Early palliative care for those who care: A qualitative exploration of cancer caregivers’ information needs during hospital stays

Communication between Caregivers of Adults with Cancer and Healthcare Professionals: a Review of Communication Experiences, Associated Factors, Outcomes, and Interventions

PURPOSE OF REVIEW

Family/unpaid caregivers play an important role in cancer care. This review aims to summarize caregiver communication experiences with healthcare professionals (HCPs).

RECENT FINDINGS

The Caregiver-Centered Communication model defines five core functions that HCPs should achieve when interacting with caregivers, including fostering relationships, exchanging information, recognizing and responding to caregiver emotions, aiding in decision making, and assisting in patient care management. The literature shows that caregivers have both positive and negative communication experiences with HCPs with respect to these five core functions. Factors at the caregiver (e.g., demographic characteristics, information sources, caregiving duration, health status), patient (e.g., demographic and clinical characteristics), and HCP levels (e.g., time constraints in clinical settings, communication skills) are associated with caregiver-HCP communication quality. Studies further show that these communication experiences may affect caregiver outcomes, including quality of life, mental health, resilience, and satisfaction with cancer care. Moreover, poor quality caregiver-HCP communication is associated with patient readmission to the hospital and unmet care needs. Interventions for caregivers or patient-caregiver dyads have been shown to enhance caregiver confidence and increase their engagement in communication with HCPs. Interventions for HCPs have shown efficacy in improving their communication skills, particularly in involving caregivers in decision-making discussions. Given time constraints during medical visits, we suggest conducting a caregiver assessment by navigators prior to visits to understand their communication needs. Additionally, reimbursing HCPs for time spent communicating with caregivers during visits could be beneficial. More research is needed to better understand how to enhance caregiver-HCP communication quality.

Exploring Differences in Caregiver Communication in Serious Illness

Background: Demographic factors, such as disease context and family relationships, are communication mediators and moderators; however, little is known about how understanding these factors can improve caregiver communication with providers. Recognition of communication differences among caregivers may aid the development of approaches to improve serious illness communication. Objective: To explore whether caregiver communication differs by disease context (cancer vs. dementia) and caregiver communication type (Manager, Carrier, Partner, and Lone). Caregiver communication type is based on communication patterns between the care recipient and caregiver. Design and Measurements: Caregivers of persons with cancer and/or dementia were surveyed from a U.S. national research registry website. Measures of caregiver communication included information needs, communication confidence, perception of provider understanding of the caregiver, perceived frequency of caregiver assessment, and caregiver stress. Analysis of variance (ANOVA) determined significant differences between caregiver communication (p < 0.05) based on disease context and caregiver communication type. Results: Cancer caregivers reported higher unrecognized-demanded information states (i.e., not recognizing information was needed), more communication confidence, and more frequent caregiver assessment compared to dementia caregivers. Among caregiver communication types, Manager caregiver types were more confident communicating than other caregiver types and perceived greater understanding by providers than the Lone caregiver type. Manager caregivers reported significantly less stress than other caregiver communication types. Conclusions: Understanding disease context and caregiver communication type may help improve caregiver communication with health care providers.

Unmet supportive care needs of people with advanced cancer and their caregivers: a systematic scoping review

Examining and addressing unmet care needs is integral to improving the provision and quality of cancer services. This review explored the prevalence of unmet supportive care needs, and factors associated with unmet need, in adults with advanced cancers (solid and hematological malignancies) and their caregivers. Electronic databases (PubMed, CINAHL, EMBASE) were searched, producing 85 papers representing 81 included studies. People with advanced cancer reported the highest unmet needs in financial, health system and information, psychological, and physical and daily living domains, whereas caregivers reported the highest unmet needs in psychological, and patient care and support domains. Distress, depression, and anxiety were associated with higher unmet needs across all unmet need domains for people with advanced cancer and their caregivers. Substantial heterogeneity in study populations and methods was observed. Findings from this review can inform targeted strategies and interventions to address these unmet needs in people with advanced cancer.

Family Caregivers' Experiences of Caring for Advanced Cancer Patients: A Qualitative Systematic Review and Meta-synthesis

BACKGROUND

Advanced cancers qualify as severe stressors to family caregivers (FCGs), which can negatively impact caregivers' psychological and physical well-being because of their association with high symptom burden, distress, and poor prognosis.

OBJECTIVE

This review aims to synthesize FCGs' experiences of caring for advanced cancer patients using a qualitative systematic review method.

METHODS

A comprehensive search was conducted in 7 databases from inception until July 2020. Two reviewers independently screened and assessed each study using Joanna Briggs Institute instruments and subsequently undertook the meta-aggregation approach to synthesize findings.

RESULTS

A total of 26 studies were included, refined to 37 findings, and integrated into 9 categories and 5 synthesized findings. When a loved one with advanced cancer faced deterioration near the end of their life, FCGs showed a tremendous sense of responsibility for care and concerted great efforts to alleviate their loved one's suffering while lacking effective professional support. Cultural beliefs had a great impact on FCGs' responsibility and role recognition. Ultimately, the caregiving helped FCGs achieve personal transcendence inherent in their unique experience.

CONCLUSIONS

Caring for advanced cancer patients is a unique, culture-specific experience marked by struggle. Effective professional support, including early palliative care, should be considered to improve the FCGs' experience of caring for advanced cancer patients. Cultural beliefs should be considered to understand and develop appropriate strategies to support FCGs.

IMPLICATIONS FOR PRACTICE

Healthcare providers need to ensure that individualized, multifaceted interventions considering FCGs' needs are delivered at the optimal time with the appropriate approach.

Characterizing uncertainty in goals-of-care discussions among black and white patients: a qualitative study

BACKGROUND

Uncertainty has been associated with distress and poorer quality of life in patients with advanced cancer. Prior studies have focused on prognostic uncertainty; little is known about other types of uncertainty that patients and family members experience when discussing goals of care. Understanding the types of uncertainty expressed and differences between Black and White patients can inform the development of uncertainty management interventions.

METHODS

This study sought to characterize the types of uncertainty expressed by Black and White patients and family members within the context of information needs during inpatient goals-of-care discussions. We performed a secondary analysis of transcripts from 62 recorded goals-of-care discussions that occurred between 2012 and 2014 at an urban, academic medical center in the United States. We applied an adapted taxonomy of uncertainty to data coded as describing information needs and used an inductive qualitative analysis method to analyze the discussions. We report the types of uncertainty expressed in these discussions.

RESULTS

Fifty discussions included patient or family expressions of information needs. Of these, 40 discussions (n=16 Black and n=24 White) included statements of uncertainty. Black and White patients and families most frequently expressed uncertainty related to processes and structures of care (system-centered uncertainty) and to treatment (scientific uncertainty). Statements of prognostic uncertainty focused on quantitative information among Whites and on qualitative information and expectations for the future among Blacks.

CONCLUSIONS

Black and White patients and families frequently expressed system-centered uncertainty, suggesting this may be an important target for intervention. Addressing other sources of uncertainty, such as prognostic uncertainty, may need more tailored approaches.

"You just need to learn": A qualitative study on the information needs of family caregivers of people with lung cancer

PURPOSE

Lung cancer caregivers often face considerable duties and responsibilities yet frequently feel unprepared for this role. The current study is the first to purposefully explore the information needs of family caregivers throughout the lung cancer trajectory.

METHODS

Semi structured interviews were conducted with nine lung cancer caregivers (7 female) including those bereaved within five years. Interviews were transcribed verbatim and analysed using thematic analysis.

RESULTS

Four main themes emerged: 1) "He knew that I'd ask questions, you see": Information-gathering during appointments; 2) "You can't really ask that with mum there": Discordant information needs between caregiver and the person with lung cancer; 3) "Trying to get the answers": Seeking information beyond the hospital; 4) "It took a while to kind of get into": Learning to adjust to changing roles and circumstances.

CONCLUSIONS

Lung cancer caregivers need reliable information to feel competent in their new roles and responsibilities. In the current study, there were a number of areas in which information was lacking, including those related to treatment, side effects, care services and symptom management. The provision of appropriate and timely information to lung cancer caregivers can ensure they feel supported in their roles and responsibilities. This will in turn benefit lung cancer survivors by ensuring that they understand information in consultations with oncology nurses and other health professionals and receive appropriate support from their caregivers that enhances their quality of life along the cancer trajectory.

The social burden experienced by families caring for members living with cancer in KwaZulu-Natal, South Africa

BACKGROUND

Cancer is a global public health problem and it affects people in different ways. Family caregivers (FCs) play an essential role in caring for patients with cancer, and thus, they experience many caregiver burdens that go unnoticed.

AIM

This research study explored the social burden that families experience in providing care to their family members living with cancer.

SETTING

This study was conducted in Durban and Pietermaritzburg, cities located in KwaZulu-Natal, South Africa.

METHODS

This was a qualitative study using the interpretative phenomenological approach that was ideal for understanding FCs subjective perspectives on their cancer caregiving experience. Data saturation were reached at 20 in-depth interviews.

RESULTS

Two major themes culminated from the data analysis; dynamics of a cancer diagnosis and psychosocial impact of a cancer diagnosis with respective sub-themes. Themes centred around the relational impact of a cancer diagnosis with FCs experiencing a shift in this dynamic and a disturbance to normality in social life. Social support systems were found to play a meaningful role in mitigating the impact of a cancer diagnosis with financial, psychosocial and educational support considered essential needs.

CONCLUSION

Cancer caregiving is a challenging task that also presents opportunities for strengthening family bonds as they evolve in new paths. A family-centred care approach is recommended as a form of social support with further collaboration with health care providers for guided patient care. If the needs of FCs are addressed accordingly through health care policies and interventions, FCs may be able to provide better care and support for their family members with cancer and thus positively impact cancer survivorship.

The validity and reliability of the Turkish version of the Family Inventory of Needs

OBJECTIVE

The aim of this methodological study was to test the validity and reliability of the Turkish version of the Family Inventory of Needs.

METHODS

The universe of the study consisted of 300 family members of inpatients hospitalized in the palliative care units of four hospitals in northern Turkey between April 12, 2019 and December 30, 2019. The translation process was performed in multiple stages using the forward-backward translation model. The reliability of the Family Inventory of Needs was evaluated using the Cronbach α reliability coefficient and item-total score correlations. Exploratory factor analyses were applied to examine the factor structure of the scale and its construct validity. To test the time invariance of the scale, the relationships between the scores obtained from the first and second applications were examined using the intraclass correlation coefficient (ICC).

RESULTS

The Kaiser-Meyer-Olkin value of the Family Inventory of Needs was found to be 0.893. The items of the Family Inventory of Needs were found to explain 45.23% of the total variance in scores. The Turkish form of the scale consisted of the importance and fulfillment subdimensions, and had 19 items. The ICCs of the test-retest scores of the importance and fulfillment subdimensions of the Family Inventory of Needs were found to be, respectively, ICC = 1.000 and ICC = 0.730 with a positive, linear, and highly significant relationship between the scores. The item-total score correlation coefficients of the scale were found to vary between 0.920 and 0.908 in the importance subdimension, and between 0.930 and 0.922 in the fulfillment subdimension.

SIGNIFICANCE OF RESULTS

The Turkish version of the Family Inventory of Needs was found to be a valid and reliable measurement tool that can be safely used with the family members of Turkish inpatients.

Supportive interventions for family members of very seriously ill patients in inpatient care: A systematic review

AIMS AND OBJECTIVES

To systematically review existing literature exploring supportive interventions for family members of very seriously ill patients in inpatient care.

BACKGROUND

Being around a patient with a very serious illness in inpatient care setting is stressful and burdensome for family members. There is little information available on interventions that support family members of very seriously ill patients in inpatient care.

DESIGN

A systematic review.

METHODS

The literature review was conducted in May 2020 using four databases: PubMed (Medline), CINAHL, PsycINFO and Cochrane. A quality assessment was performed using the Quality Assessment Tool for Before-After (Pre-Post) Studies With No Control Group by the National Heart, Lung, and Blood Institute. The PRISMA checklist was used to support specific reporting and the TIDieR checklist to form detailed descriptions of the interventions.

RESULTS

Of the 7165 identified studies, 11 studies were included in the review based on predetermined criteria. Interventions were based on meetings with family members, education or therapy. Mindfulness- and therapy-based interventions and multiple-session tailored interventions showed beneficial outcomes for psychological symptoms and educational interventions on preparedness and self-efficacy. Several different measuring instruments to evaluate similar outcomes, such as psychological symptoms and coping, were used.

CONCLUSIONS

Only a few supportive interventions for family members of very seriously ill patients in inpatient care were found, which made comparing the differences in the varying study methods and outcomes difficult. More studies on supportive interventions and their feasibility and effectiveness are essential. Further evaluation of instruments is necessary to identify the most valid and reliable ways of measuring symptoms and coping.

RELEVANCE TO CLINICAL PRACTICE

The results of this study can be used in clinical practice when selecting effective interventions or assessing family members' need for support. Additionally, the results can be used for guidance when developing new, effective interventions.

Talking about death and dying in a hospital setting - a qualitative study of the wishes for end-of-life conversations from the perspective of patients and spouses

Background

End-of-life (EOL) conversations are highly important for patients living with life-threatening diseases and for their relatives. Talking about the EOL is associated with reduced costs and better quality of care in the final weeks of life. However, there is therefore a need for further clarification of the actual wishes of patients and their relatives concerning EOL conversations in an acute hospital setting.

Aim

The purpose of this study was to explore the wishes of patients and their relatives with regard to talking about the EOL in an acute hospital setting when living with a life-threatening disease.

Methods

This study is a qualitative study using semi-structured in-depth interviews. A total of 17 respondents (11 patients and six spouses) participated. The patients were identified by the medical staff in a medical and surgical ward using SPICT™. The interview questions were focused on the respondents’ thoughts on and wishes about their future lives, as well as on their wishes regarding talking about the EOL in a hospital setting.

Results

This study revealed that the wish to talk about the EOL differed widely between respondents. Impairment to the patients’ everyday lives received the main focus, whereas talking about EOL was secondary. Conversations on EOL were an individual matter and ranged from not wanting to think about the EOL, to being ready to plan the funeral and expecting the healthcare professionals to be very open about the EOL. The conversations thus varied between superficial communication and crossing boundaries.

Conclusion

The wish to talk about the EOL in an acute hospital setting is an individual matter and great diversity exists. This individualistic stance requires the development of conversational tools that can assist both the patients and the relatives who wish to have an EOL conversation and those who do not. At the same time, staff should be trained in initiating and facilitating EOL discussions.

Supplementary Information

Supplementary information accompanies this paper at 10.1186/s12904-020-00675-1.

Information Access and Use by Patients With Cancer and Their Friends and Family: Development of a Grounded Theory

BACKGROUND

Information has been identified as a commonly unmet supportive care need for those living with cancer (ie, patients and their friends and family). The information needed to help individuals plan their lives around the consequences of cancer, such as the receipt of health care, is an example of an important informational need. A suitable theory to guide the development of interventions designed to meet this informational need has not been identified by the authors.

OBJECTIVE

The aim of this study is to generate a grounded theory capable of guiding the development of interventions designed to assist those living with cancer in meeting their informational needs.

METHODS

Classic grounded theory was used to analyze data collected through digitally recorded one-on-one audio interviews with 31 patients with cancer and 29 friends and family members. These interviews focused on how the participants had accessed and used information to plan their lives and what barriers they faced in obtaining and using this information.

RESULTS

The theory that emerged consisted of 4 variables: personal projects, cancer as a source of disruption to personal projects, information as the process of accessing and interpreting cancer-related data (CRD) to inform action, and CRD quality as defined by accessibility, credibility, applicability, and framing. CRD quality as a moderator of personal project disruption by cancer is the core concept of this theory.

CONCLUSIONS

Informational resources providing accessible, credible, applicable, and positively framed CRD are likely key to meeting the information needs of those affected by cancer. Web-based informational resources delivering high-quality CRD focused on assisting individuals living with cancer in maintaining and planning their personal projects are predicted to improve quality of life. Research is needed to develop and integrate resources informed by this theoretical framework into clinical practice.

Research roundup

Synopses of a selection of recently published research articles of relevance to palliative care