Distress and quality of life concerns of family caregivers of patients undergoing palliative surgery

Research Synthesis Related to Oncology Family Caregiver Spirituality in Palliative Care

Background: Family caregivers are central to the delivery of serious illness care and also have needs related to their role and experience. One aspect of the family caregiver quality of life (QOL) that has received less attention is caregiver spirituality. Objectives: The research objectives for this analysis were (1) Describe spirituality in oncology family caregivers. (2) Determine the impact of palliative care interventions on spirituality and related variables in oncology family caregivers. (3) Describe findings from the research literature related to spirituality in family caregivers. The authors include two nurse researchers (BF, TB) and a physician (MK) who conducted these studies and a board-certified chaplain (PG) who contributed his expertise in chaplaincy. Design: This study synthesized data from seven earlier studies by the investigators from their research in family caregiving and also compared findings to the literature. Setting/Subjects: Subjects were family caregivers (n = 1039) of patients with cancer from studies conducted primarily in the Western United States. Measurements: The key spirituality instruments used were the Functional Assessment of Chronic Illness Therapy tool and the City of Hope QOL tool. Results: Spirituality was identified as important to family caregivers and most caregivers reported a religious affiliation. Living with uncertainty was consistently reported as the worst aspect of QOL/spirituality. Having a sense of purpose and meaning was the highest rated area. Conclusions: The authors' research synthesis and the literature support the importance of additional research and clinical focus in family caregiver spirituality in serious illness care.

Effectiveness of a perioperative support programme to reduce psychological distress for family caregivers of patients with early-stage lung cancer: study protocol for a randomised controlled trial

INTRODUCTION

Family caregivers play a key role in providing ongoing long-term care and assistance to their loved ones during cancer treatment. However, family caregivers of patients with lung cancer are frequently unprepared for their roles and they may undergo psychological distress, thus reducing their own quality of life while affecting patients' health outcomes. Interventions that specifically target this population are lacking. This study aims to evaluate the effectiveness of a perioperative support programme on family caregivers of patients with early-stage lung cancer.

METHODS AND ANALYSIS

This study is guided by the Stress-Coping Model. Family caregivers of patients diagnosed with early-stage lung cancer and those who are scheduled for lung resection treatment will be invited to participate. Participants will be randomised to groups that either receive the perioperative support programme or usual care. The intervention consists of four face-to-face intervention sessions during the hospital stay and two weekly telephone follow-up sessions after discharge. Primary and secondary outcomes will be assessed at baseline and at 4 and 12 weeks after the intervention. Primary outcomes will include psychological distress and secondary outcomes will include caregiving burden, quality of life, coping style and social support. Generalised estimation equation model will be used to analyse the intervention effects.

ETHICS AND DISSEMINATION

The study was approved by the Ethics Committee of the Second Xiangya Hospital of Central South University (LYG2022003). The authors will disseminate the study's findings by publishing them in international scientific journals.

TRIAL REGISTRATION NUMBER

ChiCTR2200058280.

Unmet needs, anxiety, depression, and quality of life among caregivers of adolescents and young adults with cancer: A cross-sectional study

Objective

To assess unmet needs, anxiety, depression, and quality of life of caregivers of adolescents and young adults with cancer and examine their associations.

Methods

A total of 282 caregivers of adolescents and young adults with cancer were recruited by convenience sampling at a tertiary cancer hospital in Chinese Mainland. The participants’ unmet needs, anxiety, depression, and quality of life were assessed using self-reported questionnaires. Hierarchical regression analyses were conducted to examine associations between unmet needs and health outcomes.

Results

The five most prevalent high unmet needs were related to ‘worries about future’ and ‘information’, including dealing with not knowing what lies in the future (n ​= ​161, 57.1%), dealing with worry about the cancer getting worse (n ​= ​151, 53.5%), dealing with worry about the cancer coming back (n ​= ​147, 52.1%), finding information about complementary or alternative therapies (n ​= ​137, 48.6%), and finding information about the long-term side effects of treatments and medicines (n ​= ​126, 44.7%). Around 40% of the caregivers reported moderate to severe anxiety and depression. After adjusting for sociodemographic and clinical characteristics, personal and emotional needs, healthcare access and continuity, and financial needs remained significantly associated with anxiety, depression, or quality of life.

Conclusions

Nurses need to be aware of the unmet needs of caregivers of adolescents and young adults with cancer. More effort is needed to identify services and interventions that address the unmet needs, particularly personal and emotional, healthcare access and continuity, and financial needs, to improve the caregivers’ health outcomes.

Quality of life and associated factors among adults living with cancer and their family caregivers

This study examined the association of needs, health literacy, and quality of life among adult Nigerians with cancer and family caregivers. A descriptive study was conducted involving 240 adults with cancer and family caregivers attending a tertiary hospital. More than two-thirds of participants reported moderate or high needs. Information (90.8%) and spiritual support (85%) were the domains of highest need among adults with cancer. Family/social support (85%) and spiritual support (81.7%) ranked the highest among family caregivers. A negative correlation was found between needs and quality of life. Stepwise regression analysis showed that needs and literacy explained 36% of the variance in adults with cancer's quality of life and 28% of the variance in family caregivers' quality of life. Spiritual need accounted l for 9.5% and 9.1% of variation for adults with cancer and family caregivers, respectively. Findings suggest that interventions with a focus on social/family and spiritual needs may improve wellbeing of adults with cancer and caregivers in Nigeria. This research are generalizable to other low-income countries where family values and spirituality are often a strong feature of daily life.

Quality of Life of Family Caregivers of Patients With Cancer in Korçe, Albania

PURPOSE:

The primary objective of this study was to quantify cancer family caregiver (FCG) quality of life (QOL) in a Southern Albanian population and to determine whether differences exist between 4 domains of QOL (physical, psychological, social, and spiritual). This study also sought to compare QOL in our cohort to QOL in historical studies that used the same survey instrument, and to examine correlations between demographic characteristics and QOL to identify any high-risk groups.

METHODS:

A sample of 40 FCGs was recruited at the Mary Potter Palliative Care Clinic in Korçe, Albania. Each participant completed the City of Hope Quality of Life (Family Version), a validated 37-question instrument that measures caregiver well-being in 4 domains: physical, psychological, social, and spiritual well-being.

RESULTS:

There were no significant differences between the composite scores of the 4 QOL domains in our study. However, there were differences when comparing self-reported QOL between domains ("Rate your overall physical/psychological/social/spiritual well-being"). The QOL measured in our study was significantly lower than in 3 studies from the United States that used the same questionnaire. There were no significant correlations between demographic groups and QOL.

CONCLUSIONS:

This study examines the impact that the paucity of palliative services has on the QOL of Albanian cancer FCGs. Although there were no domains of QOL or demographic groups identified in our study that were faring significantly worse than others, the poor overall QOL provides further evidence to support the continued development of palliative services for both patients and family members in Albania.

There's an App for That; Improving Communication during Pediatric Cardiothoracic Surgery

Supplemental Digital Content is available in the text.

Introduction:

Waiting while a loved one is in surgery can be a very stressful time. Current processes for updating families vary from institution to institution. Providing timely and relevant updates, while important to the family, may strain a surgical team’s operational system. In our initial experience with the Electronic Access for Surgical Events (EASE) application (app), we tested the extent to which its implementation improved communication with patient families.

Methods:

We compared compliance data collected pre-EASE (December 2013 through September 2014) and post-EASE implementation (October 2014 until December 2015).

Results:

Although the pre-EASE compliance rate for bi-hourly updates was 46% (118/255) of cases, post-EASE implementation achieved a compliance rate of 97% (171/176). A 2-sample test of proportions confirmed a significant improvement in compliance after the introduction of EASE technology (P < 0.001). Analysis of the 177 noncompliant cases in the pre-EASE period indicated that noncompliance occurred most frequently at the end of the case (97/177, 55%) when the patient remained in the operating room > 2 hours after the last update to the family. We also observed noncompliance at the beginning of the case (46/177, 26%), when the patient arrived in the operating room > 2 hours before the time of the first update. Family satisfaction scores that rated their experience during surgery as “Very Good” improved from 80% pre-EASE implementation to 97% postimplementation. We sustained this improvement for 1 year.

Conclusions:

A mobile technology app (EASE) improved both frequency and compliance with surgical updates to families, which resulted in a statistically significant increase in family satisfaction scores.

Feasibility Testing and Refinement of a Supportive Educational Intervention for Carers of Patients with High-Grade Glioma - a Pilot Study

The aim of this pilot study was to test the feasibility and acceptability of a family carer intervention for carers of patients with high-grade glioma (HGG). The intervention consisted of: (1) an initial telephone assessment of carer needs; (2) a personalised tabbed resource file; (3) nurse-led home visit; and (4) ongoing telephone support. Two consumer representatives reviewed the intervention resources. The intervention was then piloted with participants who were the primary carer for patients undergoing treatment for HGG in Western Australia. Two consumers provided feedback on the resource, and 10 carers participated in the pilot. Positive feedback was received about the resource manual and intervention. Suggestions were also made for changes which were implemented into the trial. The surveys were shortened based on feedback. Participants identified a large range of issues during nursing assessments which would not otherwise be identified or addressed for carers receiving routine care. As a result of providing the intervention, the nurse was able to make referrals to address needs that were identified. This pilot study enabled us to refine and test the Care-IS intervention and test the feasibility and acceptability of proposed survey instruments. We were also able to estimate recruitment and retention and the overall study timeline required for the randomised controlled trial we are now conducting. It has also demonstrated the role of the nurse who delivered the intervention and allowed us to refine communication and referral pathways.

Family companions' involvement during pre-surgical consent visits for major cancer surgery and its relationship to visit communication and satisfaction

OBJECTIVE

To examine the association between family companion presence during pre-surgical visits to discuss major cancer surgery and patient-provider communication and satisfaction.

METHODS

Secondary analysis of 61 pre-surgical visit recordings with eight surgical oncologists at an academic tertiary care hospital using the Roter Interaction Analysis System (RIAS). Surgeons, patients, and companions completed post-visit satisfaction questionnaires. Poisson and logistic regression models assessed differences in communication and satisfaction when companions were present vs. absent.

RESULTS

There were 46 visits (75%) in which companions were present, and 15 (25%) in which companions were absent. Companion communication was largely emotional and facilitative, as measured by RIAS. Companion presence was associated with more surgeon talk (IRR 1.29, p = 0.006), and medical information-giving (IRR 1.41, p = 0.001). Companion presence was associated with less disclosure of lifestyle/psychosocial topics by patients (IRR 0.55, p = 0.037). In adjusted analyses, companions' presence was associated with lower levels of patient-centeredness (IRR 0.77, p 0.004). There were no differences in patient or surgeon satisfaction based on companion presence.

CONCLUSION

Companions' presence during pre-surgical visits was associated with patient-surgeon communication but was not associated with patient or surgeon satisfaction.

PRACTICE IMPLICATIONS

Future work is needed to develop interventions to enhance patient-companion-provider interactions in this setting.

Circunstâncias e consequências do cuidar: caracterização do cuidador familiar em cuidados paliativos

Resumo Os cuidadores familiares desempenham um importante papel ao cuidar de um paciente em situação de doença avançada. Este estudo teve como objetivo caracterizar o cuidador familiar de cuidados paliativos, avaliando as circunstâncias e as consequências da prestação de cuidados e a preparação para a perda do ente querido. Trata-se de um estudo quantitativo, prospectivo e longitudinal. A amostra foi constituída por 60 cuidadores familiares, maioritariamente mulheres, casadas, com idade média de 44,53 anos. A maioria dos cuidadores coabita com o paciente, dedica a maior parte do seu dia aos cuidados ao doente e uma parcela significativa deixou de trabalhar ou reduziu as horas de trabalho para poder acompanhar o paciente. Os cuidadores mais sobrecarregados apresentaram maiores níveis de ansiedade, depressão, somatização e menos apoio social. As familiares mais disfuncionais referiram pouco apoio social e os familiares que estavam menos preparados para a morte do paciente apresentaram mais sintomas de experiência dissociativa peritraumática. A maioria dos cuidadores tinha conhecimento sobre a gravidade da doença do seu familiar e a proximidade da morte, e consideraram que o paciente foi muito bem cuidado no serviço de cuidados paliativos.

[Burden of caregiving and its repercussions on caregivers of end-of-life patients: a systematic review of the literature]

Caring for a family member with an advanced and/or terminal illness can be a great emotional, physical and financial burden that has an impact on the quality of life of the caregivers. The scope of this study was to conduct a systematic review of the literature on the burden of caregiving, related factors and the consequences for family caregivers of advanced stage cancer patients or patients in end-of-life or palliative care. A search for scientific papers published in the EBSCO, Web of Knowledge and BIREME databases was conducted since records on this topic began in the databases through March 2014. Of the 582 articles found, only 27 were selected. The majority of the articles found that family caregivers were overburdened. Some studies found that the care-giving burden was associated with characteristics of the patients and their illnesses while, in other studies, it was associated with poor health of the caregiver, greater psychopathological symptoms (anxiety, depression, emotional distress) and with the development of complications in the grieving process. However, hope, social support, the ability of the caregiver to attribute meaning to the experience of caring and feeling comfortable with the tasks of caring were associated with lower levels of burden.

Effectiveness of an intervention to improve supportive care for family caregivers of patients with lung cancer: study protocol for a randomized controlled trial

Background

Family caregivers (FC) often experience higher distress levels than their relative with cancer. Many cancer centers have implemented distress screening programs, but most of them concentrate their efforts on patients, with little attention to their FC. To fill this gap, a pragmatic intervention has been designed to improve supportive care for FC of patients with lung cancer. This article describes the study protocol of a single-center randomized controlled trial to assess its effectiveness.

Methods/design

A total of 120 lung cancer patients and their FC are randomly assigned to the experimental group (exposed to intervention, N = 60) or to the control group (usual care, N = 60). The intervention includes: (1) systematic FC distress screening and problem assessment near their relative’s cancer diagnosis, and every 2 months, (2) privileged contact with an oncology nurse (ON) away from the patient to address FC problems and (3) liaison by the ON with the family physician of FC reporting high distress (thermometer score ≥5/10), or problems relying on FP expertise. In both groups, FC, patient and process-of-care outcomes are measured at baseline and every 3 months, up to 9 months. The primary endpoint is FC distress measured by the Hospital Anxiety and Depression Scale (HADS) and the Psychological Distress Index used in the Quebec Health Survey (PDQHS). Individual interviews with 10 FC and a focus group with the oncology team will be conducted at the study end to further document the effectiveness of the intervention and its impact on quality of life (for FC) and practice organization (for the oncology team).

Discussion

This trial will assess the effectiveness of an innovative intervention based on interprofessional collaboration between primary care and oncology care. It targets a population in great need, yet often neglected, and has the potential to clearly improve patient and caregiver experience of cancer care, and reduce the burden of disease.

Trial registration

ClinicalTrials.gov, ID: NCT02531464. Registered on 15 July 2015.

Electronic supplementary material

The online version of this article (doi:10.1186/s13063-017-2044-y) contains supplementary material, which is available to authorized users.

Economic Evaluation of a Hospital-Based Palliative Care Program

PURPOSE

Establish costs of an inpatient palliative care unit (PCU) and conduct a threshold analysis to estimate the maximum possible costs for the PCU to be considered cost effective.

METHODS

We used a hospital perspective to determine costs on the basis of claims from administrative data from Johns Hopkins PCU between March 2013 and March 2014. Using existing literature, we estimated the number of quality-adjusted life years (QALYs) that the PCU could generate. We conducted a threshold analysis to assess the maximum costs for the PCU to be considered cost effective, incorporating willingness to pay ($180,000 per QALY). Three types of costs were considered, which included variable costs alone, contribution margin (ie, revenue minus variable costs), and PCU cost savings compared with usual care (from a separate publication).

RESULTS

The data showed that there were 153 patient encounters (PEs), variable costs of $1,050,031 ($1,343 per PE per day), a contribution margin of $318,413 ($407 per PE per day), and savings compared with usual care of $353,645 ($452 savings per PE per day). On the basis of the literature, the program could generate 3.11 QALYs from PEs (0.05 QALY) and caregivers (3.06 QALYs). The threshold analysis determined that the maximum variable cost required to be cost effective was $559,800 (an additional $716 per PE per day could be spent).

CONCLUSION

According to variable costs, the PCU was not cost effective; however, when considering savings of the PCU compared with usual care, the PCU was cost saving. The contribution margin showed that the PCU was cost saving. This study supports efforts to expand PCUs, which enhance care for patients and their caregivers and can generate hospital savings. Future research should prospectively explore the cost utility of PCUs.

Percepción de la calidad de vida de cuidadores de pacientes asistentes a un programa de crónicos, Villavicencio, Meta

Objetivo: determinar la percepción de la calidad de vida de cuidadores informales de adultos que padecen enfermedad crónica, que asisten al Programa de Crónicos de la Empresa Social del Estado de Villavicencio, Colombia. Materiales y métodos: estudio descriptivo, de abordaje cuantitativo y de corte transversal en cuidadores informales (n = 180) de adultos crónico usuarios del Programa de Promoción y Prevención de Crónicos. Con los cuidadores se utilizó el instrumento Calidad de Vida (QOL) versión familiar de Ferrell y Grant, y para valorar la funcionalidad de los pacientes crónicos, se usó el perfil Pulses adaptado por Granger. Se determinan rangos de puntaje, medidas de tendencia central y dispersión para los dominios de bienestar y calidad de vida. Resultados: en la mayoría de los cuidadores se evidenció que los dominios de bienestar físico y social no se encuentran afectados, y las dimensiones de bienestar psicológico y espiritual están en nivel medio, al igual que la calidad de vida. Conclusiones: para la enfermería, los resultados pueden orientar procesos de capacitación a fin de fortalecer habilidades de cuidado en cuidadores que permitan promover la salud y el bienestar, evitar el deterioro de la calidad de vida y cuidar oportunamente y en mejores condiciones al familiar que padece enfermedad crónica.

Acceptability and feasibility of an e-mental health intervention for parents of childhood cancer survivors: "Cascade"

PURPOSE

The aim of this study was to evaluate the feasibility and acceptability of "Cascade": an online, group-based, cognitive behavioral therapy intervention, delivered "live" by a psychologist, to assist parents of children who have completed cancer treatment.

METHODS

Forty-seven parents were randomized to Cascade (n = 25) or a 6-month waitlist (n = 22). Parents completed questionnaires at baseline, 1-2 weeks and 6 months post-intervention. Thirty parents completed full evaluations of the Cascade program (n = 21 randomized to Cascade, n = 9 completed Cascade post-waitlist).

RESULTS

Ninety-six percent of Cascade participants completed the intervention (n = 24/25). Eighty percent of parents completed every questionnaire (mean completion time 25 min (SD = 12)). Cascade was described as at least "somewhat" helpful by all parents. None rated Cascade as "very/quite" burdensome. Parents reported that the "online format was easy to use" (n = 28, 93.3 %), "I learnt new skills" (n = 28, 93.3 %), and "I enjoyed talking to others" (n = 29, 96.7 %). Peer-to-peer benefits were highlighted by good group cohesion scores.

CONCLUSIONS

Cascade is highly acceptable and feasible. Its online delivery mechanism may address inequities in post-treatment support for parents, a particularly acute concern for rural/remote families. Future research needs to establish the efficacy of the intervention.

TRIAL REGISTRATION

ACTRN12613000270718, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12613000270718.

Psychometric properties of carer-reported outcome measures in palliative care: A systematic review

BACKGROUND

Informal carers face many challenges in caring for patients with palliative care needs. Selecting suitable valid and reliable outcome measures to determine the impact of caring and carers' outcomes is a common problem.

AIM

To identify outcome measures used for informal carers looking after patients with palliative care needs, and to evaluate the measures' psychometric properties.

DESIGN

A systematic review was conducted. The studies identified were evaluated by independent reviewers (C.T.J.M., M.B., M.P.). Data regarding study characteristics and psychometric properties of the measures were extracted and evaluated. Good psychometric properties indicate a high-quality measure.

DATA SOURCES

The search was conducted, unrestricted to publication year, in the following electronic databases: Applied Social Sciences Index and Abstracts, Cumulative Index to Nursing and Allied Health Literature, The Cochrane Library, EMBASE, PubMed, PsycINFO, Social Sciences Citation Index and Sociological Abstracts.

RESULTS

Our systematic search revealed 4505 potential relevant studies, of which 112 studies met the inclusion criteria using 38 carer measures for informal carers of patients with palliative care needs. Psychometric properties were reported in only 46% (n = 52) of the studies, in relation to 24 measures. Where psychometric data were reported, the focus was mainly on internal consistency (n = 45, 87%), construct validity (n = 27, 52%) and/or reliability (n = 14, 27%). Of these, 24 measures, only four (17%) had been formally validated in informal carers in palliative care.

CONCLUSION

A broad range of outcome measures have been used for informal carers of patients with palliative care needs. Little formal psychometric testing has been undertaken. Furthermore, development and refinement of measures in this field is required.

Protocol for the Care-IS Trial: a randomised controlled trial of a supportive educational intervention for carers of patients with high-grade glioma (HGG)

INTRODUCTION

High-grade glioma (HGG) is a rapidly progressive and debilitating disease. Primary carers experience significant levels of distress which impacts on their experience of caregiving, the quality of care received and the community in terms of the increased reliance on healthcare due to the potential development of complicated grief. This paper describes the protocol for testing the efficacy and feasibility of an intervention for primary carers of patients with HGG in order to improve preparedness to care and reduce carer distress.

METHODS

Randomised controlled trial. The target population is carers of patients with HGG who are undergoing combined chemoradiotherapy. The intervention consists of 4 components: (1) initial telephone assessment of unmet needs of the carer, (2) tailoring of a personalised resource folder, (3) home visit, (4) ongoing monthly telephone contact and support for 12 months. The control arm will receive usual care.

PRIMARY HYPOTHESIS

This intervention will improve preparedness for caring and reduce carer psychological distress.

SECONDARY HYPOTHESIS

This intervention will reduce carer unmet needs. The longer term aim of the intervention is to reduce patient healthcare resource utilisation and, by doing so, reduce costs. Assessments will be obtained at baseline, 8 weeks post intervention, then 4, 6 and 12 months. Participants will also complete a healthcare utilisation checklist and proxy performance status which will be assessed at baseline and monthly. 240 carers will be recruited. The sample size is 180. Multilevel mixed effects regression models will be applied to test the effect of the intervention.

ETHICS

Ethics approval has been gained from Curtin University and the participating sites.

DISSEMINATION

Results will be reported in international peer-reviewed journals.

TRIAL REGISTRATION NUMBER

Australian and New Zealand Clinical Trials Registration (ACTRN)12612001147875.

Experiences of cancer caregiving in socioeconomically deprived areas of Attica, Greece

The shift of the majority of cancer care from inpatient to outpatient settings has given rise to a number of issues that have not yet been adequately addressed. This is especially true in countries undergoing rapid and profound socioeconomic changes that have substantially affected the health care sector. We conducted 12 in-depth interviews with family cancer caregivers residing in socioeconomically deprived areas of Attica, Greece. Using an inductive thematic approach, we identified three major themes: (a) the truth within boundaries, focusing on the flow of information in the triad doctor-caregiver-patient; (b) the evil called "cancer," reflecting caregivers' perceptions of the illness; and (c) being left "high and dry," reflecting participant experiences of home-based care. Against a background of financial crisis, this study underlines the need for safeguarding the rights of chronically ill patients and ensuring that informal cancer care, apart from a cost-effective solution, will also be an efficient one.

A new instrument to measure quality of life of heart failure family caregivers

BACKGROUND AND PURPOSE

Family caregivers of heart failure (HF) patients experience poor physical and mental health leading to poor quality of life. Although several quality-of-life measures exist, they are often too generic to capture the unique experience of this population. The purpose of this study was to evaluate the psychometric properties of the Family Caregiver Quality of Life (FAMQOL) Scale that was designed to assess the physical, psychological, social, and spiritual dimensions of quality of life among caregivers of HF patients.

SAMPLE AND METHODS

Psychometric testing of the FAMQOL with 100 HF family caregivers was conducted using item analysis, Cronbach α, intraclass correlation, factor analysis, and hierarchical multiple regression guided by a conceptual model. Caregivers were predominately female (89%), white, (73%), and spouses (62%).

RESULTS

Evidence of internal consistency reliability (α=.89) was provided for the FAMQOL, with item-total correlations of 0.39 to 0.74. Two-week test-retest reliability was supported by an intraclass correlation coefficient of 0.91. Using a 1-factor solution and principal axis factoring, loadings ranged from 0.31 to 0.78, with 41% of the variance explained by the first factor (eigenvalue=6.5). With hierarchical multiple regression, 56% of the FAMQOL variance was explained by model constructs (F8,91=16.56, P<.001). Criterion-related validity was supported by correlations with SF-36 General (r=0.45, P<.001) and Mental (r=0.59, P<.001) Health subscales and Bakas Caregiving Outcomes Scale (r=0.73, P<.001). Evidence of internal and test-retest reliability and construct and criterion validity was provided for physical, psychological, and social well-being subscales.

CONCLUSIONS

The 16-item FAMQOL is a brief, easy-to-administer instrument that has evidence of reliability and validity in HF family caregivers. Physical, psychological, and social well-being can be measured with 4-item subscales. The FAMQOL scale could serve as a valuable measure in research, as well as an assessment tool to identify caregivers in need of intervention.

Prevalence and risk factors of depressive disorder in caregivers of patients with head and neck cancer

OBJECTIVE

The purpose of this study is to examine the prevalence and risk factors of depressive disorder in caregivers of patients with head and neck cancer.

METHODS

Study subjects were recruited from a multidisciplinary outpatient clinic for head and neck cancer in a medical center from February to July 2012. Caregivers of patients with head and neck cancer were enrolled and assessed using the Structured Clinical Interview for the DSM-IV, Clinician Version, the Short Form 36 Health Survey, and the Family APGAR index. The main aim of the study was to examine the difference in demographic data and clinical characteristics between the caregivers with and without depressive disorders. In addition, a stepwise forward model of logistic regression was used to test the possible risk factors.

RESULTS

One hundred and forty-three caregivers were included in the study. The most prevalent psychiatric disorder was depressive disorder (14.7%), followed by adjustment disorder (13.3%). Nearly one-third of the caregivers had a psychiatric diagnosis. By using logistic regression analysis, it was found that unemployment (odds ratio (OR) = 3.16; 95% CI, 1.04-9.68), lower social functioning (OR = 1.43; 95% CI, 1.18-1.72), and lower educational level (OR = 1.16; 95% CI, 1.01-1.34) were significant risk factors for the depressive disorder.

CONCLUSIONS

The clinical implication of our results is the value of using the standardized structured interview for early diagnosis of depressive disorder in caregivers of head and neck cancer patients. Early screening and management of depression in these caregivers will raise their quality of life and capability to care patients.

The relationship between self-efficacy and anxiety and general distress in caregivers of people with advanced cancer

BACKGROUND

Informal caregivers take on an important role in supporting people with advanced cancer but experience significant psychological distress.

OBJECTIVE

This study aims to describe the prevalence of anxiety and distress in a sample of caregivers of people with advanced cancer and explore the relationship with self-efficacy.

METHODS

A cross-sectional survey was used. Subjects were 94 caregivers of people with advanced cancer recruited from a specialist oncology setting. Questionnaires included the Caregiver Self-Efficacy Scale (CaSES), the State Trait Anxiety Inventory (STAI), and the Distress Thermometer. Demographic data were recorded.

RESULTS

The sample consisted of 94 caregivers of people with advanced cancer. The majority were female (66; 70.2%) with a mean age of 55 years. The mean distress score for the sample was 4.87 (standard deviation [SD] 2.49). Fifty-five caregivers (59.1%) had a score of ≥5 on the Distress Thermometer indicating distress. The state anxiety mean was 45.21 (SD 12.32) and trait anxiety mean was 41.21 (SD 10.143). Females had more distress and state anxiety than males. Only one self-efficacy scale, self-maintenance, correlated with distress. All STAI scores correlated with self-efficacy and self-maintenance had the strongest relationship.

CONCLUSIONS

Caregivers had high anxiety and distress. Caregivers with higher anxiety reported lower self-efficacy. The strongest correlation was with the self-maintenance subscale, indicating an association with psychological functioning and caregivers who are able to access respite and take care of themselves during care provision.

Family caregivers' distress levels related to quality of life, burden, and preparedness

OBJECTIVE

Family caregivers (FCGs) caring for loved ones with lung cancer are at risk for psychological distress and impaired quality of life (QOL). This study explores the relationship between FCGs' distress, per the distress thermometer (DT) and FCGs' QOL, burden, and preparedness. The purpose is to identify types of problems unique to FCGs in cancer care.

METHODS

Family caregivers of patients diagnosed with non-small cell lung cancer were recruited from an adult outpatient setting at a comprehensive cancer center. Questionnaires included demographic information, City of Hope QOL Scale-Family Version, Caregiver Burden Scale, FCG preparedness, and DT. Baseline data were utilized for this analysis.

RESULTS

Of the FCGs (N = 163), 68% were spouses, 64% female, and 34% worked full-time. FCG age ranged from 21 to 88 years with a mean of 57 years. FCGs cared for patients with non-small cell lung cancer stage I-III (44%) and stage IV (56%). Psychological distress (DT mean = 4.40) was moderate. DT scores were highly correlated with seven of the eight explanatory variables. Secondary principal components analysis of the explanatory variables combined correlated variables into three constructs identified as self-care component, FCG role component, and FCG stress component. Simultaneous multiple regression of distress onto the three components showed they accounted for 49% of the variance in distress.

CONCLUSION

This exploration of FCGs' concerns associated with elevated distress scores, as measured by the DT, helped identify three component problem areas. These areas warrant further psychosocial assessment and intervention to support FCGs as they care for the patient with cancer.

Enhancing the social well-being of family caregivers

OBJECTIVES

To provide an overview of key issues and resources useful for oncology professionals to support the social well-being of patients and their families. A caregiver narrative highlights examples of the importance of addressing the social impact of illness.

DATA SOURCES

Review of the literature and Web sites related to social well-being of oncology patients and families.

CONCLUSION

Culture influences social well-being and impacts caregiving across the life span. Coping with cancer creates a myriad of social implications with potentially significant impacts on communication; sexuality, intimacy and sexual expression; education, finances, work, and leisure.

IMPLICATIONS FOR NURSING PRACTICE

Nurses spend the greatest amount of time with patients and their families and therefore have an especially important role in identifying and addressing social needs. An interdisciplinary approach to care that includes the assessment of those at high risk and family meetings increases opportunities to address the complex multidimensional social concerns associated with oncology care.

Deriving meaning and faith in caregiving

OBJECTIVES

To review assessment of spiritual needs of family caregivers and four core interventions by nurses in addressing spirituality: presence, deep listening, bearing witness and compassion in action.

DATA SOURCES

Literature review.

CONCLUSION

Spirituality is increasingly recognized as a key domain of quality of life and essential to quality cancer care. In addition to the needs of patients, family caregivers also experience enormous spiritual needs throughout cancer diagnosis and treatment. Nurses can provide valuable spiritual assessment of family caregivers and support them as they seek support services to address spiritual needs.

IMPLICATIONS FOR NURSING PRACTICE

Family caregiving can be a time of growth and meaning when support is provided by nurses and their colleagues.

[Quality of life and satisfaction of family caregivers in palliative care - results of postmortem interviews with bereaved family members]

INTRODUCTION

Family caregivers play an important role in palliative care. However, the number of studies focussing on the quality of life of these family caregivers is limited. The current study evaluates quality of life and satisfaction with medical care in bereaved family members.

MATERIAL AND METHODS

Comparisons were made between (1) male vs. female family caregivers (N = 44) and (2) bereaved family caregivers vs. general population (EORTC QLQ-C30). Furthermore, the satisfaction of the family caregivers with medical care was assessed after the death of their relatives (ZUF HOPE). The interviews were conducted between six and eight weeks following the death of the palliative patients.

RESULTS

Regarding quality of life, bereaved family caregivers suffered from both reduced emotional functioning and general quality of life. Female caregivers had lower functional values and stronger symptoms of insomnia, fatigue and pain than male caregivers. Bereaved family caregivers had a lower quality of life than the general population. Retrospectively, family caregivers were very satisfied with most aspects of outpatient palliative care. The only aspect criticised by the bereaved family members was a lack of psycho-social support.

CONCLUSION

Family caregivers need stronger support in order to prevent burnout and to improve outpatient care. In this context, gender differences must also be considered.

Use of the Distress Thermometer to discern clinically relevant quality of life differences in women with breast cancer

PURPOSE

The purpose of this study was to explore the ability of Distress Thermometer (DT) scores to discern important differences in quality of life scores among women with breast cancer.

METHODS

The National Comprehensive Cancer Network's DT, the Functional Assessment of Cancer Therapy-Breast (FACT-B), and a demographic questionnaire were completed by 111 women recently diagnosed with breast cancer.

RESULTS

Patients considered moderately to severely distressed (score ≥ 4 on DT) scored significantly lower on FACT-B QOL scales and subscales when compared to those in the group scoring 3 or below. For those scales for which minimally important differences (MIDs) have been established, differences between the two groups were 2-3 and a half times the established MID.

CONCLUSIONS

Moderately to severely distressed patients have significantly lower QOL than those with expected or mild distress. The DT provides a quick and easy screening tool to alert the healthcare team to clinically relevant alterations in patients' QOL.

Effects of a problem-solving intervention (COPE) on quality of life for patients with advanced cancer on clinical trials and their caregivers: simultaneous care educational intervention (SCEI): linking palliation and clinical trials

CONTEXT

Patients on investigational clinical trials and their caregivers experience poor quality of life (QOL), which declines as the disease progresses.

OBJECTIVE

To examine the effect of a standardized cognitive-behavioral problem-solving educational intervention on the QOL of patients enrolled on investigational clinical trials and their caregivers.

DESIGN

Prospective, multi-institution, randomized trial. QOL was measured repeatedly over 6 months.

PARTICIPANTS

Patients were simultaneously enrolled onto phase 1, 2, or 3 Institutional Review Board (IRB)-approved cancer clinical trials.

INTERVENTION

Intervention arm dyads participated in three conjoint educational sessions during the first month, learning the COPE problem solving model. Nonintervention arm dyads received usual care.

OUTCOME MEASURES

Global QOL was measured by the City of Hope Quality of Life Instruments for Patients or Caregivers; problem solving skills were measured by the Social Problem Solving Inventory-Revised.

RESULTS

The results are reported using the CONSORT statement. The analytic data set included 476 dyads including 1596 patient data points and 1576 care giver data points. Patient QOL showed no significant difference in the rate of change between the intervention and usual care arms (p = 0.70). Caregiver QOL scores in the intervention arm declined, but at less than half the rate in the control arm (p = 0.02).

CONCLUSIONS

The COPE intervention enabled the average caregiver to come much closer to stable QOL over the 6-month follow-up. Future studies should enroll subjects much earlier in the cancer illness trajectory, a common patient/caregiver theme. The maximum effect was seen in caregivers who completed the 6-month follow-up, suggesting that the impact may increase over time.

Quality of life and related factors among cancer caregivers in China

AIMS

The present study was designed to investigate quality of life (QOL) among caregivers of cancer inpatients, and to explore the related factors with the long-term goal to improve QOL of cancer caregivers in China.

METHODS

A cross-sectional study was performed during the period January-March 2008. Subjects comprised 358 caregivers of cancer inpatients. The questionnaires pertaining to QOL, sociodemographic characteristics, caregiving demands, available social resources, caregiving situation, and caregiver's health status were used. Data were collected by nurses through interviews.

RESULTS

The average QOL score of these subjects was 5.26. General linear model analysis showed that caregiver's QOL was significantly associated with, in standardized estimate sequence, spousal relationship, patient's activities of daily living, and chronic disease (no). Overall spousal relationship to patient had the strongest association with caregiver's QOL.

CONCLUSIONS

Psychological well-being and social concerns of cancer caregivers were disrupted more seriously than spiritual well-being and physical well-being. In addition, spousal relationship, patient's disability, and caregiver's health status could affect the caregiver's QOL.

Part 1: Home-based family caregiving at the end of life: a comprehensive review of published quantitative research (1998-2008)

The changing context of palliative care over the last decade highlights the importance of recent research on home-based family caregiving at the end of life. This article reports on a comprehensive review of quantitative research (1998-2008) in this area, utilizing a systematic approach targeting studies on family caregivers, home settings, and an identified palliative phase of care (n = 129). Methodological challenges were identified, including: small, non-random, convenience samples; reliance on descriptive and bivariate analyses; and a dearth of longitudinal research. Robust evidence regarding causal relationships between predictor variables and carer outcomes is lacking. Findings suggest the need for knowledge regarding: family caregiving for patients with non-malignant terminal conditions; whether needs and outcomes differ between family caregivers at the end of life and comparison groups; and caregiver outcomes in bereavement. Clear definitions of 'family caregiving', 'end of life', and 'needs' are required as well as greater application and testing of theoretical and conceptual explanations.

Feasibility of brief psychological distress screening by a community-based telephone helpline for cancer patients and carers

Background

Up to one-third of people affected by cancer experience ongoing psychological distress and would benefit from screening followed by an appropriate level of psychological intervention. This rarely occurs in routine clinical practice due to barriers such as lack of time and experience. This study investigated the feasibility of community-based telephone helpline operators screening callers affected by cancer for their level of distress using a brief screening tool (Distress Thermometer), and triaging to the appropriate level of care using a tiered model.

Methods

Consecutive cancer patients and carers who contacted the helpline from September-December 2006 (n = 341) were invited to participate. Routine screening and triage was conducted by helpline operators at this time. Additional socio-demographic and psychosocial adjustment data were collected by telephone interview by research staff following the initial call.

Results

The Distress Thermometer had good overall accuracy in detecting general psychosocial morbidity (Hospital Anxiety and Depression Scale cut-off score ≥ 15) for cancer patients (AUC = 0.73) and carers (AUC = 0.70). We found 73% of participants met the Distress Thermometer cut-off for distress caseness according to the Hospital Anxiety and Depression Scale (a score ≥ 4), and optimal sensitivity (83%, 77%) and specificity (51%, 48%) were obtained with cut-offs of ≥ 4 and ≥ 6 in the patient and carer groups respectively. Distress was significantly associated with the Hospital Anxiety and Depression Scale scores (total, as well as anxiety and depression subscales) and level of care in cancer patients, as well as with the Hospital Anxiety and Depression Scale anxiety subscale for carers. There was a trend for more highly distressed callers to be triaged to more intensive care, with patients with distress scores ≥ 4 more likely to receive extended or specialist care.

Conclusions

Our data suggest that it was feasible for community-based cancer helpline operators to screen callers for distress using a brief screening tool, the Distress Thermometer, and to triage callers to an appropriate level of care using a tiered model. The Distress Thermometer is a rapid and non-invasive alternative to longer psychometric instruments, and may provide part of the solution in ensuring distressed patients and carers affected by cancer are identified and supported appropriately.