1
|
Basili P, Farina I, Terrenato I, Centini J, Volpe N, Rizzo V, Agoglia L, Paterniani A, Aprea P, Calignano P, Petrone F, Ciliberto G. Remote Assisted Home Dressing vs. Outpatient Medication of Central Venous Catheter (Peripherally Inserted Central Venous Catheter): Clinical Trial A.R.C.O. (Remote Assistance Oncology Caregiver). NURSING REPORTS 2024; 14:1468-1476. [PMID: 38921720 PMCID: PMC11206720 DOI: 10.3390/nursrep14020110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 06/03/2024] [Accepted: 06/03/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND Management of PICC dressing can be performed at home by the patient through adequate training and telenursing. This trial verifies that the incidence of catheter-related complications in home patients, assisted by telenursing, is not greater than that observed in outpatients. METHODS This clinical trial is composed of 72 patients with malignant tumors who underwent long-term chemotherapy with PICC insertion. They were randomly divided into an experimental group (33 cases) and a calibration group (39 cases). The control group received outpatient dressing for the PICC at the hospital, while the experimental group received a telenursing intervention about the management of the PICC. The incidence of catheter-related infections, the ability of self-management, and a rough cost/benefit estimation were compared between the two groups. This trial was performed according to the CONSORT 2010 checklist. RESULTS The two groups do not significantly differ in relation to age, sex, and PICCs in terms of the body side insertion, the type of dressing, and the agents used for cleaning. The analysis of the results showed that in the home-managed group, the clinical events reported during the connection were higher when compared with the outpatient group (p < 0.001). The patients in the homecare group developed frequent complications resulting from skin redness (p < 0.001). CONCLUSION The use of telenursing for patient education in cancer centers can reduce nurses' working time, improving the self-management capacity of patients with a long-term PICC. This trial was retrospectively registered with the Clinical Trial Gov on the 18 May 2023 with registration number NCT05880420.
Collapse
Affiliation(s)
- Paolo Basili
- Technical, Rehabilitation, Assistance and Research Direction, Vascular Access Specialist IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (P.B.); (V.R.)
| | - Ilaria Farina
- Department of Radiation Oncology, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Irene Terrenato
- Clinical Trial Center-Biostatistics & Bioinformatics, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Jacopo Centini
- Nursing, Technical, Rehabilitation, Assistance and Research Direction IFO, IRCCS Regina Elena, National Cancer Institute, 00144 Rome, Italy; (J.C.); (N.V.); (F.P.)
| | - Nina Volpe
- Nursing, Technical, Rehabilitation, Assistance and Research Direction IFO, IRCCS Regina Elena, National Cancer Institute, 00144 Rome, Italy; (J.C.); (N.V.); (F.P.)
| | - Vanessa Rizzo
- Technical, Rehabilitation, Assistance and Research Direction, Vascular Access Specialist IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (P.B.); (V.R.)
| | | | - Albina Paterniani
- School of Nursing, IRCCS Regina Elena National Cancer, 00144 Rome, Italy;
| | - Pasquale Aprea
- Vascular Access Unit, IRCCS-Fondazione G. Pascale National Cancer Institute, 80131 Napoli, Italy;
| | - Prisco Calignano
- Department of Hematology, IRCCS-Fondazione G. Pascale National Cancer Institute, 80131 Napoli, Italy;
| | - Fabrizio Petrone
- Nursing, Technical, Rehabilitation, Assistance and Research Direction IFO, IRCCS Regina Elena, National Cancer Institute, 00144 Rome, Italy; (J.C.); (N.V.); (F.P.)
| | - Gennaro Ciliberto
- Scientific Directorate, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy;
| |
Collapse
|
2
|
Carrara FSA, Piotto DGP, Silva II, Len CA, Russo GCS, Chiba SM, Sdepanian VL, Braga JAP, Figueiredo MS, Andrade MC, de Almeida Maia ML, Abreu AL, Silva CMC, Terreri MT. Factors related to the readiness of Brazilian chronic pediatric patients to transition to care in adult clinics. J Pediatr (Rio J) 2022; 99:254-262. [PMID: 36427541 DOI: 10.1016/j.jped.2022.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/28/2022] [Accepted: 10/03/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Advances in medicine have increased the life expectancy of pediatric patients with chronic illnesses, and challenges with the guided transition of adolescents and young adults from pediatric clinics to adult clinics have grown. The aim of this study was to better understand readiness and factors related to this transition process in Brazil. METHOD In this cross-sectional study of 308 patients aged from 16 to 21 years under follow-up in pediatric specialties, the degree of readiness for transition was assessed using the Transition Readiness Assessment Questionnaire (TRAQ) and its domains. Associations with demographic data, clinical data, socio-economic level, medication adherence, family functionality, and parental satisfaction with health care were evaluated. RESULTS The median TRAQ score was 3.7 (3.2 - 4.2). Better readiness was associated with female patients, socio-economic class A-B, current active employment, higher level of education, not failing any school year, attending medical appointments alone, functional family, and a good knowledge of disease and medications. A low correlation was observed between TRAQ and age. TRAQ presented good internal consistency (alpha-Cronbach 0.86). In the multiple linear regression, TRAQ score showed a significant association with female gender, advanced age, socio-economic class A-B, better knowledge of disease and medications, and independence to attend appointments alone. CONCLUSION TRAQ instrument can guide healthcare professionals to identify specific areas of approach, in order to support adolescents with chronic disease to set goals for their own personal development and improve their readiness to enter into the adult healthcare system. In this study, some factors were related to better TRAQ scores.
Collapse
Affiliation(s)
- Fernanda Souza Angotti Carrara
- Universidade Federal de São Paulo, Departamento de Pediatria, Unidade de Reumatologia Pediátrica, São Paulo, SP, Brazil.
| | - Daniela Gerent Petry Piotto
- Universidade Federal de São Paulo, Departamento de Pediatria, Unidade de Reumatologia Pediátrica, São Paulo, SP, Brazil
| | - Ilana Izidoro Silva
- Universidade Federal de São Paulo, Departamento de Pediatria, Unidade de Reumatologia Pediátrica, São Paulo, SP, Brazil
| | - Claudio Arnaldo Len
- Universidade Federal de São Paulo, Departamento de Pediatria, Unidade de Reumatologia Pediátrica, São Paulo, SP, Brazil
| | - Gleice Clemente Souza Russo
- Universidade Federal de São Paulo, Departamento de Pediatria, Unidade de Reumatologia Pediátrica, São Paulo, SP, Brazil
| | - Sonia Mayumi Chiba
- Universidade Federal de São Paulo, Departamento de Pediatria, Unidade de Pneumologia Pediátrica, São Paulo, SP, Brazil
| | - Vera Lucia Sdepanian
- Universidade Federal de São Paulo, Departamento de Pediatria, Divisão de Gastroenterologia Pediátrica, São Paulo, SP, Brazil
| | | | - Maria Stella Figueiredo
- Universidade Federal de São Paulo, Departamento de Oncologia Clínica e Experimental, Divisão de Hematologia de Adultos, São Paulo, SP, Brazil
| | - Maria Cristina Andrade
- Universidade Federal de São Paulo, Departamento de Pediatria, Unidade de Nefrologia Pediátrica, São Paulo, SP, Brazil
| | - Marta Liliane de Almeida Maia
- Universidade Federal de São Paulo, Departamento de Pediatria, Unidade de Nefrologia Pediátrica, São Paulo, SP, Brazil
| | - Ana Lúcia Abreu
- Universidade Federal de São Paulo, Departamento de Pediatria, Unidade de Nefrologia Pediátrica, São Paulo, SP, Brazil
| | - Celia Maria Camelo Silva
- Universidade Federal de São Paulo, Departamento de Medicina, Divisão de Cardiologia Pediátrica, São Paulo, SP, Brazil
| | - Maria Teresa Terreri
- Universidade Federal de São Paulo, Departamento de Pediatria, Unidade de Reumatologia Pediátrica, São Paulo, SP, Brazil
| |
Collapse
|
3
|
Effendy C, Kurianto E, Darmayanti ARI, Noviana U, Nurjannah I. Palliative Care Education to Enhance Informal Caregivers’ Skills in Caring for Patients with Cancer: A Scoping Review. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.7796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Living with cancer causes stress for both patients and caregivers. Empowering family caregivers is critical in palliative care. It is well known that a lack of proper knowledge and training of informal caregivers is a barrier to palliative care provision at home.
Objectives: This scoping review aimed to explore palliative care education to enhance informal caregiver skills in caring for cancer patient.
Methods: A scoping literature review was conducted with systematic searches in multiple databases – PubMed, Cochrane, PsycINFO and SCOPUS (2000 to 2021). Studies were selected based on programmes content and its impact evaluation.
Findings: The remaining 181 citations were examined at full-text level; 173 studies did not meet inclusion criteria, yielding eight included papers. Four papers focused on palliative care educational programs for family caregivers, and four papers included patients and caregivers. There was a diverse variation in the mode of delivery and duration of educational input. The programs offered an insight into the main elements of working with individuals at a palliative care bundle. Most studies reported that participants improved their knowledge, self-efficacy, and competency and prepared for their roles.
Conclusion: The findings indicate the need of family caregivers for more regular and reliable palliative education programs. Randomized controlled trials with rigorous randomization processes, more significant sample numbers and more appropriate control groups focused explicitly on caregiver education may improve the evidence.
Collapse
|
4
|
Nanda L, Anilkumar A. Role of nurse practitioners within health system in India: A case of untapped potential. J Family Med Prim Care 2021; 10:2751-2756. [PMID: 34660400 PMCID: PMC8483105 DOI: 10.4103/jfmpc.jfmpc_2283_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 02/02/2021] [Accepted: 03/16/2021] [Indexed: 12/02/2022] Open
Abstract
Nurses form the pillar of India's healthcare system representing 30.5% of the entire health workforce in India. Amidst a significant shortage in the provision of effective primary care, jeopardizing millions of Indians’ access to basic healthcare services, especially the poorest, it is very evident that nurse practitioners are the need of the hour in India. The current scenario of nursing in India warrants policy reforms to facilitate nurses as valuable primary care providers. It also shows the path towards making the Health and Wellness Centre operational by creating a pivotal role for the cadre in such centres, and it will also be important for the nurse practitioner to have a public health leadership role in a country like India. With additional training and qualification and also recognition of nurse practitioners as essential healthcare providers, a complete quality healthcare could be provided. In this research paper we assess the need for nurse practitioners as primary contact providers; reflect on the global evidence on nurse practitioners linking to health outcomes, effective coverage and access to services. We also try to contemplate on the training needs, their role in home-based care and as enablers of the referral mechanism, their untapped potential, and a plan for evaluating their effectiveness. This policy research paper focuses to build an argument for a policy towards making nurse practitioners the first contact providers.
Collapse
Affiliation(s)
- Lipika Nanda
- Regional Resource Hub, HTA, Indian Institute of Public Health, Hyderabad, Public Health Foundation of India
| | - Aiswarya Anilkumar
- Regional Resource Hub, HTA, Indian Institute of Public Health, Hyderabad, Public Health Foundation of India
| |
Collapse
|
5
|
Thomas Hebdon MC, Coombs LA, Reed P, Crane TE, Badger TA. Self-efficacy in caregivers of adults diagnosed with cancer: An integrative review. Eur J Oncol Nurs 2021; 52:101933. [PMID: 33799022 DOI: 10.1016/j.ejon.2021.101933] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 03/03/2021] [Accepted: 03/04/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE Cancer caregivers experience health challenges related to their caregiving role, and self-efficacy can contribute to health outcomes through behavioral, environmental, and personal factors. The purpose of this integrative review was to examine self-efficacy in caregivers of adults diagnosed with cancer, including its association with health factors. METHOD A systematic search of PubMed, CINAHL, and PsychInfo yielded 560 articles. Following duplicate removal, 232 articles were screened for inclusion criteria with 71 articles remaining for final review. RESULTS Studies were generally quantitative (n = 67), with predominantly female (n = 55), White (n = 36) caregivers, between the ages of 45-60 (n = 48). Self-efficacy was significantly associated with quality of life, caregiver function, social support, hope, depression, anxiety, and burden as a predictor, mediator, and outcome. Physical health and social determinants of health (social support and financial well-being) were addressed among fewer studies than mental and emotional health outcomes. CONCLUSIONS Addressing self-efficacy in diverse populations and within physical, mental, and social health contexts will enhance understanding of how self-efficacy impacts caregivers of adults diagnosed with cancer. Nurses and other health care professionals can then effectively address supportive needs of caregivers in the personal, behavioral, and environmental domains.
Collapse
Affiliation(s)
| | - Lorinda A Coombs
- University of North Carolina Chapel Hill, School of Nursing, Lineberger Comprehensive Cancer Center, USA.
| | - Pamela Reed
- University of Arizona College of Nursing, 1305 N. Martin Ave., Tucson, AZ, 85721, USA.
| | - Tracy E Crane
- University of North Carolina Chapel Hill, School of Nursing, Lineberger Comprehensive Cancer Center, USA.
| | - Terry A Badger
- University of North Carolina Chapel Hill, School of Nursing, Lineberger Comprehensive Cancer Center, USA.
| |
Collapse
|
6
|
Jadalla A, Ginex P, Coleman M, Vrabel M, Bevans M. Family Caregiver Strain and Burden: A Systematic Review of Evidence-Based Interventions When Caring for Patients With Cancer. Clin J Oncol Nurs 2020; 24:31-50. [DOI: 10.1188/20.cjon.31-50] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
7
|
Levesque JV, Gerges M, Girgis A. The development of an online intervention (Care Assist) to support male caregivers of women with breast cancer: a protocol for a mixed methods study. BMJ Open 2018; 8:e019530. [PMID: 29455166 PMCID: PMC5855323 DOI: 10.1136/bmjopen-2017-019530] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION It is projected that 17 730 women will be diagnosed with breast cancer in Australia in 2017, with 3114 of these predicted to be fatal. Caregiving for a person with cancer can significantly impact caregivers' physical and mental health. Many caregivers feel ill-prepared for this role, especially when care involves complex medical needs accompanied by the psychological challenges experienced following a cancer diagnosis. METHODS AND ANALYSIS This study employs a convergent, parallel, mixed methods design combining an online survey with an optional interview. Eligible, consenting participants will be invited to participate in a survey to examine (1) participants' unmet needs, (2) challenges experienced throughout the cancer journey, (3) perceived self-efficacy to determine participants' level of confidence in undertaking caregiver tasks, (4) views regarding suitable content to include in a caregiver training intervention, (5) preferred method of intervention delivery (ie, website, smartphone application and/or interactive video), and (6) preferences for the timing of delivery of the intervention content (ie, ability to choose a module, access to the entire content or have a set order in which they receive the information). Caregivers will be eligible to participate if they (1) are male, (2) have previously cared for or are currently caring for a woman with breast cancer, (3) are aged over 18 years, and (4) do not currently suffer from a cognitive impairment or mental health condition (ie, depression, anxiety). Data analysis will include examination of differences in psychological outcomes and needs based on demographic variables, and mediation analysis to explore whether self-efficacy mediates the relationship between challenges, unmet needs and distress. Qualitative data will be analysed using thematic analysis. ETHICS AND DISSEMINATION The study was reviewed and approved by two human research ethics committees within Australia. We anticipate two to three publications may be developed from the study.
Collapse
Affiliation(s)
- Janelle V Levesque
- Psycho-Oncology Research Group, Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
- South Western Sydney Clinical School, The University of New South Wales, Liverpool, New South Wales, Australia
- School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Martha Gerges
- Psycho-Oncology Research Group, Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
- South Western Sydney Clinical School, The University of New South Wales, Liverpool, New South Wales, Australia
| | - Afaf Girgis
- Psycho-Oncology Research Group, Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
- South Western Sydney Clinical School, The University of New South Wales, Liverpool, New South Wales, Australia
| |
Collapse
|
8
|
Abstract
A person living with cancer will potentially have some degree of physical, cognitive, and/or psychological impairment, periods of unemployment, financial concerns, social isolation, and existential questions, any or all of which can impact the family and friends who surround them. In our current era of health care, patients with cancer receive invasive diagnostic studies and aggressive treatment as outpatients, and then convalesce at home. As such, cancer family caregivers are de facto partners with the healthcare team. The cancer family caregiver role is demanding and may lead to increased morbidity and mortality-in effect, the cancer family caregiver can become a second patient in need of care. This chapter discusses the consequences cancer family caregivers may accrue. The topics covered include caregiver mood disturbance and psychological impairment and some of the mutable factors that contribute to these states (i.e., sleep disturbance, decline in physical health, restriction of activities, and financial concerns), uncertainty, spiritual concerns, and caregiver witnessing. There is a discussion of the factors that influence the caregiving experience (caregiver characteristics, patient characteristics, and social supports). The chapter concludes with comments on intervention studies that have been conducted to ameliorate the burden of caregiving, and the state of caregiver research.
Collapse
Affiliation(s)
- Anna-Leila Williams
- Frank H. Netter MD School of Medicine, Quinnipiac University, Hamden, CT, USA.
| |
Collapse
|
9
|
Havyer RD, van Ryn M, Wilson PM, Griffin JM. The effect of routine training on the self-efficacy of informal caregivers of colorectal cancer patients. Support Care Cancer 2016; 25:1071-1077. [PMID: 27889827 DOI: 10.1007/s00520-016-3494-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 11/11/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE Little is known about the degree to which caregiver training as part of routine clinical care influences caregiver self-efficacy. The objective of this study was to examine the relationship between training during routine clinical cancer care and self-efficacy among caregivers of colorectal cancer patients. METHODS Caregivers completed a self-administered questionnaire about their experiences with training for specific patient problems and about their task-specific and general caregiving self-efficacy. Associations between training and self-efficacy were examined for each problem using multivariate logistic regression adjusted for caregiver age, race, care burden, education, perception of patient's health, and patient stage of disease. RESULTS Four hundred seventeen caregivers completed the survey (70% response rate), of whom 374 (90%) were female and 284 (68%) were the patient's spouse/partner. Overall, 77 (38%) reported inadequate training for pain, 80 (38%) for bowel, 121 (48%) for fatigue, 65 (26%) for medication administration, and 101 (40%) for other symptoms. The odds of having low self-efficacy were significantly higher among those with perceptions of inadequate training across the following cancer-related problems: pain 10.10 (3.36, 30.39), bowel 5.04 (1.98, 12.82), fatigue 8.45 (3.22, 22.15), managing medications 9.00 (3.30, 24.51), and other 3.87 (1.68, 8.93). CONCLUSIONS Caregivers commonly report inadequate training in routine colorectal cancer care. Significant and consistent associations between training adequacy and self-efficacy were found. This study supports the value of training caregivers in common cancer symptoms. Further work on how and when to provide caregiver training to best impact self-efficacy is needed.
Collapse
Affiliation(s)
- Rachel D Havyer
- Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic College of Medicine and Science, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Michelle van Ryn
- Division of Health Care Policy and Research, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Patrick M Wilson
- Division of Health Care Policy and Research, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Joan M Griffin
- Division of Health Care Policy and Research, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| |
Collapse
|
10
|
Farquhar M, Penfold C, Walter FM, Kuhn I, Benson J. What Are the Key Elements of Educational Interventions for Lay Carers of Patients With Advanced Disease? A Systematic Literature Search and Narrative Review of Structural Components, Processes and Modes of Delivery. J Pain Symptom Manage 2016; 52:117-130.e27. [PMID: 27112309 DOI: 10.1016/j.jpainsymman.2015.12.341] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 12/21/2015] [Accepted: 12/24/2015] [Indexed: 12/14/2022]
Abstract
CONTEXT Educating carers about symptom management may help meet patient and carer needs in relation to distressing symptoms in advanced disease. Reviews of the effectiveness of carer interventions exist, but few have focused on educational interventions and none on the key elements that comprise them but which could inform evidence-based design. OBJECTIVES To identify the key elements (structural components, processes, and delivery modes) of educational interventions for carers of patients with advanced disease. METHODS We systematically searched seven databases, applied inclusion and exclusion criteria, conducted quality appraisal, extracted data, and performed a narrative analysis. RESULTS We included 62 articles related to 49 interventions. Two main delivery modes were identified: personnel-delivered interventions and stand-alone resources. Personnel-delivered interventions targeted individuals or groups, the former conducted at single or multiple time points, and the latter delivered as series. Just more than half targeted carers rather than patient-carer dyads. Most were developed for cancer; few focused purely on symptom management. Stand-alone resources were rare. Methods to evaluate interventions ranged from postintervention evaluations to fully powered randomized controlled trials but of variable quality. CONCLUSION Published evaluations of educational interventions for carers in advanced disease are limited, particularly for non-cancer conditions. Key elements for consideration in developing such interventions were identified; however, lack of reporting of reasons for nonparticipation or dropout from interventions limits understanding of the contribution of these elements to interventions' effectiveness. When developing personnel-delivered interventions for carers in advanced disease, consideration of the disease (and, therefore, caring) trajectory, intervention accessibility (timing, location, and transport), and respite provision may be helpful.
Collapse
Affiliation(s)
- Morag Farquhar
- Department of Public Health & Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom; School of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, United Kingdom.
| | - Clarissa Penfold
- Department of Public Health & Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Fiona M Walter
- Department of Public Health & Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom; General Practice & Primary Care Academic Centre, University of Melbourne, Melbourne, Victoria, Australia
| | - Isla Kuhn
- Medical Library, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - John Benson
- Department of Public Health & Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| |
Collapse
|
11
|
McDonald J, McKinlay E, Keeling S, Levack W. Becoming an expert carer: the process of family carers learning to manage technical health procedures at home. J Adv Nurs 2016; 72:2173-84. [DOI: 10.1111/jan.12984] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2016] [Indexed: 12/30/2022]
Affiliation(s)
- Janet McDonald
- University of Otago; Wellington New Zealand
- Victoria University of Wellington; Wellington New Zealand
| | | | | | | |
Collapse
|
12
|
Tjia J, Ellington L, Clayton MF, Lemay C, Reblin M. Managing Medications During Home Hospice Cancer Care: The Needs of Family Caregivers. J Pain Symptom Manage 2015; 50:630-41. [PMID: 26159294 PMCID: PMC4649436 DOI: 10.1016/j.jpainsymman.2015.06.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 06/01/2015] [Accepted: 06/02/2015] [Indexed: 10/23/2022]
Abstract
CONTEXT Family caregivers (FCGs) are often at the frontline of symptom management for patients with advanced illness in home hospice. FCGs' cognitive, social, and technical skills in complex medication management have been well studied in the literature; however, few studies have tested existing frameworks in clinical cases in home hospice. OBJECTIVES This study sought to assess the applicability of caregiver medication management skills framework by Lau et al. in the context of family caregiving in home hospice to further the understanding of FCGs' essential medication management skills. METHODS This was a secondary data analysis of 18 audio recorded home hospice visits transcribed verbatim; deductive content analysis of caregiver-nurse interactions was conducted. The target sample included FCGs of hospice patients who had cancer diagnoses in hospices located in the greater urban area of the Rocky Mountain West. Caregiver medication management skills were identified and categorized into the five domains of caregiver expertise. Exemplars of each domain were identified. RESULTS An average of four medications (SD = 3.5) was discussed at each home hospice visit. Medication knowledge skills were observed in most home hospice visits (15 of 18). Teamwork skills were observed in 11 of 18 cases, followed by organizational and personhood skills (10 of 18). Symptom management skills occurred in 12 of 18 cases. An additional two subconstructs of the personhood domain-1) advocacy for the caregiver and 2) skills in discontinuing medications-were proposed. CONCLUSION These findings support framework by Lau et al. for caregiver medication management skills and expands on the existing domains proposed. Future interventions to assess FCGs' skills are recommended.
Collapse
Affiliation(s)
- Jennifer Tjia
- University of Massachusetts Medical School, Worcester, Massachusetts, USA.
| | | | | | - Celeste Lemay
- University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | | |
Collapse
|
13
|
Hendrix CC, Bailey DE, Steinhauser KE, Olsen MK, Stechuchak KM, Lowman SG, Schwartz AJ, Riedel RF, Keefe FJ, Porter LS, Tulsky JA. Effects of enhanced caregiver training program on cancer caregiver's self-efficacy, preparedness, and psychological well-being. Support Care Cancer 2015; 24:327-336. [PMID: 26062925 DOI: 10.1007/s00520-015-2797-3] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 06/02/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE We examined the effects of an enhanced informal caregiver training (Enhanced-CT) protocol in cancer symptom and caregiver stress management to caregivers of hospitalized cancer patients. METHODS We recruited adult patients in oncology units and their informal caregivers. We utilized a two-armed, randomized controlled trial design with data collected at baseline, post-training, and at 2 and 4 weeks after hospital discharge. Primary outcomes were self-efficacy for managing patients' cancer symptoms and caregiver stress and preparedness for caregiving. Secondary outcomes were caregiver depression, anxiety, and burden. The education comparison (EDUC) group received information about community resources. We used general linear models to test for differences in the Enhanced-CT relative to the EDUC group. RESULTS We consented and randomized 138 dyads: Enhanced-CT = 68 and EDUC = 70. The Enhanced-CT group had a greater increase in caregiver self-efficacy for cancer symptom management and stress management and preparation for caregiving at the post-training assessment compared to the EDUC group but not at 2- and 4-week post-discharge assessments. There were no intervention group differences in depression, anxiety, and burden. CONCLUSION An Enhanced-CT protocol resulted in short-term improvements in self-efficacy for managing patients' cancer symptoms and caregiver stress and preparedness for caregiving but not in caregivers' psychological well-being. The lack of sustained effects may be related to the single-dose nature of our intervention and the changing needs of informal caregivers after hospital discharge.
Collapse
Affiliation(s)
- Cristina C Hendrix
- Duke University School of Nursing, 307 Trent Drive, DUMC 3322, Room 3080, Durham, NC, 27710, USA.,Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs Medical GRECC, 508 Fulton St. Durham VA Medical Center, Durham, NC, 27705, USA.,Center for the Study of Aging and Human Development, Duke University, Box 3003 DUMC, Room 3502 Busse Building, Blue Zone, Duke South Durham, NC, 27710, USA
| | - Donald E Bailey
- Duke University School of Nursing, 307 Trent Drive, DUMC 3322, Room 3080, Durham, NC, 27710, USA.,Center for the Study of Aging and Human Development, Duke University, Box 3003 DUMC, Room 3502 Busse Building, Blue Zone, Duke South Durham, NC, 27710, USA
| | - Karen E Steinhauser
- Center of Excellence for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, 508 Fulton Street, Durham, NC, 27705, USA.,Duke Palliative Care, Duke University Health System, DUMC 2706, Durham, NC, 27710, USA.,Department of Medicine, Duke University School of Medicine, DUMC 2706, Durham, NC, 27710, USA
| | - Maren K Olsen
- Center of Excellence for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, 508 Fulton Street, Durham, NC, 27705, USA.,Department of Medicine, Duke University School of Medicine, DUMC 2706, Durham, NC, 27710, USA
| | - Karen M Stechuchak
- Center of Excellence for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, 508 Fulton Street, Durham, NC, 27705, USA
| | - Sarah G Lowman
- Department of Medicine, Duke University School of Medicine, DUMC 2706, Durham, NC, 27710, USA
| | - Abby J Schwartz
- Center for the Study of Aging and Human Development, Duke University, Box 3003 DUMC, Room 3502 Busse Building, Blue Zone, Duke South Durham, NC, 27710, USA.
| | - Richard F Riedel
- Division of Medical Oncology, Duke University Medical Center, DUMC 3198, Durham, NC, 27710, USA
| | - Francis J Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, DUMC 3159, Durham, NC, 27710, USA
| | - Laura S Porter
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, DUMC 3159, Durham, NC, 27710, USA
| | - James A Tulsky
- Duke Palliative Care, Duke University Health System, DUMC 2706, Durham, NC, 27710, USA.,Department of Medicine, Duke University School of Medicine, DUMC 2706, Durham, NC, 27710, USA
| |
Collapse
|
14
|
Tan YY, Blackford J. 'Rapid discharge': issues for hospital-based nurses in discharging cancer patients home to die. J Clin Nurs 2015; 24:2601-10. [PMID: 26010267 DOI: 10.1111/jocn.12872] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2015] [Indexed: 01/21/2023]
Abstract
AIMS AND OBJECTIVES To explore issues for hospital-based nurses in arranging rapid home discharge for imminently dying cancer patients in a Singapore acute hospital. BACKGROUND Dying at home is an important measure of a 'good death'. For hospitalised terminally ill patients, achieving home death can be of paramount importance to them and their family. Nurses experience many challenges in discharging imminently dying cancer patients home, due to time limitations and complex needs of patients and their families. DESIGN Qualitative interpretive description. METHOD Using purposive sampling, 14 registered nurses from an oncology ward in a Singapore hospital were recruited to participate in individual, semi-structured interviews. RESULTS Nursing issues in facilitating rapid discharge fell into three categories: time, discharge processes and family preparation. Decisions to die at home appeared solely family/patient driven, and were made when death appeared imminent. Discharge then became time-critical, as nurses needed to complete multiple tasks within short timeframes. Stress was further exacerbated by nurses' inexperience and the infrequent occurrence of rapid discharge, as well as absence of standardised discharge framework for guidance. Together, the lack of time and discharge processes to enable smooth hospital-to-home transition potentially affected nurses' capacity to adequately prepare families, and may contribute to caregiver anxiety. CONCLUSION Rapid discharge processes are needed as sudden patient/family decisions to die at home will continue. Earlier involvement of palliative care and implementation of a discharge pathway can potentially help nurses address their multiple responsibilities to ensure a successful transition from hospital to home. RELEVANCE TO CLINICAL PRACTICE Recognition of nursing issues and challenges during rapid discharge has implications for clinical improvements in supporting nurses during this challenging situation. Results of this study can be used to inform the conceptualisation of clinical interventions to facilitate urgent discharges of imminently dying patients.
Collapse
Affiliation(s)
- Yung Ying Tan
- Division of Palliative Medicine, National Cancer Centre Singapore, Singapore
| | - Jeanine Blackford
- School of Nursing & Midwifery, La Trobe University, Bundoora, Vic., Australia
| |
Collapse
|
15
|
Williams AL. Psychosocial burden of family caregivers to adults with cancer. Recent Results Cancer Res 2014; 197:73-85. [PMID: 24305770 DOI: 10.1007/978-3-642-40187-9_6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
A person living with cancer will potentially have some degree of physical, cognitive, and/or psychological impairment, periods of unemployment, financial concerns, social isolation, and existential questions, any or all of which can impact the family and friends who surround them. In our current era of healthcare, patients with cancer receive invasive diagnostic studies and aggressive treatment as outpatients, and then convalesce at home. As such, cancer family caregivers are essential partners with the healthcare team. The intricacies of the cancer family caregiver role and responsibilities are demanding and may lead to increased morbidity and mortality-in effect, the cancer family caregiver can become a second patient in need of care. This chapter discusses the psychosocial burden of family caregivers to adults with cancer, and includes information on caregiver mood disturbance and psychological impairment and some of the mutable factors that contribute to these states (i.e., sleep disturbance, decline in physical health, and restriction of activities), uncertainty, spiritual concerns, and caregiver witnessing. There is a discussion of the factors that influence the caregiving experience (caregiver characteristics, patient characteristics, and social supports). The chapter concludes with comments on the state of caregiver research.
Collapse
Affiliation(s)
- Anna-leila Williams
- Frank H. Netter MD School of Medicine at Quinnipiac University, Hamden, Connecticut,
| |
Collapse
|
16
|
Mehta A, Chan LS, Cohen SR. Flying blind: sources of distress for family caregivers of palliative cancer patients managing pain at home. J Psychosoc Oncol 2014; 32:94-111. [PMID: 24428253 DOI: 10.1080/07347332.2013.856057] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Pain requiring treatment is experienced by many cancer patients at the end of life. Family caregivers are often directly implicated in pain management. This article highlights areas of psychosocial concern for family caregivers managing a family member's cancer pain at home as they engage in pain management processes. This article is based on the secondary analysis, guided by interpretive description, of data collected for a grounded theory study that explored the processes used by family caregivers to manage cancer patients' pain in the home. Interviews and field notes from 24 family caregiver interviews were examined to identify areas of family caregiver psychosocial distress. The analysis revealed that family caregivers experienced distress at different phases of the pain management process. Sources of distress for caregivers included feeling as though they were "in a prison" (overwhelmingly responsible), "lambs to slaughter" (unsupported), and "flying blind" (unprepared). In addition, family caregivers expressed distress when witnessing their loved one in pain and when pain crises invoked thoughts of death. In sum, family caregivers managing a loved one's cancer pain at home are at risk for psychosocial distress. This study identified four key sources of distress that can help health care professionals better understand the experiences of these family caregivers and tailor supportive interventions to meet their needs. Knowledge about sources of distress can help healthcare professionals understand the experiences of these family caregivers and tailor supportive interventions to meet their needs.
Collapse
Affiliation(s)
- Anita Mehta
- a Psychosocial Oncology, McGill University Health Center - Montreal General Hospital , Montreal , Quebec , Canada
| | | | | |
Collapse
|
17
|
Ugur O, Elcigil A, Arslan D, Sonmez A. Responsibilities and Difficulties of Caregivers of Cancer Patients in Home Care. Asian Pac J Cancer Prev 2014; 15:725-9. [DOI: 10.7314/apjcp.2014.15.2.725] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
18
|
Harding R, List S, Epiphaniou E, Jones H. How can informal caregivers in cancer and palliative care be supported? An updated systematic literature review of interventions and their effectiveness. Palliat Med 2012; 26:7-22. [PMID: 21737481 DOI: 10.1177/0269216311409613] [Citation(s) in RCA: 118] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Informal caregivers needs in cancer/advanced disease are largely unmet. The science of carer intervention evaluation is methodologically challenging, and the evidence historically weak. OBJECTIVE This systematic review updates an earlier effectiveness review to determine both the effectiveness of subsequently published intervention studies, and the current state of science. METHOD The evidence was identified and appraised using a comprehensive search strategy. Articles were searched from 2001 to 2010 using the following electronic databases: Medline, PsychINFO and CINAHL. Inclusion criteria were studies reporting intervention data for informal adult caregivers of a patient with a diagnosis of cancer or receiving palliative care. The design and evidence rigour were assessed using the Jadad Rating Scale, and the Quality Rating Scale. RESULTS 33 studies met inclusion criteria. From the original review, an encouraging increase was identified in the number of evaluations (from 8 to 33), in carer-specific interventions (from 6 to 17) and in the robustness of the study design (an increase from 2 to 12 studies with before/after measures, comparison groups and prospective data). CONCLUSIONS The evidence suggests a rapid increase in the number of robust intervention studies. However, the range of models remains narrow in relation to caregivers' needs and preferences.
Collapse
Affiliation(s)
- Richard Harding
- King's College London, School of Medicine, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, London, UK.
| | | | | | | |
Collapse
|
19
|
Abstract
BACKGROUND : The hospital-to-home transition represents a vulnerable time for older veterans who are more medically and socioeconomically challenged than the general population of older adults. OBJECTIVES : The aim of this study was examine the feasibility of delivering an individualized caregiver training program before hospital discharge of older veterans. As an exploratory aim, the impact of this training on caregiver self-efficacy and preparedness was determined. METHODS : The sample consisted 50 caregiver-patient dyads. Training included medication management, identification of medical red flags, identification of Veterans Affairs community-based resources, and specific caregiver concerns about home care. Program feasibility was determined by whether caregivers could be recruited and could complete the training before patients were discharged from the hospital. Caregiver self-efficacy (using modified Lorig's self-efficacy scale) and preparedness (using Preparedness in Caregiving Scale) were assessed before the training (T1), immediately after the training (T2), and 1 week (T3) and 4 weeks (T4) after hospital discharge. RESULTS : One thousand six hundred ninety inpatients were screened, 252 of whom (15%) met study eligibility criteria. Of these, 112 were approached, and 50 dyads (44.6%) agreed to participate. Of the 50 consented dyads, 40 caregivers (80%) received the training. The mean self-efficacy among caregivers improved at T2, and the improvement was sustained at T3 and T4 (T1, 783.86; T2, 903.64; T3, 867.85; T4, 877.02). The same trend was observed in caregiving preparedness (T1, 26. 95; T2, 30.55; T3, 28.88; T4, 28.91). DISCUSSION : Providing an individualized training program to informal caregivers of hospitalized older veterans was not only feasible but was also associated with increased self-efficacy and caregiving preparedness. This study has the potential to assist caregivers in their home care of older veterans after hospital discharge.
Collapse
|
20
|
Hendrix CC, Landerman R, Abernethy AP. Effects of an Individualized Caregiver Training Intervention on Self-Efficacy of Cancer Caregivers. West J Nurs Res 2011; 35:590-610. [PMID: 21949091 DOI: 10.1177/0193945911420742] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Caring for older cancer patients after hospital discharge is challenging and many of their caregivers lack confidence to do so. This study investigated the effects of an individualized caregiver training program on self-efficacy in home care and symptom management. A total of 120 patient–caregiver dyads were randomly assigned to either the treatment ( n = 60) or control group ( n = 60). The training focused on prevention of infection, pain control, maintenance of nutrition and adequate elimination, and specific care issues identified by the caregiver. Control group received information about community-based resources. Results revealed a significant increase in self-efficacy after the training in the treatment group but not in the control group. No intervention effect was seen on caregiver’s psychological well-being (depression, anxiety, and quality of life) and patient’s physical symptoms.
Collapse
Affiliation(s)
- Cristina C. Hendrix
- Duke University School of Nursing, Durham, NC, USA
- Durham Veterans Affairs Medical Center, NC, USA
| | | | - Amy P. Abernethy
- Duke Comprehensive Cancer Center, Durham, NC
- Duke University School of Medicine, Durham, NC
| |
Collapse
|