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Tabvuma T, Stanton R, Huang YL, Happell B. The Physical Health Nurse Consultant: Perceptions and Experiences of Those Who Care for People with Mental Illness. Issues Ment Health Nurs 2024:1-11. [PMID: 39012920 DOI: 10.1080/01612840.2024.2361317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2024]
Abstract
Mental health carers are crucial in improving the physical health outcomes of people diagnosed with a mental illness (hereafter referred to as consumers). The long-term and multifaceted mental and physical health support carers provide to consumers can contribute to caregiver burden. Consequently, carers advocate for coordinated and integrated physical healthcare to improve the physical health outcomes of consumers and alleviate caregiver burden. The aim of this qualitative exploratory study is to explore carers' perceptions and experiences with the Physical Health Nurse Consultant role. Semi-structured interviews with nine carers nominated by consumers were conducted. Interviews were transcribed and reflexively thematically analysed. Three main themes were identified: (i) Therapeutic relationship s were a catalyst for health behaviour change; (ii) Overt and covert positive changes were observed by carer and (iii) Cares' involvement in integrated mental health and physical health care. Nine carers who were nominated by consumers to be involved in their physical healthcare planning, preferred to adopt a supporting role as this prevented or reduced caregiver burden. The findings support the adoption and continuation of the Physical Health Nurse Consultant role to facilitate positive physical health outcomes for consumers and a reduction in caregiving burden. The benefits of the Physical Health Nurse Consultant provide a compelling argument to embed the role in routine practice. Mental healthcare services should advocate for continued funding and career development for such positions to provide long term benefits for consumers and carers. Future research is required to explore carer and consumer involvement in co-producing future and localised iterations of the Physical Health Nurse Consultant role. This research should also measure the outputs and outcomes of co-production to clarify how the process worked in practice.
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Affiliation(s)
- Tracy Tabvuma
- Faculty of Health, Southern Cross University, Lismore, Australia
| | - Robert Stanton
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Australia
| | - Ya-Ling Huang
- School of Nursing and Midwifery, University of Southern Queensland, Ipswich, QLD, Australia
| | - Brenda Happell
- Faculty of Health, Southern Cross University, Lismore, Australia
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
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Albani EN, Toska A, Togas C, Rigatos S, Vus V, Fradelos EC, Tzenalis A, Saridi M. Burden of Caregivers of Patients with Chronic Diseases in Primary Health Care: A Cross-Sectional Study in Greece. NURSING REPORTS 2024; 14:1633-1646. [PMID: 39051358 PMCID: PMC11270267 DOI: 10.3390/nursrep14030122] [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: 06/02/2024] [Revised: 06/26/2024] [Accepted: 06/26/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND In the world of elderly people and people with chronic diseases, caregivers give a solution to caring at home. This study aimed to evaluate the burden of caregivers of patients with chronic diseases in primary health care and identify possible demographic and other determinants of it. METHODS This was a cross-sectional study with a convenience sample, which was conducted in two health centers. The sample comprised 291 caregivers who visited the aforementioned health centers in Patra, Greece. A composite questionnaire was utilized: the first part included demographic data and care-related information and the second included the Zarit Burden Interview and the Depression, Anxiety, and Stress Scale-21 (DASS-21). RESULTS The highest mean score in the DASS was recorded in the depression subscale and the lowest in the stress subscale. Concerning the Zarit Burden Interview, the highest mean score was recorded in the personal strain subscale and the lowest in the management of care subscale. The highest correlation was recorded between role strain and anxiety and the lowest was between management of care and stress. Similarly, the total score in the Zarit Burden Interview correlated significantly (in a positive direction) with depression, anxiety, and stress. CONCLUSIONS Most of the caregivers of patients with chronic diseases in primary health care experienced a moderate to severe burden (especially in the dimension of personal strain) and moderate depression. The experienced burden was positively associated with depression, anxiety, and stress. There were significant differences in the caregivers' burden according to several demographic and care-related characteristics.
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Affiliation(s)
- Eleni N. Albani
- Department of Nursing, School of Health Rehabilitation Sciences, University of Patras, 26504 Patras, Greece; (E.N.A.); (S.R.); (A.T.)
| | - Aikaterini Toska
- Department of Nursing, School of Health Sciences, University of Thessaly, 41500 Larissa, Greece; (A.T.); (M.S.)
| | - Constantinos Togas
- Department of Psychology, Panteion University of Social and Political Sciences, 17671 Athens, Greece;
| | - Spyridon Rigatos
- Department of Nursing, School of Health Rehabilitation Sciences, University of Patras, 26504 Patras, Greece; (E.N.A.); (S.R.); (A.T.)
| | - Viktor Vus
- Institute for Social and Political Psychology, National Academy of Educational Science of Ukraine, 04070 Kyiv, Ukraine;
| | - Evangelos C. Fradelos
- Department of Nursing, School of Health Sciences, University of Thessaly, 41500 Larissa, Greece; (A.T.); (M.S.)
| | - Anastasios Tzenalis
- Department of Nursing, School of Health Rehabilitation Sciences, University of Patras, 26504 Patras, Greece; (E.N.A.); (S.R.); (A.T.)
| | - Maria Saridi
- Department of Nursing, School of Health Sciences, University of Thessaly, 41500 Larissa, Greece; (A.T.); (M.S.)
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Parmar J, Hafeez S, L'Heureux T, Charles L, Tite J, Tian PGJ, Anderson S. Family physicians' preferences for education to support family caregivers: a sequential mixed methods study. BMC PRIMARY CARE 2024; 25:80. [PMID: 38454343 PMCID: PMC10918970 DOI: 10.1186/s12875-024-02320-9] [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: 03/28/2023] [Accepted: 02/22/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND One in four Canadians is a family caregiver. Family caregivers (carers, care-partners) are relatives or chosen family, friends, or neighbors who provide 75 to 90% of the care for people with physical or mental illness, disabilities, or frailty living in community homes and assist with 15 to 30% of the care in congregate care. However, a recent (2022) Statistics Canada population health study reports 44% of family caregivers are distressed. Family physicians and primary care teams are well-positioned to support family caregivers; yet, family caregiver needs assessments tend to be ad hoc and their most common needs remain unmet. Research recommends training healthcare professionals to enhance their knowledge and skills to support family caregivers. METHODS The objective of this sequential mixed methods research, a survey followed by qualitative interviews, was to explore family physicians' desire and preferences for education about supporting family caregivers. 85 family physicians completed the online survey and eight took part in the interviews. Results from the survey and interviews were compared, contrasted, and interpreted together. RESULTS Primary care physicians expressed a desire to be better equipped to assess and support FCGs' needs. Even though most physicians (61%) were very/confident about addressing family caregivers' needs, 72% were highly/interested in education to support family caregivers of their patients. Topics with the most interest were assessing family caregivers needs in an organized way, assisting family caregivers to access resources, and address system and practice barriers to support family caregivers. The overarching theme running through the interviews was physicians hope for education to help change the patient-focused culture to inclusion of FCGs. The three themes reflect physicians' conviction about including family caregivers in patient care: We need to take care of their caregivers, Practice and system barriers thwart including family caregivers, and Practical education might help. CONCLUSIONS This study of family physicians' preferences for education to support family caregivers will inform the development of education about supporting family caregivers for family physicians and trainees.
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Affiliation(s)
- Jasneet Parmar
- Division of Care of the Elderly, Department of Family Medicine, University of Alberta, Edmonton, Canada
| | - Sara Hafeez
- Division of Care of the Elderly, Department of Family Medicine, University of Alberta, Edmonton, Canada
| | - Tanya L'Heureux
- Division of Care of the Elderly, Department of Family Medicine, University of Alberta, Edmonton, Canada
| | - Lesley Charles
- Division of Care of the Elderly, Department of Family Medicine, University of Alberta, Edmonton, Canada
| | - Josephine Tite
- Division of Care of the Elderly, Department of Family Medicine, University of Alberta, Edmonton, Canada
| | - Peter George J Tian
- Division of Care of the Elderly, Department of Family Medicine, University of Alberta, Edmonton, Canada
| | - Sharon Anderson
- Division of Care of the Elderly, Department of Family Medicine, University of Alberta, Edmonton, Canada.
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Cronin M, McLoughlin K, Foley T, McGilloway S. Supporting family carers in general practice: a scoping review of clinical guidelines and recommendations. BMC PRIMARY CARE 2023; 24:234. [PMID: 37932659 PMCID: PMC10626724 DOI: 10.1186/s12875-023-02188-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 10/19/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Increasing numbers of family carers are providing informal care in community settings. This creates a number of challenges because family carers are at risk of poor physical and psychological health outcomes, with consequences both for themselves and those for whom they provide care. General Practitioners (GPs), who play a central role in community-based care, are ideally positioned to identify, assess, and signpost carers to supports. However, there is a significant gap in the literature in respect of appropriate guidance and resources to support them in this role. METHODS A scoping review was undertaken to examine clinical guidelines and recommendations for GPs to support them in their role with family carers. This involved a multidisciplinary team, in line with Arksey & O'Malley's framework, and entailed searches of ten peer-reviewed databases and grey literature between September-November 2020. RESULTS The searches yielded a total of 4,651 English language papers, 35 of which met the criteria for inclusion after removing duplicates, screening titles and abstracts, and performing full-text readings. Ten papers focused on resources/guidelines for GPs, twenty were research papers, three were review papers, one was a framework of quality markers for carer support, and one was an editorial. Data synthesis indicated that nine (90%) of the guidelines included some elements relating to the identification, assessment, and/or signposting of carers. Key strategies for identifying carers suggest that a whole practice approach is optimal, incorporating a role for the GP, practice staff, and for the use of appropriate supporting documentation. Important knowledge gaps were highlighted in respect of appropriate clinical assessment and evidence-based signposting pathways. CONCLUSION Our review addresses a significant gap in the literature by providing an important synthesis of current available evidence on clinical guidelines for GPs in supporting family carers, including strategies for identification, options for assessment and potential referral/signposting routes. However, there is a need for greater transparency of the existing evidence base as well as much more research to evaluate the effectiveness and increase the routine utilisation, of clinical guidelines in primary care.
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Affiliation(s)
- Mary Cronin
- Centre for Mental Health and Community Research, Department of Psychology and Social Sciences Institute, Maynooth University, Maynooth, Ireland.
| | | | - Tony Foley
- Department of General Practice, University College Cork, Cork, Ireland
| | - Sinéad McGilloway
- Centre for Mental Health and Community Research, Department of Psychology and Social Sciences Institute, Maynooth University, Maynooth, Ireland
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Goodyear AC, Arola A, Rosendahl S. 'I wish I had asked for support earlier' - Immigrant family caregivers' experiences of living with a person with dementia. Scand J Caring Sci 2023; 37:710-719. [PMID: 36808759 DOI: 10.1111/scs.13155] [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: 07/19/2022] [Revised: 11/08/2022] [Accepted: 01/24/2023] [Indexed: 02/22/2023]
Abstract
INTRODUCTION Immigrant family caregivers are increasing worldwide, likewise the number of older people with dementia. Caring for a person with dementia is demanding, with the carer's own life put on hold. Immigrant family caregivers have been less studied. Therefore, the aim of this study was to explore immigrant family caregivers' experiences of living with an older person with dementia. METHOD A qualitative approach was chosen, consisting of open-ended interviews analysed using qualitative content analysis. The ethical principles of the Helsinki Declaration were applied in the study, which was duly approved by a regional ethics review board. RESULTS The content analysis resulted in three main categories: (i) the diverse roles of a family caregiver; (ii) the impact of language and culture on daily life and (iii) wish for support from society. CONCLUSIONS Living with a person with dementia is demanding and burdensome and the consequences of working without any rest may increase social isolation and impair quality of life. Immigrants and country-born family caregivers living with a person with dementia seem to have similar care experiences, but immigrant family caregivers seem to receive help rather late due to a lack of information about the services available, language barriers and to financial reasons. A wish for support earlier on in the caring process was expressed, likewise for care services in the participants' native language. The various Finnish associations and peer support were important sources of information about support services. Together with culturally adjusted care services, these could contribute to better access to care, to quality and to equal care.
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Affiliation(s)
| | - Annikki Arola
- School of Engineering, Culture and Wellbeing, Arcada University of Applied Sciences, Helsinki, Finland
| | - Sirpa Rosendahl
- School of Health Sciences, University of Skövde, Högskolevägen, Skövde, Sweden
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Nakayama G, Masumoto S, Haruta J, Maeno T. Association between family caregivers' primary care experience when they report as patients and their stress related to caregiving: A pilot cross-sectional study. J Gen Fam Med 2023; 24:231-239. [PMID: 37484121 PMCID: PMC10357097 DOI: 10.1002/jgf2.631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/30/2023] [Accepted: 05/28/2023] [Indexed: 07/25/2023] Open
Abstract
Background Few studies have examined whether family caregivers' own primary care providers can affect caregiving-specific well-being, such as caregiver stress. In this pilot study, we explored whether primary care experiences when family caregivers report as patients were associated with the stress of caregiving. Methods We used cross-sectional data from a survey conducted in Japan between November and December 2020. We recruited family caregivers aged 40-74 years who were caring for community-dwelling adults with chronic conditions. We assessed primary care experience using the Japanese version of the Primary Care Assessment Tool Short Form (JPCAT-SF) and caregiver stress using the Japanese short version of the Zarit Caregiver Burden Interview. Results In total, 406 family caregivers were included in the analysis. The mean JPCAT-SF total score was 42.1 out of 100 points. The proportion of caregivers who had higher caregiver stress was 48.8%. After adjusting for possible confounders, the JPCAT-SF score was found to be significantly associated with caregiver stress (lower stress = 0 vs. higher stress = 1; adjusted prevalence ratio per 1 SD increase in JPCAT-SF score = 0.89; 95% CI 0.80-0.98). Among the subscales of the JPCAT-SF, longitudinality, and comprehensiveness (services available) were associated with caregiver stress. Conclusions Better primary care experiences when family caregivers reported as patients were associated with lower caregiver stress. Longitudinality, which includes focusing attention on the individual as a whole person, and comprehensiveness in the context of building provider-patient relationships that make consultation easier when needed, were associated with lower stress.
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Affiliation(s)
- Gen Nakayama
- Department of Primary Care and Medical EducationInstitute of Medicine, University of TsukubaTsukubaJapan
| | - Shoichi Masumoto
- Department of Family Medicine, General Practice and Community HealthInstitute of Medicine, University of TsukubaTsukubaJapan
- Department of General MedicineTsukuba Central HospitalUshikuJapan
| | - Junji Haruta
- Medical Education Center, School of MedicineKeio UniversityTokyoJapan
- Center for General Medicine Education, School of MedicineKeio UniversityTokyoJapan
| | - Tetsuhiro Maeno
- Department of Primary Care and Medical EducationInstitute of Medicine, University of TsukubaTsukubaJapan
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Park T, Pillemer K, Loeckenhoff C, Suitor JJ, Riffin C. What Motivates Physicians to Address Caregiver Needs? The Role of Experiential Similarity. J Appl Gerontol 2023; 42:1003-1012. [PMID: 36661199 PMCID: PMC10081953 DOI: 10.1177/07334648231151937] [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] [Indexed: 01/21/2023] Open
Abstract
Despite the significant stress of family caregiving, caregivers' needs and risks are often overlooked in healthcare settings. This study examined the factors associated with primary care physicians' perceived responsibility to identify and address caregiver needs and risks. Using a national random sample of U.S. primary care physicians (N = 106), multivariable logistic regression analyses were conducted to examine associations of physicians' perceived responsibility to assess caregivers' needs with experiential similarity (personal experience with caregiving), structural similarity (being older and female), and secondary exposure variables (time seeing older adults in the outpatient setting). Most (76.5%) physicians felt responsible for identifying caregivers' needs and risks. In multivariable models, physicians who had personal experience with caregiving were four times more likely than those without it to feel responsible for identifying caregivers' needs and risks and assessing caregivers' mental health concerns. Thus, physicians may benefit from educational interventions that immerse them in caregivers' lived experiences.
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Affiliation(s)
- Taeyoung Park
- Department of Medicine, Weill Cornell Medicine, New York, NY, 10065 USA
| | - Karl Pillemer
- Department of Psychology, Cornell University, Ithaca, NY, 14850 USA
| | | | - J. Jill Suitor
- Department of Sociology, Purdue University, West Lafayette, IN, 47907 USA
| | - Catherine Riffin
- Department of Medicine, Weill Cornell Medicine, New York, NY, 10065 USA
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Masumoto S, Nakayama G, Haruta J, Maeno T. Association between experience of interprofessional care and self-medication among family caregivers: A cross-sectional study. Res Social Adm Pharm 2023; 19:773-777. [PMID: 36658019 DOI: 10.1016/j.sapharm.2023.01.005] [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: 08/25/2022] [Revised: 01/06/2023] [Accepted: 01/08/2023] [Indexed: 01/11/2023]
Abstract
BACKGROUND Although healthcare professionals pay attention to the drugs prescribed by physicians, few studies have assessed self-medication by family caregivers. Family caregivers' experience of interprofessional care in the care of patients can influence caregivers' health behaviors. OBJECTIVES This study aimed to describe self-medication among family caregivers of community-dwelling adult patients, and to assess association between family caregivers' experience of interprofessional care and their self-medication, adjusting for possible confounding factors. METHODS We conducted a cross-sectional survey from November to December 2020 in Ibaraki Prefecture, Japan. Family caregivers between 40 and 74 years old and caring for community-dwelling adult patients with chronic conditions were recruited. The use of any self-medication in the last 2 weeks by family caregivers was the outcome variable. The explanatory variable was family caregivers' experience of interprofessional care in the care of patients, using the Japanese version of the Caregivers' Experience Instrument (J-IEXPAC CAREGIVERS). Adjusted covariates were age, gender, educational attainment, annual household income, self-rated health, and caregiving time of family caregivers. RESULTS Of 1091 recruited family caregivers, 750 were included in the analysis. A total of 258 (34.4%) family caregivers reported having used self-medication in the past 2 weeks. Logistic regression analysis showed that having a higher score on the J-IEXPAC CAREGIVERS (odds ratio 0.80 per 1 standard deviation increase) was associated with less use of self-medication by caregivers. CONCLUSIONS This study revealed that about one-third of family caregivers self-medicate, and this practice is associated with a less positive experience of interprofessional care. These results suggest that it is important for healthcare professionals to be aware of the health condition of family caregivers and to provide appropriate advice regarding self-medication.
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Affiliation(s)
- Shoichi Masumoto
- Department of Family Medicine, General Practice and Community Health, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan; Department of General Medicine, Tsukuba Central Hospital, 1589-3 Kashiwadacho, Ushiku, Ibaraki, 300-1211, Japan.
| | - Gen Nakayama
- Department of Primary Care and Medical Education, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
| | - Junji Haruta
- Medical Education Center, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku ku, Tokyo, 160-8582, Japan.
| | - Tetsuhiro Maeno
- Department of Primary Care and Medical Education, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
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Sandilands K, Williams A, Rylands AJ. Carer burden in rare inherited diseases: a literature review and conceptual model. Orphanet J Rare Dis 2022; 17:428. [PMID: 36494728 PMCID: PMC9733280 DOI: 10.1186/s13023-022-02561-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 10/23/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Carers of people living with rare diseases report heavy burden and a plethora of unmet needs. A previous parental supportive care needs framework has described the needs of parents of children living with rare diseases, but it is not specific to rare inherited diseases (RIDs) and does not include non-parental carers. We conducted a targeted literature review to: (1) ascertain the burden/supportive care needs of informal carers of people living with RIDs, (2) understand the burden/supportive care needs unique to these carers, and (3) develop a conceptual model based on the findings. METHODS A targeted literature review searching Embase and Medline between 2000 and 2020 was conducted to identify journal articles describing the burden/supportive care needs of all types of informal carers of people living with RIDs. Thematic analysis was conducted on the articles to develop a conceptual model. RESULTS After screening and quality appraisal, 31 journal articles were analysed, representing 70 RIDs (including bleeding, bone, central nervous system, multisystem and inherited metabolic disorders). Most articles (74%) focused on parent carer samples. The conceptual model has three overarching domains, encompassing 13 themes: (1) Living with Rare Inherited Disease (Being a Carrier of Rare Disease, Carer Perceptions, Disease Severity); (2) Carer Needs/Burden (Social/Community, Well-being, Information, Practical); and (3) Carer Coping Strategies (Acceptance, Support Systems, Gratitude and Hope, Faith, Quest for Knowledge, Establish a Routine). Our conceptual model uniquely describes carers' transmission guilt, clinically relevant depression and anxiety, worry about future family members living with the RID, and challenging decisions about having more children. Carers often implemented psychological, structural, practical, and social coping strategies to manage their burdens. CONCLUSIONS The identified burdens underscore the need for the provision of information and social support to these carers. Future research should focus on the (1) potential mediators/moderators of carers' burden, (2) needs of carers within the wider family including siblings and grandparents, (3) needs of carers of adults living with RIDs, including spouses and children, and (4) biopsychosocial effect on carers living with a RID themselves. Our conceptual model offers a potential tool for healthcare professionals to utilise during the provision of support to carers.
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Portz JD, Powers J, Baldwin M, Gleason K, Casillas A, Bekelman DB, Boxer R, Bayliss E, Palen TE. How can patient portals support caregivers of older adults near the end-of-life? A mixed-methods study. J Am Geriatr Soc 2022; 70:2431-2435. [PMID: 35488465 PMCID: PMC9378599 DOI: 10.1111/jgs.17818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 03/07/2022] [Accepted: 03/25/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Jennifer Dickman Portz
- Division of General Internal Medicine, School of Medicine, University of Colorado, Aurora, Colorado
- Insitute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado
| | - J.D. Powers
- Insitute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado
| | - Megan Baldwin
- Insitute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado
| | - Kathy Gleason
- Insitute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado
| | - Alejandra Casillas
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, UCLA, Los Angeles, California
| | - David B. Bekelman
- Division of General Internal Medicine, School of Medicine, University of Colorado, Aurora, Colorado
- Department of Medicine, Department of Veterans Affairs, Eastern Colorado Health Care System, Aurora, Colorado
| | - Rebecca Boxer
- Insitute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado
| | - Elizabeth Bayliss
- Insitute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado
- Department of Family Medicine, School of Medicine, University of Colorado, Aurora, Colorado
| | - Ted E. Palen
- Insitute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado
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Tarberg AS, Thronaes M, Landstad BJ, Kvangarsnes M, Hole T. Physicians' perceptions of patient participation and the involvement of family caregivers in the palliative care pathway. Health Expect 2022; 25:1945-1953. [PMID: 35765248 PMCID: PMC9327811 DOI: 10.1111/hex.13551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 05/01/2022] [Accepted: 05/31/2022] [Indexed: 11/28/2022] Open
Abstract
Introduction Patient participation is essential for quality palliative care, and physicians play a crucial role in promoting participation. This study explores physicians' perceptions of patients and family caregivers' involvement in the different phases of the palliative pathway and employs a qualitative design with thematic analysis and a hermeneutic approach. Methods A purposive sampling included physicians who worked in different phases of the palliative pathway. In‐depth, semi‐structured interviews were conducted with 13 physicians in Norway between May and June 2020. Results Three main themes illustrate physicians' perceptions of patients' and family caregivers' involvement: (1) beneficence for the patient and the family caregivers in the early phase, (2) autonomy and shared decision‐making in the middle phase, and (3) family involvement in the terminal phase. Conclusion The physicians perceived bereavement conversations as essential, particularly if the pathway had been challenging. They also perceived patient participation and family caregivers' involvement as contextual. The results reveal that participation differs across the different phases of the palliative pathway. This type of knowledge should be included in the education of health‐care professionals. Future research should explore elements vital to successful patient participation and family involvement in the different phases of care. Patient or Public Contributions Family caregivers were involved in a previous study through individual interviews. The same interview guide used for the family caregivers was used when interviewing the physicians. The family caregivers' contribution led to nuanced questions in the interviews with the physicians, questions leaning on their stories told.
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Affiliation(s)
- Anett S Tarberg
- Medical Department, Møre og Romsdal Hospital Trust, Ålesund, Norway.,Department of Clinical and Molecular Medicine, European Palliative Care Centre (PRC), Faculty of Medicine and Health Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Health Sciences in Ålesund, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Ålesund, Norway
| | - Morten Thronaes
- Department of Clinical and Molecular Medicine, European Palliative Care Centre (PRC), Faculty of Medicine and Health Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Cancer Clinic, St. Olav Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Bodil J Landstad
- Department of Health Sciences, Mid Sweden University, Ostersund, Sweden.,Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway.,Unit of Research, Education and Development, Ostersund Hospital, Ostersund, Sweden
| | - Marit Kvangarsnes
- Department of Health Sciences in Ålesund, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Ålesund, Norway.,Department of Research and Innovation, Fagavdelinga, Møre og Romsdal Hospital Trust, Ålesund, Norway
| | - Torstein Hole
- Department of Research and Innovation, Fagavdelinga, Møre og Romsdal Hospital Trust, Ålesund, Norway.,Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
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Rural Family Caregiving: A Closer Look at the Impacts of Health, Care Work, Financial Distress, and Social Loneliness on Anxiety. Healthcare (Basel) 2022; 10:healthcare10071155. [PMID: 35885682 PMCID: PMC9318565 DOI: 10.3390/healthcare10071155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/13/2022] [Accepted: 06/16/2022] [Indexed: 01/02/2023] Open
Abstract
Even before the COVID-19 pandemic, earlier acute care patient discharges, restricted admissions to long-term care, and reduced home care services increased the amount and complexity of family caregivers’ care work. However, much less is known about rural caregivers’ experiences. Thus, our aim in this sequential mixed-methods study was to understand how COVID-19 affected rural family caregivers. Thematically analyzed interviews and linear regression on survey data were used to understand family caregiver stress. Fourteen rural caregivers participated in interviews. They acknowledged that they benefitted from the circle of support in rural communities; however, they all reported having to cope with fewer healthcare and social services. 126 rural caregivers participated in the online survey. About a third (31%) of these caregivers had moderate frailty, indicating that they could benefit from support to improve their health. In linear regression, frailty, social loneliness, financial hardship, and younger age were associated with caregiver anxiety. Contrary to the qualitative reports that people in rural communities are supportive, over two-thirds of the rural caregivers completing the survey were socially lonely. Rural family caregivers are vulnerable to anxiety and social loneliness due to the nature of caregiving and the lack of healthcare and social service supports in rural areas. Primary healthcare and home care teams are well-positioned to assess caregivers’ health and care situation as well as to signpost them to needed supports that are available in their areas.
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Cronin M, McGilloway S. Supporting family carers in Ireland: the role of the general practitioner. Ir J Med Sci 2022; 192:951-961. [PMID: 35701648 PMCID: PMC9197724 DOI: 10.1007/s11845-022-03031-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 05/17/2022] [Indexed: 10/24/2022]
Abstract
BACKGROUND Ireland has over half a million family carers who provide care to a family member or loved one. Internationally, it is recognised that general practitioners (GPs) have a critical role to play in the identification and support of family carers, but, to date, no guidelines exist in Ireland to support GPs in this role. AIMS The aim of this study was to examine how carers are currently supported (or not) by healthcare professionals in Ireland, with a particular focus on the role of the GP. METHODS A mixed method design was used, involving a national online survey (N = 132) of family carers in Ireland and one-to-one interviews with 10 stakeholders (4 GPs; 6 carers). The quantitative data were analysed using a series of descriptive and inferential statistics; the interview data were analysed using framework analysis. RESULTS Sixty-one per cent of the carer sample reported experiencing psychological distress, more than two-thirds of whom (69%) reported 'rarely' or 'never' being asked about their own health and wellbeing. Sixty-one per cent also felt misunderstood in terms of the challenges they face in their caring role. Three key themes were identified from the interview data including (1) GP role ambiguity; (2) navigating informal processes and (3) changing needs along the care trajectory. CONCLUSIONS The findings suggest important gaps in terms of the role of GPs vis-à-vis their support of family carers. GPs themselves indicated that they need both greater clarity regarding their role with family carers and more training and resources in this regard. A requirement for more streamlined communication and information provision was also highlighted by both GPs and carers. Carers reported a need for more information on the role of GPs in supporting carers as well as more support in addressing, in particular, the psychological complexities of carer identity and help seeking.
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Affiliation(s)
- Mary Cronin
- Centre for Mental Health and Community Research, Department of Psychology and Social Sciences Institute, Maynooth University, Maynooth, Ireland.
| | - Sinead McGilloway
- Centre for Mental Health and Community Research, Department of Psychology and Social Sciences Institute, Maynooth University, Maynooth, Ireland
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Nakayama G, Masumoto S, Haruta J, Maeno T. [Relationship between the use of home-visit nursing services and family caregivers' experience of interprofessional care]. Nihon Ronen Igakkai Zasshi 2022; 59:209-218. [PMID: 35650054 DOI: 10.3143/geriatrics.59.209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM To examine the relationship between the use of home-visit nursing services (VNS) for patients and their family caregivers' experience of interprofessional care, which is an indicator of the care process. METHODS We used data from a cross-sectional survey in Japan, 2020. Family caregivers 40-74 years old and caring for community-dwelling patients with chronic conditions were recruited. The outcome variable was family caregivers' experience, reflecting the quality of interprofessional care for patients and their caregivers. We used the Japanese version of the Caregivers' Experience Instrument (J-IEXPAC CAREGIVERS), which includes two domains: attention for the patient and attention for the caregiver. The main factor was the use of VNS, and covariates were socioeconomic factors of the caregivers and the use of other health and social care services. J-IEXPAC CAREGIVERS scores were divided into two groups by median values and analyzed by multivariate logistic regression analyses. RESULTS A total of 566 caregivers were included in the analysis. The median age was 62 years old. VNS was used in 86 cases (15.2%). Logistic regression analyses revealed that the use of VNS was significantly associated with a higher total score group for J-IEXPAC CAREGIVERS (odds ratio = 3.02; 95% confidence interval 1.54-5.91). Of the J-IEXPAC CAREGIVERS domains, attention for the patient was significant. CONCLUSIONS We found that the use of VNS was likely to provide a better experience among family caregivers. Our findings suggest that visiting nurses fulfill their expected role as core members of a multidisciplinary team.
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Affiliation(s)
- Gen Nakayama
- Department of Primary Care and Medical Education, Faculty of Medicine, University of Tsukuba
| | - Shoichi Masumoto
- Department of Family Medicine, General Practice and Community Health, Faculty of Medicine, University of Tsukuba
| | - Junji Haruta
- Department of Primary Care and Medical Education, Faculty of Medicine, University of Tsukuba.,Medical Education Center, School of Medicine, Keio University
| | - Tetsuhiro Maeno
- Department of Primary Care and Medical Education, Faculty of Medicine, University of Tsukuba
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Amar S, Biderman A, Carmel S, Bachner YG. Elderly Caregivers' Awareness of Caregiving Health Risks. Healthcare (Basel) 2022; 10:healthcare10061034. [PMID: 35742085 PMCID: PMC9222691 DOI: 10.3390/healthcare10061034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/30/2022] [Accepted: 05/31/2022] [Indexed: 11/16/2022] Open
Abstract
The aim of this study was to assess the level of awareness of elderly primary caregivers of being at physical and mental health risk due to their caregiving role, as well as to examine the impact of sociodemographic characteristics, patient care characteristics, and situational variables on caregivers’ awareness. Data were collected by interview of a sample of primary caregivers aged 60+. A total of 202 primary caregivers responded positively, representing a response rate of 65% (202/311). We found a low−moderate level of awareness. The final multivariate regression analysis (F (12, 179) = 21.26, p < 0.000) revealed six variables, out of nearly 30, that are associated with a high percentage (59%) of the variability of caregivers’ awareness, namely caregiving burden, caregivers’ self-rated health, patient’s disease severity, caregiver gender, number of children, and familial relation to the patient. Action may be taken to raise caregivers’ awareness. Such interventions would possibly contribute to the quality of life and health of caregivers, enable the optimal treatment of the patient, and reduce the costs imposed on the health system and society in general.
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Affiliation(s)
- Shimon Amar
- Department of Family Medicine, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel;
- Clalit Health Services, Southern District, Beer-Sheva 84105, Israel
- Correspondence: ; Fax: +972-8-6477405
| | - Aya Biderman
- Department of Family Medicine, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel;
- Clalit Health Services, Southern District, Beer-Sheva 84105, Israel
| | - Sara Carmel
- Department of Epidemiology, Biostatistics and Community Health Sciences, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel; (S.C.); (Y.G.B.)
- Center for Multidisciplinary Research in Aging, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel
| | - Yaacov G. Bachner
- Department of Epidemiology, Biostatistics and Community Health Sciences, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel; (S.C.); (Y.G.B.)
- Center for Multidisciplinary Research in Aging, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel
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Keihanian F, Kouchakinejad-Eramsadati L, Yousefzadeh-Chabok S, Homaie Rad E. Burden in caregivers of spinal cord injury patients: a systematic review and meta-analysis. Acta Neurol Belg 2022; 122:587-596. [PMID: 35157242 DOI: 10.1007/s13760-022-01888-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 01/31/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Caregivers of individuals with spinal cord injury encounter high levels of physical, psychosocial, and financial burden by providing lifelong assistance. In the present study, we aimed to assess the overall burden score of caregivers in spinal cord injury by pooling different standard scores together as a review. METHOD Search on databases of PubMed/Medline, Web of Science and Scopus was conducted using PRISMA guidelines. Studies that assessed the burden of care using the caregiver burden inventories of CBI (caregiver burden inventory), CBS (caregiver burden scale), CG (caregiver), CSI (Caregiver Strain Index), and short- and long-form Zarit questionnaires were included in our study. The results were analyzed using the meta-analysis method and a random effect pooled estimator. All analyses were performed using STATA SE software version 14. RESULT A total of 23 articles out of 399 retrieved studies were added to this review study. The overall score of caregiver burden in individuals with SCI was calculated 48.68 (95% CI 42.574-54.788). The I2 heterogeneity was 11.7%, suggesting a low level of heterogeneity among the included studies. There was no systematic difference between various questionnaires added to meta-analysis (P = 0.526). In addition, the caregiver burden did not differ in less and highly developed countries (P = 0.405). CONCLUSION Since SCI places a considerable burden on caregivers, scoring the burden of care can help policymakers plan for essential interventions and allocate more facilities for these patients and their caregivers.
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Semere W, Cemballi AG, Schillinger D, Casillas A, Lemberg M, Lyles CR. "We need to bring them out from the shadows:" A qualitative study of safety net physician leaders' perspectives on caregivers. PATIENT EDUCATION AND COUNSELING 2022; 105:1663-1670. [PMID: 34756473 PMCID: PMC9033884 DOI: 10.1016/j.pec.2021.10.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 09/23/2021] [Accepted: 10/19/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To explore physician leaders' perspectives on processes and priorities for engaging with caregivers in their clinical practices as well as within their safety net health systems. METHODS We conducted in-depth semi-structured interviews with primary care physicians in care management leadership at three California safety net health systems. Interviews explored physicians' experiences managing medically and socially complex patients with caregivers. Using thematic analysis, two qualitative researchers independently analyzed interview transcripts and established consensus with the broader research team through iterative input to derive major themes. RESULTS Fifteen physicians completed interviews. Nine participants were women, 8 were White and 10 reported Spanish language proficiency. Participant interviews generated six major themes: challenges uncovering caregiver identities, recognizing variation in caregivers' roles, adapting visit communication strategies to include caregivers, engaging caregivers in patient care, and caring for the caregiver. CONCLUSIONS Engaging caregivers is challenging given the limited recognition of caregiver involvement in patient care by health systems. Adapting visit communication to include caregivers requires bridging language and literacy barriers. PRACTICE IMPLICATIONS Developing mechanisms to enable the consistent identification of patients' caregivers, facilitate ongoing communication with caregivers, and extend support for them could improve outcomes for vulnerable patients and their families.
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Affiliation(s)
- Wagahta Semere
- Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA; Center for Vulnerable Populations, University of California San Francisco, San Francisco, CA, USA.
| | - Anupama G Cemballi
- Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA; Center for Vulnerable Populations, University of California San Francisco, San Francisco, CA, USA
| | - Dean Schillinger
- Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA; Center for Vulnerable Populations, University of California San Francisco, San Francisco, CA, USA
| | - Alejandra Casillas
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Miya Lemberg
- Center for Vulnerable Populations, University of California San Francisco, San Francisco, CA, USA
| | - Courtney R Lyles
- Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA; Center for Vulnerable Populations, University of California San Francisco, San Francisco, CA, USA
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Parmar JK, L'Heureux T, Anderson S, Duggleby W, Pollard C, Poole L, Charles L, Sonnenberg LK, Leslie M, McGhan G, Huhn A, Sereda S, Marion C, Tarnowski G, Mah J, Melenberg D, Weir C, Pooler C, MacLachlan N, Bremault-Phillips S, Tian PGJ, Sacrey LAR. Optimizing the integration of family caregivers in the delivery of person-centered care: evaluation of an educational program for the healthcare workforce. BMC Health Serv Res 2022; 22:364. [PMID: 35303870 PMCID: PMC8932680 DOI: 10.1186/s12913-022-07689-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 02/23/2022] [Indexed: 11/17/2022] Open
Abstract
Background While family caregivers provide 70-90% of care for people living in the community and assist with 10-30% of the care in congregate living, most healthcare providers do not meaningfully involve family caregivers as partners in care. Recent research recommends that the healthcare workforce receive competency-based education to identify, assess, support, and partner with family caregivers across the care trajectory. Objective This paper reports a mixed-methods evaluation of a person-centered competency-based education program on Caregiver-Centered Care for the healthcare workforce. Methods This foundational education was designed for all healthcare providers and trainees who work with family caregivers and is offered free online (caregivercare.ca). Healthcare providers from five healthcare settings (primary, acute, home, supportive living, long-term care) and trainees in medicine, nursing, and allied health were recruited via email and social media. We used the Kirkpatrick-Barr health workforce training evaluation framework to evaluate the education program, measuring various healthcare providers’ learner satisfaction with the content (Level 1), pre-post changes in knowledge and confidence when working with family caregivers (Level 2), and changes in behaviors in practice (Level 3). Results Participants were primarily healthcare employees (68.9%) and trainees (21.7%) and represented 5 healthcare settings. Evaluation of the first 161 learners completing the program indicated that on a 5-point Likert scale, the majority were satisfied with the overall quality of the education (Mean(M) = 4.69; SD = .60). Paired T-tests indicated that out of a score of 50, post-education changes in knowledge and confidence to work with family caregivers was significantly higher than pre-education scores (pre M = 38.90, SD = 6.90; post M = 46.60, SD = 4.10; t(150) = − 16.75, p < .0001). Qualitative results derived from open responses echoed the quantitative findings in satisfaction with the education delivery as well as improvements in learners’ knowledge and confidence. Conclusion Health workforce education to provide person-centered care to all family caregivers is an innovative approach to addressing the current inconsistent system of supports for family caregivers. The education program evaluated here was effective at increasing self-reported knowledge and confidence to work with family caregivers. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07689-w.
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Affiliation(s)
- Jasneet K Parmar
- Department of Family Medicine, Faculty of Medicine and Dentistry, University of Alberta, 6-40 University Terrace, 8303 112 St NW, Edmonton, AB, T6G 2T4, Canada.,Home Living and Transitions, Alberta Health Services - Edmonton Zone Continuing Care, Strathcona Health Centre, 2 Brower Drive, Baseline Road, Sherwood Park, AB, T8H1V4, Canada
| | - Tanya L'Heureux
- Department of Family Medicine, Faculty of Medicine and Dentistry, University of Alberta, 6-40 University Terrace, 8303 112 St NW, Edmonton, AB, T6G 2T4, Canada
| | - Sharon Anderson
- Department of Family Medicine, Faculty of Medicine and Dentistry, University of Alberta, 6-40 University Terrace, 8303 112 St NW, Edmonton, AB, T6G 2T4, Canada. .,Department of Human Ecology, University of Alberta, 335 Human Ecology Building, 8905 - 116 St NW, Edmonton, Alberta, T6G 2N1, Canada.
| | - Wendy Duggleby
- Faculty of Nursing, University of Alberta, 3-141 Edmonton Clinic Health Academy (ECHA), Edmonton, Alberta, T6G 1C9, Canada
| | - Cheryl Pollard
- Faculty of Nursing, University of Regina, RI 508, 3737 Wascana Parkway, Regina, Saskatchewan, S4S 0A2, Canada
| | - Lisa Poole
- Dementia Advocacy Canada, Calgary Dementia Network Strategic Council, Glencoe Club Dementia Advisory Group, Calgary, Canada
| | - Lesley Charles
- Department of Family Medicine, Faculty of Medicine and Dentistry, University of Alberta, 6-40 University Terrace, 8303 112 St NW, Edmonton, AB, T6G 2T4, Canada.,Care of the Elderly, Glenrose Rehabilitation Hospital-East, 10230 111 Ave NW, Edmonton, AB, T5G 0B7, Canada
| | - Lyn K Sonnenberg
- Department of Family Medicine, Faculty of Medicine and Dentistry, University of Alberta, 6-40 University Terrace, 8303 112 St NW, Edmonton, AB, T6G 2T4, Canada.,Faculty of Rehabilitation Medicine, University of Alberta, 3-14 Corbett Hall, Edmonton, AB, T6G 2G4, Canada
| | - Myles Leslie
- School of Public Policy, University of Calgary, Calgary, 906 8th Avenue S.W. 5th Floor, Alberta, T2P 1H9, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, 3D10, 3280 Hospital Drive NW, Alberta, T2N 4Z6 , Canada
| | - Gwen McGhan
- Faculty of Nursing, University of Calgary, PF 3204, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
| | - Arlene Huhn
- Client Services & Programs, Alzheimer Society of Alberta and Northwest Territories, Suite 306, 10430-61 Avenue, Edmonton, AB, T6H 2J3, Canada
| | - Sandy Sereda
- Caregivers Alberta, 12122 68 St NW, Edmonton, Alberta, T5B 1R1, Canada
| | - Cecilia Marion
- Youville Home, Covenant Health, 9A St Vital Ave, St. Albert, Alberta, T8N 1K1, Canada
| | - Glenda Tarnowski
- College of Licensed Practical Nurses of Alberta, St. Albert Trail Place, 13163-146 Street, Edmonton, AB, T5L 4S8, Canada
| | - Jennifer Mah
- Faculty of Health and Community Studies, Norquest College, Edmonton, Canada
| | - Denise Melenberg
- Palliative Care Programs/Education and Practice Development/Community Programs, Alberta Health Services, Edmonton, Canada
| | - Carolyn Weir
- Palliative Care Programs/Education and Practice Development/Community Programs, Alberta Health Services, Edmonton, Canada.,Mother Rosalie Health Service Centre, 16930 87 Ave, Edmonton, AB, T5R4H5, Canada
| | - Charlotte Pooler
- Faculty of Nursing, University of Alberta, 3-141 Edmonton Clinic Health Academy (ECHA), Edmonton, Alberta, T6G 1C9, Canada.,Palliative Care Programs/Education and Practice Development/Community Programs, Alberta Health Services, Edmonton, Canada
| | - Nora MacLachlan
- Health and Community Studies, Bow Valley College, Calgary, North Campus, Seventh Floor, 345 - 6 Avenue SE., Alberta, AB T2G 4S6, Canada
| | - Suzette Bremault-Phillips
- Faculty of Rehabilitation Medicine, University of Alberta, 3-14 Corbett Hall, Edmonton, AB, T6G 2G4, Canada
| | - Peter George J Tian
- Division of Care of the Elderly, Department of Family Medicine, University of Alberta, 6-40 University Terrace, 8303 112 St NW, Edmonton, AB, T6G 2T4, Canada
| | - Lori-Ann R Sacrey
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton Clinic Health Academy, 11405-87 Avenue, Edmonton, Alberta, T6G 1C9, Canada.,Autism Research Centre (E209), Glenrose Rehabilitation Hospital, 10230 - 111 Avenue, Edmonton, AB, T5G 0B7, Canada
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Hebdon MCT, Jones M, Neller S, Kent-Marvick J, Thomas M, Stewart E, Aaron S, Wilson C, Peterson N, Ellington L. Stress and Supportive Care Needs of Millennial Caregivers: A Qualitative Analysis. West J Nurs Res 2022; 44:205-213. [PMID: 34713777 PMCID: PMC10448700 DOI: 10.1177/01939459211056689] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Millennial caregivers, born between 1981 and 1996, are an understudied caregiver group. They experience stress-related consequences of caregiving and are unique in their developmental stage and generational norms. The purpose of this study was to understand the context of caregiving and stressors for these caregivers. In total, 42 caregivers were recruited through Research Match and social media platforms. Caregivers completed online surveys with open-ended response questions and 15 caregivers completed semistructured interviews. Data were analyzed deductively and inductively using the Stress Process Model as a framework. Millennial caregivers described uncertainty and disruption as overarching experiences. Stressors related to balancing caregiving, work, and family responsibilities were most prominent. Caregivers reported needing support from friends/family, health care team members, community, and work/governmental policy. Mental health treatment was identified as most helpful for managing stress. Millennial caregivers have distinctive contexts that impact their caregiving needs. Caregiving interventions must take these needs into consideration.
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Knowledge, attitudes, and practices of primary healthcare providers with assessing and supporting older informal caregivers. Geriatr Nurs 2022; 44:159-166. [PMID: 35182804 DOI: 10.1016/j.gerinurse.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/31/2022] [Accepted: 02/01/2022] [Indexed: 11/23/2022]
Abstract
A time burden, financial strain, and prioritizing care recipient needs over their own are key barriers preventing informal caregivers from engaging in health-promoting self-care. Primary healthcare providers are well positioned to assess and support informal caregivers. A cross sectional descriptive, correlational study was used to examine the knowledge, attitudes, and practices of healthcare providers regarding assessment and support of older informal caregivers. The Healthcare Professional Facilitated Health Promotion (HPFHP) Model guides this study by depicting the collaborative patient-healthcare professional relationship. The Caregiver Self-Care Survey for Healthcare Providers measured the knowledge, attitudes, and practices of 80 healthcare providers on assessing and supporting older informal caregivers. Descriptive and inferential statistics were calculated using IBM Statistical Package for the Social Sciences (SPSS) 28.0 software. Results indicated that despite positive attitudes, knowledge deficit and system level barriers prevented integration of caregiver assessment in practice. A caregiver identification process, user-friendly assessment tool, and system level changes are overdue.
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Prerequisites for providing effective support to family caregivers within the primary care setting - results of a study series in Germany. BMC FAMILY PRACTICE 2021; 22:252. [PMID: 34937549 PMCID: PMC8697448 DOI: 10.1186/s12875-021-01601-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 12/03/2021] [Indexed: 11/10/2022]
Abstract
Background General Practitioners are considered to be well placed to monitor home-care settings and to respond specifically to family caregivers. To do this, they must be sensitive to the needs and expectations of caregivers. In order to determine the current status of GP care in terms of the support given to family caregivers, a series of studies were conducted to gather the perspectives of both caregivers and GPs. The results are used to derive starting points as to which measures would be sensible and useful to strengthen support offered to family caregivers in the primary care setting. Methods Between 2020 and 2021, three sub-studies were conducted: a) an online survey of 612 family caregivers; b) qualitative interviews with 37 family caregivers; c) an online survey of 3556 GPs. Results Family caregivers see GPs as a highly skilled and trustworthy central point of contact; there are many different reasons for consulting them on the subject of care. In the perception of caregivers, particular weaknesses in GP support are the absence of signposting to advisory and assistance services and, in many cases, the failure to involve family caregivers in good time. At the same time, GPs do not always have sufficient attention to the physical and psychological needs of family caregivers. The doctors interviewed consider the GP practice to be well suited to being a primary point of contact for caregivers, but recognise that various challenges exist. These relate, among other things, to the timely organisation of appropriate respite services, targeted referral to support services or the early identification of informal caregivers. Conclusions GP practices can play a central role in supporting family caregivers. Caregivers should be approached by the practice team at an early stage and consistently signposted to help and support services. In order to support care settings successfully, it is important to consider the triadic constellation of needs, wishes and stresses of both the caregiver and the care recipient. More training and greater involvement of practice staff in the support and identification of caregivers seems advisable.
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Podgorski CA, Anderson SD, Parmar J. A Biopsychosocial-Ecological Framework for Family-Framed Dementia Care. Front Psychiatry 2021; 12:744806. [PMID: 34975562 PMCID: PMC8718405 DOI: 10.3389/fpsyt.2021.744806] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 11/23/2021] [Indexed: 12/05/2022] Open
Abstract
The biopsychosocial model has been applied through collaborative care dementia models to the diagnosis, symptom management, and treatment of dementia with a focus specifically on the person with dementia. Because individuals with dementia are increasingly dependent upon others particularly as the illness advances, dementia care requires the involvement and commitment of others, usually family, along with support from community-based resources. Hence, the quality and effectiveness of a person's dementia care are shaped in large part by the foundation of family relationships and the social and community networks in which they are embedded. While most current dementia care models incorporate biopsychosocial principles and recognize the essential role that family members play as caregivers, they fail to consider a patient's family system and relationships as potential risk factors or social determinants for care outcomes. This paper introduces a biopsychosocial-ecological framework to dementia care that is person-centered and "family-framed" in that it targets factors that influence care considerations at both the individual and relational levels of the social ecological networks that the patient and their family members occupy. We use this model to illustrate how current dementia care practices tend to focus exclusively on the individual patient and caregiver levels but fail to identify and address important relational considerations that cut across levels. We call for the need to add assessment of family relational histories of persons with dementia and family members who care for them in order to better meet the needs of the patient and the caregiver and to prevent harm. This model accentuates the need for interprofessional education on family assessments and caregiver-centered care, as well as interdisciplinary, collaborative models of dementia care that assume more accountability for meeting the needs of family caregivers in addition to those of persons with dementia.
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Affiliation(s)
- Carol Ann Podgorski
- Department of Psychiatry, University of Rochester, Rochester, NY, United States
| | - Sharon D. Anderson
- Department of Family Medicine, University of Alberta, Edmonton, AB, Canada
| | - Jasneet Parmar
- Department of Family Medicine, University of Alberta, Edmonton, AB, Canada
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Biderman A, Carmel S, Amar S, Bachner YG. Care for caregivers- a mission for primary care. BMC FAMILY PRACTICE 2021; 22:227. [PMID: 34784890 PMCID: PMC8593856 DOI: 10.1186/s12875-021-01579-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 10/13/2021] [Indexed: 12/02/2022]
Abstract
Background The number of elderly people living in the community who are limited in daily activities is increasing worldwide. This generates prolonged care, which usually falls on one family member, the family caregiver. Caregivers are prone to develop psychosocial and physical symptoms. As a result, the World Health Organization (WHO) issued a clear directive to assess and support these caregivers. The main goals of this study were to assess primary care physicians’ (PCP) awareness to caregivers’ health risks and the extent that they recommended preventive measures to maintain the health of the caregivers. As no suitable instrument existed, a secondary goal was to develop a scale to measure physicians’ awareness to caregivers’ health and preventive treatment and test it’s psychometric properties. Methods Data were collected from a convenience sample of 201 PCP interviewed with structured questionnaires. Results The participants’ mean age was 48.5 ± 11.2 years and 53.5% were female. Only 48.5% were Israel medical graduates and 72% were board-certified family physicians. Nearly 34% had been primary caregivers of family members. Most physicians (83.6%) were aware of the primary caregiver’s high-risk for morbidity and mortality, and recommended preventive care. On a multivariate regression, PCP's higher level of risk awareness, their country of medical school and board certification were significant for explaining recommendations for preventive care. However, being a primary caregiver for a sick family member neither contributed significantly to the physicians’ awareness to caregiving risks nor to their preventive care. Conclusion Although a high percentage of physicians were aware and concerned about caregivers’ health, their preventive care activities were relatively passive. PCPs should take a more active and preventive role for maintaining caregivers’ health. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-021-01579-6.
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Affiliation(s)
- Aya Biderman
- Department of Family Medicine and Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Ben-Gurion University of the Negev, POB 653, 84105, Beer-Sheva, Israel. .,Clalit Health Services, Southern district, Beer-Sheva, Israel.
| | - Sara Carmel
- Department of public health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Center for Multidisciplinary Research in Aging, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Shimon Amar
- Department of Family Medicine and Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Ben-Gurion University of the Negev, POB 653, 84105, Beer-Sheva, Israel.,Clalit Health Services, Southern district, Beer-Sheva, Israel
| | - Yaacov G Bachner
- Department of public health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Center for Multidisciplinary Research in Aging, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Schwabenbauer AK, Knight CM, Downing N, Morreale-Karl M, Mlinac ME. Adapting a whole health model to home-based primary care: Bridging person-driven priorities with veteran and family-centered geriatric care. FAMILIES, SYSTEMS & HEALTH : THE JOURNAL OF COLLABORATIVE FAMILY HEALTHCARE 2021; 39:374-393. [PMID: 34410781 PMCID: PMC8406673 DOI: 10.1037/fsh0000613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Through the integration of Whole Health for Life into the Department of Veterans Affairs (VA) health care system, the VA aims to transform health care delivery from a disease management approach to one that embraces person-centered care. The home-based primary care (HBPC) program is a care model that, within the VA, provides holistic primary care services to homebound veterans with multiple chronic medical conditions, mental health issues, and functional declines. These veterans may have limited access to VA programs delivered in a traditional outpatient format. This article describes adaptations to the whole health model of care that could improve its accessibility and applicability to HBPC veterans, caregivers, and the interdisciplinary teams that serve this population. These modifications are informed by whole-person geriatric and gerontological and family-systems theories and address population-based differences in the focus and approach to care. The focus on care is expanded to (a) reflect the importance of attending to caregiver needs and well-being and (b) shift from a preventative model to one that prioritizes resilience and maintenance. The approach to care emphasizes alternative modes of delivery, adaptations to interventions, and integration of geriatric-specific medical considerations into the self-care domains and more directly centers the collaboration between family, the VA, and community partners. This adapted model also addresses the unique needs of health care teams providing in-home services to medically complex veterans and offers suggestions for enhancing self-care and preventing burnout. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
| | - Cynthia M. Knight
- Veterans Affairs Boston Healthcare System, Boston, Massachusetts, United States
| | - Nicole Downing
- Veterans Affairs Boston Healthcare System, Boston, Massachusetts, United States
| | - Michelle Morreale-Karl
- Veterans Affairs Boston Healthcare System, Boston, Massachusetts, United States
- Department of Medicine, Harvard Medical School
| | - Michelle E. Mlinac
- Veterans Affairs Boston Healthcare System, Boston, Massachusetts, United States
- Department of Psychiatry, Harvard Medical School
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Family Physician's and Primary Care Team's Perspectives on Supporting Family Caregivers in Primary Care Networks. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18063293. [PMID: 33806725 PMCID: PMC8005195 DOI: 10.3390/ijerph18063293] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 03/14/2021] [Accepted: 03/18/2021] [Indexed: 12/24/2022]
Abstract
Background. Research, practice, and policy have focused on educating family caregivers to sustain care but failed to equip healthcare providers to effectively support family caregivers. Family physicians are well-positioned to care for family caregivers. Methods. We adopted an interpretive description design to explore family physicians and primary care team members’ perceptions of their current and recommended practices for supporting family caregivers. We conducted focus groups with family physicians and their primary care team members. Results. Ten physicians and 42 team members participated. We identified three major themes. “Family physicians and primary care teams can be a valuable source of support for family caregivers” highlighted these primary care team members’ broad recognition of the need to support family caregiver’s health. “What stands in the way” spoke to the barriers in current practices that precluded supporting family caregivers. Primary care teams recommended, “A structured approach may be a way forward.” Conclusion. A plethora of research and policy documents recommend proactive, consistent support for family caregivers, yet comprehensive caregiver support policy remains elusive. The continuity of care makes primary care an ideal setting to support family caregivers. Now policy-makers must develop consistent protocols to assess, and care for family caregivers in primary care.
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Halley MC, Mangurian C. Caring for the Caregivers - Covid-19 Vaccination for Essential Members of the Health Care Team. N Engl J Med 2021; 384:e33. [PMID: 33577149 PMCID: PMC8721589 DOI: 10.1056/nejmpv2101339] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Balsinha C, Iliffe S, Dias S, Freitas A, Grave J, Gonçalves-Pereira M. What is the present role for general practitioners in dementia care? Experiences of general practitioners, patients and family carers in Portugal. DEMENTIA 2020; 20:1988-2006. [PMID: 33342279 PMCID: PMC8358531 DOI: 10.1177/1471301220977710] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Governments are being challenged to integrate at least part of dementia care into primary care. However, little is known about the current role of general practitioners (GPs) regarding dementia care, especially in countries that do not have dementia strategies in place. The aim of this study was to explore the experiences of GPs, persons with dementia and their family carers in Portuguese primary care settings, to better understand GPs’ contribution to dementia care. Methods A qualitative interview study of participants recruited from six practices in different social contexts within the Lisbon metropolitan area was carried out. Purposive sampling was used to recruit GPs, persons with dementia and carers. Interviews with GPs explored dementia care comprehensiveness, including satisfactory and challenging aspects. Interviews with patients and carers explored the experience of talking to GPs about cognitive impairments and related difficulties and the type of help received. Thematic analysis of interview transcripts was carried out using the framework approach. Results Five major themes were identified: GPs have a limited contribution to dementia care, the case of advanced dementia, doctor–patient relationships, doctor–carer relationships and management of chronic conditions other than dementia. Conclusion General practitioners seemed to contribute little to dementia care overall, particularly regarding symptom management. The exception was patients with advanced stages of dementia, given that specialists no longer followed them up. Remarkably, GPs seemed to be alone within primary care teams in providing dementia care. These findings strongly suggest that Portuguese primary care is not yet prepared to comply with policy expectations regarding the management of dementia.
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Affiliation(s)
- Conceição Balsinha
- Comprehensive Health Research Centre (CHRC); NOVA Medical School/Faculdade de Ciências Médicas, 50106Universidade Nova de Lisboa, Lisboa, Portugal; 428179Unidade de Saúde Familiar Marginal, São João do Estoril, Portugal
| | - Steve Iliffe
- Research Department of Primary Care & Population Health, University College London, London, UK
| | - Sónia Dias
- Comprehensive Health Research Centre (CHRC); NOVA National School of Public Health, Public Health Research Centre, 50106Universidade NOVA de Lisboa, Portugal
| | - Alexandre Freitas
- NOVA Medical School/Faculdade de Ciências Médicas, 50106Universidade Nova de Lisboa, Lisboa, Portugal; Unidade de Saúde Familiar Ilumina,São Domingos de Rana, Portugal
| | - Joana Grave
- NOVA Medical School/Faculdade de Ciências Médicas, 50106Universidade Nova de Lisboa, Lisboa, Portugal
| | - Manuel Gonçalves-Pereira
- Comprehensive Health Research Centre (CHRC); NOVA Medical School/Faculdade de Ciências Médicas, 50106Universidade Nova de Lisboa, Lisboa, Portugal
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Physicians and Family Caregivers: Two Perspectives of Physicians' Roles in Long-Term Care. J Am Med Dir Assoc 2020; 22:1088-1095. [PMID: 32994118 DOI: 10.1016/j.jamda.2020.08.008] [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: 03/07/2020] [Revised: 08/10/2020] [Accepted: 08/10/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVES We explored the roles of attending physicians of long-term care (LTC) residents in supporting their family caregivers (FCGs). DESIGN In this mixed-methods study, we conducted surveys and focus group interviews with physicians and FCGs. SETTING AND PARTICIPANTS There were 78 FCGs and 18 physicians in the survey, and 18 FCGs and 9 physicians in the focus groups. They were recruited from 5 urban LTC settings. RESULTS Although 83.3% of physicians reported they had experience caring for FCGs, 71.8% of FCGs perceived they had not received support from the physicians. There was no statistically significant difference between the FCGs' and physicians' mean responses to the mirrored survey questions. Both groups gave similar ratings, means neutral and agree indicative of ambivalence, on physician's knowledge to identify FCGs who need assistance, ability to assess FCG stress, and aid those experiencing distress and needing advocacy. Analysis of the focus groups revealed the overarching theme: ambiguity about the LTC residents' physicians' role in supporting FCGs. Although physicians noted that residents and families come as a unit, there was ambivalence about the physician's role in supporting FCGs. FCG roles in LTC are also vague. There were 3 sub-themes: "accord on the surface"; "tension in the interface"; and "smoothing the relationship." Both groups thought FCG medical care was beyond the purview of the resident's physician. Physicians and FCGs provided different explanations for the tensions in the FCG/physician interface. Physicians attributed tension to FCG stress and inadequate knowledge, whereas FCGs thought physicians' communication could be improved. Suggestions to smooth the relationship were to align FCG expectations to reality of LTC and different staffing models. CONCLUSIONS AND IMPLICATIONS Family physicians, policy makers, and FCGs will need to work on polices to ensure LTC physicians' roles in supporting FCGs and FCGs' roles in LTC are delineated and supported.
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