs of family caregivers as a standard of care.
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Affiliation(s)
- Rinat S Nissim
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 610 University Ave., Toronto, ON, M5G 2M9, Canada.
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
- Centre for Mental Health, University Health Network, Toronto, ON, Canada.
| | - Sarah Hales
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 610 University Ave., Toronto, ON, M5G 2M9, Canada
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Centre for Mental Health, University Health Network, Toronto, ON, Canada
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10
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Hentschel L, Wellesen A, Krause LC, von Havranek M, Kramer M, Hornemann B, Bornhäuser M, Schuler U, Schütte K. Predicting unplanned hospital readmission in palliative outpatients (PRePP) – study protocol of a longitudinal, prospective study to identify informal caregiver-related and structural predictors. BMC Palliat Care 2022; 21:62. [PMID: 35501763 PMCID: PMC9059677 DOI: 10.1186/s12904-022-00955-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 04/24/2022] [Indexed: 11/29/2022] Open
Abstract
Background Although the majority of German patients in a palliative state prefer to die at home, the actual place of death is most often a hospital. Unplanned hospital readmissions (UHA) not only contradict most patients’ preferences but also increase the probability of an aggressive end-of-life treatment. As limited knowledge is available which factors contribute to an UHA, the PRePP-project aims to explore predictors related to informal caregivers (IC) as well as medical and structural factors. Methods This prospective, observational, mono-centric study will assess structural and medical factors as well as ICs’ psychological burden throughout seven study visits. Starting in April 2021 it will consecutively include 240 patients and their respective IC if available. Standardized measures concerning ICs’ Quality of Life (WHOQOL-BREF), psychological distress (NCCN-Distress Thermometer), anxiety (GAD-7) and depressiveness (PHQ-9) will be assessed. If participants prefer, assessment via phone, browser-based or paper-based will be conducted. Medical records will provide routinely assessed information concerning patient-related characteristics such as gender, age, duration of hospital stay and medical condition. Nurse-reported data will give information on whether hospitalization and death occurred unexpectedly. Data will be progressed pseudonymized. Multivariable regression models will help to identify predictors of the primary endpoint “unplanned hospital admissions”. Discussion The PRePP-project is an important prerequisite for a clinical risk assessment of UHAs. Nevertheless, it faces several methodological challenges: as it is a single center study, representativity of results is limited while social desirability might be increased as the study is partly conducted by the treatment team. Furthermore, we anticipated an underrepresentation of highly burdened participants as they might refrain from participation. Trial registration This study was retrospectively registered 19 October 2021 at clinicaltrials.gov (NCT05082389). https://clinicaltrials.gov/ct2/show/NCT05082389
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11
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Ferrell BR, Ruel N, Borneman T, Koczywas M, Cristea M. Family Caregiver Preparedness: Developing an Educational Intervention for Symptom Management. Clin J Oncol Nurs 2022; 26:165-175. [PMID: 35302549 DOI: 10.1188/22.cjon.165-175] [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: 11/17/2022]
Abstract
BACKGROUND Family caregivers provide complex care for patients with cancer, including management of multiple symptoms associated with the disease and its treatment. OBJECTIVES The objective of this pilot project was to develop and conduct feasibility testing of a family caregiver educational intervention for symptom management. METHODS The intervention was conducted with 23 family caregivers of patients with lung or gynecologic cancer to evaluate feasibility testing and assessment of caregiver preparedness, quality of life, and psychological distress at baseline and three and seven weeks postintervention. FINDINGS Family caregivers were very interested in education related to their role in symptom management, with management of constipation, dyspnea, and diarrhea as the highest priorities. The intervention was feasible and valuable in assisting family caregivers in assessing symptoms and making decisions regarding treatment choices.
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Affiliation(s)
| | - Nora Ruel
- City of Hope National Medical Center
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12
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Rangira D, Najeeb H, Shune SE, Namasivayam-MacDonald A. Understanding Burden in Caregivers of Adults With Dysphagia: A Systematic Review. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:486-501. [PMID: 34962832 DOI: 10.1044/2021_ajslp-21-00249] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION A previous review suggested that dysphagia is negatively associated with burden in caregivers of community-dwelling older adults. Other literature suggests similar patterns of burden may be found across adult patient populations. The current study, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, was conducted to determine the impact of dysphagia on caregivers of adults, regardless of etiology. METHOD Five electronic databases were searched using terms based on a review by Namasivayam-MacDonald and Shune (2018) but included all adults rather than only older adults. Searches were limited to English-language empirical studies discussing caregiver burden, included caregivers of adult care recipients, had some care recipients with dysphagia, did not include palliative care, and published in a peer-reviewed journal. RESULTS The search yielded 1,112 unique abstracts, of which 17 were accepted. Across studies, caregiver burden was found to increase due to dysphagia in care recipients. Commonly reported dysphagia-related causes of burden included changes in meal preparation, disruption in lifestyle, effects on social life, lack of support, insertion of feeding tubes, and fear of aspiration. In general, dysphagia-related caregiver burden was a common experience across caregivers, regardless of patient population, caregiver age, and relationship between caregiver and care recipient. Meta-analyses suggest 71% of caregivers of adults with dysphagia experience some degree of burden. CONCLUSIONS These findings support that dysphagia negatively impacts caregiver burden and suggests sources of burden that clinicians can address within dysphagia management to support caregivers. However, more research is needed to better delineate sources of burden, especially those specific to various dysphagia etiologies, to better meet the needs of our patients.
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Affiliation(s)
- Daniella Rangira
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Hiba Najeeb
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Samantha E Shune
- Communication Disorders and Sciences Program, University of Oregon, Eugene
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Teixeira LA, Borges MDC, Abreu DPHD, Ribeiro KB, Shimano SGN, Martins LJP. Caregivers of older adults in palliative care: level of burden and depressive symptoms. FISIOTERAPIA EM MOVIMENTO 2022. [DOI: 10.1590/fm.2022.35132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Introduction The burden perceived by informal caregivers of older adult cancer patients in palliative care is an incessant daily repetitiveness, and can negatively affect their physical and mental health, as well as their social and family life. Objective To assess the level of burden and the intensity of depressive symptoms in caregivers, and the dependence of the older adults for basic and instrumental activities of daily living. Methods This was a cross-sectional and descriptive study, composed of 20 caregivers and 20 older adults with cancer in palliative care. Caregivers and older adults were administered the socio-economic and demographic profile assessment. For the caregivers, the International Physical Activity Questionnaire - IPAQ, the Zarit Burden Interview (ZBI), and the Beck Depression Inventory (BDI) were used. For the older adults, the Katz Index of Independence in Activities of Daily Living (Katz Index ADL) and the Lawton and Brody Instrumental Activities of Daily Living scales (Lawton and Brody IADL scales) were used. Data were represented in absolute and percentage values. Results Caregivers were predominantly female, mostly daughters of the older adults, married or with a partner, with elementary school education, income of 1 to 3 times the minimum wage, and had a sedentary lifestyle. A moderate level of burden was verified in 75% of the caregivers, and mild to moderate depressive symptoms in 45%. The assessment of ADL in older adults found that 55% were independent in all six functions, with greater dependence (75%) in ADL for housekeeping such as laundry (85%) and driving vehicles (90%). Conclusion Caregivers of older adults cancer patients in palliative care show moderate level of burden, and mild to moderate depressive symptoms.
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Teixeira LA, Borges MDC, Abreu DPHD, Ribeiro KB, Shimano SGN, Martins LJP. Cuidadores de idosos em cuidados paliativos: nível de sobrecarga e sintomas depressivos. FISIOTERAPIA EM MOVIMENTO 2022. [DOI: 10.1590/fm.2022.35132.0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
Resumo Introdução A sobrecarga vivenciada por cuidadores informais de idosos com câncer em cuidados paliativos em uma repetitividade diária incessante pode afetar negativamente a saúde física e mental, bem como a vida social e familiar do cuidador. Objetivo Avaliar o nível de sobrecarga e a intensidade de sintomas depressivos nos cuidadores e a dependência para as atividades básicas e instrumentais de vida diária dos idosos. Métodos Estudo transversal e descritivo, composto por 20 cuidadores e 20 idosos com câncer em cuidados paliativos. Os cuidadores e os idosos foram submetidos à avaliação do perfil socioeconômico e demográfico. Quanto à avaliação dos cuidadores, utilizaram-se o Questionário Internacional de Atividade Física- IPAQ, a escala Zarit Burden Interview e o Inventário de Depressão de Beck. Para a avaliação dos idosos, o índice de Katz para as atividades básicas da vida diária (ABVD) e a escala de Lawton e Brody para atividades instrumentais de vida diária (AIVD). Os dados foram representados em valores absolutos e percentuais. Resultados Houve predomínio de cuidadores do sexo feminino, a maioria filha dos idosos, casadas ou com companheiro, com ensino fundamental I, renda de 1 a 3 salários mínimos e sedentárias, sendo constatado nível de sobrecarga moderado em 75% dos cuidadores e sintomas depressivos de leves a moderados em 45%. Quanto à avaliação das ABVD nos idosos, constatou-se que 55% eram independentes nas seis funções, com maior dependência (75%) em AIVD para trabalhos domésticos como lavar roupas (85%) e condução de veículos (90%). Conclusão Os cuidadores de idosos com câncer em cuidados paliativos apresentam nível de sobrecarga moderado e sintomas depressivos de leves a moderados.
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Longacre ML, Chwistek M, Collins M, Odelberg M, Siemon M, Keleher C, Fang CY. Palliative Care Clinicians' Perspectives of an Integrated Caregiver Patient-Portal System in Oncology. CANCER CARE RESEARCH ONLINE 2021; 1:e014. [PMID: 35694116 PMCID: PMC9187051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Despite recommendations and policies to integrate family caregivers into U.S. healthcare settings, caregivers are not systematically involved. Thus, we developed an Integrated Caregiver Patient-Portal system that (1) allows a patient to identify their primary caregiver and their communication preferences; (2) connects the caregiver to a unique portal page to indicate their needs; and 3) informs the care team of dyad responses to aid in integrating the caregiver. OBJECTIVE This formative research explored palliative care clinicians' perceptions of the system to inform refinements before usability testing. METHODS We conducted two focus groups with palliative care clinicians (N=11) at an NCI-designated cancer center. Transcripts were analyzed using an integrated approach to specify system benefits and concerns. RESULTS The most referenced benefits included: Learning information that they might not have known without the system; giving caregivers a voice or a way to express needs; and supporting an ideal model of care. Top concerns included lacking capacity to respond; needing to clarify clinician roles and expertise in responding to caregivers' needs; and ensuring ongoing system adaptability. CONCLUSIONS The clinicians' feedback resulted in revisions including: (1) modifying the caregiver questions; (2) integrating social workers in the response; and (3) adding a text-based report to the care team. IMPLICATIONS FOR PRACTICE This formative research provided valuable feedback for portal development, and also contributes more broadly to recommendations related to integrating caregivers in healthcare. FOUNDATIONAL This research provides practical and logistical relevance to the discussion on how to integrate caregivers into clinical care.
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Affiliation(s)
- Margaret L Longacre
- Department of Public Health, College of Health Sciences, Arcadia University, Glenside, PA
| | - Marcin Chwistek
- Fox Chase Cancer Center, Supportive Oncology and Palliative Care Program, Philadelphia, PA
| | - Molly Collins
- Fox Chase Cancer Center, Supportive Oncology and Palliative Care Program, Philadelphia, PA
| | - Michelle Odelberg
- Department of Public Health, College of Health Sciences, Arcadia University, Glenside, PA
| | - Mark Siemon
- Fox Chase Cancer Center, Web Technologies Department, Philadelphia, PA
| | - Cynthia Keleher
- Fox Chase Cancer Center, Web Technologies Department, Philadelphia, PA
| | - Carolyn Y Fang
- Fox Chase Cancer Center, Cancer Prevention and Control Program, Philadelphia, PA
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Ashare RL, Brewer B, Patterson F, Hubbard A, Longacre ML. Psychological and behavioral moderators of physical health among caregivers and non-caregivers. Geriatr Nurs 2021; 43:77-84. [PMID: 34844128 DOI: 10.1016/j.gerinurse.2021.11.004] [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: 07/30/2021] [Revised: 11/01/2021] [Accepted: 11/03/2021] [Indexed: 11/04/2022]
Abstract
The current study sought to evaluate whether psychological and/or behavioral health moderate the relationship between caregiving and physical health. MATERIALS AND METHODS Using data from the Behavioral Risk Factor Surveillance System (BRFSS) survey (2017-2018), separate composite scores were created for psychological and behavioral health. Self-reported physical health was the primary outcome. The sample was 1,387 non-caregivers and 266 caregivers. RESULTS The psychological, behavioral, and self-reported physical health did not significantly differ between caregivers and non-caregivers, but psychological and behavioral health were shown to differentially affect self-reported health outcomes among caregivers, compared to non-caregivers. Caregivers with worse psychological health had higher odds of experiencing poor physical health versus non-caregivers, while caregivers with better behavioral health had lower odds of having better general health versus non-caregivers. DISCUSSION These data extend our understanding on how to consider the impact of psychological and behavioral health as a caregiver and opportunities to develop targeted interventions.
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Affiliation(s)
- Rebecca L Ashare
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, United States; Department of Psychology, State University of New York at Buffalo, Buffalo, NY 14260, United States
| | - Benjamin Brewer
- College of Health Sciences, University of Delaware, The STAR Campus, Newark, DE 19713, United States
| | - Freda Patterson
- College of Health Sciences, University of Delaware, The STAR Campus, Newark, DE 19713, United States
| | - Adeline Hubbard
- Department of Public Health, College of Health Sciences, Arcadia University, Glenside, PA 19038, United States
| | - Margaret L Longacre
- Department of Public Health, College of Health Sciences, Arcadia University, Glenside, PA 19038, United States.
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Experiences of being a family caregiver to a patient treated for oesophageal cancer-1 year after surgery. Support Care Cancer 2021; 30:915-921. [PMID: 34414468 PMCID: PMC8636407 DOI: 10.1007/s00520-021-06501-5] [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: 04/06/2021] [Accepted: 08/10/2021] [Indexed: 11/13/2022]
Abstract
Purpose There is a need to put family caregivers on the cancer survivorship research agenda. Therefore, the aim of this is study is to explore the experiences of being a family caregiver to a patient treated for oesophageal cancer. Method This qualitative study was based on the ongoing nationwide and prospective Oesophageal Surgery on Cancer patients – Adaptation and Recovery study (OSCAR) including patients surgically treated for oesophageal cancer in Sweden and their closest family caregiver. One year after the patient’s surgery, each family caregiver received a self-report questionnaire kit to fill in. For the purpose of this study, the responses to the open-ended question “Is there anything else you would like to share?” were used and analysed by conducting thematic analysis. Results In total, 112 responses to the open-ended question were transcribed and analysed. The text rendered three themes: Discontinued support from healthcare—mostly a positive experience before surgery and in the acute survivorship phase. However, after discharge from the hospital, the family caregiver felt as though they were left alone, fully responsible for the patient’s care. A changed life—unprepared for life-changing situation after the patient received the cancer diagnosis. A feeling that nothing will ever be the same and like your sense of self is lost. Psychological distress—was described as a feeling of being alone. Family caregivers felt invisible and no longer important to family and friends. The patient was the one that mattered. Conclusion This study indicates that patients and family caregivers would benefit from a more family-centred healthcare, where the patients’ as well as the caregivers’ perspectives would be acknowledged.
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Applebaum AJ, Panjwani AA, Buda K, O'Toole MS, Hoyt MA, Garcia A, Fresco DM, Mennin DS. Emotion regulation therapy for cancer caregivers-an open trial of a mechanism-targeted approach to addressing caregiver distress. Transl Behav Med 2021; 10:413-422. [PMID: 30395306 DOI: 10.1093/tbm/iby104] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Informal caregivers (ICs) are integral to care provided to patients facing life-threatening or incurable illnesses. This responsibility causes considerable burden, as approximately one half of ICs report clinically significant symptoms of depression and/or anxiety that persist when left untreated. Psychosocial interventions containing efficacious treatment principles (e.g., cognitive behavior therapy [CBT]) show disappointing results in reducing anxiety and depression in ICs. This may reflect failure of these interventions to specifically target crucial mechanisms underlying the central feature of distress caused by the patient's illness-notably, perseverative negative thinking (PNT). Emotion Regulation Therapy (ERT) is an efficacious CBT developed to explicitly target mechanisms underlying PNT and the emotional concomitants that arise in response to stressful situations. This open trial was conducted to evaluate the acceptability and initial efficacy of ERT adapted to the experience of cancer ICs (ERT-C). Thirty-one ICs provided informed consent and completed eight weekly individual sessions of ERT-C. Participants completed self-report measures of depression and anxiety symptoms, PNT, emotion regulation deficits, and caregiver burden before and after treatment. ERT-C was well tolerated as indicated by 22 treatment completers and feedback provided in exit interviews. ICs demonstrated reduced depression and anxiety symptoms, PNT, and emotion regulation deficits with moderate to large effect sizes (Hedge's g range: 0.36-0.92). Notably, caregiver burden was not reduced but ICs expressed more ability to confront caregiving-related challenges. Findings offer promising but preliminary support for ERT-C as a conceptual model and treatment modality for distressed cancer ICs.
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Affiliation(s)
- Allison J Applebaum
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Kara Buda
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Mia S O'Toole
- Department of Psychology & Behavioral Sciences, Aarhus, Denmark
| | | | - Adam Garcia
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
| | - David M Fresco
- Department of Psychological Sciences, Kent State University, Kent, OH
| | - Douglas S Mennin
- Department of Psychology, Teachers College, Columbia, New York, NY
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Sadigh G, Switchenko J, Weaver KE, Elchoufi D, Meisel J, Bilen MA, Lawson D, Cella D, El-Rayes B, Carlos R. Correlates of financial toxicity in adult cancer patients and their informal caregivers. Support Care Cancer 2021; 30:217-225. [PMID: 34255179 DOI: 10.1007/s00520-021-06424-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 07/08/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Financial toxicity is commonly reported by cancer patients, but few studies have assessed caregiver perceptions. We aimed to validate the modified Comprehensive Score for Financial Toxicity (COST) in cancer caregivers, identify factors associated with financial toxicity in both patients and caregivers, and assess the association of caregiver financial toxicity with patient and caregiver outcomes. METHODS Using a convenience sampling method, 100 dyads of adult cancer patients and a primary caregiver visiting outpatient oncology clinics (Jan-Sep 2019) were recruited. We assessed the internal consistency and convergent and divergent validity of the modified COST. Multivariable analyses identified correlates of financial toxicity. Association of financial toxicity with care non-adherence, lifestyle-altering behaviors (e.g., home refinance/sale, retirement/saving account withdrawal), and quality of life (QOL) was investigated. RESULTS Recruited patient vs. caregiver characteristics were as follows: mean age: 60.6 vs. 56.5; 34% vs. 46.4% female; 79% vs. 81.4% white. The caregiver COST measure demonstrated high internal consistency (Cronbach α = 0.91). In patients, older age (B, 0.3 [95% CI, 0.1-0.4]) and higher annual household income (B, 14.3 [95% CI, 9.3-19.4]) correlated with lower financial toxicity (P < 0.05). In caregivers, lower patient financial toxicity (B, 0.4 [95% CI, 0.2-0.6]) and cancer stages 1-3 (compared to stage 4) (B, 4.6 [95% CI, 0.4-8.8]) correlated with lower financial toxicity (P < 0.05). Increased caregiver financial toxicity correlated with higher care non-adherence in patients, increased lifestyle-altering behaviors, and lower QOL in patients and caregivers (P < 0.05). CONCLUSION The COST measure can also be used to assess caregiver financial toxicity. Caregivers' financial toxicity was associated with negative outcomes for both dyad members.
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Affiliation(s)
- Gelareh Sadigh
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd, Suite BG20, Atlanta, GA, 30322, USA.
| | - Jeffrey Switchenko
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Kathryn E Weaver
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Deema Elchoufi
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC, USA
| | - Jane Meisel
- Department of Hematology and Oncology, Winship Cancer Institute of Emory University School of Medicine, Atlanta, GA, USA
| | - Mehmet Asim Bilen
- Department of Hematology and Oncology, Winship Cancer Institute of Emory University School of Medicine, Atlanta, GA, USA
| | - David Lawson
- Department of Hematology and Oncology, Winship Cancer Institute of Emory University School of Medicine, Atlanta, GA, USA
| | - David Cella
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
| | - Bassel El-Rayes
- Department of Hematology and Oncology, Winship Cancer Institute of Emory University School of Medicine, Atlanta, GA, USA
| | - Ruth Carlos
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
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Moss KO, Douglas SL, Lipson AR, Blackstone E, Williams D, Aaron S, Wills CE. Understanding of Health-related Decision-making Terminology Among Cancer Caregivers. West J Nurs Res 2021; 43:649-659. [PMID: 33063642 PMCID: PMC8050115 DOI: 10.1177/0193945920965238] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Research on understanding health-related decision-making terminology among family caregivers of adults living with advanced cancer is lacking. The purpose of this study was to examine interpretations of the meaning of health-related decision-making terminology such as quality-of-life and end-of-life among caregivers of adults living with advanced cancer as a basis for improved understanding of caregiver decision support needs. Interviews were conducted with a purposive sub-sample of 10 caregivers of adults diagnosed with advanced cancer who completed a longitudinal, descriptive study (NRO14856) of factors influencing cancer care decisions. Audio transcripts were analyzed using qualitative descriptive methods. Caregivers described interpretations of the meaning and process of decision-making and decision-related distress. Caregivers were uncertain about the meaning of end-of-life-related terminology, and a placed high value on quality-of-life and faith/spirituality in the decision-making process. Improvements in information and decision support interventions are needed to better support caregivers and subsequently patients towards informed cancer care decisions.
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Affiliation(s)
- Karen O Moss
- Center for Healthy Aging, Self-Management and Complex Care, College of Nursing, The Ohio State University, Columbus, OH, USA
| | - Sara L Douglas
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Amy R Lipson
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Eric Blackstone
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Dionne Williams
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Siobhan Aaron
- Interdisciplinary Training in Cancer, Caregiving, and End-of-Life Care, College of Nursing, University of Utah, USA
| | - Celia E Wills
- Center for Healthy Aging, Self-Management and Complex Care, College of Nursing, The Ohio State University, Columbus, OH, USA
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21
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Applebaum AJ, Kent EE, Lichtenthal WG. Documentation of Caregivers as a Standard of Care. J Clin Oncol 2021; 39:1955-1958. [PMID: 33945287 PMCID: PMC8260920 DOI: 10.1200/jco.21.00402] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/22/2021] [Accepted: 04/14/2021] [Indexed: 11/20/2022] Open
Affiliation(s)
- Allison J. Applebaum
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Psychology in Psychiatry, Weill Cornell Medicine, New York, NY
| | - Erin E. Kent
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Wendy G. Lichtenthal
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Psychology in Psychiatry, Weill Cornell Medicine, New York, NY
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Abstract
BACKGROUND Informal caregiving of stroke survivors often begins with intensity compared with the linear caregiving trajectories in progressive conditions. Informal caregivers of stroke survivors are often inadequately prepared for their caregiving role, which can have detrimental effects on their well-being. A greater depth of understanding about caregiving burden is needed to identify caregivers in most need of intervention. The purpose of this study was to examine caregiver burden and associated factors among a cohort of informal caregivers of stroke survivors. METHODS A cross-sectional study of 88 informal caregivers of stroke survivors was completed. Caregiver burden was determined with the Zarit Burden Interview, caregiver depressive symptoms were measured with the Patient Health Questionnaire-9, and stroke survivor functional disability was assessed with the Barthel Index. Ordinal logistic regression was used to identify independent factors associated with caregiver burden. RESULTS Forty-three informal caregivers (49%) reported minimal or no caregiver burden, 30 (34%) reported mild to moderate caregiver burden, and 15 (17%) reported moderate to severe caregiver burden. Stroke survivor functional disability was associated with informal caregiver burden (P = .0387). The odds of having mild to moderate caregiver burden were 3.7 times higher for informal caregivers of stroke survivors with moderate to severe functional disability than for caregivers of stroke survivors with no functional disability. The presence of caregiver depressive symptoms was highly correlated with caregiver burden (P < .001). CONCLUSION Caregivers of stroke survivors with functional disabilities and caregivers experiencing depressive symptoms may have severer caregiver burden. Trials of interventions aimed at decreasing informal caregiver burden should consider the potential impact of stroke survivors' functional disability and the presence of depressive symptoms.
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Prieto R, Ferrell B, Kim JY, Sun V. Self-Management Coaching: Promoting Postoperative Recovery and Caregiving Preparedness for Patients With Lung Cancer and Their Family Caregivers. Clin J Oncol Nurs 2021; 25:290-296. [PMID: 34019030 DOI: 10.1188/21.cjon.290-296] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Quality of life (QOL) for patients undergoing lung resection and their family caregivers (FCGs) is often affected by surgical treatment for lung cancer. OBJECTIVES Patients and FCGs have a great deal of distress that affects their QOL. Introducing self-management skills soon after diagnosis improves patient and FCG outcomes. METHODS This article presents a intervention model for providing patients and FCGs with self-management skills. Patients and FCGs will learn how to identify and overcome challenges, set goals, and address unmet needs throughout the phases of surgery. The model and case examples are presented. FINDINGS Patients and FCGs gained self-efficacy. They were able to identify potential stressors that would otherwise become burdensome. Patients remained in control of their preoperative care and recovery, resulting in continued independence. FCGs achieved healthier well-being, which increased positive caregiving experiences.
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Abstract
OBJECTIVE Providing care to a loved one with cancer places demands on caregivers that result in changes to their daily routines and disruptions to their social relationships that then contribute to loneliness. Though caregivers' psychosocial challenges have been well studied, loneliness - a determinant of health - has not been well studied in this population. This narrative review sought to describe the current evidence on loneliness among caregivers of cancer patients. We aimed to (1) define loneliness, (2) describe its prevalence, (3) describe the association between loneliness and health outcomes, (4) describe risks and consequences of loneliness among cancer caregivers, (5) identify ways to assess loneliness, and (6) recommend strategies to mitigate loneliness in this unique population. METHOD We used evidence from articles listed in PubMed, PsycINFO, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases, book chapters, and reports. Articles were reviewed for the following inclusion criteria: (1) published in English, (2) caregivers of cancer patients, (3) loneliness as a study variable, and (4) peer-reviewed with no restriction on the timeframe of publication. Caregivers were defined as relatives, friends, or partners who provide most of the care and support for someone with cancer. RESULTS Eighteen studies met inclusion criteria and were included in the analysis. Caregivers' experiences of loneliness can contribute to negative effects on one's social, emotional, and physical well-being. Social support interventions may not be sufficient to address this problem. Existing recommendations to mitigate loneliness include cognitive and psychological reframing, one-on-one and group therapy, befriending, resilience training, and technology-based interventions. SIGNIFICANCE OF RESULTS Limited attention to loneliness in cancer caregivers poses a twofold problem that impacts patient and caregiver outcomes. Interventions are critically needed to address loneliness as a determinant of health in caregivers, given their pivotal role in providing care and impacting health outcomes for people with cancer.
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Longacre ML, Keleher C, Chwistek M, Odelberg M, Siemon M, Collins M, Fang CY. Developing an Integrated Caregiver Patient-Portal System. Healthcare (Basel) 2021; 9:193. [PMID: 33578838 PMCID: PMC7916542 DOI: 10.3390/healthcare9020193] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/19/2021] [Accepted: 02/05/2021] [Indexed: 01/05/2023] Open
Abstract
We have developed an integrated caregiver patient-portal system (i.e., patient-caregiver portal) that (1) allows a patient to identify their primary caregiver and their communication preferences with that caregiver in the healthcare setting; (2) connects the caregiver to a unique portal page to indicate their needs; and (3) informs the healthcare team of patient and caregiver responses to aid in integrating the caregiver. The purpose of this manuscript is to report on the formative phases (Phases I and II) of system development. Phase I involved a pre-assessment to anticipate complexity or barriers in the system design and future implementation. We used the non-adaption, abandonment, scale-up, spread, and sustainability (NASSS) framework and rubric to conduct this pre-assessment. Phase II involved exploring reactions (i.e., concerns or benefits) to the system among a small sample of stakeholders (i.e., 5 palliative oncology patients and their caregivers, N = 10). The purpose of these two phases was to identify system changes prior to conducting usability testing among patient/caregiver dyads in palliative oncology (phase III). Completion of the NASSS rubric highlighted potential implementation barriers, such as the non-uniformity of caregiving, disparities in portal use, and a lack of cost-benefit (value) findings in the literature. The dyads' feedback reinforced several NASSS ratings, including the benefits of connecting caregivers and allowing for caregiver voice as well as the concerns of limited use of patient-portals by the patients (but not the caregivers) and the need for user assistance during stressful health events. One change that resulted from this analysis was ensuring that we provided research participants (users) with detailed guidance and support on how to log in and use a patient-caregiver portal. In future iterations, we will also consider allowing more than one caregiver to be included and incorporating additional strategies to enable caregivers to interact in the system as part of the care team (e.g., via email).
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Affiliation(s)
- Margaret L. Longacre
- Department of Public Health, College of Health Sciences, Arcadia University, Glenside, PA 19038, USA;
| | - Cynthia Keleher
- Fox Chase Cancer Center, Web Technologies Department, Philadelphia, PA 19111, USA; (C.K.); (M.S.)
| | - Marcin Chwistek
- Fox Chase Cancer Center, Supportive Oncology and Palliative Care Program, Philadelphia, PA 19111, USA; (M.C.); (M.C.)
| | - Michelle Odelberg
- Department of Public Health, College of Health Sciences, Arcadia University, Glenside, PA 19038, USA;
| | - Mark Siemon
- Fox Chase Cancer Center, Web Technologies Department, Philadelphia, PA 19111, USA; (C.K.); (M.S.)
| | - Molly Collins
- Fox Chase Cancer Center, Supportive Oncology and Palliative Care Program, Philadelphia, PA 19111, USA; (M.C.); (M.C.)
| | - Carolyn Y. Fang
- Fox Chase Cancer Center, Cancer Prevention and Control Program, Philadelphia, PA 19111, USA;
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Douglas SL, Mazanec P, Lipson AR, Day K, Blackstone E, Bajor DL, Saltzman J, Krishnamurthi S. Videoconference Intervention for Distance Caregivers of Patients With Cancer: A Randomized Controlled Trial. JCO Oncol Pract 2021; 17:e26-e35. [PMID: 33434451 DOI: 10.1200/op.20.00576] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
PURPOSE Approximately 20% of caregivers (CGs) live > 1 hour away from the patient and are considered distance caregivers (DCGs) who often report higher distress and anxiety than local CGs. The purpose of this study was to test the effectiveness of an intervention aimed at reducing anxiety and distress in DCGs of patients with cancer. METHODS This randomized controlled trial enrolled DCGs of patients with all cancer types who were being seen monthly by oncologists in outpatient clinics. There were three arms of the intervention delivered over a 4-month period: arm 1 (a) received 4 monthly videoconference-tailored coaching sessions with an advanced practice nurse or social worker focused on information and support, (b) participated in patient's appointments with the oncologist via videoconference over the 4-month study period, and (c) had access to a website designed for DCGs. Arm 2 did not receive the coaching sessions but received the other two components, and arm 3 received access to the DCG website only. RESULTS There were 302 DCGs who provided pre- and postintervention data. There were significant anxiety by group (P = .028 and r = 0.16) and distress by group interactions (P = .014 and r = 0.17). Arm 1 had the greatest percentage of DCGs who demonstrated improvement in anxiety (18.6%) and distress (25.2%). CONCLUSION Coaching and use of videoconference technology (to join the DCG into the patient-oncologist office visit) were effective in reducing both anxiety and distress for DCGs. These components could be considered for local CGs who-with COVID-19-are unable to accompany the patient to oncologist visits.
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Affiliation(s)
- Sara L Douglas
- School of Nursing and Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH
| | - Polly Mazanec
- Case Western Reserve University, School of Nursing, Cleveland, OH
| | - Amy R Lipson
- Case Western Reserve University, School of Nursing, Cleveland, OH
| | - Kim Day
- Independent Contractor, Cleveland, OH
| | - Eric Blackstone
- Case Western Reserve University, School of Nursing, Cleveland, OH
| | - David L Bajor
- Seidman Cancer Center and Case Comprehensive Cancer Center, Cleveland, OH
| | - Joel Saltzman
- Lake Health UH Seidman Cancer Center and Case Comprehensive Cancer Center, Mentor, OH
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Longacre ML, Miller MF, Fang CY. Racial and ethnic variations in caregiving-related physical, emotional, and financial strain during COVID-19 among those caring for adult cancer patients. Support Care Cancer 2021; 29:4137-4146. [PMID: 33404809 PMCID: PMC7785926 DOI: 10.1007/s00520-020-05933-9] [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] [Received: 09/07/2020] [Accepted: 12/03/2020] [Indexed: 11/16/2022]
Abstract
Purpose Cancer caregiving is shown to be a burdensome experience in typical times. The purpose of this study was to describe cancer caregivers’ emotional, physical, and financial strain during the COVID-19 pandemic and compared to preCOVID-19, and explore racial and ethnic variations in caregiver strain. Methods We conducted a cross-sectional online survey using Lucid, LLC, incorporating quotas for race, ethnicity, gender and age. Caregivers had to be adults living in the USA and currently providing unpaid care to an adult cancer patient (i.e., during COVID-19) and prior to the pandemic. We assessed the caregivers’ emotional, physical, and financial strain and asked them to compare to preCOVID-19 caregiving. Analyses included descriptive and linear regression adjusting for sociodemographic and caregiving-related variables. Results A total of 285 caregivers met eligibility, and most were nonHispanic white (72.3%) and female (59.6%). Based on a scale of “1: Much lower” to “5: Much higher”, the financial, physical and emotional strain/stress experienced by caregivers compared to preCOVID-19 was, on average, 3.52 (SD: 0.82; range: 1–5) for financial strain, 3.61 (SD: 0.86; range: 1–5) for physical strain, and 3.88 (SD: 0.89; range: 1–5) for emotional stress. NonHispanic black caregivers were significantly more likely than nonHispanic white caregivers to indicate that caregiving-related financial strain was higher than preCOVID-19. Moreover, Hispanic caregivers compared to nonHispanic white caregivers reported caregiving-related emotional stress was higher than preCOVID-19. Conclusion These findings suggest a need to be attentive to racial and ethnic variations in emotional and financial strain and provide targeted support in clinical care and via public policy during a public health crisis.
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Affiliation(s)
- Margaret L Longacre
- Department of Public Health, College of Health Sciences, Arcadia University, 214 Brubaker Hall, 450S. Easton Rd., Glenside, PA, 19038, USA.
| | - Melissa F Miller
- Department of Public Health, College of Health Sciences, Arcadia University, 214 Brubaker Hall, 450S. Easton Rd., Glenside, PA, 19038, USA
| | - Carolyn Y Fang
- Fox Chase Cancer Center, Cancer Prevention and Control Program, Philadelphia, PA, USA
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28
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Ugalde A, Blaschke SM, Schofield P, Lambert SD, Aranda S, Boltong A, Chambers SK, Krishnasamy M, Livingston P. Priorities for cancer caregiver intervention research: A three-round modified Delphi study to inform priorities for participants, interventions, outcomes, and study design characteristics. Psychooncology 2020; 29:2091-2096. [PMID: 32364654 DOI: 10.1002/pon.5404] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 04/24/2020] [Accepted: 04/28/2020] [Indexed: 01/16/2023]
Affiliation(s)
- Anna Ugalde
- School of Nursing & Midwifery, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Sarah-May Blaschke
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Penelope Schofield
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Psychology, Swinburne University, Hawthorn, Victoria, Australia
| | - Sylvie D Lambert
- Ingram School of Nursing, McGill University, Montreal, Quebec, Canada
| | - Sanchia Aranda
- Cancer Council Australia, Sydney, New South Wales, Australia.,Department of Nursing, University of Melbourne, Parkville, Victoria, Australia
| | - Anna Boltong
- Victorian Comprehensive Cancer Centre, Parkville, Victoria, Australia.,Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Suzanne K Chambers
- Faculty of Health, University of Technology, Sydney, New South Wales, Australia
| | - Meinir Krishnasamy
- Department of Nursing, University of Melbourne, Parkville, Victoria, Australia.,Victorian Comprehensive Cancer Centre, Parkville, Victoria, Australia.,Centre for Cancer Research, University of Melbourne, Parkville, Victoria, Australia
| | - Patricia Livingston
- School of Nursing & Midwifery, Faculty of Health, Deakin University, Geelong, Victoria, Australia
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29
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Caregiving in the shadows: National analysis of health outcomes and intensity and duration of care among those who care for people with mental illness and for people with developmental disabilities. Disabil Health J 2020; 13:100837. [DOI: 10.1016/j.dhjo.2019.100837] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 07/25/2019] [Accepted: 08/25/2019] [Indexed: 11/13/2022]
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30
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Kim Y, Carver CS. Unmet needs of family cancer caregivers predict quality of life in long-term cancer survivorship. J Cancer Surviv 2019; 13:749-758. [PMID: 31342303 PMCID: PMC6832821 DOI: 10.1007/s11764-019-00794-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 07/16/2019] [Indexed: 01/20/2023]
Abstract
PURPOSE To identify demographic and caregiving characteristics associated with caregivers' unmet needs and to examine associations of caregivers' unmet needs with their quality of life at 2 years and 5 years since their patients' initial diagnosis. METHODS Family cancer caregivers completed prospective longitudinal surveys at 2 years (T1) and 5 years (T2) post diagnosis. Demographic and caregiving characteristics were measured at T1. Unmet needs and quality of life were measured at T1 and T2. RESULTS Younger and spousal caregivers reported greater unmet needs (B > 2.03, p < .05). Independent of demographic characteristics, caregivers' perception that providing care to their relative with cancer was overwhelming was consistently associated with unfulfillment of their needs in various domains, concurrently and prospectively (B > 2.50, p < .05), across the long-term survivorship phases. CONCLUSIONS Findings highlight the contribution of earlier subjective caregiving stress to family caregivers' needs not being met both currently and years later, which, in turn, related to poorer quality of life across different family caregivership trajectories. Findings suggest identifying at-risk subgroups of family caregivers based on demographics and assessing caregiving stress as a priority in psycho-oncology research and clinical practices. IMPLICATIONS FOR CANCER SURVIVORS Family caregivers' quality of life is affected by cancer survivors' illness trajectory many years after the initial cancer diagnosis, so are the caregivers' needs. Cancer survivorship care plan should take careful consideration of the nuanced long-term contributions of caregivers' unmet needs to their specific aspects of quality of life.
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Affiliation(s)
- Youngmee Kim
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Coral Gables, FL, 33146, USA.
| | - Charles S Carver
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Coral Gables, FL, 33146, USA
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31
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Badger TA, Sikorskii A, Segrin C. Contextual and Cultural Influences on Caregivers of Hispanic Cancer Survivors. Semin Oncol Nurs 2019; 35:359-362. [DOI: 10.1016/j.soncn.2019.06.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
OBJECTIVES To review the family caregivers' unmet needs in the long-term phase of survivorship to identify unique challenges faced by family caregivers. DATA SOURCES Research-based articles and published reports. CONCLUSION Family caregivers diverge into three distinct groups in the long-term survivorship phase: those remaining in care, those whose patients have survived and where care is no longer needed, and those whose patients have died. Their primary unmet needs vary by the different caregivership trajectories. IMPLICATIONS FOR NURSING PRACTICE Comprehensive understanding of family caregivers' unmet needs is required to develop family caregiver care plans in long-term survivorship.
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33
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Ferrell B, Kravits K, Borneman T, Pal SK, Lee J. A Support Intervention for Family Caregivers of Advanced Cancer Patients. J Adv Pract Oncol 2019; 10:444-455. [PMID: 33457058 PMCID: PMC7779567 DOI: 10.6004/jadpro.2019.10.5.3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Family caregivers are the primary providers of care. Education and support are needed to prepare them for the complex physical, psychological, social, and spiritual effects of cancer. This randomized clinical trial tested a palliative care intervention with 240 family caregivers, focusing on family caregivers who reported financial strain from cancer and treatment. A four-part educational program demonstrated improved outcomes in the intervention group in the measures of objective burden, caregiving preparation, and quality of life. The role of advanced practitioners in providing tailored psychoeducation and support to caregivers is important in order to meet the integral needs of patients with cancer as well as to enhance caregiver self-care.
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Affiliation(s)
- Betty Ferrell
- From City of Hope National Medical Center, Duarte, California
| | - Kate Kravits
- From City of Hope National Medical Center, Duarte, California
| | - Tami Borneman
- From City of Hope National Medical Center, Duarte, California
| | - Sumanta K. Pal
- From City of Hope National Medical Center, Duarte, California
| | - Janet Lee
- Vital Research LLC, Los Angeles, California
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34
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Ugalde A, Gaskin CJ, Rankin NM, Schofield P, Boltong A, Aranda S, Chambers S, Krishnasamy M, Livingston PM. A systematic review of cancer caregiver interventions: Appraising the potential for implementation of evidence into practice. Psychooncology 2019; 28:687-701. [PMID: 30716183 PMCID: PMC6594143 DOI: 10.1002/pon.5018] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 12/30/2018] [Accepted: 01/25/2019] [Indexed: 01/15/2023]
Abstract
Objective nformal caregivers provide substantial support for people living with cancer. Previous systematic reviews report on the efficacy of cancer caregiver interventions but not their potential to be implemented. The aim of this systematic review was to explore the potential for cancer caregiver interventions to be implemented into practice. Methods We searched three electronic databases to identify cancer caregiver interventions on 5 January 2018. We operationalised six implementation outcomes (acceptability, adoption, appropriateness, feasibility, fidelity, and costs) into a tool to guide data extraction. Results The search yielded 33 papers (27 papers from electronic databases and six papers from other sources) reporting on 26 studies that met review criteria. Fewer than half the studies (46%) contained evidence about the acceptability of interventions from caregivers' perspectives; only two studies (8%) included interventions developed with input from caregivers. Two studies (8%) addressed potential adoption of interventions, and no studies discussed intentions, agreement, or action to implement interventions into practice. All studies reported on intervention appropriateness by providing a rationale for the interventions. For feasibility, on average less than one‐third of caregivers who were eligible to be involved consented to participate. On fidelity, whether interventions were conducted as intended was reported in 62% of studies. Cost data were reported in terms of intervention delivery, requiring a median time commitment of staff of 180 minutes to be delivered. Conclusions Caregiver intervention studies lack components of study design and reporting that could bridge the gap between research and practice. There is enormous potential for improvements in cancer caregiver intervention study design to plan for future implementation.
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Affiliation(s)
- Anna Ugalde
- School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia
| | - Cadeyrn J Gaskin
- Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Nicole M Rankin
- Cancer Research Division, Cancer Council NSW, Sydney, New South Wales, Australia
| | - Penelope Schofield
- Department of Psychology, Swinburne University, Melbourne, Victoria, Australia.,Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| | - Anna Boltong
- Strategy and Support Division, Cancer Council Victoria, Melbourne, Victoria, Australia.,Victorian Comprehensive Cancer Centre, Parkville, Victoria, Australia
| | - Sanchia Aranda
- Cancer Council Australia, Sydney, New South Wales, Australia
| | - Suzanne Chambers
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia.,Cancer Council QLD, Brisbane, Queensland, Australia
| | - Meinir Krishnasamy
- Victorian Comprehensive Cancer Centre, Parkville, Victoria, Australia.,Centre for Cancer Research, University of Melbourne, Parkville, Victoria, Australia
| | - Patricia M Livingston
- School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia.,Faculty of Health, Deakin University, Geelong, Victoria, Australia
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35
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Steigleder T, Kollmar R, Ostgathe C. Palliative Care for Stroke Patients and Their Families: Barriers for Implementation. Front Neurol 2019; 10:164. [PMID: 30894836 PMCID: PMC6414790 DOI: 10.3389/fneur.2019.00164] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 02/07/2019] [Indexed: 11/17/2022] Open
Abstract
Stroke is a leading cause of death, disability and is a symptom burden worldwide. It impacts patients and their families in various ways, including physical, emotional, social, and spiritual aspects. As stroke is potentially lethal and causes severe symptom burden, a palliative care (PC) approach is indicated in accordance with the definition of PC published by the WHO in 2002. Stroke patients can benefit from a structured approach to palliative care needs (PCN) and the amelioration of symptom burden. Stroke outcome is uncertain and outlook may change rapidly. Regarding these challenges, core competencies of PC include the critical appraisal of various treatment options, and openly and respectfully discussing therapeutic goals with patients, families, and caregivers. Nevertheless, PC in stroke has to date mainly been restricted to short care periods for dying patients after life-limiting complications. There is currently no integrated concept for PC in stroke care addressing the appropriate moment to initiate PC for stroke patients, and the question of how to screen for symptoms remains unanswered. Therefore, PC for stroke patients is often perceived as a stopgap in cases of unfavorable prognosis and very short survival times. In contrast, PC can provide much more for stroke patients and support a holistic approach, improve quality of life and ensure treatment according to the patient's wishes and values. In this short review we identify key aspects of PC in stroke care and current barriers to implementation. Additionally, we provide insights into our approach to PC in stroke care.
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Affiliation(s)
- Tobias Steigleder
- Department of Palliative Care, University Hospital Erlangen-Nuremberg, Erlangen, Germany
- Department of Neurology, University Hospital Erlangen-Nuremberg, Erlangen, Germany
| | - Rainer Kollmar
- Department of Neurology and Neurointensive Care, Darmstadt Academic Hospital, Darmstadt, Germany
| | - Christoph Ostgathe
- Department of Palliative Care, University Hospital Erlangen-Nuremberg, Erlangen, Germany
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36
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Richards-Jones S, Mihalopoulos C, Heckel L, Gunn KM, Tan M, Livingston PM. An economic evaluation of a telephone outcall intervention for informal carers of cancer patients in Australia: An assessment of costs and quality-adjusted-life-years. Psychooncology 2019; 28:525-532. [DOI: 10.1002/pon.4970] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 12/16/2018] [Accepted: 12/23/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Scott Richards-Jones
- Faculty of Health, School of Health and Social Development; Deakin University; Geelong Australia
| | - Cathrine Mihalopoulos
- Faculty of Health, School of Health and Social Development; Deakin University; Geelong Australia
| | - Leila Heckel
- Faculty of Health, School of Nursing and Midwifery; Deakin University; Geelong Australia
| | - Kate M. Gunn
- Cancer Council SA; Eastwood Australia
- Cancer Research Institute, North Terrace; University of South Australia; Adelaide Australia
| | - Marcus Tan
- Faculty of Health, School of Health and Social Development; Deakin University; Geelong Australia
| | - Patricia M. Livingston
- Faculty of Health, School of Nursing and Midwifery; Deakin University; Geelong Australia
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37
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Abuse, cancer and sexual dysfunction in women: A potentially vicious cycle. Gynecol Oncol 2018; 150:166-172. [PMID: 29661496 DOI: 10.1016/j.ygyno.2018.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 03/24/2018] [Accepted: 04/03/2018] [Indexed: 01/06/2023]
Abstract
More than 30% of women have a history of abuse. Women with cancer may be at substantially increased risk for abuse, but this issue is rarely discussed in the course of oncology care. Women with a history of abuse who present for cancer care commonly have a high prevalence of co-morbid illness. Sexual dysfunction, a highly prevalent but under-recognized condition among women of all ages, is also more common among both women with a history of abuse and women with cancer. Although common after cancer, sexual dysfunction, like abuse, can be stigmatizing and often goes undiagnosed and untreated. This review first examines the literature for evidence of a relationship between any history of abuse and cancer among women, addressing two questions: 1) How does abuse promote or create risk for developing cancer? 2) How does cancer increase a woman's susceptibility to abuse? We then examine evidence for a relationship between abuse and female sexual dysfunction, followed by an investigation of the complex relationship between all three factors: abuse, sexual dysfunction and cancer. The literature is limited by a lack of harmonization of measures across studies, retrospective designs, and small and idiosyncratic samples. Despite these limitations, it is imperative that providers integrate the knowledge of this complex relationship into the care of women with cancer.
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