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Bharadwaj A, Oliver DP, Washington KT, Benson J, Pitzer K, White P, Demiris G. Family Caregiver Communication and Perceptions of Involvement in Hospice Care. J Palliat Med 2024; 27:614-621. [PMID: 38271546 DOI: 10.1089/jpm.2023.0576] [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: 01/27/2024] Open
Abstract
Background: The burden of caregiving for family members is significant and becomes particularly challenging at end of life, with negative effects on mental health, including anxiety and depression. Research has shown caregivers need better communication with their health care team. Objectives: To evaluate the relationship between hospice team communication with caregivers and caregiver involvement in care. Methods: The purpose of this secondary analysis of data collected from a U.S.-based cluster crossover randomized trial was to evaluate whether caregiver-centered communication (Caregiver-Centered Communication Questionnaire) is associated with a caregiver's perceptions of involvement in care (Perceived Involved in Care Scale). A block-wise approach was used to estimate linear models, which were created using total scores and subscale scores. Results: Caregiver-centered communication was positively associated with perceptions of involvement in care. Conclusion: Skilled communication between hospice clinicians and family caregivers is critical in helping family members perception they are involved in the care of their loved one. There could be similar benefit in caregiver-centered communication during cancer treatment as well.
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Affiliation(s)
- Archana Bharadwaj
- Department of Anesthesiology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Debra Parker Oliver
- Division of Palliative Medicine, Department of Medicine, Goldfarb School of Nursing, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Karla T Washington
- Division of Palliative Medicine, Department of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Jacquelyn Benson
- Division of Palliative Medicine, Department of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Kyle Pitzer
- Division of Palliative Medicine, Department of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Patrick White
- Division of Palliative Medicine, Department of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - George Demiris
- Department of Biobehavioral and Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Shield T, Bayliss K, Hodkinson A, Panagioti M, Wearden A, Flynn J, Rowland C, Bee P, Farquhar M, Harris D, Grande G. What factors are associated with informal carers' psychological morbidity during end-of-life home care? A systematic review and thematic synthesis of observational quantitative studies. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2023:1-58. [PMID: 37991230 DOI: 10.3310/htjy8442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
Background Family carers are central in supporting patients nearing end of life. As a consequence, they often suffer detrimental impacts on their own mental health. Understanding what factors may affect carers' mental health is important in developing strategies to maintain their psychological well-being during caregiving. Aim To conduct a systematic review and thematic evidence synthesis of factors related to carers' mental health during end-of-life caregiving. Method Searches of MEDLINE, CINAHL, PsychINFO, Social Sciences Citation Index, EMBASE, Cochrane Central Register of Controlled Trials and Database of Abstracts of Reviews of Effects 1 January 2009-24 November 2019. We included observational quantitative studies focusing on adult informal/family carers for adult patients at end of life cared for at home considering any factor related to carer mental health (anxiety, depression, distress and quality of life) pre-bereavement. Newcastle-Ottawa Quality Assessment Scale was used. Thematic analysis with box score presentation, and meta-analysis were done where data permitted. Results Findings from 63 included studies underpinned seven emergent themes. Patient condition (31 studies): worse patient psychological symptoms and quality of life were generally associated with worse carer mental health. Patient depression was associated with higher depression in carers (standardised mean difference = 0.59, 95% confidence interval 0.32 to 0.87, I2 = 77%). Patients' other symptoms and functional impairment may relate to carer mental health, but findings were unclear. Impact of caring responsibilities (14 studies): impact on carers' lives, task difficulty and general burden had clear associations with worse carer mental health. Relationships (8 studies): family dynamics and the quality of the carer-patient relationship may be important for carer mental health and are worthy of further investigation. Finance (6 studies): insufficient resources may relate to carers' mental health and warrant further study. Carers' psychological processes (13 studies): self-efficacy and preparedness were related to better mental health. However, findings regarding coping strategies were mixed. Support (18 studies): informal support given by family and friends may relate to better carer mental health, but evidence on formal support is limited. Having unmet needs was related to worse mental health, while satisfaction with care was related to better mental health. Contextual factors (16 studies): older age was generally associated with better carer mental health and being female was associated with worse mental health. Limitations Studies were mainly cross-sectional (56) rather than longitudinal (7) which raises questions about the likely causal direction of relationships. One-third of studies had samples < 100, so many had limited statistical power to identify existing relationships. Conclusions and future work Future work must adopt a comprehensive approach to improving carers' mental health because factors relating to carer mental health cover a broad spectrum. The literature on this topic is diverse and difficult to summarise, and the field would benefit from a clearer direction of enquiry guided by explanatory models. Future research should (1) further investigate quality of relationships and finances; (2) better define factors under investigation; (3) establish, through quantitative causal analyses, why factors might relate to mental health; and (4) utilise longitudinal designs more to aid understanding of likely causal direction of associations. Study registration This study is registered as PROSPERO registration 2019 CRD42019130279 at https://www.crd.york.ac.uk/prospero/. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme HSDR 18/01/01 and is published in full in Health and Social Care Delivery Research. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Tracey Shield
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, UK
| | - Kerin Bayliss
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, UK
| | - Alexander Hodkinson
- NIHR Greater Manchester Patient Safety Translational Research Centre, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, University of Manchester, Manchester, UK
| | - Maria Panagioti
- NIHR Greater Manchester Patient Safety Translational Research Centre, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, University of Manchester, Manchester, UK
| | - Alison Wearden
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Jackie Flynn
- Public and Community Involvement and Engagement (PCIE) Panel, NIHR Applied Research Collaboration (ARC) Greater Manchester, Manchester, UK
| | - Christine Rowland
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Penny Bee
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, UK
| | - Morag Farquhar
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Danielle Harris
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, UK
- NIHR Applied Research Collaboration (ARC) Greater Manchester, Manchester, UK
| | - Gunn Grande
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, UK
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Guclu YA, Can H, Sezik HA, Kurnaz MA, Bulut U. Palyatif bakım servisinde yatmakta olan kanser hastalarına bakım veren yakınlarının anksiyete ve depresyon belirtilerinin değerlendirilmesi. FAMILY PRACTICE AND PALLIATIVE CARE 2018. [DOI: 10.22391/fppc.396925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Parker Oliver D, Washington K, Smith J, Uraizee A, Demiris G. The Prevalence and Risks for Depression and Anxiety in Hospice Caregivers. J Palliat Med 2016; 20:366-371. [PMID: 27912042 DOI: 10.1089/jpm.2016.0372] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Depression and anxiety are common concerns for hospice caregivers. OBJECTIVE This study looked at the prevalence and variables associated with hospice caregiver depression and anxiety, as well as the relationship between the two conditions. SUBJECTS We did a secondary analysis of preexisting data. MEASUREMENTS Measures included the PHQ-9 and GAD-7. RESULTS Nearly one-quarter of caregivers were moderately to severely depressed, and nearly one-third reported moderate to severe symptoms of anxiety. Risk factors for both depression and anxiety included younger age and poorer self-rated global health. Depression-specific risk factors included being married and caring for a patient with a diagnosis other than cancer. The sole anxiety-specific risk factor identified was geographic location, as caregivers living in the Southeast were found to have greater anxiety than those in the Midwest. CONCLUSION Hospice providers' recognition of family caregivers as both coproviders and corecipients of care underscores the need to more fully assess and respond to depression and anxiety among caregivers.
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Affiliation(s)
- Debra Parker Oliver
- 1 Department of Family and Community Medicine, University of Missouri , Columbia, Missouri
| | - Karla Washington
- 1 Department of Family and Community Medicine, University of Missouri , Columbia, Missouri
| | - Jamie Smith
- 1 Department of Family and Community Medicine, University of Missouri , Columbia, Missouri
| | - Aisha Uraizee
- 2 University of Missouri School of Medicine , Columbia, Missouri
| | - George Demiris
- 3 Biobehavioral Nursing and Health Systems, School of Nursing & Biomedical and Health Informatics, School of Medicine, University of Washington , Seattle, Washington
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The COPE Intervention for Caregivers of Patients with Heart Failure: An Adapted Intervention. J Hosp Palliat Nurs 2013; 15. [PMID: 24288455 DOI: 10.1097/njh.0b013e31827777fb] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Exline JJ, Prince-Paul M, Root BL, Peereboom KS. The spiritual struggle of anger toward God: a study with family members of hospice patients. J Palliat Med 2013; 16:369-75. [PMID: 23406532 DOI: 10.1089/jpm.2012.0246] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Anger toward God is a common form of spiritual struggle, one that people often experience when they see God as responsible for severe harm or suffering. The aim of this study was to assess the prevalence, correlates, and preferred coping strategies associated with anger toward God among family members of hospice patients. METHODS Teams from a large hospice in the midwestern United States distributed surveys, one per household, to family members of home-care patients. The survey assessed feelings toward God (anger/disappointment and positive feelings), depressive symptoms, religiosity, and perceived meaning. Participants also rated their interest in various strategies for coping with conflicts with God. RESULTS Surveys (n=134) indicated that 43% of participants reported anger/disappointment toward God, albeit usually at low levels of intensity. Anger toward God was associated with more depressive symptoms, lower religiosity, more difficulty finding meaning, and belief that the patient was experiencing greater pain. Prayer was the most highly endorsed strategy for managing conflicts with God. Other commonly endorsed strategies included reading sacred texts; handling the feelings on one's own; and conversations with friends, family, clergy, or hospice staff. Self-help resources and therapy were less popular options. CONCLUSION Anger toward God is an important spiritual issue among family members of hospice patients, one that is commonly experienced and linked with depressive symptoms. It is valuable for hospice staff to be informed about the issue of anger toward God, especially because many family members reported interest in talking with hospice team members about such conflicts.
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Affiliation(s)
- Julie J Exline
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, OH 44106, USA.
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Oliver DP, Albright DL, Washington K, Wittenberg-Lyles E, Gage A, Mooney M, Demiris G. Hospice caregiver depression: the evidence surrounding the greatest pain of all. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2013; 9:256-271. [PMID: 24295096 PMCID: PMC3849709 DOI: 10.1080/15524256.2013.846891] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Terminal illness affects the entire family, both the one with the illness and their loved ones. These loved ones must deal not only with the loss but with the challenges of managing daily care. The purpose of the systematic review of the peer-reviewed literature was to identify and explore depression and related interventions for caregivers of hospice patients. While the prevalence of depression reported in the identified studies of hospice caregivers ranges from 26-57%, few interventions specific to this population have been tested and the research methods have been only moderately rigorous.
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Affiliation(s)
- Debra Parker Oliver
- Curtis W. and Ann H. Department of Family and Community Medicine, University of Missouri, Medical Annex 306G, Columbia, Mo 65212, 573-356-6719
| | | | | | | | - Ashley Gage
- School of Social Work, Senior Research Specialist, University of Missouri
| | | | - George Demiris
- Biobehavioral Nursing and Health Systems, School of Nursing & Biomedical and Health Informatics, School of Medicine, University of Washington
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Exline JJ, Prince-Paul M, Root BL, Peereboom KS, Worthington EL. Forgiveness, Depressive Symptoms, and Communication at the End of Life: A Study with Family Members of Hospice Patients. J Palliat Med 2012; 15:1113-9. [DOI: 10.1089/jpm.2012.0138] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Julie J. Exline
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, Ohio
| | - Maryjo Prince-Paul
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio
- Hospice of the Western Reserve, Inc., Cleveland, Ohio
| | - Briana L. Root
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, Ohio
| | - Karen S. Peereboom
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio
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