Supporting Cancer Patients Dying at Home or at a Hospital for Taiwanese Family Caregivers

Use of Zarit Burden Interview in analysis of family caregivers' perception among Taiwanese caring with hospitalized relatives

This study was conducted to examine the relationships between family caregivers' perception of caregiving and its influencing factors among Taiwanese with hospitalized relatives. The study used a cross-sectional and descriptive correlational design. A convenience sample of 200 primary caregivers of hospitalized patients diagnosed with cancer, stroke and chronic illness was recruited in a Taiwanese Medical Center; this focus was chosen because cancer, stroke and chronic illness generally require long term care. Data were collected by structured questionnaires. Pearson product-moment correlation and stepwise multiple regression analyses were used to analyse the results of this study. Family caregivers who lacked family support and whose patients' ADL (activities of daily living) dependency was increasing experienced a greater caregiving burden. Family caregivers who had better psychological well-being, better quality of relationship and more caregiving knowledge experienced a lower caregiving burden. Quality of relationship, lack of family support and patients' ADL dependency accounted for 43% of the Zarit Burden Interview variance. The results indicated that family caregivers' perception of caregiving included sacrifice, strain, embarrassment, anger and loss of control. It is vital for nurses to understand these caregiving perceptions and their related factors to provide a holistic care plan.

Influences of Psychological Well-being, Quality of Caregiver-patient Relationship, and Family Support on the Health of Family Caregivers for Cancer Patients in Taiwan

PURPOSE

The purpose of this study was to examine the influences of psychological well-being, quality of caregiver-patient relationship, and family support on the health of family caregivers for cancer patients in a Taiwanese hospital.

METHODS

A cross-sectional, correlational design was used. A sample of 91 family caregivers of hospitalized cancer patients completed the Caregiver Reaction Assessment and Psychological Well-Being Scale. Pearson's product moment correlation and regression analyses were used to examine the data.

RESULTS

The psychological well-being and the quality of the caregiver-patient relationship of family caregivers were found to be significantly positively correlated with caregivers' health. The lack of family support was found to be significantly negatively correlated with caregivers' health. Psychological well-being, quality of caregiver-patient relationship, and family support accounted for 59% of the variance in caregivers' health.

CONCLUSION

The findings suggest that nurses, while providing care in the hospital and upon discharge need to be aware of the psychological well-being, quality of caregiver-patient relationship, and family support of a family caregiver, as these factors all have an impact on a family caregiver' health.

Settings of Care within Hospice: New Options and Questions about Dying "At Home"

Although place of death has been routinely studied in end-of-life (EOL) care, more analysis on place of death within hospice is needed because of the recent, dramatic rise in the number of hospice patients dying in inpatient settings. Using a case study to illustrate the complexity of determinants of place of death within hospice, this article highlights important known factors and elucidate gaps for further research. Individual and system level factors, sociocultural meanings, caregiving and preferences are shown to have important implications. Additionally, the unique components of home hospice, inpatient hospice and transitions between these settings may have a fundamental role in the future of quality EOL care. Further research on determinants of hospice settings of care is essential to the care of older adults at the end of life.

Clarifying delirium management: practical, evidenced-based, expert recommendations for clinical practice

Delirium is highly prevalent in those with serious or advanced medical illnesses. It is associated with many adverse consequences, including significant patient, family, and health care provider distress. This article suggests a novel approach to delirium assessment and management and provides useful, practical guidance for clinicians based on a complete review of the existing literature and the expert clinical opinion of the authors and their colleagues, derived from over a decade of collective bedside experience. Comprehensive assessment includes careful description of observed symptoms, signs, and behaviors; and an understanding of the patient's situation, including primary diagnosis, associated comorbidities, functional status, and prognosis. The importance of incorporating goals of care for the patient and family is discussed. The concepts of potential reversibility versus irreversible delirium and delirium subtype are proffered, with a description of how diagnostic and management strategies follow from these concepts. Pharmacological interventions that provide rapid, effective, and safe relief are presented. Employing both pharmacological and nonpharmacological interventions, including patient and family education, improves symptoms and relieves patient and family distress, whether the delirium is reversible or irreversible, hyperactive or hypoactive. All interventions can be provided in any setting of care, including patients' homes.

Family carer reactions and their related factors among Taiwanese with hospitalized relatives

AIM

The purpose of this study was to examine the relationships among family carer reactions and their related factors among Taiwanese with hospitalized relatives.

BACKGROUND

In Taiwan, most hospitalized patients have relatives or foreign labourers with them 24 hours a day. Limited research has focused on the reactions of family members who provide care for hospitalized relatives.

METHODS

A cross-sectional, correlation design was used. A convenience sample of 200 primary carers of hospitalized patients diagnosed with cancer, stroke, and enduring illness was recruited between 2009 and 2010. Data were collected by structured questionnaires.

RESULTS

The findings indicate that participants with a moderate level of family support experienced a moderate impact on health and finances, but a high impact on schedule. Family carers' health status and work time were significantly different between, before and after serving as a carer. The multiple regression model variables accounted for 40.1% of the total family carer reaction variance. Three factors were found to predict significantly greater impact on a family carer: (1) lower scores of caregiving knowledge, (2) increasing patient's activities of daily living dependency and (3) lack of family support.

CONCLUSION

It is vital for nurses not only to assess patients' activities of daily living, but also to assess family carers' knowledge of caregiving and the patient's existing family support in developing a plan of care that reduces negative impact on family carers.

The cancer family caregiving experience: an updated and expanded conceptual model

OBJECTIVE

The decade from 2000 to 2010 was an era of tremendous growth in family caregiving research specific to the cancer population. This research has implications for how cancer family caregiving is conceptualized, yet the most recent comprehensive model of cancer family caregiving was published ten years ago. Our objective was to develop an updated and expanded comprehensive model of the cancer family caregiving experience, derived from concepts and variables used in research during the past ten years.

METHODS

A conceptual model was developed based on cancer family caregiving research published from 2000 to 2010.

RESULTS

Our updated and expanded model has three main elements: 1) the stress process, 2) contextual factors, and 3) the cancer trajectory. Emerging ways of conceptualizing the relationships between and within model elements are addressed, as well as an emerging focus on caregiver-patient dyads as the unit of analysis.

CONCLUSIONS

Cancer family caregiving research has grown dramatically since 2000 resulting in a greatly expanded conceptual landscape. This updated and expanded model of the cancer family caregiving experience synthesizes the conceptual implications of an international body of work and demonstrates tremendous progress in how cancer family caregiving research is conceptualized.

Reliability and validity of the Chinese version of the Caregiver Reaction Assessment

AIMS

The aim of this study was to examine the reliability and validity of the Chinese version of the Caregiver Reaction Assessment, as part of a psychosocial study among family caregivers of cancer patients.

METHODS

Participants were derived from the Second Affiliated Hospital of China Medical University in Shenyang, China. The research established the internal consistent reliability, test-retest reliability and construct validity.

RESULTS

The research comprised 400 family caregivers. The Chinese version of the Caregiver Reaction Assessment showed adequate internal consistency reliability, test-retest reliability and appropriate construct validity. After adjusting items 4, 8, 15 and 18, confirmatory factor analysis confirmed the five new factors of the Chinese version of the Caregiver Reaction Assessment had goodness of fit.

CONCLUSIONS

These findings suggest that the Chinese version of the Caregiver Reaction Assessment is a reliable and valid instrument for measuring specific aspects of the caregiving experience in the Chinese population.

The trajectory of palliative care costs over the last 5 months of life: a Canadian longitudinal study

OBJECTIVE

This study aimed to highlight the trajectory of palliative care costs over the last five months of life in five urban centres across Canada.

SUBJECTS

The study sample was comprised of 160 terminally ill patients and their main informal caregivers.

RESEARCH DESIGN

A first interview took place in the patient's home, and subsequent follow-up interviews were conducted by telephone at two week intervals until the patient's passing.

MEASURES

Participants were asked to provide information on the goods and services they used related to the patients' health condition, and on informal caregiving time.

RESULTS

The overall costs of care gradually increased from the fifth to the last month of the patients' life. A large part of this cost increase was attributable to inpatient care. Among outpatient care costs the largest increase was observed for home care. Informal care costs were particularly high over the last 3 months of life.

CONCLUSIONS

The knowledge gained from this study would be useful to policy makers when developing policies that could help families caring for a terminally ill loved one at home.