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Zhang D, Chang T, Zhao K, Wei H, Feng S, Li X. The mediating effect of sense of coherence on the caregiver ability-caregiver burden relationship for caregivers of children with liver transplantation in China. J Pediatr Nurs 2023; 73:72-77. [PMID: 37647791 DOI: 10.1016/j.pedn.2023.08.011] [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: 01/22/2023] [Revised: 08/10/2023] [Accepted: 08/10/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Caregivers of children who have had liver transplantation often experience chronic care stress. Previous studies have focused on caregivers' negative feelings (e.g., caregiver burden), but few studies have focused on caregivers' positive feelings (e.g., sense of coherence) and caregiver ability. OBJECTIVES The study purpose was to investigate the status of the burden of caregivers of children with liver transplantation, and to explore the mediating role of sense of coherence between caregiver ability and caregiver burden. METHODS There were 461 questionnaires collected from a tertiary-level hospital from caregivers of children who had liver transplantation from April to June 2022. Demographic data, Family Caregiver Task Inventory, Sense of Coherence Scale-13, and Zarit Burden Interview were used. The STROBE checklist was monitored. RESULTS The average caregiver burden score was 32.19 ± 16.71. The distribution of caregiver burden levels was mild (42.52%), none (26.25%), moderate (24.95%), and severe (6.29%). Caregiver ability score was negatively correlated with caregiver burden score; however, sense of coherence score was negatively correlated with caregiver burden score. Caregiver ability partially mediated caregiver burden through sense of coherence (38.51%). CONCLUSION The caregiver burden level was not heavy in general. Both positive and negative feelings were present in caregivers. Caregiver ability also reduced the caregiver burden through sense of coherence.
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Affiliation(s)
- Dan Zhang
- School of Medicine, HuangHuai University, Zhumadian, Henan, PR China; Transplantation and Hepatobiliary Department, the First Affiliated Hospital of China Medical University, Shenyang, Liaoning, PR China
| | - Tiantian Chang
- Transplantation and Hepatobiliary Department, the First Affiliated Hospital of China Medical University, Shenyang, Liaoning, PR China; Nursing department, China-Japan Friendship Hospital, Beijing, PR China
| | - Kaijian Zhao
- School of Medicine, HuangHuai University, Zhumadian, Henan, PR China
| | - He Wei
- Transplantation and Hepatobiliary Department, the First Affiliated Hospital of China Medical University, Shenyang, Liaoning, PR China
| | - Shuang Feng
- Transplantation and Hepatobiliary Department, the First Affiliated Hospital of China Medical University, Shenyang, Liaoning, PR China
| | - Xiaofei Li
- Transplantation and Hepatobiliary Department, the First Affiliated Hospital of China Medical University, Shenyang, Liaoning, PR China.
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Jing W, Bi C, Fang Z, Qian C, Chen J, Yu J, Tian G, Ye M, Liu Z. Neuropsychiatric sequelae after liver transplantation and their possible mechanism via the microbiota-gut-liver-brain axis. Biomed Pharmacother 2023; 163:114855. [PMID: 37163780 DOI: 10.1016/j.biopha.2023.114855] [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: 04/04/2023] [Revised: 05/04/2023] [Accepted: 05/04/2023] [Indexed: 05/12/2023] Open
Abstract
Patients after liver transplantation are often impacted by mental and even neuropsychiatric disorders, including depression, sleep disorders, anxiety, and post-traumatic stress disorder. Neuropsychiatric sequelae have an adverse impact on rehabilitation and can even incapacitate people, reducing their quality of life. Despite screening tools and effective treatments, neuropsychiatric sequelae after liver transplantation (NSALT) have not been fully diagnosed and treated. Current research suggests that NSALT may be partly related to intestinal microbial variation, but the detailed mechanism remains unclear. In this review, we describe the clinical and diagnostic features, prevalence, prediction, clinical course and outcome, management, and treatment of NSALT; we also summarize their mechanisms through the microbiota-gut-liver-brain axis. Finally, we propose to improve NSALT on the basis of adjusting the gastrointestinal flora, immune inflammation or vagus nerve (VN), providing a novel strategy for clinical prevention and treatment.
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Affiliation(s)
- Wenhao Jing
- Department of Psychiatry, Shaoxing seventh people's hospital, Mental Health Center, School of Medicine, Shaoxing University, Shaoxing 312000, Zhejiang, China; Department of Pharmacology, School of Medicine, Shaoxing University, Shaoxing, Zhejiang 312000, China; Department of Clinical Medicine, School of Medicine, Shaoxing University, Shaoxing, Zhejiang 312000, China
| | - Chenchen Bi
- Department of Clinical Medicine, School of Medicine, Shaoxing University, Shaoxing, Zhejiang 312000, China
| | - Zhou Fang
- Department of General Practice, Lizhu Branch, Shaoxing Second Hospital, Shaoxing 312000, Zhejiang, China
| | - Chao Qian
- Department of Psychiatry, Shaoxing seventh people's hospital, Mental Health Center, School of Medicine, Shaoxing University, Shaoxing 312000, Zhejiang, China
| | - Jiaqi Chen
- Department of Pharmacology, School of Medicine, Shaoxing University, Shaoxing, Zhejiang 312000, China; Department of Emergency Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong, China
| | - Jingru Yu
- Department of Clinical Medicine, School of Medicine, Shaoxing University, Shaoxing, Zhejiang 312000, China
| | - Guoqiang Tian
- Department of Psychiatry, Shaoxing seventh people's hospital, Mental Health Center, School of Medicine, Shaoxing University, Shaoxing 312000, Zhejiang, China
| | - Mengfei Ye
- Department of Psychiatry, Shaoxing seventh people's hospital, Mental Health Center, School of Medicine, Shaoxing University, Shaoxing 312000, Zhejiang, China.
| | - Zheng Liu
- Department of Pharmacology, School of Medicine, Shaoxing University, Shaoxing, Zhejiang 312000, China.
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Özdemi R AA, Budak FK. The relationship between the care burden and burnout levels of primary caregivers of patients undergoing liver transplantation. Perspect Psychiatr Care 2022; 58:273-277. [PMID: 33792057 DOI: 10.1111/ppc.12782] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 03/06/2021] [Accepted: 03/10/2021] [Indexed: 12/27/2022] Open
Abstract
PURPOSE This study was conducted to determine the relationship between the care burden and burnout level of primary caregivers of patients undergoing liver transplantation. DESIGN AND METHODS The sample size of this descriptive and correlational was determined to be 202 primary caregivers via the power analysis. FINDINGS It can be asserted that the primary caregivers had high burnout and had moderate care burden. It was found that there was a statistically positive moderate correlation between the caregivers' care burden and burnout (p ˂ 0.05). PRACTICE IMPLICATIONS In the study, it was determined that primary caregivers of patients undergoing liver transplantation had higher burnout and moderate care burden. Also, care burden affected burnout.
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Affiliation(s)
- Aysel A Özdemi R
- Department of Psychiatric Nursing, Health Sciences Faculty, Malatya Turgut Özal Unıversıty, Malatya, Turkey
| | - Funda K Budak
- Department of Psychiatric Nursing, Inonu Unıversıty, Malatya, Turkey
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Shah R, Ali FM, Finlay AY, Salek MS. Family reported outcomes, an unmet need in the management of a patient's disease: appraisal of the literature. Health Qual Life Outcomes 2021; 19:194. [PMID: 34353345 PMCID: PMC8339395 DOI: 10.1186/s12955-021-01819-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 07/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A person's chronic health condition or disability can have a huge impact on the quality of life (QoL) of the whole family, but this important impact is often ignored. This literature review aims to understand the impact of patients' disease on family members across all medical specialities, and appraise existing generic and disease-specific family quality of life (QoL) measures. METHODS The databases Medline, EMBASE, CINHAL, ASSIA, PsycINFO and Scopus were searched for original articles in English measuring the impact of health conditions on patients' family members/partner using a valid instrument. RESULTS Of 114 articles screened, 86 met the inclusion criteria. They explored the impact of a relative's disease on 14,661 family members, mostly 'parents' or 'mothers', using 50 different instruments across 18 specialities including neurology, oncology and dermatology, in 33 countries including the USA, China and Australia. These studies revealed a huge impact of patients' illness on family members. An appraisal of family QoL instruments identified 48 instruments, 42 disease/speciality specific and six generic measures. Five of the six generics are aimed at carers of children, people with disability or restricted to chronic disease. The only generic instrument that measures the impact of any condition on family members across all specialities is the Family Reported Outcome Measure (FROM-16). Although most instruments demonstrated good reliability and validity, only 11 reported responsiveness and only one reported the minimal clinically important difference. CONCLUSIONS Family members' QoL is greatly impacted by a relative's condition. To support family members, there is a need for a generic tool that offers flexibility and brevity for use in clinical settings across all areas of medicine. FROM-16 could be the tool of choice, provided its robustness is demonstrated with further validation of its psychometric properties.
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Affiliation(s)
- R. Shah
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - F. M. Ali
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - A. Y. Finlay
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - M. S. Salek
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
- Institute of Medicines Development, Cardiff, UK
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Chang YH, Lai YH, Lee PH, Tsai MK, Shun SC. Unmet Care Needs and Related Factors of Spouses of Liver or Kidney Transplant Recipients. Clin Nurs Res 2021; 30:1038-1046. [PMID: 33403861 DOI: 10.1177/1054773820985289] [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: 11/15/2022]
Abstract
This study aimed to (1) explore the unmet care needs of spouses of liver or kidney transplant recipients, (2) compare the unmet care needs, depression, and anxiety levels of transplant recipients and their spouses, and (3) identify factors related to spouses' unmet care needs. A cross-sectional study was conducted using purposive sampling from transplant outpatient departments at a medical center. Ninety-one liver or kidney transplant recipient-spouse dyads were recruited. Most unmet needs for dyads were involved in the psychological needs and health system and service needs domains. Spouses had significantly higher unmet needs, anxiety, and depression than recipients did. The significant factors related to the spouses' unmet needs included being male, having higher anxiety, and whose partners had higher unmet needs. Health care professionals must attend to the needs of both recipients and spouses. Providing disease-specific information and resources to spouses who potentially had higher unmet needs is strongly suggested.
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Affiliation(s)
- Yu-Hsuan Chang
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Nursing, National Tainan Junior College of Nursing, Tainan, Taiwan
| | - Yeur-Hur Lai
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Nursing, National Taiwan University Cancer Center, Taipei, Taiwan
| | - Po-Huang Lee
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Meng-Kun Tsai
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.,College of Medicine, National Taiwan University, Taipei, Taiwan.,National Taiwan University Hospital Hsin-Chu Branch, HsinChu, Taiwan
| | - Shiow-Ching Shun
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
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Lu H, Hu Y, Xu J, Qin W, Cao Y, Li J, Wei L, Li C, Qiao Y. WITHDRAWN: Self-Management Behavior, Symptom Occurrence, and Psychological Distress in Liver Transplant Recipients in China: A Descriptive Correlational Study. Transplant Proc 2020:S0041-1345(18)31373-3. [PMID: 32622520 DOI: 10.1016/j.transproceed.2019.02.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 02/03/2019] [Indexed: 12/26/2022]
Abstract
This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.
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Affiliation(s)
- Huijuan Lu
- School of Nursing, Fudan University, Shanghai, People's Republic of China
| | - Yan Hu
- School of Nursing, Fudan University, Shanghai, People's Republic of China
| | - Jianming Xu
- Department of Nursing, Zhongshan Hospital, affiliated with Fudan University, Shanghai, People's Republic of China
| | - Wei Qin
- Department of Nursing, Zhongshan Hospital, affiliated with Fudan University, Shanghai, People's Republic of China
| | - Yanpei Cao
- Department of Nursing, Huashan Hospital, affiliated with Fudan University, Shanghai, People's Republic of China
| | - Juan Li
- Department of Nursing, Huashan Hospital, affiliated with Fudan University, Shanghai, People's Republic of China
| | - Linbo Wei
- School of Nursing, Fudan University, Shanghai, People's Republic of China
| | - Caixia Li
- School of Nursing, Fudan University, Shanghai, People's Republic of China
| | - Yue Qiao
- School of Nursing, Fudan University, Shanghai, People's Republic of China
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Yanny B, Pham NV, Saleh H, Saab S. Approaches to Assessing Burden in Caregivers of Patients with Cirrhosis. J Clin Transl Hepatol 2020; 8:127-134. [PMID: 32832392 PMCID: PMC7438349 DOI: 10.14218/jcth.2019.00054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 02/12/2020] [Accepted: 03/15/2020] [Indexed: 12/28/2022] Open
Abstract
Background and Aims: Being a caregiver for a patient with chronic liver disease (CLD) can be burdensome mentally, emotionally financially, and physically. The aim of this study was to systemically review the available tools and propose tools that can comprehensively evaluate caregiver burden for individuals caring for patients with CLD. Methods: We searched the PubMed database for all studies on the impact of patients with CLD on caregiver burden without timeframe restriction. Eligible studies included cohort studies, review studies, or cross-sectional studies. The number of patients and caregivers was isolated from each paper. Studies in the same categories were isolated and statistically compared. Results: A total of 13 studies meeting our inclusion criteria as stated in the methods sections were included. In total, 2528 caregivers were taking care of 2003 patients with CLD. Women made up the majority of caregivers at 78.2%, 95.7% of whom identified as the patient's spouse. Caregiver strain index is one of the most comprehensive tools; however, the questions are very general and do not fully elucidate financial strain. Beck depression and anxiety were correlated (p=0.0001), and both depression and anxiety were correlated with perceived caregiver burden (PCB) and Zarit Burden Interview (ZBI) (p=0.002). Depression scale correlated with Interpersonal Support Evaluation - Short Form, and Model for End-Stage Liver Disease score correlated with ZBI and PCB (total and in most domains; p=0.001). Patient's poorer cognitive performance correlated with higher ZBI and PCB (employed patients had higher cognitive performance and lower ZBI and PCB). Conclusions: Caregiver burden remains poorly understood due to the lack of uniformity in the assessment tools used to evaluate caregiver burden. None of the tools used to evaluate caregiver burden are comprehensive; however, most tools correlate statistically in the ability to identify caregiver burden. A comprehensive tool is lacking for identifying caregiver burden in patients with CLD.
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Affiliation(s)
- Beshoy Yanny
- Department of Medicine, University of California at Los Angeles, CA, USA
| | - Nguyen V. Pham
- Department of Surgery, University of California at Los Angeles, CA, USA
| | - Hussein Saleh
- Department of Surgery, University of California at Los Angeles, CA, USA
| | - Sammy Saab
- Department of Medicine, University of California at Los Angeles, CA, USA
- Department of Surgery, University of California at Los Angeles, CA, USA
- Correspondence to: Sammy Saab, Pfleger Liver Institute, UCLA Medical Center, 200 Medical Plaza, Suite 214, Los Angeles, CA 90095, USA. Tel: +1-310-206-6705, Fax: +1-310-206-4197, E-mail:
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8
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Yagelniski A, Rosaasen N, Cardinal L, Fenton ME, Tam J, Mansell H. A Qualitative Study to Explore the Needs of Lung Transplant Caregivers. Prog Transplant 2020; 30:243-248. [PMID: 32552359 DOI: 10.1177/1526924820933842] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Providing support throughout the lung transplant process is an intensive task, which requires a dedicated caregiver. The needs of caregivers who must relocate with their loved one receiving the transplant are currently unknown. The objective of this study is to explore experiences and perceptions of lung transplant caregivers identified from a satellite clinic to inform the development of educational resources. METHODS A qualitative study with a phenomenology approach was undertaken with individuals who have taken on the role of a caregiver for lung transplant candidates or recipients and must travel to the specialized transplant center. Semistructured interviews were conducted with 12 caregivers. Interviews conducted by phone were audio-recorded and then transcribed verbatim. NVivo software was used to code the data and identify emerging themes. RESULTS Ideas were classified into the following 4 themes: (1) the stress of being a caregiver, (2) caregivers undertake a variety of roles, (3) caregivers require support, and (4) satisfaction with health care providers. Even though the caregivers lived an average of 7.1 (standard deviation 2) hours from the surgical transplant center, all expressed satisfaction with the level of care that they received. Caregivers identified several stressors during the transplant process and described various strategies for coping. CONCLUSION Caregivers shared their experiences on the transplant process. It was evident that being a caregiver was a stressful and supports were necessary for those undertaking this role. These insights will help inform the development of a new educational resource for patients and caregivers.
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Affiliation(s)
| | - Nicola Rosaasen
- Saskatchewan Transplant Program, 7234Saskatchewan Health Authority, Saskatoon, Saskatchewan, Canada
| | - Louise Cardinal
- Saskatchewan Transplant Program, 7234Saskatchewan Health Authority, Saskatoon, Saskatchewan, Canada
| | - Mark E Fenton
- Division of Respirology, Critical Care, and Sleep Medicine, College of Medicine, 12371University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Julian Tam
- Division of Respirology, Critical Care, and Sleep Medicine, College of Medicine, 12371University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Holly Mansell
- College of Pharmacy and Nutrition, 70398University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Shrestha D, Rathi S, Grover S, Taneja S, Duseja A, Chawla YK, Dhiman RK. Factors Affecting Psychological Burden on the Informal Caregiver of Patients With Cirrhosis: Looking Beyond the Patient. J Clin Exp Hepatol 2020; 10:9-16. [PMID: 32025162 PMCID: PMC6995890 DOI: 10.1016/j.jceh.2019.06.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 06/13/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND AND AIMS Cirrhosis leads to considerable morbidity and mortality, compromises quality of life, and often necessitates assistance in activities of daily living. An informal caregiver bears the psychological burden of coping with the needs of the patient and the knowledge of morbid prognosis of a loved one. This aspect is rarely recognized and almost never addressed in a clinical practice. METHODS This cross-sectional study assessed the factors influencing psychological burden of cirrhosis on the caregivers in a predominantly lower-middle socioeconomic class Indian population. Patients underwent psychometric tests [Psychometric Hepatic Encephalopathy Score (PHES)], and questionnaires for quantifying caregiver burden [Perceived Caregiver Burden (PCB) and Zarit Burden Interview (ZBI)] and assessing depression [Beck Depression Inventory (BDI)] and anxiety [Beck Anxiety Inventory (BAI)] were administered. RESULTS One hundred patients with cirrhosis [70% male, 27% with past hepatic encephalopathy (HE), and 53% with minimal HE] and their caregivers (66% women, 81% spouse, 26.51 years of mean relationship) were evaluated. Caregiver burden scores were higher in patients with previous overt HE than in those without previous overt HE [PCB (74.63 vs. 66.15, P = 0.001), ZBI (27.93 vs. 21.11, P = 0.023), BDI (11.63 vs. 8.96, P = 0.082), and BAI (11.37 vs. 8.12, P = 0.027)]. Similarly, caregivers of patients with minimal HE had higher caregiver burden that those of patients who did not have minimal HE [PCB (70.74 vs. 65.85, P = 0.027), ZBI (26 vs. 19.51, P = 0.015)]. Burden scores correlated well with each other and with liver disease severity scores and negatively correlated with socioeconomic status. Repeated hospital admissions, alcohol as etiology, and lower socioeconomic status were the independent predictors of caregiver burden. CONCLUSION Higher perceived burden is common in caregivers of patients with cirrhosis. Repeated hospital admissions, alcoholism, and lower socioeconomic status influence caregiver burden.
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Affiliation(s)
- Deepa Shrestha
- Department of Internal Medicine, Postgraduate Institution of Medical Education and Research, Chandigarh, India
| | - Sahaj Rathi
- Department of Hepatology, Postgraduate Institution of Medical Education and Research, Chandigarh, India
| | - Sandeep Grover
- Department of Psychiatry, Postgraduate Institution of Medical Education and Research, Chandigarh, India
| | - Sunil Taneja
- Department of Hepatology, Postgraduate Institution of Medical Education and Research, Chandigarh, India
| | - Ajay Duseja
- Department of Hepatology, Postgraduate Institution of Medical Education and Research, Chandigarh, India
| | - Yogesh K. Chawla
- Department of Hepatology, Postgraduate Institution of Medical Education and Research, Chandigarh, India
| | - Radha K. Dhiman
- Department of Hepatology, Postgraduate Institution of Medical Education and Research, Chandigarh, India,Address for correspondence: Radha K Dhiman, MD, DM, FAMS, FACG, FRCP Edin, FRCP London, FAASLD Professor and Head, Department of Hepatology Post Graduate Institute of Medical Education and Research, Chandigarh, India.
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