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Rodrigues R, Simmons C, Zólyomi E, Vafaei A, Rehnberg J, Kadi S, Socci M, Fors S, Phillips SP. Depends on whom you ask: Discordance in reporting spousal care between older women and men across European welfare states. Arch Gerontol Geriatr 2024; 125:105518. [PMID: 38876081 DOI: 10.1016/j.archger.2024.105518] [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: 03/09/2024] [Revised: 05/13/2024] [Accepted: 06/01/2024] [Indexed: 06/16/2024]
Abstract
PURPOSE We aim to investigate systematic differences in reporting spousal care between caregivers and cared-for persons and their possible effects for the analysis of care regimes and correlation of care with health. MATERIALS AND METHODS Using information on care provided/received from the Survey on Health, Ageing and Retirement in Europe (SHARE), we estimate the prevalence of spousal care and discordance between caregivers and cared-for persons in the reporting of care among caregiving dyads. Multinomial regressions are used to estimate systematic differences in reporting spousal care. We then use multivariable logistic regressions to assess the association between discordance in reporting informal care and carer's self-rated health (SRH) and depression using the EURO-D scale. RESULTS Only 53.9 % of dyads report care that is confirmed by both spouses. Multinomial regressions show that agreement on care being provided/received is more common when women are caregivers, while men are likely to underreport when providing or receiving personal care. Prevalence of spousal care across care regimes is sensitive to who reports care. There is no effect on the association of care with SRH regardless of who identifies the carer, while the magnitude and statistical significance of the association between depression symptoms and care varies according to the choice of respondent. CONCLUSIONS Informal care may be understated across Europe when relying solely on carer self-identification through description of tasks in surveys. From a policy standpoint, relying on self-identification of carers to access support or social benefits may potentially reduce the take-up of such benefits or support.
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Affiliation(s)
- Ricardo Rodrigues
- SOCIUS/CSG, ISEG (Lisbon School of Economics & Management), Universidade de Lisboa, Lisboa, Portugal.
| | - Cassandra Simmons
- European Centre for Social Welfare Policy & Research, Vienna, Austria
| | - Eszter Zólyomi
- European Centre for Social Welfare Policy & Research, Vienna, Austria
| | - Afshin Vafaei
- School of Health Studies, Western University, London, ON, Canada
| | - Johan Rehnberg
- Aging Research Center, Karolinska Institutet & Stockholm University, Stockholm, Sweden
| | - Selma Kadi
- European Centre for Social Welfare Policy & Research, Vienna, Austria
| | - Marco Socci
- Centre for Socio-Economic Research on Ageing, INRCA IRCCS - National Institute of Health & Science on Ageing, Ancona, Italy
| | - Stefan Fors
- Aging Research Center, Karolinska Institutet & Stockholm University, Stockholm, Sweden; Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden; Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
| | - Susan P Phillips
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada; Department of Family Medicine, Queen's University, Kingston, ON, Canada
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van Gorkom RNFG, Meulenbroek AL, de Vries J, Frost DM, van der Laan L. A fluctuating intensity of care: A qualitative study on the experiences of informal caregivers of patients with critical limb-threatening ischemia. PLoS One 2024; 19:e0298959. [PMID: 38739667 PMCID: PMC11090309 DOI: 10.1371/journal.pone.0298959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 02/01/2024] [Indexed: 05/16/2024] Open
Abstract
Informal caregivers play a significant role in providing care for older, often vulnerable, patients, and supporting them as they live with chronic diseases. Due to the rising prevalence of older vascular patients and their use of healthcare, the role of their informal caregivers will become more important. However, little is known about the experiences of informal caregivers of patients with critical limb-threatening ischemia and the impact of informal care on different aspects of these caregivers' lives. In addition, literature does not describe the burden this role brings with it, or lack thereof. Therefore a qualitative study using a phenomenological approach, specifically interpretive phenomenological analysis, was used to gain insight into the experiences of the primary informal caregivers of patients with chronic limb-threatening ischemia. Data were collected via semi-structured interviews and focus groups discussions. Fifteen primary informal caregivers of patients with critical limb-threatening ischemia under the care of the vascular surgeon at a tertiary teaching hospital in the Netherlands were included. Data analysis yielded three themes: the perceived identity of this group of caregivers; the varying intensity of informal care; and the collaboration between informal carers, their care recipients and the professional care provider within the vascular surgery department. In contrast to carers of other chronic diseases, the shifting intensity of care that informal caregivers of critical limb-threatening ischemia patients experience seems to prevent long-term overload. Adapting to that fluctuating situation requires flexibility from healthcare providers within the vascular surgery department. In addition, professionals need to involve informal caregivers in the patient's decision-making process and recognize their role in that process.
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Affiliation(s)
| | | | - Jolanda de Vries
- Admiraal de Ruyter Hospital, Goes, The Netherlands
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Donna M. Frost
- School of People & Health Studies, Fontys University of Applied Sciences, Tilburg, The Netherlands
| | - Lijckle van der Laan
- Department of Surgery, Amphia Hospital, Breda, The Netherlands
- Department of Cardiovascular Science, University Hospitals Leuven, Leuven, Belgium
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Quintiens B, Smets T, Chambaere K, Van den Block L, Deliens L, Cohen J. Willingness to support neighbours practically or emotionally: a cross-sectional survey among the general public. Palliat Care Soc Pract 2024; 18:26323524241249196. [PMID: 38737406 PMCID: PMC11085024 DOI: 10.1177/26323524241249196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 04/05/2024] [Indexed: 05/14/2024] Open
Abstract
Background Wider social networks are increasingly recognized for supporting people with care needs. Health-promoting initiatives around the end of life aim to foster these social connections but currently provide little insight into how willing people are to help neighbours facing support needs. Objectives This study describes how willing people are to help neighbours who need support practically or emotionally, whether there is a difference in willingness depending on the type of support needed and what determines this willingness. Design We applied a cross-sectional survey design. Methods We distributed 4400 questionnaires to a random sample of people aged >15 across four municipalities in Flanders, Belgium. These surveys included attitudinal and experiential questions related to serious illness, caregiving and dying. Respondents rated their willingness (scale of 1-5) to provide support to different neighbours in hypothetical scenarios: (1) an older person in need of assistance and (2) a caregiver of a dying partner. Results A total of 2008 questionnaires were returned (45.6%). The average willingness to support neighbours was 3.41 (case 1) and 3.85 (case 2). Helping with groceries scored highest; cooking and keeping company scored lowest. Factors associated with higher willingness included an optimistic outlook about receiving support from others, family caregiving experience and prior volunteering around serious illness or dying. Conclusion People are generally willing to support their neighbours who need help practically or emotionally, especially when they have prior experience with illness, death or dying and when they felt supported by different groups of people. Community-based models that build support around people with care needs could explore to what extent this willingness translates into durable community support. Initiatives promoting social connection and cohesion around serious illness, caregiving and dying may harness this potential through experiential learning.
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Affiliation(s)
- Bert Quintiens
- End-of-Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Laarbeeklaan 103, Brussels 1090, Belgium
| | - Tinne Smets
- End-of-Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Brussels, Belgium
| | - Kenneth Chambaere
- End-of-Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Brussels, Belgium
| | - Lieve Van den Block
- End-of-Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Brussels, Belgium
| | - Luc Deliens
- End-of-Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Brussels, Belgium
| | - Joachim Cohen
- End-of-Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Brussels, Belgium
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Bowness B, Henderson C, Akhter Khan SC, Akiba M, Lawrence V. Participatory research with carers: A systematic review and narrative synthesis. Health Expect 2024; 27:e13940. [PMID: 39102730 PMCID: PMC10734554 DOI: 10.1111/hex.13940] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 11/14/2023] [Accepted: 12/05/2023] [Indexed: 08/07/2024] Open
Abstract
INTRODUCTION As patient and public involvement (PPI) in research has become increasingly common, research-based recommendations on its principles and impacts have been established. The specifics of conducting PPI are likely to differ when involving different groups. Family/informal carers for those with health conditions or disabilities have a lot to contribute to research, but instances of their involvement have yet to be reviewed. OBJECTIVE To systematically review and synthesize studies where family/informal carers have been involved in the research process, to develop an understanding of the benefits, barriers and facilitating factors. METHODS A search of five electronic databases was conducted using a combination of terms relating to carers, involvement and research. A grey literature search, expert consultation and hand-searching were also used. Following screening, data extraction and quality assessment, a narrative synthesis incorporating thematic analysis was conducted. FINDINGS A total of 55 studies met the inclusion criteria, with diverse design and participatory approaches. Four themes were identified, relating to the outcomes, challenges, and practicalities of involving carers: (re) building relationships with carers; carers as equals not afterthoughts; carers have unique experiences; carers create change. Full involvement throughout the research was not always possible, due to barriers from the research world and responsibilities of the caring role. The literature demonstrated ways for carers to contribute in ways that suited them, maximizing their impact, while attending to relationships and power imbalances. CONCLUSION By summarizing the reported instances of carer involvement in research, this review brings together different examples of how successful research partnerships can be built with carers, despite various challenges. Carers are a heterogeneous group, and participatory approaches should be tailored to specific situations. Wider understanding of the challenges of conducting empowering research with carers, and the resources required to address these, are needed. PATIENT AND PUBLIC INVOLVEMENT The initial findings and themes were presented to a group of carers who had been involved in research and whose reflections informed the final synthesis.
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Affiliation(s)
- Bryher Bowness
- King's College London, Institute of PsychiatryPsychology and NeuroscienceLondonUK
| | - Claire Henderson
- King's College London, Institute of PsychiatryPsychology and NeuroscienceLondonUK
| | | | - Mia Akiba
- King's College London, Institute of PsychiatryPsychology and NeuroscienceLondonUK
| | - Vanessa Lawrence
- King's College London, Institute of PsychiatryPsychology and NeuroscienceLondonUK
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Gilfoyle M, Melro C, Koskinas E, Salsberg J. Recruitment of patients, carers and members of the public to advisory boards, groups and panels in public and patient involved health research: a scoping review. BMJ Open 2023; 13:e072918. [PMID: 37832980 PMCID: PMC10582988 DOI: 10.1136/bmjopen-2023-072918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 09/28/2023] [Indexed: 10/15/2023] Open
Abstract
OBJECTIVES The objectives of this scoping review are to: (1) identify the distribution of and context of the recruitment strategies used, (2) explore the facilitators, benefits, barriers and ethical issues of the identified recruitment strategies, (3) distinguish the varying terminology for involvement (ie, panels, boards, individual) and (4) determine if the individual recruitment strategies used were to address issues of representation or bias. DESIGN A scoping review. SETTING This scoping review follows the framework by Peters et al. Seven electronic databases were explored including Scopus, Medline, PubMed, Web of Science, CINAHL, Cochrane Library and PsycINFO (conducted July 2021). The search strategy was codeveloped among the research team, PPI research experts and a faculty librarian. Two independent reviewers screened articles by title and abstract and then at full text based on predetermined criteria. PRIMARY AND SECONDARY OUTCOME MEASURES Explore recruitment strategies used, facilitators, benefits, barriers and ethical issues of the identified recruitment strategies. Identify terminology for involvement. Explore recruitment strategies used to address issues of representation or bias. RESULTS The final sample was from 51 sources. A large portion of the extracted empirical literature had a clinical focus (37%, n=13) but was not a randomised control trial. The most common recruitment strategies used were human networks (78%, n=40), such as word of mouth, foundation affiliation, existing networks, clinics or personal contacts. Within the reviewed literature, there was a lack of discussion pertaining to facilitators, benefits, barriers and ethical considerations of recruitment strategies was apparent. Finally, 41% (n=21) of studies employed or proposed recruitment strategies or considerations to address issues of representation or bias. CONCLUSION We conclude with four key recommendations that researchers can use to better understand appropriate routes to meaningfully involve patients, carers and members of the public to cocreate the evidence informing their care.
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Affiliation(s)
- Meghan Gilfoyle
- School of Medicine, University of Limerick, Limerick, Ireland
- McMaster University, Hamilton, Ontario, Canada
| | | | - Elena Koskinas
- School of Medicine, University of Limerick, Limerick, Ireland
| | - Jon Salsberg
- School of Medicine, University of Limerick, Limerick, Ireland
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Sullivan MP, Camic PM, Harding E, Stott J, Windle G, Brotherhood EV, Grillo A, Crutch SJ. Situating support for people living with rarer forms of dementia. BMC Geriatr 2023; 23:627. [PMID: 37803252 PMCID: PMC10557369 DOI: 10.1186/s12877-023-04268-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 08/31/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND Awareness of a multitude of diseases that can cause neurodegenerative decline and their unique symptom profiles in the dementia care and support sectors remains limited. Obtaining an accurate diagnosis and post-diagnostic care and support is a challenge for many people and their families. As part of a larger study examining multi-component forms of support for people living with rarer dementias, the aim of this present study was to examine how rare dementia was situated within the complex social groupings, their organization and embedded discursive constructions that broadly form dementia care and support delivery. METHODS Adopting a situational analysis approach, we undertook an examination of public documents and organizational websites within the support sector for people living with dementia in Canada, England, and Wales. We also surveyed professionals to further explore the situation at the point of care and support delivery. Consistent with our approach, data collection and analysis occurred concurrently including the development of a series of analytic maps. RESULTS Recognizing the complexities within the situation, our findings provided new insights on the situated structures for support action and the discursive representations that illuminate both the limitations of the current support landscape and possibilities for a more flexible and tailored rare dementia support. Alongside, the predominant universal versus tailored support positionings within our data reinforced the complexity from which a promising new social space for people living with rarer dementias is being cultivated. CONCLUSIONS The social worlds engaged in supportive action with people living with rare dementia are less visible within the shadow of a universally constructed dementia support milieu and appear to be negotiated within this powerful arena. However, their evolving organization and discursive constructions point to an emerging new social space for people living with rarer conditions.
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Affiliation(s)
- Mary Pat Sullivan
- Faculty of Education and Professional Studies, School of Social Work, Nipissing University, North Bay, ON, Canada.
| | - Paul M Camic
- Dementia Research Centre, Queen Square Institute of Neurology, University College London (UCL), London, UK
| | - Emma Harding
- Dementia Research Centre, Queen Square Institute of Neurology, University College London (UCL), London, UK
| | - Joshua Stott
- Department of Clinical, Educational and Health Psychology, University College London (UCL), London, UK
| | - Gill Windle
- Ageing and Dementia @ Bangor, Dementia Services Development Centre (DSDC), School of Medical and Health Sciences, Bangor University, Bangor, UK
| | - Emilie V Brotherhood
- Dementia Research Centre, Queen Square Institute of Neurology, University College London (UCL), London, UK
| | - Adetola Grillo
- Faculty of Education and Professional Studies, School of Social Work, Nipissing University, North Bay, ON, Canada
| | - Sebastian J Crutch
- Dementia Research Centre, Queen Square Institute of Neurology, University College London (UCL), London, UK
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7
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McMullen S, Panagioti M, Planner C, Giles S, Angelakis I, Keers RN, Robinson C, Fu Y, Johnson J, Tyler N. Supporting carers to improve patient safety and maintain their well-being in transitions from mental health hospitals to the community: A prioritisation nominal group technique. Health Expect 2023; 26:2064-2074. [PMID: 37421272 PMCID: PMC10485304 DOI: 10.1111/hex.13813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 06/20/2023] [Accepted: 06/22/2023] [Indexed: 07/10/2023] Open
Abstract
INTRODUCTION Carers of people with mental illness may face distinct challenges, including navigating fragmented health and social services during discharge from mental health hospitals. Currently, limited examples of interventions that support carers of people with mental illness in improving patient safety during transitions of care exist. We aimed to identify problems and solutions to inform future carer-led discharge interventions, which is imperative for ensuring patient safety and the well-being of carers. METHODS The nominal group technique was used which combines both qualitative and quantitative data collection methods in four distinct phases: (1) problem identification, (2) solution generation, (3) decision making and (4) prioritisation. The aim was to combine expertise from different stakeholder groups (patients, carers and academics with expertise in primary/secondary care, social care or public health) to identify problems and generate solutions. RESULTS Twenty-eight participants generated potential solutions that were grouped into four themes. The most acceptable solution for each was as follows: (1) 'Carer Involvement and Improving Carer Experience' a dedicated family liaison worker, (2) 'Patient Wellness and Education' adapting and implementing existing approaches to help implement the patient care plan, (3) 'Carer Wellness and Education' peer/social support interventions for carers and (4) 'Policy and System Improvements' understanding the co-ordination of care. CONCLUSION The stakeholder group concurred that the transition from mental health hospitals to the community is a distressing period, where patients and carers are particularly vulnerable to safety and well-being risks. We identified numerous feasible/acceptable solutions to enable carers to improve patient safety and maintain their own mental wellbeing. PATIENT AND PUBLIC CONTRIBUTION Patient and public contributors were represented in the workshop and the focus of the workshop was to identify the problems they faced and co-design potential solutions. Patient and public contributors were involved in the funding application and study design.
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Affiliation(s)
- Sarah McMullen
- Centre for Primary Care and Health Services Research, Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and HealthThe University of ManchesterManchesterUK
| | - Maria Panagioti
- NIHR Greater Manchester Patient Safety Translational Research CentreThe University of ManchesterManchesterUK
- NIHR School for Primary Care ResearchThe University of ManchesterManchesterUK
| | - Claire Planner
- NIHR Greater Manchester Patient Safety Translational Research CentreThe University of ManchesterManchesterUK
| | - Sally Giles
- NIHR Greater Manchester Patient Safety Translational Research CentreThe University of ManchesterManchesterUK
| | - Ioannis Angelakis
- Department of Primary Care and Mental HealthThe University of LiverpoolLiverpoolUK
| | - Richard N. Keers
- Division of Pharmacy and Optometry, Centre for Pharmacoepidemiology and Drug SafetyThe University of ManchesterManchesterUK
- NIHR Greater Manchester Patient Safety Translational Research CentreManchester Academic Health Science NetworkManchesterUK
- Suicide, Risk and Safety Research UnitGreater Manchester Mental Health NHS Foundation TrustManchesterUK
| | - Catherine Robinson
- Social Care and Society, School of Health SciencesThe University of ManchesterManchesterUK
| | - Yu Fu
- Population Health Sciences InstituteNewcastle UniversityNewcastleUK
| | | | - Natasha Tyler
- NIHR Greater Manchester Patient Safety Translational Research CentreThe University of ManchesterManchesterUK
- NIHR School for Primary Care ResearchThe University of ManchesterManchesterUK
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Richardson CL, Black D, Lindsey L, Nazar H. Community pharmacies as a place for informal carer support in mental health and wellbeing. Int J Clin Pharm 2023; 45:1302-1306. [PMID: 37269442 PMCID: PMC10239217 DOI: 10.1007/s11096-023-01606-9] [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: 02/09/2023] [Accepted: 05/12/2023] [Indexed: 06/05/2023]
Abstract
There are 5.3 million informal carers in the United Kingdom who take on caring responsibilities for family and friends. Informal carers can be forgotten patients within health and care services, yet because of carer burden, they are at risk of deterioration in health and wellbeing. There are higher levels of anxiety, depression, burnout and low self-esteem amongst carers but, to our knowledge work to date has mainly focused on supporting carers to provide better care for their family member, and less on carers' health and wellbeing. There is increasing interest in social prescribing as a method of linking patients with community-based services to improve health and wellbeing. Initiatives have included social prescribing via community pharmacies which are already recognized to be accessible for support and signposting. The coming together of community pharmacy services and social prescribing could represent a framework to better support carers in their mental health and wellbeing.
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Affiliation(s)
- Charlotte Lucy Richardson
- Faculty of Medical Sciences, School of Pharmacy, Newcastle University, King George VI Building, Newcastle Upon Tyne, NE2 7RU, UK.
| | - David Black
- Faculty of Medical Sciences, School of Pharmacy, Newcastle University, King George VI Building, Newcastle Upon Tyne, NE2 7RU, UK
| | - Laura Lindsey
- Faculty of Medical Sciences, School of Pharmacy, Newcastle University, King George VI Building, Newcastle Upon Tyne, NE2 7RU, UK
| | - Hamde Nazar
- Faculty of Medical Sciences, School of Pharmacy, Newcastle University, King George VI Building, Newcastle Upon Tyne, NE2 7RU, UK
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Zabeen S, Phua D, Mohammadi L, Lawn S. Family involvement to support cardiovascular self-management care for people with severe mental illness: a systematic review. J Ment Health 2023; 32:290-306. [PMID: 32924668 DOI: 10.1080/09638237.2020.1818194] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Family members play a pivotal role in supporting cardiovascular self-management-based care of community-living adults with severe mental illness (SMI). However, little is known about what strategies caregivers employ as part of their caring roles. AIM This paper aims to explore what caregiving strategies work (or not), why and how by collating and synthesising existing evidence on this issue. METHODS A systematic search of peer-reviewed qualitative and mixed-method studies published between 2000 and 2019 was employed. This comprehensive process generated only nine papers for subsequent meta-synthesis of qualitative data. RESULTS Findings suggested that caregivers have a complex yet comprehensive role to play in initiating and perpetuating self-management-based cardiovascular care. The elements of recovery such as promoting hope, normality, autonomy and identity were flagged as critical underpinning factors that motivated the person with SMI to adopt a healthy lifestyle. However, it was evident that caregivers needed to walk alongside the person, at times, to help them reach their maximum potential in sustaining improved self-management behaviours. CONCLUSION Caregivers sit in a favourable bridging position between healthcare systems and community-living individuals with SMI, to support their cardiovascular health. However, this powerful but invisible 'workforce' clearly needs further support involving finance, skill-development and acknowledgement.
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Affiliation(s)
- Sara Zabeen
- College of Medicine and Public Health, Flinders University, Bedford Park, Australia
| | - Delphine Phua
- College of Medicine and Public Health, Flinders University, Bedford Park, Australia
| | - Leila Mohammadi
- College of Medicine and Public Health, Flinders University, Bedford Park, Australia
| | - Sharon Lawn
- College of Medicine and Public Health, Flinders University, Bedford Park, Australia
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Koya K, Chowdhury G, Green E. Young informal carers’ information needs communicated online: Professional and personal growth, finance, health and relationships. J Inf Sci 2022. [DOI: 10.1177/01655515221136829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Young informal carers (YICs) are non-professional young individuals providing care and support in various forms, usually to immediate family members, afflicted from a diverse range of both long- and short-term health conditions. Although there is significant knowledge about the information needs of adult carers in general, information needs and information seeking characteristics of the YICs’ community are understudied and are different. This study aims to identify the information needs of YICs communicated over the Internet and understanding their information seeking characteristics through a three-stage qualitative content analysis of posts written by YICs on two notable Internet forums. The analysis of 323 posts dated between March 2010 and April 2019 finds YICs’ needs are categorised by two types of online expression of needs, situational and information. Situational needs are illustrations of current difficult conditions and information needs are direct requests for information. Under situational and information needs, we identify four types of needs expressed: personal and professional growth, health (self and caree), finance and relationships. In addition, the findings indicate 94.36% posts in the sample as situational needs, which depict the uncertainty experienced by YICs under caring circumstances. The findings can assist government organisations and charities by improving the indexing of advice pages of their websites appropriate to the YICs’ search words, better availability of information and advertising, in addition to building quality mobile applications or digital support tools.
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Affiliation(s)
- Kushwanth Koya
- Information School, Faculty of Social Sciences, The University of Sheffield, UK
| | - Gobinda Chowdhury
- iSchool, Department of Computer & Information Sciences, University of Strathclyde, UK
| | - Emma Green
- Leeds Business School, Leeds Beckett University, UK
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Urwin S, Lau YS, Grande G, Sutton M. A Comparison of Methods for Identifying Informal Carers: Self-Declaration Versus a Time Diary. PHARMACOECONOMICS 2022; 40:611-621. [PMID: 35396699 PMCID: PMC9130170 DOI: 10.1007/s40273-022-01136-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/29/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Two main methods for identifying whether an individual is an informal carer are self-declaration and the use of a time diary. We analysed the level and predictors of agreement between these two methods among co-residential informal carers of adult recipients. METHODS We used the 2014/15 UK Time Use Survey, which is a large-scale household survey for those aged 8 years old and over. It contains an individual questionnaire for self-declaration and a time diary for activity-based identification that records all activity in 10-min slots for two 24-h periods. Our analysis: (i) assesses the degree of overlap across approaches; (ii) explores the differences in characteristics between carers identified via one approach relative to non-carers using a bivariate probit estimator; and (iii) shows what factors are associated with being identified by both approaches using two independent probit estimators. RESULTS Out of 6301 individuals, we identified 545 carers (8.6%) by at least one method and only 104 (19.1% of 545 carers) by both methods. We found similar factors predicted caregiving using either method but the magnitudes of the effects of these factors were larger for self-declared carers. Activity-based carers who provided more activities to a dependent adult and spent more time caregiving were more likely to also self-declare. CONCLUSIONS Our results show low levels of agreement between the two main methods used to identify informal carers. Any assessment of current caregiving research or future means to collect caregiving information should pay particular attention to the identification method as it may only relate to certain carer groups.
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Affiliation(s)
- Sean Urwin
- Health Organisation, Policy and Economics, School of Health Sciences, University of Manchester, 6th Floor Williamson building, Oxford Road, Manchester, M13 9PL, UK.
| | - Yiu-Shing Lau
- Health Organisation, Policy and Economics, School of Health Sciences, University of Manchester, 6th Floor Williamson building, Oxford Road, Manchester, M13 9PL, UK
| | - Gunn Grande
- Division of Nursing, Midwifery and Social Work, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Matt Sutton
- Health Organisation, Policy and Economics, School of Health Sciences, University of Manchester, 6th Floor Williamson building, Oxford Road, Manchester, M13 9PL, UK
- Melbourne Institute, Applied Economic and Social Research, University of Melbourne, Melbourne, Australia
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12
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Harvey M, Hastings DP, Chowdhury G. Understanding the costs and challenges of the digital divide through UK council services. J Inf Sci 2021. [DOI: 10.1177/01655515211040664] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study investigates the issue of digital exclusion resulting from the digitisation of government and council services within the United Kingdom. An initial analysis of customer support log data from a council in a large UK city helped identify the most commonly queried services and modes of support. The main findings are based on qualitative analysis of 10 interviews, structured around the results from the log analysis, conducted with front-line staff members at the central library of the same council. The study identifies a range of issues associated with the provision of e-government services and the subsequent under-utilisation by the public, including poor design, issues with effective access and the level of digital literacy among end users. The study also proposes the concept of the ‘digital carer’, a friend or family member who is relied upon by users unable to interact with e-government services themselves. The findings of this study have implications for the way in which these services are designed and delivered and point to the need for further work that can contribute to the UK digital economy by facilitating better access to e-government services and reduce digital exclusion, especially for elderly and marginalised users.
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Bidwell JT, Hostinar CE, Higgins MK, Abshire MA, Cothran F, Butts B, Miller AH, Corwin E, Dunbar SB. Caregiver subjective and physiological markers of stress and patient heart failure severity in family care dyads. Psychoneuroendocrinology 2021; 133:105399. [PMID: 34482256 PMCID: PMC8530937 DOI: 10.1016/j.psyneuen.2021.105399] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 08/23/2021] [Indexed: 12/20/2022]
Abstract
Greater family caregiver exposure to uncontrolled patient symptoms is predictive of greater caregiver psychological and physiological stress in dementia and other chronic illnesses, but these phenomena have not been well-studied in heart failure (HF) - a disease with high symptom burden. The purpose of this study was to test the hypothesis that worse patient functional status (as reflected by increasing HF symptoms) would be associated with elevated psychological and physiological stress for the caregiver. This was a secondary analysis of data from 125 HF caregivers in the Caregiver Opportunities for Optimizing Lifestyle (COOL) study. Psychological stress was measured on four dimensions: care-related strain/burden (Oberst Caregiving Burden Scale), depression (Center for Epidemiological Studies Depression Scale), anxiety (State-Trait Anxiety Index), and general stress (Perceived Stress Scale). Physiological stress was measured by markers of HPA axis function (elevated cortisol awakening response [CAR]), endothelial dysfunction (increased PAI-1), and inflammation (increased IL-6, hsCRP). HF patient functional status was quantified by caregiver assessment of New York Heart Association (NYHA) Class. Generalized linear models were used to test associations between patient NYHA Class and stress (one model per indicator). NYHA Class (ordinal) was backwards difference coded in each model to examine caregiver stress in relation to increasing levels of HF severity. Caregivers were mostly female and in their mid-fifties, with a slight majority of the sample being African American and the patient's spouse. Overall, patient functional status was associated with greater caregiver psychological and physiological stress. In terms of psychological stress, higher NYHA Class was significantly associated with greater caregiver anxiety and general stress, but not with caregiver burden or depression. In terms of physiological stress, higher NYHA Class was associated with elevated markers in all models (elevated CAR and higher IL-6, hsCRP, and PAI-1). Across models, most associations between NYHA Class and stress were present at relatively early stages of functional limitation (i.e. Class II), while others emerged when functional limitations became more severe. To inform timing and mechanisms for much-needed caregiver interventions, research is needed to determine which aspects of HF symptomatology are most stressful for caregivers across the HF trajectory.
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Affiliation(s)
- Julie T. Bidwell
- Family Caregiving Institute at the Betty Irene Moore School of Nursing; University of California, Davis; 2570 48th Street, Sacramento, CA 95817, United States of America
| | - Camelia E. Hostinar
- Department of Psychology; University of California, Davis; 1 Shields Avenue, Davis, CA 95616, United States of America
| | - Melinda K. Higgins
- Nell Hodgson Woodruff School of Nursing; Emory University; 1520 Clifton Road, Atlanta, GA 30322, United States of America
| | - Martha A. Abshire
- School of Nursing; Johns Hopkins University; 525 N Wolfe Street, Baltimore, MD 21205, United States of America
| | - Fawn Cothran
- Family Caregiving Institute at the Betty Irene Moore School of Nursing, University of California, Davis, 2570 48th Street, Sacramento, CA 95817, United States.
| | - Brittany Butts
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road, Atlanta, GA 30322, United States.
| | - Andrew H. Miller
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Emory University, 12 Executive Park Dr, NE. 2nd Floor, Atlanta, GA 30329
| | - Elizabeth Corwin
- School of Nursing, Columbia University, 560 W. 168th St, Room 600, New York, NY 10032, United States.
| | - Sandra B. Dunbar
- Nell Hodgson Woodruff School of Nursing; Emory University; 1520 Clifton Road, Atlanta, GA 30322, United States of America
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14
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Grundberg Å, Sandberg J, Craftman ÅG. Childrens' and young adults' perspectives of having a parent with dementia diagnosis: A scoping review. DEMENTIA 2021; 20:2933-2956. [PMID: 34096358 DOI: 10.1177/14713012211023653] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Dementia is a key health issue worldwide. In Sweden, as in other European countries, most persons with dementia live in domestic settings and are often cared for by their family members. This scoping review aims to describe the perspectives of children and young adults with a parent diagnosed with dementia. Young family members may be alone and without support despite their high level of care burden. DESIGN AND METHODS Three electronic databases (PubMed, Web of Science and PsycINFO) were used to search for English-language articles focusing on children and young adults between the ages of 6 and 34 who have a parent diagnosed with dementia. A thematic synthesis of the included articles was performed. FINDINGS Sixteen original published qualitative studies were identified. These studies were categorised based on information about the authors, year of publication, study location, participants, aim of the study, data collection, analysis and main findings. Five main analytical themes were identified: (1) children and young adults identify changes in their parents' behaviour and personality, (2) children and young adults experience changed roles and relationships within the family, (3) children and young adults need to cope with an uncertain future, (4) children and young adults relate changes in their parent to their own mixed emotions and (5) children and young adults need help and seek it out but experience inadequate support. CONCLUSIONS The children and young adults in the included studies seem to provide significant levels of care and support to their affected parent, which may affect their own health, social relations, community participation, employment, education, finances and sense of security. This means that it is important for health care systems and social services to identify barriers to these young family members' access to relevant care and support for themselves.
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Affiliation(s)
- Åke Grundberg
- Department of Learning, Informatics, Management and Ethics, LIME, 27106Karolinska Institutet, Solna, Sweden
| | - Jonas Sandberg
- Department of Caring Science, Sophiahemmet University, Stockholm, Sweden
| | - Åsa G Craftman
- Department of Caring Science, Sophiahemmet University, Stockholm, Sweden; Department of Neurobiology, Care Sciences and Society, NVS, 27106Karolinska Institutet, Huddinge, Sweden
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15
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Urwin S, Lau YS, Grande G, Sutton M. The extent and predictors of discrepancy between provider and recipient reports of informal caregiving. Soc Sci Med 2021; 277:113890. [PMID: 33845393 PMCID: PMC7613109 DOI: 10.1016/j.socscimed.2021.113890] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/02/2021] [Accepted: 03/29/2021] [Indexed: 11/29/2022]
Abstract
Informal care research mainly relies upon carers reporting that they provide this type of care. Little is known about whether reports from recipients would produce similar information. We explore whether providers and recipients are in agreement with each other's reports of informal care at the extensive and intensive margin and whether particular characteristics of providers and recipients predict any discrepancies. Using data from the 2015-2017 wave of the UK Household Longitudinal Study (UKHLS), we find that among those who reported receiving informal care a provider confirmed only 37.5% of these. Each additional restriction on activities and instrumental activities of daily living for a recipient increases the probability of agreement by 5.2 and 9.3 percentage points, respectively. When both parties report informal care, providers report on average 10.55 (37%) more hours per week compared to recipients. This represents an annual difference of £12,081 using the replacement monetary valuation method. If we rely on recipient reports, we may be more likely to capture how many in the population are caregivers. However, we may also be less likely to capture the full hours of care for each caregiver. These discrepancies in reported caregiving affect studies of the consequences of caregiving and economic evaluations of interventions that impact on caregiving.
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Affiliation(s)
- Sean Urwin
- Health Organisation, Policy and Economics, School of Health Sciences, University of Manchester, Manchester, UK.
| | - Yiu-Shing Lau
- Health Organisation, Policy and Economics, School of Health Sciences, University of Manchester, Manchester, UK
| | - Gunn Grande
- Division of Nursing, Midwifery and Social Work, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Matt Sutton
- Health Organisation, Policy and Economics, School of Health Sciences, University of Manchester, Manchester, UK; Melbourne Institute, Applied Economic and Social Research, University of Melbourne, Melbourne, Australia
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16
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Dominello A, Howell M, Craig JC, Scholes-Robertson N, Guha C, Sinka V, Jesudason S, Wong G, Ladhani M, Tong A. Equity in national policies for Australians with kidney disease. Aust N Z J Public Health 2021; 45:370-375. [PMID: 33818846 DOI: 10.1111/1753-6405.13096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 01/01/2021] [Accepted: 02/01/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To describe how the Australian Government Department of Health policies address equity in the management of chronic kidney disease (CKD). METHODS We searched the websites of the Australian Government Department of Health, Kidney Health Australia, Australian Indigenous HealthInfoNet and the National Rural Health Alliance for policies using the search terms: kidney, renal and chronic. RESULTS We included 24 policies that addressed groups of people that experience health inequities: 23 addressed Aboriginal and Torres Strait Islander peoples, 18 rural/remote communities, 12 low socioeconomic status groups, six culturally and linguistically diverse communities and four addressed gender disparities. The scope of the policies ranged from broad national frameworks to subsidised access to health services and medicines. Only two policies explicitly addressed equity for patients with CKD. CONCLUSION CKD outcomes are highly variable across population groups yet Australian Government policies that address access to and the experience of care are limited in both number and their attention to equity issues. Implications for public health: In Australia, some groups of people with CKD have a substantially higher risk of mortality and morbidity than the general CKD population. We advocate for the development and implementation of policies to attain equity for people with CKD.
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Affiliation(s)
- Amanda Dominello
- Centre for Kidney Research, The Children's Hospital at Westmead, New South Wales.,Sydney School of Public Health, The University of Sydney, New South Wales
| | - Martin Howell
- Centre for Kidney Research, The Children's Hospital at Westmead, New South Wales.,Sydney School of Public Health, The University of Sydney, New South Wales
| | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, South Australia
| | - Nicole Scholes-Robertson
- Centre for Kidney Research, The Children's Hospital at Westmead, New South Wales.,Sydney School of Public Health, The University of Sydney, New South Wales
| | - Chandana Guha
- Centre for Kidney Research, The Children's Hospital at Westmead, New South Wales.,Sydney School of Public Health, The University of Sydney, New South Wales
| | - Victoria Sinka
- Centre for Kidney Research, The Children's Hospital at Westmead, New South Wales.,Sydney School of Public Health, The University of Sydney, New South Wales
| | - Shilpanjali Jesudason
- Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, South Australia
| | - Germaine Wong
- Centre for Kidney Research, The Children's Hospital at Westmead, New South Wales.,Sydney School of Public Health, The University of Sydney, New South Wales
| | - Maleeka Ladhani
- Centre for Kidney Research, The Children's Hospital at Westmead, New South Wales.,Sydney School of Public Health, The University of Sydney, New South Wales
| | - Allison Tong
- Centre for Kidney Research, The Children's Hospital at Westmead, New South Wales.,Sydney School of Public Health, The University of Sydney, New South Wales
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17
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Enoch J, Dickinson C, Subramanian A. What support is beneficial for caregivers of individuals with vision impairment? Clin Exp Optom 2021; 104:455-470. [PMID: 33689667 DOI: 10.1080/08164622.2021.1878814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Previous studies and reviews have documented the stress and challenges that may be associated with providing informal care for individuals with vision impairment (IVI). This scoping review was therefore conducted in order to synthesise published literature about forms of support which may benefit the informal caregivers of both adults and children with vision impairment (VI), and to identify research gaps in the support available for this population. A systematic literature search was carried out using CINAHL, Medline, PsycINFO and PsycARTICLES, followed by citation tracking. A total of 23 published studies met the eligibility criteria and were included in the review. The included studies focused on: exploring caregiver support needs (8/23); novel interventions supporting caregivers of IVI (10/23); evaluating usual care (2/23); and exploring how treatment for IVI directly impacts the caregiver (3/23). Overall, support for caregivers of IVI is a relatively new research topic, with no eligible studies identified before 1999. Twelve of the 23 studies (52%) focused on support for caregivers of adults with VI, while 11 (48%) focused on support for caregivers of children with VI. The studies illustrate that support groups may generally help to improve caregivers' knowledge and awareness of VI, although benefits for emotional wellbeing are more modest. Support interventions for parents of children with VI appear to reduce stress effectively; however, evidence regarding the value of interventions for caregivers of adults with vision impairment is less clear, partly due to small samples and a lack of standardised, comparable outcome measures. Caregivers often express a need for better information about the condition of the IVI, even when information is apparently available. Further research is required comparing the benefits of different support modalities for caregivers of people with VI over longer follow-up periods.
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Affiliation(s)
- Jamie Enoch
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, UK
| | - Christine Dickinson
- Division of Pharmacy and Optometry, University of Manchester and the Manchester Academic Health Sciences Centre, Manchester, UK
| | - Ahalya Subramanian
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, UK
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18
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Darley S, Knowles S, Woodward-Nutt K, Mitchell C, Grande G, Ewing G, Rhodes S, Bowen A, Patchwood E. Challenges implementing a carer support intervention within a national stroke organisation: findings from the process evaluation of the OSCARSS trial. BMJ Open 2021; 11:e038129. [PMID: 33436462 PMCID: PMC7805355 DOI: 10.1136/bmjopen-2020-038129] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 11/02/2020] [Accepted: 12/14/2020] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To examine the implementation of an intervention to support informal caregivers and to help understand findings from the Organising Support for Carers of Stroke Survivors (OSCARSS) cluster randomised controlled trial (cRCT). DESIGN Longitudinal process evaluation using mixed methods. Normalisation process theory informed data collection and provided a sensitising framework for analysis. SETTING Specialist stroke support services delivered primarily in the homes of informal carers of stroke survivors. PARTICIPANTS OSCARSS cRCT participants including carers, staff, managers and senior leaders. INTERVENTION The Carer Support Needs Assessment Tool for Stroke (CSNAT-Stroke) intervention is a staff-facilitated, carer-led approach to help identify, prioritise and address support needs. RESULTS We conducted qualitative interviews with: OSCARSS cRCT carer participants (11 intervention, 10 control), staff (12 intervention, 8 control) and managers and senior leaders (11); and obtained 140 responses to an online staff survey over three separate time points. Both individual (carer/staff) and organisational factors impacted implementation of the CSNAT-Stroke intervention and how it was received by carers. We identified four themes: staff understanding, carer participation, implementation, and learning and support. Staff valued the idea of a structured approach to supporting carers, but key elements of the intervention were not routinely delivered. Carers did not necessarily identify as 'carers', which made it difficult for staff to engage them in the intervention. Despite organisational enthusiasm for OSCARSS, staff in the intervention arm perceived support and training for implementation of CSNAT-Stroke as delivered primarily by the research team, with few opportunities for shared learning across the organisation. CONCLUSIONS We identified challenges across carer, staff and organisation levels that help explain the OSCARSS cRCT outcome. Ensuring training is translated into practice and ongoing organisational support would be required for full implementation of this type of intervention, with emphasis on the carer-led aspects, including supporting carer self-identification. TRIAL REGISTRATION NUMBER ISRCTN58414120.
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Affiliation(s)
- Sarah Darley
- Alliance Manchester Business School, The University of Manchester, Manchester, UK
| | - Sarah Knowles
- Alliance Manchester Business School, The University of Manchester, Manchester, UK
| | - Kate Woodward-Nutt
- NIHR Collaboration for Leadership in Applied Health Research and Care, Greater Manchester, Manchester, UK
| | - Claire Mitchell
- Division of Neuroscience and Experimental Psychology, The University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
| | - Gunn Grande
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, The University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
| | - Gail Ewing
- Centre for Family Research, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Sarah Rhodes
- Centre for Biostatistics, Division of Population Health, Health Services Research and Primary Care, The University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
| | - Audrey Bowen
- Division of Neuroscience and Experimental Psychology, The University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
| | - Emma Patchwood
- Division of Neuroscience and Experimental Psychology, The University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
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19
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Sigurgeirsdottir J, Halldorsdottir S, Arnardottir RH, Gudmundsson G, Bjornsson EH. Frustrated Caring: Family Members' Experience of Motivating COPD Patients Towards Self-Management. Int J Chron Obstruct Pulmon Dis 2020; 15:2953-2965. [PMID: 33235444 PMCID: PMC7680160 DOI: 10.2147/copd.s273903] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 10/14/2020] [Indexed: 01/08/2023] Open
Abstract
Aim The aim of this phenomenological study was to explore principal family members’ experience of motivating patients with chronic obstructive pulmonary disease (COPD) towards self-management. Methods Interviews were conducted with 10 family members (spouses and adult children) of COPD patients. The interviews were audio recorded, transcribed and analyzed thematically. Results Being a principal family member of a COPD patient is characterized by frustrated caring; wanting the best for him/her and yet carrying a heavier burden than the person feels equipped for, lacking both knowledge about the disease progress and information about available healthcare resources. The situation demands much energy, due to COPD patients’ lack of stamina; family members’ fear of the patient’s possible breathlessness; willingness to help, though sometimes meeting with negative reactions from the patient; and feeling ignored by health professionals (HPs). Family members expressed a need for a formal connection between patient–family–HPs. The increasing burden experienced by patients’ family members is characterized by a sequential process in three phases of the patient’s declining self-management. In the early phase, family and patient are ignorant of COPD yet recognize the patient’s smoking as a risky lifestyle. In the intermediary phase, signs of COPD become evident to the family. The first turning point is when the family first observes the patient’s acute exacerbation. A second turning point is in the advanced phase, when family and patient recognize COPD as a progressive disease, possibly fatal. We also identified family members’ views on COPD patients’ needs, and their own roles, main frustrations and concerns. Conclusion Family members’ experience of motivating COPD patients towards self-management is a sequential process where the family experiences advancing caring burden and declining self-management by the patient. We propose the establishment of COPD patients’ teams consisting of patient–family–HP, aimed at the patients’ best possible self-management.
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Affiliation(s)
- Jonina Sigurgeirsdottir
- University of Iceland, Medical Faculty, Reykjavik, Iceland.,Reykjalundur Rehabilitation Center, Lung Department, Mosfellsbaer, Iceland
| | - Sigridur Halldorsdottir
- University of Akureyri, School of Health Sciences, Faculty of Graduate Studies, Akureyri, Iceland
| | - Ragnheidur Harpa Arnardottir
- University of Akureyri, School of Health Sciences, Faculty of Graduate Studies, Akureyri, Iceland.,Akureyri Hospital, Department of Rehabilitation, Akureyri, Iceland.,Uppsala University, Department of Medical Sciences, Respiratory-, Allergy- and Sleep Research, Uppsala, Sweden
| | - Gunnar Gudmundsson
- University of Iceland, Medical Faculty, Reykjavik, Iceland.,Landspitali University Hospital, Department of Respiratory Medicine, Reykjavik, Iceland
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20
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van Wyk NC. Care for carers: A concept analysis of support for carers of ill relatives. Nurs Forum 2020; 56:202-207. [PMID: 33125730 DOI: 10.1111/nuf.12520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/04/2020] [Accepted: 10/09/2020] [Indexed: 11/28/2022]
Abstract
The aim of the study is to clarify the concept "care for carers," and enhance our understanding of caring for carers of ill relatives. Healthcare professionals often refer to "care for carers" when discussing methods to support the carers of ill family relatives. These carers do not always receive the support they need. A literature search of electronic databases and search engines, using the keywords carer, caregiver, caring for the carer, caring for the caregiver was done. Peer-reviewed research articles published between 2014 and 2019 and written in the English language were analyzed. Following retrieval, research articles were analyzed to describe the uses, attributes, antecedents, consequences, and empirical referents of the concept "care for carers." Research articles describing borderline, related, contrary, and illegitimate examples were included. "Care for carers" addresses the unique support needs of those taking care of ill family members. Carers may derive a sense of empowerment from receiving individualized and proactively rendered support. Carers should be supported to develop control over their circumstances, to find meaning in their caring, to become resilient when experiencing challenges, and to confirm their identity as carers of their ill relatives.
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Affiliation(s)
- Neltjie C van Wyk
- Department of Nursing Science, University of Pretoria, Pretoria, South Africa
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21
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White C, Wray J, Whitfield C. 'A fifty mile round trip to change a lightbulb': An exploratory study of carers' experiences of providing help, care and support to families and friends from a distance. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:1632-1642. [PMID: 32227545 DOI: 10.1111/hsc.12988] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 02/21/2020] [Accepted: 03/11/2020] [Indexed: 06/10/2023]
Abstract
While the role of carers has been widely investigated, the experiences of those who care from a distance have been little explored, especially in the United Kingdom. However, contemporary patterns of family life suggest that this may be a significant experience for many. This exploratory study employed an anonymous online survey, conducted April-November 2017, to collect data about specific issues (experiences, challenges and satisfactions) faced by carers living at a distance requiring at least 1 hr travel time (each way) from the person they support. One hundred and twenty-eight participant responses were analysed. Qualitative (thematic) analysis identified that 'distance carers' carry out multiple care tasks, both when with, and apart from, the person they care for. Distance creates specific challenges for carers who have to work to 'bridge the distance gap' and who cannot 'just drop in' and see the person they support. Distance further exposes carers to emotional, financial and temporal demands. The use of technologies or the availability of a wider support network may support distance carers, and some explore the viability of relocation. However, these potential support strategies were identified as 'fragile' and at risk of breaking down. Despite the challenges identified, distance carers also reported satisfactions derived from supporting their relative/friend. While the numbers of those providing distance care are unknown, this research suggests that this is a significant carer group, whose needs should be recognised in health and social care policy, practice and research.
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Affiliation(s)
- Caroline White
- Faculty of Health Sciences, University of Hull, Hull, UK
| | - Jane Wray
- Faculty of Health Sciences, University of Hull, Hull, UK
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22
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Supported cognitive-behavioural therapy self-help versus treatment-as-usual for depressed informal caregivers of stroke survivors (CEDArS): feasibility randomised controlled trial. COGNITIVE BEHAVIOUR THERAPIST 2020. [DOI: 10.1017/s1754470x20000239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Abstract
Demands placed on informal caregivers can result in an increased likelihood of experiencing common mental health difficulties that may affect their ability to undertake the caring role. Currently, however, few evidence-based interventions have been specifically developed for informal caregivers and available interventions are difficult to access. The Improving Access to Psychological Therapies (IAPT) programme aims to improve access to evidence-based psychological therapies for all groups and may therefore present an opportunity to meet informal caregiver needs. Located within the MRC Complex Intervention Framework, a Phase II feasibility randomised controlled trial (RCT) examines key methodological, procedural and clinical uncertainties associated with running a definitive Phase III RCT of an adapted written cognitive behavioural therapy (CBT) self-help intervention for informal caregivers of stroke survivors. Recruitment was low despite different recruitment strategies being adopted, highlighting significant challenges moving towards a Phase III RCT until resolved. Difficulties with study recruitment may reflect wider challenges engaging informal caregivers in psychological interventions and may have implications for IAPT services seeking to improve access for this group. Further attempts to develop a successful recruitment protocol to progress to a Phase III RCT examining effectiveness of the adapted CBT self-help intervention should be encouraged.
Key learning aims
After reading this article, readers should be able to:
(1)
Consider key feasibility issues with regard to recruitment and attrition when running a randomised controlled trial of an adapted written cognitive behavioural therapy (CBT) self-help intervention for informal caregivers of stroke survivors.
(2)
Understand potential barriers experienced by an informal caregiving population to accessing psychological interventions.
(3)
Appreciate implications for clinical practice to enhance access to IAPT services and low-intensity CBT working with an informal caregiver population.
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23
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Tang EYH, Price C, Stephan BCM, Robinson L, Exley C. Impact of Memory Problems Post-stroke on Patients and Their Family Carers: A Qualitative Study. Front Med (Lausanne) 2020; 7:267. [PMID: 32637417 PMCID: PMC7317277 DOI: 10.3389/fmed.2020.00267] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 05/15/2020] [Indexed: 11/18/2022] Open
Abstract
Background: Memory problems post-stroke are common and for some, these problems could then progress to a dementia illness. Once in the community, stroke-survivors are looked after by their family doctors although there is evidence that these patients may struggle to access appropriate help in the community for these problems. Although a stroke-survivor may be physically capable of performing daily tasks, they and their families may have to learn to manage and adapt to their new memory deficits. There is often less focus on cognitive recovery post-stroke from clinical services perhaps because of the lack of awareness and evidence of these adaptations. There is also good evidence that organized stroke care improves physical recovery but no equivalent evidence for the effectiveness of cognitive rehabilitation. The aim of this qualitative study was to report the impact of memory problems on the stroke-survivor and their family once they are living in the community. Methods: Semi-structured interviews were conducted with patients and family carers to gain an in-depth understanding of their experiences. Participants were invited to take part in an interview at around six and 12-months post-stroke. A topic guide was developed to explore participant's care experiences post-stroke when they have also presented with memory difficulties. Data collection and analysis were iterative; all transcripts were anonymized. The data were thematically analyzed. Results: Twenty-two interviews were conducted. Five family carers and ten stroke-survivors were interviewed at six-months post-stroke, of these eight stroke-survivors and four family carers agreed to a 12-month follow-up interview. They identified several areas of impact: (1) impact on daily life; (2) emotional impact; and (3) compensating strategies implemented in response to impact. Conclusion: Living with stroke combined with memory impairment can have negative effects on the stroke-survivor and their family once in the community. Health professionals and services in the community need to recognize the burden of managing symptoms post-stroke for these individuals and their families. Understanding the impact can enable more effective community and specialist support to be provided particularly if we were to also identify those who may then be at risk of a future dementia illness.
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Affiliation(s)
- Eugene Y H Tang
- Population Health Sciences Institute, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, United Kingdom
| | - Christopher Price
- Population Health Sciences Institute, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, United Kingdom
| | - Blossom C M Stephan
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, School of Medicine, University of Nottingham, Innovation Park, Nottingham, United Kingdom
| | - Louise Robinson
- Population Health Sciences Institute, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, United Kingdom
| | - Catherine Exley
- Population Health Sciences Institute, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, United Kingdom
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24
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Shah KK, Murtagh FEM, McGeechan K, Crail SM, Burns A, Morton RL. Quality of life among caregivers of people with end-stage kidney disease managed with dialysis or comprehensive conservative care. BMC Nephrol 2020; 21:160. [PMID: 32366220 PMCID: PMC7199363 DOI: 10.1186/s12882-020-01830-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 04/27/2020] [Indexed: 01/03/2023] Open
Abstract
Background To measure health-related and care-related quality of life among informal caregivers of older people with end-stage kidney disease (ESKD), and to determine the association between caregiver quality of life and care recipient’s treatment type. Methods A prospective cross-sectional study was conducted. Three renal units in the UK and Australia were included. Informal caregivers of people aged ≥75 years with ESKD managed with dialysis or comprehensive conservative non-dialytic care (estimated glomerular filtration (eGFR) ≤10 mL/min/1.73m2) participated. Health-related quality of life (HRQoL) was assessed using Short-Form six dimensions (SF-6D, 0–1 scale) and care-related quality of life was assessed using the Carer Experience Scale (CES, 0–100 scale). Linear regression assessed associations between care-recipient treatment type, caregiver characteristics and the SF-6D utility index and CES scores. Results Of 63 caregivers, 49 (78%) were from Australia, 26 (41%) cared for an older person managed with dialysis, and 37 (59%) cared for an older person managed with comprehensive conservative care. Overall, 73% were females, and the median age of the entire cohort was 76 years [IQR 68–81]. When adjusted for caregiver sociodemographic characteristics, caregivers reported significantly worse carer experience (CES score 15.73, 95% CI 5.78 to 25.68) for those managing an older person on dialysis compared with conservative care. However, no significant difference observed for carer HRQoL (SF-6D utility index − 0.08, 95% CI − 0.18 to 0.01) for those managing an older person on dialysis compared with conservative care. Conclusions Our data suggest informal caregivers of older people on dialysis have significantly worse care-related quality of life (and therefore greater need for support) than those managed with comprehensive conservative care. It is important to consider the impact on caregivers’ quality of life when considering treatment choices for their care recipients.
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Affiliation(s)
- Karan K Shah
- National Health and Medical Research Council (NHMRC) Clinical Trials Centre, The University of Sydney, 92-94 Parramatta Road, Camperdown, NSW, 2050, Australia.
| | - Fliss E M Murtagh
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Kingston upon Hull, UK
| | - Kevin McGeechan
- School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | | | - Aine Burns
- Royal Free Hospital, London NHS Foundation Trust, London, UK
| | - Rachael L Morton
- National Health and Medical Research Council (NHMRC) Clinical Trials Centre, The University of Sydney, 92-94 Parramatta Road, Camperdown, NSW, 2050, Australia
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25
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Smith J, Ali P, Birks Y, Curtis P, Fairbrother H, Kirk S, Saltiel D, Thompson J, Swallow V. Umbrella review of family‐focused care interventions supporting families where a family member has a long‐term condition. J Adv Nurs 2020. [DOI: 10.1111/jan.14367] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 01/23/2020] [Accepted: 03/16/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Joanna Smith
- School of Healthcare University of Leeds Leeds UK
| | | | - Yvonne Birks
- Social Policy Research Unit University of York York UK
| | - Penny Curtis
- School of Nursing & Midwifery University of Sheffield Sheffield UK
| | | | - Susan Kirk
- School of Health Sciences University of Manchester Manchester UK
| | | | - Jill Thompson
- School of Nursing & Midwifery University of Sheffield Sheffield UK
| | - Veronica Swallow
- College of Health Wellbeing and Life SciencesSheffield Hallan University Sheffield UK
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26
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Peters M, Rand S, Fitzpatrick R. Enhancing primary care support for informal carers: A scoping study with professional stakeholders. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:642-650. [PMID: 31770820 PMCID: PMC7027470 DOI: 10.1111/hsc.12898] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 10/21/2019] [Accepted: 11/07/2019] [Indexed: 06/10/2023]
Abstract
Informal carers (i.e. people who provide unpaid care to family and/or friends) are crucial in supporting people with long-term conditions. Caring negatively impacts on carers' health and experiences of health services. Internationally and nationally, policies, legislation, professional guidance and research advocate for health and care services to do more to support carers. This study explored the views of health and social care providers, commissioners and policy makers about the role and scope for strengthening health service support for carers. Twenty-four semi-structured interviews, with 25 participants were conducted, audio-recorded, transcribed verbatim and analysed by thematic analysis. Three main themes emerged: (a) identifying carers, (b) carer support, and (c) assessing and addressing carer needs. Primary care, and other services, were seen as not doing enough for carers but having an important role in identifying and supporting carers. Two issues with carer identification were described, first people not self-identifying as carers and second most services not being proactive in identifying carers. Participants thought that carer needs should be supported by primary care in collaboration with other health services, social care and the voluntary sector. Concerns were raised about primary care, which is under enormous strain, being asked to take on yet another task. There was a clear message that it was only useful to involve primary care in identifying carers and their needs, if benefit could be achieved through direct benefits such as better provision of support to the carer or indirect benefit such as better recognition of the carer role. This study highlights that more could be done to address carers' needs through primary care in close collaboration with other health and care services. The findings indicate the need for pilots and experiments to develop the evidence base. Given the crucial importance of carers, such studies should be a high priority.
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Affiliation(s)
- Michele Peters
- Health Services Research UnitNuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - Stacey Rand
- Personal Social Services Research UnitSchool of Social Policy, Sociology and Social ResearchUniversity of KentCanterburyUK
| | - Ray Fitzpatrick
- Health Services Research UnitNuffield Department of Population HealthUniversity of OxfordOxfordUK
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27
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Nimmon L, Kimel G, Lingard L, Bates J. Can a complex adaptive systems perspective support the resiliency of the heart failure patient - informal caregiver dyad? Curr Opin Support Palliat Care 2019; 13:9-13. [PMID: 30507631 DOI: 10.1097/spc.0000000000000406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
PURPOSE OF REVIEW A holistic palliative approach for heart failure care emphasizes supporting nonprofessional informal caregivers. Informal caregivers play a vital role caring for heart failure patients. However, caregiving negatively affects informal caregivers' well being, and in turn heart failure patients' health outcomes. This opinion article proposes that complex adaptive systems (CAS) theory applied to heart failure models of care can support the resiliency of the heart failure patient - informal caregiver dyad. RECENT FINDINGS Heart failure care is enacted within a complex system composed of patients, their informal caregivers and a variety of health professionals. In a national study, we employed a CAS perspective to explore how all parts of the heart failure team function interdependently in emergent and adaptive ways. Salient in our data were the severe vulnerability of elderly heart failure patients and their long-term partners who suffered from a chronic illness. Novel approaches are needed that can quickly adapt and reorganize care when unpredictable disturbances occur in the couples' functional capacity. SUMMARY The linear protocol-driven care models that shape heart failure guidelines, training and care delivery initiatives do not adequately capture heart failure patients' social environment. CAS is a powerful theoretical tool that can render visible the most vulnerable members of the heart failure team, and incite robust specialized holistic palliative heart failure care models.
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Affiliation(s)
- Laura Nimmon
- Centre for Health Education Scholarship, Department of Occupational Science and Occupational Therapy
| | - Gil Kimel
- St. Paul's Hospital, Palliative Care Program, Division of Internal Medicine, Department of Medicine
| | - Lorelei Lingard
- Centre for Education Research and Innovation, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Joanna Bates
- Centre for Health Education Scholarship, Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia
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28
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Brignon M, Vioulac C, Boujut E, Delannoy C, Beauvais C, Kivits J, Poivret D, Giraudet Le Quintrec JS, Untas A, Rat AC. Patients and relatives coping with inflammatory arthritis: Care teamwork. Health Expect 2019; 23:137-147. [PMID: 31774612 PMCID: PMC6978873 DOI: 10.1111/hex.12982] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 09/13/2019] [Accepted: 09/16/2019] [Indexed: 11/27/2022] Open
Abstract
Objective To explore how patients and relatives experience and talk together about their life with inflammatory arthritis. Design Qualitative research. Setting A convenience sample was used. Participants were recruited in seven rheumatology departments in France. Participants Patients with rheumatoid arthritis or spondyloarthritis, agreeing to participate in the study with a relative, age at least 18 years. Data collection and analysis Two psychologists conducted face‐to‐face interviews with 20 patient‐relative dyads (40 individuals). A thematic analysis followed a general inductive approach. Results Saturation was reached after interviews with 20 dyads. The analysis revealed four main themes: (a) disease ‘lived’ together: a new role for the relative (providing help in physical tasks, emotional support, acting as a driving force, having a role in medical care) and communication around the disease (not focusing on the disease); (b) impact of the disease on the relationship; (c) social impact of the disease on the dyad (social isolation); (d) difficulties and needs of the relative (need to better know the disease). Conclusion This study has highlighted the importance of recognizing the role of the relative in the management of inflammatory arthritis disease, especially when medical decisions are shared with professionals. A joint approach to treatment is a basis for coping with the disease. This approach supposes (a) discussions about relatives’ new roles to clarify them, (b) patients’ and relatives’ communication skills and (c) a good understanding of each other, which can be improved by providing information on the disease and coping strategies for both the patient and the relative.
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Affiliation(s)
| | - Christel Vioulac
- Laboratory of Psychopathology and Health Processes EA 4057, University of Paris Descartes - Sorbonne Paris Cité, Boulogne-Billancourt, France
| | - Emilie Boujut
- Laboratory of Psychopathology and Health Processes EA 4057, University of Paris Descartes - Sorbonne Paris Cité, Boulogne-Billancourt, France
| | | | - Catherine Beauvais
- Hôpitaux universitaires Est Parisien, AP-HP, Rheumatology Department, Saint-Antoine Hospital, Paris, France
| | - Joelle Kivits
- EA 4360 APEMAC, Université de Lorraine, Nancy, France
| | | | | | - Aurélie Untas
- Laboratory of Psychopathology and Health Processes EA 4057, University of Paris Descartes - Sorbonne Paris Cité, Boulogne-Billancourt, France
| | - Anne-Christine Rat
- EA 4360 APEMAC, Université de Lorraine, Nancy, France.,Rheumatology Department, University Hospital Nancy, Nancy, France
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Greenwood N, Pound C, Brearley S. 'What happens when I can no longer care?' Informal carers' concerns about facing their own illness or death: a qualitative focus group study. BMJ Open 2019; 9:e030590. [PMID: 31481376 PMCID: PMC6731855 DOI: 10.1136/bmjopen-2019-030590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Older informal carers play an increasingly important role in supporting others with long-term health conditions. This study aimed to explore in depth the perspectives of older carers (70+ years) supporting others with a variety of conditions and disabilities focusing on their thoughts and experiences about when they are unable to continue caring. DESIGN Qualitative with four focus groups. SETTING Greater London, UK. PARTICIPANTS 28 older carers (70+ years) recruited from the voluntary sector participated in this study. Most were women and many were spouses caring for partners with age-related conditions such as dementia, arthritis and visual impairment. Nearly a third were parents of adult children with severe physical or cognitive disabilities. FINDINGS Thematic analysis identified two main aspects for carers when contemplating the future-when they are unable to care in the short term or long term if they die or can no longer manage. Themes included the following: the impact of age, health conditions and relationships on future planning; anxiety about future care; carers' ambivalence and challenges in broaching the subject; interventions that might help older carers talk about and plan for the future of those they care for. CONCLUSIONS Services need to be open to talking about this difficult topic. Our findings suggest that frank discussions about when older carers cannot care and having plans in place, whether these are financial or address other practical issues, makes it easier for all concerned. However, this issue is not easily broached and its timing and ways to access this support must be carefully and individually gauged. Future research with more diverse demographic groups is needed to improve understanding of these carers' perspectives. Research is also needed to develop interventions to support older carers to talk about and plan for the future.
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Affiliation(s)
- Nan Greenwood
- Faculty of Health, Social Care and Education, Kingston University and St George's University of London, London, UK
| | - Carole Pound
- Faculty of Health and Social Sciences, Bournemouth University, Poole, UK
| | - Sally Brearley
- Faculty of Health, Social Care and Education, Kingston University and St George's University of London, London, UK
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McMillan SS, King MA, Sav A, Wheeler AJ, Kelly F. Support for Australian carers from community pharmacy: Insight into carer perspectives of a novel service. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:320-329. [PMID: 30187990 DOI: 10.1111/hsc.12649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 06/14/2018] [Accepted: 07/16/2018] [Indexed: 06/08/2023]
Abstract
The feasibility of an individualised carer support service delivered in community pharmacies was assessed from the perspective of carer participants using a pre-post questionnaire and semistructured interviews. Eligible pharmacies were required to offer a medication management service relevant to carers and have a semiprivate space for conversations. Carers were required to self-identify as an unpaid support person for someone with a chronic condition or disability. Between September 2016 and March 2017, staff from 11 community pharmacies in South-East Queensland, Australia were trained, and provided with ongoing mentoring from a pharmacist and carer to support service implementation. Identification of carers and support to achieve a personal and care-giving goal were key features of the service. Questionnaires included the EQ-5D-3L, the Bakas Caregiving Outcomes Scale, and questions relating to goal achievement, carer roles, and responsibilities. Seven follow-up carer interviews were undertaken between March and May 2017 and analysed thematically. Pre-post questionnaires were available for 17 carers (one withdrew, two incomplete). Of the 29 goals set, 10 were achieved and 14 partially achieved. EQ-5D-3L scores were unchanged, while 7 of the 15 items comprising the Bakas score improved (p < 0.05). Carer service evaluation was generally favourable, and these two main interview themes were the impact of caring and pharmacy experience. The impact of caring, while variable, was significant. Pharmacy experiences were mostly positive and the opportunity for carers to further engage with pharmacy staff was appreciated. The service was feasible and initial reported benefits to carers may support further research potentially in terms of a larger controlled trial.
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Affiliation(s)
- Sara S McMillan
- Griffith University, Quality Use of Medicines Network, Menzies Health Institute Queensland, Southport, Queensland, Australia
| | - Michelle A King
- Griffith University, Quality Use of Medicines Network, Menzies Health Institute Queensland, Southport, Queensland, Australia
| | - Adem Sav
- School of Public Health and Social Work, Faculty of Health, Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology, Brisbane, Queensland, Australia
| | - Amanda J Wheeler
- Griffith University, Quality Use of Medicines Network, Menzies Health Institute Queensland, Nathan, Queensland, Australia
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - Fiona Kelly
- Griffith University, Quality Use of Medicines Network, Menzies Health Institute Queensland, Southport, Queensland, Australia
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31
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McKinlay E, McDonald J, Darlow B, Perry M. The social networks of New Zealand patients with multimorbidity and the work of those nominated as their 'significant supporters': An exploratory study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:392-399. [PMID: 30175532 DOI: 10.1111/hsc.12657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 05/04/2018] [Accepted: 08/03/2018] [Indexed: 06/08/2023]
Abstract
Social networks are informal relationships often with social ties and voluntary or mandatory obligations that can positively support a patient with multimorbidity. This exploratory study sought insights into the social networks of New Zealand people with multimorbidity and also the work of those nominated as providing significant support. Ten participants were recruited from general practice as part of an education programme in which health professional students discussed living with multimorbidity and completed a social network template together with patients. Each patient nominated an individual from their social network whom they considered provided significant support. A researcher interviewed each supporter about their experience of providing support, and their view of the patient's social network. Significant supporters included three classified as 'lay' supporters (sister, wife and daughter) and seven classified as 'professional' supporters (exercise physiologist, general practitioners, nurse, medical specialists). The activities described by supporters was classified according to Vassilev et al.'s expansion of Corbin and Strauss's 1985 classification of work in chronic illness, including the categories of "illness," "everyday" and "emotional" work. Irrespective of whether supporters were lay or professional, they gave examples of each category. While this is expected of lay supporters, it is not expected of professional supporters who are typically viewed as undertaking illness work. Lay supporters described a complex array of activities sometimes impacting on their own personal well-being, making them more akin to meeting the formal definition of being a carer, while professional supports gave objective yet professionally invested descriptions. The work of lay and professional supporters is complementary in the provision of support for those with multimorbidity. Consideration should be given to the role of lay supporters and to their own needs if they are to be able to sustain their support work with patients.
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Affiliation(s)
| | - Janet McDonald
- Health Services Research Centre, Victoria University of Wellington, Wellington, New Zealand
| | - Ben Darlow
- University of Otago Wellington, Wellington, New Zealand
| | - Meredith Perry
- School of Physiotherapy, Centre for Health, Activity and Rehabilitation Research, University of Otago Wellington, Wellington, New Zealand
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32
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Leu A, Frech M, Jung C. Young carers and young adult carers in Switzerland: Caring roles, ways into care and the meaning of communication. HEALTH & SOCIAL CARE IN THE COMMUNITY 2018; 26:925-934. [PMID: 30074654 DOI: 10.1111/hsc.12622] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 06/14/2018] [Accepted: 06/21/2018] [Indexed: 06/08/2023]
Abstract
Although there is already general recognition of the fact that many relatives provide unpaid care for family members, there is still little awareness that children, adolescents and young adults under 25 also provide such care. Until recently, the situation of young carers and young adult carers, as those young persons are referred to in international research, has not been in the focus of professionals, research and the public in Switzerland. Between September 2015 and October 2016, 30 interviews in seven cantons were conducted with 16 young carers aged 10-17 and 14 young adult carers aged 18-25. The interviews were recorded, transcribed and analysed following a grounded theory approach. This paper now presents the first qualitative data on Swiss young carers and young adult carers. It explores their sociodemographic backgrounds, the nature and intensity of caring tasks they carry out, their pathways into caring as well as the role of communication with family members, extended family, professionals and peers. Our findings provide a first insight in the lives of young carers and young adult carers in Switzerland and illustrate, as well, the challenges they face.
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Affiliation(s)
- Agnes Leu
- Careum Research, Kalaidos University of Applied Sciences, Department of Health Science, Zurich, Switzerland
- Institute for Biomedical Ethics, Science and Medical Faculties, University of Basel, Switzerland
| | - Marianne Frech
- Careum Research, Kalaidos University of Applied Sciences, Department of Health Science, Zurich, Switzerland
- Department of Nursing Science, Faculty of Social Sciences, University of Vienna
| | - Corinna Jung
- Careum Research, Kalaidos University of Applied Sciences, Department of Health Science, Zurich, Switzerland
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
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McDougall E, O'Connor M, Howell J. "Something that happens at home and stays at home": An exploration of the lived experience of young carers in Western Australia. HEALTH & SOCIAL CARE IN THE COMMUNITY 2018; 26:572-580. [PMID: 29457295 DOI: 10.1111/hsc.12547] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/11/2018] [Indexed: 06/08/2023]
Abstract
There are approximately 350,000 young carers in Australia, yet their experience is not well understood. Young carers face adversities and disenfranchisement by being a young person in a caring role, and the role can affect other areas of their lives. We explored the lived experiences of young carers, aged 14-25 years (N = 13), from Western Australia through in-depth semi-structured interviews. A phenomenological approach was adopted. A thematic analysis of the transcribed interview data revealed four key themes. "Lessons from the experience" articulates the perceived benefits of the role and the themes: "navigating competing demands," "desire for normalcy" and "lost in the system" capture the struggles and complexities associated with being a young carer. Although there are challenges to being a young carer, it is something that young carers report can be beneficial and something that is done for those they love.
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Affiliation(s)
- Emma McDougall
- School of Psychology and Speech Pathology, Curtin University, Perth, WA, Australia
| | - Moira O'Connor
- School of Psychology and Speech Pathology, Curtin University, Perth, WA, Australia
| | - Joel Howell
- School of Psychology and Speech Pathology, Curtin University, Perth, WA, Australia
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34
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Nimmon L, Bates J, Kimel G, Lingard L. Patients with heart failure and their partners with chronic illness: interdependence in multiple dimensions of time. J Multidiscip Healthc 2018; 11:175-186. [PMID: 29588596 PMCID: PMC5858542 DOI: 10.2147/jmdh.s146938] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Background Informal caregivers play a vital role in supporting patients with heart failure (HF). However, when both the HF patient and their long-term partner suffer from chronic illness, they may equally suffer from diminished quality of life and poor health outcomes. With the focus on this specific couple group as a dimension of the HF health care team, we explored this neglected component of supportive care. Materials and methods From a large-scale Canadian multisite study, we analyzed the interview data of 13 HF patient-partner couples (26 participants). The sample consisted of patients with advanced HF and their long-term, live-in partners who also suffer from chronic illness. Results The analysis highlighted the profound enmeshment of the couples. The couples' interdependence was exemplified in the ways they synchronized their experience in shared dimensions of time and adapted their day-to-day routines to accommodate each other's changing health status. Particularly significant was when both individuals were too ill to perform caregiving tasks, which resulted in the couples being in a highly fragile state. Conclusion We conclude that the salience of this couple group's oscillating health needs and their severe vulnerabilities need to be appreciated when designing and delivering HF team-based care.
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Affiliation(s)
- Laura Nimmon
- Centre for Health Education Scholarship.,Department of Occupational Science and Occupational Therapy
| | - Joanna Bates
- Centre for Health Education Scholarship.,Department of Family Practice, Faculty of Medicine, University of British Columbia
| | - Gil Kimel
- Palliative Care Program, St Paul's Hospital.,Department of Medicine, Division of Internal Medicine, University of British Columbia, Vancouver, BC
| | - Lorelei Lingard
- Centre for Education Research and Innovation, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
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35
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Caswell G, Hardy B, Ewing G, Kennedy S, Seymour J. Supporting family carers in home-based end-of-life care: using participatory action research to develop a training programme for support workers and volunteers. BMJ Support Palliat Care 2017; 9:e4. [PMID: 28768679 PMCID: PMC6579492 DOI: 10.1136/bmjspcare-2017-001317] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 06/02/2017] [Accepted: 06/07/2017] [Indexed: 11/09/2022]
Abstract
Background Family carers are crucial in enabling dying people to stay at home, but are often not prepared for their caring role, receiving little support from formal health and social care services. It is increasingly likely that any help or support family carers receive will be provided by a third sector organisation on either a voluntary basis or by untrained carer support workers. Objectives To produce a training programme designed to equip carer support workers and volunteers with the basic skills and knowledge needed to support family carers. Process of development Participatory action research, a collaborative form of working in which those who are affected by an issue take a lead role in the research, was used. Bereaved carers acting as research partners, support workers and representatives of third sector organisations took an active part in designing, developing, piloting and refining the programme in a number of interlinked stages. During development, the programme was piloted on four occasions and evaluated by 36 trainees and 3 trainers. Final training programme The outcome of the project is an innovative, 1-day training programme, offering an introduction to supporting family carers who are looking after someone approaching the end of life. The use of participatory action research methods enabled the development of a programme that addresses support needs identified by bereaved carers and training needs identified by carer support workers. The finished programme includes all the materials necessary to run a training day for support workers and volunteers: facilitator’s notes, trainee workbook, slides, promotional poster and pre-course reading for trainees. Knowledge of issues involved in end-of-life and palliative care is not required, although some experience in delivering training is advisable. Conclusion The programme evaluated well during development, but further research is required to examine the transfer of learning into the workplace.
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Affiliation(s)
- Glenys Caswell
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Beth Hardy
- Department of Health Sciences, University of York, York, North Yorkshire, UK
| | - Gail Ewing
- Centre for Family Research, University of Cambridge, Cambridge, UK
| | - Sheila Kennedy
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Jane Seymour
- School of Nursing and Midwifery, University of Sheffield, Sheffield, UK
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36
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LaDonna KA, Bates J, Tait GR, McDougall A, Schulz V, Lingard L. 'Who is on your health-care team?' Asking individuals with heart failure about care team membership and roles. Health Expect 2017; 20:198-210. [PMID: 26929430 PMCID: PMC5354030 DOI: 10.1111/hex.12447] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2016] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Complex, chronically ill patients require interprofessional teams to address their multiple health needs; heart failure (HF) is an iconic example of this growing problem. While patients are the common denominator in interprofessional care teams, patients have not explicitly informed our understanding of team composition and function. Their perspectives are crucial for improving quality, patient-centred care. OBJECTIVES To explore how individuals with HF conceptualize their care team, and perceive team members' roles. SETTING AND PARTICIPANTS Individuals with advanced HF were recruited from five cities in three Canadian provinces. DESIGN Individuals were asked to identify their HF care team during semi-structured interviews. Team members' titles and roles, quotes pertaining to team composition and function, and frailty criteria were extracted and analysed using descriptive statistics and content analysis. RESULTS A total of 62 individuals with HF identified 2-19 team members. Caregivers, nurses, family physicians and cardiologists were frequently identified; teams also included dentists, foot care specialists, drivers, housekeepers and spiritual advisors. Most individuals met frailty criteria and described participating in self-management. DISCUSSION Individuals with HF perceived being active participants, not passive recipients, of care. They identified teams that were larger and more diverse than traditional biomedical conceptualizations. However, the nature and importance of team members' roles varied according to needs, relationships and context. Patients' degree of agency was negotiated within this context, causing multiple, sometimes conflicting, responses. CONCLUSION Ignoring the patient's role on the care team may contribute to fragmented care. However, understanding the team through the patient's lens - and collaborating meaningfully among identified team members - may improve health-care delivery.
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Affiliation(s)
- Kori A. LaDonna
- Centre for Education Research & InnovationSchulich School of Medicine & DentistryWestern UniversityLondonONCanada
| | - Joanna Bates
- Department of Family PracticeFaculty of MedicineUniversity of British ColumbiaVancouverBCCanada
| | - Glendon R. Tait
- Department of Psychiatry and Division of Medical EducationDalhousie UniversityHalifaxNSCanada
| | - Allan McDougall
- Centre for Education Research & InnovationSchulich School of Medicine & DentistryWestern UniversityLondonONCanada
| | - Valerie Schulz
- Department of Anesthesia & Perioperative MedicineLondon Health Sciences CentreLondonONCanada
- Western UniversityLondonONCanada
| | - Lorelei Lingard
- Centre for Education Research & InnovationSchulich School of Medicine & DentistryWestern UniversityLondonONCanada
- Department of MedicineWestern UniversityLondonONCanada
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Aasbø G, Rugkåsa J, Solbraekke KN, Werner A. Negotiating the care-giving role: family members' experience during critical exacerbation of COPD in Norway. HEALTH & SOCIAL CARE IN THE COMMUNITY 2017; 25:612-620. [PMID: 27103468 DOI: 10.1111/hsc.12350] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/08/2016] [Indexed: 06/05/2023]
Abstract
Healthcare policies often state that complex conditions are to be treated outside hospital in various forms of public-private partnership. Chronic obstructive pulmonary disease (COPD) is a progressive illness that includes episodes of serious acute exacerbations characterised by extreme breathlessness. There is limited knowledge about COPD exacerbations from the perspective of family caregivers and implications of the changing boundary between hospital care and care at home. In this paper, we explore how caregivers negotiate their role as caregivers with patients and healthcare professionals during acute exacerbations. We conducted 10 qualitative interviews with family caregivers of COPD patients in 2011, all were spouses over the age of 60. The participants were recruited through the patient pool of ambulatory pulmonary services of two hospitals in Oslo, Norway. Data were interpreted using thematic analysis. The caregivers described a lack of understanding and support from health professionals in some situations. They shouldered considerable responsibility, but were not always acknowledged as competent carers by professionals. Caregivers had to balance their involvement. They noted that they could lose the professionals' co-operation if their involvement was perceived as interfering or preventing the professionals from exercising their expertise. However, by not sharing their personalised knowledge about the patients, they risked that the professionals would not understand the severity of the exacerbation, which could undermine their own ability to maintain a sense of safety and control. The negotiations caregivers participated in and the uncertainty they experienced shed new light on the complexity of their role, and the discrepancy between practice and ideals in healthcare policy regarding collaboration of care. It is crucial to develop further knowledge about structural, interactional and communicational facilitators and barriers for reaching shared understandings and facilitating mutual trust in these demanding situations.
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Affiliation(s)
- Gunvor Aasbø
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
- Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Jorun Rugkåsa
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | | | - Anne Werner
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
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Evans KL, Girdler SJ, Falkmer T, Richmond JE, Wagman P, Millsteed J, Falkmer M. Viewpoints of working sandwich generation women and occupational therapists on role balance strategies. Scand J Occup Ther 2016; 24:366-382. [PMID: 27809698 DOI: 10.1080/11038128.2016.1250814] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Occupational therapists need to be cognizant of evidence-based role balance advice and strategies that women with multigenerational caring responsibilities can implement independently or with minimal assistance, as role balance may not be the primary goal during many encounters with this population. Hence, this study aimed to identify the viewpoints on the most helpful role balance strategies for working sandwich generation women, both from their own perspectives and from the perspective of occupational therapists. This was achieved through a Q methodology study, where 54 statements were based on findings from interviews, sandwich generation literature and occupational therapy literature. In total, 31 working sandwich generation women and 42 occupational therapists completed the Q sort through either online or paper administration. The data were analysed using factor analysis with varimax rotation and were interpreted through collaboration with experts in the field. The findings revealed similarities between working sandwich generation women and occupational therapists, particularly in terms of advocating strategies related to sleep, rest and seeking practical assistance from support networks. Differences were also present, with working sandwich generation women viewpoints tending to emphasize strategies related to coping with a busy lifestyle attending to multiple responsibilities. In contrast, occupational therapy viewpoints prioritized strategies related to the occupational therapy process, such as goal setting, activity focused interventions, monitoring progress and facilitating sustainable outcomes.
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Affiliation(s)
- Kiah L Evans
- a Occupational Therapy Program, School of Medical and Health Sciences , Edith Cowan University , Perth , Australia.,b School of Occupational Therapy and Social Work , Curtin University , Perth , Australia
| | - Sonya J Girdler
- a Occupational Therapy Program, School of Medical and Health Sciences , Edith Cowan University , Perth , Australia.,b School of Occupational Therapy and Social Work , Curtin University , Perth , Australia
| | - Torbjorn Falkmer
- b School of Occupational Therapy and Social Work , Curtin University , Perth , Australia.,d Department for Rehabilitation, School of Health and Welfare , Jönköping University , Jönköping , Sweden.,e Rehabilitation Medicine, Department of Medicine and Health Sciences (IMH), Faculty of Health Sciences , Linköping University & Pain and Rehabilitation Centre , Linköping , Sweden.,f School of Occupational Therapy , La Trobe University , Melbourne , Australia
| | - Janet E Richmond
- a Occupational Therapy Program, School of Medical and Health Sciences , Edith Cowan University , Perth , Australia
| | - Petra Wagman
- d Department for Rehabilitation, School of Health and Welfare , Jönköping University , Jönköping , Sweden
| | - Jeannine Millsteed
- a Occupational Therapy Program, School of Medical and Health Sciences , Edith Cowan University , Perth , Australia
| | - Marita Falkmer
- b School of Occupational Therapy and Social Work , Curtin University , Perth , Australia.,c School of Education and Communication, CHILD programme , Institute of Disability Research, Jönköping University , Jönköping , Sweden
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