An observational study of family caregivers' quality of life caring for patients with a stoma

Psychometric characteristics of the multidimensional scale of perceived social support in ostomy patients and their caregivers

Despite the importance of social support in ostomy care, the Multidimensional Scale of Perceived Social Support (MSPSS) does not appear to be validated in the context of ostomy care. This study evaluated the psychometric characteristics of MSPSS in ostomy patients and their informal caregivers. The MSPSS was tested in a sample of 775 participants with confirmatory factor analysis. Internal consistency reliability was assessed with the ordinal Omega coefficient. Criterion-related validity was ascertained via hypothesis testing by correlating the scores of the MSPSS with other measures. MSPSS for patients and caregivers has a three-factor structure with a good fit. Internal consistency reliability of the factors was excellent. Concurrent validity was supported by the negative correlations between MSPSS scores with depression and stoma-related QoL, and the positive correlations with perceived mutuality. Our research indicates that the MSPSS is a sound measure of social support for ostomy patients and their caregivers.

Caregiver Burden in Bladder Cancer Patients with Urinary Diversion Post-Radical Cystectomy and the Need for Comprehensive Nursing Education: A Narrative Literature

Background

Bladder cancer ranks seventh in global cancer prevalence. Radical cystectomy and urinary diversion are standard for muscle-invasive bladder cancer. Family caregivers shoulder a substantial care burden, affecting their own quality of life, with repercussions extending to patients' health-related quality of life (HRQOL).

Objective

This narrative review aims to highlight the major concerns perceived by the caregivers and efficacy of nurse-led interventions in alleviating their concerns and improving HRQOL.

Methods

A systematic search of the PubMed, CINAHL, and Science Direct databases was carried out to identify studies published in the last 5 years (from Jan 2018 to Aug 2023) that have evaluated the concerns and problems of caregivers attending bladder cancer patients with urinary diversion. Additionally, studies evaluating the efficacy of nurse-led interventions in alleviating these concerns were also searched.

Results

Overall, 6 studies involving 933 BC patients with UD and 1042 caregivers were identified as suitable for inclusion in this narrative literature review. Major concerns identified included psychological well-being, medical assistance needs, and peer support. Significant psychological impact was evident in the caregivers which operated in a dyadic manner. Nurse-led stoma education programs have demonstrated potential in enhancing caregivers' quality of life, although they remain restricted.

Conclusion

Emphasizing caregivers' role and program effectiveness is critical. Our review addresses these gaps, focusing on caregivers' concerns and the impact of nursing education for improved patient outcomes.

Implications for Practice

Holistic and collaborative approach could enhance the overall well-being and quality of life of bladder cancer patients and their caregivers.

The clarification of the concept of colostomy nursing care in ostomy care centers: A concept analysis through Walker and Avant's method

BACKGROUND

Specialist nurses need to have an accurate understanding of colostomy care-related concepts to provide care. Although patients with different types of ostomy have different types of needs, terms such as ostomy care, colostomy care, and ileostomy nursing are interchangeably used. Moreover, there are limited concept analysis studies into the concept of colostomy nursing care (CNC) in ostomy care centers (OCCs). The aim of this study was to analyze and clarify the concept of CNC in outpatient OCCs.

METHODS AND MATERIAL

This was a concept analysis study. This concept analysis was conducted using Walker and Avant's eight-step method. The online databases were searched until 2022 to retrieve documents on CNC. Finally, 35 articles and four books were included in the analysis, the defining attributes, antecedents, and consequences of the concepts were determined, and model and additional cases as well as empirical referents were presented.

RESULTS

The defining attributes of CNC in OCCs are the development of professional role, participatory practice and interdisciplinary care, selection of the best clinical procedures, care based on patient education, and patient rehabilitation. The antecedents of the concept are nurse-related antecedents, patient- and family-related antecedents, environmental antecedents, and professional rules and regulations. Its consequences are patients' and families' greater care-related knowledge, improvement of nurses' care quality, patient autonomy, and self-efficacy.

CONCLUSION

The concept of CNC in OCCs can be defined as "a continuous and coherent care based on knowledge, skill, expertise, experience, and colostomy type which uses interdisciplinary collaboration and the best available evidence in order to select and provide the best services according to patients' and families' culture and background, fulfill patients' physical, mental, sexual, social, and spiritual needs, and timely refer patients to specialists, with the ultimate goal of improving patient autonomy and facilitating their return to normal life."

Trajectory of Caregiver Burden and Associated Factors in Family Caregivers of Individuals with Colorectal Cancer: A Longitudinal, Observational Multicenter Study

Purpose

To (1) investigate the changes in 5 domains (lack of family support, impact on finance, impact on daily schedule, impact on health, and self-esteem) of family caregiver (FC) burden and overall burden for first diagnosed colorectal cancer; (2) exploring changes in FC burden for colorectal cancer patients over time and analyze the trajectory and sub-trajectories of FC burden; and (3) identify the FC-related and patient-related factors most associated with the overall FC burden and each of its sub-trajectories.

Patients and methods

This study is a descriptive longitudinal study. A convenience sampling method was used to recruit patients with colorectal cancer and their primary FCs from seven hospitals.

Results

A total of 185 pairs of first diagnosed colorectal cancer patient and their FC were investigated for 4 times. The results reveal the overall burden and 5 domains of burden showed a trend of increasing first and then decreasing, and the burden was the heaviest at the time in the middle of chemotherapy. In the course of time, the aspect that caused the greatest amount of burden on average transitioned from the "effect on daily schedule" (range= 3.3 and 3.9) to the "effect on finances" (range= 3.1 to 3.4).

Conclusion

Almost 88% of FCs have a either a moderate or a high level of burden. The quality of life of patients and the self-efficacy, social support and care ability of FCs have a great impact on the overall FC burden and each sub-trajectory.

Determinants of quality of life in primary family caregivers of patients with advanced cancer: a comparative study in southern China

Objective

To examine and compare the quality of life (QoL) of the primary family caregivers (PFCs) of inpatients with advanced cancer and the PFCs of home hospice patients with advanced cancer and to analyze the determinants of QoL.

Methods

Four hospices and three comprehensive or tumor hospitals in Guangdong Province, China were research sites. QoL was measured using paper-based and online questionnaires. Multiple stepwise linear regression was used to analyze the determinants of QoL of PFCs.

Results

The PFCs of inpatients had significantly better QoL than did the PFCs of home hospice patients (p < 0.01). One-way ANOVA results indicated the following: for the PFCs of inpatients, PFC age (t = 2.411, p < 0.05), type of relationship with patient (F = 2.985, p < 0.05), and family economic situation (F = 3.423, p < 0.05) significantly affected PFCs' QoL; for the PFCs of home hospice patients, family economic situation (F = 3.757, p < 0.05) and care experience (t = 2.021, p < 0.05) significantly affected PFCs' QoL. A multiple stepwise linear regression was conducted: for the PFCs of inpatients, family economic situation and whether the PFC was the patient's immediate family member were included as predictors of QoL; for the PFCs of home hospice patients, family economic situation and care experience were included as predictors of QoL.

Conclusion

Our findings can help improve the home hospice care service model in mainland China. In particular, the QoL of the PFCs of home hospice patients requires urgent attention. The PFCs of home hospice patients requires more nursing guidance and interactions with community.

Caregiver Burden among Family Caregivers of Cancer Survivors Aged 75 Years or Older in Japan: A Pilot Study

The purpose of this study was to assess the burden of caregiving among family caregivers of cancer survivors aged 75 years or older in Japan. We included family caregivers of cancer survivors aged 75 years or older who were attending two hospitals in Ishikawa Prefecture, Japan, or receiving treatment during home visits. A self-administered questionnaire was developed based on previous studies. We obtained 37 responses from 37 respondents. Excluding those with incomplete responses, we had data from 35 respondents for analysis. The factor that significantly influenced the burden of caregiving for cancer survivors aged 75 years or older and family caregivers living together was the provision of full-time care (p = 0.041). Helping cancer survivors manage money (p = 0.055) was also associated with a higher burden. For family caregivers living separately, a more detailed examination of the association between the sense of caregiving burden and distance of travel to provide home-visit care is necessary, along with more support to attend hospitals with cancer survivors.

Quality of life of family caregivers of patients with a stoma: a cross-sectional study from Iran

AIM

The family plays a key role in supporting and caring for patients who have a gastrointestinal stoma because of cancer. This study investigated the quality of life of family members caring for such patients.

METHODS

A descriptive study was conducted in 2020 in Iran. The study sample consisted of 250 family members caring for cancer patients with an intestinal stoma. The Caregiver Quality of Life Index-Cancer scale was used to measure quality of life. This scale has 35 questions, which are categorised into four subscales: mental/emotional burden; lifestyle disruption; positive adaptation; and financial concerns. The highest possible total score is 140 (35 in each subscale), and a high score indicates a poor quality of life.

RESULTS

A total of 250 carers took part in the study. Of these, 143 (57.2%) were men and the average age was 35.1 years. Mean scores of mental/emotional burden, lifestyle disruption, positive adaptation, and financial concerns were 28.4±41, 17.3±3.2, 19.8±28, and 8.6±1.2 respectively. No significant relationship was found between participants' quality of life and demographic variables.

CONCLUSION

Carers' quality of life is relatively poor. Carers' quality of life need to be improved and support programmes, devised and delivered by nurses, could have a role in this.

Caregiver contribution to self-care and its associated variables among caregivers of ostomy patients: Results of a cross-sectional study

AIMS AND OBJECTIVES

To describe caregiver contribution (CC) to ostomy self-care and identify its associated variables among caregivers of ostomy patients.

BACKGROUND

Self-care is essential for ostomy patients, but it can be difficult to perform. In these cases, caregivers play a key role in promoting self-care behaviours. So far, the CC to ostomy self-care has not been investigated thoroughly.

DESIGN

This is a cross-sectional and multicentre study conducted at seven outpatient clinics of two Italian regions.

METHODS

We recruited 252 caregivers between February 2017-May 2018. The Caregiver Contribution to Ostomy Self-Care Index (CC-OSCI) was used to measure CC to ostomy self-care. Three multivariable linear regression models were fitted to identify variables associated with CC dimensions (maintenance, monitoring and management). The STROBE checklist was used to report the present study.

RESULTS

The sample (mean age = 58.73, SD = 13.98) was mostly female (80.60%), unemployed (58.70%) and resided with the patient (81.00%). Caregivers being employed and those declaring more hours of contribution per week were associated with a significantly lower contribution to self-care maintenance. Caregivers with lower levels of education and those residing with the patient were less likely to contribute to CC to self-care monitoring. Spousal caregivers and those with higher preparedness contributed significantly lower to CC to self-care management.

CONCLUSIONS

We found a variety of sociodemographic factors associated with CC to ostomy self-care.

RELEVANCE TO CLINICAL PRACTICE

Sociodemographic variables associated with CC to ostomy self-care can help clinicians develop more tailored educational interventions for caregivers who find their contribution challenging.

Application of the hospital-family holistic care model in caregivers of patients with permanent enterostomy: A randomized controlled trial

AIMS

To evaluate the effectiveness of the hospital-family holistic care model based on the theory of 'Timing It Right' in caregivers of patients with permanent enterostomy.

DESIGN

A prospective randomized controlled trial.

METHODS

One hundred and twenty-five caregivers of patients with permanent enterostomy were recruited from 1 May 2017-31 August 2019. They were randomized into either intervention group (N = 62) or control group (N = 63). The control group received routine care and follow-up, while the intervention group received routine care, follow-up, and hospital-family holistic care intervention based on 'Timing It Right'. The care ability, psychological distress, and life quality of the caregivers were evaluated between the groups before the intervention, at discharge, and 3 and 6 months after discharge.

RESULTS

One hundred and eleven caregivers completed the study (88.8%). At 3 and 6 months after discharge, the care ability and life quality in the intervention group were significantly better than those in the control group (t = 8.506/9.783, t = 22.652/26.179, p < 0.05) based on the t tests, and the psychological distress was lower than that in the control group. The ostomy adaptability of the control group was significantly lower than that in the intervention group (p < 0.001) based on the t tests, and the χ² test showed that ostomy complication was more than that in the intervention group (23.81% vs. 12.90% and 34.92% vs. 19.35%; p < 0.05) at 3 and 6 months after discharge. The interaction between time and group showed that the effect of time factor varied with the group and the four evaluation indexes in the intervention group gradually improved with the extension of the observation time and were better than those in the control group based on generalized estimating equation model.

CONCLUSION

The hospital-family holistic care model based on 'Timing It Right' can effectively improve the care ability of caregivers of patients with permanent enterostomy, reduce psychological distress, and improve the quality of life.

IMPACT

The caregivers of patients with permanent enterostomy showed dynamic changes in their care experience and needs at different stages of the disease. The hospital-family holistic care intervention strategy based on 'Timing It Right' can effectively improve the caregiver's care ability, alleviate psychological distress, and improve the quality of life. Additionally, improving the patients' stoma adaptability and reducing the incidence of complications related to ostomy.

Burden of Care in Caregivers of Iranian patients with chronic disorders: a systematic review and meta-analysis

Introduction

Caring for patients with chronic disorders can lead to different problems for caregivers in physical, psychological, social, family, and financial domains. High levels of burden of care can make caregivers vulnerable to physical and psychological conditions and influence their quality of life. Therefore, the goal of the present study was to estimate the overall percentage of burden of care in caregivers of Iranian patients with chronic disorders.

Methods

A total of 25 articles published from inception to February 2019 were reviewed. Search for articles was conducted in international (Scopus, Web of Science, and PubMed) and domestic (Scientific Information Database (SID) and MagIran) databases, using the following keywords: “Caregiver,” “Burden,” and “Iran,” and their possible combinations. The data were analyzed using the meta-analysis method and the random effects model. All the analyses were performed using STATA, version 14.

Results

The overall percentage of burden of care in caregivers of Iranian patients with chronic disorders was 53.28% (95% CI: 46.13–60.43). The highest percentage of burden of care was related to dialysis (62.75; 95% CI: 56.11–69.38), mental disorders (58.69; 95% CI: 49.70–67.69), and Alzheimer’s disease (57.07; 95% CI: 46.23–67.92), respectively; and the lowest percentage of burden of care was related to diabetes (34.92; 95% CI: 18.01–51.82).

Conclusions

Caregivers of Iranian patients with chronic disorders experience high levels of burden of care, especially those caring for patients undergoing dialysis, patients with mental disorders, and patients with Alzheimer’s disease. Therefore, necessary measures need to be taken by Iranian health care officials to reduce burden of care in caregivers.

Health-Related Quality of Life (HRQOL) of Gastrointestinal Cancer Caregivers: The Impact of Caregiving

Objective: This study examined the quality of life (QOL) of caregivers for gastrointestinal (GI) cancer patients, and associated factors. Methods: A cross-sectional study was conducted at three referral hospitals in Klang Valley, Malaysia. A total of 323 pairs of patients and caregivers from the oncology units of these hospitals completed questionnaires in Malay. The QOL of caregivers was measured using The Malay Caregiver Quality of Life questionnaire. The independent variables were caregiver and patient factors, care-related factors, the Caregiver Strain Index-Malay, and the Multidimensional Scale of Perceived Social Support-Malay. Simple and multiple linear regression analyses were performed to determine the factors associated with the QOL. Variables with p < 0.05 were considered significant in the multiple analyses. Results: Female caregivers were 68.1% of the total, and 46.4% caregivers were spouses to cancer patients. Their mean age was 44.50 (13.29) years old. About 51.7% were of Malay ethnicity. The mean score for QOL was 80.17 (21.58). Being a male caregiver (beta = 5.165, p = 0.011) and of Indian ethnicity (beta = -9.163, p = 0.001) were strongly associated with caregiver QOL. Male patients contributed higher QOL scores for the caregivers compared to female patients. There was an inverse relationship among caregiving strain, duration of caregiving, and caregiver QOL. Conclusion: The identification of factors that affect QOL will allow healthcare providers to develop appropriate interventions. It is important that caregivers be in good health so as not to compromise the care they provide to their patients.

Experiences and coping with the altered body image in digestive stoma patients

Objective:

to describe the coping of stoma patients with the news about the ostomy, as well as to analyze the meaning and the experience of their new bodily reality.

Method:

qualitative phenomenological study undertaken through semistructured interviews with 21 stoma patients. The analysis was based on the constant comparison of the data, the progressive incorporation of subjects and triangulation among researchers and stomal therapy nurses. The software Atlas.ti was used.

Results:

two main categories emerge: "Coping with the news about receiving a stoma" and "Meaning and experience of the new bodily reality". The informants' answer varies, showing situations that range from the natural acceptance of the process to resignation and rejection. The previous experiences of other family members, the possible reconstruction of the stoma or the type of illness act as conditioning factors.

Conclusions:

the coping with the news about the stoma is conditioned by the type of illness, although the normalization of the process is the trend observed in most informants. Nursing plays a fundamental role in the implementation of cognitive-behavioral interventions and other resources to promote the patients' autonomy in everything related to care for the stoma.

Effectiveness of Problem-Focused Coping Strategies on the Burden on Caregivers of Hemodialysis Patients

BACKGROUND

Studies have shown that family caregivers of hemodialysis patients experience high levels of burden. However, these caregivers are often neglected, and no studies are available on the effectiveness of coping strategies on the burden of care among these caregivers.

OBJECTIVES

This study aimed to examine the effectiveness of problem-focused coping strategies (communication skills, anger management, and deep breathing) on the burden on caregivers of hemodialysis patients.

PATIENTS AND METHODS

A randomized controlled clinical trial was conducted on 76 family caregivers of hemodialysis patients referred to Shahid Hasheminejad hemodialysis center in Tehran, Iran. The subjects were equally allocated into two groups of 38. Through a coin-tossing method, caregivers of patients who referred on even or odd days of the week were randomly assigned into the intervention group or the control group, respectively. The intervention group received four training sessions on problem-focused coping strategies, but the control group did not receive any intervention. Both groups answered the caregiver's burnout inventory at the start and six weeks after the last educational session. Descriptive statistics, chi-square, Fisher's exact test, independent-samples t-test, and Mann-Whitney U test were used to analyze the data.

RESULTS

The majority of caregivers (54%) were in the age range of 35 - 55 years, female (68.4%), and married (70%). No significant difference was found between the baseline mean caregivers' burden scores of the intervention and control groups (88.56 ± 11.74 vs. 84.97 ± 15.13, P = 0.308). However, the mean caregivers' burden in the intervention group decreased, and the two groups were significantly different at the end of the study (58.77 ± 6.64 vs. 87.84 ± 11.74, P < 0.001).

CONCLUSIONS

The current study showed the effectiveness of problem-focused coping strategies on reducing the burden on caregivers of hemodialysis patients. Authorities and policymakers in the healthcare system are responsible for developing strategies to integrate educational programs, such as the program implemented in the current study, into the country's healthcare system.

The Experience of Family Caregivers of Patients With a Left Ventricular Assist Device

Objective:

The purpose of this review is to understand the experience of caregivers of patients with left ventricular assist device (LVAD) and to evaluate how health professionals can support them properly.

Background:

Left ventricular assist device can improve quality of life, enhance functional status, and prolong survival in patients with advanced heart failure. Nonetheless, LVAD can adversely influence quality of life for their family caregivers.

Methods:

An integrative literature review was conducted using scientific databases between January to March 2015.

Results:

A total of 15 studies are included in the final review. Three major themes emerged “emotional distress,” “responsibility,” and “coping strategies” that characterize family caregivers’ experiences with care of patients with LVAD.

Conclusion:

Health care providers should understand the pivotal role of caregivers in promoting and maintaining patients’ well-being and be able to help the caregiver to moderate the impact being overloaded. Research should be addressed to create interventions that motivate the caregivers to engage in activities that promote their health.