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Merritt RK, Hotham S, Schrag A. Support Needs in Carers of People With Parkinson's From Early to Later Stages: A Qualitative Study With 36 Carers in 11 European Countries. J Geriatr Psychiatry Neurol 2023; 36:505-510. [PMID: 37081815 PMCID: PMC10578036 DOI: 10.1177/08919887231168404] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 02/26/2023] [Accepted: 03/10/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Parkinson's Disease (PD) is associated with considerable carer burden, but there has been little qualitative research on the support needs of carers of People with Parkinson's (PwP). METHODS Semi-structured in-depth interviews with carers of PwP in 11 European countries. RESULTS Interviews with 36 carers of PwP were analysed. At the time of diagnosis, carers often felt that they had a role in helping get a diagnosis and then in dealing with the impact of the diagnosis on the family. Information on medication was seen as particularly important for carers, and many of the carers felt that their informational needs differed from that of the PwPs. Many of the carers also felt that they needed to be present at all appointments to request referrals or ask for medication changes. Carers of those in the later stages of the disease often reported feeling isolated and not having any time for themselves. CONCLUSIONS The involvement of carers should be addressed more actively in the management of Parkinson's.
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Affiliation(s)
- Rowena K. Merritt
- Centre for Health Services Studies, University of Kent, Canterbury, UK
| | - Sarah Hotham
- Centre for Health Services Studies, University of Kent, Canterbury, UK
| | - Anette Schrag
- Department of Clinical Neurosciences, Institute of Neurology, Royal Free Campus, University College London, London, UK
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2
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Agyemang-Duah W, Rosenberg MW. Healthcare utilization among informal caregivers of older adults in the Ashanti region of Ghana: a study based on the health belief model. Arch Public Health 2023; 81:187. [PMID: 37872631 PMCID: PMC10591341 DOI: 10.1186/s13690-023-01200-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 10/09/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Existing global evidence suggests that informal caregivers prioritize the health (care) of their care recipients (older adults) over their own health (care) resulting in sub-optimal health outcomes among this population group. However, data on what factors are associated with healthcare utilization among informal caregivers of older adults are not known in a sub-Saharan African context. Guided by the Health Belief Model (HBM), the principal objective of this study was to examine the association between the dimensions of the HBM and healthcare utilization among informal caregivers of older adults in the Ashanti Region of Ghana. METHODS Data were extracted from a large cross-sectional study of informal caregiving, health, and healthcare survey among caregivers of older adults aged 50 years or above (N = 1,853; mean age of caregivers = 39.15 years; and mean age of care recipients = 75.08 years) in the Ashanti Region of Ghana. Poisson regression models were used to estimate the association between the dimensions of the HBM and healthcare utilization among informal caregivers of older adults. Statistical significance of the test was set at a probability level of 0.05 or less. RESULTS The results showed that 72.9% (n = 1351) of the participants were females, 56.7% (n = 1051) were urban informal caregivers and 28.6% (n = 530) had no formal education. The results further showed that 49.4% (n = 916) of the participants utilized healthcare for their health problems at least once in the past year before the survey. The final analysis showed a positive and statistically significant association between perceived susceptibility to a health problem (β = 0.054, IRR = 1.056, 95% CI = [1.041-1.071]), cues to action (β = 0.076, IRR = 1.079, 95% CI = [1.044-1.114]), self-efficacy (β = 0.042, IRR = 1.043, 95% CI = [1.013-1.074]) and healthcare utilization among informal caregivers of older adults. The study further revealed a negative and statistically significant association between perceived severity of a health problem and healthcare utilization (β= - 0.040, IRR = 0.961, 95% CI= [0.947-0.975]) among informal caregivers of older adults. The results again showed that non-enrollment in a health insurance scheme (β= - 0.174, IRR = 0.841, 95% CI= [0.774-0.913]) and being unemployed (β= - 0.088, IRR = 0.916, 95% CI= [0.850-0.986]) were statistically significantly associated with a lower log count of healthcare utilization among informal caregivers of older adults. CONCLUSION The findings of this study to a large extent support the dimensions of the HBM in explaining healthcare utilization among informal caregivers of older adults in the Ashanti Region of Ghana. Although all the dimensions of the HBM were significantly associated with healthcare utilization in Model 1, perceived barriers to care-seeking and perceived benefits of care-seeking were no longer statistically significant after controlling for demographic, socio-economic and health-related variables in the final model. The findings further suggest that the dimensions of the HBM as well as demographic, socio-economic and health-related factors contribute to unequal healthcare utilization among informal caregivers of older adults in the Ashanti Region of Ghana.
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Affiliation(s)
- Williams Agyemang-Duah
- Department of Geography and Planning, Queen's University, Kingston, ON, K7L 3N6, Canada.
| | - Mark W Rosenberg
- Department of Geography and Planning, Queen's University, Kingston, ON, K7L 3N6, Canada
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3
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Care-seeking and delay of care during COPD exacerbations. NPJ Prim Care Respir Med 2022; 32:7. [PMID: 35169140 PMCID: PMC8847354 DOI: 10.1038/s41533-022-00269-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 12/22/2021] [Indexed: 11/29/2022] Open
Abstract
Patients who receive earlier treatment for acute exacerbations of chronic obstructive pulmonary disease (COPD) have a better prognosis, including earlier symptom resolution and reduced risk of future emergency-department visits (ED) or hospitalizations. However, many patients delay seeking care or do not report worsening symptoms to their healthcare provider. In this study, we aimed to understand how patients perceived their breathing symptoms and identify factors that led to seeking or delaying care for an acute exacerbation of COPD. We conducted semistructured interviews with 60 individuals following a recent COPD exacerbation. Participants were identified from a larger study of outpatients with COPD by purposive sampling by exacerbation type: 15 untreated, 15 treated with prednisone and/or antibiotics in the outpatient setting, 16 treated in an urgent care or ED setting, and 14 hospitalized. Data were analyzed using inductive content analysis. Participants were primarily male (97%) with a mean age of 69.1 ± 6.9 years, mean FEV1 1.42 (±0.63), and mean mMRC dyspnea of 2.7 (±1.1). We identified 4 primary themes: (i) access and attitudinal barriers contribute to reluctance to seek care, (ii) waiting is a typical response to new exacerbations, (iii) transitioning from waiting to care-seeking: the tipping point, and (iv) learning from and avoiding worse outcomes. Interventions to encourage earlier care-seeking for COPD exacerbations should consider individuals’ existing self-management approaches, address attitudinal barriers to seeking care, and consider health-system changes to increase access to non-emergent outpatient treatment for exacerbations. Clinical Trial Registration NCT02725294
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4
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Blanck E, Fors A, Ali L, Brännström M, Ekman I. Informal carers in Sweden - striving for partnership. Int J Qual Stud Health Well-being 2021; 16:1994804. [PMID: 34720063 PMCID: PMC8567876 DOI: 10.1080/17482631.2021.1994804] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Purpose Informal carers have an important role in society through their care and support of their long-term ill relatives. Providing informal care is challenging and can lead to caregiver burden; moreover, many support needs of the carers are not met, leading to confusion, disappointment and frustration. We conducted an interview study to clarify the meaning of support given and received by informal carers to relatives with chronic obstructive pulmonary disease or chronic heart failure. Methods We purposively selected and recruited informants via participants in another study, thereby conducting interviews over the phone from June 2016 to May 2017. In total, we conducted 14 interviews with 12 informants. All interviews were transcribed verbatim and the content was analysed using a phenomenological hermeneutical approach. Result and conclusion Our comprehensive understanding of the meaning of support for these carers is twofold: it is a self-evident struggle for the good life of their relatives and that they want to be carers in partnership. The healthcare system must recognize the efforts of carers and include them in the strategic planning and operational stages of care and treatment for people with long-term illness.
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Affiliation(s)
- Elin Blanck
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
| | - Andreas Fors
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden.,Research and Development Primary Health Care, Gothenburg, Sweden
| | - Lilas Ali
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden.,Psychiatric Department, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Margareta Brännström
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Nursing, Umeå University, Campus Skellefteå, Sweden
| | - Inger Ekman
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
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5
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Marques A, Cruz J, Brooks D. Interventions to Support Informal Caregivers of People with Chronic Obstructive Pulmonary Disease: A Systematic Literature Review. Respiration 2021; 100:1230-1242. [PMID: 34261069 DOI: 10.1159/000517032] [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: 01/04/2021] [Accepted: 04/20/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) imposes tremendous challenges for both patients and informal caregivers. Caregivers are key players in the management of COPD. Recently, COVID-19 further increased reliance on informal caregivers who urgently need specific support. This systematic literature review aimed to systematically describe the content and explore the effects of interventions to support informal caregivers of people with COPD. METHODS A mixed-methods systematic review was conducted. PubMed, Scopus, Web of Science, and EBSCO were searched. Studies implementing interventions supporting informal caregivers of people with COPD were included. Data were extracted and analysed in outcome domains and categories using framework analysis. RESULTS Twenty (14 quantitative, 4 mixed-methods, and 2 qualitative) studies were included. Informal caregivers were mainly female (86%). Caregiving context was poorly/never described. Interventions included patient-caregiver dyads and never caregivers only. Informal caregivers were invited to participate if available. Interventions were delivered across all COPD phases (acute/stable/advanced) and settings (inpatient/outpatient/home), with a wide range of total length, frequency, and duration of sessions. All included education about the disease and its management. Discharge/action plans (n = 12); adherence to therapy and healthy lifestyles (n = 9); and family concerns and psychosocial issues (n = 7) were also commonly addressed. Only 9 (45%) studies reported caregiver-related outcomes, and overall positive effects were observed in 7/9 outcome domains, using a high variety of qualitative and qualitative methods. Often categories were addressed but not assessed. CONCLUSION Interventions have a narrow scope (i.e., education) and have not been specifically designed to support informal caregivers. Current evidence showed positive effects, but high methodological heterogeneity exists. Future studies need to explore caregiver-tailored, taking into consideration gender differences; multicomponent; and flexibly administered interventions to effectively support COPD caregivers.
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Affiliation(s)
- Alda Marques
- Lab3R-Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal.,Institute of Biomedicine (iBiMED), University of Aveiro, Aveiro, Portugal
| | - Joana Cruz
- School of Health Sciences (ESSLei), Polytechnic of Leiria, Leiria, Portugal.,Center for Innovative Care and Health Technology (ciTechCare), Polytechnic of Leiria, Leiria, Portugal
| | - Dina Brooks
- Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada.,Department of Physical Therapy, Rehabilitation Science Institute, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
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6
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Micklewright K, Farquhar M. Does the carer support needs assessment tool cover the established support needs of carers of patients with chronic obstructive pulmonary disease? A systematic literature search and narrative review. Palliat Med 2020; 34:1305-1315. [PMID: 32669040 PMCID: PMC7543023 DOI: 10.1177/0269216320939243] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Informal carers play a key supportive role for patients with chronic obstructive pulmonary disease. However, caring can have a considerable impact on health and wellbeing. Carers may have unidentified support needs that could be a target for intervention. Literature on the support needs of informal carers has not been fully synthesised, and our knowledge of the comprehensiveness of the Carer Support Needs Assessment Tool for these individuals is limited. AIM To explore whether the Carer Support Needs Assessment Tool covers the support needs of carers of patients with chronic obstructive pulmonary disease identified in published literature. DESIGN English language studies were identified against predetermined inclusion/exclusion criteria through database searching. Further studies were identified through searching reference lists and citations of included papers. Papers were critically appraised and data extracted and synthesised by two reviewers. Identified needs were mapped to Carer Support Needs Assessment Tool questions. DATA SOURCES MEDLINE, CINAHL, EMBASE, CDSR, ASSIA, PsycINFO and Scopus databases (Jan 1997-Dec 2017). RESULTS Twenty-four studies were included. Results suggest that carers have support needs in a range of domains including physical, social, psychological and spiritual. Many of these needs are unmet. Particular areas of concern relate to prolonged social isolation, accessing services, emotional support and information needs. Findings also suggest amendment of the Carer Support Needs Assessment Tool may be required relating to difficulties within relationship management. CONCLUSION Evidence suggests that carers of patients with chronic obstructive pulmonary disease would benefit from identification and response to their support needs by healthcare professionals but to enable this, the Carer Support Needs Assessment Tool requires an additional question. Future planned work will explore this with carers of patients with chronic obstructive pulmonary disease.
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Affiliation(s)
| | - Morag Farquhar
- School of Health Sciences, University of East Anglia, Norwich, UK
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7
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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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8
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Siltanen H, Jylhä V, Holopainen A, Paavilainen E. Family members' experiences and expectations of self-management counseling while caring for a person with chronic obstructive pulmonary disease: a systematic review of qualitative evidence. ACTA ACUST UNITED AC 2020; 17:2214-2247. [PMID: 31567526 DOI: 10.11124/jbisrir-d-19-00056] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE The objective of this review was to identify and synthesize existing evidence on the experiences and expectations of self-management counseling of adult family members who are informal caregivers of a person with chronic obstructive pulmonary disease (COPD) in the context of inpatient or outpatient care. INTRODUCTION Chronic obstructive pulmonary disease is the fourth leading cause of mortality and morbidity worldwide. It is a progressive, lifelong and unpredictable disease. As the disease progresses, both the people with COPD and their family members require information and practical skills to manage the disease. The role of family members is particularly important at the advanced stage of COPD. This systematic review examined family members' experiences and expectations of self-management counseling. INCLUSION CRITERIA This review considered qualitative studies that investigated adult (older than18 years) family members' experiences or expectations of COPD self-management counseling in the context of inpatient or outpatient care. "Family member" refers to a person who is an informal caregiver because of his or her relationship to the person with COPD. METHODS A three-step search strategy was utilized in this review. The search strategy aimed to find published and unpublished studies in English and Finnish. The databases MEDLINE, CINAHL, PsycINFO, Scopus and the Finnish medical bibliographic database, Medic, were searched. The search was conducted in December 2015 and updated in September 2018. Titles and abstracts were screened by two independent reviewers for the review's inclusion criteria. Eligible studies were then critically appraised by two independent reviewers for methodological quality. The findings and illustrations of the findings were extracted and assigned a level of credibility. The qualitative research findings were pooled using the JBI method of meta-aggregation. RESULTS Ten papers were selected for inclusion in this review. These studies were published from 2002 to 2017. The quality of all included studies was at least moderate. Each study had a total score between 7 and 10 on the JBI Critical Appraisal Checklist for Qualitative Research. The following four synthesized findings were aggregated from nine categories and 39 study findings: i) Family members' experiences with unresponsive behavior from health professionals, ii) Family members' experiences of unmet needs in self-management counseling, iii) Family members' information needs concerning COPD management, and iv) Family members' information needs concerning coping strategies. CONCLUSIONS The synthesized findings indicate that family members are frustrated by the shortcomings of self-management counseling. They also feel unprepared for and uncertain about their caring role. They need more information about COPD and coping strategies for COPD. Counseling is essential to high-quality care and should be offered to family members caring for a loved one at any stage of COPD.
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Affiliation(s)
- Hannele Siltanen
- Department of Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland.,Nursing Research Foundation, Helsinki, Finland.,Finnish Centre for Evidence-Based Health Care: a Joanna Briggs Institute Affiliated Group
| | - Virpi Jylhä
- Finnish Centre for Evidence-Based Health Care: a Joanna Briggs Institute Affiliated Group.,Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
| | - Arja Holopainen
- Nursing Research Foundation, Helsinki, Finland.,Finnish Centre for Evidence-Based Health Care: a Joanna Briggs Institute Affiliated Group
| | - Eija Paavilainen
- Department of Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland.,Etelä-Pohjanmaa Hospital District, Seinäjoki, Finland
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9
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Keast R, Butow PN, Juraskova I, Laidsaar-Powell R. Online resources for family caregivers of cognitively competent patients: A review of user-driven reputable health website content on caregiver communication with health professionals. PATIENT EDUCATION AND COUNSELING 2020; 103:S0738-3991(20)30235-4. [PMID: 32739067 DOI: 10.1016/j.pec.2020.04.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 04/19/2020] [Accepted: 04/22/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Most patients want their family involved in consultations and decisions, however some family caregivers report feeling overwhelmed and unsure of their role. As caregivers are increasingly looking to medical websites for guidance, this study aimed to review reputable web-resources available to inform family caregivers on how to be involved in medical consultations and decisions. METHODS Google searches were performed using lay search strings, to imitate how a cancer caregiver may locate information. Relevant webpages were included if they were directed at caregivers and from a reputable health organisation. Qualitative content analyses were performed on the included webpages. RESULTS 22 webpages were included and 8 were directed at caregivers of cancer patients. Six key categories of information were identified: preparing for consultations, helping during consultations, advocating for the patient, decision-making, communicating in hospital settings, and communicating with family and friends. CONCLUSION A range of online resources were found to guide family caregivers, particularly cancer caregivers, on involvement in consultations. However, few provided information to caregivers on complex situations such as treatment decision-making, advocating for patient's needs, and communicating in a hospital setting. PRACTICE IMPLICATIONS Clinicians can actively refer family caregivers to online resources that support caregiver communication in medical settings.
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Affiliation(s)
- Rachael Keast
- Centre for Medical Psychology & Evidence-Based Decision-Making, University of Sydney, Sydney, NSW, Australia.
| | - Phyllis N Butow
- Centre for Medical Psychology & Evidence-Based Decision-Making, University of Sydney, Sydney, NSW, Australia; Psycho-Oncology Cooperative Research Group, University of Sydney, Sydney, NSW, Australia
| | - Ilona Juraskova
- Centre for Medical Psychology & Evidence-Based Decision-Making, University of Sydney, Sydney, NSW, Australia
| | - Rebekah Laidsaar-Powell
- Centre for Medical Psychology & Evidence-Based Decision-Making, University of Sydney, Sydney, NSW, Australia
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10
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Lee JE, Lee J, Lee H, Park JK, Park Y, Choi WS. End-of-life care needs for noncancer patients who want to die at home in South Korea. Int J Nurs Pract 2020; 26:e12808. [PMID: 31975562 DOI: 10.1111/ijn.12808] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 10/10/2019] [Accepted: 11/10/2019] [Indexed: 11/27/2022]
Abstract
AIM The awareness for the need for end-of-life care has increased among noncancer patients. However, studies on the topic have rarely targeted the needs of noncancer patients who want to die at home. This study assessed the end-of-life care needs of noncancer patients who were receiving care and wanted to die at home. METHODS A cross-sectional study design was used and involved 200 participants who were diagnosed as noncancer patients and receiving home care nursing. Data were collected on demographics, disease, Palliative Performance Scale (PPS) scores, and end-of-life care needs, in April and May, 2016. RESULTS Among the six areas of care, "supporting fundamental needs" of patients required the most care, followed by "coordination among family or relatives." Multivariate analysis revealed that the duration of home care nursing held a significant association with end-of-life care needs. CONCLUSION By reflecting on the comprehensive care needs of patients with chronic illnesses and including them in the care process, it will be possible to provide better quality palliative care to patients at home in the end-of-life stages.
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Affiliation(s)
- Jong-Eun Lee
- College of Nursing, The Catholic University of Korea, Seoul, Korea
| | - Jiwon Lee
- College of Nursing, Ajou University, Suwon, Republic of Korea
| | - Hanul Lee
- College of Nursing, The Catholic University of Korea, Seoul, Korea
| | | | - Younghye Park
- Team Manager in Home Care, Seoul St. Mary's Hospital, Seoul, Korea
| | - Whan Seok Choi
- Department of Family Care Medicine, Seoul St. Mary's Hospital, Seoul, Korea
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11
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Siltanen H, Jylhä V. Supporting the supporter: a focus on families of patients with chronic obstructive pulmonary disease. ACTA ACUST UNITED AC 2019; 17:2212-2213. [PMID: 31725513 DOI: 10.11124/jbisrir-d-19-00329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Affiliation(s)
- Hannele Siltanen
- Department of Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland.,Nursing Research Foundation, Helsinki, Finland.,Finnish Centre for Evidence-Based Health Care: a Joanna Briggs Institute Affiliated Group
| | - Virpi Jylhä
- Finnish Centre for Evidence-Based Health Care: a Joanna Briggs Institute Affiliated Group.,Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
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12
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Noonan MC, Wingham J, Dalal HM, Taylor RS. Involving caregivers in self‐management interventions for patients with heart failure and chronic obstructive pulmonary disease. A systematic review and meta‐analysis. J Adv Nurs 2019; 75:3331-3345. [DOI: 10.1111/jan.14172] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 06/24/2019] [Accepted: 08/05/2019] [Indexed: 12/25/2022]
Affiliation(s)
- Miriam C. Noonan
- European Centre for Environment and Human Health College of Medicine and Health University of Exeter, Knowledge SpaRoyal Cornwall Hospital Truro Cornwall UK
| | - Jennifer Wingham
- Primary Care Research Group College of Medicine and Health University of Exeter Exeter UK
| | - Hasnain M. Dalal
- Institute of Health Research College of Medicine and Health University of Exeter Exeter UK
- Royal Cornwall Hospitals NHS Trust Truro UK
| | - Rod S. Taylor
- Institute of Health Research College of Medicine and Health University of Exeter Exeter UK
- Institute of Health and Well Being University of Glasgow Glasgow UK
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13
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Scott D, Hudson P, Charnley K, Payne C, Westcott G. Development of an eHealth information resource for family carers supporting a person receiving palliative care on the island of Ireland. BMC Palliat Care 2019; 18:74. [PMID: 31470841 PMCID: PMC6717391 DOI: 10.1186/s12904-019-0457-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 08/13/2019] [Indexed: 01/22/2023] Open
Abstract
Background Many people receiving palliative care wish to die at home. Often, support from family or friends is key to ensuring that this wish is fulfilled. However, carers report feeling underprepared to undertake this role. This paper describes the process of developing a consensus and evidence based website to provide core information to help people support someone receiving palliative care on the island of Ireland. Methods The project comprised three phases: (1) a review of systematic reviews facilitated the identification of core information needs; (2) content was developed in collaboration with a Virtual Reference Group (VRG) comprising patients, carers and professionals; and, (3) subject experts within the project team worked with a web developer to précis the agreed content and ensure it was in a format that was appropriate for a website. Members of the VRG were then invited to test and approve the website before it was made available to the general public. Results Nineteen systematic reviews identified nine consensus areas of core information required by carers; a description of palliative care; prognosis and treatment of the condition; medication and pain management; personal care; specialist equipment; locally available support services; what to do in an emergency; nutrition; and, support for the carer. This information was shared with the VRG and used to develop website content. Conclusions We engaged with service users and professionals to develop an evidence-based website addressing the agreed core information needs of non-professional carers who wish to provide palliative care to a friend or relative.
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Affiliation(s)
- David Scott
- School of Nursing and Midwifery, Medical Biology Centre, Queen's University Belfast, Lisburn Road, Belfast, BT9 7BL, UK.
| | - Peter Hudson
- School of Nursing and Midwifery, Medical Biology Centre, Queen's University Belfast, Lisburn Road, Belfast, BT9 7BL, UK
| | - Karen Charnley
- All Ireland Institute of Hospice and Palliative Care, Our Lady's Hospice and Care Services, Harold's Cross, Dublin 6, Ireland
| | - Cathy Payne
- All Ireland Institute of Hospice and Palliative Care, Our Lady's Hospice and Care Services, Harold's Cross, Dublin 6, Ireland
| | - Gareth Westcott
- All Ireland Institute of Hospice and Palliative Care, Our Lady's Hospice and Care Services, Harold's Cross, Dublin 6, Ireland
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Aasbø G, Kristvik E, Nyheim Solbrække K, Werner A. Searching for "transformative moments": A qualitative study of nurses' work during home visits to COPD patients and their caregivers in Norway. Nurs Open 2019; 6:293-300. [PMID: 30918681 PMCID: PMC6419110 DOI: 10.1002/nop2.209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 08/15/2018] [Accepted: 09/05/2018] [Indexed: 11/07/2022] Open
Abstract
AIM The integration of families into healthcare services is being emphasized increasingly in healthcare polices. The aim of this study was to investigate how professionals during home visits support both patients and caregivers in accepting and accommodating to illness. DESIGN An explorative qualitative design. METHODS Participant observations from home visits (N = 20) of pulmonary ambulatory nurses to COPD patients in Norway, followed by interviews with these nurses. RESULTS Our findings demonstrate the delicate nature of nurses' work during home visits to COPD patients and their caregivers. They support both patients and caregivers in reconciling themselves with the negative consequences of illness, as well as giving legitimation to and potential room for, sustainable arrangements within the scope of the relationship. The nurses address significant issues, having transformative potential concerning attitudes and practices related to the management of illness and adjusting to a complex illness trajectory.
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Affiliation(s)
- Gunvor Aasbø
- Health Services Research UnitAkershus University HospitalLørenskogNorway
- Institute of Health and SocietyUniversity of OsloOsloNorway
| | - Ellen Kristvik
- Health Services Research UnitAkershus University HospitalLørenskogNorway
| | | | - Anne Werner
- Health Services Research UnitAkershus University HospitalLørenskogNorway
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15
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Jany BH, Bals R, Buhr-Schinner H, Dreher M, Koczulla AR, Jany L, Meyer A, Randerath W. COPD: Rethinking Patient Management - How to Approach a Challenging Patient Group Successfully. Respiration 2019; 97:363-368. [PMID: 30879009 DOI: 10.1159/000493759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 09/12/2018] [Indexed: 11/19/2022] Open
Abstract
In comparison to other chronically ill people, patients suffering from chronic obstructive pulmonary disease (COPD) have many additional difficulties to face and conquer. Due to the contribution of avoidable causes of their illness ("smokers' lung"), society holds people with COPD responsible for their disease, which in return often leads to stigmatization and social isolation. In addition, COPD patients commonly belong to a less privileged social class, own a low socioeconomic status, and lower education. Their physical symptoms are easily observable and - by employing moderate adherence - treatable. Nonetheless, the influence of COPD on a patient's psyche often plays an overly prominent role during therapy. "There is only half a patient laying on the examination table," a revelation that sums up the current state of COPD research and the result of the expert meeting "Luftschlösser" ("castles in the clouds"), which took place in spring 2018. Within the limits of the meeting, participants identified practically applicable approaches aiming to enhance the patient management of this challenging patient group. These considerations are supposed to support healthcare professionals in their daily work and aim to improve the therapy as well as the outcome for COPD patients.
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Affiliation(s)
- Berthold H Jany
- Department of Respiratory Medicine, Klinikum Würzburg Mitte gGmbH, Würzburg, Germany,
| | - Robert Bals
- Department of Internal Medicine V - Pulmonology, Allergology, and Intensive Care Medicine, Saarland University Hospital, Homburg, Germany
| | | | - Michael Dreher
- Department of Pneumology and Intensive Care Medicine, University Hospital Aachen, Aachen, Germany
| | - A Rembert Koczulla
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps University Marburg, German Center for Lung Research (DZL), Marburg, Germany.,Department of Respiratory Medicine and Pulmonary Rehabilitation, Schön Klinik Berchtesgadener Land, Schönau am Königssee, Germany
| | | | - Andreas Meyer
- Respiratory Medicine, Allergology and Sleep Medicine, Kliniken Maria Hilf, Mönchengladbach, Germany
| | - Winfried Randerath
- Clinic for Pneumology and Allergology, Centre of Sleep Medicine and Respiratory Care, Bethanien Hospital, Institute of Pneumology, University of Cologne, Solingen, Germany
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16
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Strøm A, Dreyer A. Next of kin's protracted challenges with access to relevant information and involvement opportunities. J Multidiscip Healthc 2018; 12:1-8. [PMID: 30588005 PMCID: PMC6302821 DOI: 10.2147/jmdh.s183946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Next of kin are considered a resource for both the patient and the health service. Need for information varies with severity and duration of health changes. A clear requirement is about what to expect upon homecoming, and what supportive services are available. The picture of relatives’ access to involvement and information is still somewhat unclear. Objective To investigate what information, knowledge, and involvement next of kin considered important for managing their caring role and collaboration with their close relatives who experienced events that led to chronic illness. Design, setting, and methods A qualitative exploratory design. Seventeen informants were recruited through various courses offered to relatives. Data were collected in 2017 from individual interviews, analyzed in an interpretative tradition, and involved qualitative content analysis. Results The results reflect a long intervening period in between the activating incident and a clarification of the situation. This period was characterized by unpreparedness for duration of anxiety and amount of energy involved in balancing the relationship. Further, the interviewees saw retrospectively that information about disease and treatment was available, but they had to find such resources themselves. Information about how to handle the situation was almost absent. Ultimately, they were disappointed over not being involved. Conclusion Previously provided prospective information about the embedded anxiety in the situation and consequences for relationships, involvement in patients’ services, and better communication about existing services seem to be significant. Health care professionals, especially in outpatient care, may improve their services by debating how they can implement family-oriented care in personalized treatment as usual. Focus on prospective information, early involvement, and relevant information about existing resources may empower relatives and relieve the experience of care burden.
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Affiliation(s)
- Anita Strøm
- Faculty of Health, VID Specialized University, Oslo, Norway,
| | - Anne Dreyer
- Department of Health Sciences in Ålesund, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Ålesund, Norway
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17
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The Effect of Telenursing on Referral Rates of Patients With Head Trauma and Their Family's Satisfaction After Discharge. J Trauma Nurs 2018; 25:248-253. [PMID: 29985860 DOI: 10.1097/jtn.0000000000000382] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We aimed to assess the effect of telenursing on referral rates of patients with head trauma and their family's satisfaction after discharge. Seventy-two patients with head trauma were randomly allocated to equal intervention and control groups. The caregivers in both groups were provided with 1-hr face-to-face training on patients' home care and educational booklets, 2 days before discharge. The cell phone numbers of the telenurse was given to the caregivers of the intervention group. Then, the patients in the intervention group were followed up every week through phone calls by the telenurse for 12 weeks and the patient status checklists were completed. Caregivers in the intervention group could call the telenurse any time they desired. The health status of the control group was followed once by a phone call after 12 weeks. Data were analyzed using SPSS software, version 19. Ultimately, 33 patients with a mean ± SD age of 31.12 ± 10.83 years were studied in the control group and 35 patients with a mean ± SD age of 34.11 ± 12.34 years were studied in the intervention group (p = .098). The 2 groups differed significantly with respect to referral rates; 39.4% of the participants in the control group referred to physicians whereas only 25.7% of the patients in the intervention group needed to refer to physicians (p = .017). Also, the mean times of referring to a physician differed significantly in both groups. In general, 53.8% of the caregivers were satisfied with the telenursing program. Follow-up programs using telephone calls were effective and would lead to higher caregiver satisfaction.
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18
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Roberts NJ, Kidd L, Kirkwood K, Cross J, Partridge MR. A systematic review of the content and delivery of education in pulmonary rehabilitation programmes. Respir Med 2018; 145:161-181. [PMID: 30509706 DOI: 10.1016/j.rmed.2018.11.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 11/01/2018] [Accepted: 11/02/2018] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Pulmonary rehabilitation (PR) is a core component of Chronic Obstructive Pulmonary Disease (COPD) management with well recognized benefits. While suggestions for educational content within pulmonary rehabilitation have been detailed in clinical guidance, it is unclear what educational content is delivered as part of pulmonary rehabilitation, who delivers it, and how it is delivered. METHODS A systematic review was conducted to identify what educational content is delivered as part of pulmonary rehabilitation, how is this delivered and who delivers it. Databases were searched from 1981 to 2017 using multiple search terms related to "pulmonary rehabilitation" and "education". RESULTS Fourteen studies were identified. This included 6 survey studies, 5 quasi-experimental studies and 3 RCTs. Five key topics that were consistently included within PR programmes were identified as: 1) Anxiety/depression and stress management. 2) Early recognition of signs of infection. 3) Dyspnea and symptom management. 4) Nutrition. 5) Techniques using inhalers and nebulizers. Broader topics such as welfare/benefits, sexuality, and advance care directives did not frequently feature. Only four studies used tools to measure knowledge or learning pre and post rehabilitation in an attempt to evaluate the effectiveness of the education delivered as part of PR. CONCLUSIONS The delivery of education in PR programmes is variable and does not follow suggested educational topics. Education needs to take a patient centered motivational approach to ensure effective delivery. Further research into appropriate educational outcome measures are needed, in order to evaluate the changes in behaviour associated with education.
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Affiliation(s)
- N J Roberts
- School of Health and Life Sciences, Glasgow Caledonian University, United kingdom.
| | - L Kidd
- School of Medicine, Dentistry and Nursing, University of Glasgow, United kingdom
| | - K Kirkwood
- Pulmonary Rehabilitation, NHS Greater Glasgow and Clyde, United kingdom
| | - J Cross
- School of Health Sciences, University of East Anglia, United kingdom
| | - M R Partridge
- National Heart and Lung Institute, Imperial College London, United kingdom
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19
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Pugh P, Hemingway P, Christian M, Higginbottom G. Children's, parents' and other stakeholders' perspectives on early dietary self-management to delay disease progression of chronic disease in children: a protocol for a mixed studies systematic review with a narrative synthesis. Syst Rev 2018; 7:20. [PMID: 29370832 PMCID: PMC5785819 DOI: 10.1186/s13643-017-0671-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 12/29/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic disease of childhood may be delayed by early dietary intervention. The purpose of this systematic review is to provide decision-makers with a perspective on the role of early dietary intervention, as a form of self-management, to delay disease progression in children with early chronic disease, as described by children, parents and other stakeholders. METHODS The study will systematically review empirical research (qualitative, quantitative and mixed method designs), including grey literature, using a narrative synthesis. A four-stage search process will be conducted involving a scoping search, the Scottish Intercollegiate Guidelines Network (SIGN) Patient Issues search filter on MEDLINE, the search of seven databases using a chronic disease and chronic kidney disease (CKD) search strategy, and hand searching the reference lists of identified papers for additional studies. All studies retrieved during the search process will undergo a screening and selection process against the inclusion/exclusion criteria. Methodological quality of relevant studies will be assessed using a validated Mixed Studies Review scoring system, before inclusion in the review. Relevant grey literature will be assessed for methodological quality and relative importance using McGrath et al.'s framework and the Academy Health advisory committee categories, respectively. Data extraction will be guided by the Centre for Review and Dissemination guidance and Popay et al.'s work. The narrative synthesis of the findings will use elements of Popay et al.'s methodology of narrative synthesis, applying recognised tools for each of the four elements: (1) developing a theory of how the intervention works, why and for whom; (2) developing a preliminary synthesis of findings of included studies; (3) exploring relationships in the data; and (4) assessing the robustness of the synthesis. DISCUSSION This mixed studies systematic review with a narrative synthesis seeks to elucidate the gaps in current knowledge and generate a fresh explanation of research findings on early dietary self-management in chronic disease, with particular application to CKD, from the stakeholders' perspective. The review will provide an important platform to inform future research, identifying the facilitators and barriers to implementing early dietary interventions. Ultimately, the review will contribute vital information to inform future improvements in chronic disease. The lead author has a particular interest in CKD paediatric service delivery. SYSTEMATIC REVIEW REGISTRATION The review has been registered with PROSPERO (CRD42017078130).
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Affiliation(s)
- Pearl Pugh
- School of Health Sciences, University of Nottingham, Nottingham, UK.
| | - Pippa Hemingway
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Martin Christian
- Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
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20
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Clari M, Ivziku D, Casciaro R, Matarese M. The Unmet Needs of People with Chronic Obstructive Pulmonary Disease: A Systematic Review of Qualitative Findings. COPD 2018; 15:79-88. [PMID: 29308932 DOI: 10.1080/15412555.2017.1417373] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The complexity of chronic obstructive pulmonary disease (COPD) can negatively impact the lives of people with the condition and compromise their capacity to take care of their needs. Unmet needs can then lead to significant morbidity, unpleasant emotional experiences and a poor quality of life; thus this systematic review aimed to identify, evaluate and synthesise the qualitative literature on the unmet needs of people with COPD. A qualitative meta-synthesis was performed according to the Joanna Briggs Institute method. A systematic search of five databases was conducted, searching for articles published from January 1995 to May 2017. Eight papers were identified. Two researchers extracted the data and independently assessed their quality. The total sample of people with COPD included was 108. Nine categories were derived from 49 findings, and aggregated into three synthesised findings: (1) people with COPD have unmet needs regarding information about the disease; (2) people with COPD have unmet physical, emotional and social needs, due to the disease symptoms and treatments; and (3) people with COPD have unmet care needs. This review showed qualitative evidence regarding the dimensions in which people with COPD express their unmet needs. The needs that are mainly unsatisfied include physical, psychosocial, informational and practical aspects, as well as the need for healthcare professional care. A global approach, which includes the areas identified by our findings, could lead to an improvement in the care of people with COPD and could improve the self-care management of those individuals who do not correctly identify their needs.
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Affiliation(s)
- Marco Clari
- a Department of Biomedicine and Prevention , University of Rome 'Tor Vergata', Rome , Italy
| | - Dhurata Ivziku
- a Department of Biomedicine and Prevention , University of Rome 'Tor Vergata', Rome , Italy
| | | | - Maria Matarese
- c Research Unit of Nursing Science , Campus Bio-Medico University of Rome , Rome , Italy
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21
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Hasanpour M, Galehdar N, Kazemi A, Zamani A. Reminding the Health Team About What Companions of the Patients Undergoing Gynecological Surgery Should Know: A Qualitative Study. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2017; 22:408-413. [PMID: 29033999 PMCID: PMC5637153 DOI: 10.4103/ijnmr.ijnmr_140_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background: Patients’ family members often do not receive sufficient information, especially because the reproductive system of women is considered a taboo, providing information becomes problematic. The aim of the current study was to explore the informational-educational needs of companions of the patients who were undergoing gynecological surgery. Materials and Methods: This study was conducted using inductive and conventional content analysis method. For data collection, 34 semi-structured in-depth interviews were performed at a gynecology and obstetrics center with purposeful sampling and maximum variation. The participants included patients’ companions, nurses, physicians, patients, and service personnel. Results: Qualitative content analysis extracted 8 categories, 2 main categories of “Informational needs of companions” and “Educational needs of companions” and a final theme of “the need for knowing.” Conclusions: According to the results, “the need for knowing” is one of the most important needs of the patients’ companions during hospitalization. Knowing companions’ needs in the hospital and understanding its deficiencies would assist health care professionals, especially authorities, in providing high-quality care and developing programs to meet the informational needs of patients’ companions.
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Affiliation(s)
- Marzieh Hasanpour
- School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran.,Nursing and Midwifery Care Research Center, Isfahan University of Midical Sciences, Isfahan, Iran
| | - Nasrin Galehdar
- Nursing and Midwifery Care Research Center, Isfahan University of Midical Sciences, Isfahan, Iran
| | - Ashraf Kazemi
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ahmadreza Zamani
- Community and Family Medicine Department, Isfahan Medical University, Isfahan, Iran
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22
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Abstract
Young carers often provide care because they have always done so for the people they care about, and because they believe that the care recipient could not manage without them. For many young carers, looking after their own health, combining caring with schoolwork, getting access to training or having time off from carer duties can be a major challenge ( Department of Health [DH], 2008 ). This paper presents evidence from a literature review that builds a substantial body of knowledge to suggest that community nursing teams must develop supportive approaches towards increasing an awareness of young carers' needs. Identification of young carers by community nurses will encourage referral to appropriate services and agencies. The aim of this study was to appraise, for the Queen's Nursing Institute, the published evidence base to explore young carers' needs and how community nurses could support young carers' needs in England. Databases were systematically searched. Title and abstract reviews found 606 potential studies (see Figure 1 ), which were identified around topics corresponding to the headings of three distinct categories: mental health and wellbeing; education needs and resilience; and development of coping strategies. Full-text review resulted in 26 publications that met the study's inclusion criteria. The results of this work show that there is a scarcity of publications around the community nursing needs of young carers. However, studies consistently report young carers are hidden from view and have a significant requirement for support and information. Therefore, effective ways of delivering community nursing support and information to young carers needs to be developed by service providers as a matter of priority, and implemented to give the support that young carers need.
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Affiliation(s)
- Sally Sprung
- (Queen's Nurse) Senior Lecturer, Liverpool John Moores University, School of Nursing and Allied Health & Member of the Association on District Nurse Educators
| | - Michelle Laing
- Leadership and Development Foundation Associate, Liverpool John Moores University, School of Nursing and Allied Health
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23
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Anderson EW, White KM. "It Has Changed My Life": An Exploration of Caregiver Experiences in Serious Illness. Am J Hosp Palliat Care 2017; 35:266-274. [PMID: 28413927 PMCID: PMC5768253 DOI: 10.1177/1049909117701895] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background: Informal, unpaid caregivers shoulder much of the care burden for individuals with serious illness. As part of a project to create an innovative model of supportive care for serious illness, a series of user interviews were conducted, forming the basis for this article. Objective: To understand both individual and interpersonal aspects of caregiving for serious illness. Methods: Twelve semistructured group interviews were conducted with patients, families, and professionals as part of a larger study of late-life serious illness. Transcript data were analyzed with descriptive coding, and then coded material was analyzed to elicit major themes and subthemes. Results: A total of 73 individuals participated in group interview sessions. Using descriptive coding, quotes were assigned to first-order codes of rewards, challenges, and a category of learnings and adaptations. Subthemes of reward included gratitude, a sense of accomplishment or mastery, and closeness in personal relationships. The most oft-cited challenges included emotional and physical stresses of caregiving and feeling unprepared or unsupported in caregiving. Reflecting on their experiences, caregivers cited new ways in which they had learned to be creative, to show assertiveness and advocacy, and to create personal balance in a demanding situation. Conclusions: The experience of caregiving is a life-altering journey as individuals rise to challenges and reflect on the rewards. Caregivers described intensive caregiving, often without acknowledgment or understanding of their role from the health-care system. This invisibility created its own iatrogenic caregiving challenge. The identified themes suggest avenues of meaningful caregiver support that bear further exploration.
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Affiliation(s)
- Eric W Anderson
- 1 Late Life Supportive Care, Division of Applied Research, Allina Health, Minneapolis, MN, USA
| | - Katie M White
- 2 Division of Health Policy & Management, University of Minnesota School of Public Health, Minneapolis, MN, USA
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24
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Rosa F, Bagnasco A, Aleo G, Kendall S, Sasso L. Resilience as a concept for understanding family caregiving of adults with Chronic Obstructive Pulmonary Disease (COPD): an integrative review. Nurs Open 2017; 4:61-75. [PMID: 28286662 PMCID: PMC5340167 DOI: 10.1002/nop2.63] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 05/29/2016] [Indexed: 11/24/2022] Open
Abstract
AIMS This paper was a report of the synthesis of evidence on examining the origins and definitions of the concept of resilience, investigating its application in chronic illness management and exploring its utility as a means of understanding family caregiving of adults with Chronic Obstructive Pulmonary Disease. BACKGROUND Resilience is a concept that is becoming relevant to understanding how individuals and families live with illness, especially long-term conditions. Caregivers of adults with Chronic Obstructive Pulmonary Disease must be able to respond to exacerbations of the condition and may themselves experience cognitive imbalances. Yet, resilience as a way of understanding family caregiving of adults with COPD is little explored. DESIGN Literature review - integrative review. DATA SOURCES CINAHL, PubMed, Google Scholar and EBSCO were searched between 1989-2015. REVIEW METHODS The principles of rapid evidence assessment were followed. RESULTS We identified 376 relevant papers: 20 papers reported the presence of the concept of resilience in family caregivers of chronic diseases patients but only 12 papers reported the presence of the concept of resilience in caregivers of Chronic Obstructive Pulmonary Disease patients and have been included in the synthesis. The term resilience in Chronic Obstructive Pulmonary Disease caregiving is most often understood using a deficit model of health.
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Affiliation(s)
- Francesca Rosa
- Department of Health SciencesUniversity of GenoaGenoaItaly
| | | | - Giuseppe Aleo
- Department of Health SciencesUniversity of GenoaGenoaItaly
| | - Sally Kendall
- Centre for Research in Primary and Community Care (CRIPACC)University of HertfordshireHatfieldUK
| | - Loredana Sasso
- Department of Health SciencesUniversity of GenoaGenoaItaly
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25
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Ewing G, Penfold C, Benson JA, Mahadeva R, Howson S, Burkin J, Booth S, Lovick R, Gilligan D, Todd C, Farquhar M. Clinicians' Views of Educational Interventions for Carers of Patients With Breathlessness Due to Advanced Disease: Findings From an Online Survey. J Pain Symptom Manage 2017; 53:265-271. [PMID: 27725250 DOI: 10.1016/j.jpainsymman.2016.08.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 07/20/2016] [Accepted: 08/04/2016] [Indexed: 11/17/2022]
Abstract
CONTEXT Carers' needs in advanced disease, and specifically in relation to breathlessness, are well evidenced. Publications on educational interventions for carers of patients with advanced disease that focus on symptoms are scarce and absent for breathlessness. OBJECTIVES To establish current education provided by clinicians for carers of patients with breathlessness in advanced disease, views about educating carers about breathlessness, and relevant outcomes for a future randomized controlled trial of an educational intervention for carers. METHODS An online survey was completed by 365 clinicians: medical, nursing, and allied health professionals from primary care, hospital, and hospice. Descriptive statistics summarized respondent characteristics and survey responses, and the Chi-squared test was applied. Content analysis of free-text comments was conducted. RESULTS Most clinicians reported educating carers by educating patients at clinical contacts with patients. Carer involvement was largely an 'add-on'; an active carer education strategy, where all carers were invited to attend, was not currently apparent. Clinicians endorsed the importance of educating carers about breathlessness through increasing carer confidence and/or control, helping patients' better self-manage breathlessness and potentially reducing admissions. Joint education with patients, giving practical advice, and strategies for helping patients were advised. To inform a future trial, clinicians identified improvement in patient outcomes, particularly patient quality of life as very important in enhancing clinician adoption of an educational intervention for carers. CONCLUSION This survey revealed an appetite among clinicians for an educational intervention for carers of patients with breathlessness in advanced disease and provided important insights to underpin a future Phase II randomized controlled trial.
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Affiliation(s)
| | | | | | - Ravi Mahadeva
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Sophie Howson
- Cambridge and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Julie Burkin
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | | | - David Gilligan
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Morag Farquhar
- Department of Public Health & Primary Care, University of Cambridge Institute of Public Health, Cambridge, UK.
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26
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Farquhar M, Penfold C, Benson J, Lovick R, Mahadeva R, Howson S, Burkin J, Booth S, Gilligan D, Todd C, Ewing G. Six key topics informal carers of patients with breathlessness in advanced disease want to learn about and why: MRC phase I study to inform an educational intervention. PLoS One 2017; 12:e0177081. [PMID: 28475655 PMCID: PMC5419601 DOI: 10.1371/journal.pone.0177081] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 04/21/2017] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION Breathlessness is a common symptom of advanced disease placing a huge burden on patients, health systems and informal carers (families and friends providing daily help and support). It causes distress and isolation. Carers provide complex personal, practical and emotional support yet often feel ill-prepared to care. They lack knowledge and confidence in their caring role. The need to educate carers and families about breathlessness is established, yet we lack robustly developed carer-targeted educational interventions to meet their needs. METHODS We conducted a qualitative interview study with twenty five purposively-sampled patient-carer dyads living with breathlessness in advanced disease (half living with advanced cancer and half with advanced chronic obstructive pulmonary disease (COPD). We sought to identify carers' educational needs (including what they wanted to learn about) and explore differences by diagnostic group in order to inform an educational intervention for carers of patients with breathlessness in advanced disease. RESULTS There was a strong desire among carers for an educational intervention on breathlessness. Six key topics emerged as salient for them: 1) understanding breathlessness, 2) managing anxiety, panic and breathlessness, 3) managing infections, 4) keeping active, 5) living positively and 6) knowing what to expect in the future. A cross-cutting theme was relationship management: there were tensions within dyads resulting from mismatched expectations related to most topics. Carers felt that knowledge-gains would not only help them to support the patient better, but also help them to manage their own frustrations, anxieties, and quality of life. Different drivers for education need were identified by diagnostic group, possibly related to differences in caring role duration and resulting impacts. CONCLUSION Meeting the educational needs of carers requires robustly developed and evaluated interventions. This study provides the evidence-base for the content of an educational intervention for carers of patients with breathlessness in advanced disease.
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Affiliation(s)
- Morag Farquhar
- School of Health Sciences, University of East Anglia, Norwich, United Kingdom
- * E-mail:
| | - Clarissa Penfold
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - John Benson
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | | | - Ravi Mahadeva
- Department of Respiratory Medicine, Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom
| | | | - Julie Burkin
- Palliative Care Team, Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom
| | - Sara Booth
- Department of Oncology, University of Cambridge, Cambridge, United Kingdom
| | - David Gilligan
- Department of Oncology, University of Cambridge, Cambridge, United Kingdom
| | - Christopher Todd
- School of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, United Kingdom
| | - Gail Ewing
- Centre for Family Research, University of Cambridge, Cambridge, United Kingdom
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Cruz J, Marques A, Figueiredo D. Impacts of COPD on family carers and supportive interventions: a narrative review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2017; 25:11-25. [PMID: 26499310 DOI: 10.1111/hsc.12292] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/02/2015] [Indexed: 06/05/2023]
Abstract
Caring for a relative with chronic disease influences multiple dimensions of family carers' lives. This study aimed to provide an overview of the impacts of chronic obstructive pulmonary disease (COPD) on family carers and identify interventions aimed at supporting them. A narrative review was conducted. Searches were performed in electronic databases using a combination of keywords. Articles were screened for relevance and selected articles were analysed in two groups considering the study aims. Eighteen articles were selected. Fifteen studies evaluated the impacts of COPD on family carers and three studies presented interventions aimed at supporting them. Carers reported negative impacts of caring on physical health, emotional, social, relational and financial/employment life dimensions. Positive aspects of care-giving were reported in four studies and were related to carers' personal growth and satisfaction in being able to do something useful for their relatives. The existing interventions were directed at both patients and carers; however, studies provided limited information on how carers were involved, hindering the interpretation of findings. In conclusion, COPD poses several unique challenges to family carers related to the specificities of the disease. Further research with appropriate intervention studies is needed to promote carers' healthy adjustment to the disease.
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Affiliation(s)
- Joana Cruz
- Department of Health Sciences (SACS), University of Aveiro, Aveiro, Portugal
- School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal
| | - Alda Marques
- School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal
- Center for Health Technology and Services Research (CINTESIS), School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal
| | - Daniela Figueiredo
- School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal
- Center for Health Technology and Services Research (CINTESIS), School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal
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Bernabeu-Mora R, García-Guillamón G, Montilla-Herrador J, Escolar-Reina P, García-Vidal JA, Medina-Mirapeix F. Rates and predictors of depression status among caregivers of patients with COPD hospitalized for acute exacerbations: a prospective study. Int J Chron Obstruct Pulmon Dis 2016; 11:3199-3205. [PMID: 28008245 PMCID: PMC5167454 DOI: 10.2147/copd.s118109] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Hospitalization is common for acute exacerbation of COPD, but little is known about its impact on the mental health of caregivers. OBJECTIVE The aim of this study was to determine the rates and predictors of depressive symptoms in caregivers at the time of hospitalization for acute exacerbation of COPD and to identify the probability and predictors of subsequent changes in depressive status 3 months after discharge. MATERIALS AND METHODS This was a prospective study. Depression symptoms were measured in 87 caregivers of patients hospitalized for exacerbation at hospitalization and 3 months after discharge. We measured factors from four domains: context of care, caregiving demands, caregiver resources, and patient characteristics. Univariate and multivariate multiple logistic regressions were used to determine the predictors of depression at hospitalization and subsequent changes at 3 months. RESULTS A total of 45 caregivers reported depression at the time of hospitalization. After multiple adjustments, spousal relationship, dyspnea, and severe airflow limitation were the strongest independent predictors of depression at hospitalization. Of these 45 caregivers, 40% had a remission of their depression 3 months after discharge. In contrast, 16.7% of caregivers who were not depressive at hospitalization became depressive at 3 months. Caregivers caring >20 hours per week for patients with dependencies had decreased odds of remission, and patients having dependencies after discharge increased the odds of caregivers becoming depressed. CONCLUSION Depressive symptoms are common among caregivers when patients are hospitalized for exacerbation of COPD. Although illness factors are determinants of depression at hospitalization, patient dependence determines fluctuations in the depressive status of caregivers.
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Affiliation(s)
- Roberto Bernabeu-Mora
- Division of Pneumology, Hospital Morales Meseguer; Department of Physical Therapy, University of Murcia; Physiotherapy and Disability Research Group, Instituto Murciano de Investigación Biosanitaria Virgen de la Arrixaca (IMIB), Murcia, Spain
| | | | - Joaquina Montilla-Herrador
- Department of Physical Therapy, University of Murcia; Physiotherapy and Disability Research Group, Instituto Murciano de Investigación Biosanitaria Virgen de la Arrixaca (IMIB), Murcia, Spain
| | - Pilar Escolar-Reina
- Department of Physical Therapy, University of Murcia; Physiotherapy and Disability Research Group, Instituto Murciano de Investigación Biosanitaria Virgen de la Arrixaca (IMIB), Murcia, Spain
| | | | - Francesc Medina-Mirapeix
- Department of Physical Therapy, University of Murcia; Physiotherapy and Disability Research Group, Instituto Murciano de Investigación Biosanitaria Virgen de la Arrixaca (IMIB), Murcia, Spain
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Bove DG, Zakrisson AB, Midtgaard J, Lomborg K, Overgaard D. Undefined and unpredictable responsibility: a focus group study of the experiences of informal caregiver spouses of patients with severe COPD. J Clin Nurs 2016; 25:483-93. [PMID: 26818373 DOI: 10.1111/jocn.13076] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2015] [Indexed: 01/23/2023]
Abstract
AIMS AND OBJECTIVES To explore how spouses of patients with severe chronic obstructive pulmonary disease experience their role as informal caregiver. BACKGROUND Informal caregiver spouses are of pivotal importance in the way that patients with chronic obstructive pulmonary disease cope with their daily life, including their opportunity to stay at home and avoid hospitalisations in the last stages of the disease. However, caregiving is associated with increased morbidity and mortality among caregivers. Further understanding of the role as an informal caregiver spouse of patients with severe chronic obstructive pulmonary disease is needed to develop supportive interventions aimed at reducing the caregiver burden. DESIGN The study had a qualitative exploratory design. The data collection and analysis were based on framework method. Framework method is a thematic methodology and consists of five key stages: familiarisation, identifying a thematic framework, indexing, charting and mapping & interpretation. METHODS Three focus groups were conducted in November 2013 with 22 spouses of patients with severe chronic obstructive pulmonary disease. RESULTS Undefined and unpredictable responsibility was found to be the overarching theme describing the informal caregiver role. Underlying themes were: being constantly in a state of alertness, social life modified, maintaining normality, ambivalence in the relationship and a willingness to be involved. CONCLUSIONS The informal caregiver spouses experienced ambiguity about expectations from their private and the health professionals' surroundings. The informal caregiver spouses wanted to provide meaningful care for their partners, but sought knowledge and support from the health professionals. RELEVANCE TO CLINICAL PRACTICE We recommend that nurses take on the responsibility for including the informal caregiver spouses in those aspects of decision-making that involve the common life of the patients and their spouses.
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Affiliation(s)
- Dorthe Gaby Bove
- Department of Pulmonary and Infectious Diseases, Nordsjaellands Hospital, University of Copenhagen, Denmark
| | - Ann-Britt Zakrisson
- University Healthcare Research Centre, Faculty of Health and Medicine, Örebro University, Sweden.,Centre for Assessment of Medical Technology, Örebro University, Sweden
| | - Julie Midtgaard
- Institute of Public Health, University of Copenhagen, Copenhagen, Denmark.,The University Hospital Centre for Health Research, Copenhagen University Hospital, Rigshospitalet, København Ø, Denmark
| | - Kirsten Lomborg
- Section for Nursing, Department of Clinical Medicine and Department of Public Health, Faculty of Health Sciences, Aarhus University, Aarhus N, Danmark
| | - Dorthe Overgaard
- Research Unit, Nordsjaellands Hospital, University of Copenhagen, Department of Nursing, Metropolitan University College, Copenhagen, Denmark
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Farquhar M, Penfold C, Walter FM, Kuhn I, Benson J. What Are the Key Elements of Educational Interventions for Lay Carers of Patients With Advanced Disease? A Systematic Literature Search and Narrative Review of Structural Components, Processes and Modes of Delivery. J Pain Symptom Manage 2016; 52:117-130.e27. [PMID: 27112309 DOI: 10.1016/j.jpainsymman.2015.12.341] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 12/21/2015] [Accepted: 12/24/2015] [Indexed: 12/14/2022]
Abstract
CONTEXT Educating carers about symptom management may help meet patient and carer needs in relation to distressing symptoms in advanced disease. Reviews of the effectiveness of carer interventions exist, but few have focused on educational interventions and none on the key elements that comprise them but which could inform evidence-based design. OBJECTIVES To identify the key elements (structural components, processes, and delivery modes) of educational interventions for carers of patients with advanced disease. METHODS We systematically searched seven databases, applied inclusion and exclusion criteria, conducted quality appraisal, extracted data, and performed a narrative analysis. RESULTS We included 62 articles related to 49 interventions. Two main delivery modes were identified: personnel-delivered interventions and stand-alone resources. Personnel-delivered interventions targeted individuals or groups, the former conducted at single or multiple time points, and the latter delivered as series. Just more than half targeted carers rather than patient-carer dyads. Most were developed for cancer; few focused purely on symptom management. Stand-alone resources were rare. Methods to evaluate interventions ranged from postintervention evaluations to fully powered randomized controlled trials but of variable quality. CONCLUSION Published evaluations of educational interventions for carers in advanced disease are limited, particularly for non-cancer conditions. Key elements for consideration in developing such interventions were identified; however, lack of reporting of reasons for nonparticipation or dropout from interventions limits understanding of the contribution of these elements to interventions' effectiveness. When developing personnel-delivered interventions for carers in advanced disease, consideration of the disease (and, therefore, caring) trajectory, intervention accessibility (timing, location, and transport), and respite provision may be helpful.
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Affiliation(s)
- Morag Farquhar
- Department of Public Health & Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom; School of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, United Kingdom.
| | - Clarissa Penfold
- Department of Public Health & Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Fiona M Walter
- Department of Public Health & Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom; General Practice & Primary Care Academic Centre, University of Melbourne, Melbourne, Victoria, Australia
| | - Isla Kuhn
- Medical Library, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - John Benson
- Department of Public Health & Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
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Luckett T, Disler R, Hosie A, Johnson M, Davidson P, Currow D, Sumah A, Phillips J. Content and quality of websites supporting self-management of chronic breathlessness in advanced illness: a systematic review. NPJ Prim Care Respir Med 2016; 26:16025. [PMID: 27225898 PMCID: PMC4881311 DOI: 10.1038/npjpcrm.2016.25] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 03/08/2016] [Accepted: 04/05/2016] [Indexed: 11/09/2022] Open
Abstract
Chronic breathlessness is a common, burdensome and distressing symptom in many advanced chronic illnesses. Self-management strategies are essential to optimise treatment, daily functioning and emotional coping. People with chronic illness commonly search the internet for advice on self-management. A review was undertaken in June 2015 to describe the content and quality of online advice on breathlessness self-management, to highlight under-served areas and to identify any unsafe content. Google was searched from Sydney, Australia, using the five most common search terms for breathlessness identified by Google Trends. We also hand-searched the websites of national associations. Websites were included if they were freely available in English and provided practical advice on self-management. Website quality was assessed using the American Medical Association Benchmarks. Readability was assessed using the Flesch-Kincaid grades, with grade 8 considered the maximum acceptable for enabling access. Ninety-one web pages from 44 websites met the inclusion criteria, including 14 national association websites not returned by Google searches. Most websites were generated in the USA (n=28, 64%) and focused on breathing techniques (n=38, 86%) and chronic obstructive pulmonary disease (n=27, 61%). No websites were found to offer unsafe advice. Adherence to quality benchmarks ranged from 9% for disclosure to 77% for currency. Fifteen (54%) of 28 written websites required grade ⩾9 reading level. Future development should focus on advice and tools to support goal setting, problem solving and monitoring of breathlessness. National associations are encouraged to improve website visibility and comply with standards for quality and readability.
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Affiliation(s)
- Tim Luckett
- Faculty of Health, University of Technology Sydney (UTS), Sydney, NSW, Australia
| | - Rebecca Disler
- Faculty of Health, University of Technology Sydney (UTS), Sydney, NSW, Australia
| | - Annmarie Hosie
- Faculty of Health, University of Technology Sydney (UTS), Sydney, NSW, Australia
| | - Miriam Johnson
- Hull York Medical School, University of Hull, Hull, East Yorkshire, UK
| | - Patricia Davidson
- Faculty of Health, University of Technology Sydney (UTS), Sydney, NSW, Australia.,School of Nursing, Johns Hopkins University, Baltimore, MD, USA
| | - David Currow
- Palliative and Supportive Services, Flinders University, Adelaide, SA, Australia
| | - Anthony Sumah
- Faculty of Health, University of Technology Sydney (UTS), Sydney, NSW, Australia
| | - Jane Phillips
- Faculty of Health, University of Technology Sydney (UTS), Sydney, NSW, Australia
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Alhaddad B, Taylor KM, Robertson T, Watman G, Smith FJ. Assistance of family carers for patients with COPD using nebulisers at home: a qualitative study. Eur J Hosp Pharm 2016; 23:156-160. [PMID: 31156838 DOI: 10.1136/ejhpharm-2015-000735] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 10/05/2015] [Accepted: 10/06/2015] [Indexed: 11/04/2022] Open
Abstract
Objective For many patients with chronic conditions, such as chronic obstructive pulmonary disease (COPD), the assistance of family carers with medicines is vital for optimal treatment outcomes. The aim of this study was to identify the assistance carers provide to patients with COPD using nebuliser-delivered therapy at home, and the problems experienced that may impact on the safety and effectiveness of therapy and contribute to carer burden. Methods A cross-sectional, qualitative descriptive study was conducted with participants recruited from primary and intermediate care. Home interviews were conducted with 14 carers who assisted a family member with COPD using a nebuliser. Qualitative procedures enabled analysis of nebuliser-related activities and problems experienced by carers. Results The carer sample included 10 female and 4 male carers, with a mean age of 61 years: 11 spouses and 3 daughters. They had assisted patients with use of their nebuliser and associated medications for, on average, 4.5 years. Assistance ranged from taking full responsibility for nebuliser use to providing help with particular aspects only when required. Nebuliser-related activities included assembling and setting up equipment, mixing medicines, operating the device, dismantling and cleaning equipment. Difficulties were described with all aspects of care. Carers reported concerns about medication side effects and the lack of information provided. Conclusions The study revealed the vital role of carers in enabling effective therapy. The wide-ranging responsibilities assumed by carers and problems experienced relate to all aspects of COPD management with nebulisers, and have a potential impact on treatment outcomes and carer burden. A systematic approach to addressing carers' needs and prioritising support would be anticipated to have positive consequences for patients, carers and health services.
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Affiliation(s)
- Bothaina Alhaddad
- Public Authority for Applied Education & Training, College of Health Sciences, Shwaikh, Kuwait
| | - Kevin Mg Taylor
- Department of Pharmaceutics, UCL School of Pharmacy, London, UK
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Knowles S, Combs R, Kirk S, Griffiths M, Patel N, Sanders C. Hidden caring, hidden carers? Exploring the experience of carers for people with long-term conditions. HEALTH & SOCIAL CARE IN THE COMMUNITY 2016; 24:203-13. [PMID: 25706665 PMCID: PMC4744729 DOI: 10.1111/hsc.12207] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/12/2014] [Indexed: 05/14/2023]
Abstract
Informal carers make a significant contribution to illness management in communities, but many struggle to access support and remain 'hidden carers'. We aimed to explore how carers of people with common long-term conditions (LTCs, such as coronary heart disease or kidney disease) conceptualised their caring, and whether they struggled to identify themselves with the term 'carer' or access for support. We conducted semi-structured interviews with 19 informal carers of people with LTCs recruited from local support groups. Topic guides were designed to encourage participants to provide their retrospective accounts of identifying as a carer or struggling to do so. Data were analysed using the constant comparative method. The study was designed collaboratively with a patient and public involvement (PPI) partner, and we consulted with a PPI steering group of people with lived experience of caring during the study. Results showed how participants drew on comparisons with those caring for more dependent relatives in explaining their reluctance to define themselves as a carer, and resisted adopting the label due to concerns that it would threaten the identity of the cared-for person. The data were interpreted in terms of types of 'work' undertaken to manage LTCs, and revealed that carers of patients with LTCs appear to primarily engage in biographical and emotional support, which may be more difficult to conceptualise as legitimate caring 'work'. Participants indicated that health professionals may be in a unique position to validate their role as carers and encourage support seeking. The study suggests how the greater focus on self-management of LTCs in the community must be complemented by recognition of this group as potentially 'hidden carers', who support the patient to minimise the impact the illness has on their lives and consequently may minimise their own caring role, with negative implications for support seeking.
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Affiliation(s)
- Sarah Knowles
- Centre for Primary CareInstitute of Population HealthUniversity of ManchesterManchesterUK
| | - Ryan Combs
- Centre for Primary CareInstitute of Population HealthUniversity of ManchesterManchesterUK
| | - Sue Kirk
- School of Nursing, Midwifery and Social WorkUniversity of ManchesterManchesterUK
| | - May Griffiths
- Centre for Primary CareInstitute of Population HealthUniversity of ManchesterManchesterUK
| | - Neesha Patel
- Centre for Primary CareInstitute of Population HealthUniversity of ManchesterManchesterUK
| | - Caroline Sanders
- Centre for Primary CareInstitute of Population HealthUniversity of ManchesterManchesterUK
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Siltanen H, Jylhä V, Paavilainen E. Family members’ experiences and expectations of self-management counseling while caring for a person with chronic obstructive pulmonary disease: a systematic review protocol. ACTA ACUST UNITED AC 2016; 14:16-25. [DOI: 10.11124/jbisrir-2016-2259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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36
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Jester R, Titchener K, Doyle-Blunden J, Caldwell C. The development of an evaluation framework for a Hospital at Home service. JOURNAL OF INTEGRATED CARE 2015. [DOI: 10.1108/jica-09-2015-0038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– The purpose of this paper is to share good practice with interested professionals, commissioners and health service managers regarding the development of an evidence-based approach to evaluation of an integrated care service providing acute level care for patients in their own homes in South London called the Guys and St Thomas’ @home service.
Design/methodology/approach
– A literature review related to Hospital at Home (HH) schemes was carried out with an aim of scoping approaches used during previous evaluations of HH type interventions to inform the development of an evaluation strategy for @home. The results of the review were then applied to the Donabedian conceptual model: Structure; Process; and Outcome and contextualised to the population being served by the scheme to ensure a robust, practical and comprehensive approach to evaluation.
Findings
– Due to the heterogeneity of the studies it was not possible to conduct a systematic review or meta-analysis. In total, 28 studies were identified that met the inclusion criteria and included both HH to facilitate early discharge and admission prevention across a wide range of conditions. The key finding was there is a dearth of literature evaluating staff preparation to work on HH, models of delivery, specifically integrated care and trans-disciplinary working and few studies included the experiences of family carers.
Originality/value
– This paper will be of value to those involved in the commissioning and delivery of HH and other models of integrated care services type services and will help to inform evaluation strategies that are practical, evidence based and include all stakeholder perspectives.
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37
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Figueiredo D, Jácome C, Gabriel R, Marques A. Family care in chronic obstructive pulmonary disease: what happens when the carer is a man? Scand J Caring Sci 2015; 30:721-730. [DOI: 10.1111/scs.12298] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 09/02/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Daniela Figueiredo
- School of Health Sciences; University of Aveiro (ESSUA); Aveiro Portugal
- Research member at Centro de Investigação em Tecnologias e Serviços de Saúde (CINTESIS.UA); Aveiro Portugal
| | - Cristina Jácome
- School of Health Sciences; University of Aveiro (ESSUA); Aveiro Portugal
| | - Raquel Gabriel
- School of Health Sciences; University of Aveiro (ESSUA); Aveiro Portugal
| | - Alda Marques
- School of Health Sciences; University of Aveiro (ESSUA); Aveiro Portugal
- Research member at Centro de Investigação em Tecnologias e Serviços de Saúde (CINTESIS.UA); Aveiro Portugal
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Svettini A, Johnson B, Magro C, Saunders J, Jones K, Silk S, Hargarter L, Schreiner A. Schizophrenia through the carers' eyes: results of a European cross-sectional survey. J Psychiatr Ment Health Nurs 2015; 22:472-83. [PMID: 25944551 DOI: 10.1111/jpm.12209] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/05/2015] [Indexed: 01/30/2023]
Abstract
Schizophrenia is a serious mental disorder affecting approximately 29 million people worldwide. The ideal treatment and care of patients with schizophrenia should be provided by a multidisciplinary 'team' involving psychiatrists, nurses and other healthcare professionals, together with carers and patients. In light of the key role carers play in the care of patients with schizophrenia, the present survey was designed to assess the opinions of family members and friends of patients with schizophrenia across Europe and to ascertain their attitudes towards the illness, medication and adherence to medication. Among carers participating in this survey, there was widespread awareness of the issues involved in supporting patients with schizophrenia and the importance of their role in improving poor adherence to medication. Three differences in opinion emerged between the views of carers and psychiatrists; psychiatrists rely more on the patient themselves when assessing adherence than carers would recommend; in contrast to psychiatrists, many carers believe the illness itself contributes to non-adherence; two thirds of carers think that schizophrenia medication damages health (higher than estimated by psychiatrists). The findings from the present survey, taken together with the results from the Adherencia Terapéutica en la Esquizofrenia surveys of psychiatrists and nurses, support the need for a collaborative approach to the issue of treatment nonadherence. In particular, healthcare professionals should recognize the valuable contribution that family carers can make to improve treatment adherence and consequently clinical outcomes for patients with schizophrenia. Schizophrenia carries a significant burden for families providing care. The Adherencia Terapéutica en la Esquizofrenia (ADHES) carers' survey was designed to assess the opinions of family and friends of patients with schizophrenia across Europe and ascertain their attitudes towards the illness, medication and adherence to medication. A questionnaire-based cross-sectional survey of 138 carers across 16 European countries. Interpretation of results was based on a descriptive comparison of responses. Carers recognized the importance of medication to help patients get better (76%) and improve their quality of life (76%) and relationships (74%). Sixty-seven per cent believed medication damages general health. Sixty-five per cent reported that treatment adherence was a burden for patients. Thirty-eight per cent indicated that it was a daily struggle to get patients to take their medication. Fifty per cent perceived that medication administered every few weeks rather than daily was quite/very important. Ninety-three per cent agreed on the importance of family support to boost adherence, with education and information deemed important for families and patients. Carers rely less on the patient themselves when assessing adherence than psychiatrists. The burden faced by carers and patients in taking medication provides an opportunity for healthcare professionals to provide support in a multidisciplinary 'team' involving psychiatrists, nurses and carers.
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Affiliation(s)
| | | | | | | | | | - S Silk
- Communication & Public Affairs, Janssen EMEA, High Wycombe, UK
| | - L Hargarter
- European Medical Affairs, Janssen EMEA, Neuss, Germany
| | - A Schreiner
- Medical and Scientific Affairs, Janssen EMEA, Neuss, Germany
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Beauchamp A, Buchbinder R, Dodson S, Batterham RW, Elsworth GR, McPhee C, Sparkes L, Hawkins M, Osborne RH. Distribution of health literacy strengths and weaknesses across socio-demographic groups: a cross-sectional survey using the Health Literacy Questionnaire (HLQ). BMC Public Health 2015; 15:678. [PMID: 26194350 PMCID: PMC4508810 DOI: 10.1186/s12889-015-2056-z] [Citation(s) in RCA: 240] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 07/14/2015] [Indexed: 11/10/2022] Open
Abstract
Background Recent advances in the measurement of health literacy allow description of a broad range of personal and social dimensions of the concept. Identifying differences in patterns of health literacy between population sub-groups will increase understanding of how health literacy contributes to health inequities and inform intervention development. The aim of this study was to use a multi-dimensional measurement tool to describe the health literacy of adults in urban and rural Victoria, Australia. Methods Data were collected from clients (n = 813) of 8 health and community care organisations, using the Health Literacy Questionnaire (HLQ). Demographic and health service data were also collected. Data were analysed using descriptive statistics. Effect sizes (ES) for standardised differences in means were used to describe the magnitude of difference between demographic sub-groups. Results Mean age of respondents was 72.1 (range 19–99) years. Females comprised 63 % of the sample, 48 % had not completed secondary education, and 96 % reported at least one existing health condition. Small to large ES were seen for mean differences in HLQ scales between most demographic groups. Compared with participants who spoke English at home, those not speaking English at home had much lower scores for most HLQ scales including the scales ‘Understanding health information well enough to know what to do’ (ES −1.09 [95 % confidence interval (CI) -1.33 to −0.84]), ‘Ability to actively engage with healthcare providers’ (ES −1.00 [95 % CI −1.24, −0.75]), and ‘Navigating the healthcare system’ (ES −0.72 [95 % CI −0.97, −0.48]). Similar patterns and ES were seen for participants born overseas compared with those born in Australia. Smaller ES were seen for sex, age group, private health insurance status, number of chronic conditions, and living alone. Conclusions This study has revealed some large health literacy differences across nine domains of health literacy in adults using health services in Victoria. These findings provide insights into the relationship between health literacy and socioeconomic position in vulnerable groups and, given the focus of the HLQ, provide guidance for the development of equitable interventions.
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Affiliation(s)
- Alison Beauchamp
- Public Health Innovation, Population Health Strategic Research Centre, School of Health and Social Development, Deakin University, 221 Burwood Highway, Melbourne, VIC, 3125, Australia. .,Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Rachelle Buchbinder
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia. .,Monash Department of Clinical Epidemiology, Cabrini Hospital, Malvern, VIC, Australia.
| | - Sarity Dodson
- Public Health Innovation, Population Health Strategic Research Centre, School of Health and Social Development, Deakin University, 221 Burwood Highway, Melbourne, VIC, 3125, Australia.
| | - Roy W Batterham
- Public Health Innovation, Population Health Strategic Research Centre, School of Health and Social Development, Deakin University, 221 Burwood Highway, Melbourne, VIC, 3125, Australia.
| | - Gerald R Elsworth
- Public Health Innovation, Population Health Strategic Research Centre, School of Health and Social Development, Deakin University, 221 Burwood Highway, Melbourne, VIC, 3125, Australia.
| | - Crystal McPhee
- Public Health Innovation, Population Health Strategic Research Centre, School of Health and Social Development, Deakin University, 221 Burwood Highway, Melbourne, VIC, 3125, Australia.
| | - Louise Sparkes
- School of Nursing, Monash University, Melbourne, Australia.
| | - Melanie Hawkins
- Public Health Innovation, Population Health Strategic Research Centre, School of Health and Social Development, Deakin University, 221 Burwood Highway, Melbourne, VIC, 3125, Australia.
| | - Richard H Osborne
- Public Health Innovation, Population Health Strategic Research Centre, School of Health and Social Development, Deakin University, 221 Burwood Highway, Melbourne, VIC, 3125, Australia.
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Marques A, Jácome C, Cruz J, Gabriel R, Brooks D, Figueiredo D. Family-based psychosocial support and education as part of pulmonary rehabilitation in COPD: a randomized controlled trial. Chest 2015; 147:662-672. [PMID: 25340477 DOI: 10.1378/chest.14-1488] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Involving family as part of the patient's rehabilitation plan of care might enhance the management of COPD. The primary aim of this study was to investigate the impact of a family-based pulmonary rehabilitation (PR) program on patients and family members' coping strategies to manage COPD. METHODS Family dyads (patient and family member) were randomly assigned to family-based (experimental) or conventional (control) PR. Patients from both groups underwent exercise training three times a week and psychosocial support and education once a week, during 12 weeks. Family members of the family-based PR attended the psychosocial support and education sessions together with patients. In the conventional PR, family members did not participate. Family coping and psychosocial adjustment to illness were assessed in patients and family members of both groups. Patients' exercise tolerance, functional balance, muscle strength, and health-related quality of life were also measured. All measures were collected pre/post-program. RESULTS Forty-two dyads participated (patients: FEV1, 70.4% ± 22.1% predicted). Patients (P = .048) and family members (P = .004) in the family-based PR had significantly greater improvements in family coping than the control group. Family members of the family-based PR had significantly greater changes in sexual relationships (P = .026) and in psychologic distress (P = .033) compared with the control group. Patients from both groups experienced significant improvements in exercise tolerance, functional balance, knee extensors strength, and health-related quality of life after intervention (P < .001). CONCLUSIONS This research supports family-based PR programs to enhance coping and psychosocial adjustment to illness of the family system. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT02048306; URL: www.clinicaltrials.gov.
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Affiliation(s)
- Alda Marques
- School of Health Sciences (ESSUA), Unidade de Investigação e Formação sobre Adultos e Idosos (UNIFAI), Porto, Portugal.
| | - Cristina Jácome
- School of Health Sciences (ESSUA), University of Aveiro, Aveiro, Portugal
| | - Joana Cruz
- School of Health Sciences (ESSUA), Department of Health Sciences (SACS), University of Aveiro, Aveiro, Portugal
| | - Raquel Gabriel
- School of Health Sciences (ESSUA), Department of Health Sciences (SACS), University of Aveiro, Aveiro, Portugal
| | - Dina Brooks
- Graduate Department of Rehabilitation Science, Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Daniela Figueiredo
- School of Health Sciences (ESSUA), Unidade de Investigação e Formação sobre Adultos e Idosos (UNIFAI), Porto, Portugal
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Coombs M, Long-Sutehall T, Darlington AS, Richardson A. Doctors' and nurses' views and experience of transferring patients from critical care home to die: a qualitative exploratory study. Palliat Med 2015; 29:354-62. [PMID: 25519147 PMCID: PMC4370931 DOI: 10.1177/0269216314560208] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Dying patients would prefer to die at home, and therefore a goal of end-of-life care is to offer choice regarding where patients die. However, whether it is feasible to offer this option to patients within critical care units and whether teams are willing to consider this option has gained limited exploration internationally. AIM To examine current experiences of, practices in and views towards transferring patients in critical care settings home to die. DESIGN Exploratory two-stage qualitative study SETTING/PARTICIPANTS Six focus groups were held with doctors and nurses from four intensive care units across two large hospital sites in England, general practitioners and community nurses from one community service in the south of England and members of a Patient and Public Forum. A further 15 nurses and 6 consultants from critical care units across the United Kingdom participated in follow-on telephone interviews. FINDINGS The practice of transferring critically ill patients home to die is a rare event in the United Kingdom, despite the positive view of health care professionals. Challenges to service provision include patient care needs, uncertain time to death and the view that transfer to community services is a complex, highly time-dependent undertaking. CONCLUSION There are evidenced individual and policy drivers promoting high-quality care for all adults approaching the end of life encompassing preferred place of death. While there is evidence of this choice being honoured and delivered for some of the critical care population, it remains debatable whether this will become a conventional practice in end of life in this setting.
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Affiliation(s)
- Maureen Coombs
- Graduate School of Nursing, Midwifery and Health, Victoria University of Wellington, Wellington, New Zealand Faculty of Health Sciences, University of Southampton, Southampton, UK
| | | | | | - Alison Richardson
- Faculty of Health Sciences, University of Southampton, Southampton, UK
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Miravitlles M, Peña-Longobardo LM, Oliva-Moreno J, Hidalgo-Vega Á. Caregivers' burden in patients with COPD. Int J Chron Obstruct Pulmon Dis 2015; 10:347-56. [PMID: 25709429 PMCID: PMC4334315 DOI: 10.2147/copd.s76091] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Chronic obstructive pulmonary disease (COPD) is a very prevalent and invalidating disease. The aim of this study was to analyze the burden borne by informal caregivers of patients with COPD. METHODS We used the Survey on Disabilities, Personal Autonomy, and Dependency Situations (Encuesta sobre Discapacidad, Autonomía personal y Situaciones de Dependencia [EDAD]-2008) to obtain information on the characteristics of disabled individuals with COPD and their caregivers in Spain. Additionally, statistical multivariate analyses were performed to analyze the impact that an increase in dependence would have on the problems for which caregivers provide support, in terms of health, professional, and leisure/social dimensions. RESULTS A total of 461,884 individuals with one or more disabilities and with COPD were identified, and 220,892 informal caregivers were estimated. Results showed that 35% of informal caregivers had health-related problems due to the caregiving provided; 83% had leisure/social-related problems; and among caregivers of working age, 38% recognized having profession-related problems. The probability of a problem arising was significantly associated with the degree of dependence of the patient receiving care. Caregivers of patients with great dependence showed a 39% higher probability of presenting health-related problems, 27% more professional problems, and 23% more leisure problems compared with those with nondependent patients. CONCLUSION The results show the large impact on society in terms of the welfare of informal caregivers of patients with COPD. A higher level of dependence was associated with more severe problems in caregivers, in all dimensions.
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Affiliation(s)
- Marc Miravitlles
- Pneumology Department, University Hospital Vall d'Hebron, Ciber of Respiratory Diseases (CIBERES), Barcelona, Spain
| | | | - Juan Oliva-Moreno
- Faculty of Law and Social Sciences, University of Castilla-La Mancha, Toledo, Spain
| | - Álvaro Hidalgo-Vega
- Faculty of Law and Social Sciences, University of Castilla-La Mancha, Toledo, Spain
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Ivarsson B, Ekmehag B, Hesselstrand R, Rådegran G, Sjöberg T. Perceptions of received information, social support, and coping in patients with pulmonary arterial hypertension or chronic thromboembolic pulmonary hypertension. CLINICAL MEDICINE INSIGHTS-CIRCULATORY RESPIRATORY AND PULMONARY MEDICINE 2014; 8:21-8. [PMID: 25374462 PMCID: PMC4213136 DOI: 10.4137/ccrpm.s18586] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Revised: 08/17/2014] [Accepted: 08/25/2014] [Indexed: 01/25/2023]
Abstract
Patients with a life-limiting diagnosis of pulmonary arterial hypertension (PAH) or chronic thromboembolic pulmonary hypertension (CTEPH) need disease-specific information, ability to cope, and functioning social networks. This cohort study investigated the experiences of PAH and CTEPH patients who received information about their diagnosis, treatment, and management, in addition to coping and social support. Sixty-eight adult patients (mean ± SD, age 67 ± 14; 66% women) were included. A total of 54% of the patients wanted more information. Patients received information mostly in areas concerning medical test procedures, the diagnosis, disease severity, possible disease causes, and how to manage their disease. Coping ability was significantly better in patients who were satisfied with the received information (P = 0.0045). The information given to PAH or CTEPH patients and their communication with healthcare professionals can be greatly improved. Gaps in information and misunderstandings can be avoided by working in cooperation with the patients, their relatives, and within the PAH team.
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Affiliation(s)
- Bodil Ivarsson
- Department of Cardiothoracic Surgery, Clinical Sciences, Lund University, Lund, Sweden. ; The clinic for Cardiothoracic Surgery, Skåne University Hospital, Lund, Sweden. ; Medical Services, University Healthcare, Skåne, Sweden
| | - Björn Ekmehag
- Department of Public Health and Caring Science, Uppsala University, and Uppsala University Hospital, Uppsala, Sweden
| | - Roger Hesselstrand
- Department of Rheumatology, Clinical Sciences, Lund University, Lund, Sweden. ; The clinic for Rheumatology, Skåne University Hospital, Lund, Sweden
| | - Göran Rådegran
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden. ; The Section for Heart Failure and Valvular Disease, Skåne University Hospital, Lund, Sweden
| | - Trygve Sjöberg
- Department of Cardiothoracic Surgery, Clinical Sciences, Lund University, Lund, Sweden. ; The clinic for Cardiothoracic Surgery, Skåne University Hospital, Lund, Sweden
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Yeh PM, Chang Y. Use of Zarit Burden Interview in analysis of family caregivers' perception among Taiwanese caring with hospitalized relatives. Int J Nurs Pract 2014; 21:622-34. [PMID: 25307788 DOI: 10.1111/ijn.12333] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This study was conducted to examine the relationships between family caregivers' perception of caregiving and its influencing factors among Taiwanese with hospitalized relatives. The study used a cross-sectional and descriptive correlational design. A convenience sample of 200 primary caregivers of hospitalized patients diagnosed with cancer, stroke and chronic illness was recruited in a Taiwanese Medical Center; this focus was chosen because cancer, stroke and chronic illness generally require long term care. Data were collected by structured questionnaires. Pearson product-moment correlation and stepwise multiple regression analyses were used to analyse the results of this study. Family caregivers who lacked family support and whose patients' ADL (activities of daily living) dependency was increasing experienced a greater caregiving burden. Family caregivers who had better psychological well-being, better quality of relationship and more caregiving knowledge experienced a lower caregiving burden. Quality of relationship, lack of family support and patients' ADL dependency accounted for 43% of the Zarit Burden Interview variance. The results indicated that family caregivers' perception of caregiving included sacrifice, strain, embarrassment, anger and loss of control. It is vital for nurses to understand these caregiving perceptions and their related factors to provide a holistic care plan.
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Affiliation(s)
- Pi-Ming Yeh
- Department of Nursing, Missouri Western State University, St Joseph, Missouri, USA
| | - Yuanmay Chang
- Chairman Office, Shin Kong Memorial Hospital, Taipei, Taiwan.,Nursing, National Taipei University of Nursing and Health Science, Taipei, Taiwan
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Marques A, Gabriel R, Jácome C, Cruz J, Brooks D, Figueiredo D. Development of a family-based pulmonary rehabilitation programme: an exploratory study. Disabil Rehabil 2014; 37:1340-6. [PMID: 25255297 DOI: 10.3109/09638288.2014.964376] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE This study explored the expectations of patients with chronic obstructive pulmonary disease (COPD) and family members about a family-based pulmonary rehabilitation (PR) programme; developed and implemented a family-based PR programme and explored the impacts of the intervention on patients and family members. METHOD Patients with COPD and family members were interviewed. A family-based PR programme was designed. Patients' breathlessness, muscle strength, exercise tolerance, functional balance and health-related quality of life were collected pre/post-programme. Family coping and adjustment to illness were measured in patients and family members. Focus groups were conducted after the programme. RESULTS Patients (n = 35; 69 ± 10 years; FEV1 62 ± 15% predicted) and family members (n = 35; 57 ± 12 years) had similar expectations/needs about a PR programme. Nine dyads participated. Patients' quadriceps strength, exercise tolerance and functional balance improved significantly (all p values < 0.023). Patients and family members seem to use more positive coping behaviours (p = 0.026; p = 0.011). Patients (n = 7; 78%) and family members (n = 8; 89%) considered having more knowledge about COPD and its management. Patients felt more functional (n = 9; 100%) and reported their family members to be more active (n = 3; 38%). In family members' perspective, their relationship with the care receiver was enhanced (n = 2; 22%). CONCLUSIONS PR programmes, if inclusive of family members, may enhance the skills of the whole family to manage COPD. Implications for Rehabilitation Patients with chronic obstructive pulmonary disease (COPD) and their family members have similar expectations and needs about a family-based pulmonary rehabilitation (PR) programme. A family-based PR programme is feasible to implement within primary care. PR programmes, if inclusive of family members, may enhance the skills of the whole family to manage COPD.
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Affiliation(s)
- Alda Marques
- School of Health Sciences, University of Aveiro (ESSUA) , Aveiro , Portugal
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46
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Figueiredo D, Gabriel R, Jácome C, Cruz J, Marques A. Caring for relatives with chronic obstructive pulmonary disease: how does the disease severity impact on family carers? Aging Ment Health 2014; 18:385-93. [PMID: 24053489 DOI: 10.1080/13607863.2013.837146] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Chronic Obstructive Pulmonary Disease (COPD) is a major cause of disability, morbidity and mortality in old age, representing a significant burden for families. However, information on the impacts of caring for relatives with COPD on carers' psychological health is limited. This study aimed to analyse the subjective burden of family carers of people with early and advanced COPD and its predictor variables. METHODS A cross-sectional study was conducted. A structured questionnaire was used to collect socio-demographics and care-giving characteristics. Self-rated physical and mental health were measured by two items from the International Classification of Functioning, Disability and Health checklist. The Hospital Anxiety and Depression Scale was used to assess anxiety and depression. Subjective burden was assessed with the Carers' Assessment of Difficulties Index (CADI). Descriptive and inferential analyses were performed. RESULTS A total of 167 family carers participated: 113 were caring for people with early and 54 with advanced COPD. Both groups presented anxiety/depression symptoms. Those caring for people with advanced COPD reported higher subjective burden, more depression symptoms and poorer self-rated mental health than those caring for early COPD. Advanced COPD (coefficient 6.7), depression (coefficient 6.3), anxiety (coefficient 5.6), care-giving hours per week (coefficient 3.2) and self-rated mental health (coefficient 2.8) were significant predictors of carers' subjective burden. CONCLUSION The findings suggest that the gradual course of COPD imposes an increasing physical and emotional burden on carers, with negative impacts on their psychological health. The study highlights the relevance of early interventions in the context of COPD to prevent carers' burden.
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Affiliation(s)
- Daniela Figueiredo
- a School of Health Sciences , University of Aveiro (ESSUA) , Aveiro, Portugal
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47
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Dignani L, Toccaceli A, Guarinoni MG, Petrucci C, Lancia L. Quality of Life in Chronic Obstructive Pulmonary Disease: An Evolutionary Concept Analysis. Nurs Forum 2014; 50:201-13. [PMID: 25155165 DOI: 10.1111/nuf.12110] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM To explore the concept of quality of life (QoL) of people with chronic obstructive pulmonary disease (COPD) in the nursing context. BACKGROUND The issue of QoL takes on a leading role in the COPD field because it is an incurable pathology. Despite its relevance, this concept is quite ambiguous, and there is no consensus of opinion in the literature regarding its definition. DESIGN AND METHODS Rodgers' method of evolutionary concept analysis was employed to delineate and clarify the concept of QoL in COPD. An electronic review was made on scientific databases from 2008 to 2013. The 75 selected articles were analyzed in order to highlight the main themes related to QoL concept. RESULTS The QoL appears as a dynamic and multidimensional concept that evolves with the progression of the pathology and the impairment of health status. It has both subjective and objective characteristics, intrinsic and extrinsic elements. CONCLUSIONS This analysis provides an overview of the QoL concept related to COPD patients that is useful as a guide to research into nursing care and for clinical practice.
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Affiliation(s)
| | - Andrea Toccaceli
- Department of Health, Life and Environmental Sciences, Nursing Science Doctorate School, University of L'Aquila, L'Aquila, Italy
| | | | - Cristina Petrucci
- Department of Health, Life and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Loreto Lancia
- Department of Health, Life and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
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48
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Zakrisson AB, Theander K, Anderzén-Carlsson A. The experience of a multidisciplinary programme of pulmonary rehabilitation in primary health care from the next of kin's perspective: a qualitative study. PRIMARY CARE RESPIRATORY JOURNAL : JOURNAL OF THE GENERAL PRACTICE AIRWAYS GROUP 2014; 22:459-65. [PMID: 24301859 PMCID: PMC6442863 DOI: 10.4104/pcrj.2013.00094] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Pulmonary rehabilitation increases functional capacity and quality of life and decrease exacerbations in patients with chronic obstructive pulmonary disease (COPD), but there is little knowledge of how it influences their next of kin. AIMS To describe the experience of a multidisciplinary programme of pulmonary rehabilitation in primary health care from the perspective of the next of kin. METHODS A descriptive qualitative study was undertaken as part of a longitudinal study comprising a multidisciplinary programme for patients with COPD where the next of kin were invited to one session. Semi-structured interviews were conducted with 20 next of kin and analysed by qualitative content analysis. RESULTS One main theme emerged - Life still remains overshadowed by illness. There were three sub-themes: a sense of deepened understanding; a sense of personal vulerability; and a sense of relief of burden. CONCLUSIONS The next of kin's life was still overshadowed by illness, despite the multidisciplinary programme. Although experiencing positive outcomes two years after the programme, the next of kin expressed a need for more support. This study has shown that next of kin could benefit from their own participation and/or that of the patient in a multidisciplinary programme of pulmonary rehabilitation. We believe that next of kin should be offered primary health care support for the sake of their own health, but also in order to manage their informal caregiver role. The experiences described here could form a basis for further development of interventions for next of kin of patients with COPD.
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Affiliation(s)
- Ann-Britt Zakrisson
- Family Medicine Research Centre, Örebro, Sweden • School of Health and Medical Sciences, Örebro University, Sweden • Centre for Assessment of Medical Technology, Örebro, Sweden
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Yeh PM, Wierenga ME, Yuan SC. Influences of Psychological Well-being, Quality of Caregiver-patient Relationship, and Family Support on the Health of Family Caregivers for Cancer Patients in Taiwan. Asian Nurs Res (Korean Soc Nurs Sci) 2014; 3:154-66. [PMID: 25030627 DOI: 10.1016/s1976-1317(09)60027-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2009] [Revised: 08/24/2009] [Accepted: 11/16/2009] [Indexed: 10/20/2022] Open
Abstract
PURPOSE The purpose of this study was to examine the influences of psychological well-being, quality of caregiver-patient relationship, and family support on the health of family caregivers for cancer patients in a Taiwanese hospital. METHODS A cross-sectional, correlational design was used. A sample of 91 family caregivers of hospitalized cancer patients completed the Caregiver Reaction Assessment and Psychological Well-Being Scale. Pearson's product moment correlation and regression analyses were used to examine the data. RESULTS The psychological well-being and the quality of the caregiver-patient relationship of family caregivers were found to be significantly positively correlated with caregivers' health. The lack of family support was found to be significantly negatively correlated with caregivers' health. Psychological well-being, quality of caregiver-patient relationship, and family support accounted for 59% of the variance in caregivers' health. CONCLUSION The findings suggest that nurses, while providing care in the hospital and upon discharge need to be aware of the psychological well-being, quality of caregiver-patient relationship, and family support of a family caregiver, as these factors all have an impact on a family caregiver' health.
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Affiliation(s)
- Pi-Ming Yeh
- Department of Nursing, Missouri Western State University, Missouri, USA
| | - Mary E Wierenga
- College of Nursing, University of Wisconsin-Milwaukee, Wisconsin, USA
| | - Su-Chuan Yuan
- College of Nursing, Chung-Shan Medical University, Taichung, Taiwan
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50
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Abstract
Carers provide care because they want to help the people they care about, and because their care recipient could not manage without them. For many carers, looking after their own health, combining caring with work, getting access to training or having time off can be a major challenge. Patients' and carers' experiences of home-based care are a key factor in the appraisal of the quality of the professional care services they receive. This article presents the evidence from a literature review that builds a substantial body of knowledge to inform district nursing teams and community nurses to develop a supportive approach towards carers' needs. The aim of the study was to appraise the published evidence base relating to carers' needs and how professionals can support carers' needs when providing care to patients in the community. The studies consistently reported carers' requirements of practical support and information as a theme across studies, suggesting that effective ways of delivering information and support to caregivers need to be developed and implemented as a matter of priority. It also highlighted the needs of the professionals providing support to carers, to ensure the health and wellbeing needs of carers, to include signposting and referral to avoid reaching crisis point and resultant burnout.
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Affiliation(s)
- Michelle Laing
- Professional Lead for Adult Nursing, School of Nursing and Allied Health, Liverpool John Moores University
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