Examination of the Relationship Between Hopelessness Levels and Coping Strategies Among the Family Caregivers of Patients With Cancer

The relationship between hope levels and unmet needs of caregivers of advanced cancer patients†

AIM

The effects in cultural and health provisions can lead to different unmet support needs. Hope is seen as an important support, a supportive power, and an efficient coping strategy for cancer caregivers. The purpose of this study in Turkish society is to determine supportive care needs of caregivers of cancer patients, to determine the hope levels of those caring for cancer patients and foresee how variables and hope can trigger needs.

METHODS

To identify the unmet needs and hope levels of caregivers of advanced cancer patients in Turkish society. Data were collected using the Supportive Care Needs of Caregivers Scale and Herth Hope Index.

RESULTS

More than half of the advanced cancer caregivers (56.51%) reported unmet care needs. Their unmet needs and hope levels were above average. Regression analysis showed the total score for hope was related to health care and information needs, work-social needs.

CONCLUSION

Hope was related to health care and information needs and work-social needs. Oncology nurses should focus on the unmet needs of caregivers, taking into account their cultural differences in order to raise their hopes.

The relationship between spiritual well-being, hope and depression in gynecologic oncology patients

The authors' aim in this study was to determine the relationship between spiritual well-being, hope and depression in gynecologic oncology patients. This is a descriptive and correlational study. The patients received a total of 41.59 ± 12.11 points from the Spiritual Well-Being Scale, 5.57 ± 4.19 points from the Beck Hopelessness Scale, and 14.92 ± 11.61 points from the Beck Depression Scale. Gynecologic oncology patients had high spiritual well-being levels and low hopelessness and depression levels, and their hopelessness and depression levels decreased and hope levels increased as their spiritual well-being levels increased.

Communicating prognostic information and hope to families of dying patients in intensive care units: A descriptive qualitative study

AIMS AND OBJECTIVES

To understand how prognostic information is communicated by Jordanian doctors and nurses to the families of dying patients in intensive care units, with an emphasis on exploring how hope and truth telling about patients' poor prognosis are managed.

BACKGROUND

Improving end-of-life care requires a focus on adequate family-professionals prognostic communication, while maintaining a realistic level of hope and family support.

DESIGN

A descriptive qualitative approach was applied.

METHODS

Semi-structured interviews were conducted with 20 nurses and 15 resident doctors caring for dying patients. Bardin's procedure of categorical content analysis was applied. The COREQ checklist for reporting qualitative studies was followed.

RESULTS

Two main categories emerged from the data of this study: 'perspectives on optimistic hope' and 'approaches to prognostic communication'. Health professionals experience extreme difficulty, and therefore, frequently avoid openly disclosing information about patients' poor prognosis to the families. Consequently, the health professionals adopted various methods to balance truth telling against sustaining hope among the patients' families. Providing false assurance was perceived as permissible and understandable, in order to nurture the families' hope.

CONCLUSIONS

Improving end-of-life care in intensive care units in Jordan requires a focus on family-professional communication. Jordanian intensive care doctors and nurses perceived honest family-professional communication regarding dying patients to be extremely challenging. Healthcare professionals should develop their competency of meeting the informational and emotional needs of patients in ICUs and their families, while also honouring their cultural values, during prognostic communication.

RELEVANCE TO CLINICAL PRACTICE

Effective training of healthcare professionals is vital on ways to enhance communication of prognostic information and to foster realistic hope among families of dying patients in intensive care units. There is a need to also explore the families' perspectives on prognostic communication in order to understand the similarities and differences between the professionals' and families' perspectives.

Testing of a Dual Process Model to Resolve the Socioeconomic Health Disparities: A Tale of Two Asian Countries

A wealth of past studies documented that individuals of lower socioeconomic status (SES) are more susceptible to both acute and chronic life stress than those of higher SES, but some recent evidence documents that not all individuals from the lower SES group experience immense stress. The present study was grounded in theories of coping and psychological adjustment, and a dual process model was formulated to address some resolved issues regarding socioeconomic disparities in health. For a robust test of the proposed dual process model, data were collected from two Asian countries—Hong Kong and Indonesia—with different socioeconomic heritage and conditions. Consistent with the predictions of our model, the present findings revealed that coping flexibility was a psychological mechanism underlying the positive association between social capital and health for the lower SES group, whereas active coping was a psychological mechanism underlying this positive association for the higher SES group. These patterns of results were largely replicable in both Asian samples, providing robust empirical support for the proposed dual process model.

The effects of a brief hope intervention on decision-making in chronic kidney disease patients: A study protocol for a randomized controlled trial

AIMS

This study describes the study protocol of a manualized brief hope intervention that is based on the theoretical proposition - hope theory.

BACKGROUND

Patients with stage 5 chronic kidney disease often had decisional regret when facing the tension of treatment alternatives between dialysis initiation and palliative care. Hope has been found to account for therapeutic changes in clients with depressive symptoms, heightens positive expectations, and striving to accomplish chosen goals. Nevertheless, little is known about the effect of hope on decisional conflict and its influences to the quality of life in these chronic kidney disease patients.

DESIGN

This study is a single-blinded, randomized controlled trial.

METHODS

Participants will be recruited from a regional hospital (approved in April 2018). They will be randomly assigned in equal numbers to either the brief hope intervention or the control arm on completion of the baseline assessment on the possible need of dialysis initiation. Participants in the intervention group will receive the pre-dialysis education and a 4-week Brief Hope Intervention [consisting of four sessions at weekly intervals (two face-to-face sessions and two telephone follow-up sessions in between)], while those allocated to the control arm will receive the renal education and social chats. Outcome measures will be carried out prior to the intervention (baseline), immediately, and 1 month after the intervention. These consist of the hope level, decisional conflict, and quality of life. Healthcare resources use data will be reported.

IMPACT

The study results have the potential to add scientific evidence to the research-tested programme when developing renal services integral to multimodal care management to optimize decision-making and attain better health outcomes.

Relationship Between the Needs of Turkish Relatives of Patients Admitted to an Intensive Care Unit and Their Coping Styles

Admission to an intensive care unit is a traumatic event for many patients' relatives. Also, the relatives may be subject to many requirements to during this process. Therefore, it is very important to determine their requirements and coping styles. This study used a descriptive, relational design. The sample of the research consisted of 247 relatives of patients staying in six intensive care units. It was found that, 65.2% of the patients' relatives were women, and their mean age was 37.25 ± 12.7 years. What they mostly needed was support, proximity, information, assurance and comfort. In that order; among the coping styles it was found that they usually used the following approaches: self-confident approach, an problem-focused coping method; was found to be used by relatives most frequently, followed by helpless approach, an emotion-focused coping style. Requirements: Assurance, information, support and comfort sub-dimension scores and problem-focused coping style; self-confident approach and social support search approach sub-dimension scores between statistically positive, significant relationship was found. Information, proximity, support and comfort sub-dimension scores and emotion-focused coping style; helpless approach and submissive sub-dimension scores between statistically positive, significant relationship was found (p<0.05). It was found that patients' relatives used the helpless approach and submissive approach to cope with stres: during this process their information needs increased and upon fulfillment of requirements, they started using self-confident approach and the social support approach, which are problem-focused coping styles.

Estrategias de afrontamiento en familiares de pacientes críticos

Introducción: la estadía en la unidad de cuidados intensivos genera cambios en la dinámica familiar causados por las alteraciones en las actividades diarias que obligan a utilizar estrategias que los mitiguen. Objetivo: describir las estrategias de afrontamiento de los familiares de pacientes críticos. Materiales y métodos: revisión integradora de literatura en las bases de datos PUBMED, LILACS, EPISTEMONIKOS, CUIDEN, SCIELO, CINAHL y CLINICALKEY, obteniendo 13 artículos: 7 estudios cuantitativos observacionales, 4 cualitativos fenomenológicos y 2 revisiones sistemáticas. Resultados: se determinó que las estrategias más utilizadas por los familiares de pacientes críticos son respuesta emocional, apoyo social, valores y creencias y crisis familiar. La más recurrente en los estudios revisados es la respuesta emocional debido a la implicación afectiva que tiene en los familiares la hospitalización de su ser querido.  Conclusión: la respuesta emocional usada por los familiares como estrategia evidencia la necesidad de que las enfermeras garanticen espacios de acercamiento y expresión de sentimientos. Los servicios de salud deben priorizar el trato humanizado y una comunicación acorde con las necesidades de los familiares.

Pediatric oncology social workers' experience of compassion fatigue

Pediatric oncology social workers play an important role in supporting cancer patients and their families as they learn to talk about and cope with the physical and psychological impacts of cancer. As a result, social workers are particularly vulnerable to compassion fatigue and the associated psychological and physical impacts. The purpose of this qualitative study was to understand the experience of compassion fatigue among 27 pediatric oncology social workers. Four main themes emerged throughout the five focus groups: Conditions that contribute to compassion fatigue; the influence of compassion fatigue; coping strategies to alleviate compassion fatigue; and desire for systematic support to prevent compassion fatigue. Our study findings emphasize the importance of developing programs, policies and research geared toward the prevention of compassion fatigue, in addition to coping with symptoms. Further, this study brings attention to the importance of including pediatric oncology social workers in efforts to develop and implement systemic supports.

Effectiveness of nursing intervention for increasing hope in patients with cancer: a meta-analysis

Objective:

to evaluate the efficacy of nursing interventions to increase the level of hope in cancer patients, in a meta-analysis.

Methods:

electronic databases were searched. Two of the authors independently extracted data from the eligible studies, and Stata 13.0 software was used to pool the data.

Results:

nine randomized controlled trials were included, and methodological quality of each randomized controlled trial (RCT) was evaluated using Cochrane handbook recommendations. A random effects model was used to combine results from eligible studies. The pooled results using the fixed effects model showed that scores to first effects increase significantly after the use of nursing intervention between the groups. Heterogeneity was observed among the studies for posttest (df = 8, P = 0.000; I² =76.1 %). The results indicated significant heterogeneity across the nine selected studies. The test for heterogeneity showed no homogeneity among studies for follow-up (df = 8, P = 0.328; I² = 12.9 %), and there was no statistical significance.

Conclusion:

the current evidence suggests that nursing intervention has a positive effect on hope in cancer patients. However, more large-scale and high-quality randomized controlled trials are needed to confirm these results.

Psychometric Properties and Correlates of the Beck Hopelessness Scale in Family Caregivers of Nigerian Patients with Psychiatric Disorders in Southwestern Nigeria

Objectives:

To examine the construct and correlates of hopelessness among family caregivers of Nigerian psychiatric patients.

Materials and Methods:

This is a cross-sectional, descriptive study involving 264 family caregiver-patients’ dyads recruited from two university teaching hospitals psychiatric clinics in Southwestern Nigeria.

Results:

Exploratory factor analysis revealed a two-factor 9-item model of the Beck Hopelessness Scale (BHS) among the family caregivers. Confirmatory factor analysis of the model revealed satisfactory indices of fitness (goodness of fit index = 0.97, comparative fit index = 0.96, Chi-square/degree of freedom (CMIN/DF) = 1.60, root mean square error of approximation = 0.048, expected cross-validation index = 0.307, and standardized root mean residual = 0.005). Reliability of the scale was modestly satisfactory (Cronbach's alpha 0.72). Construct validity of scale was supported by significant correlations with the family caregivers’ scores on the Zarit Burden Interview, mini international neuropsychiatric interview suicidality module, General Health Questionnaire-12 (GHQ-12), and Patient Health Questionnaire-9. The greatest variance in the family caregivers’ scores on the BHS was contributed by their scores on the psychological distress scale (GHQ-12).

Conclusions:

The BHS has adequate psychometric properties among Nigerian psychiatric patients’ family caregivers. There is the need to pay attention to the psychological well-being of the family caregivers of Nigerian psychiatric patients.

Gender differences in caregiver burden and its determinants in family members of terminally ill cancer patients

OBJECTIVE

Female family caregivers consistently report higher levels of stress and burden compared to male caregivers. Explanations for the apparently higher psychological vulnerability of female caregivers are largely missing to date. This study assesses the correlates and determinants of caregiver burden in family caregivers of advanced cancer patients with a specific focus on gender differences.

METHODS

Three hundred and eight self-identified main informal caregivers of advanced cancer patients were cross-sectionally assessed using structured questionnaires for caregiver burden and hypothesised determinants of burden, including sociodemographic characteristics, caring arrangements, support needs, hope and coping style. Gender differences and predictors of burden were assessed using t-tests, chi-squared tests and univariate linear regression. Significant univariate predictors were entered in an analysis of covariance separately for men and women.

RESULTS

Burden was significantly higher in women. Hope was the most significant protective factor against burden in both genders, together with perceived fulfilment of support needs. Only in women emotion-oriented coping and being in employment while caring were significantly predictive of higher burden in the multivariate analysis. The model explained 36% of the variance in burden in men and 29% in women.

CONCLUSION

Psychological support interventions for family caregivers should take gender-specific risk factors into account. Interventions focusing on keeping up hope while caring for a terminally ill family member may be a valuable addition to palliative services to improve support for family carers. Women may benefit from interventions that address adaptive coping and strategies to deal with the dual demands of employment and caring. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

The Effect of Reflective Garden Walking on Adults With Increased Levels of Psychological Stress

PURPOSE

The purpose of this evaluation was to determine the benefits of a reflective garden walking program on adults with increased levels of psychological stress. Outcomes measured included levels of hopefulness, personal growth, and quality of life.

DESIGN

The evaluation used a one-group, pretest-posttest to determine the success of the Stroll for Well-Being to assist participants to overcome psychological stressors. Participants were recruited through local support groups. All participants signed informed consent to participate in the study program. A total of 195 participants completed the 6-week program, attended all meetings, and completed all measurement tools.

FINDINGS

All of the outcome measures statistically improved on the posttest compared to the pretest scores. The outcome measure that had the largest change in mean score was the Personal Growth Scale.

DISCUSSION

Holistic nursing as a specialty should continue to explore the use of green spaces and nature on patients. More research is needed to increase the amount of evidence regarding spending time in nature and using reflection and journaling as a tool to reconnect with the natural environment.

Cuidado de pacientes oncológicos: una revisión sobre el impacto de la situación de estrés crónico y su relación con la personalidad del cuidador y otras variables moduladoras

Objetivo: La incidencia y prevalencia de enfermedades de larga duración como el cáncer se ha incrementado en los últimos años. En este contexto, nuestro principal objetivo será el análisis de las principales consecuencias que la exposición a una situación de estrés crónico, como es el cuidado de un paciente oncológico, tiene sobre la salud psicosocial y la función cognitiva del cuidador informal y su relación con variables moduladoras. Método: Se realizó una revisión bibliográfica en las bases de datos PubMed y PsychINFO sobre las consecuencias de la situación de cuidado en pacientes crónicos. Resultados: Diversos estudios sugieren que la condición de cuidador de un paciente oncológico puede considerarse una situación estresante que conlleva consecuencias tanto a nivel de salud física como psicosocial del cuidador además de un deterioro en su funcionamiento cognitivo que pueden estar modulados por diferentes variables. Conclusión: Estos datos sugieren la importancia de implementar programas de intervención que amortigüen las consecuencias deletéreas de la labor de cuidado.

Escala de estrategias de enfrentamento para cuidadores primarios informales de pacientes con cáncer

Objetivo: Analizar propiedades psicométricas de un nuevo instrumento válido y confiable, que evalúa las estrategias de enfrentamiento en cuidadores primarios informales (CPI) de pacientes oncológicos. El Instrumento de Estrategias de Enfrentamiento en Cuidadores Primarios Informales (IEECPI), consta de 2 factores (Dirigido a la emoción) y 3 indicadores (Dirigido al problema). Método: Se evaluó a 20 CPI de pacientes oncológicos mediante un cuestionario de preguntas abiertas, para obtener información sobre la conceptualización de las dimensiones teóricas de las estrategias de enfrentamiento obteniendo 216 indicadores, agrupados en dos categorías (Dirigido a la emoción y al problema), de los cuales se generaron 55 reactivos que se aplicaron a 255 CPI. Una vez obtenidos los datos se siguió el procedimiento propuesto por Nunnally y Bernstein (1994) y el de Reyes-Lagunes, García y Barragán (2008) que consiste en: Análisis de frecuencia de cada reactivo, para conocer el tipo de distribución predominante, discriminación y direccionalidad de los reactivos, confiabilidad inicial, análisis de correlación, análisis factorial y confiabilidad total y por factores. Resultados: Los resultados muestran que de los 55 reactivos iniciales, posterior al análisis estadístico, finalmente se obtuvieron 15 reactivos divididos en 2 factores (Dirigido a la emoción evitativo y Dirigido a la emoción emocional negativo) y 3 indicadores (Dirigido al problema directo, Dirigido al problema revaluación cognitiva positiva y Revaluación cognitiva negativa). Conclusión: El IEECPI, es un instrumento válido, confiable y culturalmente relevante para evaluar estrategias de enfrentamiento en CPI de pacientes oncológicos y detectar necesidades con necesidad de intervención.