Complexity and function of family involvement in advance care planning: A qualitative study of perspectives from people living with advanced cancer, family members and healthcare professionals

Correlation between benefit finding and caregiving abilities among family caregivers of patients with lung cancer: a network analysis

Objective

This study aimed to construct a network analysis model for benefit finding (BF) and caregiving abilities to clarify the interrelationships and mutual influences among different dimensions and propose nursing strategies.

Methods

Convenience sampling was used to select 272 family caregivers of patients with lung cancer admitted to a tertiary hospital in Guangzhou City, China, from April 2023 to November 2023. Socio-demographic and disease characteristics questionnaire, the revised BF Scale, and the Family Caregiver Task Inventory (FCTI) were used for data collection. The R software was used to construct networks for BF and caregiving abilities, and network analysis methods were employed to identify network characteristics, core nodes, and bridge nodes.

Results

In the overall network, the social relationship dimension (rs = 3.04) exhibited the highest strength centrality index, followed by the family relationship dimension (rs = 2.94). In addition, the social relationship dimension (rbs = 0.30) had the highest bridge strength centrality index, followed by the dimension of addressing personal emotional needs (rbs = 0.26).

Conclusion

This study provides a new perspective on exploring the underlying mechanisms of interaction among different dimensions of BF and caregiving abilities in family caregivers of patients with lung cancer using network analysis. The findings suggest that healthcare professionals can improve family caregivers' social relationships, family relationships and address emotion regulation to enhance BF and caregiving abilities. Specific nursing strategies are proposed, offering new intervention targets for enhancing BF and caregiving abilities among family caregivers of patients with lung cancer.

Effectiveness of Dyadic Advance Care Planning: A Systematic Review and Meta-Analysis

CONTEXT

Making decisions regarding end-of-life care is particularly challenging for patients and their family caregivers. Studies have advocated that family involvement in advance care planning is important to provide goal-concordant care and to increase family caregivers' preparation for surrogate decision-making. However, there is a lack of evidence to examine the effectiveness of advance care planning using the patient-caregiver dyadic approach.

OBJECTIVES

To evaluate the effectiveness of dyadic advance care planning.

METHODS

A literature search was systematically carried out in 7 databases from inception to March 2023. All randomized controlled trials with advance care planning interventions for mentally competent adults and their family caregivers were included. Meta-analysis was conducted for available quantitative data related to end-of-life care; Otherwise, narrative syntheses were performed.

RESULTS

In total, 14 randomized controlled trials were included. The main contents of all interventions were summarized into five categories, namely sharing illness experience and perception, introducing knowledge about advance care planning and end-of-life care, discussing individual's/dyads' values, goals, and care preferences, addressing dyads' discordance, and providing supports to complete advance care planning behaviors. The meta-analysis showed that dyadic advance care planning had significant effects on advance directive documentation (OR = 7.58, 95% CI [1.41, 40.63], P = 0.02) and proactive communication with doctors (OR = 2.42, 95% CI [1.42, 4.12], P = 0.001). In addition, interventions may improve dyad's congruence on end-of-life care, family caregivers' confidence in surrogate decision-making, and quality of end-of-life communication.

CONCLUSIONS

This review supports that dyadic advance care planning is a promising approach to preparing patients and their family caregivers for end-of-life communication and decision-making. Given that this multifaceted process is influenced by multiple factors within the socio-cultural context, future studies are warranted to identify the barriers and facilitators to implement dyadic advance care planning in real-world settings.

Journey to inpatient hospice care: A qualitative study on the decision-making process of Chinese family caregivers of persons with terminal cancer

OBJECTIVE

To understand family caregivers' decision-making process to place their family members with terminal cancer in inpatient hospice care, especially in the social-cultural contexts whereby the caregivers have a dominant say about the care of their seriously ill family members.

METHODS

A qualitative study with a phenomenological approach was undertaken to understand the lived experience of caregivers of persons with terminal cancer in the decision-making process. Semi-structured qualitative interviews were conducted with a purposive sample of 17 caregivers in Shanghai, China. Thematic analysis was used to analyze the data.

RESULTS

The caregivers underwent a winding and socioculturally mediated four-stage process. The stages are (i) trigger for alternatives: lost hope for a cure, (ii) meandering the see-saw process, (iii) the last straws: physical limitations and witnessing unbearable suffering, and (iv) the aftermath: acceptance versus lingering hope. Caregivers' attitudes towards death and their family members with advanced cancer expressed care wishes influence the state of the aftermath.

CONCLUSIONS

Chinese sociocultural values and beliefs about caregiving and death provide insightful explanations for the observed process.

PRACTICAL IMPLICATIONS

Training healthcare professionals in cultural competence, developing an effective hospice referral system, and delivering socioculturally acceptable death education are critical interventions to facilitate better decision-making experiences.