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Shaffer KM, Perepezko K, Glazer JV, Mattos MK, Klinger J, Buysse DJ, Ritterband LM, Donovan H. Caregiver Experiences With an Internet-Delivered Insomnia Intervention: SHUTi-CARE Trial Primary Qualitative Analysis. Ann Behav Med 2024:kaae041. [PMID: 38990523 DOI: 10.1093/abm/kaae041] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND Digital health interventions show potential to increase caregivers' access to psychosocial care; however, it is unclear to what extent existing interventions may need to be tailored to meet caregivers' unique needs. PURPOSE This study aimed to determine whether-and if so, how-an efficacious Internet-delivered insomnia program should be modified for caregivers. The generalizability of these findings beyond the tested program was also examined. METHODS Higher-intensity family caregivers (N = 100; age M = 52.82 [SD = 13.10], 75% non-Hispanic White, 66% ≥college degree) received access to an Internet-based cognitive-behavioral therapy for insomnia (CBT-I) program. Participants who completed one or more intervention "Cores" provided open-ended feedback on their experience; nonusers (completed no Cores) shared their barriers. RESULTS Most caregivers who used the program (n = 82, 82%) found it feasible, citing its user-friendly, fully automated online format. Many reported that CBT-I strategies were helpful, although some faced challenges in implementing these strategies due to the unpredictability of their caregiving responsibilities. Opinions were divided on the utility of tailoring the program for caregivers. Nonusers (n = 18, 18%) primarily cited concerns about time burden and lifestyle compatibility as usage barriers. CONCLUSIONS Delivering fully automated behavioral interventions through the Internet appears suitable for many caregivers. Extensive tailoring may not be required for most caregivers to benefit from an existing online CBT-I program, although additional guidance on integrating CBT-I strategies in the context of challenging sleep schedules and environments may help a subset of caregivers. Future research should explore how such tailoring may enhance digital health intervention uptake and effectiveness for caregivers.
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Affiliation(s)
- Kelly M Shaffer
- Center for Behavioral Health and Technology, University of Virginia, Charlottesville, VA, USA
- School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Kate Perepezko
- National Center on Family Support, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jillian V Glazer
- Center for Behavioral Health and Technology, University of Virginia, Charlottesville, VA, USA
| | - Meghan K Mattos
- Center for Behavioral Health and Technology, University of Virginia, Charlottesville, VA, USA
- School of Nursing, University of Virginia, Charlottesville, VA, USA
| | - Julie Klinger
- National Center on Family Support, University of Pittsburgh, Pittsburgh, PA, USA
| | - Daniel J Buysse
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Lee M Ritterband
- Center for Behavioral Health and Technology, University of Virginia, Charlottesville, VA, USA
- School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Heidi Donovan
- National Center on Family Support, University of Pittsburgh, Pittsburgh, PA, USA
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
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Shaffer KM, Ritterband LM, You W, Mattos MK, Buysse DJ, Glazer JV, Klinger J, Donovan H. Caregivers' Internet-Delivered Insomnia Intervention Engagement and Benefit: SHUTi-CARE Trial Primary Quantitative Analysis. Ann Behav Med 2024:kaae031. [PMID: 38982942 DOI: 10.1093/abm/kaae031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2024] Open
Abstract
BACKGROUND Delivering insomnia treatment by the Internet holds promise for increasing care access to family caregivers, but their ability to adhere to and benefit from such fully-automated programs has not been rigorously tested. PURPOSE This fully-powered, single-group trial tested whether characteristics of the caregiving context influence high-intensity caregivers' engagement with and benefit from an empirically validated Internet intervention for insomnia. METHODS At baseline, caregivers providing unpaid time- and responsibility-intensive care who reported insomnia (N = 100; age M = 52.82 [SD = 13.10], 75% non-Hispanic white, 66% ≥college degree) completed questionnaires about caregiving context and sleep, then 10 prospectively-collected online daily sleep diaries. Caregivers then received access to SHUTi (Sleep Healthy Using the Internet), which has no caregiver-specific content, for 9 weeks, followed by post-assessment (questionnaires, diaries). Engagement was tracked by the SHUTi delivery system. RESULTS Sixty caregivers completed SHUTi, 22 initiated but did not complete SHUTi, and 18 did not initiate SHUTi. Caregivers were more likely to use SHUTi (than not use SHUTi) when their care recipient (CR) had worse functioning, and were more likely to complete SHUTi when supporting more CR activities of daily living (ADL; ps < .03). Higher caregiver guilt, more CR problem behaviors, and being bedpartners with the CR related to more improved sleep outcomes, whereas supporting more CR instrumental ADL related to less improvement (ps < .05). CONCLUSIONS Factors associated with greater caregiving burden, including greater CR impairment and caregiving guilt, were generally associated with better engagement and outcomes. Caregivers with substantial burdens can adhere to and benefit from a fully automated insomnia program without caregiver-specific tailoring.
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Affiliation(s)
- Kelly M Shaffer
- Center for Behavioral Health and Technology, University of Virginia, Charlottesville, VA, USA
- School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Lee M Ritterband
- Center for Behavioral Health and Technology, University of Virginia, Charlottesville, VA, USA
- School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Wen You
- School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Meghan K Mattos
- Center for Behavioral Health and Technology, University of Virginia, Charlottesville, VA, USA
- School of Nursing, University of Virginia, Charlottesville, VA, USA
| | - Daniel J Buysse
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jillian V Glazer
- Center for Behavioral Health and Technology, University of Virginia, Charlottesville, VA, USA
| | - Julie Klinger
- National Center on Family Support, University of Pittsburgh, Pittsburgh, PA, USA
| | - Heidi Donovan
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- National Center on Family Support, University of Pittsburgh, Pittsburgh, PA, USA
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
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Shaffer KM, Glazer JV, Chow PI, Ingersoll KS, Ritterband LM. Family Cancer Caregiver Use of and Benefit from an Internet-delivered Insomnia Intervention: Results from a Single-Group Feasibility Trial. JOURNAL OF PSYCHOSOCIAL ONCOLOGY RESEARCH AND PRACTICE 2024; 6:129. [PMID: 38962167 PMCID: PMC11218539 DOI: 10.1097/or9.0000000000000129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/05/2024]
Abstract
Background Cancer caregivers are more likely to report clinically significant symptoms of insomnia than cancer patients and the general population, yet research has been limited regarding cognitive-behavioral therapy for insomnia (CBT-I) among this population. Methods To better understand cancer caregivers' engagement with and benefit from CBT-I, cancer caregivers were enrolled in a nonrandomized pilot feasibility trial of an evidence-based Internet-delivered insomnia program. Thirteen caregivers completed mixed-methods assessments prior to receiving the insomnia program and after the nine-week intervention period. Results Compared to the five caregivers who did not complete any intervention Cores, the eight caregivers who completed at least one of the intervention Cores tended to report more sleep impairment (insomnia symptom severity; minutes of sleep onset latency and wake after sleep onset), less physical and emotional strain from caregiving, and less maladaptive sleep beliefs at the baseline assessment. These caregivers who used the program also showed large improvements in their insomnia symptoms. Caregivers' qualitative feedback about their experience with the program identified potential areas that might be modified to improve caregivers' engagement with and benefit from Internet-delivered insomnia programs. Conclusions Findings suggest that family cancer caregivers can use and benefit from a fully-automated Internet-delivered CBT-I program, even without caregiving-specific tailoring. Further rigorous research is needed to better understand whether and how program modifications may allow more caregivers to initiate and engage with this program.
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Affiliation(s)
- Kelly M Shaffer
- Center for Behavioral Health and Technology, University of Virginia, Charlottesville, VA, USA
| | - Jillian V Glazer
- Center for Behavioral Health and Technology, University of Virginia, Charlottesville, VA, USA
| | - Philip I Chow
- Center for Behavioral Health and Technology, University of Virginia, Charlottesville, VA, USA
| | - Karen S Ingersoll
- Center for Behavioral Health and Technology, University of Virginia, Charlottesville, VA, USA
| | - Lee M Ritterband
- Center for Behavioral Health and Technology, University of Virginia, Charlottesville, VA, USA
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Ahn S, Chung ML, Logan JG. Sleep Deficiency by Caregiving Status: Findings From Nationally Representative Data. West J Nurs Res 2023; 45:1120-1129. [PMID: 37902143 PMCID: PMC11298120 DOI: 10.1177/01939459231208416] [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: 10/31/2023]
Abstract
OBJECTIVE Caregiving demands may influence caregivers' sleep duration and quality, which are essential for optimal health. We aimed to examine the association between caregiving status and sleep deficiency (i.e., short sleep duration and/or poor quality) and identify factors associated with sleep deficiency among caregivers. METHODS This secondary analysis used data from 3870 adults living in the United States, obtained from the 2019 Health Information National Trends Survey. Multinomial logistic regressions were performed to examine the association between caregiving status (i.e., caregivers vs. non-caregivers) and sleep status (i.e., normal duration-good quality [optimal sleep, reference], short duration-good quality, normal duration-poor quality, and short duration-poor quality), and to identify caregiving-related factors associated with sleep deficiency in the caregiver group. RESULTS Compared to non-caregivers, caregivers were more likely to report short sleep duration (<7 hours) with good quality sleep (relative risk ratio [RRR] = 1.566, 95% CI [1.238, 1.980]) or poor quality sleep (RRR = 1.376, 95% CI [1.034, 1.832]) than the optimal sleep status. Caregivers providing care for ≥20 hours per week (vs. <20 hours) and providing care to individuals with dementia (vs. no dementia caregiving) were 2.8 times more likely to report normal sleep duration with poor sleep quality than optimal sleep (RRR = 2.796, 95% CI [1.125, 6.950]; RRR = 2.776, 95% CI [1.154, 6.675], respectively). CONCLUSION The findings of a higher risk of sleep deficiency among caregivers suggest that health care providers need to assess both caregivers' sleep duration and quality status. Interventions tailored to the caregiving context are also warranted.
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Affiliation(s)
- Soojung Ahn
- School of Nursing, Vanderbilt University, Nashville, TN, USA
| | - Misook L. Chung
- College of Nursing, University of Kentucky, Lexington, KY, USA
| | - Jeongok G. Logan
- School of Nursing, University of Virginia, Charlottesville, VA, USA
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Yin L, Rong T, Zhang Y, Gao J. The relationship between sleep quality and anxiety and depression among older caregivers of centenarians in China: A cross-sectional study. Geriatr Nurs 2023; 54:302-309. [PMID: 37918038 DOI: 10.1016/j.gerinurse.2023.10.005] [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: 08/07/2023] [Revised: 10/05/2023] [Accepted: 10/05/2023] [Indexed: 11/04/2023]
Abstract
To explore the relationship between sleep quality and anxiety and depression in older caregivers. From April 2020 to November 2022, GAD-7, GDS-15, and PSQI were used to measure anxiety, depression, and sleep quality. The correlation of each variable was explored by regression analysis. Among 442 caregivers ≥ 65 years old, the prevalence of sleep disorders, anxiety, and depression was 40.5 %, 20.2 %, and 26.4 %. After adjustment for multiple potential confounders, anxiety (OR1.1; 95 % CI 1-1.2) and depression (OR 1.29; 95 % CI 1.21-1.38) were associated with sleep disorders. Daytime dysfunction components of PSQI measurements were associated with anxiety(P < 0.05). Meanwhile, sleep efficiency, sleep medication use, and daytime dysfunction components of PSQI measurements were associated with depression(P < 0.05). Therefore, the sleep quality of older caregivers is strongly related to anxiety and depression. It is necessary to provide sleep guidance or professional intervention for older caregivers to reduce anxiety and depression.
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Affiliation(s)
- Lanxin Yin
- Medical School of Nantong University, Nantong 226001, China; Research Center of Clinical Medicine, Affiliated Hospital of Nantong University, Nantong University, Nantong 226001, China; Research Center of Gerontology and Longevity, Affiliated Hospital of Nantong University, Nantong 226001, China
| | - Ting Rong
- Research Center of Clinical Medicine, Affiliated Hospital of Nantong University, Nantong University, Nantong 226001, China; Research Center of Gerontology and Longevity, Affiliated Hospital of Nantong University, Nantong 226001, China; School of Public Health, Nantong University, Nantong 226001, China
| | - Yi Zhang
- Medical School of Nantong University, Nantong 226001, China; Research Center of Clinical Medicine, Affiliated Hospital of Nantong University, Nantong University, Nantong 226001, China; Research Center of Gerontology and Longevity, Affiliated Hospital of Nantong University, Nantong 226001, China
| | - Jianlin Gao
- Medical School of Nantong University, Nantong 226001, China; Research Center of Clinical Medicine, Affiliated Hospital of Nantong University, Nantong University, Nantong 226001, China; Research Center of Gerontology and Longevity, Affiliated Hospital of Nantong University, Nantong 226001, China.
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Hua LS, Chen YY, Yiin JJ, Lee KC. Caregiving burdens of family members of patients living with hepatocellular carcinoma. Int J Palliat Nurs 2023; 29:17-27. [PMID: 36692481 DOI: 10.12968/ijpn.2023.29.1.17] [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: 01/25/2023]
Abstract
BACKGROUND Caregiving burden is common among family caregivers (FCs). In Taiwan, no reports have compared caregiving burden according to disease stage, or explored the comprehensive factors of caregiving burden in the FCs of patients with hepatocellular carcinoma (HCC). AIM The aim of the study was to investigate caregiving burden at different diagnosis stages and its potential predictors in the FCs of patients with hepatocellular carcinoma. METHODS This descriptive, cross-sectional study included 192 FCs. Caregiving burden was measured using the Caregiver Reaction Assessment tool. The predictive factors of caregiving burden in the FCs of patients with HCC were identified using a linear regression model. RESULTS The global caregiving burden had no significant differences between the four disease stages. The lack of family support and impact on schedule were significantly higher at the terminal stage than at the earlier stage. The risk factors of caregiving burden were high depression, high financial demand, heavy caregiving tasks, advanced age and frequent patient contact, which obtained a variance of 47.8% in the regression model. CONCLUSION Healthcare providers need to proactively identify and assess FCs with risk factors of caregiving burden and provide appropriate interventions specific to individual needs at different disease stages.
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Affiliation(s)
- Lu-Shu Hua
- School of Nursing, China Medical University; Department of Nursing, China Medical University Hospital, Taiwan
| | - Ya-Yun Chen
- Department of Nursing, Shu-Zen Junior College of Medicine and Management, Taiwan
| | - Jia-Jean Yiin
- Department of General Neurosurgery, Taichung Veterans General Hospital, Taiwan
| | - Kwo-Chen Lee
- School of Nursing, China Medical University; Department of Nursing, China Medical University Hospital, Taiwan
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Sfeir M, Zeitoun A, Hallit S, Obeid S. Presence of a psychiatric patient at home and work fatigue in family caregivers: The moderating effect of spirituality. Perspect Psychiatr Care 2022; 58:2664-2675. [PMID: 35578158 DOI: 10.1111/ppc.13107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 04/25/2022] [Accepted: 04/29/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To assess the association between the mental health of caregivers having a psychiatric patient at home and work fatigue, and if this association is moderated by spirituality. METHODS This case-control study enrolled 600 caregivers (July-September 2019). RESULTS Stress, anxiety, insomnia and the presence of a psychiatric patient at home were associated with higher levels of physical, mental, and emotional work fatigue. In the case of caregivers who have a psychiatric patient at home, those with low spirituality had more mental and emotional work fatigue. PRACTICAL IMPLICATIONS Healthcare professionals should enlighten caregivers more on the risks and the consequences of their job, assist them with information on what to expect, and teach them how to normalize feelings that they may face.
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Affiliation(s)
- Michel Sfeir
- Department of Psychology, University of Fribourg, Fribourg, Switzerland
| | - Abeer Zeitoun
- Department of Quality Assurance of Pharmaceutical Products, National Pharmacovigilance Program, Lebanese Ministry of Public Health, Beirut, Lebanon
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh, Lebanon.,Department of Psychology, College of Humanities, Effat University, Jeddah, Saudi Arabia.,Department of Research, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon
| | - Sahar Obeid
- Department of Social and Education Sciences, School of Arts and Sciences, Lebanese American University, Jbeil, Lebanon
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Chaghazardi M, Janatolmakan M, Rezaeian S, Khatony A. Care burden and associated factors in caregivers of children with cancer. Ital J Pediatr 2022; 48:92. [PMID: 35698160 PMCID: PMC9195224 DOI: 10.1186/s13052-022-01291-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 06/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Evidence suggests that many parents who care for their children with cancer are affected by the care burden due to the chronic nature of the disease. The aim of this study was to determine the burden of care level and its related factors in the caregivers of children with cancer. METHOD A total of 270 caregivers of children with cancer were included in this cross-sectional study by convenience sampling method. Data collection tools were a personal information form and the Novak & Guest's Caregiver Burden Inventory. Data were analyzed by descriptive and inferential statistics (chi-square and univariate linear regression model). RESULTS The mean ages of caregivers and patients were 35.7 ± 7.0 and 3.1 ± 1.6 years, respectively. The mean care burden was 68.4 ± 1.5 out of 120. About 50 and 36% of caregivers had moderate and severe care burden, respectively. CONCLUSION Caregivers had moderate to high care burden. A number of factors associated with care burden were identified. Health authorities need to take family-centered measures to reduce the burden of caregivers.
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Affiliation(s)
- Mahnaz Chaghazardi
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Maryam Janatolmakan
- Social Development and Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Shahab Rezaeian
- School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Alireza Khatony
- Social Development and Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Infectious Diseases Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Mo Y, Lai X, Li L, Lu YZ. Sleep, depression, and anxiety in family caregivers of nasopharyngeal carcinoma patients before therapy. Acta Psychol (Amst) 2022; 223:103504. [PMID: 35051844 DOI: 10.1016/j.actpsy.2022.103504] [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: 01/20/2021] [Revised: 01/08/2022] [Accepted: 01/14/2022] [Indexed: 11/30/2022] Open
Abstract
Sleep disturbance, anxiety, and depression are frequently observed in cancer patients. There have fewer studies about the sleep and emotional status of nasopharyngeal carcinoma (NPC) patient family caregivers (FCs) before treatment. We explored the sleep, depression, and anxiety in NPC patient FCs before therapy, compared sleep quality between caregivers with and without depression and anxiety, and examined and related factors of sleep disturbance in FCs of NPC patients before therapy. FC-patient dyads included from two centers were 92 in total. The proportions of poor sleep, anxiety, and depression in NPC patient FCs were 45.7%, 43.5%, and 54.3%, respectively. FCs with anxiety or depression were more inclined to report decreased sleep quality. Depressed caregivers were 11.11 times more to be poor quality sleep before patients treatment (OR = 11.11, 95%; CI = 2.94-42.05). NPC patient FCs before treatment are at high risk of sleep disturbances, depression, and anxiety, especially those already experiencing anxiety and depression symptoms.
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Affiliation(s)
- Yanlin Mo
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Cancer Institute of Guangxi Zhuang Autonomous Region, Nanning 530021, China
| | - Xiaoying Lai
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Cancer Institute of Guangxi Zhuang Autonomous Region, Nanning 530021, China
| | - Ling Li
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Cancer Institute of Guangxi Zhuang Autonomous Region, Nanning 530021, China
| | - Yao-Zhen Lu
- Department of Radiation Oncology, Minzu Hospital of Guangxi Zhuang Autonomous Region, Affiliated Minzu Hospital of Guangxi Medical University, Nanning 530001, China.
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Shaffer KM, Ritterband LM, You W, Buysse DJ, Mattos MK, Camacho F, Glazer JV, Klinger J, Donovan H. Single-Group Trial of an Internet-Delivered Insomnia Intervention Among Higher-Intensity Family Caregivers: Rationale and Protocol for a Mixed Methods Study. JMIR Res Protoc 2022; 11:e34792. [PMID: 35019846 PMCID: PMC8792774 DOI: 10.2196/34792] [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: 11/17/2021] [Revised: 12/03/2021] [Accepted: 12/08/2021] [Indexed: 11/13/2022] Open
Abstract
Background Family caregivers are more likely to experience insomnia relative to noncaregivers but have significant barriers to accessing gold standard cognitive behavioral therapy for insomnia treatment. Delivering interventions to caregivers through the internet may help increase access to care, particularly among higher-intensity caregivers who provide assistance with multiple care tasks over many hours per week. Although there are existing internet interventions that have been thoroughly studied and demonstrated as effective in the general population, the extent to which these interventions may be effective for caregivers without tailoring to address this population’s unique psychosocial needs has not been studied. Objective The goal of this trial is to determine what tailoring may be necessary for which caregivers to ensure they receive optimal benefit from an existing evidence-based, internet-delivered cognitive behavioral therapy for insomnia program named Sleep Healthy Using the Internet (SHUTi). Specifically, we will test the association between caregivers’ engagement with SHUTi and their caregiving context characteristics (ie, caregiving strain, self-efficacy, and guilt) and environment (ie, proximity to care recipient; functional status, cognitive status, and problem behavior of care recipient; and type of care provided). Among caregivers using the program, we will also test the associations between change in known treatment mechanisms (sleep beliefs and sleep locus of control) and caregiving context factors. Methods A total of 100 higher-intensity caregivers with significant insomnia symptoms will be recruited from across the United States to receive access to SHUTi in an open-label trial with mixed methods preassessments and postassessments. At postassessment (9 weeks following preassessment completion), participants will be categorized according to their engagement with the program (nonusers, incomplete users, or complete users). Study analyses will address 3 specific aims: to examine the association between caregivers’ engagement with SHUTi and their caregiving context (aim 1a); to describe caregivers’ barriers to and motivations for SHUTi engagement from open-ended survey responses (aim 1b); and among caregivers using SHUTi, to determine whether cognitive mechanisms of change targeted by SHUTi are associated with differences in caregiving context (aim 2). Results Institutional review board approvals have been received. Data collection is anticipated to begin in December 2021 and is expected to be completed in 2023. Conclusions Findings will inform the next research steps for tailoring and testing SHUTi for optimal impact and reach among caregivers. Beyond implication to the SHUTi program, the findings will be translatable across intervention programs and will hold significant promise to reduce inefficiencies in developing digital health interventions for caregivers while also increasing their impact and reach for this underserved population. Trial Registration ClinicalTrials.gov; NCT04986904; https://clinicaltrials.gov/ct2/show/NCT04986904?term=NCT04986904 International Registered Report Identifier (IRRID) PRR1-10.2196/34792
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Affiliation(s)
- Kelly M Shaffer
- Center for Behavioral Health and Technology, University of Virginia, Charlottesville, VA, United States
| | - Lee M Ritterband
- Center for Behavioral Health and Technology, University of Virginia, Charlottesville, VA, United States
| | - Wen You
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, United States
| | - Daniel J Buysse
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Meghan K Mattos
- School of Nursing, University of Virginia, Charlottesville, VA, United States
| | - Fabian Camacho
- Center for Behavioral Health and Technology, University of Virginia, Charlottesville, VA, United States
| | - Jillian V Glazer
- Center for Behavioral Health and Technology, University of Virginia, Charlottesville, VA, United States
| | - Julie Klinger
- National Center on Family Support, University of Pittsburgh, Pittsburgh, PA, United States
| | - Heidi Donovan
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States.,National Center on Family Support, University of Pittsburgh, Pittsburgh, PA, United States.,School of Nursing, University of Pittsburgh, Pittsburgh, PA, United States
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11
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Li Q, Zhang L, Chen C, Gan Y, Jiang L, Li S, Xiang W, Ming Y, Yang C, Zhou J. Caregiver burden and influencing factors among family caregivers of patients with glioma: A cross-sectional survey. J Clin Neurosci 2021; 96:107-113. [PMID: 34840093 DOI: 10.1016/j.jocn.2021.11.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 11/12/2021] [Accepted: 11/13/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The main responsibility of caring for patients with glioma is assumed by family caregivers who experience a considerable burden during the care process. This study aimed to investigate the level of caregiver burden and explore its associated factors among family caregivers of patients with glioma. METHODS We conducted a cross-sectional study among 131 family caregivers of glioma patients from October 2017 to November 2019. We used the following measurement tools: a demographic questionnaire, the Zarit Burden interview (ZBI), the Hamilton anxiety and depression scale, and the family APGAR index. We used multiple linear regression analysis to determine the factors related to caregiver burden. RESULTS The ZBI score for the family caregivers of glioma patients was 31.29 (SD = 13.54), and most caregivers (71.7%) reported moderate and severe caregiver burdens. Caregivers' daily sleep time and anxiety symptoms and patients' depressive symptoms independently predicted caregiver burden. CONCLUSIONS Family caregivers of glioma patients experienced a moderate burden. Personalised psychological intervention and sleep health guidance for patients and caregivers should be considered to reduce family caregiver burden and enhance the quality of life and mental health of both patients and their caregivers.
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Affiliation(s)
- Qianqian Li
- School of Nursing, Southwest Medical University, Taiping Street 25#, Lu Zhou 646000, China; Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Taiping Street 25#, Lu Zhou 646000, China
| | - Liying Zhang
- School of Nursing, Southwest Medical University, Taiping Street 25#, Lu Zhou 646000, China; Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Taiping Street 25#, Lu Zhou 646000, China
| | - Chaoyi Chen
- Affiliated Hospital of Traditional Chinese Medicine of Southwest Medical University, Chunhui Road 16#, Lu Zhou 646000, China
| | - Yajie Gan
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Taiping Street 25#, Lu Zhou 646000, China; Sichuan Clinical Research Center for Neurosurgery, Taiping Street 25#, Lu Zhou 646000, China; Academician (Expert) Workstation of Sichuan Province, Taiping Street 25#, Lu Zhou 646000, China; Laboratory of Neurosurgery Diseases and Brain Function, Taiping Street 25#, Lu Zhou 646000, China
| | - Lin Jiang
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Taiping Street 25#, Lu Zhou 646000, China; Sichuan Clinical Research Center for Neurosurgery, Taiping Street 25#, Lu Zhou 646000, China; Academician (Expert) Workstation of Sichuan Province, Taiping Street 25#, Lu Zhou 646000, China; Laboratory of Neurosurgery Diseases and Brain Function, Taiping Street 25#, Lu Zhou 646000, China
| | - Shenjie Li
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Taiping Street 25#, Lu Zhou 646000, China; Sichuan Clinical Research Center for Neurosurgery, Taiping Street 25#, Lu Zhou 646000, China; Academician (Expert) Workstation of Sichuan Province, Taiping Street 25#, Lu Zhou 646000, China; Laboratory of Neurosurgery Diseases and Brain Function, Taiping Street 25#, Lu Zhou 646000, China
| | - Wei Xiang
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Taiping Street 25#, Lu Zhou 646000, China; Sichuan Clinical Research Center for Neurosurgery, Taiping Street 25#, Lu Zhou 646000, China; Academician (Expert) Workstation of Sichuan Province, Taiping Street 25#, Lu Zhou 646000, China; Laboratory of Neurosurgery Diseases and Brain Function, Taiping Street 25#, Lu Zhou 646000, China
| | - Yang Ming
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Taiping Street 25#, Lu Zhou 646000, China; Sichuan Clinical Research Center for Neurosurgery, Taiping Street 25#, Lu Zhou 646000, China; Academician (Expert) Workstation of Sichuan Province, Taiping Street 25#, Lu Zhou 646000, China; Laboratory of Neurosurgery Diseases and Brain Function, Taiping Street 25#, Lu Zhou 646000, China
| | - Changmei Yang
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Taiping Street 25#, Lu Zhou 646000, China; Sichuan Clinical Research Center for Neurosurgery, Taiping Street 25#, Lu Zhou 646000, China; Academician (Expert) Workstation of Sichuan Province, Taiping Street 25#, Lu Zhou 646000, China; Laboratory of Neurosurgery Diseases and Brain Function, Taiping Street 25#, Lu Zhou 646000, China.
| | - Jie Zhou
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Taiping Street 25#, Lu Zhou 646000, China; Sichuan Clinical Research Center for Neurosurgery, Taiping Street 25#, Lu Zhou 646000, China; Academician (Expert) Workstation of Sichuan Province, Taiping Street 25#, Lu Zhou 646000, China; Laboratory of Neurosurgery Diseases and Brain Function, Taiping Street 25#, Lu Zhou 646000, China.
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12
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O’Toole MS, Mennin DS, Applebaum AJ, Fresco DM, Zachariae R. Moderators and mediators of emotion regulation therapy for psychologically distressed caregivers of cancer patients: secondary analyses from a randomized controlled trial. Acta Oncol 2021; 60:992-999. [PMID: 34112063 DOI: 10.1080/0284186x.2021.1924400] [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: 10/21/2022]
Abstract
BACKGROUND Being an informal caregiver (IC) of a cancer patient is often associated with psychological distress. We have recently, in a randomized controlled trial (RCT), demonstrated efficacy of Emotion Regulation Therapy for ICs (ERT-C), evidenced as lower levels of psychological distress. Such efficacy demonstration is important, but a crucial step in improving treatments for the IC population is the identification of moderators (i.e., for whom the treatment works) and mediators (i.e., the drivers of the detected effect). MATERIAL AND METHODS In a sample of 65 psychologically distressed ICs (combining participants who received immediate and delayed treatment in the RCT); we investigated age, gender, and homework completion as moderators of treatment outcome. Proposed mediators were derived from the ERT model and included mindfulness, emotion regulation dysfunction, decentering, and cognitive reappraisal. RESULTS AND CONCLUSIONS The strongest moderation effect was found for homework completion, predicting improvements on psychological distress. Correlational mediation analyses generally supported the ERT model. However, temporal precedence was only established for the association between decentering and worry, where a bidirectional relation was revealed. Homework thus emerged as an important aspect of ERT-C and, albeit a bidirectional relationship, changes in decentering may precede changes in worry. Future trials should ensure the robustness of these results, hone the specificity of process measures, and further investigate the causal timeline of change.
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Affiliation(s)
- Mia S. O’Toole
- Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark
| | - Douglas. S. Mennin
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, NY, USA
| | - Allison J. Applebaum
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David M. Fresco
- Department of Psychiatry, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Robert Zachariae
- Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark
- Unit for Psycho-Oncology and Health Psychology, Aarhus University & Aarhus University Hospital, Aarhus, Denmark
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13
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Valero-Cantero I, Wärnberg J, Carrión-Velasco Y, Martínez-Valero FJ, Casals C, Vázquez-Sánchez MÁ. Predictors of sleep disturbances in caregivers of patients with advanced cancer receiving home palliative care: A descriptive cross-sectional study. Eur J Oncol Nurs 2021; 51:101907. [PMID: 33636585 DOI: 10.1016/j.ejon.2021.101907] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 01/30/2021] [Accepted: 02/02/2021] [Indexed: 01/07/2023]
Abstract
PURPOSE To evaluate the quality of sleep in caregivers of patients with advanced cancer receiving home palliative care, basing the analysis on subjective and objective measures, and to develop a predictive model of sleep disturbances among this population. METHOD A descriptive cross-sectional study was conducted in six clinical management units within primary healthcare centres. Data were obtained during a period of six months, from a sample population of 41 caregivers. The Pittsburgh Sleep Quality Index (PSQI) and a 7-day accelerometry evaluation were performed to assess sleep quality. Daytime sleepiness, caregiver strain and quality of life were also evaluated. RESULTS According to the PSQI, 90.2% of participants had poor sleep quality. The average duration of night-time sleep, measured by accelerometry and the PSQI, was 6 h. Taking PSQI as the dependent variable, the study model predicted 40.7% of the variability (p < 0.01). The variables "Caregiver strain" and "Daily hours dedicated to care" produced the following results: B coefficient 0.645; p = 0.001; and B coefficient 0.230; p = 0.010, respectively. CONCLUSIONS The caregivers presented significant health-related alterations, including sleep disturbances, which were directly related to two variables: the index of caregiver strain and the number of hours per day dedicated to providing care.
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Affiliation(s)
- Inmaculada Valero-Cantero
- Nurse Case Manager, Puerta Blanca Clinical Management Unit, Malaga-Guadalhorce Health District, Malaga, Spain.
| | - Julia Wärnberg
- Professor at the Department of Nursing, Faculty of Health Sciences, University of Malaga and Malaga Biomedical Research Institute (IBIMA), Malaga, Spain; CIBER Fisiopatología de La Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
| | - Yolanda Carrión-Velasco
- Nurse Case Manager, Tiro Pichón Clinical Management Unit, Malaga-Guadalhorce Health District, Malaga, Spain.
| | | | - Cristina Casals
- Professor at the Department of Physical Education, MOVE-IT Research Group, University of Cadiz, Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital, Cadiz, Spain.
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14
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Jeon MS, Dhillon HM, Koh ES, Nowak AK, Hovey E, Descallar J, Miller L, Marshall NS, Agar MR. Exploring sleep disturbance among adults with primary or secondary malignant brain tumors and their caregivers. Neurooncol Pract 2020; 8:48-59. [PMID: 33664969 DOI: 10.1093/nop/npaa057] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background Emerging evidence supports the clinical impact of sleep disturbance (SD) on cancer patients. This study aimed to determine the prevalence and predictors of SD in people with malignant brain tumors and caregivers, and explore any relationship between the patient-caregiver dyad's sleep. Methods Eighty-one adults with primary malignant (91%) or metastatic (9%) brain tumors and their family caregivers (n = 44) completed a series of self-report questionnaires, including the Pittsburgh Sleep Quality Index (PSQI), the Insomnia Severity Index, and the drowsiness item of The MD Anderson Symptom Inventory-Brain Tumor in an Australian ambulatory neuro-oncology setting. Participants were grouped by the PSQI cutoff (SD > 5), and binary logistic regression analyses were performed to identify risk factors. Results Of patients, 53% reported SD and 15% of those clinically significant insomnia, and 27% reported moderate to severe daytime drowsiness. Whereas anxiety, depression, fatigue, pain, neurocognitive symptoms, and antiemetic use were higher in patients with SD, fatigue and KPS were strong predictors of SD. In caregivers, 55% reported poor sleep and 13% clinical insomnia. Anxiety, caregiver burden, and comorbid illness were significantly associated with caregivers' SD. The individual's SD did not affect the chance of the other member of the patient-caregiver dyad experiencing SD. Conclusions More than half the sample had sleep disturbance, which was linked to many concomitant symptoms, such as fatigue in patients and anxiety in caregivers, potentially contributing to distress and functional impairment. Understanding underlying mechanisms of SD, the potential use of these clinical predictors in care settings, and options for management is warranted.
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Affiliation(s)
- Megan S Jeon
- South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - Haryana M Dhillon
- Centre for Medical Psychology & Evidence-based Decision-making, University of Sydney, Sydney, Australia
| | - Eng-Siew Koh
- South Western Sydney Clinical School, University of New South Wales, Sydney, Australia.,Ingham Institute for Applied Medical Research, Liverpool, Australia.,Department of Radiation Oncology, Liverpool Hospital, Liverpool, NSW, Australia
| | - Anna K Nowak
- Medical School, QEII Medical Centre Unit, University of Western Australia, Crawley, Australia.,Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands WA, Australia
| | - Elizabeth Hovey
- Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, Australia.,University of New South Wales, Sydney, Australia
| | - Joseph Descallar
- South Western Sydney Clinical School, University of New South Wales, Sydney, Australia.,Ingham Institute for Applied Medical Research, Liverpool, Australia
| | - Lisa Miller
- Sir Charles Gairdner Hospital, Perth, Australia
| | - Nathaniel S Marshall
- Woolcock Institute for Medical Research & Sydney Nursing School, University of Sydney, Sydney, Australia
| | - Meera R Agar
- South Western Sydney Clinical School, University of New South Wales, Sydney, Australia.,Ingham Institute for Applied Medical Research, Liverpool, Australia.,IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), Faculty of Health, University of Technology Sydney, Sydney, Australia
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15
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Sleep disturbance in people with brain tumours and caregivers: a survey of healthcare professionals' views and current practice. Support Care Cancer 2020; 29:1497-1508. [PMID: 32712828 DOI: 10.1007/s00520-020-05635-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 07/15/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Sleep disturbance is easily overlooked in subspecialty consultations and may remain untreated during and after initial treatment of malignant brain tumours (BT). This study aimed to explore perceptions of healthcare professionals (HCPs) actively engaged in neuro-oncology care towards sleep disturbance in adults with primary or secondary BT and to identify facilitators and barriers to assessment and management of sleep disturbance. METHODS A survey was conducted to explore HCPs' perceptions about their knowledge, skills, and confidence in managing sleep disturbance in people with BT. The survey also explored their beliefs, motivation, and perceived role in managing sleep disturbance, and views on contributing external factors that impacted management. RESULTS Seventy-three interdisciplinary HCPs with average of 9.3 years of clinical experience in neuro-oncology participated. Fifty-five percent of participants were medical or radiation oncologists. Participants reported a high observed prevalence of sleep disturbance, especially in inpatient settings, during initial treatment, and after tumour progression or recurrence. Only 20% of participants reported routinely reviewing sleep-related symptoms during consultations. General symptom screening questions were perceived as helpful to identify sleep disturbance. Almost all respondents (92%) viewed corticosteroids as the most relevant risk factor, followed by psychological distress. The most frequent clinical responses were offering verbal advice and prescribing medication. The lack of time, resources, and training for managing sleep issues were commonly reported barriers. CONCLUSIONS Overall, participants perceived sleep disturbance as highly prevalent in neuro-oncology and positively viewed the importance of managing this symptom. Practical barriers to management were reported that future interventions can target.
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16
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Wan CF, Meng QZ, Wang YW, Qi L, Ai CL, Sui X, Song T. Patient-controlled subcutaneous analgesia using sufentainil or morphine in home care treatment in patients with stage III-IV cancer: A multi-center randomized controlled clinical trial. Cancer Med 2020; 9:5345-5352. [PMID: 32500675 PMCID: PMC7402833 DOI: 10.1002/cam4.3194] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 05/03/2020] [Accepted: 05/06/2020] [Indexed: 01/04/2023] Open
Abstract
Purpose Patient‐controlled subcutaneous analgesia (PCSA) with sufentanil is an alternative analgesia strategy in patients with stage III‐IV cancer; however, its efficacy and safety have not been fully investigated. Methods From May 10, 2017 to November 10, 2017, 120 patients with stage III‐IV cancer suffering from moderate to severe pain were prospectively enrolled from six hospitals and randomized to receive PCSA with morphine (control group) or sufentanil (intervention group). Before the PCSA and on days 1, 3, 7, 14, 28, and 56 after treatment, the numeric rating scale (NRS) and 36‐item Short Form health survey (SF‐36) were completed for each patient and the side effects were also recorded. RESULTS No significant differences (P > .05) were observed in the preoperative NRS score and the SF‐36 parameters between the two groups. Patients in the intervention group achieved better pain relief, as indicated by lower NRS scores at days 14 (P = .040), 28 (P < .001), and 56 (P < .001) after PCSA device implantation (vs control group). Furthermore, the patients in the intervention group also achieved a better life quality, as indicated by the physical role, general health, social function body pain, and mental health scores. Finally, the patients receiving sufentanil showed lower levels of nausea and somnolence than those in the control group. Conclusion PCSA with sufentanil achieves better pain control and life quality as well as fewer adverse reactions in stage III‐IV cancer patients with pain and may be a promising pain management in these patients. Trial registration This study was registered at chictr.org.cn with the trial number: ChiCTR‐IPR‐17011280.
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Affiliation(s)
- Cheng-Fu Wan
- Pain Department of the First Affiliated Hospital, China Medical University, Shenyang, China
| | - Qing-Zhu Meng
- Pain Department of the Central Hospital of Haicheng city, Anshan, China
| | - Yan-Wei Wang
- Pain Department of the Third People's Hospital of Anshan city, Anshan, China
| | - Liang Qi
- Pain Department of the Central Hospital of Fuxin city, Fuxin, China
| | - Chang-Liang Ai
- Pain Department of the Women and Children's Hospital of Dandong city, Dandong, China
| | - Xin Sui
- Pain Department of the Central Hospital of Kuandian city, Dandong, China
| | - Tao Song
- Pain Department of the First Affiliated Hospital, China Medical University, Shenyang, China
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17
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Lee Wong C, Choi KC, Mei Nok Lau, Lam KL, Wei So WK. Caregiving burden and sleep quality amongst family caregivers of Chinese male patients with advanced cancer: A cross-sectional study. Eur J Oncol Nurs 2020; 46:101774. [PMID: 32460141 DOI: 10.1016/j.ejon.2020.101774] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 03/15/2020] [Accepted: 05/10/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE To examine the level of caregiving burden and sleep quality as well as their interrelationship amongst family caregivers of Chinese male patients with advanced cancer. METHOD A cross-sectional study was conducted in Hong Kong. The Caregiver Reaction Assessment (CRA) and the Pittsburgh Sleep Quality Index (PSQI) were used to measure caregiving burden and sleep quality of the family caregivers. RESULTS A total of 96 family caregivers were recruited. Disrupted schedule (3.8; SD = 0.8) was rated as the most affected consequence of caregiving burden. Around 78.1% of the caregivers suffered from sleep problems. Hierarchical multiple regression revealed that health problems due to caregiving burden was independently associated with poor sleep quality after controlling for socio-demographic characteristics of both patients and caregivers (regression coefficient, B = 2.09, P = 0.012). CONCLUSIONS Caregiving burden amongst family caregivers of male patients with advanced cancer was remarkably high and associated with poor sleep quality. Strategies aiming to alleviate caregiving burden of caregivers may help break this vicious cycle to enhance the sleep quality of caregivers. Results also underscore the need to assess and develop intervention to relieve caregiving burden for family caregivers of cancer patients.
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Affiliation(s)
- Cho Lee Wong
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
| | - Kai Chow Choi
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
| | - Mei Nok Lau
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
| | - Ka Ling Lam
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
| | - Winnie Kwok Wei So
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
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18
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O’Toole MS, Mennin DS, Applebaum A, Weber B, Rose H, Fresco DM, Zachariae R. A Randomized Controlled Trial of Emotion Regulation Therapy for Psychologically Distressed Caregivers of Cancer Patients. JNCI Cancer Spectr 2020; 4:pkz074. [PMID: 32337491 PMCID: PMC7050163 DOI: 10.1093/jncics/pkz074] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 08/22/2019] [Accepted: 09/09/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Previous cognitive behavioral therapies for informal caregivers (ICs) have produced negligible effects. The purpose of this study was to evaluate, in a randomized controlled trial, the efficacy of Emotion Regulation Therapy adapted for caregivers (ERT-C) on psychological and inflammatory outcomes in psychologically distressed ICs and the cancer patients cared for. METHODS A total of 81 ICs with elevated psychological distress were randomly assigned to ERT-C or a waitlist condition and assessed pre-, mid-, and post-treatment. In 52 cases, the patient cared for by the IC was included. Patients did not receive ERT-C. Both the ERT-C and waitlist groups were followed 3 and 6 months post-treatment. Data were analyzed with multilevel models, and P values were two-sided. RESULTS Compared with ICs in the waitlist condition, ICs in the ERT-C condition experienced medium to large statistically significant reductions in psychological distress (Hedge's g = 0.86, 95% confidence interval [CI] = 0.40 to 1.32, P < .001), worry (g = 0.96, 95% CI = 0.50 to 1.42, P < .001), and caregiver burden (g = 0.53, 95% CI = 0.10 to 1.99, P = .007) post-treatment. No statistically significant effects were found for rumination (g = 0.24, 95% CI = -0.20 to 0.68, P = .220). Results concerning caregiver burden were maintained through 6 months follow-up. Although the effects on psychological distress and worry diminished, their end-point effects remained medium to large. No statistically significant effects on systemic inflammation were detected (C-reactive protein: g = .17, 95% CI = -0.27 to 0.61, P = .570; interleukin-6: g = .35, 95% CI = -0.09 to 0.79, P = .205; tumor necrosis factor-alpha: g = .11, 95% CI = -0.33 to 0.55, P = .686). Patients whose ICs attended ERT-C experienced a large increase in quality of life post-treatment (g = 0.88, 95% CI = 0.18 to 1.58, P = .017). CONCLUSIONS To our knowledge, this is the first randomized controlled trial evaluating the efficacy of ERT-C for ICs. Given the previous disappointing effects of other cognitive behavioral therapies for this population, the present findings are very encouraging. Identifying ICs with elevated psychological distress and providing them with relevant psychotherapy appears an important element of comprehensive cancer care.
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Affiliation(s)
- Mia S O’Toole
- Unit for Psychooncology and Health Psychology, Aarhus University and Aarhus University Hospital, Denmark
| | - Douglas S Mennin
- Department of Psychology, Teachers College, Columbia University, New York, NY
| | - Allison Applebaum
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Britta Weber
- Department of Oncology, Aarhus University Hospital, Denmark
| | - Hanne Rose
- Department of Oncology, Aarhus University Hospital, Denmark
| | - David M Fresco
- Department of Psychological Sciences, Kent State University, Kent, OH
| | - Robert Zachariae
- Unit for Psychooncology and Health Psychology, Aarhus University and Aarhus University Hospital, Denmark
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19
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Saimaldaher ZH, Wazqar DY. Relationships between caregiving stress, mental health and physical health in family caregivers of adult patients with cancer: implications for nursing practice. Scand J Caring Sci 2019; 34:889-898. [DOI: 10.1111/scs.12795] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 09/15/2019] [Accepted: 10/29/2019] [Indexed: 02/06/2023]
Affiliation(s)
- Zahra'a H. Saimaldaher
- Department of Medical Surgical Nursing Faculty of Nursing King Abdulaziz University Jeddah Saudi Arabia
| | - Dhuha Y. Wazqar
- Department of Medical Surgical Nursing Faculty of Nursing King Abdulaziz University Jeddah Saudi Arabia
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20
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Otto AK, Gonzalez BD, Heyman RE, Vadaparampil ST, Ellington L, Reblin M. Dyadic effects of distress on sleep duration in advanced cancer patients and spouse caregivers. Psychooncology 2019; 28:2358-2364. [PMID: 31518026 DOI: 10.1002/pon.5229] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 08/30/2019] [Accepted: 09/07/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Short sleep duration is a common problem for both advanced cancer patients and their spouse caregivers. Sleep and distress have been shown to be interdependent in patient-caregiver and spouse dyads, yet virtually, no work has explored the dyadic effects of psychological distress on sleep in advanced cancer patients and spouse caregivers. The goal of the present study was to examine the dyadic impact of anxiety and depression on sleep duration in a sample of advanced cancer patients and their spouse caregivers. It was hypothesized that, for both patients and caregivers, anxiety and depression in individuals would be associated with sleep duration in both themselves (actor effects) and in their spouses (partner effects). METHOD Advanced cancer patients and their spouse caregivers (N = 87 dyads) completed cross-sectional questionnaires assessing demographic variables, subjective health, subjective sleep duration, and anxiety and depression symptoms. RESULTS Controlling for sex, age, and subjective health, individuals' anxiety was negatively associated with their own and their partner's sleep duration. No significant actor or partner effects were found for depression. CONCLUSIONS Results provided partial support for hypotheses. Although past work has demonstrated links between subjective sleep disturbance and anxiety/psychological distress, this is one of the first studies to examine partner effects of distress on sleep disturbance in advanced cancer patients and spouse caregivers.
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Affiliation(s)
- Amy K Otto
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA
| | - Brian D Gonzalez
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA
| | | | - Susan T Vadaparampil
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA
| | - Lee Ellington
- College of Nursing, University of Utah, Salt Lake City, Utah, USA
| | - Maija Reblin
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA
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21
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Rensen N, Steur LMH, Schepers SA, Merks JHM, Moll AC, Grootenhuis MA, Kaspers GJL, van Litsenburg RRL. Concurrence of sleep problems and distress: prevalence and determinants in parents of children with cancer. Eur J Psychotraumatol 2019; 10:1639312. [PMID: 31448065 PMCID: PMC6691919 DOI: 10.1080/20008198.2019.1639312] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 05/23/2019] [Accepted: 06/18/2019] [Indexed: 12/20/2022] Open
Abstract
Background: Parents of children with cancer are at risk for sleep problems. If these problems persist, an important perpetuating factor might be ongoing parental distress. Objective: The aim of this study is to assess the prevalence of sleep problems and the concurrence with distress in parents of children treated for cancer, and to identify predictors of this symptom clustering. Method: Parents completed the Medical Outcomes Study (MOS) Sleep Scale and Distress Thermometer for Parents (DT-P). Clinically relevant sleep problems were defined as a score >1SD above the norm and clinical distress as a thermometer score above the established cut-off of 4. Four parent categories were constructed: neither sleep problems nor distress; no distress but sleep problems; no sleep problems but distress; both sleep problems and distress. Predictive determinants (sociodemographic, medical, psychosocial) for each category were assessed with multilevel multinomial logistic regression. Results: Parents (202 mothers and 150 fathers) of 231 children with different cancers participated. Mean time since diagnosis was 3.3 ± 1.4 years (90% off-treatment). The prevalence of sleep problems was 37%. Fifty percent of parents reported neither sleep problems nor distress, 9% had only sleep problems, 13% only distress, and 28% reported both. Compared to parents without sleep problems or distress, parents who reported both were more likely to report parenting problems (OR 4.4, [2.2-9.1]), chronic illness (OR 2.8, [1.2-6.5]), insufficient social support (OR 3.7, [1.5-9.1]), pre-existent sleep problems (OR 6.2, [2.0-18.6]) and be female (OR 1.8, [1.1-4.2]). Conclusions: Sleep problems are common in parents of children treated for cancer, and occur mostly in the presence of clinical distress. Future research must show which interventions are most effective in this group: mainly targeted at sleep improvement or with prominent roles for stress management or trauma processing.
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Affiliation(s)
- Niki Rensen
- Pediatric Oncology-Hematology, Cancer Center Amsterdam, Amsterdam UMC, Emma Children’s Hospital, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Lindsay M. H. Steur
- Pediatric Oncology-Hematology, Cancer Center Amsterdam, Amsterdam UMC, Emma Children’s Hospital, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Sasja A. Schepers
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
- Psychosocial Department, Amsterdam UMC, Emma Children’s Hospital, University of Amsterdam, Amsterdam, Netherlands
| | - Johannes H. M. Merks
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
- Pediatric Oncology-Hematology, Amsterdam UMC, Emma Children’s Hospital, University of Amsterdam, Amsterdam, Netherlands
| | - Annette C. Moll
- Ophthalmology, Amsterdam UMC, Vrije Universiteit, Amsterdam, Netherlands
| | - Martha A. Grootenhuis
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
- Psychosocial Department, Amsterdam UMC, Emma Children’s Hospital, University of Amsterdam, Amsterdam, Netherlands
| | - Gertjan J. L. Kaspers
- Pediatric Oncology-Hematology, Cancer Center Amsterdam, Amsterdam UMC, Emma Children’s Hospital, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Raphaële R. L. van Litsenburg
- Pediatric Oncology-Hematology, Cancer Center Amsterdam, Amsterdam UMC, Emma Children’s Hospital, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
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22
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Lai XY, Tang ZM, Zhu XD, Li L, Qin XY, Lan JL, Lu CP, Lyu ZC, Liang LQ, Chen LJ. Sleep Disturbance and Related Factors in Patients with Nasopharyngeal Carcinoma and Their Family Caregivers Prior to the Initiation of Treatment. Sci Rep 2018; 8:14263. [PMID: 30250207 PMCID: PMC6155287 DOI: 10.1038/s41598-018-32587-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 09/07/2018] [Indexed: 11/09/2022] Open
Abstract
Sleep disturbance is a common complaint in cancer patients. However, less is known about the parameters of sleep in patients with nasopharyngeal cancer (NPC) and their family caregivers (FCs) when they are about to begin treatment. We investigated the sleep quality in patients with NPC and their FCs before treatment and determined the related factors that predict sleep disturbance in these patients before therapy. A total of 101 patient-FC dyads were recruited. They completed the Pittsburgh Sleep Quality Index (PSQI) prior to treatment. No differences were found in sleep disturbance between patients (38.6%) and their FCs (31.7%). Patients reported significantly higher rates of short sleep duration than their FCs (P = 0.011). Logistic regression analyses showed that older patients were more prone to suffer from poor sleep quality before treatment (OR = 1.06, 95% CI = 1.01-1.10, P = 0.008), while patients with a higher BMI were less likely to experience sleep disturbance (OR = 0.83, 95% CI = 0.71-0.96, P = 0.012). Sleep disturbance is a significant problem in patients with NPC and their FCs before therapy. Older patients and those with a lower BMI appear to be more inclined to suffer from poor sleep before treatment.
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Affiliation(s)
- Xiao-Ying Lai
- Department of Radiation Oncology, Cancer Hospital of Guangxi Medical University, Cancer Institute of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Zhong-Min Tang
- Department of Radiation Oncology, Cancer Hospital of Guangxi Medical University, Cancer Institute of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Xiao-Dong Zhu
- Department of Radiation Oncology, Cancer Hospital of Guangxi Medical University, Cancer Institute of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Ling Li
- Department of Radiation Oncology, Cancer Hospital of Guangxi Medical University, Cancer Institute of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Xue-Yan Qin
- Department of Radiation Oncology, Cancer Hospital of Guangxi Medical University, Cancer Institute of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Jiang-Ling Lan
- Department of Radiation Oncology, Cancer Hospital of Guangxi Medical University, Cancer Institute of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Chun-Ping Lu
- Department of Radiation Oncology, Cancer Hospital of Guangxi Medical University, Cancer Institute of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Zhi-Chan Lyu
- Department of Radiation Oncology, Cancer Hospital of Guangxi Medical University, Cancer Institute of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Li-Qiao Liang
- Department of Radiation Oncology, Cancer Hospital of Guangxi Medical University, Cancer Institute of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Li-Jun Chen
- Department of Quality Control, Cancer Hospital of Guangxi Medical University, Cancer Institute of Guangxi Zhuang Autonomous Region, Nanning, China.
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23
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Shaffer KM, Garland SN, Mao JJ, Applebaum AJ. Insomnia among Cancer Caregivers: A Proposal for Tailored Cognitive Behavioral Therapy. JOURNAL OF PSYCHOTHERAPY INTEGRATION 2018; 28:275-291. [PMID: 30245560 PMCID: PMC6147560 DOI: 10.1037/int0000105] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Caregivers are relatives, friends, or partners who have a significant relationship with and provide assistance (i.e., physical, emotional) to a patient with often life-threatening, serious illnesses. Between 40 and 76 percent of caregivers for people with cancer experience sleep disturbance. This is thought to be due, in part, to the unique responsibilities, stressors, and compensatory behaviors endemic to caregiving that serve as precipitating and perpetuating factors of insomnia. Sleep disturbances are associated with significant alterations in one's mental and physical health. Once chronic, insomnia does not remit naturally. Cognitive-behavioral therapy for insomnia (CBT-I) is well-suited to address the multifaceted contributing factors unique to caregivers' sleep disturbance, yet only one intervention has tested a CBT-I informed intervention among cancer caregivers. Toward the goal of developing effective, tailored treatments for insomnia in caregivers, we address the distinct presentation of insomnia among cancer caregivers and describe key modifications to standard CBT-I that address these specific needs and enhance sensitivity and feasibility, modeled in a demonstrative case vignette. Future research must seek to provide a wide range of effective treatment options for this population, including internet-based, dyadic, and alternative integrative medicine treatments. Applicability of key modifications for caregivers of patients with other chronic illnesses is discussed. Establishing empirically-supported interventions for insomnia among cancer caregivers has the potential to enhance their quality of life and care provided, lead to improved bereavement outcomes, and attenuate the notable mental and physical health disparities present in this vulnerable population.
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Affiliation(s)
- Kelly M Shaffer
- Memorial Sloan Kettering Cancer Center, Department of Psychiatry and Behavioral Sciences
| | - Sheila N Garland
- Memorial University, Departments of Psychology and Oncology, St. John's, NL, Canada
| | - Jun J Mao
- Memorial Sloan Kettering Cancer Center, Department of Medicine
| | - Allison J Applebaum
- Memorial Sloan Kettering Cancer Center, Department of Psychiatry and Behavioral Sciences
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24
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Al-Daken LI, Ahmad MM. Predictors of burden and quality of sleep among family caregivers of patients with cancer. Support Care Cancer 2018; 26:3967-3973. [DOI: 10.1007/s00520-018-4287-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 05/21/2018] [Indexed: 10/16/2022]
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25
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Washington KT, Parker Oliver D, Smith JB, McCrae CS, Balchandani SM, Demiris G. Sleep Problems, Anxiety, and Global Self-Rated Health Among Hospice Family Caregivers. Am J Hosp Palliat Care 2017; 35:244-249. [PMID: 28393543 DOI: 10.1177/1049909117703643] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Although research has linked sleep problems, anxiety, and poor health outcomes among patients' family members in nonhospice settings, little is known about these often interrelated issues among hospice family caregivers. OBJECTIVES We sought to examine the relationships between sleep problems, anxiety, and global self-rated health among hospice family caregivers. Methods, Setting, and Patients: We conducted a secondary analysis of quantitative data from 395 family caregivers of hospice patients in the Midwest and Southeastern United States. RESULTS Nearly one-third of the hospice family caregivers who participated in this study experienced clinically noteworthy levels of sleep problems and/or anxiety. Caregivers' symptoms of anxiety and sleep problems were strongly correlated. Caregivers who reported more frequent sleep problems and higher levels of anxiety reported poorer overall health. CONCLUSION Hospice providers, who are charged with attending to the needs of both patients and their family caregivers, may improve their practice by regularly assessing for sleep problems and anxiety among family caregivers and providing appropriate interventions or referrals.
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Affiliation(s)
| | | | - Jamie B Smith
- 1 School of Medicine, University of Missouri, Columbia, MO, USA
| | - Christina S McCrae
- 2 School of Health Professions, University of Missouri, Columbia, MO, USA
| | | | - George Demiris
- 3 School of Medicine, University of Washington, Seattle, WA, USA.,4 School of Nursing, University of Washington, Seattle, WA, USA
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26
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Sleep disturbances in caregivers of patients with advanced cancer: A systematic review. Palliat Support Care 2017; 15:125-140. [PMID: 28095943 DOI: 10.1017/s1478951516001024] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Sleep disturbances are a common issue for those who provide informal care to someone with a life-limiting condition. The negative consequences of poor sleep are well documented. The purpose of the present study was to determine the sleep patterns of caregivers of patients with advanced cancer. METHOD An extensive systematic review of studies reporting empirical sleep data was undertaken in 2015 in accordance with the PRISMA Statement. A total of eight electronic databases were searched, with no date restrictions imposed. Additionally, a search of the bibliographies of the studies identified during the electronic search was conducted. Search terms included: "sleep," "insomnia," "sleep disturbance," "circadian rhythm," "caregiver," "carer," "advanced cancer," "palliative cancer," and MESH suggestions. The inclusion criteria required studies to be in English and to report primary qualitative and/or quantitative research that examined sleep in caregivers of patients with advanced cancer. Unpublished studies, conference papers, and dissertations were excluded. RESULTS Overall, 10 studies met the inclusion criteria and were included in the review. Two major findings emerged from the data synthesis. First, at least 72% of caregivers reported moderate to severe sleep disturbance as measured by the Pittsburgh Sleep Quality Index. Second, objective measurement of caregivers' sleep identified that some caregivers experienced up to a 44% reduction in their total sleep time compared to the recommended eight hours. SIGNIFICANCE OF RESULTS Reduction in total sleep time appears to be the biggest issue facing caregivers' sleep. Future studies need to explore the specific factors that cause these sleep disturbances and thus help to identify interventions to optimize sleep.
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27
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Byun E, Lerdal A, Gay CL, Lee KA. How Adult Caregiving Impacts Sleep: a Systematic Review. CURRENT SLEEP MEDICINE REPORTS 2016; 2:191-205. [PMID: 31080704 DOI: 10.1007/s40675-016-0058-8] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Sleep disturbance can contribute to negative health outcomes. However, sleep complaints have been under-recognized and undertreated in caregivers of ill family members. This systematic review describes the impact of family caregiving on sleep and summarizes factors associated with sleep disturbance in caregivers. A literature search using PubMed, MEDLINE, PsycINFO, and CINAHL databases yielded 22 relevant research articles on family caregivers of ill adults. Analyses revealed that up to 76% of caregivers reported poor sleep quality, and the proportion is considerably higher for female caregivers compared to male caregivers. Sleep measures indicated short sleep duration and frequent night awakenings. Characteristics of the care recipient, such as health status, and the caregiver's own health status and symptoms, such as depression, fatigue, and anxiety, were associated with sleep disturbance in caregivers. These factors may help clinicians identify caregivers at highest risk for developing sleep disturbance and guide the family toward additional support.
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Affiliation(s)
- Eeeseung Byun
- Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA
| | - Anners Lerdal
- Lovisenberg Diakonale Hospital, Oslo, Norway.,Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Norway
| | - Caryl L Gay
- Department of Family Health Care Nursing, University of California at San Francisco, San Francisco, CA
| | - Kathryn A Lee
- Department of Family Health Care Nursing, University of California at San Francisco, San Francisco, CA
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28
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Chan JS, Yu NX, Chow AY, Chan CL, Chung KF, Ho RT, Ng SM, Yuen L, Chan CH. Dyadic associations between psychological distress and sleep disturbance among Chinese patients with cancer and their spouses. Psychooncology 2016; 26:856-861. [DOI: 10.1002/pon.4240] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 06/24/2016] [Accepted: 07/27/2016] [Indexed: 11/10/2022]
Affiliation(s)
- Jessie S.M. Chan
- Department of Social Work and Social Administration, Faculty of Social Sciences; The University of Hong Kong; Hong Kong
- Centre on Behavioral Health, Faculty of Social Sciences; The University of Hong Kong; Hong Kong
| | - Nancy Xiaonan Yu
- Department of Applied Social Sciences; City University of Hong Kong; Hong Kong
| | - Amy Y.M. Chow
- Department of Social Work and Social Administration, Faculty of Social Sciences; The University of Hong Kong; Hong Kong
| | - Cecilia L.W. Chan
- Department of Social Work and Social Administration, Faculty of Social Sciences; The University of Hong Kong; Hong Kong
- Centre on Behavioral Health, Faculty of Social Sciences; The University of Hong Kong; Hong Kong
| | - Ka-Fai Chung
- Department of Psychiatry, Li Ka Shing Faculty of Medicine; The University of Hong Kong; Hong Kong
| | - Rainbow T.H. Ho
- Department of Social Work and Social Administration, Faculty of Social Sciences; The University of Hong Kong; Hong Kong
- Centre on Behavioral Health, Faculty of Social Sciences; The University of Hong Kong; Hong Kong
| | - Siu-man Ng
- Department of Social Work and Social Administration, Faculty of Social Sciences; The University of Hong Kong; Hong Kong
| | - L.P. Yuen
- International Association for Health and Yangsheng; Hong Kong
| | - Celia H.Y. Chan
- Department of Social Work and Social Administration, Faculty of Social Sciences; The University of Hong Kong; Hong Kong
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29
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Transition journey from hospital to home in patients with cancer and their caregivers: a qualitative study. Support Care Cancer 2016; 24:4319-26. [PMID: 27178439 DOI: 10.1007/s00520-016-3269-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 05/05/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND The National Cancer Institute Singapore initiated the NUH2 Home program in January 2014, referred to as "Caring Across the Cancer Continuum," a nurse-led cancer transitional care service (CTCS) that provides home care to patients with cancer and their caregivers. The study aimed to explore the transition experiences of patients with cancer and their caregivers. METHOD Using a purposive sampling, 12 patients with cancer and 12 caregivers were recruited. Audiotape interviews were conducted until data saturation was achieved. Each interview was transcribed verbatim, and thematic analyses were performed to extract significant themes and subthemes. RESULTS Four themes emerged from the data including (1) ongoing concerns, (2) needing timely help, (3) resuming control and normality of life, and (4) appreciating the transition care. The transition journey of patients and caregivers provided them with an ability to regain control and normality in their lives, be reassured and confident in being able to care for themselves and manage the physiological and psychological strains associated with the multiple vicissitudes associated with having cancer and its treatment while at home. CONCLUSION Our study addressed the nature, patterns, conditions, and responses to transition care. Our findings provided relevant contextual knowledge to further improve the transition care service based on the recommendations of the patients with cancer and their caregivers who first experienced the new service.
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30
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Ross A, Yang L, Klagholz SD, Wehrlen L, Bevans MF. The relationship of health behaviors with sleep and fatigue in transplant caregivers. Psychooncology 2016; 25:506-12. [PMID: 26179453 PMCID: PMC5526445 DOI: 10.1002/pon.3860] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 04/06/2015] [Accepted: 05/10/2015] [Indexed: 01/28/2023]
Abstract
OBJECTIVE The burden and psychological impact of providing care to a loved one with cancer is significant and associated with a number of problems including sleep disturbance and fatigue. While engaging in healthy behaviors such as proper nutrition, exercise, and stress reduction may improve sleep and fatigue, few studies have focused on this relationship. The objective of this study is to examine the relationship of health behaviors with sleep quality and fatigue in transplant caregivers. METHODS Data were analyzed from a cross-sectional survey of 78 caregivers of patients undergoing allogeneic hematopoietic stem cell transplantation. Measures included: Health-Promoting Lifestyle Profile II (HPLP-II), Brief Symptom Inventory (Distress), Caregiver Reaction Assessment (Caregiver Burden), Pittsburgh Sleep Quality Index, and the Multidimensional Fatigue Symptom Inventory Short-Form. RESULTS Controlling for age, gender, BMI, burden and distress, health behaviors predicted sleep quality (B = -0.408, p = 0.021) and fatigue (B = -0.966, p < 0.001). Stress management (B = -0.450, p = 0.001), nutrition (B = -0.249, p = 0.048), and interpersonal relationships (B = -0.319, p = 0.049) were the HPLP-II subscales that significantly predicted sleep quality; nearly every HPLP-II subscale predicted fatigue. CONCLUSIONS Despite the burden and distress associated with caregiving, engaging in healthy behaviors may help to improve sleep and fatigue in transplant caregivers. Published 2015. This article is a U.S. Government work and is in the public domain in the USA.
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Affiliation(s)
- Alyson Ross
- National Institutes of Health Clinical Center, Nursing Department, Bethesda, MD
| | - Li Yang
- National Institutes of Health Clinical Center, Nursing Department, Bethesda, MD
| | - Stephen D. Klagholz
- National Institutes of Health Clinical Center, Nursing Department, Bethesda, MD
| | - Leslie Wehrlen
- National Institutes of Health Clinical Center, Nursing Department, Bethesda, MD
| | - Margaret F. Bevans
- National Institutes of Health Clinical Center, Nursing Department, Bethesda, MD
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31
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Lee KC, Yiin JJ, Lin PC, Lu SH. Sleep disturbances and related factors among family caregivers of patients with advanced cancer. Psychooncology 2015; 24:1632-8. [PMID: 25871014 DOI: 10.1002/pon.3816] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Revised: 02/11/2015] [Accepted: 02/13/2015] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Sleep disturbances among family caregivers (FCs) are common in advanced cancer. The comprehensive factors for sleep disturbances among the FCs of patients with cancer have not been investigated in Taiwan. The purposes of this study were to investigate the sleep disturbances among the FCs of patients with advanced cancer and to determine predictors of sleep disturbance. METHODS A descriptive, cross-sectional study was conducted among 172 FCs. Data were collected using the Pittsburgh Sleep Quality Index and wrist actigraphy. A linear regression model was used to identify the predictive factors for sleep quality. RESULTS Seventy-six percent of the FCs experienced some sleep disturbances. Female gender, more fatigue, greater depression, more caregiving burden, and spending over 16 h per day on caregiving tasks were risk factors for sleep disturbances in caregivers. CONCLUSIONS Sleep disturbances were common among the Taiwanese FCs of patients with advanced cancer. FCs with risk factors for sleep disturbances should be identified and provided assistance.
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Affiliation(s)
- Kwo-Chen Lee
- School of Nursing, China Medical University, 91, Hsueh-Shih Road, Taichung, 40402, Taiwan.,Department of Nursing, China Medical University Hospital, 2, Yude Road, Taichung, 40447, Taiwan
| | - Jia-Jean Yiin
- Department of Neurosurgery, Neurological Institute, Taichung Veteran General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan
| | - Pi-Chu Lin
- School of Nursing and Master Program in Long-Term Care, College of Nursing, Taipei Medical University, 250 Wuxing Street, Taipei City, 110, Taiwan
| | - Shu-Hua Lu
- School of Nursing, China Medical University, 91, Hsueh-Shih Road, Taichung, 40402, Taiwan.,Department of Nursing, China Medical University Hospital, 2, Yude Road, Taichung, 40447, Taiwan
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