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Clarke JJ, Halkett GKB, McDougall E, Dhillon HM, Lobb E, Phillips JL, Hudson P, Nowak AK. What do carers of people with high-grade glioma perceive could improve their preparedness to care, and what additional support do they require? Neurooncol Pract 2024; 11:296-306. [PMID: 38737602 PMCID: PMC11085844 DOI: 10.1093/nop/npae015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024] Open
Abstract
Background Concerning levels of stress, strain, and poorer mental health are observed in family carers of patients diagnosed with high-grade glioma (HGG). Understanding the reported unmet needs of these carers will enable future interventions to address such needs to improve their preparedness for care and well-being. In this secondary analysis, we aimed to explore: (i) what carers of people with HGG perceive could improve their preparedness to care; and (ii) what needs carers reported they required additional support with. Methods Responses from 188 carers of patients with HGG participating in a randomized controlled trial of the Care-IS intervention were analyzed to identify reported unmet needs. Of this larger sample, 92 participants answered a qualitative question seeking to identify perceived unmet needs in carer preparedness over 12 months. These responses comprised the data for the current secondary analysis. Content analysis was used to analyze the qualitative data and observe trends across participant responses. Results Five overarching themes were identified: carer needs, providing emotional and practical care, coping with uncertainty, coping with the consequences of illness progression, and processing and supporting end-of-life care. Notably, the content analysis identified differences in response numbers between groups in the Care-IS trial, particularly with the control group having more needs regarding illness progression and end-of-life care. Conclusions Future interventions aimed at improving the well-being and preparedness of carers of people with HGG should consider providing better support centered on carer needs, their changed circumstances, living with uncertainty, and care transition.
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Affiliation(s)
- James J Clarke
- Faculty of Health Sciences, Curtin School of Nursing/Curtin Health Innovation Research Institute, Curtin University, Bentley, Western Australia, Australia
- Faculty of Health Sciences, Curtin School of Population Health/Curtin EnAble Institute, Curtin University, Bentley, Western Australia, Australia
| | - Georgia K B Halkett
- Faculty of Health Sciences, Curtin School of Nursing/Curtin Health Innovation Research Institute, Curtin University, Bentley, Western Australia, Australia
| | - Emma McDougall
- Faculty of Health Sciences, Curtin School of Nursing/Curtin Health Innovation Research Institute, Curtin University, Bentley, Western Australia, Australia
| | - Haryana M Dhillon
- Faculty of Science, Psycho-Oncology Cooperative Research Group, School of Psychology, University of Sydney, Sydney, Australia
- Centre for Medical Psychology & Evidence-based Decision-making, Sydney, Australia
| | - Elizabeth Lobb
- Faculty of Health, ImPACCT, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Jane L Phillips
- Faculty of Health, ImPACCT, University of Technology Sydney, Ultimo, New South Wales, Australia
- Faculty of Health, School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Peter Hudson
- Centre for Palliative Care, St Vincent’s Hospital Melbourne, Melbourne, Victoria, Australia
- Department of Nursing, University of Melbourne, Melbourne, Victoria, Australia
- End of LIfe Research Department, Vrije University Brussels, Brussels, Belgium
| | - Anna K Nowak
- University of Western Australia, Crawley, Western Australia, Australia
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Salazar MM, Khera N, Chino F, Johnston E. Financial hardship for patients with cancer and caregivers at end of life in the USA: narrative review. BMJ Support Palliat Care 2024; 14:25-35. [PMID: 38123962 DOI: 10.1136/spcare-2023-004556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 11/16/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Patients and their families face financial hardship during cancer treatment, which may intensify at end of life (EOL) due to increased symptoms and care needs. We undertook a narrative literature review to describe the current understanding of the causes, impacts and factors associated with financial hardship at EOL. We identify gaps in research, policy and clinical practice and propose steps to mitigate financial hardship for patients and caregivers at EOL. METHODS We conducted a Medline search to identify US studies since 2000 that examined EOL financial hardship for patients with cancer and their caregivers. RESULTS Twenty-seven adult and four paediatric studies met review criteria. Adults with cancer and their caregivers face significant financial hardship at EOL and in bereavement, especially due to employment changes and informal caregiving time costs. Financial hardship may be higher for younger caregivers and for patients who are uninsured, low income, rural, with high symptom burdens or with certain cancer types. The few paediatric studies showed high financial hardship and employment impact lasting well beyond a child's death. CONCLUSIONS There is limited literature examining financial hardship at EOL in the USA, especially in paediatrics. Priorities for future research include longitudinal studies in diverse populations of patients with cancer and informal caregivers using standardised financial hardship measures. Policies to address financial hardship at EOL, especially with hospice care, should include insurance coverage for family caregiving and medical leave policies. There is need for increased financial hardship screening at EOL and in bereavement and a need for financial navigation interventions.
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Affiliation(s)
- Marisa Martinez Salazar
- School of Medicine, Mayo Clinic School of Medicine-Scottsdale Campus, Scottsdale, Arizona, USA
| | - Nandita Khera
- Mayo Clinic School of Medicine, Phoenix, Arizona, USA
| | - Fumiko Chino
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Emily Johnston
- Pediatrics, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
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Thaqi Q, Riguzzi M, Blum D, Peng-Keller S, Lorch A, Naef R. End-of-life and bereavement support to families in cancer care: a cross-sectional survey with bereaved family members. BMC Health Serv Res 2024; 24:155. [PMID: 38303007 PMCID: PMC10832212 DOI: 10.1186/s12913-024-10575-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 01/08/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Losing a close other to cancer is an incisive experience that occurs after a long course of illness and intense family caregiving. Despite an evident need for family engagement and support and guidance on this, patients and family members may not receive the attention and support they need when a family unit is experiencing a disruption by death. A clear understanding of the quality of care that is currently provided and its ability to address family needs is necessary to improve end-of-life and bereavement support to families affected by cancer. The purpose of this study is to investigate the quality of support of end-of-life and bereavement care to families, their (un)met needs, grief experiences, and self-perceived health outcomes. METHODS A multi-center, cross-sectional observational survey study with family members (n = 35) whose close other died of cancer in a health institution or their own home in German-speaking Switzerland. RESULTS Bereaved family members were mostly satisfied with end-of-life care. Information on the grief process and services, and acknowledgment of their grief was experienced as helpful. Most coped with their grief drawing on family resources and exhibited resilience, but they reported unmet needs in relation to family togetherness and caregiving. CONCLUSION This study with a small number of family members indicates that support provided to families across settings and illness trajectories is perceived as helpful, with specific needs related to family support. The findings suggest that improvements should focus on ensuring care that addresses the family as a unit and enables togetherness, mutual reflection, meaningful relationships, preparedness for death, resilience, and benefit-finding. PROTOCOL REGISTRATION https://osf.io/j4kfh .
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Affiliation(s)
- Qëndresa Thaqi
- Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Universitaetstrasse 84, 8006, Zurich, Switzerland
- Centre of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland
| | - Marco Riguzzi
- Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Universitaetstrasse 84, 8006, Zurich, Switzerland
- Centre of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland
| | - David Blum
- Competence Centre for Palliative Care, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Centre for Palliative Care, City Hospital Zurich, Zurich, Switzerland
| | - Simon Peng-Keller
- Spiritual Care, Faculty of Theology, University of Zurich, Zurich, Switzerland
| | - Anja Lorch
- Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland
| | - Rahel Naef
- Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Universitaetstrasse 84, 8006, Zurich, Switzerland.
- Centre of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland.
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4
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Wen FH, Hou MM, Su PJ, Shen WC, Chou WC, Chen JS, Chang WC, Tang ST. Factors of preparedness for loss from cancer among Taiwanese family caregivers. DEATH STUDIES 2024; 48:630-639. [PMID: 38236991 DOI: 10.1080/07481187.2024.2305340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
This cohort study investigated factors associated with 336 Taiwanese family caregivers' emotional and cognitive preparedness for death of a loved one with terminal cancer. Caregivers' death-preparedness states (no-death-preparedness [as reference], cognitive-death-preparedness-only, emotional-death-preparedness-only, and sufficient-death-preparedness states) were previously identified. Associations of factors with these states were determined by a hierarchical generalized linear model. Financial hardship decreased caregivers' likelihood for the emotional-death-preparedness-only and sufficient-death-preparedness states. Physician prognostic disclosure increased membership in the cognitive-death-preparedness-only and sufficient-death-preparedness states. The better the quality of the patient-caregiver relationship, the higher the odds for the emotional-death-preparedness-only and sufficient-death-preparedness states, whereas the greater the tendency for caregivers to communicate end-of-life issues with their loved one, the lower the odds for emotional-death-preparedness-only state membership. Stronger coping capacity increased membership in the emotional-death-preparedness-only state, but perceived social support was not associated with state membership. Providing effective interventions tailored to at-risk family caregivers' specific needs may facilitate their death preparedness.
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Affiliation(s)
- Fur-Hsing Wen
- Department of International Business, Soochow University, Taipei, Taiwan, ROC
| | - Ming-Mo Hou
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, ROC
| | - Po-Jung Su
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, ROC
| | - Wen-Chi Shen
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, ROC
| | - Wen-Chi Chou
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, ROC
- College of Medicine, Chang Gung University, Tao-Yuan, Taiwan, ROC
| | - Jen-Shi Chen
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, ROC
- College of Medicine, Chang Gung University, Tao-Yuan, Taiwan, ROC
| | - Wen-Cheng Chang
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, ROC
- College of Medicine, Chang Gung University, Tao-Yuan, Taiwan, ROC
| | - Siew Tzuh Tang
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, ROC
- School of Nursing, Chang Gung University, Tao-Yuan, Taiwan, ROC
- Department of Nursing, Chang Gung Memorial Hospital at Kaohsiung, Taiwan, ROC
- Department of Nursing, Chang Gung University of Science and Technology, Tao-Yuan, Taiwan, ROC
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Matsuzaka S, Ohba A, Masukawa K, Aoyama M, Morita T, Kizawa Y, Tsuneto S, Shima Y, Miyashita M. Factors associated with the preparedness for bereavement in families of patients with cancer: A secondary analysis of a nationwide bereaved family survey. Psychooncology 2024; 33:e6276. [PMID: 38282233 DOI: 10.1002/pon.6276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 11/29/2023] [Accepted: 12/13/2023] [Indexed: 01/30/2024]
Abstract
OBJECTIVES Insufficient preparedness for bereavement can affect a family's psychological health status after bereavement. However, factors associated with preparedness remain unclear. This study aimed to identify factors associated with preparedness for bereavement in families of patients with cancer. METHODS We conducted a secondary analysis of a nationwide bereaved family survey in Japan, analyzing data from 9123 family members of patients with cancer. Logistic regression analysis was conducted to explore how sociodemographic factors, health status, and perceived care for patients and families were associated with preparedness for bereavement. RESULTS Of the 9123 families, 1338 (15.1%) were not prepared for bereavement. Factors associated with insufficient preparedness for bereavement (all p < 0.001) were found as follows: patients' spouses (OR = 2.54), receiving care in acute hospitals (OR = 1.83), worse psychological health status during caregiving (OR = 2.13), lower social support for family members (OR = 1.90), wrong patients' awareness of medical condition from family's perspective (OR = 1.75-2.12), family preference of more aggressive treatment rather than palliative care (OR = 1.71) or not sure (OR = 2.31), not wanting to know information about the patient's prognosis (OR = 1.64-1.77), end-of-life discussion with physician 1 month before patient's death (OR = 1.45), and late or early end-of-life discussions with physician and family (OR = 1.78-1.95). CONCLUSIONS This study's results might assist clinicians in assessing and identifying families who are not prepared for bereavement; however, preparedness for bereavement may have been associated with other factors.
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Affiliation(s)
- Sakiko Matsuzaka
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Akiho Ohba
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Kento Masukawa
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Maho Aoyama
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Palliative Care Team, Seirei Mikatahara General Hospital, Hamamtsu, Shizuoka, Japan
| | - Yoshiyuki Kizawa
- Department of Palliative and Supportive Care, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Satoru Tsuneto
- Department of Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yasuo Shima
- Department of Palliative Medicine, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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Walbaum C, Philipp R, Oechsle K, Ullrich A, Vehling S. Existential distress among family caregivers of patients with advanced cancer: A systematic review and meta-analysis. Psychooncology 2024; 33:e6239. [PMID: 37985531 DOI: 10.1002/pon.6239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 09/13/2023] [Accepted: 10/21/2023] [Indexed: 11/22/2023]
Abstract
OBJECTIVE Caregiving for a loved one is challenging and requires significant resources. Existential distress in family caregivers may include hopelessness, demoralization, fear of death, pre-loss grief, or a sense of not being emotionally prepared. The aim of this systematic review is to synthesize the quantitative literature on existential distress among family caregivers of patients with advanced cancer, focusing on its prevalence, association with mental disorders, as well as with sociodemographic, disease, and treatment-related factors. METHODS We systematically searched electronic databases for quantitative studies of the above-described existential distress concepts in family caregivers of patients with advanced cancer. Two independent reviewers extracted data and evaluated study quality. Data were analyzed using random-effects meta-analysis. RESULTS We retrieved 17.587 records, of which 31 studies fulfilled inclusion criteria. 63% of the studies (n = 20) provided sufficient data for meta-analysis for 5558 patients. We found an overall pooled prevalence of 30.6% for existential distress, 95% CI [24.2-37.0]. For existential distress subconcepts, prevalence rates were 57.0%, 95% CI [37.8-76.2], for death anxiety, 13.9%, 95% CI [10.8-17.0], for demoralization, 24.0%, 95% CI [18.0-30.0], for pre-loss grief, 18.4%, 95% CI [4.0-32.7], for hopelessness, 35.2%, 95% CI [28.2-42.2], for loneliness, and 35.6%, 95% CI [13.0-58.3], for emotional unpreparedness. CONCLUSIONS Approximately one third of the respondents were affected by high levels of existential distress. The review provides evidence for further development of support services that can reduce existential distress, focused on death anxiety, and improve the quality of life for family caregivers of patients with advanced cancer.
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Affiliation(s)
- Charlotte Walbaum
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Rebecca Philipp
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Karin Oechsle
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anneke Ullrich
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sigrun Vehling
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Bybee S, Hebdon M, Cloyes K, Hiatt S, Iacob E, Reblin M, Clayton M, Ellington L. Cancer caregivers at the end-of-life: How much me vs. how much we? PEC INNOVATION 2023; 3:100193. [PMID: 37554722 PMCID: PMC10404724 DOI: 10.1016/j.pecinn.2023.100193] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 07/18/2023] [Accepted: 07/24/2023] [Indexed: 08/10/2023]
Abstract
OBJECTIVE This study explored cancer caregivers' individual and communal coping through their use of personal and communal pronouns during naturally occurring conversations. METHODS Nurse-home hospice visits involving cancer patients and their partner caregivers were audio recorded and then transcribed. Pronoun use was analyzed using Linguistic Inquiry Word Count (LIWC) software and descriptive statistics compared patient and partner caregivers' pronoun use. Personal and communal pronoun use was examined within six identified topics of caregiver speech: patient medical care, daily life, emotion, criticism/disagreement, relationships with family/friends, and asserting needs. RESULTS Dyads (N = 76) had an average of 35.8 years in their relationship. Caregivers used proportionately more first-person singular (I-talk) than first-person plural (we-talk). However, they used significantly less I-talk than patients and less I-talk than LIWC measures in naturally occurring speech. Caregivers were most likely to discuss patient medical care (41.9%) and least likely to discuss their own needs (3.8%). CONCLUSION Partner caregivers may find it easier to express emotions related to communal stressors, rather than their individual ability to cope with end-of-life caregiving. INNOVATION Examining personal and communal pronoun use by partner caregivers during nurse-home hospice visits may provide a more objective measure of caregiver coping than standard self-report measures.
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Affiliation(s)
- Sara Bybee
- University of Utah College of Nursing, 10 S 2000 E, Salt Lake City, UT 84112, United States of America
| | - Megan Hebdon
- UT Austin School of Nursing, 1710 Red River St, Austin, TX 78712, United States of America
| | - Kristin Cloyes
- Oregon Health & Science University, 3455 SW US Veterans Hospital Rd., Portland, OR 97239-2941, United States of America
| | - Shirin Hiatt
- University of Utah College of Nursing, 10 S 2000 E, Salt Lake City, UT 84112, United States of America
| | - Eli Iacob
- University of Utah College of Nursing, 10 S 2000 E, Salt Lake City, UT 84112, United States of America
| | - Maija Reblin
- University of Vermont College of Medicine, Given Medical Building, E-126, 89 Beaumont Ave, Burlington, VT 05405, United States of America
| | - Margaret Clayton
- University of Utah College of Nursing, 10 S 2000 E, Salt Lake City, UT 84112, United States of America
| | - Lee Ellington
- University of Utah College of Nursing, 10 S 2000 E, Salt Lake City, UT 84112, United States of America
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Carr AL, Bilenduke E, Adolf E, Kessler ER, Arch JJ, Ranby KW, Kilbourn K. A pilot randomized study of a telephone-based cognitive-behavioral stress-management intervention to reduce distress in phase 1 oncology trial caregivers. Palliat Support Care 2023; 21:820-828. [PMID: 36994841 PMCID: PMC10544682 DOI: 10.1017/s1478951523000196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
OBJECTIVES Caregivers of adult phase 1 oncology trial patients experience high levels of distress and face barriers to in-person supportive care. The Phase 1 Caregiver LifeLine (P1CaLL) pilot study assessed the feasibility, acceptability, and general impact of an individual telephone-based cognitive behavioral stress-management (CBSM) intervention for caregivers of phase I oncology trial patients. METHODS The pilot study involved 4 weekly adapted CBSM sessions followed by participant randomization to 4 weekly cognitive behavioral therapy sessions or metta-meditation sessions. A mixed-methods design used quantitative data from 23 caregivers and qualitative data from 5 caregivers to examine the feasibility and acceptability outcomes. Feasibility was determined using recruitment, retention, and assessment completion rates. Acceptability was assessed with self-reported satisfaction with program content and participation barriers. Baseline to post-intervention changes in caregiver distress and other psychosocial outcomes were assessed for the 8-session intervention. RESULTS The enrollment rate was 45.3%, which demonstrated limited feasibility based on an a priori criterion enrollment rate of 50%. Participants completed an average of 4.9 sessions, with 9/25 (36%) completing all sessions and an 84% assessment completion rate. Intervention acceptability was high, and participants found the sessions helpful in managing stress related to the phase 1 oncology trial patient experience. Participants showed reductions in worry and isolation and stress. SIGNIFICANCE OF RESULTS The P1CaLL study demonstrated adequate acceptability and limited feasibility and provided data on the general impact of the intervention on caregiver distress and other psychosocial outcomes. Caregivers of phase 1 oncology trial patients would benefit from supportive care services; a telephone-based intervention may have more utilization and thus make a larger impact.
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Affiliation(s)
- Alaina L. Carr
- Department of Psychology, University of Colorado Denver, Denver, CO, USA
- Lombardi Comprehensive Cancer Center, Cancer Prevention and Control, Washington, DC, USA
| | - Emily Bilenduke
- Department of Psychology, University of Colorado Denver, Denver, CO, USA
| | - Esmeralda Adolf
- Department of Psychology, University of Colorado Denver, Denver, CO, USA
| | - Elizabeth R. Kessler
- Division of Medical Oncology, Department of Medicine, University of Colorado, Aurora, CO, USA
| | - Joanna J. Arch
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, USA
| | - Krista W. Ranby
- Department of Psychology, University of Colorado Denver, Denver, CO, USA
| | - Kristin Kilbourn
- Department of Psychology, University of Colorado Denver, Denver, CO, USA
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Economos AD, Kluemper T, Woods R. The lived experiences of young adults grieving an intimate partner or spouse: A phenomenological pilot study. DEATH STUDIES 2023; 48:600-608. [PMID: 37676793 DOI: 10.1080/07481187.2023.2253771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
This pilot study explored the lived experiences of six young adults between the ages of 18-32 years grieving an intimate partner or spouse. Through Moustakas's (1994) steps of transcendental phenomenological analysis, four key themes revealed a traumatic initial period after the death, the importance of helpful vs dismissive community support, a continuation of meaningful activities and ritual to honor the deceased, and significant shifts in participants' life plans and worldviews. These themes suggest that clinicians may consider facilitating identity-restructuring exercises (e.g., journaling) and inclusive community spaces to support this unique population of grievers. Implications for future research are discussed, including the suggestion to create more targeted inclusion criteria to improve the clinical relevance of results in future studies.
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Affiliation(s)
- Alexa D Economos
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Tamara Kluemper
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Regina Woods
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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10
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Lombardo L, Veneziani G, Giraldi E, Morelli E, Durante S, Aceto P, Lai C. How attachment style, mentalization and preparedness for death are associated with pre-loss grief symptoms' severity: A network analysis study in caregivers of terminally ill cancer patients. DEATH STUDIES 2023; 48:537-549. [PMID: 37565791 DOI: 10.1080/07481187.2023.2246022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
Several psychological dimensions influence the psychological adjustment of terminally ill cancer patients' caregivers, during the end-of-life phase. The present study explored the associations between attachment styles, mentalization, preparedness for death, and the severity of pre-loss grief symptoms in 102 caregivers of terminal cancer patients. The results of the network analysis showed that insecure attachment dimensions were positively associated with several central pre-loss grief symptoms. Mentalization and preparedness for death showed negative associations with several pre-loss grief symptoms. Interestingly, bitterness showed a negative association with need for approval and a positive association with mentalization. The results provided insight into the grieving process for palliative care providers to implement effective caregiver support interventions.
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Affiliation(s)
- Luigi Lombardo
- Centro di Cure Palliative, Fondazione Sanità e Ricerca, Rome, Italy
| | - Giorgio Veneziani
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
| | - Emanuele Giraldi
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
| | - Emanuela Morelli
- Centro di Cure Palliative, Fondazione Sanità e Ricerca, Rome, Italy
| | - Sieva Durante
- Centro di Cure Palliative, Fondazione Sanità e Ricerca, Rome, Italy
| | - Paola Aceto
- Department of Emergency, Anesthesiological and Reanimation Sciences, Università Cattolica del Sacro Cuore di Roma, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Carlo Lai
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
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11
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Hasdenteufel M, Quintard B. Psychosocial factors affecting the bereavement experience of relatives of palliative-stage cancer patients: a systematic review. Palliat Care 2022; 21:212. [PMID: 36451118 PMCID: PMC9713164 DOI: 10.1186/s12904-022-01096-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 11/07/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Cancer is one of the leading causes of death worldwide and a cancer death is a major risk factor for pathological bereavement. This systematic review of the literature aimed to identify biopsychosocial and existential determinants specific to the palliative phase of cancer that influence the grieving experience of the caregiving relative. METHOD A systematic review of the literature was conducted without language or time restrictions. The Cairn, Cochrane Library, PubMed, PsycArticle, PsychInfo, Psychology and Behavioral Sciences Collection databases were explored. All studies assessing pre- and post-death measures and focusing on friends and relatives caring for adults with cancer in palliative care services were included in the review. RESULTS Out of 645 articles identified, 18 full text studies were finally included in our systematic review of the literature. Many factors specific to the cancer palliative phase were identified as influencing the bereavement experience of caregivers, with factors relating to: 1) the caregiver (e.g. social support, psychological burden, preparation for loss, action and discussion related to death); 2) the patient (e.g. denial or acceptance); 3) the interactions between patient and their caregivers (e.g. tensions, communication difficulties, and presence at the time of death); and 4) the end-of-life context. The caregiver's grief experience can be described by the following terms: typical and pathological grief, anxiety, depression, guilt, psychological distress, post-traumatic stress disorder and post-traumatic growth, and life satisfaction. CONCLUSIONS Many contextual, sociodemographic, dispositional and transactional factors specific to the palliative cancer phase are involved in the caregiver's grieving experience. Avenues for reflection and recommendations are proposed including supporting communication and patient-relative relationships, evaluating the nature and degree of functionality of coping strategies, strengthening the robustness of methodologies, considering impact of COVID-19, and new lines of enquiry for research.
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Affiliation(s)
- Marie Hasdenteufel
- grid.412041.20000 0001 2106 639XLaboratoire de Psychologie EA 4139, Université de Bordeaux, Faculté de Psychologie, 3 Ter, Place de La Victoire, 33076 Bordeaux-Cedex, France
| | - Bruno Quintard
- grid.412041.20000 0001 2106 639XLaboratoire de Psychologie EA 4139, Université de Bordeaux, Faculté de Psychologie, 3 Ter, Place de La Victoire, 33076 Bordeaux-Cedex, France
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12
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Schmidt V, Kaiser J, Treml J, Kersting A. Factors associated with pre-loss grief and preparedness in relatives of people with cancer during the COVID-19 pandemic: A cross-sectional study. PLoS One 2022; 17:e0278271. [PMID: 36445887 PMCID: PMC9707745 DOI: 10.1371/journal.pone.0278271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 11/13/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Before the loss of a loved one to cancer, relatives have time to adapt to the impending death. However, due to the current COVID-19 pandemic, adjustment to an imminent death may be more difficult. This study investigates factors related to pre-loss grief and preparedness during the COVID-19 pandemic and their relationship with COVID-19 related fears. METHODS Data of 299 participants from a cross-sectional study was used. Participants were included if they were relatives of people with cancer, spoke German and were at least 18 years. Multivariate linear regression analyses were conducted to measure the relationship between predictors (dysfunctional coping, emotion-focused coping, problem-focused coping, attachment anxiety, attachment avoidance, COVID-19 related fears, prognosis, perceived depth of the relationship, perceived conflict in the relationship, health status) and pre-loss grief, preparedness for caregiving and preparedness for death as the dependent variables. RESULTS Perceived depth (β = .365, p < .001), COVID-19 related fears (β = .141, p = .002), prognosis for death (β = .241, p < .001), dysfunctional coping strategies (β = .281, p < .001) and emotion-focused coping strategies (β = -.320, p < .001) significantly predicted pre-loss grief. Prognosis for death (β = .347, p < .001), dysfunctional coping strategies (β = -.229, p < .001), emotion-focused coping strategies (β = .242, p < .001), COVID-19 related fears (β = -.112, p = .037) and health status (β = .123, p = .025) significantly predicted preparedness for death. Dysfunctional coping (β = -.147, p = .009), problem-focused coping (β = .162, p = .009), emotion-focused coping (β = .148, p = .017), COVID-19 related fears (β = -.151, p = .006), attachment anxiety (β = -.169, p = .003), perceived conflict in the relationship with the patient with cancer (β = -.164, p = .004), perceived depth in the relationship (β = .116, p = .048) and health status (β = .157, p = .003) significantly predicted preparedness for caregiving. CONCLUSIONS This study shows COVID-19 pandemic impacts on the grieving process of relatives of patients with cancer. Consequently, screening for pre-loss grief, preparedness and their associated factors may help provide early support for relatives of people with cancer at need. However, further research is needed to help understand the stability of pre-loss grief and preparedness.
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Affiliation(s)
- Viktoria Schmidt
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - Julia Kaiser
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - Julia Treml
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - Anette Kersting
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
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13
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Schmidt V, Kaiser J, Treml J, Kersting A. The Relationship Between Pre-Loss Grief, Preparedness and Psychological Health Outcomes in Relatives of People With Cancer. OMEGA-JOURNAL OF DEATH AND DYING 2022:302228221142675. [PMID: 36420732 DOI: 10.1177/00302228221142675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
The aim of this study was to examine the simultaneous effects of pre-loss grief, preparedness for death and preparedness for caregiving on different psychological health outcomes in relatives of people with cancer. Two hundred ninety-nine relatives of people with cancer participated in a cross-sectional online survey. Participants were included if they spoke German and were 18 years or older. Multivariate regression analysis was conducted. Pre-loss grief was significantly associated with depression (β = .388, p < .001), anxiety (β = .429, p < .001), somatization (β = .221, p < .001) and satisfaction with life (β = -.205, p < .001). Preparedness for death was significantly associated with somatization (β = -.247, p < .001). Results suggest that people with high scores in pre-loss grief and low scores in preparedness for death are in need of early support. Interventions should address pre-loss grief and the various aspects of preparedness for death and take into account the psychological health in relatives of people with cancer. Future studies should investigate underlying mechanisms.
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Affiliation(s)
- Viktoria Schmidt
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - Julia Kaiser
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - Julia Treml
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - Anette Kersting
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
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14
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Wen FH, Chou WC, Hou MM, Su PJ, Shen WC, Chen JS, Chang WC, Hsu MH, Tang ST. Caregivers' Death-Preparedness States Impact Caregiving Outcomes and Patients' End-of-Life Care. J Pain Symptom Manage 2022; 63:199-209. [PMID: 34563630 DOI: 10.1016/j.jpainsymman.2021.09.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 09/13/2021] [Accepted: 09/15/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND/OBJECTIVE Preparing family caregivers, cognitively, emotionally, and behaviorally, for their relative's death is an actionable component of high-quality end-of-life care. We aimed to examine the never-before-examined associations of conjoint cognitive prognostic awareness and emotional preparedness for death with caregiving outcomes and end-of-life care received by cancer patients. DESIGN/SETTING/PARTICIPANTS/MAIN MEASURES For this longitudinal study, associations of death-preparedness states (no-death-preparedness, cognitive-death-preparedness-only, emotional-death-preparedness-only, and sufficient-death-preparedness states) with subjective caregiving burden, depressive symptoms, and quality of life (QOL) and patients' end-of-life care (chemotherapy and/or immunotherapy, cardiopulmonary resuscitation, intensive care unit care, intubation, mechanical ventilation support, vasopressors, nasogastric tube feeding, and hospice care) were evaluated using multivariate hierarchical linear and logistic regression modeling, respectively, for 377 caregivers in cancer patients' last 6 months and 1 month, respectively. KEY RESULTS Caregivers in the cognitive-death-preparedness-only state experienced a higher level of subjective caregiving burden than those in the sufficient-death-preparedness state. Caregivers in the no-death-preparedness and cognitive-death-preparedness-only states reported significantly more depressive symptoms and worse QOL than those in the sufficient-death-preparedness state. Cancer patients with caregivers in the sufficient-death-preparedness state were less likely to receive chemotherapy and/or immunotherapy, intubation, mechanical ventilation, and nasogastric tube feeding than patients with caregivers in other death-preparedness states. However, patients' receipt of hospice care was not associated with their caregivers' death-preparedness states. CONCLUSION Family caregivers' death-preparedness states were associated with caregiving outcomes and their relative's end-of-life care. Cultivating caregivers' accurate prognostic awareness and improving their emotional preparedness for their relative's death may facilitate more favorable end-of-life-caregiving outcomes and may limit potentially nonbeneficial end-of-life care.
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Affiliation(s)
- Fur-Hsing Wen
- Department of International Business (F-H.W.), Soochow University, Taipei, Taiwan, Republic of China
| | - Wen-Chi Chou
- Division of Hematology-Oncology (W-C. C, M-M.H, P.J.S., W-C.S., J.-S.C., W-C.C., S.T.T.), Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, Republic of China; College of Medicine (W-C.C., J-S.C., W-C.C.), Chang Gung University, Tao-Yuan, Taiwan, Republic of China
| | - Ming-Mo Hou
- Division of Hematology-Oncology (W-C. C, M-M.H, P.J.S., W-C.S., J.-S.C., W-C.C., S.T.T.), Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, Republic of China
| | - Po-Jung Su
- Division of Hematology-Oncology (W-C. C, M-M.H, P.J.S., W-C.S., J.-S.C., W-C.C., S.T.T.), Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, Republic of China
| | - Wen-Chi Shen
- Division of Hematology-Oncology (W-C. C, M-M.H, P.J.S., W-C.S., J.-S.C., W-C.C., S.T.T.), Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, Republic of China
| | - Jen-Shi Chen
- Division of Hematology-Oncology (W-C. C, M-M.H, P.J.S., W-C.S., J.-S.C., W-C.C., S.T.T.), Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, Republic of China; College of Medicine (W-C.C., J-S.C., W-C.C.), Chang Gung University, Tao-Yuan, Taiwan, Republic of China
| | - Wen-Cheng Chang
- Division of Hematology-Oncology (W-C. C, M-M.H, P.J.S., W-C.S., J.-S.C., W-C.C., S.T.T.), Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, Republic of China; College of Medicine (W-C.C., J-S.C., W-C.C.), Chang Gung University, Tao-Yuan, Taiwan, Republic of China
| | - Mei Huang Hsu
- School of Nursing (M.H.H., S.T.T.), Chang Gung University, Tao-Yuan, Taiwan, Republic of China
| | - Siew Tzuh Tang
- Division of Hematology-Oncology (W-C. C, M-M.H, P.J.S., W-C.S., J.-S.C., W-C.C., S.T.T.), Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, Republic of China; School of Nursing (M.H.H., S.T.T.), Chang Gung University, Tao-Yuan, Taiwan, Republic of China; Department of Nursing (S.T.T.), Chang Gung Memorial Hospital at Kaohsiung, Taiwan, Republic of China.
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15
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Tay DL, Iacob E, Reblin M, Cloyes KG, Jones M, Hebdon MCT, Mooney K, Beck AC, Ellington L. What contextual factors account for anxiety and depressed mood in hospice family caregivers? Psychooncology 2022; 31:316-325. [PMID: 34510631 PMCID: PMC8818016 DOI: 10.1002/pon.5816] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/30/2021] [Accepted: 08/31/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE End-of-life caregiving is associated with poorer mental health compared with other caregiving. The objective of this study was to examine the association between contextual characteristics and appraisal factors on family caregivers' mental health and well-being. METHODS Family hospice caregivers were recruited across four states using a non-probabilistic sampling approach. This study analyzed contextual (demographic, caregiving, economic) and appraisal factors (Medical Outcomes Study Social Support Survey, Zarit Burden Interview) on caregivers' anxiety and depression (Hospital Anxiety and Depression scale, and positive affect and well-being (Positive Affect and Well-being Scale). Hierarchical linear regression models were generated in SPSS version 24. RESULTS Data from 102 family caregivers were analyzed. On average, participants were 58.93 years of age (SD = 14.24), mostly female (72.55%), spouses/partners (51.96%), and non-Hispanic White (78.43%). Most (75.49%) described their financial situation as comfortable or more than adequate. Younger age (B = -0.11, 95% CI = -0.18 to -0.05) and increased caregiving burden (B = 0.18, 95% CI = 0.09 to 0.27) were associated with increased anxiety, while lower perceived financial adequacy (B = -1.19, 95% CI = -2.07 to -0.32), lower social support (B = -0.04, 95% CI = -0.06 to -0.01), and increased caregiving burden (B = 0.15, 95% CI = 0.08-0.22) were associated with worsened depression. Greater social support (B = 0.10, 95% CI = 0.05-0.14) and lower caregiving burden (B = -0.19, 95% CI = -0.32 to -0.07) were associated with greater positive affect and well-being. CONCLUSIONS Findings suggest significant impact of contextual factors on mental health and well-being, and support the need for holistic assessment of hospice caregivers' wellbeing and programs and policies providing social services and economic support to caregivers.
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Affiliation(s)
| | - Eli Iacob
- College of Nursing, University of Utah, USA
| | - Maija Reblin
- Department of Family Medicine, University of Vermont, USA
| | | | - Miranda Jones
- Department of Psychology, University of Michigan, USA
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16
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Wen FH, Chou WC, Hou MM, Su PJ, Shen WC, Chen JS, Chang WC, Hsu MH, Tang ST. Associations of death-preparedness states with bereavement outcomes for family caregivers of terminally ill cancer patients. Psychooncology 2021; 31:450-459. [PMID: 34549848 DOI: 10.1002/pon.5827] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 08/28/2021] [Accepted: 09/17/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Death preparedness involves cognitive prognostic awareness and emotional acceptance of a relative's death. Effects of retrospectively assessed cognitive prognostic awareness and emotional preparedness for patient death have been individually investigated among bereaved family caregivers. We aimed to prospectively examine associations of caregivers' death-preparedness states, determined by conjoint cognitive prognostic awareness and emotional preparedness for death, with bereavement outcomes. METHODS Associations of caregivers' death-preparedness states (no-death-preparedness, cognitive-death-preparedness-only, emotional-death-preparedness-only, and sufficient-death-preparedness states) at last preloss assessment with bereavement outcomes over the first two bereavement years were evaluated among 332 caregivers of advanced cancer patients using hierarchical linear models with the logit-transformed posterior probability for each death-preparedness state. RESULTS Caregivers with a higher logit-transformed posterior probability for sufficient death-preparedness state reported less prolonged-grief symptoms, lower likelihoods of severe depressive symptoms and heightened decisional regret, and better mental health-related quality of life (HRQOL). Caregivers with a higher logit-transformed posterior probability for no-death-preparedness state reported less prolonged-grief symptoms, a lower likelihood of severe depressive symptoms, and better mental HRQOL. A higher logit-transformed posterior probability for cognitive-death-preparedness-only state was associated with bereaved caregivers' higher likelihood of heightened decisional regret, whereas that for emotional-death-preparedness-only state was not associated with caregivers' bereavement outcomes. CONCLUSIONS Caregivers' bereavement outcomes were associated with their preloss death-preparedness states, except for physical health-related QOL. Interventions focused on not only cultivating caregivers' accurate prognostic awareness but also adequately preparing them emotionally for their relative's forthcoming death are actionable opportunities for high-quality end-of-life care and are urgently warranted to facilitate caregivers' bereavement adjustment.
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Affiliation(s)
- Fur-Hsing Wen
- Department of International Business, Soochow University, Taipei, Taiwan, ROC
| | - Wen-Chi Chou
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, ROC.,School of Medicine, Chang Gung University, Tao-Yuan, Taiwan, ROC
| | - Ming-Mo Hou
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, ROC
| | - Po-Jung Su
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, ROC
| | - Wen-Chi Shen
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, ROC
| | - Jen-Shi Chen
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, ROC.,School of Medicine, Chang Gung University, Tao-Yuan, Taiwan, ROC
| | - Wen-Cheng Chang
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, ROC.,School of Medicine, Chang Gung University, Tao-Yuan, Taiwan, ROC
| | - Mei Huang Hsu
- School of Nursing, Chang Gung University, Tao-Yuan, Taiwan, ROC
| | - Siew Tzuh Tang
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, ROC.,School of Nursing, Chang Gung University, Tao-Yuan, Taiwan, ROC.,Department of Nursing, Chang Gung Memorial Hospital at Kaohsiung, Taiwan, ROC
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Treml J, Schmidt V, Nagl M, Kersting A. Pre-loss grief and preparedness for death among caregivers of terminally ill cancer patients: A systematic review. Soc Sci Med 2021; 284:114240. [PMID: 34303292 DOI: 10.1016/j.socscimed.2021.114240] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 07/15/2021] [Accepted: 07/16/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Cancer is one of the most common causes of death. The period of time between receiving a terminal diagnosis of cancer and the death of a loved one has been operationalized as pre-loss grief and, more recently, as preparedness for death. Originally, grief before loss was thought to have positive effects on the bereavement outcome, but some studies have revealed contradictory findings. This systematic review investigates definitions and measurement tools of pre-loss grief and preparedness for death, as well as the associations of both constructs with caregiver characteristics, pre-loss psychological aspects and post-loss adjustment among caregivers of people living with terminal cancer. METHODS PubMed/Medline, PsycINFO and Web of Science were searched for studies published up until October 2020. Quantitative empirical studies from peer reviewed journals were included if a measurement tool for pre-loss grief or preparedness for death was used and if they focused on adult caregivers of adult people with cancer in an end-of-life trajectory and were excluded when they were not written in English or were descriptive/qualitative studies. Quality assessment of all studies was performed. RESULTS Most studies used convenience samples and had a mean number of 725 participants. Overall, 16,326 participants in 35 articles were included and narratively synthesized. High levels of pre-loss grief, as well as low levels of perceived preparedness for death, were associated with poor post-loss adjustment (e.g., prolonged grief, depressive symptoms, etc.). CONCLUSIONS Caregivers with high levels of pre-loss grief and low levels of preparedness for the death of their loved one would benefit from targeted support for post-loss adjustment. Results are limited by an inconsistent operationalization of both constructs.
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Affiliation(s)
- Julia Treml
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Semmelweisstraße 10, 04103, Leipzig, Germany.
| | - Viktoria Schmidt
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Semmelweisstraße 10, 04103, Leipzig, Germany.
| | - Michaela Nagl
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Semmelweisstraße 10, 04103, Leipzig, Germany.
| | - Anette Kersting
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Semmelweisstraße 10, 04103, Leipzig, Germany.
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18
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Tang ST, Hsieh CH, Chou WC, Chang WC, Chen JS, Wen FH. Course of Changes in Emotional Preparedness for Death and Its Associations With Caregiving Outcomes for Family Caregivers of Terminally Ill Cancer Patients Over Their Last Year of Life. J Pain Symptom Manage 2021; 61:974-982. [PMID: 32991973 DOI: 10.1016/j.jpainsymman.2020.09.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/17/2020] [Accepted: 09/19/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Preparing family caregivers for a patient's death is an integral component of quality end-of-life care, but temporal changes in emotional preparedness for death and its associations with caregivers' psychological well-being or quality of life (QOL) while providing end-of-life caregiving are under-researched. Our study was conducted to fill this gap. METHODS For this prospective, longitudinal study, the course of changes in adequate emotional preparedness for death and its associations with severe depressive symptoms and QOL were examined on 309 consecutive caregivers of terminally ill cancer patients by univariate and multivariate generalized estimating equation analyses, respectively. RESULTS Prevalence of adequate emotional preparedness for death was 57.2%, 61.3%, 54.4%, and 46.0% at 181-365, 91-180, 31-90, and 1-30 days before the patient's death, respectively, without significant changes as the patient's death approached. Adequate emotional preparedness for death was associated with caregivers' lower likelihood of severe depressive symptoms (adjusted odds ratio [95% CI]: 0.23 [0.16, 0.32], P < 0.001) but with their better QOL (adjusted β [95% CI]: 7.65 [6.38, 8.92], P < 0.001) in the patient's last year. CONCLUSIONS Without active, effective clinical interventions to promote caregivers' emotional preparedness for death, they cannot automatically become more prepared for the patient's death over time. Adequate emotional preparedness for the patient's death benefits caregivers by its associations with a lower likelihood of depressive symptoms and better QOL. Supportive programs for caregivers of terminally ill cancer patients should focus on not only enhancing caregiving skills but also cultivating emotional preparedness for their relative's death to promote their psychological well-being and QOL.
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Affiliation(s)
- Siew Tzuh Tang
- School of Nursing, Medical College, Chang Gung University, Taiwan, ROC; Department of Nursing, Chang Gung Memorial Hospital at Kaohsiung, Taiwan, ROC; Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Taiwan, ROC.
| | - Chia-Hsun Hsieh
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Taiwan, ROC; Chang Gung University College of Medicine, Taiwan, ROC
| | - Wen-Chi Chou
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Taiwan, ROC; Chang Gung University College of Medicine, Taiwan, ROC
| | - Wen-Cheng Chang
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Taiwan, ROC; Chang Gung University College of Medicine, Taiwan, ROC
| | - Jen-Shi Chen
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Taiwan, ROC; Chang Gung University College of Medicine, Taiwan, ROC
| | - Fur-Hsing Wen
- Department of International Business, Soochow University, Taiwan, ROC
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Leplus-Habeneck J, Kirakosyan V, Fasse L, Soulié O. Le processus du deuil, du normal au pathologique : une observation clinique pour présenter le référentiel AFSOS à destination des soignants. PSYCHO-ONCOLOGIE 2021. [DOI: 10.3166/pson-2021-0140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Le deuil est un processus naturel réactionnel à la perte d’un être cher. Il s’agit d’un phénomène psychique complexe tributaire de facteurs tant socioculturels qu’individuels. Un groupe de travail a élaboré un référentiel AFSOS à l’usage des soignants dans le but d’aider à mieux appréhender les dynamiques de ce processus et de savoir distinguer les deuils « normaux » des deuils compliqués. Une situation clinique nous permettra d’observer les différents facteurs de vulnérabilité et de protection impliqués au cours de l’évolution complexe d’un deuil. Nous proposerons des pistes de réflexion et d’action d’aide à l’accompagnement des endeuillés.
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20
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Tzuh S, Chang WC, Chou WC, Hsieh CH, Chen JS, Wen FH. Family Caregivers' Emotional Preparedness for Death is Distinct from Their Cognitive Prognostic Awareness for Cancer Patients. J Palliat Med 2021; 24:405-412. [PMID: 32790487 DOI: 10.1089/jpm.2020.0264] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background: Cognitive prognostic awareness (PA) and emotional preparedness for a loved one's death are distinct but related phenomena. However, the distinction between these two concepts has not been studied in family caregivers. Objective: To examine whether these two concepts are distinct by comparing their evolution and predictors over cancer patients' last year. Methods: Agreement between emotional preparedness for death and cognitive PA was longitudinally evaluated for 309 family caregivers by percentages and kappa coefficients. Predictors of the two outcomes were evaluated by multivariate logistic regression models with the generalized estimating equation. Results: Agreement between family caregivers' emotional preparedness for death and cognitive PA decreased slightly (54.73%-43.64%) from 181-365 to 1-30 days before the patient's death, with kappa values (95% confidence interval) from -0.060 (-0.123 to 0.003) to 0.050 (-0.074 to 0.174), indicating poor agreement. Participants were more likely to report adequate emotional preparedness for death if they had financial sufficiency, more contact/communication with the patient, lower caregiving burden, and stronger perceived social support. Family caregivers were more likely to have accurate PA if they were 56-65 years old, the patient's adult child, and had more contact/communication with the patient and greater subjective caregiving burden. Conclusions/Implications: Family caregivers' emotional preparedness for death and cognitive PA were distinct, as supported by their poor agreement, lack of reciprocal associations, and two different sets of predictors. Health care professionals should facilitate family caregivers' accurate PA and cultivate their emotional preparedness for death by enhancing patient-family contact/communication and easing their caregiving burden to improve quality of end-of-life care.
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Affiliation(s)
- Siew Tzuh
- School of Nursing, Medical College, Chang Gung University, Tao-Yuan, Taiwan.,Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan.,Department of Nursing, Chang Gung Memorial Hospital at Kaohsiung, Kaohsiung, Taiwan
| | - Wen-Cheng Chang
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan.,College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Wen-Chi Chou
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan.,College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Chia-Hsun Hsieh
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan.,College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Jen-Shi Chen
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan.,College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Fur-Hsing Wen
- Department of International Business, Soochow University, Taipei, Taiwan
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21
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Stahl ST, Neagoe I, Smagula SF, Posluszny D, Bovbjerg DH. Cancer Bereavement and Depression Symptoms in Older Spouses: The Possible Modifying Role of the Circadian Rest-Activity Rhythm. Clin Gerontol 2021; 44:126-132. [PMID: 32856562 PMCID: PMC7886956 DOI: 10.1080/07317115.2020.1812787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES This study examines the associations of cancer death and aspects of the 24-h circadian rest-activity rhythm (RAR) on depression symptoms in older spouses. METHODS Participants included 46 adults aged 60-94 years (M = 73 years) who experienced the death of a spouse. We tested a multivariate model using cancer death (vs. non-cancer death) and RAR variables as correlates of depression symptoms while controlling for age, sex, physical illness burden, and preparedness for death. We also present a case example to describe the behavioral activity patterns of a participant bereaved by cancer. RESULTS Cancer death was associated with elevated levels of depression symptoms. However, the timing of the RAR moderated this association. Cancer bereavement was associated with depression symptoms when participants "settled-down" after 11:00 PM. The case example illustrates how intrusive thoughts about death quality impacts a widower's drive to stay busy with daily activities. CONCLUSIONS Settling down earlier in the evening is important for older spouses bereaved by cancer, in terms of fewer symptoms of depression. CLINICAL IMPLICATIONS Objectively specifying the activity patterns of older spouses bereaved by cancer is a promising avenue for interventions that aim to reduce depression symptoms.
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Affiliation(s)
- Sarah T Stahl
- Department of Psychiatry, University of Pittsburgh , Pittsburgh, Pennsylvania, USA
| | - Ioana Neagoe
- Department of Psychiatry, University of Pittsburgh , Pittsburgh, Pennsylvania, USA
| | - Stephen F Smagula
- Department of Psychiatry, University of Pittsburgh , Pittsburgh, Pennsylvania, USA
| | - Donna Posluszny
- Department of Medicine, University of Pittsburgh , Pittsburgh, Pennsylvania, USA
| | - Dana H Bovbjerg
- Department of Psychiatry, University of Pittsburgh , Pittsburgh, Pennsylvania, USA
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22
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Schellekens MP, van den Hurk DG, Jansen ET, van der Lee ML, Prins JB, van der Drift MA, Speckens AE. Perspectives of bereaved partners of lung cancer patients on the role of mindfulness in dying and grieving: A qualitative study. Palliat Med 2021; 35:200-208. [PMID: 33308039 DOI: 10.1177/0269216320967281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Mindfulness-Based Stress Reduction (MBSR) has been shown to reduce psychological distress in cancer patients but not their partners. Whether MBSR can support patients and partners in coping with the dying and grieving process is less well examined. AIM We aimed to gain more insight in the role of mindfulness in the dying and grieving process from the perspective of the partner after the patient's death. DESIGN As part of a pilot study or subsequent randomized controlled trial, partners had participated together with the patient in MBSR. After the patient's death partners were invited for qualitative in-depth interviews. Data from the interviews was analyzed using the grounded theory approach. SETTING/PARTICIPANTS Interviews were conducted with 11 partners in their homes, on average 11 months after the patient's death (SD = 7.8). RESULTS Mindfulness helped couples to allow and regulate difficult thoughts and feelings, which in turn helped them to accept the patient's impending death. It also facilitated them to enjoy things together and communicate more openly. For a few couples, however, participation was physically too burdensome or emotionally too confrontational. During the partners' grieving process, mindfulness helped allowing difficult thoughts and feelings, and taking the time to grieve, which helped them to take good care of themselves, giving them faith in the future. CONCLUSION The present study showed that MBSR can facilitate lung cancer patients and their partners in accepting the forthcoming death and openly communicating about this, which can support a peaceful death and healthy grieving process.
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Affiliation(s)
- Melanie Pj Schellekens
- Scientific Research Department, Helen Dowling Institute, Centre for Psycho-Oncology, Bilthoven, The Netherlands
| | | | - Ellen Tm Jansen
- Radboud Centre for Mindfulness, Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Marije L van der Lee
- Scientific Research Department, Helen Dowling Institute, Centre for Psycho-Oncology, Bilthoven, The Netherlands
| | - Judith B Prins
- Department of Medical Psychology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Miep A van der Drift
- Department of Lung Disease, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Anne Em Speckens
- Radboud Centre for Mindfulness, Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands
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23
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Durepos P, Ploeg J, Akhtar-Danesh N, Sussman T, Orr E, Kaasalainen S. Caregiver preparedness for death in dementia: an evaluation of existing tools. Aging Ment Health 2020; 24:1671-1680. [PMID: 31144986 DOI: 10.1080/13607863.2019.1622074] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objectives: Death preparedness amongst family caregivers (CG) is a valuable and measurable concept. Preparedness predicts CG outcomes in bereavement and is modifiable through a palliative approach which includes advance care planning (ACP) interventions. Improving death preparedness is important for CGs of persons with dementia (PwD) whom are more likely to develop negative outcomes in bereavement, and experience less than adequate palliative care. However, the adequacy of existing tools to measure death preparedness in CGs of PwD is unknown, which limits intervention design and prospective evaluation of ACP effectiveness.Methods: We conducted a review and evaluation of existing tools measuring the attribute domains and traits of CG death preparedness. Literature was searched for articles describing caregiving at end of life (EOL). Measurement tools were extracted, screened for inclusion criteria, and data extracted regarding: conceptual basis, population of development, and psychometrics. Tool content was compared to preparedness domains/traits to assess congruency and evaluate the adequacy of tools as measures of death preparedness for CGs of PwD.Results: Authors extracted 569 tools from articles, retaining seven tools for evaluation. The majority of tools, n = 5 (70%) did not sample all preparedness domains/traits. Few tools had items specific to EOL; only one tool had a specific item questioning CG preparedness for death, and only one tool had items specific to dementia.Conclusion: Limitations in existing tools suggest they are not adequate measures of death preparedness for CGs of PwD. Consequently, the authors are currently developing a questionnaire to be titled, 'Caring Ahead' for this purpose.
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Affiliation(s)
- Pamela Durepos
- McMaster University, Faculty of Health Sciences, School of Nursing, Hamilton, Ontario, Canada.,Hamilton Health Sciences Corporation, Hamilton, Ontario, Canada
| | - Jenny Ploeg
- McMaster University, Faculty of Health Sciences, School of Nursing, Hamilton, Ontario, Canada.,Aging, Community and Health Research Unit, Hamilton, Ontario, Canada
| | - Noori Akhtar-Danesh
- McMaster University, Faculty of Health Sciences, School of Nursing, Hamilton, Ontario, Canada
| | - Tamara Sussman
- Department of Social Work, McGill University, Montreal, Quebec, Canada
| | - Elizabeth Orr
- McMaster University, Faculty of Health Sciences, School of Nursing, Hamilton, Ontario, Canada
| | - Sharon Kaasalainen
- McMaster University, Faculty of Health Sciences, School of Nursing, Hamilton, Ontario, Canada
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24
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Durepos P, Ploeg J, Sussman T, Akhtar-Danesh N, Kaasalainen S. "A Crazy Roller Coaster at the End": A Qualitative Study of Death Preparedness With Caregivers of Persons With Dementia. SAGE Open Nurs 2020; 6:2377960820949111. [PMID: 33415300 PMCID: PMC7774442 DOI: 10.1177/2377960820949111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 07/19/2020] [Indexed: 12/22/2022] Open
Abstract
Introduction Caregivers of persons with dementia experience challenges that can make
preparing for end-of-life particularly difficult. Feeling prepared for death
is associated with caregiver well-being in bereavement and is promoted by
strategies supporting a palliative approach. Further conceptualization of
caregiver preparedness for death of persons with dementia is needed to guide
the practice of healthcare providers and to inform development of a
preparedness questionnaire. Objectives We aimed to: 1) explore the end-of-life experiences of caregivers of persons
with dementia to understand factors perceived as influencing preparedness;
and 2) identify the core concepts (i.e., components), barriers and
facilitators of preparedness for death. Methods This study used an interpretive descriptive design. Semi-structured
interviews were conducted with sixteen bereaved caregivers of persons with
dementia, recruited from long-term care homes in Ontario. Data was analyzed
through reflexive thematic analysis. Findings Four themes were interpreted including: ‘A crazy rollercoaster at the end’
which described the journey of caregivers at end-of-life. The journey
provided context for the development of core concepts (i.e., components) of
preparedness represented by three themes: ‘A sense of control, ‘Doing right’
and ‘Coming to terms’. Conclusion The study findings serve to expand the conceptualization of preparedness and
can guide improvements to practice in long-term care. Core concepts,
facilitators and influential factors of preparedness will provide the
conceptual basis and content to develop the Caring Ahead: Preparing for
End-of-Life with Dementia questionnaire.
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Affiliation(s)
- Pamela Durepos
- School of Nursing, Faculty of Health Sciences, McMaster University.,Canadian Frailty Network, Kingston, Ontario, Canada.,Hamilton Health Sciences Corporation, Hamilton, Ontario, Canada
| | - Jenny Ploeg
- School of Nursing, Faculty of Health Sciences, McMaster University.,Aging, Community and Health Research Unit, Hamilton, Ontario, Canada
| | | | - Noori Akhtar-Danesh
- School of Nursing, Faculty of Health Sciences, McMaster University.,Aging, Community and Health Research Unit, Hamilton, Ontario, Canada
| | - Sharon Kaasalainen
- School of Nursing, Faculty of Health Sciences, McMaster University.,Aging, Community and Health Research Unit, Hamilton, Ontario, Canada
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25
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Reblin M, Baucom BRW, Clayton MF, Utz R, Caserta M, Lund D, Mooney K, Ellington L. Communication of emotion in home hospice cancer care: Implications for spouse caregiver depression into bereavement. Psychooncology 2019; 28:1102-1109. [PMID: 30883985 DOI: 10.1002/pon.5064] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 02/21/2019] [Accepted: 03/09/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Family caregivers of cancer hospice patients likely benefit from clinician provision of verbal support and from expression of positive emotions. Our aim was to identify the effects of hospice nurse supportive communication as well as caregiver-nurse exchange of positive emotions on family caregiver depression during bereavement. METHODS This prospective, observational longitudinal study included hospice nurses (N = 58) and family caregivers of cancer patients (N = 101) recruited from 10 hospice agencies in the United States. Digitally recorded nurse home visit conversations were coded using Roter interaction analysis system to capture emotion-focused caregiver-nurse communication and supportive nurse responses. Caregivers completed the Hospital Anxiety and Depression Scale Anxiety Subscale and Geriatric Depression Scale-Short Form at study enrollment and at 2, 6, and 12 months after patient death. RESULTS Caregivers had moderate levels of depression at study enrollment and throughout bereavement. Multilevel modeling revealed that caregiver positive emotion communication and nurse emotional response communication are associated with caregiver depression in bereavement. There was no significant association between caregiver distress communication and depression in bereavement. CONCLUSIONS This is the first study to demonstrate that communication demonstrating emotional expression between cancer spouse caregivers and nurses during home hospice may have implications for caregiver depression up to a year after patient death. Our findings may help identify caregivers who may be coping well in the short term but may struggle more over time.
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Affiliation(s)
- Maija Reblin
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Brian R W Baucom
- Department of Psychology, University of Utah, Salt Lake City, Utah
| | | | - Rebecca Utz
- Department of Sociology, University of Utah, Salt Lake City, Utah
| | - Michael Caserta
- College of Nursing, University of Utah, Salt Lake City, Utah
| | - Dale Lund
- Department of Sociology, California State University San Bernardino, San Bernardino, California
| | - Kathi Mooney
- College of Nursing, University of Utah, Salt Lake City, Utah
| | - Lee Ellington
- College of Nursing, University of Utah, Salt Lake City, Utah
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