1
|
Lee Y, Vance DE, Batey DS. Older Caregivers With HIV: Their Story of Caregiving. J Assoc Nurses AIDS Care 2024:00001782-990000000-00116. [PMID: 39137418 DOI: 10.1097/jnc.0000000000000484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2024]
Abstract
ABSTRACT As people with HIV live longer and healthier, it has become more likely that they will assume a caregiver role for their families and/or friends. Yet, there is a significant gap in the literature that older caregivers with HIV (OCWH) have not received attention from practitioners and researchers. To fill the gap, our qualitative study was conducted with OCWH (N = 19) to explore various themes such as adjustment to caregiving, caregiving responsibilities, HIV and other health issues, support systems, caregiving outcomes, needs assessment, cognitive health, and the impact of COVID-19. Results indicated that each OCWH faced their own unique challenges (e.g., severity of health conditions, intense caregiving responsibilities, caregiving situation, lack of social support/transportation/financial means), but they expressed positive and fulfilling caregiving outcomes. Understanding the lived experiences of OCWH is requisite to develop holistic service programs to meet their caregiving needs while supporting their HIV health and co-occurring health conditions.
Collapse
Affiliation(s)
- Yookyong Lee
- Yookyong Lee, PhD, MSW, is an Associate Professor, Department of Social Work, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA. David E. Vance, PhD, MGS, is a Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA. D. Scott Batey, PhD, MSW, is an Associate Professor, School of Social Work at Tulane University, New Orleans, Louisiana, USA
| | | | | |
Collapse
|
2
|
Hayes A, Courey L, Kells M, Hyndman D, Dempsey M, Murphy M. Caregivers of individuals with borderline personality disorder: The relationship between leading caregiver interventions and psychological distress/positive mental well-being. FAMILY PROCESS 2024. [PMID: 39091082 DOI: 10.1111/famp.13042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 04/15/2024] [Accepted: 07/08/2024] [Indexed: 08/04/2024]
Abstract
Burden and psychological distress are higher in informal caregivers (ICs) of people with severe emotional and behavior dysregulation who have been given a diagnosis of borderline personality disorder (BPD) compared with non-caregivers. The current cross-sectional study examines the difference in outcomes of ICs of people with BPD who have received the intervention Family Connections (FC) and who also led interventions for other caregivers (caregiver-leaders) compared with those who have attended FC but not led caregiver interventions (non-leader-FC participants). The sample for this research is from a larger study (Hayes et al., 2023, Borderline Personality Disorder and Emotion Dysregulation, 10, 31). Data for 347 participants who self-reported receiving FC and completed the McLean Screening Instrument for BPD-Carer Version, the Brief COPE, the Multidimensional Scale of Perceived Social Support, the Kessler Psychological Distress scale, the WHO-5 Well-being Index, and the Coronavirus Anxiety Scale were analyzed. The results found that being a caregiver-leader was associated with higher positive mental well-being and lower psychological distress compared with non-leader-FC participants. Being a caregiver-leader was also associated with significantly greater use of the coping strategy of positive reframing and lower use of behavioral disengagement and self-blame than non-leader-FC participants. The study provides preliminary evidence that for those who have received FC, becoming an intervention leader is associated with better outcomes than caregivers who do not become leaders and provides support for caregiver-led rollout of FC across services.
Collapse
Affiliation(s)
- Aoife Hayes
- School of Applied Psychology, University College Cork, Cork, Ireland
- Mental Health Services, Cork Kerry Community Healthcare, Health Service Executive, Cork, Ireland
| | - Lynn Courey
- The Sashbear Foundation, Toronto, Ontario, Canada
| | - Mary Kells
- Mental Health Services, Cork Kerry Community Healthcare, Health Service Executive, Cork, Ireland
| | | | - Maria Dempsey
- School of Applied Psychology, University College Cork, Cork, Ireland
| | - Mike Murphy
- School of Applied Psychology, University College Cork, Cork, Ireland
| |
Collapse
|
3
|
Abshire Saylor M, McIlvennan CK. SUSTAINing the Care of Patients With Advanced Heart Failure by Supporting Family Caregivers. Circ Heart Fail 2024; 17:e011874. [PMID: 38913051 DOI: 10.1161/circheartfailure.124.011874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/25/2024]
Affiliation(s)
| | - Colleen K McIlvennan
- Division of Cardiology, University of Colorado School of Medicine, Aurora (C.K.M.)
- Adult and Child Consortium for Outcomes Research and Delivery Science, Aurora, CO (C.K.M.)
| |
Collapse
|
4
|
Applebaum AJ, Kent EE, Ellington L, Campbell G, Donovan H, Trivedi R, Van Houtven C, Gray TF, Gebert RR, Rosa WE, Odom JN. Top Ten Tips Palliative Care Clinicians Should Know About Caring for Family Caregivers. J Palliat Med 2024; 27:930-938. [PMID: 38157333 DOI: 10.1089/jpm.2023.0640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
Family and friend caregivers play critical roles in ensuring that persons with serious illness receive high-quality care, and their responsibilities often increase as patients transition from receiving solely curative-focused care to primarily palliative-focused care. Integrating family caregivers into the health care team and supporting them in their role has significant benefits for family caregivers, patients, health care systems, communities, and society. Palliative care clinicians across all disciplines are uniquely suited to provide necessary training and support to family caregivers as they navigate the demands of their role. Here, we contend that providing comprehensive palliative care includes addressing the needs of family caregivers and provide ten tips and practical guidance to assist palliative care clinicians to support family caregivers. Engaging family caregivers as partners in care will ultimately allow palliative care clinicians to deliver the highest quality patient care and ensure the best possible outcomes for families facing serious illnesses.
Collapse
Affiliation(s)
- Allison J Applebaum
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Erin E Kent
- Department of Health Policy and Management, University of North Carolina Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Lee Ellington
- College of Nursing, University of Utah, Salt Lake City, Utah, USA
| | - Grace Campbell
- Duquesne University School of Nursing and University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Heidi Donovan
- University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, USA
| | - Ranak Trivedi
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA
| | - Courtney Van Houtven
- Department of Population Health Science, Duke University School of Medicine, and Health Services Research and Development in Primary Care at the Durham Veteran's Administration, Durham, North Carolina, USA
| | - Tamryn F Gray
- Department of Psychosocial Oncology, Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Rebecca R Gebert
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - William E Rosa
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - J Nicholas Odom
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| |
Collapse
|
5
|
Nguyen DD, Spertus JA, Benton MC, Thomas M, Jones PG, Andrei AC, Wu T, Baldridge AS, Grady KL. Association of Patient Reported Outcomes With Caregiver Burden in Older Patients With Advanced Heart Failure: Insights From the SUSTAIN-IT Study. Circ Heart Fail 2024; 17:e011705. [PMID: 38910557 DOI: 10.1161/circheartfailure.124.011705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 04/03/2024] [Indexed: 06/25/2024]
Abstract
BACKGROUND Caregivers of patients with advanced heart failure may experience burden in providing care, but whether changes in patient health status are associated with caregiver burden is unknown. METHODS This observational study included older patients (60-80 years old) receiving advanced surgical heart failure therapies and their caregivers at 13 US sites. Patient health status was assessed using the 12-item Kansas City Cardiomyopathy Questionnaire (range, 0-100; higher scores are better). Caregiver burden was assessed using the Oberst Caregiving Burden Scale, which measures time on task (OCBS-time) and task difficulty (OCBS-difficulty; range, 1-5; lower scores are better). Measurements occurred before surgery and 12 months after in 3 advanced heart failure cohorts: patients receiving long-term left ventricular assist device support; heart transplantation with pretransplant left ventricular assist device support; and heart transplantation without pretransplant left ventricular assist device support. Multivariable linear regression was used to identify predictors of change in OCBS-time and OCBS-difficulty at 12 months. RESULTS Of 162 caregivers, the mean age was 61.0±9.4 years, 139 (86%) were female, and 140 (86%) were the patient's spouse. At 12 months, 99 (61.1%) caregivers experienced improved OCBS-time, and 61 (37.7%) experienced improved OCBS-difficulty (versus no change or worse OCBS). A 10-point higher baseline 12-item Kansas City Cardiomyopathy Questionnaire predicted lower 12-month OCBS-time (β=-0.09 [95% CI, -0.14 to -0.03]; P<0.001) and OCBS-difficulty (β=-0.08 [95% CI, -0.12 to -0.05]; P<0.001). Each 10-point improvement in the 12-item Kansas City Cardiomyopathy Questionnaire predicted lower 12-month OCBS-time (β=-0.07 [95% CI, -0.12 to -0.03]; P=0.002) and OCBS-difficulty (β=-0.09 [95% CI, -0.12 to -0.06]; P<0.001). CONCLUSIONS Among survivors at 12 months, baseline and change in patient health status were associated with subsequent caregiver time on task and task difficulty in dyads receiving advanced heart failure surgical therapies, highlighting the potential for serial 12-item Kansas City Cardiomyopathy Questionnaire assessments to identify caregivers at risk of increased burden. REGISTRATION URL: https://www.clinicaltrials.gov; unique identifier: NCT02568930.
Collapse
Affiliation(s)
- Dan D Nguyen
- University of Missouri, Kansas City (D.D.N., J.A.S., M.C.B., M.T., P.G.J.)
- Saint Luke's Mid America Heart Institute, Kansas City, MO (D.D.N., J.A.S., M.C.B., M.T., P.J.)
| | - John A Spertus
- University of Missouri, Kansas City (D.D.N., J.A.S., M.C.B., M.T., P.G.J.)
- Saint Luke's Mid America Heart Institute, Kansas City, MO (D.D.N., J.A.S., M.C.B., M.T., P.J.)
| | - Mary C Benton
- University of Missouri, Kansas City (D.D.N., J.A.S., M.C.B., M.T., P.G.J.)
- Saint Luke's Mid America Heart Institute, Kansas City, MO (D.D.N., J.A.S., M.C.B., M.T., P.J.)
| | - Merrill Thomas
- University of Missouri, Kansas City (D.D.N., J.A.S., M.C.B., M.T., P.G.J.)
- Saint Luke's Mid America Heart Institute, Kansas City, MO (D.D.N., J.A.S., M.C.B., M.T., P.J.)
| | - Philip G Jones
- University of Missouri, Kansas City (D.D.N., J.A.S., M.C.B., M.T., P.G.J.)
- Saint Luke's Mid America Heart Institute, Kansas City, MO (D.D.N., J.A.S., M.C.B., M.T., P.J.)
| | - Adin-Cristian Andrei
- Feinberg School of Medicine at Northwestern University, Chicago, IL (A.-C.A., T.W., A.S.B., K.L.G.)
| | - Tingqing Wu
- Feinberg School of Medicine at Northwestern University, Chicago, IL (A.-C.A., T.W., A.S.B., K.L.G.)
| | - Abigail S Baldridge
- Feinberg School of Medicine at Northwestern University, Chicago, IL (A.-C.A., T.W., A.S.B., K.L.G.)
| | - Kathleen L Grady
- Feinberg School of Medicine at Northwestern University, Chicago, IL (A.-C.A., T.W., A.S.B., K.L.G.)
| |
Collapse
|
6
|
Leng QL, Lyons KS, Winters-Stone KM, Medysky ME, Dieckmann NF, Denfeld QE, Sullivan DR. Preliminary effects of a yoga intervention for lung cancer dyads: benefits for care partners. Support Care Cancer 2024; 32:447. [PMID: 38902487 DOI: 10.1007/s00520-024-08638-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 06/07/2024] [Indexed: 06/22/2024]
Abstract
PURPOSE Lung cancer is a disease with high mortality and morbidity, impacting both the patient and their closest contact, referred to in this paper as their care partner. There is limited evidence on how to support mental health and quality of life (QOL) for patient-care partner dyads during cancer treatment. This pilot study examines yoga as an intervention to improve well-being for the dyad. METHODS A single-group, 12-week pilot trial of yoga for patients and their care partners recruited from two hospitals during cancer treatment (N = 23 patient-partner dyads or 46 individuals). Most care partners were spouses (70%), with the remainder being adult children (22%), a sibling (4%), or a friend (4%). Descriptive statistics, Cohen's d effect sizes, and paired t-tests for validated psychosocial measures were calculated at baseline and 12 weeks. RESULTS Sixty-five percent of dyads (N = 13) completed the study, with withdrawals mostly due to disease progression. Among care partners, there was a decrease in depression symptomology on the PHQ-8 (p = 0.015, Cohen's d = 0.96) and improvement in QOL on the Caregiver QOL-Cancer scale (p = 0.001, Cohen's d = 0.61). Fifty percent of dyads experienced concordant improvement in depressive symptoms and 77% in QOL. CONCLUSION Patient-partner yoga is a promising intervention for improving mental health and QOL for patient-partner dyads among lung cancer survivors. This study demonstrates yoga to be acceptable, feasible, and with high concordance within patient-partner dyads for improvements in QOL. Yoga shows promise for patients and care partners to alleviate the negative psychosocial impacts of lung cancer, though more research is needed to confirm effects. TRIAL REGISTRATION ClinicalTrials.gov, NCT03649737, 12/9/2020.
Collapse
Affiliation(s)
- Qian L Leng
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA.
| | - Karen S Lyons
- School of Nursing, Oregon Health and Science University, Portland, OR, USA
| | - Kerri M Winters-Stone
- School of Nursing, Oregon Health and Science University, Portland, OR, USA
- Knight Cancer Institute, Oregon Health and Science University, Portland, OR, USA
| | - Mary E Medysky
- School of Nursing, Oregon Health and Science University, Portland, OR, USA
| | - Nathan F Dieckmann
- School of Nursing, Oregon Health and Science University, Portland, OR, USA
| | - Quin E Denfeld
- School of Nursing, Oregon Health and Science University, Portland, OR, USA
- Division of Cardiovascular Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Donald R Sullivan
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA
- Division of Pulmonary, Allergy and Critical Care Medicine, Oregon Health and Science University, Portland, OR, USA
- Knight Cancer Institute, Oregon Health and Science University, Portland, OR, USA
| |
Collapse
|
7
|
Chuzi S, Manning K. Integration of palliative care across the spectrum of heart failure care and therapies: considerations, contemporary data, and challenges. Curr Opin Cardiol 2024; 39:218-225. [PMID: 38567949 DOI: 10.1097/hco.0000000000001120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
PURPOSE OF REVIEW Heart failure (HF) is characterized by significant symptoms, compromised quality of life, frequent hospital admissions, and high mortality, and is therefore well suited to palliative care (PC) intervention. This review elaborates the current PC needs of patients with HF across the spectrum of disease, including patients who undergo advanced HF surgical therapies, and reviews the current data and future directions for PC integration in HF care. RECENT FINDINGS Patients with chronic HF, as well as those who are being evaluated for or who have undergone advanced HF surgical therapies such as left ventricular assist device or heart transplantation, have a number of PC needs, including decision-making, symptoms and quality of life, caregiver support, and end-of-life care. Available data primarily supports the use of PC interventions in chronic HF to improve quality of life and symptoms. PC skills and teams may also help address preparedness planning, adverse events, and psychosocial barriers in patients who have had HF surgeries, but more data are needed to determine association with outcomes. SUMMARY Patients with HF have tremendous PC needs across the spectrum of disease. Despite this, more data are needed to determine the optimal timing and structure of PC interventions in patients with chronic HF, left ventricular assist device, and heart transplantation. Future steps must be taken in clinical, research, and policy domains in order to optimize care.
Collapse
Affiliation(s)
- Sarah Chuzi
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Katharine Manning
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center
- Section of Palliative Medicine, Department of Internal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| |
Collapse
|
8
|
Cheung A, Kuti EL, Osenenko KM, Friesen M, Donato BMK. Impact of Caring for Individuals With Heart Failure in the United States: A Systematic Literature Review. J Cardiovasc Nurs 2024; 39:128-141. [PMID: 37249549 DOI: 10.1097/jcn.0000000000001005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Given the functional impairments and complex care routines associated with heart failure (HF), patients often rely on the support of informal caregivers. Although the importance of caregivers' roles is widely recognized, the intensity and time required for care duties may negatively impact caregiver health and well-being, potentially precipitating their own need for care. OBJECTIVE The aim of this study was to synthesize estimates of economic, clinical, burden, and health-related quality-of-life impact among caregivers of those with HF in the United States. METHODS A systematic review was conducted to identify studies reporting estimates of caregiver impact. Abstract and full-text review as well as data extraction were performed according to established guidelines. Patient and caregiver characteristics were summarized, as well as estimates of impact of caring for those with HF. RESULTS From 3680 abstracts, 44 studies reporting caregiver burden estimates were included. Mean caregiver age ranged from 41.4 to 71.4 years; caregivers were primarily female (range, 49%-100%) and the patient's spouse/partner (21%-100%). Time spent caregiving (6 studies) ranged from 2 to 52 h/wk, and depression was identified in up to 40% of caregivers (9 studies). Numerous instruments were used to measure burden, which consistently documented the high impact of caregiving. CONCLUSIONS This review demonstrates the multifaceted impact of caregiving for patients with HF. Despite limited data, notable findings included the considerable burden to caregivers, variability in time spent caregiving, and frequent experience of depression among caregivers, possibly leading to increased healthcare resource use. Future research is needed to better characterize the caregiving impact in HF, including evaluating the drivers of burden.
Collapse
|
9
|
Son HM, Lee H. Association Between Nurse-Led Multidisciplinary Education and Cardiac Events in Patients With Heart Failure: A Retrospective Chart Review. Asian Nurs Res (Korean Soc Nurs Sci) 2024; 18:60-67. [PMID: 38311228 DOI: 10.1016/j.anr.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 01/28/2024] [Accepted: 01/29/2024] [Indexed: 02/10/2024] Open
Abstract
PURPOSE This study examined the modifiable factors, including nurse-led multidisciplinary education and in/out-of-hospital rehabilitation, to predict cardiac events in patients with heart failure (HF) in South Korea. METHODS A retrospective review of the medical records was conducted using data of patients admitted for HF between June 2021 and April 2022. A total of 342 patients were included in this study. Information related to HF education, cardiac rehabilitation, and demographic and clinical characteristics were collected. Cardiac events, including emergency department visits, readmissions, and deaths, were defined as a composite of events. After adjusting for covariates, a multivariate Cox proportional hazard regression model was used to explore the association between modifiable factors and cardiac events in patients with HF. RESULTS During the follow-up period (median, 823 days), 123 patients (36.0%) experienced at least one cardiac event. In the Cox regression model, patients who received nurse-led multidisciplinary HF education during hospitalization were less likely to experience cardiac events (hazard ratio: 0.487; 95% confidence interval [CI]:0.239-0.993). Additionally, high NT-pro BNP levels were associated with an increased risk of cardiac events. CONCLUSIONS The education led by nurses on HF was a factor that reduced adverse prognoses in patients with HF. Our results highlight the importance of a nurse-led multidisciplinary approach during hospitalization.
Collapse
Affiliation(s)
- Haeng-Mi Son
- Department of Nursing, University of Ulsan, Ulsan, Republic of Korea.
| | - Hyeongsuk Lee
- College of Nursing, Gachon University, Incheon, Republic of Korea.
| |
Collapse
|
10
|
Dong X, He D, Zhang Y, Zhao Q, Zhang X, Fan X. Dyadic Associations Between Burden and Depressive Symptoms Among Patients With Heart Failure and Their Caregivers: The Mediating Role of Perceived Stress. J Cardiovasc Nurs 2023; 38:517-527. [PMID: 37816079 DOI: 10.1097/jcn.0000000000000974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Depressive symptoms are prevalent in patients with heart failure and their family caregivers. Given the interpersonal interactions between dyadic individuals with intimate relationship, it is essential to consider the dyads as a unit when exploring the factors associated with depressive symptoms in heart failure patient-caregiver dyads. OBJECTIVE The aims of this study were to explore the dyadic effects of burden on depressive symptoms in heart failure patient-caregiver dyads and investigate whether perceived stress acts as a mediator in these relationships. METHODS In this cross-sectional study, 237 heart failure patient-caregiver dyads were recruited from 3 hospitals in China between November 2018 and June 2019. Symptom burden, caregiving burden, perceived stress, and depressive symptoms were assessed using self-report questionnaires. The actor-partner interdependence model and actor-partner interdependence mediation model were used to analyze the data. RESULTS Patients' symptom burden had an actor effect on their own depressive symptoms and a partner effect on their caregivers' depressive symptoms. Similarly, caregivers' caregiving burden had an actor effect on their own depressive symptoms and a partner effect on patients' depressive symptoms. The actor effects between burden and depressive symptoms were partially mediated by their own perceived stress in heart failure patient-caregiver dyads. Furthermore, the partner effect between caregivers' caregiving burden and patients' depressive symptoms was completely mediated by patients' perceived stress. CONCLUSIONS Patients' symptom burden and caregivers' caregiving burden aggravated their depressive symptoms by increasing their own perceived stress. Moreover, patients' symptom burden led to caregivers' depressive symptoms, and caregivers' caregiving burden contributed to patients' depressive symptoms through patients' perceived stress. These interdependent relationships suggest that dyadic interventions focused on reducing burden and perceived stress may be beneficial for relieving depressive symptoms in heart failure patient-caregiver dyads.
Collapse
|
11
|
Liu YC, Chou MC, Chiang MC, Hang CL, Chen SM, Chung ML, Lin CY, Huang TY. A Biomarker of Stress and Self-reported Caregiving Distress Predict Poor Quality of Life in Family Caregivers of Patients With Heart Failure. J Cardiovasc Nurs 2023:00005082-990000000-00140. [PMID: 37830903 DOI: 10.1097/jcn.0000000000001050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
BACKGROUND Family caregivers are at a high risk for low quality of life due to caregiving-related stress. Caregivers' stress is commonly assessed using self-reported measures, which reflect relatively subjective and long-term stress related to caregiving, but objective biological markers of stress are rarely used for caregivers. The purposes of this study were (1) to determine whether caregiver characteristics were associated with stress assessed using a stress biomarker (serum cortisol) and a self-reported caregiving distress measure (Caregiver Burden Inventory) and (2) to determine the predictability of both stress measures for quality of life in caregivers of patients with heart failure. METHODS Taiwanese family caregivers (N = 113; mean age, 54.5 years; 70.8% female) of patients with heart failure completed surveys including caregiving distress and quality of life measured by the Caregiver Burden Inventory and the Short Form-36 (physical and psychological well-being subscales), respectively, and provided blood samples for serum cortisol. Independent t tests, correlation, and hierarchical regression were conducted. RESULTS Single caregivers had higher serum cortisol levels than married caregivers (P = .002). Men had significantly higher serum cortisol levels than women (P = .010), but men reported lower caregiving distress than women (P = .049). Both serum cortisol (β = -0.32, P = .012) and caregiving distress (β = -0.29, P = .018) were significant predictors of quality of life in the physical well-being scale while controlling for caregivers' characteristics and depressive symptoms. Serum cortisol (β = -0.28, P = .026) and caregiving distress (β = -0.25, P = .027) also predicted quality of life in the psychological well-being scale. CONCLUSIONS Serum cortisol and self-reported caregiving distress have similar predictability for quality of life in family caregivers of patients with heart failure. Reducing stress and caregiving distress is critical to improving quality of life in this population.
Collapse
|
12
|
Hansell AK, Olmstead R, López Maya E, Banijamali S. Stress reduction for paid home care aides: A feasibility study of mindfulness meditation and Tai Chi interventions. Home Health Care Serv Q 2023; 42:328-346. [PMID: 37194733 DOI: 10.1080/01621424.2023.2214087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Evidence of effective self-care strategies to support Home Care Aides' (HCAs) mental health is limited. This study compares the feasibility of implementing one of two non-clinical, evidence-based stress-reduction treatments: mindful awareness practices (MAPs) meditation versus Korean-style Tai Chi. Program effectiveness was assessed on a range of self-reported health and mental health quantitative outcomes at three time-points. Both groups showed statistically significant improvements in depression, insomnia, and negative affect during the six weeks (all p. <0.05), but only the MAPs group demonstrated a sustained improvement in negative affect at three-month follow-up (p. <0.05). At three-month follow-up, 55% of Tai Chi participants continued practicing learned techniques, compared to 75% of MAPs participants. MAPs were found to be more practical and amenable to integration in daily life compared to Tai Chi. Showing positive results on both feasibility and effectiveness assessment, MAPs were chosen over Tai Chi to be scaled as a benefit to HCAs.
Collapse
Affiliation(s)
- Allison K Hansell
- Research Insights and Innovations, Senior Program Manager of Population Health and Safety SEIU 775 Benefits Group, Seattle, WA, USA
| | - Richard Olmstead
- Research Psychologist Cousins Center for Psychoneuroimmunology Semel Institute, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - Eric López Maya
- Director General, Instituto Mexicano de Mindfulness & Cousins Center for Psychoneuroimmunology Semel Institute, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - Sahar Banijamali
- Department is Research Insights and Innovations, Director of Research Insights and Innovations SEIU 775 Benefits Group 215 Columbia St #300, Seattle, Washington, USA
| |
Collapse
|
13
|
Bidwell JT, Conway C, Babicheva V, Lee CS. Person with Heart Failure and Care Partner Dyads: Current Knowledge, Challenges, and Future Directions: State-of-the-Art Review. J Card Fail 2023; 29:1187-1206. [PMID: 36958392 PMCID: PMC10514243 DOI: 10.1016/j.cardfail.2023.02.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 02/07/2023] [Accepted: 02/23/2023] [Indexed: 03/25/2023]
Abstract
Over the past decade, there has been substantial growth in heart failure (HF) research that focuses on persons with HF and their care partners (family members or other close friends that provide unpaid support) as an interdependent team, or care dyad. In this state-of-the-art review, we use a dyadic lens to identify and summarize current research on HF care dyads, from qualitative studies, to nonexperimental quantitative studies, to randomized controlled trials. Although much work has been done, this literature is younger and less well-developed than care dyad literatures from other conditions (eg, cancer, Alzheimer's disease). We discuss the substantial challenges and limitations in this body of work, with an eye toward addressing common issues that impact rigor. We also look toward future directions, and discuss the promise dyadic research holds for improving patient, care partner, and relationship health.
Collapse
Affiliation(s)
- Julie T Bidwell
- University of California Davis Betty Irene Moore School of Nursing, Sacramento, California.
| | - Catherine Conway
- Boston College William F. Connell School of Nursing, Chestnut Hill, Massachusetts
| | - Viktoriya Babicheva
- Boston College William F. Connell School of Nursing, Chestnut Hill, Massachusetts
| | - Christopher S Lee
- Boston College William F. Connell School of Nursing, Chestnut Hill, Massachusetts
| |
Collapse
|
14
|
Chuzi S, Wilcox JE, Kao A, Spertus JA, Hsich E, Dew MA, Yancy CW, Pham DT, Hartupee J, Petty M, Cotts W, Pamboukian SV, Pagani FD, Lampert B, Johnson M, Murray M, Takeda K, Yuzefpolskaya M, Silvestry S, Kirklin JK, Wu T, Andrei AC, Baldridge A, Grady KL. Change in Caregiver Health-Related Quality of Life From Before to Early After Surgery: SUSTAIN-IT Study. Circ Heart Fail 2023; 16:e010038. [PMID: 37345518 PMCID: PMC10482357 DOI: 10.1161/circheartfailure.122.010038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 04/18/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND Information about health-related quality of life (HRQOL) among caregivers of older patients with heart failure who receive heart transplantation (HT) and mechanical circulatory support (MCS) is sparse. We describe differences and factors associated with change in HRQOL before and early post-surgery among caregivers of older heart failure patients who underwent 3 surgical therapies: HT with pretransplant MCS (HT MCS), HT without pretransplant MCS (HT non-MCS), and long-term MCS. METHODS Caregivers of older patients (60-80 years) from 13 US sites completed the EQ-5D-3 L visual analog scale (0 [worst]-100 [best] imaginable health state) and dimensions before and 3 and 6 months post-surgery. Analyses included linear regression, t tests, and nonparametric tests. RESULTS Among 227 caregivers (HT MCS=54, HT non-MCS=76, long-term MCS=97; median age 62.7 years, 30% male, 84% White, 83% spouse/partner), EQ-5D visual analog scale scores were high before (84.8±14.1) and at 3 (84.7±13.0) and 6 (83.9±14.7) months post-surgery, without significant differences among groups or changes over time. Patient pulmonary hypertension presurgery (β=-13.72 [95% CI, -21.07 to -6.36]; P<0.001) and arrhythmia from 3 to 6 months post-operatively (β=-14.22 [95% CI, -27.41 to -1.02]; P=0.035) were associated with the largest decrements in caregiver HRQOL; patient marital/partner status (β=6.21 [95% CI, 1.34-11.08]; P=0.013) and presurgery coronary disease (β=8.98 [95% CI, 4.07-13.89]; P<0.001) were associated with the largest improvements. CONCLUSIONS Caregivers of older patients undergoing heart failure surgeries reported overall high HRQOL before and early post-surgery. Understanding factors associated with caregiver HRQOL may inform decision-making and support needs. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT02568930.
Collapse
Affiliation(s)
| | | | - Andrew Kao
- St. Luke’s Medical Center, Kansas City, MO
| | | | | | | | | | | | | | - Michael Petty
- University of Minnesota Medical Center, Minneapolis, MN
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Loureiro M, Parola V, Duarte J, Mendes E, Oliveira I, Coutinho G, Martins MM, Novo A. Interventions for Caregivers of Heart Disease Patients in Rehabilitation: Scoping Review. NURSING REPORTS 2023; 13:1016-1029. [PMID: 37606457 PMCID: PMC10443275 DOI: 10.3390/nursrep13030089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 06/29/2023] [Accepted: 07/24/2023] [Indexed: 08/23/2023] Open
Abstract
Map the interventions/components directed to the caregivers of heart disease patients in cardiac rehabilitation programs that promote their role and health. METHODS The Joanna Briggs Institute method was used to guide this scoping review. Two independent reviewers assessed articles for relevance and extracted and synthesized data. Inclusion criteria comprised articles published in English, Spanish, and Portuguese since 1950. The following databases were searched: CINAHL Complete (Via EBSCO), Medline (via PubMed), Scopus, PEDro, and Repositórios Científicos de Acesso Aberto de Portugal (RCAAP). RESULTS From 351 articles retrieved, 10 were included in the review. The interventions identified directed to the caregiver were: educational interventions and lifestyle changes; physical exercise; psychological interventions/stress management; and a category "Other" with training interventions in basic life support, elaboration of guidelines/recommendations, and training for the role of caregiver. CONCLUSIONS It was found that most of the related cardiac rehabilitation interventions are aimed at the dyad heart failure patient and their caregivers/family. Including specific interventions targeting caregivers improves the caregiver's health and empowers them. Patient care planning should include interventions specifically aimed at them that result in health gains for caregivers and patients, striving to improve the quality of care. This study was not registered.
Collapse
Affiliation(s)
- Maria Loureiro
- Instituto Ciências Biomédicas Abel Salazar, Cintesis-NursID, Centro Hospitalar e Universitário de Coimbra, 3000-602 Coimbra, Portugal
| | - Vítor Parola
- Nursing School of Coimbra (ESEnfC), The Health Sciences Research Unit: Nursing (UICISA:E), Portugal Centre for Evidence-Based Practice: A Joanna Briggs Institute Centre of Excellence, 3004-011 Coimbra, Portugal
| | - João Duarte
- Instituto Ciências Biomédicas Abel Salazar, Cintesis-NursID, Centro Hospitalar e Universitário de Coimbra, 3000-602 Coimbra, Portugal
| | - Eugénia Mendes
- Instituto Politécnico de Bragança-Escola Superior de Saúde, Cintesis-NursID, 5300-121 Bragança, Portugal
| | - Isabel Oliveira
- Escola Superior de Saúde Norte Cruz Vermelha Portuguesa Oliveira de Azeméis, Center for Health Studies and Research of the University of Coimbra, 3040-156 Coimbra, Portugal
| | - Gonçalo Coutinho
- Faculdade de Medicina de Coimbra, Centro Hospitalar e Universitário de Coimbra, 3000-602 Coimbra, Portugal
| | | | - André Novo
- Instituto Politécnico de Bragança-Escola Superior de Saúde, Cintesis-NursID, 5300-121 Bragança, Portugal
| |
Collapse
|
16
|
Bouchard K, Gareau A, Greenman PS, Lalande K, Sztajerowska K, Tulloch H. What's love got to do with it? Relationship quality appraisals and quality of life in couples facing cardiovascular disease. Health Psychol Behav Med 2023; 11:2237564. [PMID: 37484832 PMCID: PMC10360988 DOI: 10.1080/21642850.2023.2237564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 07/08/2023] [Indexed: 07/25/2023] Open
Abstract
Objective Changes in couples' relationship quality are common post-cardiac event but it is unclear how relationship quality is linked to patients' and spouses' quality of life (QoL). The purpose of the present study was to examine the association between relationship quality on QoL in patient-spouse dyads within six months of a cardiac event. Methods Participants (N = 181 dyads; 25.9% female patients), recruited from a large cardiac hospital, completed validated questionnaires measuring demographic, relationship (Dyadic Adjustment Scale; DAS) and QoL variables (Heart-QoL & Quality of life of Cardiac Spouses Questionnaire). An Actor-Partner Interdependence Model was used to investigate actor (i.e. responses influencing their own outcome) and partner effects (responses influencing their partner's outcome) of relationship quality and QoL. Results Patients' and spouses' perceptions of relationship quality were in the satisfied range (DAS > 108; 65% of sample) and, as expected, patients reported lower general physical QoL than did their spouse (t(180) = -10.635, p < .001). Patient and spouse relationship quality appraisals were positively associated with their own physical (patient β = .25; spouse β = .05) and emotional/social (patient β = .21; spouse β = .04) QoL. No partner effects were identified. Conclusion High quality relationship appraisals appear to matter for patients' and spouses' QoL after the onset of CVD.
Collapse
Affiliation(s)
- Karen Bouchard
- Prevention and Rehabilitation Center, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | | | - Paul S. Greenman
- Prevention and Rehabilitation Center, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada
- Université du Québec en Outaouais, Gatineau, Canada
- Monfort Hospital, Ottawa, Canada
| | - Kathleen Lalande
- Prevention and Rehabilitation Center, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada
| | | | - Heather Tulloch
- Prevention and Rehabilitation Center, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
| |
Collapse
|
17
|
Liang M, Xie X, Pan Y, Cheng ASK, Ye Z. A qualitative meta-synthesis of patient dignity from the perspective of caregivers. BMC Geriatr 2023; 23:351. [PMID: 37277725 DOI: 10.1186/s12877-023-04071-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 05/26/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND The concept of dignity remains disputed, with most studies defining dignity based on its external dimension. Although its inherent dimension is a rooted attribute of dignity, it has received scarce attention. Caregivers have close relationships with their care recipients and thus may perceive their patient's inherent as well as external dimensions of dignity. Therefore, in this study, we aimed to identify, analyze, and synthesize evidence on human dignity presented in qualitative studies from the perspective of caregivers to gain a deeper comprehension of the preservation of patients' dignity by their caregivers. METHODS A qualitative meta-synthesis was performed by searching for relevant qualitative literature via systematic electronic databases, including MEDLINE, PsycINFO, ProQuest, CINAHL, Embase, Health Source, and Web of Science, from inception to March 15, 2022. RESULTS Nine studies were eligible for inclusion and included in the meta-synthesis. Three overarching categories were identified: integrated person, "rootedness" and "growth" atmosphere, and balanced state. CONCLUSIONS Dignity is rooted in its inherent dimension, whereas its external dimension may promote individual dignity. Furthermore, caregiver-patient relationships may be a key factor linking the inherent dimension of dignity with its external dimension. Thus, further studies should focus on the mechanism of relationships in preserving dignity.
Collapse
Affiliation(s)
- Minyu Liang
- School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China
| | - Xiyan Xie
- Nursing Department, Home for the Aged Guangzhou, Guangzhou, Guangdong Province, China
| | - Yichao Pan
- Department of Cardiovascular Medicine, Guangzhou First People's Hospital, Guangzhou, Guangdong Province, China
| | - Andy S K Cheng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Zengjie Ye
- School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China.
| |
Collapse
|
18
|
Locatelli G, Rebora P, Occhino G, Ausili D, Riegel B, Cammarano A, Uchmanowicz I, Alvaro R, Vellone E, Zeffiro V. The Impact of an Intervention to Improve Caregiver Contribution to Heart Failure Self-care on Caregiver Anxiety, Depression, Quality of Life, and Sleep. J Cardiovasc Nurs 2023:00005082-990000000-00090. [PMID: 37204336 DOI: 10.1097/jcn.0000000000000998] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
BACKGROUND Better caregiver contribution to self-care in heart failure is associated with better patient outcomes. However, caregiver contribution to self-care is also associated with high anxiety and depression, poor quality of life, and poor sleep in caregivers. It is still unclear whether interventions that encourage caregivers to contribute more to patient self-care might increase caregivers' anxiety and depression and decrease their quality of life and sleep. OBJECTIVE The aim of this study was to assess the impact of a motivational interview intervention aimed at improving caregiver contribution to self-care in heart failure on caregivers' anxiety, depression, quality of life, and sleep. METHODS This is a secondary outcome analysis of the MOTIVATE-HF trial. Patients with heart failure and their caregivers were randomized into arm 1 (motivational interview to patients), arm 2 (motivational interview to patients and caregivers), and arm 3 (standard care). Data were collected between June 2014 and October 2018. The article has been prepared following the Consolidated Standards of Reporting Trials checklist. RESULTS A sample of 510 patient-caregiver dyads was enrolled. Over the year of the study, the levels of anxiety, depression, quality of life, and sleep in caregivers did not significantly change among the 3 arms. CONCLUSIONS Motivational interview aimed at improving caregiver contribution to self-care does not seem to increase caregiver anxiety and depression, nor decrease their quality of life and sleep. Thus, such an intervention might be safely delivered to caregivers of patients with heart failure, although further studies are needed to confirm our findings.
Collapse
|
19
|
The Subjective Component of the Dutch Objective Burden Inventory: A Psychometric Analysis. J Cardiovasc Nurs 2023; 38:192-197. [PMID: 36753626 DOI: 10.1097/jcn.0000000000000899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The reliability and validity of the subjective component of the Dutch Objective Burden Inventory (DOBI) are unknown. OBJECTIVE The validity and reliability of the subjective component of the DOBI were examined in caregivers of individuals with heart failure, using the original 38- and a 24-item version. METHODS In an online cross-sectional investigation, confirmatory factor analysis was used to examine factorial validity. In examining convergent validity, corrected item-dimension correlations assessed item performance and associations between subjective subscale scores and the Bakas Caregiving Outcomes Scale. Cronbach's α examined internal consistency. RESULTS The original 4-factor solution was retained and both the original and shorter versions of the subjective component of the DOBI supported adequate construct validity and internal consistency. CONCLUSIONS Both the 38- and 24-item forms of the subjective DOBI supported construct validity and reliability. Further studies examining the usefulness of both versions are needed in carers of individuals with more severe HF.
Collapse
|
20
|
Zapata CB, Dionne-Odom JN, Harris HA, Kalanithi L, Lin J, Bischoff K, Fazzalaro K, Pantilat SZ. Honoring What We Say We Do: Developing Real-World Tools for Routine Family Caregiver Assessment and Support in Outpatient Palliative Care. J Palliat Med 2023; 26:376-384. [PMID: 36608316 DOI: 10.1089/jpm.2022.0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background: Family caregivers are essential to the care of patients with serious illness and supporting caregivers alongside patients is a core tenet of palliative care. While there is increasing recognition of the need to support family caregivers, there are limited resources to assess and support their needs in a systematic way in outpatient palliative care practice. Objectives: The aim of this study is to develop an approach to conducting assessments of routine needs and support of family caregivers in outpatient palliative care practice using a quality improvement framework. Setting: Seven, interdisciplinary, outpatient palliative care teams in California collaborated in this study. Measurements: Family caregivers were surveyed about levels of distress and support using a 10-point scale and asked about specific areas of need for support. Usefulness of a supportive caregiver resource was also measured on a 10-point scale, in addition to qualitative assessment of clinician satisfaction and feasibility of routine caregiver assessment and support. Results: Seven hundred thirty-six caregiver needs assessments were conducted and 44 supportive tool kits were distributed. A majority of family caregivers reported moderate or severe distress related to caregiving (score ≥4 on a 10-point scale). The most common sources of distress included emotional distress, worry caregiving was negatively impacting their own health, and planning for the future. Most caregivers reported feeling moderately or very well supported, most commonly by family, friends, and faith/spirituality. Caregivers rated the supportive tool kit an 8.4 on a 10-point usefulness scale and 92% would recommend it to others. Conclusions: We successfully developed and piloted practical clinical tools for routine family caregiver screening and support.
Collapse
Affiliation(s)
- Carly B Zapata
- Division of Palliative Medicine, University of California, San Francisco, San Francisco, California, USA
| | | | - Heather A Harris
- Division of Hospital Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, California, USA
| | | | - Jessica Lin
- Stanford University Medical Partners, Oakland, California, USA
| | - Kara Bischoff
- Division of Palliative Medicine, University of California, San Francisco, San Francisco, California, USA
| | | | - Steven Z Pantilat
- Division of Palliative Medicine, University of California, San Francisco, San Francisco, California, USA
| |
Collapse
|
21
|
Wennberg AM, Anderson LR, Cagnin A, Chen-Edinboro LP, Pini L. How both positive and burdensome caregiver experiences are associated with care recipient cognitive performance: Evidence from the National Health and Aging Trends Study and National Study of Caregiving. Front Public Health 2023; 11:1130099. [PMID: 36860389 PMCID: PMC9969137 DOI: 10.3389/fpubh.2023.1130099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 01/23/2023] [Indexed: 02/16/2023] Open
Abstract
Introduction Being an informal caregiver to a person with chronic disease, including persons living with dementia (PLWD), is a big role to take on and many caregivers experience both substantial burden and emotional reward related to caregiving. Care recipient factors (e.g., behavioral symptoms) are associated with caregiver experience. However, the relationship between caregiver and care recipient is bidirectional, so it is likely that caregiver factors impact the care recipient, though few studies have investigated this. Methods In the 2017 round of the National Health and Aging Trends Study (NHATS) and National Study of Caregiving (NSOC), we studied 1,210 care dyads--170 PLWD dyads and 1,040 without dementia dyads. Care recipients completed immediate and delayed word list memory tasks, the Clock Drawing Test, and a self-rated memory rating, while caregivers were interviewed about their caregiving experiences using a 34-item questionnaire. Using principal component analysis, we created a caregiver experience score with three components-Practical Care Burden, Positive Care Experiences, and Emotional Care Burden. We then investigated the cross-sectional association between caregiver experience components and care recipient cognitive test performance using linear regression models adjusted for age, sex, education, race, and depressive and anxiety symptoms. Results Among PLWD dyads, a higher caregiver Positive Care Experiences score was associated with better care recipient performance on the delayed word recall (B = 0.20, 95% CI 0.05, 0.36) and Clock Draw (B = 0.12, 95% CI 0.01, 0.24) tests while higher Emotional Care Burden score was associated with worse self-rated memory score (B = -0.19, 95% CI -0.39, -0.003). Among participants without dementia, higher Practical Care Burden score was associated with poorer care recipient performance on the immediate (B = -0.07, 95% CI -0.12, -0.01) and delayed (B = -0.10, 95% CI -0.16, -0.05) word recall tests. Discussion These findings support the concept that caregiving is bidirectional within the dyad and that positive variables can positively impact both members of the dyad. This suggests that caregiving interventions should target the caregiver and recipient both individually and as a unit, with the goal of holistically improving outcomes for both.
Collapse
Affiliation(s)
- Alexandra M. Wennberg
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden,*Correspondence: Alexandra M. Wennberg ✉
| | - Loretta R. Anderson
- Program in Gerontology, Department of Epidemiology and Public Health, University of Maryland, Baltimore, MD, United States
| | - Annachiara Cagnin
- Department of Neuroscience (DNS) and Padova Neuroscience Center, University of Padova, Padova, Italy
| | - Lenis P. Chen-Edinboro
- School of Health and Applied Human Sciences, University of North Carolina Wilmington, Wilmington, NC, United States
| | - Lorenzo Pini
- Padova Neuroscience Center, University of Padova, Padova, Italy
| |
Collapse
|
22
|
Bouchard K, Dans M, Higdon G, Quinlan B, Tulloch H. Caregiver Distress and Coronary Artery Disease: Prevalence, Risk, Outcomes, and Management. Curr Cardiol Rep 2022; 24:2081-2096. [PMID: 36418650 DOI: 10.1007/s11886-022-01810-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/12/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Caregivers of patients with coronary artery disease (CAD) are integral to the health care system and contribute substantially to patients' management. The purpose of this review is to provide a narrative synthesis of existing research on caregiving for patients who experienced an acute coronary syndrome (MI/unstable angina) and/or coronary revascularization (PCI/CABG). RECENT FINDINGS Thirty-one articles are included in this review. Overall, caregiver distress is low to moderate, ranging from 6 to 67% of caregivers, and seems to dissipate over time for most caregivers. Interventions have demonstrated success in reducing the distress of caregivers of patients with CAD. Due to the heterogeneity in study samples, measurements used, and timing of assessments and programming, these results are far from definitive. Although evidence is accumulating, further advancement in caregiving science and clinical care is required to adequately understand and respond to the needs of caregivers throughout the patient's illness trajectory.
Collapse
Affiliation(s)
- Karen Bouchard
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y4W7, Canada
| | - Michael Dans
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y4W7, Canada
| | - Gloria Higdon
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y4W7, Canada
| | - Bonnie Quinlan
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y4W7, Canada
| | - Heather Tulloch
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y4W7, Canada.
| |
Collapse
|
23
|
It Takes a Village. J Cardiovasc Nurs 2022; 37:E160-E168. [DOI: 10.1097/jcn.0000000000000862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
24
|
Nelson KE, Saylor MA, Anderson A, Buck H, Davidson PM, DeGroot L, Fisher M, Gilotra NA, Pavlovic N, Szanton SL. "We're all we got is each other": Mixed-methods analysis of patient-caregiver dyads' management of heart failure. Heart Lung 2022; 55:24-28. [PMID: 35436655 DOI: 10.1016/j.hrtlng.2022.04.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 03/21/2022] [Accepted: 04/08/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Individuals living with heart failure often require informal caregiving assistance for optimal self-care maintenance. The influence of caregiver burden and resilience on dyadic congruence is not well understood. OBJECTIVE To compare how dyadic congruence is influenced by level of burden and resilience expressed by caregivers of patients with heart failure. METHODS Mixed-methods analysis of individuals with heart failure and their caregivers, focusing on measures of caregiver burden (Zarit Burden Interview) and resilience (Brief Resilience Scale). Data were integrated using the Heart Failure Care Dyadic Typology. RESULTS Twelve dyads (n=24 participants) were classified as Type II (n=7) and Type III (n=5) dyads. Among Type II dyads, average caregiver burden was 19.43 (± 13.89) and resilience was 3.16 (± 1.04). For Type III dyads, average caregiver burden was 3.80 (± 4.27) and resilience 4.07 (± 1.36), respectively. Two key themes were derived: 1) caregivers' tendency to take the lead, and 2) the usefulness of cognitive reframing. Data integration elucidated that theme 1 was more common among Type II dyads and those with higher burden, and theme 2 was more prevalent among Type III dyads and those with higher resilience. CONCLUSION Findings highlight important variances in how dyads collectively manage heart failure. Future inquiry should involve tailored intervention development to bolster informal caregivers' quality of life and ability to better support patients throughout their heart failure trajectory.
Collapse
Affiliation(s)
- Katie E Nelson
- Johns Hopkins University School of Nursing, Baltimore, MD 21205, USA.
| | | | - Annabel Anderson
- Johns Hopkins University School of Nursing, Baltimore, MD 21205, USA
| | - Harleah Buck
- University of Iowa College of Nursing, Iowa City, IA, USA
| | | | - Lyndsay DeGroot
- Johns Hopkins University School of Nursing, Baltimore, MD 21205, USA
| | - Marlena Fisher
- Johns Hopkins University School of Nursing, Baltimore, MD 21205, USA
| | - Nisha A Gilotra
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Noelle Pavlovic
- Johns Hopkins University School of Nursing, Baltimore, MD 21205, USA
| | - Sarah L Szanton
- Johns Hopkins University School of Nursing, Baltimore, MD 21205, USA; Johns Hopkins University School of Medicine, Baltimore, MD, USA; Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
25
|
Petty MG, Wu T, Andrei AC, Baldridge A, Warzecha A, Kao A, Spertus J, Hsich E, Dew MA, Pham D, Yancy C, Hartupee J, Cotts W, Pamboukian SV, Pagani F, Lampert B, Johnson M, Murray M, Tekeda K, Yuzefpolskaya M, Silvestry S, Kirklin JK, Grady KL. Baseline Quality-of-Life of Caregivers of Patients With Heart Failure Prior to Advanced Therapies: Findings From the Sustaining Quality of Life of the Aged: Transplant or Mechanical Support (SUSTAIN-IT) Study. J Card Fail 2022; 28:1137-1148. [PMID: 35470057 PMCID: PMC10010287 DOI: 10.1016/j.cardfail.2022.03.358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 03/09/2022] [Accepted: 03/09/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND We compared health-related quality of life (HRQOL), depressive symptoms, anxiety, and burden in caregivers of older patients with heart failure based on the intended therapy goal of the patient: awaiting heart transplantation (HT) with or without mechanical circulatory support (MCS) or prior to long-term MCS; and we identified factors associated with HRQOL. METHODS Caregivers (n = 281) recruited from 13 HT and MCS programs in the United States completed measures of HRQOL (EQ-5D-3L), depressive symptoms (PHQ-8), anxiety (STAI-state), and burden (Oberst Caregiving Burden Scale). Analyses included ANOVA, Kruskal-Wallis tests, χ2 tests, and linear regression. RESULTS The majority of caregivers were female, white spouses with ≤ 2 comorbidities, median [Q1,Q3] age = 62 [57.8, 67.0] years. Caregivers (HT with MCS = 87, HT without MCS = 98, long-term MCS = 96) reported similarly high baseline HRQOL (EQ-5D-3L visual analog scale median score = 90; P = 0.67 for all groups) and low levels of depressive symptoms. STAI-state median scores were higher in the long-term MCS group vs the HT groups with and without MCS, (38 vs 32 vs 31; P < 0.001), respectively. Burden (task: time spent/difficulty) differed significantly among groups. Caregiver factors (number of comorbidities, diabetes and higher anxiety levels) were significantly associated with worse caregiver HRQOL, R2 = 26%. CONCLUSIONS Recognizing caregiver-specific factors, including comorbidities and anxiety, associated with the HRQOL of caregivers of these older patients with advanced HF may guide support strategies.
Collapse
Affiliation(s)
- M G Petty
- From the M Health Fairview, University of Minnesota Medical Center, Minneapolis, Minnesota.
| | - T Wu
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - A C Andrei
- Division of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - A Baldridge
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - A Warzecha
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - A Kao
- Heart Failure and Transplantation Cardiology, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - J Spertus
- Cardiovascular Division, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - E Hsich
- Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - M A Dew
- Department of Psychiatry, University of Pittsburgh School of Medicine and Medical Center, Pittsburgh, Pennsylvania
| | - D Pham
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - C Yancy
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - J Hartupee
- Cardiovascular Division, Department of Medicine, Washington University, St. Louis, Missouri
| | - W Cotts
- Advocate Heart and Vascular Institute, Advocate Christ Medical Center, Oak Lawn, Illinois
| | - S V Pamboukian
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - F Pagani
- Division of Cardiovascular Surgery, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Michigan
| | - B Lampert
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - M Johnson
- Department of Cardiovascular Medicine, University of Wisconsin, Madison, Wisconsin
| | - M Murray
- Department of Cardiovascular Surgery, University of Wisconsin Hospital and Clinics, Madison, Wisconsin
| | - K Tekeda
- Department of Surgery, Columbia University Medical Center, New York, New York
| | - M Yuzefpolskaya
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York
| | - S Silvestry
- Thoracic Transplant Programs, Florida Hospital Transplant institute, Orlando, Florida
| | - J K Kirklin
- Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - K L Grady
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| |
Collapse
|
26
|
Levoy K, Rivera E, McHugh M, Hanlon A, Hirschman K, Naylor M. Caregiver Engagement Enhances Outcomes Among Randomized Control Trials of Transitional Care Interventions: A Systematic Review and Meta-analysis. Med Care 2022; 60:519-529. [PMID: 35679175 PMCID: PMC9202479 DOI: 10.1097/mlr.0000000000001728] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Fluctuations in health among chronically ill adults result in frequent health care transitions. Some interventions to improve patient outcomes after hospitalization include caregiver engagement as a core component, yet there is unclear evidence of the effects of this component on outcomes. OBJECTIVE The objective of this study was to synthesize evidence regarding the attention given to caregiver engagement in randomized control trials of transitional care interventions (TCIs), estimate the overall intervention effects, and assess caregiver engagement as a moderator of intervention effects. METHODS Three databases were systematically searched for randomized control trials of TCIs targeting adults living with physical or emotional chronic diseases. For the meta-analysis, overall effects were computed using the relative risk (RR) effect size and inverse variance weighting. RESULTS Fifty-four studies met criteria, representing 31,291 participants and 66 rehospitalizations effect sizes. Half (51%) the interventions lacked focus on caregiver engagement. The overall effect of TCIs on all-cause rehospitalizations was nonsignificant at 1 month (P=0.107, k=29), but significant at ≥2 months [RR=0.89; 95% confidence interval (CI): 0.82, 0.97; P=0.007, k=27]. Caregiver engagement moderated intervention effects (P=0.05), where interventions with caregiver engagement reduced rehospitalizations (RR=0.83; 95% CI: 0.75, 0.92; P=0.001), and those without, did not (RR=0.97; 95% CI: 0.87, 1.08; P=0.550). Interventions with and without caregiver engagement did not differ in the average number of components utilized, however, interventions with caregiver engagement more commonly employed baseline needs assessments (P=0.032), discharge planning (P=0.006), and service coordination (P=0.035). DISCUSSION Future TCIs must consistently incorporate the active participation of caregivers in design, delivery, and evaluation.
Collapse
Affiliation(s)
- Kristin Levoy
- Department of Community and Health Systems, Indiana University (IU) School of Nursing, 600 Barnhill Dr., Indianapolis, IN 46202
- IU Center for Aging Research, Regenstrief Institute, 1101 W. 10 St., Indianapolis, IN 46202
| | - Eleanor Rivera
- University of Illinois Chicago College of Nursing, 845 S. Damen Ave, Chicago, IL 60612
| | - Molly McHugh
- NewCourtland Center for Transitions and Health, Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, 3615 Chestnut Street, Ralston-Penn Center, Philadelphia, PA 19104
| | - Alexandra Hanlon
- Center for Biostatistics and Health Data Science, Department of Statistics, College of Science, Virginia Tech, 4 Riverside Circle, Roanoke, VA 24016
| | - Karen Hirschman
- NewCourtland Center for Transitions and Health, Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, 3615 Chestnut Street, Ralston-Penn Center, Philadelphia, PA 19104
| | - Mary Naylor
- NewCourtland Center for Transitions and Health, Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, 3615 Chestnut Street, Ralston-Penn Center, Philadelphia, PA 19104
| |
Collapse
|
27
|
Schutz SE, Walthall HE. What are the needs and experiences of caregivers of people with heart failure? A qualitative study. Heart Lung 2022; 54:42-48. [PMID: 35339892 DOI: 10.1016/j.hrtlng.2022.03.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/15/2022] [Accepted: 03/15/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND The global burden of heart failure is estimated to be around 64 million people, with many needing care and support for daily living activities. These needs are usually filled by close relatives, often a spouse, and therefore someone of a similar age to the person for whom they care. OBJECTIVES The aim of this study was to explore the needs and experiences of caregivers caring for a person with heart failure through a qualitative interview approach. METHODS A qualitative study was conducted in a large region in South England. 17 caregivers were interviewed using a semi-structured approach and the data analysed using thematic analysis. RESULTS Four themes were identified from the data: a) Taking on the role of caregiver with the sub-themes of: acceptance and life changes; b) Getting to grips with being a caregiver with sub-themes: carrying out the care and coping with the care; c) Impact on own health and wellbeing: sub-themes of physical health and mental and emotional health and finally: d) Need for information and Support with sub-themes: trying to get knowledge and making sense. CONCLUSIONS This study has shown that heart failure caregiving can have a negative impact on caregivers' own health and wellbeing and involves complex care delivery for which they receive little support. Caregivers of people with heart failure report having significant information needs in order to understand the reasons for the care they provide yet feel marginalised by health care professionals.
Collapse
Affiliation(s)
- S E Schutz
- Senior Lecturer, Oxford Brookes University, Faculty of Health and Life Sciences, Oxford School of Nursing and Midwifery, Jack Straws Lane, Oxford, United Kingdom OX3 0FL, UK.
| | - H E Walthall
- Director of Nursing and Midwifery Research and Innovation, Oxford University Hospitals Foundation NHS Trust, Oxford and Oxford Biomedical Research Centre. OX3 9DU, United Kingdom
| |
Collapse
|
28
|
Asano R, Anderson KM, Koirala B, Abshire M, Himmelfarb CD, Davidson PM. The Edmonton Symptom Assessment Scale in Heart Failure: A Systematic Review. J Cardiovasc Nurs 2022; 37:341-349. [PMID: 37707967 DOI: 10.1097/jcn.0000000000000835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Heart failure is a troublesome condition with high healthcare utilization and cost. Most individuals with heart failure experience multiple symptoms including breathlessness, pain, depression, and anxiety. PURPOSE The aim of this study was to review the literature describing the use of the Edmonton Symptom Assessment Scale to assess the burden of symptoms and the impact of symptoms on heart failure outcomes including quality of life and functional outcomes. METHODS The search engines PubMed, Scopus, CINAHL, and Web of Science were searched from January 2001 to March 2020. A review of literature was undertaken using key terms "heart failure," "CHF," "cardiac failure," "heart decompensation," "myocardial failure," "Edmonton Symptom Assessment Scale". Hand searching of articles was also undertaken. RESULTS The search resulted in 33 relevant articles, which were imported into Rayyan, a Web-based systematic review software program. We present synthesis of results of studies (1) using the Edmonton Symptom Assessment Scale as an assessment of symptom burden and (2) evaluating the impact of symptom burden on quality of life and functional status. CONCLUSION This review highlighted the Edmonton Symptom Assessment Scale as a predictive instrument to identify symptom burden, symptom clusters, and symptom changes for patients living with heart failure. The clinical use of the Edmonton Symptom Assessment Scale may identify treatment priorities, promote self-management, inform the treatment plan, and advance effective therapeutic adjustments. The symptom burden in heart failure is high, and improving the symptom experience is an important focus of future healthcare interventions. The Edmonton Symptom Assessment Scale has utility in heart failure management due to psychometric properties and ease of administration. CLINICAL IMPLICATIONS The Edmonton Symptom Assessment Scale may be useful in measuring patient-reported symptom burden in patients with heart failure in the clinical setting because it correlates well with other heart failure measures on quality of life and functional outcomes and provides useful information on symptom burden.
Collapse
|
29
|
Hashemlu L, Esmaeili R, Bahramnezhad F, Rohani C. The experiences of home care team members regarding the needs of family caregivers of heart failure patients in home health care services in Iran: A qualitative study. ARYA ATHEROSCLEROSIS 2022; 18:1-10. [PMID: 36817345 PMCID: PMC9937671 DOI: 10.48305/arya.2022.24350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 09/06/2021] [Indexed: 02/24/2023]
Abstract
BACKGROUND Home healthcare guidelines emphasize the engagement of family caregivers of heart failure (HF) patients in patient care at home. Thus, this study was conducted with the aim to explore the deep experiences of home care team members regarding the needs of family caregivers of HF patients in home healthcare services in Iran. METHODS The present qualitative study was performed with a conventional content analysis approach. Data were collected through in-depth, semi-structured interviews with 23 participants who were recruited through purposive sampling. The Data were analyzed using the Graneheim and Lundman method for conventional content analysis in MAXQDA Software. RESULTS The participants included 14 women and 9 men with the mean age of 46.21 ± 11.44 years. After analyzing the interviews, 3 main categories and 15 subcategories were extracted. The main categories were "family caregiver's unmet needs" (with 5 subcategories), "Empowering Informal Caregivers" (with 3 subcategories), and "access to a standard home healthcare system" (with 7 subcategories). CONCLUSION Deep understanding of the needs of family caregivers of HF patients in home health care services increases the quality of services, the quality of life (QOL) of the family, and prevents patients' hospital readmissions. Moreover, it will contribute to our next project of the home healthcare guideline for HF patients in the health care system of Iran. Identifying the training needs of caregivers within the home health care services has an important role in the designing of education strategies in policy making programs at the level of the Ministry of Health or planning at lower levels of the health network.
Collapse
Affiliation(s)
- Leila Hashemlu
- PhD Student in Nursing, Student Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Roghayeh Esmaeili
- Associate Professor, Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Address for correspondence: Roghayeh Esmaeili; Associate Professor, Department of Medical-Surgical Nursing, School of Nursing and
Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran;
| | - Fatemeh Bahramnezhad
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery AND Department of Spiritual Health, Research Center of Quran, Hadith and Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Camelia Rohani
- Affiliated Researcher, Department of Health Care Sciences, Palliative Care Center, Marie Cederschiöld Högskola, Campus Ersta, Stockholm, Sweden AND Associate Professor, Department of Community Health Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
30
|
Leykum LK, Penney LS, Dang S, Trivedi RB, Noël PH, Pugh JA, Shepherd-Banigan ME, Pugh MJ, Rupper R, Finley E, Parish-Johnson J, Delgado R, Peacock K, Kalvesmaki A, Van Houtven CH. Recommendations to Improve Health Outcomes Through Recognizing and Supporting Caregivers. J Gen Intern Med 2022; 37:1265-1269. [PMID: 34981348 PMCID: PMC8722428 DOI: 10.1007/s11606-021-07247-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 10/19/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Luci K Leykum
- Department of Veterans Affairs Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, San Antonio, USA.
- South Texas Veterans Health Care System, 7400 Merton Minter Blvd, San Antonio, TX, 78229, USA.
- University of Texas at Austin Dell Medical School, Austin, USA.
- VA Palo Alto Health Care System, Palo Alto, USA.
| | - Lauren S Penney
- Department of Veterans Affairs Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, San Antonio, USA
- South Texas Veterans Health Care System, 7400 Merton Minter Blvd, San Antonio, TX, 78229, USA
- Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - Stuti Dang
- Department of Veterans Affairs Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, San Antonio, USA
- Miami VA Healthcare System, Miami, USA
- University of Miami School of Medicine, Miami, USA
| | - Ranak B Trivedi
- Department of Veterans Affairs Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, San Antonio, USA
- VA Greater Los Angeles Health Care System, Los Angeles, USA
- VA Palo Alto Health Care System, Palo Alto, USA
- Stanford University School of Medicine, Stanford, USA
| | - Polly H Noël
- Department of Veterans Affairs Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, San Antonio, USA
- South Texas Veterans Health Care System, 7400 Merton Minter Blvd, San Antonio, TX, 78229, USA
- Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - Jacqueline A Pugh
- Department of Veterans Affairs Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, San Antonio, USA
- South Texas Veterans Health Care System, 7400 Merton Minter Blvd, San Antonio, TX, 78229, USA
- Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - Megan E Shepherd-Banigan
- Department of Veterans Affairs Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, San Antonio, USA
- Duke University School of Medicine, Durham, USA
- Center of Innovation To Accelerate Discovery and Practice Transformation, Durham VAMC, Durham, USA
| | - Mary Jo Pugh
- Department of Veterans Affairs Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, San Antonio, USA
- VA Salt Lake City Health Care System/GRECC, Salt Lake City, USA
- University of Utah Health Care School of Medicine, Salt Lake City, USA
| | - Rand Rupper
- Department of Veterans Affairs Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, San Antonio, USA
- VA Salt Lake City Health Care System/GRECC, Salt Lake City, USA
- University of Utah Health Care School of Medicine, Salt Lake City, USA
| | - Erin Finley
- Department of Veterans Affairs Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, San Antonio, USA
- South Texas Veterans Health Care System, 7400 Merton Minter Blvd, San Antonio, TX, 78229, USA
- Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - Julie Parish-Johnson
- Department of Veterans Affairs Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, San Antonio, USA
- South Texas Veterans Health Care System, 7400 Merton Minter Blvd, San Antonio, TX, 78229, USA
- Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - Roxana Delgado
- Department of Veterans Affairs Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, San Antonio, USA
- South Texas Veterans Health Care System, 7400 Merton Minter Blvd, San Antonio, TX, 78229, USA
- Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - Kimberly Peacock
- Department of Veterans Affairs Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, San Antonio, USA
- South Texas Veterans Health Care System, 7400 Merton Minter Blvd, San Antonio, TX, 78229, USA
- Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - Andrea Kalvesmaki
- Department of Veterans Affairs Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, San Antonio, USA
- VA Salt Lake City Health Care System/GRECC, Salt Lake City, USA
- University of Utah Health Care School of Medicine, Salt Lake City, USA
| | - Courtney H Van Houtven
- Department of Veterans Affairs Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, San Antonio, USA
- Duke University School of Medicine, Durham, USA
- Center of Innovation To Accelerate Discovery and Practice Transformation, Durham VAMC, Durham, USA
| |
Collapse
|
31
|
Graven LJ, Abbott L, Boel-Studt S, Grant JS, Buck HG. Classifying Heart Failure Caregivers as Adequately or Inadequately Resourced to Care: A Latent Class Analysis. J Palliat Care 2022; 38:62-70. [PMID: 35171062 DOI: 10.1177/08258597221079244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To identify classes of heart failure (HF) caregivers based upon indicators of coping resources and stress, and then, to examine the relationships between the identified caregiver classes and depression, caregiver burden, and life changes. METHODS Cross-sectional data from 530 HF caregivers were analyzed in this secondary analysis using a three-step latent class mixture model to classify caregivers based on level of resources and examine the relationship between the identified classes and depression, caregiver burden, and life changes. Using an online survey, caregivers reported on social support, problem-solving, family function, depression, caregiver burden, and life changes. RESULTS Caregivers were 41.39 (± 10.38) years of age, 49.1% women, 78.3% white, 77.6% urban-dwelling, and 61.7% college/postgraduate educated. Three classes of caregivers (42.3% Adequately Resourced, 25.1% At Risk for Decompensation, 32.6% Inadequately Resourced) were identified. Inadequately Resourced caregivers had the lowest levels of social support, problem-solving, and family function and the highest levels of depression and caregiver burden. Caregivers At Risk for Decompensation had the best family function and reported the most positive perceptions of life changes despite low levels of social support and problem-solving. CONCLUSION Social support, problem-solving, and family function are modifiable coping resources which may buffer stress and influence stress indicators. Caregivers with few coping resources may experience higher degrees of depression and burden, and less positive perceptions of life changes. More research is needed to examine the influence of these coping resources on caregiver adaptation to facilitate the development of targeted interventions which support caregiver mental health.
Collapse
Affiliation(s)
- Lucinda J Graven
- College of Nursing, Florida State University, Tallahassee, FL, USA
| | - Laurie Abbott
- College of Nursing, Florida State University, Tallahassee, FL, USA
| | - Shamra Boel-Studt
- College of Social Work, Florida State University, Tallahassee, FL, USA
| | - Joan S Grant
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Harleah G Buck
- College of Nursing, University of Iowa, Iowa City, IA, USA
| |
Collapse
|
32
|
Heart Failure Care: Testing Dyadic Dynamics Using the Actor-Partner Interdependence Model (APIM)-A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19041919. [PMID: 35206131 PMCID: PMC8871794 DOI: 10.3390/ijerph19041919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 02/05/2022] [Accepted: 02/06/2022] [Indexed: 02/04/2023]
Abstract
Self-care behaviors are essential for the effective treatment of heart failure (HF), and poor self-care may lead to adverse clinical events in patients with HF. A growing body of literature addresses the need to analyze the characteristics of both patient and caregiver since they are in mutual, long-term interaction, and their reactions to events are dependent on each other. One of the most common approaches for analyzing data on HF self-care dyads is the Actor–Partner Interdependence Model (APIM). The purpose of this study was to conduct a scoping review to answer the following question: what did we learn from HF dyadic studies based on the APIM approach? Medline, Academic Search Ultimate, and CINAHL Complete databases were searched, using the terms “dyad,” “dyadic,” and “heart failure,” for studies published between 2009 and April 2021. Fifteen studies were reviewed from a pool of 106 papers. Studies using the APIM approach revealed interrelated patient and caregiver characteristics that influence self-care and explain many complex dyadic behaviors. Our analysis provided evidence that (1) APIM is a useful analytical approach; (2) a family-oriented approach can improve the functioning of a patient with HF; and (3) social support from caregivers significantly enhances patients’ adaptation to illness.
Collapse
|
33
|
Yun S, Enjuanes C, Calero-Molina E, Hidalgo E, José N, Calvo E, Verdú-Rotellar JM, Garcimartín P, Chivite D, Formiga F, Jiménez-Marrero S, Garay A, Alcoberro L, Moliner P, Corbella X, Comín-Colet J. Effectiveness of telemedicine in patients with heart failure according to frailty phenotypes: Insights from the iCOR randomised controlled trial. Eur J Intern Med 2022; 96:49-59. [PMID: 34656406 DOI: 10.1016/j.ejim.2021.09.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 09/02/2021] [Accepted: 09/14/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND The potential impact of telemedicine (TM) in the monitoring of patients with heart failure (HF) is still uncertain particularly in the frailest patients. The aim of this study was to define the efficacy of a TM-based managed care solution across different HF patient frailty phenotypes. METHODS We performed a clustering analysis on the basis of 8 frailty-related dimensions to the HF-patients included in the 'insuficiència Cardíaca Optimització Remota' (iCOR) randomised study comparing TM vs. usual care (UC) in HF patients. The primary study endpoint was the incidence of a non-fatal HF event after 6 months of inclusion. The healthcare-related costs in each study group and cluster were also evaluated. The event rates of primary and secondary study endpoints were calculated for each cluster. Cox proportional-hazards regression models were used to evaluate the effect of cluster, treatment group and the interaction term cluster by treatment group on study endpoints. RESULTS 5 different frailty phenotypes were identified. The positive effect of TM compared to UC strategy was consistent across all frailty phenotypes (p-value for interaction 0.711). The risk of experiencing a primary event was significantly lower in patients that underwent allocation to the TM arm compared to UC (p-value = 0.016). Ultimately, the healthcare costs were significantly reduced in patients allocated to the TM compared to UC in all 5 frailty phenotypes (all p-value < 0.05). CONCLUSIONS Non-invasive TM-based follow-up tools are effective compared to UC follow-up in preventing HF events in the early post-discharge period, regardless of the 5 frailty phenotypes.
Collapse
Affiliation(s)
- Sergi Yun
- Community Heart Failure Program, Departments of Cardiology and Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Department of Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Cristina Enjuanes
- Community Heart Failure Program, Departments of Cardiology and Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Esther Calero-Molina
- Community Heart Failure Program, Departments of Cardiology and Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Encarnación Hidalgo
- Community Heart Failure Program, Departments of Cardiology and Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Núria José
- Community Heart Failure Program, Departments of Cardiology and Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Elena Calvo
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Faculty of medicine and Health Sciences, School of Nursing, University of Barcelona (UB), Barcelona, Spain
| | - José María Verdú-Rotellar
- Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Jordi Gol Primary Care Research Institute, Catalan Institute of Heath, Barcelona, Spain
| | - Paloma Garcimartín
- Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Outpatient Clinics, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain; Escuela Superior de Enfermería del Mar, Parc de Salut Mar, Barcelona, Spain
| | - David Chivite
- Department of Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Francesc Formiga
- Department of Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Santiago Jiménez-Marrero
- Community Heart Failure Program, Departments of Cardiology and Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Department of Cardiology, Cardio-Oncology Unit, Bellvitge University Hospital and Catalan Institute of Oncology, L'Hospitalet del Llobregat, Barcelona, Spain
| | - Alberto Garay
- Community Heart Failure Program, Departments of Cardiology and Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Department of Cardiology, Cardio-Oncology Unit, Bellvitge University Hospital and Catalan Institute of Oncology, L'Hospitalet del Llobregat, Barcelona, Spain
| | - Lídia Alcoberro
- Community Heart Failure Program, Departments of Cardiology and Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Pedro Moliner
- Community Heart Failure Program, Departments of Cardiology and Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Department of Cardiology, Cardio-Oncology Unit, Bellvitge University Hospital and Catalan Institute of Oncology, L'Hospitalet del Llobregat, Barcelona, Spain
| | - Xavier Corbella
- Department of Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Hestia Chair in Integrated Health and Social Care, School of Medicine, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Josep Comín-Colet
- Community Heart Failure Program, Departments of Cardiology and Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Department of Clinical Sciences, School of Medicine, University of Barcelona (UB), Barcelona, Spain.
| |
Collapse
|
34
|
Dellafiore F, Arrigoni C, Nania T, Caruso R, Baroni I, Vangone I, Russo S, Barello S. The impact of COVID-19 pandemic on family caregivers' mental health: a rapid systematic review of the current evidence. ACTA BIO-MEDICA : ATENEI PARMENSIS 2022; 93:e2022154. [PMID: 35545977 PMCID: PMC9534216 DOI: 10.23750/abm.v93is2.12979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 04/01/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIM OF THE WORK Older adults, especially in isolation and with cognitive decline/dementia, can become more anxious and stressed during the quarantine. All these symptoms negatively affect the psycho-physical health of their caregivers. This study aimed to synthesize the current evidence on the impact of the COVID-19 pandemic on caregivers' mental health. METHODS A rapid systematic review was conducted using the following databases: Pubmed/Medline, CINAHL, Scopus, and PsycInfo (PROSPERO registration number: CRD42020215485). The 'PRISMA' flow chart guided the selection of articles. The search was entirely performed up to September 15th, 2021. RESULTS The narrative synthesis has brought out two main themes that represent the current debate in literature: "Family caregivers COVID-19 related stress", and "(Mal)adaptive strategies to the "new" normality". CONCLUSIONS This study provides an evidence synthesis of the negative mental health impact experienced by caregivers of older adults during the COVID-19 pandemic.
Collapse
Affiliation(s)
- Federica Dellafiore
- Department of Public Health, Experimental and Forensic Medicine, Section of Hygiene, University of Pavia, Pavia, Italy
| | - Cristina Arrigoni
- Department of Public Health, Experimental and Forensic Medicine, Section of Hygiene, University of Pavia, Pavia, Italy
| | - Tiziana Nania
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato (MI), Department of Psychology, EngageMinds HUB – Consumer, Food & Health Engagement Research Center, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Rosario Caruso
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato (MI)
| | - Irene Baroni
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato (MI)
| | - Ida Vangone
- Department of Oncology and Hematology-Oncology, IEO IEO-European Institute of Oncology, Milan, Italy
| | - Sara Russo
- Nursing degree course, University of Pavia, section Istituti Clinici di Pavia e Vigevano S.p.A., Pavia, Italy
| | - Serena Barello
- Department of Psychology, EngageMinds HUB – Consumer, Food & Health Engagement Research Center, Università Cattolica del Sacro Cuore, Milan, Italy
| |
Collapse
|
35
|
Suksatan W, Tankumpuan T, Davidson PM. Heart Failure Caregiver Burden and Outcomes: A Systematic Review. J Prim Care Community Health 2022; 13:21501319221112584. [PMID: 35938489 PMCID: PMC9364181 DOI: 10.1177/21501319221112584] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Introduction/Objective: This review aimed to summarize articles describing caregiver burden and the
relationship between health outcomes as well as describing interventions
focusing on this population. Methods: The review used the PRISMA statement and Whittemore and Knafl guidelines. The
search engines Scopus, PubMed, Ovid (PsycINFO), and CINAHL were searched for
articles published in English. Results: This review included 30 studies that met the criteria. Physical,
psychological, and social factors were associated with HF caregiver burden.
HF caregiver interventions included health education, post-discharge home
visits, phone calls, counseling, and support groups that demonstrated some
potential to reduce the caregivers’ burden. Discussion: Healthcare provider team should screen for caregiver burden and promote
healthy behaviors, and strategies to improve quality of life. Further
studies should include caregivers as care team members and embed social
networking in the interventions for reducing HF caregiver burden. The
caregivers’ burden could influence the poor outcomes of care, including
physical, psychological, societal, and functional dimensions. Future
interventions should develop to alleviate HF caregiver burden.
Collapse
Affiliation(s)
- Wanich Suksatan
- Faculty of Nursing, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand.,Trudy Busch-Valentine School of Nursing, Saint Louis University, Saint Louis, MO, USA
| | | | | |
Collapse
|
36
|
Li S, Li Q, Jiang C, Chen X, Lai Y, He L, Cui F, Wu J, Hu R, Jia C, Feng L, Sang C, Tang R, Long D, Du X, Dong J, Ma C. Factors associated with depression and anxiety among caregivers of patients with atrial fibrillation. J Clin Nurs 2021; 31:3263-3271. [PMID: 34866264 DOI: 10.1111/jocn.16165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 11/16/2021] [Accepted: 11/19/2021] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To assess the prevalence and associated factors of depression and anxiety among caregivers of patients with atrial fibrillation. BACKGROUND Depression and anxiety are common in caregivers of patients with cardiovascular diseases, including heart failure and coronary artery disease. However, studies about depression and anxiety among caregivers of patients with atrial fibrillation are limited. DESIGN Cross-sectional study. METHODS We enrolled 465 dyads of patients with atrial fibrillation and their primary family caregivers from Beijing Anzhen Hospital between September 2020 and March 2021. The patient-caregiver dyads were excluded if primary family caregivers had previous mental disorders before the patient diagnosis of atrial fibrillation. Depression and anxiety of patients and caregivers were measured by Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7 scale. Multivariate logistic regression analysis was used to assess factors associated with depression and anxiety of caregivers. STROBE guidelines were followed to report this study. RESULTS The prevalence of caregiver depression (Patient Health Questionnaire-9 score ≥5) and anxiety (Generalized Anxiety Disorder-7 score ≥5) was 14.0% and 13.5% respectively. Caregiver number of comorbidities ≥2 and patient depression were significantly associated with caregiver depression. Caregiver age ≥65 years, caregiver female sex and patient anxiety were predictors of caregiver anxiety. CONCLUSIONS Depression and anxiety are common in caregivers of patients with AF. Better management of caregiver mental problems and associated factors may benefit both patients and caregivers. RELEVANCE TO CLINICAL PRACTICE Clinicians and nurses should pay more attention to depression and anxiety in caregivers of patients with atrial fibrillation, and provide support to caregivers in most need.
Collapse
Affiliation(s)
- Sitong Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Qifan Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Chao Jiang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Xuan Chen
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Yiwei Lai
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Liu He
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Feihuan Cui
- Department of Psychology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jiahui Wu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Rong Hu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Changqi Jia
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Li Feng
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Caihua Sang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Ribo Tang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Deyong Long
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Xin Du
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China.,Heart Health Research Center, Beijing, China
| | - Jianzeng Dong
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Changsheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| |
Collapse
|
37
|
Patient and Caregiver Health-related Quality of Life and Caregiver Burden While Awaiting Heart Transplantation: Findings From the Sustaining Quality of Life of the Aged: Heart Transplant or Mechanical Support (SUSTAIN-IT) Study. Transplant Direct 2021; 7:e796. [PMID: 34841048 PMCID: PMC8613352 DOI: 10.1097/txd.0000000000001249] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 09/22/2021] [Indexed: 11/26/2022] Open
Abstract
Background We sought to compare change over time (baseline to 2 y) in health-related quality of life (HRQOL) between older (60-80 y) patients awaiting heart transplantation (HT) with mechanical circulatory support (MCS) versus without MCS and their caregivers and caregiver burden. Methods This study was conducted at 13 United States sites. Patient HRQOL was examined using the EuroQol 5-dimensional questionnaire (EQ-5D-3L) and Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12). Caregiver measures included the EQ-5D-3L and Oberst Caregiving Burden Scale, measuring time on task and difficulty. Analyses included analysis of variance, χ2, and linear regression. Results We enrolled 239 HT candidates (n = 118 with MCS and n = 121 without MCS) and 193 caregivers (n = 92 for candidates with MCS and n = 101 for candidates without MCS). Baseline differences in HRQOL were observed between HT candidates with and without MCS: EQ-5D-3L visual analog scale (VAS) score (67.7 ± 17.6 versus 54.1 ± 23.3, P < 0.001) and KCCQ-12 overall summary score (59.9 ± 21.0 versus 48.9 ± 21.6, P < 0.001), respectively. HT candidates with MCS had significantly higher EQ-5D-3L VAS scores and KCCQ-12 overall summary score across time versus without MCS. Baseline EQ-5D-3L VAS scores did not differ significantly between caregivers of HT candidates with and without MCS (84.6 ± 12.9 versus 84.3 ± 14.4, P = 0.9), respectively, nor were there significant between-group differences over time. Caregivers for HT candidates with MCS reported more task difficulty (range: 1 = not difficult to 5 = extremely difficult) versus caregivers for those without MCS at baseline (1.4 ± 0.5 versus 1.2 ± 0.3, P = 0.004) and over time. Conclusions Understanding differences in HRQOL and caregiver burden among older HT candidates with and without MCS and their caregivers may inform strategies to enhance HRQOL and reduce burden.
Collapse
|
38
|
Bidwell JT, Hostinar CE, Higgins MK, Abshire MA, Cothran F, Butts B, Miller AH, Corwin E, Dunbar SB. Caregiver subjective and physiological markers of stress and patient heart failure severity in family care dyads. Psychoneuroendocrinology 2021; 133:105399. [PMID: 34482256 PMCID: PMC8530937 DOI: 10.1016/j.psyneuen.2021.105399] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 08/23/2021] [Indexed: 12/20/2022]
Abstract
Greater family caregiver exposure to uncontrolled patient symptoms is predictive of greater caregiver psychological and physiological stress in dementia and other chronic illnesses, but these phenomena have not been well-studied in heart failure (HF) - a disease with high symptom burden. The purpose of this study was to test the hypothesis that worse patient functional status (as reflected by increasing HF symptoms) would be associated with elevated psychological and physiological stress for the caregiver. This was a secondary analysis of data from 125 HF caregivers in the Caregiver Opportunities for Optimizing Lifestyle (COOL) study. Psychological stress was measured on four dimensions: care-related strain/burden (Oberst Caregiving Burden Scale), depression (Center for Epidemiological Studies Depression Scale), anxiety (State-Trait Anxiety Index), and general stress (Perceived Stress Scale). Physiological stress was measured by markers of HPA axis function (elevated cortisol awakening response [CAR]), endothelial dysfunction (increased PAI-1), and inflammation (increased IL-6, hsCRP). HF patient functional status was quantified by caregiver assessment of New York Heart Association (NYHA) Class. Generalized linear models were used to test associations between patient NYHA Class and stress (one model per indicator). NYHA Class (ordinal) was backwards difference coded in each model to examine caregiver stress in relation to increasing levels of HF severity. Caregivers were mostly female and in their mid-fifties, with a slight majority of the sample being African American and the patient's spouse. Overall, patient functional status was associated with greater caregiver psychological and physiological stress. In terms of psychological stress, higher NYHA Class was significantly associated with greater caregiver anxiety and general stress, but not with caregiver burden or depression. In terms of physiological stress, higher NYHA Class was associated with elevated markers in all models (elevated CAR and higher IL-6, hsCRP, and PAI-1). Across models, most associations between NYHA Class and stress were present at relatively early stages of functional limitation (i.e. Class II), while others emerged when functional limitations became more severe. To inform timing and mechanisms for much-needed caregiver interventions, research is needed to determine which aspects of HF symptomatology are most stressful for caregivers across the HF trajectory.
Collapse
Affiliation(s)
- Julie T. Bidwell
- Family Caregiving Institute at the Betty Irene Moore School of Nursing; University of California, Davis; 2570 48th Street, Sacramento, CA 95817, United States of America
| | - Camelia E. Hostinar
- Department of Psychology; University of California, Davis; 1 Shields Avenue, Davis, CA 95616, United States of America
| | - Melinda K. Higgins
- Nell Hodgson Woodruff School of Nursing; Emory University; 1520 Clifton Road, Atlanta, GA 30322, United States of America
| | - Martha A. Abshire
- School of Nursing; Johns Hopkins University; 525 N Wolfe Street, Baltimore, MD 21205, United States of America
| | - Fawn Cothran
- Family Caregiving Institute at the Betty Irene Moore School of Nursing, University of California, Davis, 2570 48th Street, Sacramento, CA 95817, United States.
| | - Brittany Butts
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road, Atlanta, GA 30322, United States.
| | - Andrew H. Miller
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Emory University, 12 Executive Park Dr, NE. 2nd Floor, Atlanta, GA 30329
| | - Elizabeth Corwin
- School of Nursing, Columbia University, 560 W. 168th St, Room 600, New York, NY 10032, United States.
| | - Sandra B. Dunbar
- Nell Hodgson Woodruff School of Nursing; Emory University; 1520 Clifton Road, Atlanta, GA 30322, United States of America
| |
Collapse
|
39
|
Bouchard K, Gareau A, Gallant NL, Lalande K, Greenman PS, Sztajerowska K, Tulloch H. Dyadic effects of anxiety and depression on quality of life among couples facing cardiovascular disease. J Psychosom Res 2021; 149:110601. [PMID: 34419759 DOI: 10.1016/j.jpsychores.2021.110601] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 08/12/2021] [Accepted: 08/14/2021] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Anxiety and depression are frequently comorbid in patients with cardiovascular disease (CVD) and a patient's poor mental health may implicate the quality of life (QoL) of a partner. The bidirectional effects of comorbid anxiety and depression on patient and partner outcomes are inadequately understood. The aim of this study was to investigate associations of the combined role of depression and anxiety on patients' and partners' QoL. METHOD In this cross-sectional study, patients with CVD and their partners completed questionnaires measuring anxiety, depression, and QoL. Dyadic data was analyzed using the Actor-Partner Interdependence Model and polynomial interaction for examining the synergistic and dysergistic effects of anxiety and depression (i.e., in combination). RESULTS 181 dyads comprised the study sample (66.3% coronary artery disease; 25.9% female patients). Anxiety and depression, in synergy was associated with poorer QoL in patients and partners (actor effects). Patients that are more anxious than depressed have greater physical QoL whereas partners that are more depressed than anxious have greater emotional QoL (dysergistic actor effects). Patients' more severe symptoms of anxiety and depression, in synergy, was associated with partners' poorer QoL (partner effect). CONCLUSION Anxiety and depression are comorbid and associated with poor QoL in patients and their partners. The results may have implications for secondary prevention programming but future longitudinal studies are warranted to substantiate the cross-sectional findings.
Collapse
Affiliation(s)
- Karen Bouchard
- University of Ottawa Heart Institute, Ottawa, Canada; University of Ottawa, Ottawa, Canada
| | | | | | - Kathleen Lalande
- University of Ottawa Heart Institute, Ottawa, Canada; University of Ottawa, Ottawa, Canada
| | | | | | - Heather Tulloch
- University of Ottawa Heart Institute, Ottawa, Canada; University of Ottawa, Ottawa, Canada.
| |
Collapse
|
40
|
|
41
|
Abstract
BACKGROUND In a study of Italian heart failure patient-caregiver dyads, greater caregiver strain significantly predicted lower patient clinical event risk. OBJECTIVE The purpose of this secondary analysis was to examine this relationship in a sample from the United States. METHODS Data came from 92 dyads who participated in a self-care intervention. Logistic regression was used to test the relationship between baseline strain (Bakas Caregiving Outcomes Scale, divided into tertiles) and patient likelihood of events (heart failure hospitalization/emergency visit or all-cause mortality) over 8 months. RESULTS Nearly half of patients (n = 40, 43.5%) had an event. High (vs low) caregiver strain was associated with a 92.7% event-risk reduction, but with substantial variability around the effect (odds ratio, 0.07; 95% confidence interval, 0.01-0.63; P = .02). CONCLUSIONS Although findings were similar to the Italian study, the high degree of variability and contrasting findings to other studies signal a level of complexity that warrants further investigation.
Collapse
|
42
|
Gilotra NA, Pamboukian SV, Mountis M, Robinson SW, Kittleson M, Shah KB, Forde-McLean RC, Haas DC, Horstmanshof DA, Jorde UP, Russell SD, Taddei-Peters WC, Jeffries N, Khalatbari S, Spino CA, Richards B, Yosef M, Mann DL, Stewart GC, Aaronson KD, Grady KL. Caregiver Health-Related Quality of Life, Burden, and Patient Outcomes in Ambulatory Advanced Heart Failure: A Report From REVIVAL. J Am Heart Assoc 2021; 10:e019901. [PMID: 34250813 PMCID: PMC8483456 DOI: 10.1161/jaha.120.019901] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background Heart failure (HF) imposes significant burden on patients and caregivers. Longitudinal data on caregiver health-related quality of life (HRQOL) and burden in ambulatory advanced HF are limited. Methods and Results Ambulatory patients with advanced HF (n=400) and their participating caregivers (n=95) enrolled in REVIVAL (Registry Evaluation of Vital Information for VADs [Ventricular Assist Devices] in Ambulatory Life) were followed up for 24 months, or until patient death, left ventricular assist device implantation, heart transplantation, or loss to follow-up. Caregiver HRQOL (EuroQol Visual Analog Scale) and burden (Oberst Caregiving Burden Scale) did not change significantly from baseline to follow-up. At time of caregiver enrollment, better patient HRQOL by Kansas City Cardiomyopathy Questionnaire was associated with better caregiver HRQOL (P=0.007) and less burden by both time spent (P<0.0001) and difficulty (P=0.0007) of caregiving tasks. On longitudinal analyses adjusted for baseline values, better patient HRQOL (P=0.034) and being a married caregiver (P=0.016) were independently associated with better caregiver HRQOL. Patients with participating caregivers (versus without) were more likely to prefer left ventricular assist device therapy over time (odds ratio, 1.43; 95% CI, 1.03-1.99; P=0.034). Among patients with participating caregivers, those with nonmarried (versus married) caregivers were at higher composite risk of HF hospitalization, death, heart transplantation or left ventricular assist device implantation (hazard ratio, 2.99; 95% CI, 1.29-6.96; P=0.011). Conclusions Patient and caregiver characteristics may impact their HRQOL and other health outcomes over time. Understanding the patient-caregiver relationship may better inform medical decision making and outcomes in ambulatory advanced HF.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Wendy C Taddei-Peters
- Division of Cardiovascular Sciences National Heart, Lung, and Blood Institute Bethesda MD
| | - Neal Jeffries
- Division of Cardiovascular Sciences National Heart, Lung, and Blood Institute Bethesda MD
| | - Shokoufeh Khalatbari
- University of MichiganMichigan Institute for Clinical and Health Research Ann Arbor MI
| | | | - Blair Richards
- University of MichiganMichigan Institute for Clinical and Health Research Ann Arbor MI
| | - Matheos Yosef
- University of MichiganMichigan Institute for Clinical and Health Research Ann Arbor MI
| | | | | | | | | |
Collapse
|
43
|
Srisuk N, Wichit N, Thompson DR, Ski CF. A psychometric evaluation of the Caregiver Contribution to Self-Care of Heart Failure Index in a Thai population. Health Qual Life Outcomes 2021; 19:177. [PMID: 34246255 PMCID: PMC8272368 DOI: 10.1186/s12955-021-01814-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 07/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Caregivers are major contributor to the self-care of patients with heart failure. The Caregiver Contribution to Self-Care of Heart Failure Index (CC-SCHFI) measures these contributions across three scales: self-care maintenance (symptom monitoring and treatment adherence); self-care management (dealing with symptoms); and confidence in contributing to the self-care (self-efficacy in managing self-care) of patients with heart failure. Informal caregivers play a vital role in supporting family members with heart failure in Thailand, yet no validated tool exists to measure their contribution. We examined the psychometric properties of the CC-SCHFI in a Thai population. METHODS The CC-SCHFI was translated into Thai using a standard forward and backward translation procedure. A cross-sectional design was used to examine the psychometric properties of the Thai version of the CC-SCHFI in 100 family caregivers of heart failure patients in Southern Thailand. Confirmatory factor analysis was used to assess construct validity, and factor score determinacy coefficients were computed to evaluate internal consistency reliability. RESULTS The Thai version of the CC-SCHFI demonstrated acceptable internal consistency (composite reliability of each scale ranged from 0.76 to 0.99). Reliability estimates were adequate for each scale (McDonald's omega ranged from 0.75 to 0.96). Confirmatory factor analysis supported the original factor structure of the instrument, with good fit indices for all three scales (comparative fit index = 0.98-1.00; root-mean-square error of approximation = 0.00-0.07). CONCLUSIONS The Thai version of the CC-SCHFI appears to be a valid and reliable instrument for measuring caregiver contributions to self-care maintenance and self-care management as well as contributing to caregiver confidence in the self-care of Thai heart failure patients.
Collapse
Affiliation(s)
- Nittaya Srisuk
- Faculty of Nursing, Surat Thani Rajabhat University, Surat Thani, Thailand
| | - Nutchanath Wichit
- Faculty of Nursing, Surat Thani Rajabhat University, Surat Thani, Thailand
| | - David R Thompson
- School of Nursing and Midwifery, Medical Biology Centre, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, UK.
| | - Chantal F Ski
- Integrated Care Academy, University of Suffolk, Ipswich, UK
| |
Collapse
|
44
|
Wand AL, Russell SD, Gilotra NA. Ambulatory Management of Worsening Heart Failure: Current Strategies and Future Directions. Heart Int 2021; 15:49-53. [PMID: 36277316 PMCID: PMC9524605 DOI: 10.17925/hi.2021.15.1.49] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 02/16/2021] [Indexed: 10/29/2023] Open
Abstract
Heart failure (HF) is a highly prevalent and morbid disease in the USA. The chronic, progressive course of HF is defined by periodic exacerbations of symptoms, described as 'worsening heart failure' (WHF). Previously, episodes of WHF have required hospitalization for intravenous diuretics; however, recent innovations in care delivery models for patients with HF have allowed a transition from the acute care setting to the ambulatory setting. The development of remote monitoring strategies, including device-based algorithms and implantable haemodynamic monitoring systems, has facilitated more advanced surveillance of patients, aiming to prevent the clinical deterioration that leads to hospitalization. Additionally, the establishment of multidisciplinary HF clinics has provided the setting and resources for the outpatient treatment of WHF, specifically the administration of intravenous diuretics. Here we review the current state of ambulatory HF management, including mechanisms for patient monitoring and treatment, and outline future opportunities for outpatient management of this patient population.
Collapse
Affiliation(s)
- Alison L Wand
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Stuart D Russell
- Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Nisha A Gilotra
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
45
|
Longitudinal family caregiving experiences in heart failure: Secondary qualitative analysis of interviews. Heart Lung 2021; 50:627-633. [PMID: 34091108 DOI: 10.1016/j.hrtlng.2021.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 05/09/2021] [Accepted: 05/11/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Considering the potential impacts of family caregivers on heart failure management and the costs of healthcare, health professionals need to pay attention to the challenges faced by family caregivers. OBJECTIVE This study longitudinally explored the caregiving experiences of family caregivers of persons with heart failure. METHODS Serial interview scripts collected from 53 family caregivers were analyzed using a content analysis method. RESULTS The following themes emerged: (1) accumulating knowledge and skills for caregiving; (2) losing a sense of control; (3) balancing an unstable life; (4) constructing illness memory; (5) centering the patient in daily life; (6) accepting the loss of a family member; (7) coping with grief by drawing on social support; (8) facing financial responsibility; and (9) rethinking hospice care. CONCLUSION Family caregivers experience concern about unpredictable caregiving years, disease's fluctuating symptoms and poor prognosis. More educational opportunities, financial counseling programs, and palliative care consultations should be provided.
Collapse
|
46
|
Huhtala M, Geurts S, Mauno S, Feldt T. Intensified job demands in healthcare and their consequences for employee well-being and patient satisfaction: A multilevel approach. J Adv Nurs 2021; 77:3718-3732. [PMID: 34048606 DOI: 10.1111/jan.14861] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 02/22/2021] [Accepted: 03/30/2021] [Indexed: 01/21/2023]
Abstract
AIMS Intensified job demands (IJDs) and their effects on employee burnout, work engagement and patient satisfaction were investigated across different work units and occupational groups in a healthcare setting. DESIGN A multilevel study. METHODS One thousand twenty-four healthcare employees responded to a survey in 2019 and rated their experiences of IJDs, burnout and work engagement. Nine hundred fifty-one patients rated their satisfaction with care received from healthcare staff. RESULTS Work units and occupational groups who shared more experiences of increased time pressure and multitasking reported higher exhaustion. Shared perceptions of increased planning and performing one's work autonomously correlated with higher exhaustion and lower patient satisfaction at the work-unit level. Moreover, work intensification was found to be highest in emergency care and among nurses, while job-related planning demands were highest in leadership services. CONCLUSION IJDs are a shared risk to employee well-being among heterogeneous healthcare staff and relate negatively to customer-rated patient satisfaction. We found that high time-pressure demands increase the shared risk of burnout-especially among nurses and healthcare staff working in emergency care. Furthermore, increased independence and self-determination in planning and executing work tasks also increase the shared risk of burnout especially among those in leadership services. This can lead to lower customer/care satisfaction among patients. IMPACT With the accelerating pace of socio-economic change, the pace of work is also getting faster. Our findings help understand how IJDs are experienced among heterogeneous healthcare staff. Because different occupational groups and work units had different demands, this research shows that attempts to mitigate the negative effects of IJDs need to be planned and implemented in a context-specific way. It seems crucial to pay more attention especially to adequate nurse staffing so that the adverse effects of IJDs could be mitigated among them.
Collapse
Affiliation(s)
- Mari Huhtala
- Department of Psychology, University of Jyväskylä, Jyväskylä, Finland.,School of Business, JAMK University of Applied Sciences, Jyväskylä, Finland
| | - Sabine Geurts
- Faculty of Social Sciences, Radboud University, Nijmegen, The Netherlands
| | - Saija Mauno
- Department of Psychology, University of Jyväskylä, Jyväskylä, Finland.,Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Taru Feldt
- Department of Psychology, University of Jyväskylä, Jyväskylä, Finland
| |
Collapse
|
47
|
Nwosu WO, Rajani R, McDonaugh T, Driscoll E, Hughes LD. Patients' and carers' perspective of the impact of heart failure on quality of life: a qualitative study. PSYCHOL HEALTH MED 2021; 27:1381-1396. [PMID: 33947277 DOI: 10.1080/13548506.2021.1922719] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Heart failure (HF) is a syndrome associated with high mortality and morbidity. HF patients tend to be at a high risk of poor clinical and psychosocial outcomes. This study aimed to capture patients' and carers perspectives of HF, the impact on their health reported QoL, and the factors associated with their poor health outcomes. To explore HF patients' and carers' views on their QoL since diagnosis. This study used a cross-sectional, qualitative design with semi-structured interviews conducted with participating patients and carers. Thirteen adults (> 18 years) with HF and 21 carers were interviewed over the telephone, following a semi-structured interview schedule. Interviews were transcribed verbatim and analysed using inductive thematic analysis. Three main themes were identified, with an overarching theme . Themes included impact on patients' lifestyle including diet, smoking and inability to part-take in social activities, adjusting to HF diagnosis and co-morbidity management, and psychological/mental health issues such as anxiety and depression. Patients with HF are at high-risk of various issues which can negatively impact their QoL. Additionally, Carers play a vital role in the management of HF patients. Effective patient centred care and better communication between patients, carers and healthcare professionals is vital in HF management.
Collapse
Affiliation(s)
- Winifred Onyinyechi Nwosu
- Health Psychology Section, Institute of Psychiatry, Psychology & Neuroscience (Ioppn), King's College London, London, UK
| | - Ronak Rajani
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust London, London, UK
| | - Theresa McDonaugh
- Cardiology Department, King's College Hospital NHS Foundation Trust London, London, UK
| | - Elizabeth Driscoll
- Health Psychology Section, Institute of Psychiatry, Psychology & Neuroscience (Ioppn), King's College London, London, UK
| | - Lyndsay D Hughes
- Health Psychology Section, Institute of Psychiatry, Psychology & Neuroscience (Ioppn), King's College London, London, UK
| |
Collapse
|
48
|
Reblin M, Ketcher D, McCormick R, Barrios-Monroy V, Sutton SK, Zebrack B, Wells KJ, Sahebjam S, Forsyth P, Byrne MM. A randomized wait-list controlled trial of a social support intervention for caregivers of patients with primary malignant brain tumor. BMC Health Serv Res 2021; 21:360. [PMID: 33865382 PMCID: PMC8052543 DOI: 10.1186/s12913-021-06372-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 04/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Informal family caregivers constitute an important and increasingly demanding role in the cancer healthcare system. This is especially true for caregivers of patients with primary malignant brain tumors based on the rapid progression of disease, including physical and cognitive debilitation. Informal social network resources such as friends and family can provide social support to caregivers, which lowers caregiver burden and improves overall quality of life. However, barriers to obtaining needed social support exist for caregivers. To address this need, our team developed and is assessing a multi-component caregiver support intervention that uses a blend of technology and personal contact to improve caregiver social support. METHODS We are currently conducting a prospective, longitudinal 2-group randomized controlled trial which compares caregivers who receive the intervention to a wait-list control group. Only caregivers directly receive the intervention, but the patient-caregiver dyads are enrolled so we can assess outcomes in both. The 8-week intervention consists of two components: (1) The electronic Social Network Assessment Program, a web-based tool to visualize existing social support resources and provide a tailored list of additional resources; and (2) Caregiver Navigation, including weekly phone sessions with a Caregiver Navigator to address caregiver social support needs. Outcomes are assessed by questionnaires completed by the caregiver (baseline, 4-week, 8-week) and the cancer patient (baseline, and 8-week). At 8 weeks, caregivers in the wait-list condition may opt into the intervention. Our primary outcome is caregiver well-being; we also explore patient well-being and caregiver and patient health care utilization. DISCUSSION This protocol describes a study testing a novel social support intervention that pairs a web-based social network visualization tool and resource list (eSNAP) with personalized caregiver navigation. This intervention is responsive to a family-centered model of care and calls for clinical and research priorities focused on informal caregiving research. TRIAL REGISTRATION clinicaltrials.gov , Registration number: NCT04268979 ; Date of registration: February 10, 2020, retrospectively registered.
Collapse
Affiliation(s)
- Maija Reblin
- Department of Health Outcomes & Behavior, Moffitt Cancer Center, 12902 Magnolia Dr, Tampa, FL, 33612, USA.
| | - Dana Ketcher
- Department of Health Outcomes & Behavior, Moffitt Cancer Center, 12902 Magnolia Dr, Tampa, FL, 33612, USA
| | - Rachael McCormick
- Department of Health Outcomes & Behavior, Moffitt Cancer Center, 12902 Magnolia Dr, Tampa, FL, 33612, USA
| | - Veronica Barrios-Monroy
- Department of Health Outcomes & Behavior, Moffitt Cancer Center, 12902 Magnolia Dr, Tampa, FL, 33612, USA
| | - Steven K Sutton
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, FL, USA
| | - Bradley Zebrack
- School of Social Work, University of Michigan, Ann Arbor, MI, USA
| | - Kristen J Wells
- Department of Psychology, San Diego State University, San Diego, CA, USA
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Solmaz Sahebjam
- Department of Neuro-Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Peter Forsyth
- Department of Neuro-Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Margaret M Byrne
- Department of Health Outcomes & Behavior, Moffitt Cancer Center, 12902 Magnolia Dr, Tampa, FL, 33612, USA
| |
Collapse
|
49
|
Lyons KS, Johnson SH, Lee CS. The role of symptom appraisal, concealment and social support in optimizing dyadic mental health in heart failure. Aging Ment Health 2021; 25:734-741. [PMID: 31920088 DOI: 10.1080/13607863.2020.1711866] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Objectives: Heart failure patients and their family care partners experience poor mental health, yet the majority of the research focuses on patients and care partners separately. Guided by the Theory of Dyadic Illness Management, the purpose of the current study was to identify distinct patterns of dyadic mental health in heart failure and identify the individual, dyadic and familial factors associated with group membership.Method: Fifty nine heart failure community-dwelling patients and their spouse care partners were recruited from an outpatient heart failure clinic. Mental health was operationalized by depressive symptoms, measured with the Patient Health Questionnaire-9 (PHQ-9) measure of depression. Distinct groups of dyadic mental health were determined by categorizing depression scores within dyads.Results: Three groups of dyadic mental health were identified: an optimal dyadic mental health group (31%), a poor dyadic mental health group (32%) and an incongruent dyadic mental health group (37%). Patient age, patient fatigue, patient concealment, incongruent dyadic appraisal of pain interference and social/familial support were significantly associated with group membership.Conclusion: Findings underscore the salience of a dyadic approach to health and the clinical relevance of identifying patterns of dyadic mental health so we may determine those most in need of intervention.
Collapse
|
50
|
McHorney CA, Mansukhani SG, Anatchkova M, Taylor N, Wirtz HS, Abbasi S, Battle L, Desai NR, Globe G. The impact of heart failure on patients and caregivers: A qualitative study. PLoS One 2021; 16:e0248240. [PMID: 33705486 PMCID: PMC7951849 DOI: 10.1371/journal.pone.0248240] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 02/23/2021] [Indexed: 01/04/2023] Open
Abstract
Background Heart failure is rising in prevalence but relatively little is known about the experiences and journey of patients and their caregivers. The goal of this paper is to present the symptom and symptom impact experiences of patients with heart failure and their caregivers. Methods This was a United States-based study wherein in-person focus groups were conducted. Groups were audio recorded, transcribed and a content-analysis approach was used to analyze the data. Results Ninety participants (64 patients and 26 caregivers) were included in the study. Most patients were female (52.0%) with mean age 59.3 ± 8 years; 55.6% were New York Heart Association Class II. The most commonly reported symptoms were shortness of breath (81.3%), fatigue/tiredness (76.6%), swelling of legs and ankles (57.8%), and trouble sleeping (50.0%). Patients reported reductions in social/family interactions (67.2%), dietary changes (64.1%), and difficulty walking and climbing stairs (56.3%) as the most common adverse disease impacts. Mental-health sequelae were noted as depression and sadness (43.8%), fear of dying (32.8%), and anxiety (32.8%). Caregivers (mean age 55.5 ± 11.2 years and 52.0% female) discussed 33 daily heart failure impacts, with the top three being reductions in social/family interactions (50.0%); being stressed, worried, and fearful (46.2%); and having to monitor their “patience” level (42.3%). Conclusions There are serious unmet needs in HF for both patients and caregivers. More research is needed to better characterize these needs and the impacts of HF along with the development and evaluation of disease management toolkits that can support patients and their caregivers.
Collapse
Affiliation(s)
| | | | - Milena Anatchkova
- Patient Centered Research, Evidera, Bethesda, MD, United States of America
- * E-mail:
| | - Natalie Taylor
- Patient Centered Research, Evidera, Bethesda, MD, United States of America
| | - Heidi S. Wirtz
- Global Health Economics, Amgen, Thousand Oaks, CA, United States of America
| | - Siddique Abbasi
- Global Health Economics, Amgen, Thousand Oaks, CA, United States of America
| | - Lynwood Battle
- Patient Author from Cincinnati, Cincinnati, OH, United States of America
| | - Nihar R. Desai
- Yale School of Medicine, New Haven, CT, United States of America
| | - Gary Globe
- Global Health Economics, Amgen, Thousand Oaks, CA, United States of America
| |
Collapse
|