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

'Not a panacea' - Expert perspectives on the concept of resilience and its potential for palliative care

Background

Resilience is an increasingly used term in medicine and subject to various definitions, often not easy to grasp. There are established core concepts for patients receiving palliative care, for example, meaning in life, that have already been researched a lot. Resilience, relative to these concepts, is a new object of research in palliative care, where it has so far been used predominantly with regard to the well-being of teams.

Aim

To explore how experts in palliative care define the concept of resilience and its suitability for patients, significant others, and professionals.

Design

Qualitative study using summarizing content analysis according to Mayring.

Setting/participants

Twenty-one health and social care professionals with expertise caring for persons with life-threatening/limiting illnesses and their relatives were interviewed in three individual interviews and four focus groups. All conversations were recorded, transcribed, coded via MAXQDA, and validated by another researcher.

Results

Resilience has been described as something procedural, dynamic, individual, and flexible. In connection with well-known concepts such as posttraumatic growth or terms from the field of mindfulness, social environment or personal factors have also been linked to resilience. Resources such as spirituality can contribute to resilience, and resilience itself can function as a resource, for example, by contributing to quality of life. An active use of the term in practical work with patients or relatives is rare, but it is used in education or team measures. Limited lifespan can pose a challenge to an active use of the concept of resilience.

Conclusion

Resilience as a very individual approach provides added value to other core concepts of palliative care. Within the palliative context, the normative dimension of resilience must be well reflected. A broader definition of resilience is recommended, leaving room for everyone to find their own form of resilience. The concept of resilience in palliative care includes opportunities as well as risks and should, therefore, be implemented carefully, requiring specific training.

The Experiences of Close Relatives to Women with Chronic Obstructive Pulmonary Disease Stages III or IV: A Qualitative Study

Chronic obstructive pulmonary disease stage III or IV is a progressive and incurable disease. The hallmark of the disease is breathlessness, and it is graded into four different stages, from mild to severe. Living with chronic obstructive pulmonary disease impacts almost every aspect of everyday life for an affected person. As the illness progresses to stages III and IV, the need for support from close relatives increases. The aim of this study was to explore and describe the experiences of close relatives of women with chronic obstructive pulmonary disease stage III or IV and it used qualitative content analysis of individual, semi-structured interviews. Close relatives (n = 9) were interviewed about their experience of being close to a woman with chronic obstructive pulmonary disease stage III or IV. They experienced stress and uncertainty in an unpredictable everyday life. Close relatives supported the women both practically and emotionally and they called for tailored information about the illness, considering it as an essential tool for support. The results highlighted that healthy close relatives had difficulty in understanding the experience of living with chronic obstructive pulmonary, as they take the simple fact of breathing for granted most of the time.

Attitudes and perceptions of healthcare professionals related to family participation in surgical cancer care-A mixed method study

AIM

This study investigated healthcare professionals' attitudes and perceptions towards the family's participation in surgical cancer care.

DESIGN

A prospective mixed method study.

METHODS

The study was conducted at three hospitals in Sweden with registered nurses, assistant nurses and surgeons. Data included 43 completed Families Importance in Nursing Care (FINC-NA) questionnaires answered by registered nurses and qualitative data from 14 interviews with surgeons and assistant nurses. Data analysis was performed according to the Creswell convergent parallel mixed method.

RESULTS

Both quantitative and qualitative data demonstrated that the family was an important resource in nursing care, was highly valued as a conversational partner and had resources that should be considered. Each family should be supported in determining their role and as implements for maintaining a functioning family constellation and increasing their participation.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Carer preparedness improved by providing a supportive educational intervention for carers of patients with high-grade glioma: RCT results

BACKGROUND

High-grade glioma (HGG) is a rapidly progressing and debilitating disease. Family carers take on multiple responsibilities and experience high levels of distress. We aimed to deliver a nurse-led intervention (Care-IS) to carers to improve their preparedness to care and reduce distress.

METHODS

We conducted a randomised controlled trial (ACTRN:12612001147875). Carers of HGG patients were recruited during patients' combined chemoradiation treatment. The complex intervention comprised four components: (1) initial telephone assessment of carer unmet needs; (2) tailored hard-copy resource folder; (3) home visit; and, (4) monthly telephone support for up to 12 months. Primary outcomes included preparedness for caregiving and distress at 2, 4, 6 and 12 months. Intervention effects were estimated using linear mixed models which included a time by group interaction. Secondary outcomes included anxiety, depression, quality of life, carer competence and strain.

RESULTS

We randomised 188 carers (n = 98 intervention, n = 90 control). The intervention group reported significantly higher preparedness for caregiving at 4 months (model β = 2.85, 95% CI 0.76-4.93) and all follow-up timepoints including 12 months (model β = 4.35, 95% CI 2.08-6.62), compared to the control group. However, there was no difference between groups in carer distress or any secondary outcomes.

CONCLUSIONS

This intervention was effective in improving carer preparedness. However, carer distress was not reduced, potentially due to the debilitating/progressive nature of HGG and ongoing caring responsibilities. Future research must explore whether carer interventions can improve carer adjustment, self-efficacy and coping and how we support carers after bereavement. Additionally, research is needed to determine how to implement carer support into practice.

Adaptation and validation of an adult patient classification instrument with emphasis on the family dimension

Objectives:

to adapt and validate an instrument for classifying adult patients that emphasizes the family support network in the demand for nursing care.

Methods:

methodological study, carried out in three phases: adaptation of an instrument considering the reality of adult patients; content validation with seven experts and assessment of measurement properties (construct validity and internal consistency) with 781 hospitalized patients.

Results:

in content validation, the indicators reached the values established for the Content Validity Index (0.85-1.00). In the confirmatory factor analysis, the 11 indicators were distributed in three domains and presented average variance extracted and factor loading greater than 0.5. Composite reliability was greater than 0.7.

Conclusions:

the present study adapted and made available, with evidence of validity and reliability, an instrument for classifying adult patients that considers the family support network in the demand for nursing care.

Adaptação e validação de instrumento de classificação de paciente adulto com ênfase na dimensão familiar

RESUMO Objetivos: adaptar e validar um instrumento para classificação de pacientes adultos que enfatiza a rede de suporte familiar na demanda de cuidados de enfermagem. Métodos: estudo metodológico, realizado em três fases: adaptação de um instrumento considerando a realidade de pacientes adultos; validação de conteúdo com sete especialistas e avaliação das propriedades de medida (validade de construto e consistência interna) com 781 pacientes internados. Resultados: na validação de conteúdo, os indicadores alcançaram os valores estabelecidos para o Índice de Validade de Conteúdo (0,85-1,00). Na análise fatorial confirmatória, os 11 indicadores foram distribuídos em três domínios e apresentaram variância média extraída e carga fatorial superiores a 0,5. A confiabilidade composta foi superior a 0,7. Conclusões: o presente estudo adaptou e disponibilizou, com evidências de validade e confiabilidade, um instrumento para classificação de pacientes adultos que considera a rede de suporte familiar na demanda de cuidados de enfermagem.

Healthcare professionals' perceptions of psychosocial support for family members in palliative care inpatient units—A qualitative descriptive study

AIM

This study aimed to describe the psychosocial support healthcare professionals in specialist palliative inpatient units provide to family members of palliative care patients.

DESIGN

A qualitative descriptive design.

METHOD

The data were collected with focus group interviews and analysed with inductive content analysis.

RESULTS

Altogether, 48 healthcare professionals, including physicians, registered nurses and practical nurses, participated in the study. Information sharing was recognised as an essential element of support. Methods to improve support of family members included an opportunity to allocate recourses to the families, systematic support and strengthening healthcare professionals' competence in family care. The healthcare professionals describe their perceptions of psychosocial support for family members primarily through patient care and the patient's situation rather than family needs. Direct support for the family members is realised principally by information sharing and conversations. Healthcare professionals express their opportunities to implement support focusing on family members' needs restricted by reason of organisational resources. The information can be used when developing and improving family care in palliative care context to recognise the most relevant needs from healthcare professionals' perspective and also when implementing healthcare professionals' education and training.