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Gray TF, Do KM, Amonoo HL, Sullivan L, Kelkar AH, Pirl WF, Hammer MJ, Tulsky JA, El-Jawahri A, Cutler CS, Partridge AH. Family Caregiver Experiences in the Inpatient and Outpatient Reduced-Intensity Conditioning Allogeneic Hematopoietic Cell Transplantation Settings: A Qualitative Study. Transplant Cell Ther 2024; 30:610.e1-610.e16. [PMID: 37783339 DOI: 10.1016/j.jtct.2023.09.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 09/21/2023] [Accepted: 09/24/2023] [Indexed: 10/04/2023]
Abstract
Caregivers (ie, family and friends) are essential in providing care and support for patients undergoing hematopoietic cell transplantation (HCT) and throughout their recovery. Traditionally delivered in the hospital, HCT is being increasingly provided in the outpatient setting, potentially heightening the burden on caregivers. Extensive work has examined the inpatient HCT caregiving experience, yet little is known about how caregiver experiences may differ based on whether the HCT was delivered on an inpatient or outpatient basis, particularly during the acute recovery period post-HCT. This study explored the similarities and differences in caregiver experiences in the inpatient and outpatient settings during the early recovery from reduced-intensity conditioning (RIC) allogeneic HCT. We conducted semistructured interviews (n = 15) with caregivers of adults undergoing RIC allogeneic HCT as either an inpatient (n = 7) or an outpatient (n = 8). We recruited caregivers using purposeful criterion sampling, based on the HCT setting, until thematic saturation occurred. Interview recordings were transcribed and coded through thematic analysis using Dedoose v.9.0. The study analysis was guided by the transactional model of stress and coping and the model of adaptation of family caregivers during the acute phase of BMT. Three themes emerged to describe similar experiences for HCT caregivers regardless of setting: (1) caregivers reported feeling like they were a necessary yet invisible part of the care team; (2) caregivers described learning to adapt to changing situations and varying patient needs; and (3) caregivers recounted how the uncertainty following HCT felt like existing between life and death while also maintaining a sense of gratitude and hope for the future. Caregivers also reported distinct experiences based on the transplantation setting and 4 themes emerged: (1) disrupted routines: inpatient caregivers reported disrupted routines when caring for the HCT recipient while simultaneously trying to manage non-caregiving responsibilities at home and work, and outpatient caregivers reported having to establish new routines that included frequent clinic visits with the patient while altering or pausing home and work responsibilities; (2) timing of caregiver involvement: inpatient caregivers felt more involved in care after the patient was discharged from the HCT hospitalization, whereas outpatient caregivers were already providing the majority of care earlier in the post-transplantation period; (3) fear of missing vital information: inpatient caregivers worried about missing vital information about the patient's care and progress if not physically present in the hospital, whereas outpatient caregivers feared overlooking vital information that may warrant contacting the care team as they monitored the patient at home; and (4) perceived adequacy of resources to meet psychosocial and practical needs: inpatient caregivers reported having adequate access to resources (ie, hospital-based services), whereas outpatient caregivers felt they had more limited access and needed to be resourceful in seeking out assistance. Inpatient and outpatient HCT caregivers described both similar and distinct experiences during the acute recovery period post-HCT. Specific interventions should address caregiver psychosocial needs (ie, distress, illness uncertainty, communication, and coping) and practical needs (ie, community resource referral, preparedness for home-based caregiving, and transplantation education) of HCT caregivers based on setting.
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Affiliation(s)
- Tamryn F Gray
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts; Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts; Division of Stem Cell Transplantation and Cellular Therapies, Dana-Farber Cancer Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer, Boston, Massachusetts; Division of Palliative Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Cancer Outcomes Research and Education Program, Massachusetts General Hospital Cancer Center, Boston, Massachusetts.
| | - Khuyen M Do
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Hermioni L Amonoo
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Cancer Outcomes Research and Education Program, Massachusetts General Hospital Cancer Center, Boston, Massachusetts; Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts
| | - Lauren Sullivan
- Division of Stem Cell Transplantation and Cellular Therapies, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Amar H Kelkar
- Division of Stem Cell Transplantation and Cellular Therapies, Dana-Farber Cancer Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - William F Pirl
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts
| | - Marilyn J Hammer
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer, Boston, Massachusetts
| | - James A Tulsky
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Division of Palliative Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Areej El-Jawahri
- Harvard Medical School, Boston, Massachusetts; Cancer Outcomes Research and Education Program, Massachusetts General Hospital Cancer Center, Boston, Massachusetts; Divison of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Corey S Cutler
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts; Division of Stem Cell Transplantation and Cellular Therapies, Dana-Farber Cancer Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Ann H Partridge
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
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Engin E, Cam MO, Demirkol H, Dogan O. The Effect of Psychoeducation on Care Burden Applied to Mothers of Children Who Underwent Allogeneic Bone Marrow Transplantation in Turkey: A Quasi-Experimental Study. Semin Oncol Nurs 2022; 38:151342. [PMID: 36244886 DOI: 10.1016/j.soncn.2022.151342] [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: 05/09/2022] [Revised: 08/26/2022] [Accepted: 09/09/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVES The purpose of this study was to examine at the effect of psychoeducation on the care burden for mothers whose children underwent allogeneic bone marrow transplantation (Allo-BMT). DATA SOURCES The single group, quasi-experimental study was conducted in a children's BMT unit in the Aegean Region of Turkey. No sampling method was used, and the study sample consisted of 21 mothers who fulfilled the inclusion criteria of turning 18 years old, volunteering for study participation, speaking and understanding Turkish, and having a child who had undergone Allo-BMT. The psychoeducation covered the following topics: (i) Allo-BMT and Child Care After Transplantation, (ii) Feelings Concerning the Disease and the Role of Caregiver, (iii) Stress and Anger Management, and (iv) Family-Spousal and Social Relations. The care burden was measured using the Clinically Adapted Zarit Burden Interview (CA-ZBI). Data analysis was performed on SPSS 20.0 software using repeated measures of analysis of variance (ANOVA) and Bonferroni adjusted post hoc test. After the psychoeducation, a significant difference was found between pretest (26.85 ± 12.9) and posttest (20.42 ± 12.66) care burden of mean scores (P < .05). In addition, a significant difference was found between pretest and follow-up test (20.52 ± 11.49) mean scores of care burden (P < .05). CONCLUSION The psychoeducation reduced the care burden experienced by the mothers of the children who underwent Allo-BMT and this positive impact lasted for a month. IMPLICATIONS FOR NURSING PRACTICE Nurses, especially consultation liaison psychiatric nurses, can provide similar psychoeducation to caregivers in BMT units, assisting them in protecting their physical and mental health by reducing their care burden.
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Affiliation(s)
- Esra Engin
- Professor, Nursing Faculty, Psychiatric and Mental Health Nursing Department, Ege University, Izmir, Turkey
| | - Mahire Olcay Cam
- Professor, Nursing Faculty, Psychiatric and Mental Health Nursing Department, Ege University, Izmir, Turkey
| | - Hacer Demirkol
- Faculty of Health Sciences, Psychiatric and Mental Health Nursing Department, Bozok University, Yozgat, Turkey.
| | - Ozenir Dogan
- Faculty of Medicine Hospital, Psychiatry Department, Ege University, Izmir, Turkey
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Kisch AM, Bergkvist K, Alvariza A, Årestedt K, Winterling J. Family caregivers' support needs during allo-HSCT-a longitudinal study. Support Care Cancer 2020; 29:3347-3356. [PMID: 33125539 PMCID: PMC8062346 DOI: 10.1007/s00520-020-05853-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 10/22/2020] [Indexed: 01/04/2023]
Abstract
PURPOSE The study aimed to explore family caregivers' support needs prior to allo-HSCT, how these change over time and whether they are associated with demographic factors and caregiver outcome. METHODS This longitudinal repeated measure study included 87 family caregivers of allo-HSCT recipients: 63% were partners, 74% women, 65% lived with the recipient, and their mean age was 54 years. They completed the 14-item Carer Support Needs Assessment Tool (CSNAT) and caregiver outcome measures (caregiver burden, anxiety, depression, preparedness for caregiving and general health) prior to allo-HSCT and 3, 6 and 16 weeks later. RESULTS The two top support needs prior to allo-HSCT were 'knowing what to expect in the future' (79%) and 'dealing with your own feelings' (70%). Several support needs were associated with younger age and not being a partner, while higher needs implied worse caregiver outcomes for at least one of the outcomes prior to transplantation. Most support needs remained the same at the last follow-up. CONCLUSION The findings that high support needs are often associated with worse caregiver outcomes and most support needs do not diminish over time indicate that more attention should be placed on the situation of family caregivers.
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Affiliation(s)
- Annika M Kisch
- Haematology Department, Lund University Hospital, Lund, Sweden. .,Institute of Health Sciences, Lund University, Lund, Sweden.
| | - Karin Bergkvist
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Sophiahemmet University, Stockholm, Sweden
| | - Anette Alvariza
- Department of Health Care Sciences/Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
| | - Kristofer Årestedt
- Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden.,The Research Section, Region Kalmar County, Kalmar, Sweden
| | - Jeanette Winterling
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Medical Unit Hematology, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
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Langer SL, Yi JC, Chi NC, Lindhorst T. Psychological Impacts and Ways of Coping Reported by Spousal Caregivers of Hematopoietic Cell Transplant Recipients: A Qualitative Analysis. Biol Blood Marrow Transplant 2020; 26:764-771. [DOI: 10.1016/j.bbmt.2019.11.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 11/08/2019] [Accepted: 11/18/2019] [Indexed: 12/20/2022]
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Bergkvist K, Larsen J, Johansson UB, Mattsson J, Fossum B. Family members' life situation and experiences of different caring organisations during allogeneic haematopoietic stem cells transplantation-A qualitative study. Eur J Cancer Care (Engl) 2016; 27. [PMID: 27859940 DOI: 10.1111/ecc.12610] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2016] [Indexed: 11/30/2022]
Abstract
The aim of this study was to describe family members' life situation and experiences of care in two different care settings, the patient's home or in hospital during the acute post-transplantation phase after allogeneic haematopoietic stem cell transplantation (HSCT). Data were collected through semi-structured interviews with 14 family members (seven women and seven men). An inductive qualitative content analysis was used to analyse the data. The majority of the family members' (n = 10) had experiences from home care. The findings show the family members' voice of the uncertainty in different ways, related with the unknown prognosis of the HSCT, presented as Being me being us in an uncertain time. The data are classified into; To meet a caring organisation, To be in different care settings, To be a family member and To have a caring relationship. Positive experiences such as freedom and security from home care were identified. The competence and support from the healthcare professionals was profound. Different strategies such as adjusting, having hope and live in the present used to balance to live in an uncertain time. The healthcare professionals need to identify psychosocial problems, and integrate the psychosocial support for the family to alleviate or decrease anxiety during HSCT, regardless of the care setting.
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Affiliation(s)
| | - J Larsen
- The Red Cross University College, Stockholm, Sweden
| | - U-B Johansson
- Sophiahemmet University, Stockholm, Sweden.,Department of Clinical Sciences and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - J Mattsson
- Center for Allogeneic Stem Cell Transplantation, Karolinska University Hospital, Huddinge, Stockholm, Sweden.,Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
| | - B Fossum
- Sophiahemmet University, Stockholm, Sweden.,Department of Clinical Sciences and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
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Applebaum AJ, Bevans M, Son T, Evans K, Hernandez M, Giralt S, DuHamel K. A scoping review of caregiver burden during allogeneic HSCT: lessons learned and future directions. Bone Marrow Transplant 2016; 51:1416-1422. [PMID: 27295270 DOI: 10.1038/bmt.2016.164] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 04/11/2016] [Accepted: 05/05/2016] [Indexed: 11/09/2022]
Abstract
The extant literature documents burden among caregivers of patients undergoing a hematopoietic stem cell transplantation (HSCT), but little is known about the burden of caregivers of patients receiving outpatient and homebound HSCTs. This scoping study sought to evaluate what is known about the burden of the increasing number of adult caregivers of patients receiving outpatient HSCTs and to create practice guidelines for how to best support this vulnerable group. Online databases were searched for studies that evaluated caregiver burden in adult caregivers of HSCT patients since 2010 (the publication date of the most recent systematic review on HSCT caregiver burden). Of the 1271 articles retrieved, 12 met the inclusion criteria, though none specifically examined outpatient or homebound caregivers. Overall, studies corroborated existing literature on the experience of significant burden among HSCT caregivers across the HSCT trajectory, and highlighted the emotional costs of outpatient transplants on caregivers and the need to identify caregivers at high risk for burden early in the transplant process. Future studies of outpatient caregivers should include a comprehensive assessment of burden and seek to identify points along the transplant trajectory at which caregivers are at particular risk for negative outcomes and when intervention is most appropriate.
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Affiliation(s)
- A J Applebaum
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - M Bevans
- National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - T Son
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - K Evans
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - M Hernandez
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - S Giralt
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - K DuHamel
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
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7
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McCarthy B, Andrews T, Hegarty J. Emotional Resistance Building: how family members of loved ones undergoing chemotherapy treatment process their fear of emotional collapse. J Adv Nurs 2014; 71:837-48. [DOI: 10.1111/jan.12549] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2014] [Indexed: 12/01/2022]
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Manohar A, Cheung K, Wu CL, Stierer TS. Burden incurred by patients and their caregivers after outpatient surgery: a prospective observational study. Clin Orthop Relat Res 2014; 472:1416-26. [PMID: 24005979 PMCID: PMC3971218 DOI: 10.1007/s11999-013-3270-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
INTRODUCTION The burden of patients and their caregivers after outpatient surgery has not been fully examined. The number of outpatient surgeries has dramatically increased in the last several years, particularly in the orthopaedic sector. Patients undergoing outpatient orthopaedic procedures may be expected to have more postdischarge pain than those undergoing nonorthopaedic outpatient procedures. In light of this, assessment of patient and caregiver expectations and actual burden after discharge is of importance. QUESTIONS/PURPOSES We assessed the impact of outpatient surgery on recovery of patients and their caregivers in the postoperative period by determining (1) expected versus actual time to resume daily activities, including work; (2) expected versus actual recovery at 7 and 30 days postoperatively; and (3) the number of caregivers that felt emotional or physical disturbances from caring for outpatients. METHODS Forty-four adult patients undergoing outpatient surgical procedures and their primary caregivers were enrolled in this prospective survey study, of which 30% were orthopaedic patients. Surveys assessing postoperative recovery were given to patients at six time points, on Postoperative Days 0 to 3, 7, and 30. Surveys assessing the burden of informal caregiving were given to each patient's primary caregiver at four time points, on Postoperative Days 1 to 3 and 7. The enrollment rate was 79% (44 enrolled of 56 approached) and the survey response rate was 100% for patients and 93% (41 of 44) for caregivers. RESULTS We found that 16 of 44 patients (36%) needed more time than originally anticipated to resume their daily activities and three of 29 patients (10%) needed more time off from work than originally anticipated. Patients were approximately 66% and 88% fully recovered 7 and 30 days after surgery, respectively. The primary caregivers noted disturbances in emotional (nine of 43, 21%) and physical (17 of 43, 40%) aspects of their daily lives while providing care for patients. Our surveyed patients were from multiple surgical services; however, our results may be generalized to an orthopaedic population, although they may underestimate actual results for this population given their generally higher pain scores. CONCLUSIONS Patients may take longer to recover from outpatient surgery than previously recognized. As increased pain and prolonged recovery may be associated with increased caregiver burden, these data are of particular significance to the outpatient orthopaedic surgical population. Informal caregiving after outpatient surgery may be an unrecognized physical and psychologic burden and may have a significant societal impact. LEVEL OF EVIDENCE Level II, prognostic study. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Asha Manohar
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University and School of Medicine, Zayed 8-120, 1800 Orleans Street, Baltimore, MD 21287 USA
| | - Kristin Cheung
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University and School of Medicine, Zayed 8-120, 1800 Orleans Street, Baltimore, MD 21287 USA
| | - Christopher L. Wu
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University and School of Medicine, Zayed 8-120, 1800 Orleans Street, Baltimore, MD 21287 USA
| | - Tracey S. Stierer
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University and School of Medicine, Zayed 8-120, 1800 Orleans Street, Baltimore, MD 21287 USA
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Pillay B, Lee SJ, Katona L, De Bono S, Warren N, Fletcher J, Burney S. The psychosocial impact of haematopoietic SCT on sibling donors. Bone Marrow Transplant 2012; 47:1361-5. [DOI: 10.1038/bmt.2012.22] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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10
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Gemmill R, Cooke L, Williams AC, Grant M. Informal caregivers of hematopoietic cell transplant patients: a review and recommendations for interventions and research. Cancer Nurs 2011; 34:E13-21. [PMID: 21242762 PMCID: PMC3123439 DOI: 10.1097/ncc.0b013e31820a592d] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Informal caregivers (ICs) for medically fragile hematopoietic cell transplantation (HCT) patients are a vital unrecognized population supporting the transplant patient along the illness continuum. The long transplant recovery period shifts a greater burden of care to the patient's IC. Assessment of HCT caregivers' quality of life (QOL) and health status is critical to implementation of timely intervention and support. METHODS A literature search using several search strategies covering 1980 to 2010 identified studies on ICs of HCT patients. These studies were summarized within the caregiver concepts of QOL, role, and resources. Findings of this review were used to create recommended interventions and identify implications for further research. RESULTS Although limited, research on ICs of hematopoietic call transplant patients provides beginning evidence for clinical interventions to support this caregiver population. Interventions created focus on education, psychosocial support, and self-care. CONCLUSIONS Although limited randomized trials of interventions have been reported, descriptive studies provide evidence for creating intervention content that addresses the needs of ICs of HCT patients. Testing of these interventions and additional areas of research are identified. IMPLICATIONS FOR PRACTICE Beginning descriptive evidence provides the basis for interventions for ICs of HCT patients. These interventions support caregiver QOL and role implementation, depending on individual caregivers' resources and needs. Further evaluation and clinical research are needed.
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Affiliation(s)
- Robin Gemmill
- Division of Nursing Research and Education, City of Hope, Duarte, California 91010, USA
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Beattie S, Lebel S. The experience of caregivers of hematological cancer patients undergoing a hematopoietic stem cell transplant: a comprehensive literature review. Psychooncology 2011; 20:1137-50. [PMID: 21425389 DOI: 10.1002/pon.1962] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2010] [Revised: 02/14/2011] [Accepted: 02/15/2011] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Hematopoietic stem cell transplant (HSCT) is a demanding procedure with associated physical and psychological sequelae that affects patients and their families. Caregivers to HSCT patients not only have to cope with the life-threatening nature of the disease and treatment, but they also have care-giving responsibilities. This study reviews the literature on the psychosocial impact of being a caregiver to a HSCT patient. METHODS A critical review of the literature published before June 2010 was conducted. Databases searched included CINAHL, Medline, PsycInfo, and Academic Search Complete, as well as a comprehensive reference review. Studies that pertained to caregivers of children (under the age of 18) undergoing a HSCT or caregivers to patients with non-hematological malignancies were excluded. Sixteen quantitative research articles and three qualitative research articles were reviewed and analyzed. RESULTS Caregiver distress is highest pre-transplant and decreases over time, and caregivers display distress levels comparable to or higher than patients' reported distress levels. Predictors of caregiver distress include female gender, elevated subjective burden, and higher patient symptom distress. Caregivers reported uncertainty, fear of the future, juggling patients' needs with their own, and difficulties adapting to role changes; however, they also reported positive aspects to care giving, such as personal growth and developing a more positive relationship with the patient. CONCLUSIONS There are many limitations to the current research and future directions should include both members of the dyad to evaluate the reciprocal relation between caregiver and patient variables, as well as theory-driven research and research with direct clinical applications.
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Affiliation(s)
- Sara Beattie
- School of Psychology, University of Ottawa, Ottawa, ON, Canada.
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12
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Cooke L, Grant M, Eldredge DH, Maziarz RT, Nail LM. Informal caregiving in Hematopoietic Blood and Marrow Transplant patients. Eur J Oncol Nurs 2011; 15:500-7. [PMID: 21306952 DOI: 10.1016/j.ejon.2011.01.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2010] [Revised: 01/13/2011] [Accepted: 01/15/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE Hematopoietic cell transplant patients are among the most vulnerable and acutely ill cancer populations (Bevans et al., 2008). The responsibility of caring for the daily physical and psychosocial needs of these patients after transplant is placed mostly on family caregivers (Williams, 2007). The purpose of this descriptive correlational research study was to describe caregiving experiences of 56 caregivers of HCT patients 3-12 months following transplant. METHODS & SAMPLE: Patients and caregivers were recruited from two west coast regional transplant programs in the United States. Variables studied were: relationship quality, rewards of caregiving, predictability, role strain, patient function, caregiving activities, and caregiver quality of life (QOL). KEY RESULTS Results indicated that all areas of role strain are significantly negatively correlated with caregiver's QOL. Predictability was negatively associated with problem solving and emotional strain indicating that as the level of predictability of the situation decreases, caregiver strain and problem solving increase. Predictability was positively correlated to caregiver QOL indicating that as the situation is more predictable caregiver QOL increases. Emotional strain, problem-solving strain, and usual care strain were significantly positively related, indicating that emotional strain and problem-solving strain increased together. As usual care strain increased, so did problem-solving strain and emotional strain. CONCLUSIONS Suggestions for interventions include assessing and responding to caregiver issues such as emotional strain, problem-solving strain, usual care strain, unpredictability, and QOL. Examples of caregiver-focused interventions include providing timely appropriate information about these caregiver concerns including elements that make the caregiving situation predictable, and incorporating best practices for preventing and minimizing caregiver emotional strain.
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Affiliation(s)
- Liz Cooke
- City of Hope, Nursing Research & Education, Duarte, CA 91010, USA.
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13
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Stenberg U, Ruland CM, Miaskowski C. Review of the literature on the effects of caring for a patient with cancer. Psychooncology 2011; 19:1013-25. [PMID: 20014159 DOI: 10.1002/pon.1670] [Citation(s) in RCA: 530] [Impact Index Per Article: 40.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To adequately help family caregivers (FCs) of cancer patients, clinicians need to understand the complexity of the problems and responsibilities associated with cancer patients illness that FCs experience. METHODS This systematic review identified the types of problems and burdens that FCs of cancer patients experience during the patient's illness. We also analyzed the language caregivers use to communicate their problems and responsibilities related to caregiving for the cancer patient. RESULTS Of 2845 titles identified, 192 articles met the inclusion criteria and are included in this review. Of these, 164 were research-based. In addition to FC responsibilities and the impact of being a caregiver on daily life, a number of other physical, social, and emotional problems related to caregiving for these FCs were identified. CONCLUSION A substantial evidence base supports the conclusion that FCs experience many difficult problems and increased responsibilities during and after the patient is undergoing treatment and rehabilitation for cancer. The insights gained from this review will help researchers and clinicians to understand the complexity of problems and responsibilities FCs experience. This understanding may encourage them to include support for FCs as part of total or holistic patient care. However, more research is needed to better understand the variations in caregiving experiences over time; how the caregiving perspective is influenced by different cultural, ethnic, or socioeconomic backgrounds as well as gender and age; and how problems and responsibilities related to caregiving interfere with daily life.
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Affiliation(s)
- Una Stenberg
- Center for Shared Decision Making and Nursing Research, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
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14
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Akkuş Y. Multiple sclerosis patient caregivers: the relationship between their psychological and social needs and burden levels. Disabil Rehabil 2010; 33:326-33. [DOI: 10.3109/09638288.2010.490866] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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16
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Cooke L, Gemmill R, Kravits K, Grant M. Psychological issues of stem cell transplant. Semin Oncol Nurs 2009; 25:139-50. [PMID: 19411017 DOI: 10.1016/j.soncn.2009.03.008] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To address the psychological impact of transplant on quality of life, including physical, psychological, social, and spiritual, for the patient and caregiver, and to discuss the nurse's "emotional labor of caring" and "compassion fatigue" for such an intense vulnerable population. DATA SOURCES Psychological transplant studies, peer review journals, and textbooks. CONCLUSION The psychological impact after the experience of transplant can leave an indelible impression on the patient, caregiver, and nurse. IMPLICATIONS FOR NURSING PRACTICE Suggestions are made for assessment and management of various potential psychological issues for the three mentioned populations. With these issues being better understood, nurses can actively lessen psychological morbidity.
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Affiliation(s)
- Liz Cooke
- Department of Nursing Research, City of Hope Medical Center, Duarte, CA 91010, USA.
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