Exploring factors and caregiver outcomes associated with feelings of preparedness for caregiving in family caregivers in palliative care: a correlational, cross-sectional study

Family Care Partner's Preparedness in Caring for Hospitalized Persons With Dementia

OBJECTIVES

To examine care partner preparedness in caring for recently hospitalized persons with dementia and care partner characteristics associated with preparedness at discharge, 2 months, and 6 months post discharge.

METHODS

Stepwise regression in a sample of 461 care partners of hospitalized persons with dementia who participated in the Fam-FFC clinical trial.

RESULTS

On average, care partners were 61.81 years old (SD = 14.19) and primarily female (n = 334, 72.5%). Care partners reported having some preparedness in general and it increased from discharge (23.75, SD = 6.78) to 2 months (24.5, SD = 6.49) and 6 months (26.35, SD = 6.73). Multiple care partner characteristics were associated with preparedness at discharge [age (b = -0.071; p < 0.001), burden (b = -0.283; p < 0.001), and depression (b = -0.284; p < 0.01)], 2 months [burden (b = -0.226; p < 0.001), strain (b = -0.144; p < 0.05), depression (b = -0.185; p < 0.05)] and 6 months [burden (b = -0.164; p < 0.01), strain (b = -0.183; p < 0.05), depression (b = -0.279; p < 0.01)] post discharge. While care partners' feelings of greater burden and depression were associated with lower preparedness at all time points, care partners' higher age was associated with lower preparedness at discharge only and care partners' feelings of higher strain was associated with lower preparedness at two and 6 months post discharge.

CONCLUSION

Findings suggest the need to address care partners' feelings of burden, strain, and depression with tailored interventions and programs to optimize their preparedness in meeting unique care needs of hospitalized persons with dementia. Resilience-based interventions and programs can be useful to manage feelings of burden, strain, and depression and optimize preparedness.

Family hardiness among primary caregivers of breast cancer patients in Hunan Province: a cross-sectional study exploring the relationship with attachment and caregiver preparedness

Background

Family hardiness is a key variable contributing to positive family functioning, which has significant effects on the quality of life and the mental health of patientsand caregivers. The factors that contribute to family hardiness support both the psychological and physical well-being of caregivers is unknown. More specifically, the relationship of family hardiness with attachment and caregiver preparedness has not been explored.

Aim

The current study aimed to investigate the family hardiness in caregivers of breast cancer patients and explore the relationship with attachment and caregiver preparedness and identify the associated factors.

Methods

This cross-sectional correlational study was conducted from March to July, 2022. 140 caregivers of breast cancer patients were recruited in two IIIA-grade hospitals in Hunan Province using convenience sampling. Data were collected using a personal characteristics questionnaire, The Family Hardiness Index (FHI), Caregiver Preparedness Scale (CPS), and the Experiences in Close Relationships Inventory-Revised Edition (ECR-R). Chi-square, Pearson's correlation coefficient, generalized additive model and multiple logistic regression analyses were performed.

Results

A total of 140 caregivers participated in the study. The mean age of participants was (42.29 ± 14.54) years and most of them were male (57.1%). The mean FHI score of caregivers was 58.11 ± 5.67. Multiple linear regression analysis indicated that family hardiness is affected by ECR-R, CPS, education level, and knowledge of breast cancer. The score of CPS was positively associated with family hardiness (β = 0.265, p < 0.001), whereas ECR-R negatively predicted family hardiness (β = -0.078, p < 0.001).

Conclusion

Family hardiness plays a critical role in helping caregivers manage the stresses associated with providing care to breast cancer patients. Enhancing caregiver preparedness and education, as well as addressing attachment-related issues, can significantly improve family hardiness. In light of our findings, we suggest that closer relationships within families, adding preparedness and knowledge of disease should be encouraged during the care of breast cancer patients.

Caregiver Preparedness: A Therapeutic Mechanism and Moderating Factor on Outcomes for the Savvy Caregiver Program

OBJECTIVES

Evidence-based interventions for dementia caregivers, such as the Savvy Caregiver Program (SC), seek to address skills and knowledge deficits, caregiver burden, depressive symptoms, and grief. Little research has examined mechanisms by which these interventions accomplish their goals. Caregiver preparedness may be a possible mechanism by which caregiver interventions may confer benefits.

METHODS

The sample included 76 dementia caregivers who completed the 6-session SC. Participants completed the Anticipatory Grief Scale, Center for Epidemiological Studies-Depression Scale, the Preparedness for Caregiving Scale, and the Zarit Burden Interview-Short Form.

RESULTS

A repeated measures ANOVA was utilized to determine the interaction between baseline scores and pre-post change in caregiver preparedness. Analysis significantly predicted caregiver burden, (F(1) = 6.68, p=.012, partial η2=.10), depressive symptom endorsement, (F(1) = 6.41, p=.014, partial η2=.09, and anticipatory grief, (F(1) = 6.22, p=.02, partial η2=.1), post-treatment.

CONCLUSIONS

Pre-post change in caregiver preparedness significantly predicted pre-post change across measures of caregiver burden, depressive symptom endorsement, and anticipatory grief. Findings suggest that caregiver preparedness may be one mechanism by which the SC confers positive outcomes. These findings provide an empirical and theoretical basis for tailoring future dementia caregiver interventions.

CLINICAL IMPLICATIONS

Clinical Interventions may seek to improve caregiver preparedness and subsequent outcomes through utilization of programs like SC.

Adapting a Preparatory Skills-Building Programme for Carers of People With Cancer Through Co-Design: The iCanSupport Project

INTRODUCTION

Health services rely upon carers to provide care for loved ones with cancer, yet many carers often feel ill-prepared for this role. Despite a multitude of programmes to support carer mental health, programmes that help carers feel better equipped to support a person with cancer are lacking. This study aimed to address this need by adapting an evidence-based intervention to be suitable for carers of people with cancer.

METHODS

This study used an exploratory, qualitative design consisting of experienced-based co-design and an in-depth stakeholder engagement strategy. An existing evidence-based programme to promote resilience in the context of providing care was adapted for relevance to carers for people with cancer via two co-design workshops with carers and healthcare professionals (n = 8). The resulting prototype programme was refined based on stakeholder consultations with staff and consumer members of cancer and carer support organisations across Australia (n = 16). Transcripts of the workshops, meetings and written feedback from carers were thematically analysed.

RESULTS

Major programme developments were guided by three themes that emerged from the co-design workshops: 'creating value for carers', 'multiple contributors to carer distress' and 'the need for flexible implementation'. Analysis of the stakeholder consultation data showed that the themes of 'diversity in carer journeys' and 'creating impact for carers' were key to further tailoring the programme for applicability to practice. An adapted programme called 'iCanSupport' resulted from the process, with key adaptations being more relevant case study scenarios for carers and greater flexibility in accessing and engaging with the intervention to accommodate a range of carer circumstances.

CONCLUSION

Programmes to build skills for becoming a carer for someone with cancer are absent, yet they are desired by carers. Using co-design provided a user-centric approach to adapt an existing evidence-based programme. Programme evaluation is required to determine the effectiveness of the co-designed approach in improving carer preparedness among a range of cohorts.

PATIENT OR PUBLIC CONTRIBUTION

Carers and consumers with lived experience and others involved in supporting consumers made valuable contributions to co-designing and refining the programme in addition to providing ongoing guidance in the unfolding analysis and reporting of this research.

Distance interventions for enhancing preparedness in informal caregivers of older adults: A systematic review protocol

INTRODUCTION

Informal caregivers provide care to older adults but report lack of preparedness to enact the role. Intervention programs delivered by distance offer one alternative to support preparedness. Three review studies conducted to date have highlighted the benefits of distance interventions for enhancing preparedness among informal caregivers of older adults. However, these reviews have been limited in presenting and discussing how intervention components influenced outcomes. Additionally, they have not compared different distance delivery approaches for informal caregivers of older adults or assessed their varying impact on preparedness outcomes. These limitations make the effectiveness of diverse distance approaches unclear.

AIM

To evaluate the effects of distance interventions aimed at enhancing preparedness among informal caregivers of older adults.

METHODS

This protocol follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) guidelines and is guided by the Cochrane Handbook for Systematic Reviews of Interventions. It has been registered in PROSPERO (CRD42023400668). Databases used in the search will include CINAHL, Cochrane Library, EMBASE, MEDLINE, PsycINFO, Scopus, and ProQuest Theses and Dissertations Global. The search will not be restricted by publication year to include all relevant studies. Studies published in English and Portuguese will be included. Study quality will be assessed using Downs and Black's checklist. If metanalysis is possible, it will be performed using the ReviewManager (RevMan) software.

CONCLUSIONS

The study will be the first of its type to systematically review and synthesize components and approaches of distance interventions aimed at supporting preparedness of informal caregivers of older adults.

Preparedness for caregiving among informal caregivers of people with dementia: A scoping review

INTRODUCTION

Dementia is a global health concern, and informal caregivers often provide care for those affected. Caregiver preparedness is crucial for optimizing quality of life. However, knowledge about the determinants of caregiver preparedness is limited.

PURPOSE

The aim of this scoping review was to identify the factors associated with preparedness for caregiving among informal caregivers of people with dementia.

METHODOLOGY

The review adhered to the methods from the Joanna Briggs Institute. Studies exploring the preparedness of informal caregivers of people with dementia were included in this review. Data were extracted from studies found in five major databases: PubMed, PsycINFO, Scopus, CINAHL, and Embase.

RESULTS

The final review included twenty-three studies. Self-efficacy and confidence, resilience and self-conduct, knowledge, education and training, mutuality, mental health, less caregiving conflict, and mindfulness were associated with caregiver preparedness.

CONCLUSION

This review identified a significant research gap in preparedness among caregivers of people with dementia. More research is essential to understand the factors associated with caregivers' preparedness. Recognizing these elements can inform tailored interventions, assisting informal caregivers in their caregiving transition and journey.

Determinants of preparedness in family caregivers of patients with heart failure

AIMS

Inadequate preparedness of family caregivers contributes to adverse outcomes of patients with heart failure (HF). However, evidence on caregiver preparedness is limited. This study aims to examine the determinants and potential mechanisms of preparedness in family caregivers of patients with HF.

METHODS AND RESULTS

In the cross-sectional study, 298 HF patient-caregiver dyads were recruited from 4 tertiary hospitals in China. Preparedness, uncertainty in illness, family relational quality, social support, and positive aspects of caregiving (PAC) were assessed in family caregivers using self-reported questionnaires. In the path analysis model, uncertainty in illness had an indirect negative effect on preparedness via reduced PAC [indirect effect = -0.020; 95% confidence interval (CI) -0.050 to -0.002]. Whereas, family relational quality had direct (β = 0.266; P < 0.001) and indirect positive effects on preparedness through increased PAC (indirect effect = 0.027; 95% CI, 0.003-0.067). Similarly, social support also had direct (β = 0.184; P = 0.004) and indirect positive effects on preparedness through increased PAC (indirect effect = 0.027; 95% CI, 0.004-0.065).

CONCLUSION

This study highlights that diminishing uncertainty in illness may indirectly improve caregiver preparedness through the enhancement of PAC, while raising family relational quality and social support may improve caregiver preparedness both directly and indirectly by augmenting PAC. These findings provide insightful implications for healthcare professionals in developing tailored interventions to ameliorate preparedness in family caregivers of patients with HF.

Care preparedness of family caregivers of maintenance hemodialysis patients: a cross-sectional study

With the increasing number of maintenance hemodialysis (MHD) patients, growing attention has been paid to the quality of care. Strengthening care preparedness of family caregivers is essential to improving the nursing quality. The purpose of this study is to explore the care preparedness level of family caregivers of MHD patients and its influencing factors, so as to provide guidance for the development of targeted care interventions. A total of 237 family caregivers of MHD patients were recruited from the hemodialysis room of two tertiary hospitals in Wuhan using the Convenience sampling method. They were surveyed by the general data questionnaire, Care Preparedness Scale and Positive Aspects of Caregiving. Statistical analysis was conducted using IBM SPSS software, version 21.0. The statistical tests conducted in this study were two-tailed, and a significance level of P < 0.05 was deemed as statistically significant. The care preparedness and positive aspects of caregiving scores of family caregivers of MHD patients were 19.05 ± 5.64 and 31.28 ± 7.28 points, respectively. The care preparedness level of family caregivers was significantly positively correlated with positive aspects of caregiving (P < 0.01). The results of multiple linear regression analysis showed that the total nursing time and whether family caregivers had chronic diseases and positive aspects of caregiving were the main factors influencing their care preparedness (all P < 0.05). These three factors accounted for 49.6% of the variance. The care preparedness of family caregivers of MHD patients remains to be continuously improved. Medical staff should emphasize the important role of total nursing time, whether the caregiver has a chronic disease, and positive aspects of caregiving in improving care preparedness in this population. To achieve this end, medical staff can provide targeted support and guidance for caregivers according to the influencing factors, such as implementing group psychological education, strengthening the training, offering social support, remote intervention (including family caregivers' education through the media), and so on. Meanwhile, caregivers should be evaluated dynamically, and information and emotional support should be provided for them.

Web-based support for spouses of patients with life-threatening illness cared for in specialized home care - A feasibility study

OBJECTIVES

Psychoeducational interventions for family caregivers have shown to be effective but not possible for all caregivers to attend; thus, web-based interventions may be a complement. This study aimed to evaluate feasibility of a web-based intervention, "narstaende.se," from the perspective of spouses of patients receiving specialized home care.

METHODS

A website was developed, containing videos with conversations between health-care professionals and family caregivers (actors), informative texts, links to further information, and a chat forum. The aim of the website is to provide support and promote preparedness for caregiving and death, and the content is theoretically and empirically grounded. The study had a descriptive cross-sectional design. Altogether, 26 spouses answered a questionnaire, before accessing the website, and 4 weeks after this, 12 spouses were interviewed. Descriptive statistics and qualitative content analysis were used.

RESULTS

Spouses experienced the website as being easy to use, welcoming, and with relevant content. Participating spouses would recommend "narstaende.se" to others in similar situations, and the majority found the website introduced timely. Videos seemed easily accessible and were most used, contributing to a feeling of recognition and sharing the situation. The online format was perceived as flexible, but still not all spouses visited the website, stating the desire for support in real life.

SIGNIFICANCE OF RESULTS

A web-based intervention can be feasible for spouses in specialized home care; however, the digital format is not suitable for everyone. Further research is needed to determine the website's potential to provide support and increase preparedness for family caregivers in general.

The Importance of Providing Training to Informal Caregivers of Hospice Patients: Caregiver Experience With Hospice Care Based on Consumer Assessment of Healthcare Providers & Systems Surveys

BACKGROUND

Informal caregivers aid hospice patients at the end of life. Little is known of their preparation and confidence in providing care, and how this relates to experiences of hospice care.

OBJECTIVE

Examine factors associated with informal caregivers' rating of home hospice care.

METHODS

Data come from 828 completed CAHPS® surveys mailed between January 2022 and December 2023 from a single non-profit Hospice organization. Multivariate logistic regression analyses examined the independent influence of various aspects of hospice care on ratings of hospice.

RESULTS

Nine of every 10 respondents rated hospice care high (9 or 10). Most aspects of hospice care were rated favorably. Nearly all respondents felt the patient was treated with dignity and respect (96%). The measure with the greatest room for improvement was getting help as soon as needed (82% "always"). Multivariate analyses revealed 6 factors that independently predicted overall rating of hospice care. The strongest predictor was always getting help as soon as needed, followed by believing the hospice team cared about the patient. Three measures of caregiver training were significantly associated with higher ratings of hospice care being trained to: safely move the patient, what to do if patient became restless, and on pain medications.

CONCLUSIONS

When informal caregivers feel trained to assess and manage the symptoms, they rate hospice care more favorably. Greater attention to informal caregiver training and support are imperative to improving hospice care.

The meaning of preparedness for informal caregivers of older adults: A concept analysis

AIM

To examine the concept of preparedness over time in research with informal caregivers of older adults.

DESIGN

Concept analysis.

METHODS

Rodgers' evolutionary method of concept analysis was used to guide this theoretical paper due to the dynamic nature of preparedness, which is influenced by both context and time. Using Rodgers' inductive approach, concept elements were derived from a content analysis of included studies. In the final step, to generate hypotheses and implications regarding the concept, the conceptual structure of preparedness of informal caregivers of older adults was connected to a theoretical problem in the nursing discipline using the Caregiving Stress Process Framework.

DATA SOURCES

Four databases (EBSCO CINAHL, Ovid MEDLINE, Ovid PsycINFO and Scopus) were searched in November 2022 and updated in September 2023. No date limits were set for searching, as the intent was to analyse possible variations of the concept over time.

RESULTS

The attributes of preparedness include self-confidence, having knowledge, skills and abilities to perform daily tasks, handling emotions and developed over time. These attributes can be compared with the stressors outlined in the Caregiving Stress Process Framework (i.e., the moment the caregiver identifies some 'stressor'; something that prevents them from feeling confident in their preparedness).

CONCLUSION

The concept of preparedness of informal caregivers of older adults is defined as caregiver's self-confidence about their current competence related to the knowledge, skills and abilities to perform daily tasks, and to handle emotions over time. To link the concept to a theoretical perspective, we propose adaptations to a well-known theory, the Caregiving Stress Process Framework. Future research on caregiving preparedness needs to avoid circular definitions and work with the attributes of preparedness to support caregivers.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

This paper contributes to the development of interventions that focus on the health and preparedness of informal caregivers of older adults. Clarifying the concept of preparedness helps nurses to support caregivers since it is then known which aspects are included in the preparedness of caregivers (e.g., daily tasks and handling emotions). A more fulsome understanding of preparedness supports us to see beyond stressors of caregiving.

IMPACT

This study addresses informal caregivers of older adults' preparedness to provide care. We synthesized existing definitions that have been used in research with this population to propose a robust conceptualization of the concept of preparedness, which contributes to better understanding of how preparedness can be supported.

REPORTING METHOD

We were unable to locate a reporting method related to this kind of work (concept analysis).

PATIENT OR PUBLIC CONTRIBUTION

Not applicable as no new data generated.

Increased preparedness for caregiving among family caregivers in specialized home care by using the Carer Support Needs Assessment Tool Intervention

OBJECTIVES

Family caregivers often feel insufficiently prepared for a caregiving role, experiencing challenges and demands related to care at home that may negatively affect their own quality of life. Supportive interventions have been shown to influence negative effects, but more studies are needed. Therefore, this study aims to explore potential effects of the Carer Support Needs Assessment Tool Intervention on preparedness, caregiver burden, and quality of life among Swedish family caregivers in specialized home care.

METHODS

The study had a pre-post intervention design and was conducted at 6 specialized home care services in Sweden. Family caregivers who received the intervention completed a questionnaire, including the Preparedness for caregiving scale, Caregiver Burden Scale, and Quality of Life in Life-Threatening Illness - Family carer version, at 2 time points, baseline and follow up, about 5 weeks later. Data were analyzed using descriptive statistics and Wilcoxon signed-rank test.

RESULTS

Altogether, 33 family caregivers completed the baseline and follow-up assessment. A majority were retired (n = 26, 81%) and women (n = 19, 58%) and two-fifths had a university degree (n = 13, 41%). The family caregivers had significantly increased their preparedness for caregiving between the baseline and follow-up assessment (Mdn = 18 vs. 20, p = 0.002). No significant changes were found on caregiver burden or quality of life.

SIGNIFICANCE OF RESULTS

The results add to knowledge regarding the Carer Support Needs Assessment Tool Intervention's potential to improve family caregiver outcomes. Findings suggest that the intervention may be used to improve the preparedness for caregiving and support among family caregivers in specialized home care.

Associations between preparedness, perceived stress, depression, and quality of life in family caregivers of patients with a temporary enterostomy

PURPOSE

To investigate the preparedness, perceived stress, risk of depression, and quality of life of family caregivers of patients receiving a temporary enterostomy, to provide a reference for improving the long-term care and quality of life of patients receiving a temporary enterostomy.

METHODS

We enrolled 181 family caregivers of patients in a hospital in China from 2021 to 2023. Responses to the General Information Questionnaire, the Chinese Caregiver Preparedness Scale, the Chinese Perceived Stress Scale, the Chinese bilingual version of the Patient Health Questionnaire-2, and the 12-item Short Form Survey were collected online.

RESULTS

Pearson's correlation analysis revealed that family caregivers' risk of depression was negatively correlated with their preparedness, the physical component summary score, and the mental component summary score but was positively correlated with perceived stress. Multiple linear regression analysis identified factors influencing caregiver preparedness.

CONCLUSIONS

These findings help healthcare personnel to identify high-risk individuals among family caregivers of patients receiving a temporary enterostomy. This provides a basis for formulating well-planned, dynamic health education programs that meet patients' needs for disease-related knowledge and care.

Family caregivers' preferences for support when caring for a family member with cancer in late palliative phase who wish to die at home - a grounded theory study

BACKGROUND

Family caregivers are essential in end-of-life care for cancer patients who wish to die at home. The knowledge is still limited regarding family caregivers needs and preferences for support and whether the preferences change during the patient's illness trajectory. Therefore, the aim was to explore family caregivers' preferences for support from home care services over time when caring for a family member with cancer at the end of life who wished to die at home.

METHODS

A qualitative method was applied according to Grounded Theory. Data was collected longitudinally over the illness trajectory by means of repeated individual interviews (n = 22) with adult family caregivers (n = 11). Sampling, data collection and data analysis were undertaken simultaneously in line with the constant comparative method.

RESULTS

The findings are captured in the core category "hold out in duty and love". The categories "having control and readiness for action" and "being involved in care" describe the family caregivers' preferences for being prepared and able to handle procedures, medical treatment and care, and to be involved by the healthcare personnel in the patient's care and decision making. The categories "being seen and confirmed" and "having a respite" describe family caregivers' preferences for support according to their own needs to be able to persevere in the situation.

CONCLUSION

Despite deterioration in the patient's illness and the increasing responsibility family caregiver struggle to hold out and focus on being in the present. Over time together with deterioration in the patient's illness and changes in the situation, they expressed a need for more intense and extensive support from the home care services. To meet the family caregivers' preferences for support a systematic implementation of a person-centred care model and multicomponent psycho- educational interventions performed by nurses can be proposed. Moreover, we suggest developing a tool based on the conceptual model generated in this study to identify and map family caregivers' needs and preferences for support. Such a tool can facilitate communication and ensure person-centred interventions.

What factors are associated with informal carers' psychological morbidity during end-of-life home care? A systematic review and thematic synthesis of observational quantitative studies

Background

Family carers are central in supporting patients nearing end of life. As a consequence, they often suffer detrimental impacts on their own mental health. Understanding what factors may affect carers' mental health is important in developing strategies to maintain their psychological well-being during caregiving.

Aim

To conduct a systematic review and thematic evidence synthesis of factors related to carers' mental health during end-of-life caregiving.

Method

Searches of MEDLINE, CINAHL, PsychINFO, Social Sciences Citation Index, EMBASE, Cochrane Central Register of Controlled Trials and Database of Abstracts of Reviews of Effects 1 January 2009-24 November 2019. We included observational quantitative studies focusing on adult informal/family carers for adult patients at end of life cared for at home considering any factor related to carer mental health (anxiety, depression, distress and quality of life) pre-bereavement. Newcastle-Ottawa Quality Assessment Scale was used. Thematic analysis with box score presentation, and meta-analysis were done where data permitted.

Results

Findings from 63 included studies underpinned seven emergent themes. Patient condition (31 studies): worse patient psychological symptoms and quality of life were generally associated with worse carer mental health. Patient depression was associated with higher depression in carers (standardised mean difference = 0.59, 95% confidence interval 0.32 to 0.87, I2 = 77%). Patients' other symptoms and functional impairment may relate to carer mental health, but findings were unclear. Impact of caring responsibilities (14 studies): impact on carers' lives, task difficulty and general burden had clear associations with worse carer mental health. Relationships (8 studies): family dynamics and the quality of the carer-patient relationship may be important for carer mental health and are worthy of further investigation. Finance (6 studies): insufficient resources may relate to carers' mental health and warrant further study. Carers' psychological processes (13 studies): self-efficacy and preparedness were related to better mental health. However, findings regarding coping strategies were mixed. Support (18 studies): informal support given by family and friends may relate to better carer mental health, but evidence on formal support is limited. Having unmet needs was related to worse mental health, while satisfaction with care was related to better mental health. Contextual factors (16 studies): older age was generally associated with better carer mental health and being female was associated with worse mental health.

Limitations

Studies were mainly cross-sectional (56) rather than longitudinal (7) which raises questions about the likely causal direction of relationships. One-third of studies had samples < 100, so many had limited statistical power to identify existing relationships.

Conclusions and future work

Future work must adopt a comprehensive approach to improving carers' mental health because factors relating to carer mental health cover a broad spectrum. The literature on this topic is diverse and difficult to summarise, and the field would benefit from a clearer direction of enquiry guided by explanatory models. Future research should (1) further investigate quality of relationships and finances; (2) better define factors under investigation; (3) establish, through quantitative causal analyses, why factors might relate to mental health; and (4) utilise longitudinal designs more to aid understanding of likely causal direction of associations.

Study registration

This study is registered as PROSPERO registration 2019 CRD42019130279 at https://www.crd.york.ac.uk/prospero/.

Funding

This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme HSDR 18/01/01 and is published in full in Health and Social Care Delivery Research. See the NIHR Funding and Awards website for further award information.

Influence of preparedness on caregiver burden, depression, and quality of life in caregivers of people with disabilities

Introduction

Caregiver preparedness is defined as the perceived preparation of caregivers to care for the physical and emotional needs of the patient.

Purpose

This study investigated caregiver preparedness and its influences on caregiver burden, depression, and quality of life (QoL) in caregivers of individuals with disabilities.

Methods

We conducted a multicenter cross-sectional survey study on caregivers caring for patients with disabilities. Sociodemographic characteristics were collected via questionnaires. The Preparedness for Caregiving Scale (PCS), Burden Interview (BI), Center for Epidemiologic Studies Depression Scale (CES-D), and EuroQol-Visual Analogue Scale (EQ-VAS) were administered.

Results

A total of 151 caregivers were enrolled. The mean age of caregivers was 53.7 ± 12.4 years, and 80.8% were female. The majority of participants were the main caregivers of patients with stroke, spinal cord injury, or traumatic brain injury. The mean PCS score was 2.1 ± 0.9, demonstrating significant relationships with BI (r = -0.512, p < 0.001), CES-D (r = -0.622, p < 0.001), and EQ-VAS (r = 0.441, p < 0.001). The CES-D was significantly associated with the PCS after controlling other variables. However, PCS did not show any correlation with the duration of caregiving or amount of time spent per day on caregiving.

Discussion

The clinical implications of this study are that higher caregiver preparedness is a predictor of less caregiver burden and depression, and better QoL. However, preparedness did not increase as the duration or time spent on caregiving was extended. Therefore, efforts to enhance the caregivers' preparedness are required to reduce caregiver burden and improve health outcomes for both caregivers and patients.

Preparedness for caregiving and preparedness for death: Associations and modifiable thereafter factors among family caregivers of patients with advanced cancer in specialized home care

The purpose of this study was to (1) explore associations between preparedness for caregiving and preparedness for death among family caregivers of patients with advanced cancer and (2) explore modifiable preparedness factors, such as communication and support. Data was derived from a baseline questionnaire collected in specialized home care. The questionnaire included socio-demographics, the Preparedness for Caregiving Scale, and single items addressing preparedness for death, received support and communication about incurable illness. Data was analyzed using descriptive statistics and Spearman correlations. Altogether 39 family caregivers participated. A significant association was found between preparedness for caregiving and preparedness for death. Received support and communication about the illness was associated with higher levels of preparedness for caregiving and death. This study contributes to evidence on the association between preparedness for caregiving and death, but also that communication and support employed by healthcare professionals could improve family caregiver preparedness and wellbeing.

Moderating Effect of Work on Burden and Hospice Family Caregiver Well-Being

Background: Hospice family caregiving is often physically and emotionally taxing, but it is unclear how employment status impacts hospice caregiver burden and well-being. Objective(s): To examine the relationship between caregiver burden and well-being, and the moderating role of employment status (i.e., working, not working). Design, Setting/Subjects: This was a secondary data analysis of baseline data from a longitudinal observational study of family caregivers of home hospice cancer patients in the United States. Descriptive statistics, correlations, hierarchical linear regressions, and moderation analyses were used. Measurements: Baseline data included demographics, preparedness for caregiving, perceived burden, and well-being (i.e., global health, positive affect and well-being, anxiety, depression). Results: The majority of the 90 participants were White (86.7%), married (71.1%), and college educated (85.6%). The mean age was 58.27 ± 14.22, 53.3% cared for a spouse, and 56.6% worked full or part time. After controlling for demographics, and using employment status as a moderator, greater caregiver burden was significantly associated with lower global health (β = -0.82 [-1.22 to -0.42], p < 0.001), positive affect and well-being scores (β = -0.69 [-1.03 to -0.36], p < 0.001), and higher depression (β = 0.24 [0.12-0.37], p < 0.001) and anxiety scores (β = 0.22 [0.07-0.37], p < 0.005). Employment status significantly moderated the relationship between burden and global health (β = 0.65 [0.22 to 1.08], p < 0.005), and burden and positive affect and well-being (β = 0.45 [0.06 to 0.84], p < 0.05). At high levels of burden, workers had greater well-being than nonworkers. Conclusion(s): More burdened hospice caregivers may experience worse well-being, especially among nonworking caregivers. Employment may be a protective factor for highly burdened hospice family caregivers.

"Been there, done that:" A grounded theory of future caregiver preparedness in former caregivers of parents living with dementia

BACKGROUND

Family caregivers offer essential support to persons living with dementia (PLWD). Providing care for more than one family member or close other across adulthood is becoming increasingly common, yet little is known about the ways that caregiving experiences shape caregiver preparedness. The current study presents a grounded theory of future caregiver preparedness in former caregivers of PLWD.

METHOD

A coding team (five coders and two auditors) used Consensual Qualitative Research and grounded theory techniques to analyze transcripts from 32 semi-structured interviews with midlife former caregivers of parents who died following advanced Alzheimer's disease and related dementias.

RESULTS

Qualitative analysis revealed two dimensions of future caregiver preparedness: caregiving confidence and caregiving insights. Narratives from caregiving experiences informed participants' descriptions of their future caregiver preparedness. Though some former caregivers described a positive (i.e., boosted or sustained) sense of caregiving confidence following care for their parents, others described a diminished (i.e., restricted or impeded) sense of confidence. Regardless of their confidence, all caregivers described specific caregiving insights related to one or more categories (i.e., caregiving self-conduct, care systems and resources, and relating with a care partner).

CONCLUSIONS

Preparedness for future caregiving following recent care for a PLWD varies: For some, past experiences appear to offer cumulative advantages in anticipating future care roles, whereas for others, past experiences may contribute to apprehension towards, or rejection of, future care roles. Entering new caregiving roles with diminished confidence may have negative consequences for caregivers' and care partners' wellbeing. Multidimensional assessment of future caregiver preparedness in former caregivers of PLWD may support development of resources for former caregivers entering new caregiving roles.

Factors associated with pre-loss grief and preparedness in relatives of people with cancer during the COVID-19 pandemic: A cross-sectional study

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.

The Relationship Between Pre-Loss Grief, Preparedness and Psychological Health Outcomes in Relatives of People With Cancer

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.

Effectiveness of Motivational Interviewing on contribution to self-care, self-efficacy, and preparedness in caregivers of patients with heart failure: a secondary outcome analysis of the MOTIVATE-HF randomized controlled trial

AIMS

Caregiver characteristics and behaviours are associated with patients' and caregivers' outcomes. However, there is scarce evidence on interventions aimed at improving caregiver contribution (CC) to patient self-care, caregiver self-efficacy, and caregiver preparedness in heart failure (HF). This study aims to evaluate the effect of Motivational Interviewing (MI) on CC to patient self-care, caregiver self-efficacy, and caregiver preparedness in HF.

METHODS AND RESULTS

This is a secondary outcome analysis of MOTIVATE-HF randomized controlled trial. Caregivers of patients with HF were randomized into three arms: Arm 1 (MI for patients), Arm 2 (MI for patients and caregivers), and Arm 3 (standard care). The intervention consisted of one MI session plus three telephone contacts. Data were collected at baseline and after 3, 6, 9, and 12 months. A total of 510 patient and caregiver (median age 54 years, 76% females) dyads were enrolled, 235 caregivers and 238 patients completed the study until 12 months. Caregiver contribution to self-care maintenance and management and caregiver preparedness significantly improved over time, but without significant differences among the three arms. At 9 months, caregiver self-efficacy improved more in Arm 2 than Arm 3 [difference: 8.36, 95% confidence interval (CI) (3.13; 13.59), P = 0.001]. This improvement remained significant also at linear mixed model [β^ = 1.39, 95% CI (0.02; 2.75), P = 0.046].

CONCLUSION

Motivational Interviewing did not improve CC to patient self-care and caregiver preparedness. However, it increased caregiver self-efficacy, which is known to be a powerful mediator of CC to self-care.

REGISTRATION

Clinicaltrials.gov: NCT02894502.

Care readiness and positive feelings of family caregivers of children with liver transplantation in China: A cross-sectional study

AIM

This research aimed to explore the level of care readiness and positive feelings of family caregivers of children with liver transplantation, and predictive factors of care readiness were alsoinvestigated.

BACKGROUND

Children with liver transplant require high level and extensive postoperative care. Family caregivers lack professional care knowledge and experience for surgical trauma, postoperative care, anti rejection drug guidance and so on. Good care readiness can not only promote family caregivers to improve their positive emotions and physical and mental health, but also play a positive role in the recovery of children's diseases. Therefore, efforts are needed to improve the readiness of family caregivers.

DESIGN/METHODS

A total of 107 family caregivers of children undergoing liver transplantation participated in this cross-sectional study. Sociodemographic data, disease characteristics, and measures of care readiness and positive feelings were collected using questionnaires.The Care Preparedness Scale (CPS) was used to assess care readiness, and the Positive Aspects of Caregiving (PAC) was used to assess positive feelings of family caregivers of children with liver transplantation. This paper adhered to the STROBE guidelines.

RESULTS

According to the statistical results, the total score of the CPS was 18.07 ± 5.51, and that of the PAC was 26.63 ± 4.05. There was a positive correlation between care readiness and positive feelings (r = 0.413, p < 0.05). Multiple linear step-wise regression analysis revealed that the total score of the PAC, undernourishment, caregiver education, relationship with children and care trainingresidence were the independent influencing factors of the readiness of caregivers (p < 0.05).

CONCLUSIONS

The care readiness of the family caregivers of children with liver transplantation was at a medium level. Medical personnel can implement targeted health education and carry out personalized care skill training to improve the positive feelings of caregivers and then improve the readiness of caregivers.

Adolescents' and young people's needs and preferences for support when living with a parent with life-threatening cancer: a grounded theory study

BACKGROUND

Living with a parent facing life-threatening illness and losing a mom or dad at a young age can cause both short- and long-term health problems. Without satisfactory support, adolescents' and young people are at risk of developing low self-esteem, behavioural difficulties (e.g., anger and aggression), long-term illness or premature death caused by severe mental illness, substance abuse, self-harm and suicide attempts. The aim of this study was to explore adolescents' and young people's needs and preferences for support as they live with a parent with life-threatening cancer.

METHODS

Qualitative interviews were conducted with 10 respondents (17-24 years) in Norway and Sweden. Data were analysed through grounded theory according to Charmaz.

RESULTS

Adolescents' and young peoples' needs and preferences for support were described through the main category 'To feel safe and secure and to be prepared' and further broken down into five subcategories 'Relationships in the immediate family-balancing support and protection'; 'The social network-support and normalcy in a carefully selected group'; 'Maintaining everyday life-challenges in school and working life'; 'The right support at the right time-competence, trust and continuity in meeting health care professionals'; and 'Support outside the home-an opportunity for full transparency'.

CONCLUSION

Adolescents' and young peoples' preferences for support when living with a parent facing life-threatening illness are individual and unique, but they share a common need to feel safe and secure and to be prepared. Adolescents and young people express that they primarily want support from parents and friends, but they also want support from health care professionals, especially in situations when the ill parent becomes worse. Therefore, it is of the utmost importance for health care professionals to identify the most vulnerable adolescents and young people by mapping their social networks and paying extra attention to their needs for support when there is deterioration in the parent's illness state. This study also highlights the importance for health care professionals to establish a good relationship with adolescents and young people to meet their needs and preferences for support. In addition, information and support are needed in a timely manner and adapted to the life-threatening ill parent's illness state and individual's needs and preferences to optimise preparedness.

Examination of family caregivers of advanced cancer patients within the scope of the cancer family caregiving experience model: An embedded mixed-methods design

OBJECTIVE

This study aimed to examine the stressors and contextual factors that affect the quality of life (QoL) of caregivers of advanced cancer patients and to address their caregiving experiences.

METHODS

The study had an embedded mixed-methods design and was conducted in the medical oncology unit of a training and research hospital in Turkey. In the quantitative phase, 125 patients with advanced cancer and their family caregivers were included. In the qualitative phase, 21 family caregivers were included. The analysis of quantitative data was carried out using SPSS 25.0 statistical program, and qualitative data were carried out using Collaizi's seven-step descriptive analysis approach. QoL was determined as the dependent variable and evaluated with Caregiver QoL Index-Cancer (CQOLC).

RESULTS

The symptoms, care dependency of patients, and preparedness to the care of caregivers showed a direct impact on the CQOLC. Income level, employment status, and daily caregiving hours demonstrated a direct effect on the CQOLC. Four themes emerged from the interviews: Understanding the dynamics of the caregiving process, losing control of life during the caregiving process, limitation of socio-economic freedom in the caregiving process, and the effort to hold on to life in the caregiving process.

CONCLUSION

The cancer family caregiving experience model is a useful model for evaluating the QoL of caregivers from a multidimensional perspective. Health care professionals should not forget that the QoL of family caregivers should be evaluated in multiple ways, and education programmes for family members should be structured.

Piloting a Dementia Caregiver Intervention in a Primary Care Setting

OBJECTIVES

The purpose of this pilot study is to examine the efficacy of a theoretically based, 6-week dementia caregiver support group in a primary care setting.

METHODS

Using a quasi-experimental design, 22 participants completed the caregiver support group. Participants were mostly in their mid-60 s (M = 63 years old), female (n = 19), Caucasian (n = 14), and identified as either the care recipient's child or spouse (n = 19). At baseline and 6 weeks, participants completed self-report measures related to demographic information, caregiver preparedness, strain, and depressive symptoms, and care recipient's neuropsychiatric symptoms. Participants also completed a satisfaction survey. Within-subjects t-tests were run to determine if participants' scores changed over time.

RESULTS

Results revealed that participants demonstrated a significant increase in mean caregiver preparedness scores. No significant effects were found for caregiver strain, depressive symptoms, and distress related to neuropsychiatric symptoms. Participants rated being largely satisfied with the program.

CONCLUSIONS

Results suggest that this 6-week caregiver support group may be a promising caregiver intervention in primary care clinics.

CLINICAL IMPLICATIONS

Findings support the importance of caregiver support for persons with dementia in primary care.

Predictive model for the preparedness level of the family caregiver

Background

Many caregivers are insufficiently prepared, and little is known about measures that can be employed to enhance their preparedness.

Aim

The aim of this study was to explore the factors associated with caregiver preparedness and establish a predictive model including the relationship between preparedness, burden, resilience and anxiety.

Design

A cross‐sectional design was used.

Methods

The sample included 172 family caregivers who were selected from one private hospital and daytime nursing centres. Caregivers were recruited from 2018 to 2019; they completed assessments for caregiver preparedness, anxiety, resilience and burden. A multiple linear regression analysis was performed to identify the factors associated with preparedness.

Results

Preparedness was significantly associated with high levels of resilience and a low level of burden, while it was not associated with anxiety. Caregivers' gender, experience and cohabitation status were the main predictors. Resilience is an explanatory factor for caregiver preparedness in the predictive model.

Conclusion

The demographic variables related to preparedness can be used to guide efforts to meet the needs of vulnerable caregivers. A caregiver's preparedness depends on their level of burden and resilience. Nursing interventions focused on these aspects could make the caregiver's role easier and improve the quality of care provided.

What is already known about this topic?

Many caregivers are inadequately prepared for this role, and ensuring adequate preparedness is important for family caregivers.

Preparedness and factors predictive of this in Spanish family caregivers have not been well‐documented.

Resilience, burden and anxiety affect caregivers, but the degree to which they influence caregivers' preparation levels is unknown.

What is the contribution of this paper?

Specific factors influence the preparedness of family caregivers. Men and caregivers who do not cohabit in the same household with the care‐dependent person may present greater deficits in preparedness. Moreover, poor health and lack of experience in caring can result in inadequate caregiving performance.

Readiness, resilience and burden are significantly related, and the best predictor of family caregivers' preparedness is resilience.

Resilience leads to greater preparedness in caregivers, and better‐prepared caregivers experience a lighter burden.

What are the implications of this paper?

Knowing the factors associated with preparedness in advance will allow health‐care professionals to prevent deficits in vulnerable family caregivers.

Resilience is a decisive factor which prevents negative consequences such as low preparedness. A resilient coping style can diminish the burden and promote successful adaptation in caregivers.

Comparing adult-child and spousal caregiver burden and potential contributors

BACKGROUND

Adult-children caring for a parent with cancer comprise a significant segment of caregivers. Yet less is known about adult-child caregivers, their burden, or caregivers' and patients' gender's impact, which may differ from the well-studied spousal caregiver. This knowledge gap may hinder efforts to ameliorate adult-children's caregiver burden.

METHODS

We analyzed caregiver surveys from the Cancer Care Outcomes Research and Surveillance Consortium, a multi-regional population-based study of patients with colorectal or lung cancer. Using t tests and multivariate regression models, we assessed whether adult-child and spousal caregivers' caregiving responsibilities and social/emotional and financial burdens differed and used structural equation models (SEMs) to examine mediating factors.

RESULTS

Compared with spouses/partners (N = 1007), adult-children (N = 227) spent less time caregiving (14 vs 23 hours/week; P < .001), but experienced higher social/ emotional burden (P < .01). In models adjusted for objective caregiving burden measures and demographics, adult-children's social/emotional (P < .05) and financial burdens (P < .01) were greater than spouses'. Poor communication quality was associated with greater social/emotional burden for both groups (P < .05). SEMs indicated that gender concordance between caregivers and patients (eg, daughters caring for mothers) and caregiver employment increased the difference between adult-child and spouses' social/emotional burden, whereas caregiver-patient relationship quality reduced it.

CONCLUSIONS

Adult-children spend less time caregiving than spouses/partners, but have higher social/emotional and financial caregiving burdens, partially due to adult-children's employment, caregiver-patients' gender concordance, and relationship quality. Gender concordance's contribution to greater social/emotional burden adds important context to prior findings, indicating female caregivers experience the most burden. Interventions that improve caregiver-patient communication may reduce both adult-child and spousal caregiver burden.

Support for Informal Caregivers in Canada: A Scoping Review from a Hospice and Palliative/End-of-Life Care Lens

Objective: Informal caregivers (ICs) providing care for those at the end-of-life face physical, psycho-social, emotional, and/or financial challenges. However, there is a paucity of research towards the effectiveness of available interventions for this vulnerable population. The purpose of this scoping review was to investigate the availability and efficacy of interventions for ICs providing hospice and palliative/end-of-life care in Canada. Methods: Using Arksey and O’Malley's five step framework, a scoping review was conducted in the spring of 2020. Key electronic healthcare, social sciences, and grey literature databases were searched. Relevant publications from 2005 to 2019 were screened for inclusion criteria, and a thematic content analysis was conducted to summarize all key findings. Results: Initial searches yielded 145 results out of which 114 distinct articles were obtained. De-duplication and final screening yielded 28 sources which met inclusion criteria (22 peer-reviewed articles [78%] and 6 grey sources [22%]; 12 qualitative papers [42%]). Through thematic content analysis, four major themes were identified: [1] Direct financial support, [2] Direct psycho-sociospiritual support, [3] Indirect patient information provision/education, and [4] Indirect patient support. Conclusions: Healthcare practitioners should provide information on patient care and financial aid to ICs. Policies should aim to expand eligibility for and access to financial aid, in particular the Compassionate Care Benefits (CCB). Future research should focus on exploring other interventions, such as physical activities, to better support this vulnerable population. The results from this review will help inform and improve the well-being of ICs providing end-of-life care in Canada and beyond.

Perceptions of Burden and Preparedness for Caregiving among the Family Caregivers of Hospitalised Older Adults: A Cross-Sectional Study

BACKGROUND

Due to the increasing care needs of older adults, family caregivers are more and more solicited. This can have a negative impact on their quality of life related to a lack of preparedness for caregiving and feelings of burden.

OBJECTIVES

To measure perceptions of burden and preparedness for caregiving among the family caregivers of hospitalised older adults, and to explore their possible associations.

METHODS

A cross-sectional study conducted in two university hospital geriatrics wards in Switzerland. Principal family caregivers of hospitalised older adults were invited to complete sociodemographic, the Zarit Burden Interview, and the Preparedness for Caregiving Scale questionnaires. Descriptive and correlational data analyses were performed.

RESULTS

Of the 38 responding caregivers, 80% provided informal care to their spouse or parent; 45% reported a lack of preparedness to provide care and 61% reported substantial levels of burden. There was no statistically significant correlation between preparedness and burden (ρ ≤ -0.30, p = 0.07).

CONCLUSIONS

A significant proportion of caregivers reported burden and a lack of preparedness. Healthcare professionals should provide adequate support to help informal caregivers to fulfil their roles.

Practical and emotional preparation for death: A mixed methods study investigating experiences of family carers of people with dementia

Background

When family carers are more prepared for the end of the life of a person they care for, they report improved bereavement outcomes. Few studies have explored how carers prepare for the death of a person with dementia. We aimed to explore how carers for people with all stages of dementia experience preparing for end of life care and death.

Methods

This was a mixed methods cross-sectional study. Family carers of people with dementia (n = 150) completed a structured interview with validated scales, alongside questions about death preparedness and advance decisions. A sub-sample (n = 16) completed qualitative interviews exploring their experiences of planning for end of life. We fitted logistic regression models to explore associations with preparedness, and thematically analysed qualitative data.

Results

We addressed practical and emotional preparation separately for 143 participants. Fifty seven percent of participants were very practically prepared for death, while only 29% were very emotionally prepared. Male carers were more likely than female carers to report being very emotionally and practically prepared. Higher engagement with healthcare professionals was associated with feeling very practically prepared; although we found that formal discussions of end of life care issues with healthcare professionals did not impact carers’ feelings of preparation. Higher levels of dementia severity and carer depression were associated with feeling very emotionally prepared. Three qualitative themes related to practical and emotional preparation were identified: (1) ambiguity and uncertainty; (2) support from the system; and (3) how death is perceived by the carer.

Conclusions

While most carers felt practically prepared for death, emotional preparation was much lower. Further research is needed to understand how engagement with healthcare professionals or other forms of social or emotional support could help carers, particularly female carers, to emotionally prepare for their relative’s death.

Balancing Work and Hospice Caregiving-A Closer Look at Burden, Preparedness, and Mental Health

CONTEXT

Navigating end-of-life is stressful and many caregivers feel unprepared for caregiving tasks. Being employed may further increase caregiver burden.

OBJECTIVES

Study objectives were 1) to examine the relationships among caregiver burden (financial burden, daily schedule disruption, lack of family support) and mental health (depression and anxiety), and 2) explore if preparedness for caregiving mediates these relationships in employed hospice caregivers.

METHODS

This was a secondary analysis of baseline data from a prospective multi-site project of hospice family caregivers of cancer patients. Employed hospice caregivers (n = 166) completed items assessing burden, mental health, and preparedness for caregiving. Hierarchical linear regression and mediation analysis were conducted.

RESULTS

Caregivers were primarily White (n = 155, 93%) and female (n = 116, 70%), with a mean age of 55 (SD = 11.7). After controlling for demographic variables, financial burden was significantly related to anxiety (b =.16[.001, .32], P <.05), lack of family support was significantly related to depression (b = 1.27[.76, 1.79], P <.01), and daily schedule disruption was significantly related to both anxiety (b = 1.92[1.07, 2.77], P <.01), and depression (b =.70[.14, 1.26], P <.05) in regression analyses. In mediation analysis, financial burden, daily schedule disruption, and lack of family support were indirectly related to both depression and anxiety through preparedness for caregiving.

CONCLUSION

To better support employed caregivers, hospice team members should be ready to address concerns about finances, daily schedule changes, and family support and screen for preparedness for caregiving. Developing strategies to help employed hospice caregivers feel more prepared may mitigate adverse mental health outcomes.

Exploring Factors Associated With Family Caregivers' Preparedness to Care for an Older Family Member Together With Home Care Nurses: An Analysis in a Swiss Urban Area

Introduction:

Home-dwelling older people with chronic diseases often need the support of informal and formal caregivers in order to continue living at home. Family members, however, need to be willing and prepared for caregiving together with home care nurses.

Objectives:

The purpose of this study was to explore factors associated with family caregivers’ preparedness to care for older home-dwelling adults who also receive home care nursing services.

Methods:

For this cross-sectional correlational study, a structured questionnaire was sent to family caregivers of adults aged 65 years or older receiving services from a community care agency. A total of 243 participants returned the questionnaire, of which 199 could be analyzed.

Results:

The stepwise backward regression model explained 29.1% of the variance of family caregivers’ preparedness. Mutuality was the most strongly associated factor with family caregivers’ preparedness whereas professional involvement of family caregiver in care process was important as well. Care intensity showed no significant impact.

Conclusion:

Nurses should support the whole family emotionally, and appreciate, admire, reinforce, and respect the caregivers’ situation. Home care nurses need to invest in helping families to find solutions, to strengthen their relationships between family members and the older person dwelling at home.

Utilization of Parallel Resources and Sociodemographic Factors in Treating Children with Complex Chronic Diseases: A Cross-Sectional Study

Background: Children with complex chronic conditions have a high need for health and social care resources. Many parents explore parallel resources such as alternative therapies, associations, psychological support, private medical consultations, and other out-of-pocket expenses for healthcare. The use of these alternative health resources is sometimes unclear and may lead to health inequalities. To characterize the use made of alternative healthcare resources for children with complex chronic conditions. Additionally, we evaluate the influence of sociodemographic factors on the distribution of this utilization of resources; (2) Methods: Cross-sectional study. Children with complex chronic diseases were treated at a tertiary hospital in Granada, Spain in 2016. We analyzed their use of healthcare resources and socioeconomic variables. This research complies with STROBE guidelines for observational studies; (3) Results: In total, 265 children were analyzed (mean age 7.3 years, SD 4.63). A total of 105 children (39.6%) attended private consultations with specialists, and 12.1% (n = 32) of the children had additional private health insurance. One out three parents belonged to a mutual support association (n = 78), and 26% (n = 69) of the children used alternative therapies. Furthermore, 75.4% (n = 199) of the children received no psychological support. Children whose parents had a higher educational level and occupations status made greater use of parallel healthcare resources.; (4) Conclusions: A significant proportion of children used multiple health resources in addition to the public healthcare system depending on sociodemographic determinants. Studies are needed to determine whether the use of these alternative services achieves better levels of health.

Evaluation of care burden and caregiving preparedness in caregivers of patients with epilepsy: A sample in eastern Turkey

AIM

This study was conducted to evaluate the care burden and caregiving preparedness in caregivers of patients with epilepsy.

METHODS

This descriptive, cross-sectional study evaluated the caregivers of patients with epilepsy who were referred to the neurology outpatient clinic of a university hospital in Erzurum, eastern Turkey, between February 2020 and February 2021. The study was carried out with 147 volunteers among the patients with epilepsy who were referred to the neurology outpatient clinic between the specified dates. The data were collected with Caregiver Question Form, the Brief Disability Questionnaire (BDQ), the Burden Interview (BI), and the Preparedness for Caregiving Scale (PCS).

RESULTS

The mean BI score of the caregivers who participated in the study was 43.14 ± 18.08, their mean PCS score was 14.12 ± 7.76, and their mean BDQ score was 10.53 ± 4.65. In the regression analysis conducted, it was found that being married, having little knowledge of patient care, undertaking all of the roles in caregiving and having caregiving duration of 24 months and longer had a negative effect on PCS total score, while having an undergraduate degree and higher had a positive significant effect. It was found that having an undergraduate degree and higher had a negative effect on BI total score, while all of the roles undertaken in caregiving had a positive significant effect on BI total score. It was found that PCS had a negative significant effect on BI total score (p < 0.001).

CONCLUSION

Caregivers of patients with epilepsy had a moderate level of burden and caregiving preparedness, and the patients cared for had a moderate level of disability. Caregiver burden increased as disability of patients with epilepsy and the tasks undertaken in caregiving increased, whereas burden decreased as caregiver education and caregiving preparedness increased.

How Does a Family Caregiver's Sense of Role Loss Impact the Caregiving Experience?

Family caregivers reportedly have a powerful sense of role loss, which is felt when one senses a change in role or responsibility, relationship distancing, or a changed asymmetry. Little is known about the impact it has on the caregiving experience, so the purpose of this study was to clarify this in three distinct settings: when an individual’s primary role changed to the caregiver role after the start of caregiving; when their primary role was other than the caregiver role after this start; and when their primary role was the caregiver role before caregiving started. Sixty-six individuals responded to an online survey, and a framework method was employed to organize the collected data and uncover themes for analysis. Our findings shed light on the sense of caregiver role loss and pointed to the possibility of generating it when family caregivers rotate through held roles and the use of it as a tool to maintain or regain a sense of personal choice in life and self-priority. Our study is probably the first to analyze this phenomenon in different caregiving settings based on an individual’s primary role and role transitions and brings to light a new perspective of the phenomenon by understanding how it arises, its nuances, and its impact on the caregiver’s experience.

Interventions to Improve the Preparedness to Care for Family Caregivers of Cancer Patients: A Systematic Review and Meta-analysis

Background

Preparedness for caregiving could balance the negative impacts of caregiving. The interventions aimed at increasing readiness among the caregivers are important during the illness period for both patients and their caregivers.

Objectives

The aims of this study were to review the interventions applied to the caregivers of cancer patients and to examine the effects of these interventions on the preparedness to care.

Methods

The ScienceDirect, Scopus, CENTRAL, Web of Science, MEDLINE, and PubMed were searched for relevant studies published between 2000 and 2020. The methodological quality was assessed using the Quality Assessment Tool for Quantitative Studies. The statistical analyses were performed using the Comprehensive Meta-Analysis software version 3.0. The publication bias was assessed using the Egger test, for funnel plots.

Results

Eleven studies were selected for the meta-analysis, including those about psychoeducation programs (n = 5), education programs (n = 3), supportive programs (n = 2), and a self-care support program for the caregivers (n = 1). The methodological quality assessment revealed 2 studies as “strong.” The results indicated an increase in the caregivers’ preparedness to care after the interventions. The subgroup analysis revealed that the programs with higher ratios of female caregivers were more effective.

Conclusion

The interventions applied to the family caregivers can exert beneficial effects on caregivers’ preparedness to care. Nonetheless, future studies should focus on methodological issues, such as randomization and blinding.

Implications for Practice

Nurse-driven interventions may be used as a useful strategy to improve the preparedness to care among the caregivers of cancer patients. The male caregivers should be closely followed by healthcare professionals for knowledge and support needs.

Needs Assessment of Safe Medicines Management for Older People With Cognitive Disorders in Home Care: An Integrative Systematic Review

Background and Objectives: The global trend of healthcare is to improve the quality and safety of care for older people with cognitive disorders in their own home. There is a need to identify how medicines management for these older people who are cared by their family caregivers can be safeguarded. This integrative systematic review aimed to perform the needs assessment of medicines management for older people with cognitive disorders who receive care from their family caregivers in their own home.

Methods: An integrative systematic review of the international literature was conducted to retrieve all original qualitative and quantitative studies that involved the family caregivers of older people with cognitive disorders in medicines management in their own home. MeSH terms and relevant keywords were used to search four online databases of PubMed (including Medline), Scopus, CINAHL, and Web of Science and to retrieve studies published up to March 2021. Data were extracted by two independent researchers, and the review process was informed by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Given that selected studies were heterogeneous in terms of the methodological structure and research outcomes, a meta-analysis could not be performed. Therefore, narrative data analysis and knowledge synthesis were performed to report the review results.

Results: The search process led to retrieving 1,241 studies, of which 12 studies were selected for data analysis and knowledge synthesis. They involved 3,890 older people with cognitive disorders and 3,465 family caregivers. Their methodologies varied and included cohort, randomised controlled trial, cross-sectional studies, grounded theory, qualitative framework analysis, and thematic analysis. The pillars that supported safe medicines management with the participation of family caregivers in home care consisted of the interconnection between older people's needs, family caregivers' role, and collaboration of multidisciplinary healthcare professionals.

Conclusion: Medicines management for older people with cognitive disorders is complex and multidimensional. This systematic review provides a comprehensive image of the interconnection between factors influencing the safety of medicines management in home care. Considering that home-based medicines management is accompanied with stress and burden in family caregivers, multidisciplinary collaboration between healthcare professionals is essential along with the empowerment of family caregivers through education and support.

Protective Role of Caregiver Preparedness on the Relationship Between Depression and Quality of Life in Stroke Dyads

BACKGROUND AND PURPOSE

Depression and quality of life (QOL) have an interdependent and transactional nature in stroke survivor-caregiver dyads. While the strong relationship between depression and physical and emotional QOL in stroke survivor-caregiver dyads is well known, it is less clear if this relationship is moderated by caregiver preparedness, which could easily be targeted with interventions. In this study, we examined the moderating role of caregiver preparedness on the association between depression and QOL in stroke survivor-caregiver dyads.

METHODS

We used a longitudinal design with follow-ups every 3 months over a 1-year period. Considering the nonindependent nature of the data (survivors and their caregivers), we used multilevel modeling to analyze data at the dyad level. We implemented 4 longitudinal dyadic moderation models (one for each QOL domain: physical, psychological, social, and environmental) using hierarchical linear modeling.

RESULTS

A sample of 222 stroke survivor-caregiver dyads was analyzed. Stroke survivors were older (M=70.8, SD=11.9) than their caregivers (M=52.4, SD=13.1). Stroke survivors predominantly had an ischemic stroke, equally distributed by site. Caregivers were primarily female (66%), with a medium to high educational level (57%). Caregiver preparedness significantly moderated the association between survivor depression and survivor psychological (B=0.56, P<0.01) and environmental (B=0.58, P<0.01) QOL at baseline and social QOL over time (B=0.24, P<0.05). Similarly, caregiver preparedness significantly moderated the association between caregiver depression and caregiver physical (B=0.25, P<0.01) and environmental (B=0.18, P<0.05) QOL over time.

CONCLUSIONS

Caregiver preparedness has a positive influence on both members of the dyad. Assessment of stroke-caregiver preparedness could be helpful to motivate clinicians to develop and implement interventions for stroke survivor-caregiver dyads.

The Influence of Caregiver Preparedness on Caregiver Contributions to Self-care in Heart Failure and the Mediating Role of Caregiver Confidence

BACKGROUND

Caregiver contributions (CC) to heart failure (HF) self-care maintenance (ie, CC to maintaining HF stability) and management (ie, CC to dealing with HF signs and symptoms) improve patient outcomes, but it is unknown whether caregiver preparedness influences CC to self-care and whether caregiver confidence mediates this process.

OBJECTIVES

We evaluated the influence of caregiver preparedness on CC to HF self-care maintenance and management and the mediating role of caregiver confidence.

METHODS

This is a secondary analysis of the MOTIVATE-HF study. Patients were 18 years or older, with a diagnosis of HF in New York Heart Association classes II to IV, who had insufficient self-care and did not have severe cognitive impairment. Patients' informal caregivers were those people inside or outside the family who gave most of the informal care to the patients. We used the Caregiver Preparedness Scale and the Caregiver Contribution to Self-Care of HF Index. We tested a path analysis model and the indirect effects.

RESULTS

Caregivers (n = 323) were 55 (SD, 15) years old on average and predominantly female (77%). The path analysis showed that higher scores in caregiver preparedness were associated with higher scores in caregiver confidence. In turn, higher caregiver confidence was associated with higher CC to self-care maintenance and management. Caregiver confidence mediated the association between caregiver preparedness and CC to self-care maintenance and management.

CONCLUSIONS

Caregiver confidence may play a role in CC to self-care. Interventions to improve CC to HF self-care should not only be focused on improving caregiver preparedness but also should consider the role of caregiver confidence.

Examining the course of transitions from hospital to home-based palliative care: A mixed methods study

BACKGROUND

Hospital-to-home transitions in palliative care are fraught with challenges. To assess transitions researchers have used patient reported outcome measures and qualitative data to give unique insights into a phenomenon. Few measures examine care setting transitions in palliative care, yet domains identified in other populations are likely relevant for patients receiving palliative care.

AIM

Gain insight into how patients experience three domains, discharge readiness, transition quality, and discharge-coping, during hospital-to-home transitions.

DESIGN

Longitudinal, convergent parallel mixed methods study design with two data collection visits: in-hospital before and 3-4 weeks after discharge. Participants completed scales assessing discharge readiness, transition quality, and post discharge-coping. A qualitative interview was conducted at both visits. Data were analyzed separately and integrated using a merged transformative methodology, allowing us to compare and contrast the data.

SETTING AND PARTICIPANTS

Study was set in two tertiary hospitals in Toronto, Canada. Adult inpatients (n = 25) and their caregivers (n = 14) were eligible if they received a palliative care consultation and transitioned to home-based palliative care.

RESULTS

Results were organized aligning with the scales; finding low discharge readiness (5.8; IQR: 1.9), moderate transition quality (66.7; IQR: 33.33), and poor discharge-coping (5.0; IQR: 2.6), respectively. Positive transitions involved feeling well supported, managing medications, feeling well, and having healthcare needs met. Challenges in transitions were feeling unwell, confusion over medications, unclear healthcare responsibilities, and emotional distress.

CONCLUSIONS

We identified aspects of these three domains that may be targeted to improve transitions through intervention development. Identified discrepancies between the data types should be considered for future research exploration.

Preparedness for family caregiving prior to allogeneic hematopoietic stem cell transplantation

Objective

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a curative treatment associated with high morbidity and mortality. It is often necessary for family caregivers to become highly involved in the care, especially when patients return home after a long period of inpatient care. Family caregivers’ preparedness for the tasks and demands of the caregiving role prior to allo-HSCT might help them during this distressing time. The aim of this study was to explore whether demographic factors are associated with preparedness for caregiving prior to allo-HSCT and if such preparedness for caregiving is associated with caregiver outcomes in terms of caregiver burden, anxiety/depression, competence, self-efficacy, and general health among family caregivers.

Method

This correlational cross-sectional study included 86 family caregivers of patients to undergo allo-HSCT, who completed a self-administered questionnaire on preparedness, caregiver burden, anxiety/depression, competence, self-efficacy, and general health. Descriptive statistics and multiple regression models (linear and ordinal) were used to analyze the data.

Results

Family caregivers with a higher education and those who were the patient's partner were significantly associated with a higher level of preparedness for caregiving, while gender and age were not significant. Higher preparedness was significantly associated with higher competence and self-efficacy and lower symptoms of depression, even after the model was adjusted for education, relationship to the patient, gender, and age but not for anxiety or caregiver burden. Higher levels of preparedness were also significantly associated with better general health.

Significance of results

A higher level of preparedness for caregiving prior to allo-HSCT was associated with better family caregiver outcomes. Assessing family caregivers prior to allo-HSCT to identify those with insufficient preparedness might enable the provision of individually tailored psycho-educational support to help them cope with their caregiving role and prevent potential negative consequences.

Perceived caregiving preparedness and quality of life among Indonesian family caregivers of patients with life-limiting illness

BACKGROUND

Family caregivers play an important role in palliative care. However, family caregivers often report that they felt insufficiently prepared to become a caregiver. This lack of preparedness may lead to a decline in the caregiver's quality of life (QoL), and they may not be able to provide sufficient palliative care to their family member.

AIMS

To investigate the preparedness of family members to become caregivers alongside their QoL.

METHOD

A correlational cross-sectional study design was used. A sample of 104 family caregivers completed a World Health Organization Quality of Life Brief to assess the QoL of participants. The Caregiving Inventory (CGI) was used to assess how prepared family members felt to become care-givers, and the CGI also included questions related to the patient's socio-demographic status and illness. Correlation analysis was used to address the research questions. Caregivers were caring for a family member with a life-limiting illness in a suburban district of Indonesia.

FINDINGS

The 104 family caregivers had a relatively low score for both QoL and caregiving preparedness. A caregiver feeling more prepared was associated with a higher QoL. The study also found a positive correlation (r value, between 0.236-0.481) between perceived caregiving preparedness, including its factors, and domains of QoL.

CONCLUSION

A person's preparedness to become a caregiver is significantly associated with all QoL domains: physical, psychological, social and environmental. Family members can be better prepared to become a caregiver with training and information about personal care and symptom management.

Systematic review of factors associated with hope in family carers of persons living with chronic illness

AIMS

To identify factors associated with hope in family carers of persons living with chronic illness.

DESIGN

A systematic review of quantitative and mixed method studies on hope in carers of persons living with chronic illness.

DATA SOURCES

Five electronic databases (Medline, Cumulative Index to Nursing and Allied Health Literature, Web of Science, ProQuest Dissertations and PsycINFO) were searched from inception to 13 July 2020.

REVIEW METHODS

Inclusion criteria were the following: (a) study population of adult (18 years of age and older) carers of persons living with chronic illness, (b) hope was measured as a variable, (c) reported factors associated with hope, (d) employed either quantitative or mixed methods design, (e) written in English and (f) was published in peer reviewed journals. All included studies were evaluated for quality using the Mixed Method Appraisal Tool.

RESULTS

Twenty-six studies were included in the systematic review. Quality of life, physical and mental health, life satisfaction and the hope of care recipients were found to be positively associated with hope. Carer's coping increased (self-efficacy and caregiver preparedness) as hope increased with a decrease in maladaptive coping strategies. Anxiety, depression, distress, grief and guilt were negatively associated with carers' hope. Carers' hope did not appear to be associated with carer or care-recipient demographic variables.

CONCLUSION

Carers' hope appears to be associated with the carers' over all positive health. The factors associated with carers' hope provide potential areas to focus intervention development such as strategies that increase self-efficacy. More research is needed to clarify if factors such as stage of disease and resilience are associated with hope. Research on carers' hope assessment and intervention development should also focus on factors associated with hope.

IMPACT

The findings underscore the need to assess and work with carers of persons living with chronic illness to enhance their hope.

Evaluation of care burden and preparedness of caregivers who provide care to palliative care patients

OBJECTIVE

Caregivers have a great role in palliative care. Considering the difficult process of palliative care, the caregiver undertakes an extra burden with the responsibility of the patient. This study was carried out to evaluate the care burden and preparedness of caregivers who provide care for palliative care patients.

METHOD

This study was conducted in the palliative care unit of a state hospital in Turkey between January and May 2019. No sample was selected in the study, and the study was carried out with individuals who were hospitalized in the palliative care unit and who volunteered to participate in the study between the specified dates. The data were collected with Patient Relative Questionnaire Form, Burden Interview, and Preparedness for Caregiving Scale.

RESULTS

The average Burden Interview score was found as 33.6, SD 13.03 in the study. Patient relatives perceived the patients they cared for as a burden at moderate levels. The Preparedness for Caregiving score average was found as 18.55, SD 6.83. It was found that patient relatives were moderately prepared to undertake the role of caregiver. It was found that care burden decreased as preparedness for caregiving increased and burden increased as preparedness for caregiving decreased (p = 0.001).

SIGNIFICANCE OF RESULTS

As a result of the study, it was found that caregivers of palliative patients had the moderate levels of care burden and preparedness for caregiving. It was found that as the preparedness levels of caregivers increased, their burdens decreased. Accordingly, it is important that nurses will plan nursing interventions by considering the factors that affect the care burden and preparedness of caregivers.

Willingness and preparedness to provide care: interviews with individuals of different ages and with different caregiving experiences

Background

At present, the provision of informal care to older relatives is an essential pillar of the long-term care system in Germany. However, the impact of demographic and social changes on informal caregiving remains unclear.

Methods

Thirty-three semi-structured interviews were conducted with care consultants, informal caregivers and people without any caregiving experience to explore if people are willing to provide older adult care and how prepared these are with regard to the possibility of becoming care dependent themselves.

Results

In total, three main categories (willingness to provide care, willingness to receive care and information as preparation) with several sub-categories were identified during the content analysis. While almost all interviewees were willing to provide care for close family members, most were hesitant to receive informal care. Other factors such as the available housing space, flexible working hours and the proximity of relatives were essential indicators of a person’s preparedness to provide informal care. It is, however, unclear if care preferences change over time and generations. Six out of 12 informal caregivers and nine out of 14 care consultants also reported an information gap. Because they do not possess adequate information, informal caregivers do not seek help until it is too late and they experience high physical and mental strain. Despite the increased efforts of care consultants in recent years, trying to inform caregivers earlier was seen as almost impossible.

Conclusions

The very negative perception of caregiving as a burden was a reoccurring theme throughout all interviews and influenced people’s willingness to receive care as well as seeking timely information. Despite recent political efforts to strengthen home-based care in Germany, it remains unclear whether political efforts will be effective in changing individuals’ perceptions of informal caregiving and their willingness to be better prepared for the highly likely scenario of having to care for a close relative or becoming care dependent at a later stage in life.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-021-02149-2.

Psychological symptoms in widowed parents with minor children, 2-4 years after the loss of a partner to cancer

OBJECTIVES

This study aimed to explore psychological symptoms in widowed parents with minor children, 2-4 years after the death of their partner. A second aim was to examine the associations between psychological symptoms and nonmodifiable and modifiable illness and healthcare-related factors.

METHODS

A cross-sectional survey study on widowed parents with minor children after the loss of a partner to cancer. In total, 42 parents completed an online questionnaire including instruments for assessing symptoms of anxiety, depression, grief rumination, prolonged grief, and posttraumatic stress. Descriptive statistics, Spearman's correlation coefficients, Mann-Whitney U tests and Kruskal-Wallis tests were used to analyze differences in symptomology based on modifiable and nonmodifiable factors.

RESULTS

Parents reported moderate-severe symptoms of anxiety, posttraumatic stress, and depression. Reporting having received more information during the partner's illness regarding how the illness could affect the partner's somatic and psychological health and where to turn for support were associated with fewer psychological symptoms.

CONCLUSIONS

A substantial proportion of widowed parents with minor children reported a moderate-severe symptom burden regarding depression, anxiety, and posttraumatic stress, and less so with prolonged grief symptoms. This study also highlighted the value of receiving information from healthcare personnel regarding the somatic and psychological effects of a partner's illness and where widowed parents can turn for support.

The #PalliativeCare Conversation on Twitter: An Analysis of Trends, Content, and Caregiver Perspectives

CONTEXT

Palliative care is known to improve patients' quality of life, but oftentimes these conversations occur outside of the health-care setting.

OBJECTIVES

To characterize the #PalliativeCare Twitter network and evaluate the caregiver experience within palliative care.

METHODS

In this cross-sectional study, a total of 182,661 #PalliativeCare tweets by 26,837 users from June 1, 2015 to June 1, 2019 were analyzed using Symplur Signals. Analysis included activity metrics, content analysis, user characteristics, engagement, and network analysis. Similar metrics were performed on tweets by self-identified caregivers (482), who wrote a total of 3952 tweets. Qualitative analysis was completed on a systematic sample of caregiver tweets.

RESULTS

The number of #PalliativeCare tweets, users, and impressions has increased by an annual average of 18.7%, 16.4%, and 32.5%, respectively. Support, access, and patients were among the Trending Terms. About 39.4% of Trending Articles were scientifically valid, and information about palliative care and comorbidities had the greatest number of articles. The majority of users wrote five or less #PalliativeCare tweets. Network analysis revealed central hubs to be palliative care advocacy organizations and physicians. The five main themes from qualitative analysis of caregiver tweets were 1) advocacy and events, 2) care strategies, 3) resources, 4) public health issues, and 5) myths related to palliative care.

CONCLUSION

The use of Twitter as a platform for palliative care conversations is growing rapidly. Twitter serves as a platform to facilitate #PalliativeCare conversation among patients, caregivers, physicians, and other healthcare providers.

Death and Grieving for Family Caregivers of Loved Ones With Life-Limiting Illnesses in the Era of COVID-19: Considerations for Case Managers

Purpose:

Family caregivers of a loved one with a life-limiting or terminal illness are often overwhelmed by, and underprepared for, their responsibilities. They often need help from family members and friends to provide comprehensive care. When death occurs, funerals and other death-related rituals bring family and communities together to honor the life and mourn the death of a loved one and provide needed support to family and caregivers. These collective rituals are often deeply rooted in culturally-bound values and can facilitate grief and help make sense about loss. Rituals act as bridge-building activities that allow people to organize and appraise emotions, information, and actions after a loss. With the emergence of the coronavirus disease-2019 (COVID-19) pandemic and the recommended restrictions to reduce infection and transmission, family members and caregivers are often faced with weighing options for honored rituals to help them grieve. Grieving during the pandemic has become disorganized. The purpose of this article is to provide case managers and other clinical staff with recommendations on guiding caregivers/families through safety precautions when a loved one dies either because of a life-limiting illness or from COVID-19 during the pandemic using guidelines from the Centers for Disease Control and Prevention (CDC). The authors also present information about complicated grief and ways to support coping with death and suggest safe alternatives to traditional death-related rituals and funerals in a COVID-19 era.

Primary Practice Setting(s):

Primary practice settings include home health care, hospice, hospital discharge planning, case management, and primary care.

Findings/Conclusions:

Precautions necessary in a COVID-19 era may add anxiety and stress to an already difficult situation of caring for loved ones at end-of-life and grieving with their loss. Utilization of CDC guidelines lessens the risk of infection while honoring loved ones’ wishes and cultural traditions surrounding death and burial. Recognition of social and spiritual connections that comfort mourners must also be considered.