PANDORA dyadic project: hope, spiritual well-being and quality of life of dyads of patients with chronic obstructive pulmonary disease in Switzerland - a multicentre longitudinal mixed-methods protocol study

INTRODUCTION

Chronic obstructive pulmonary disease (COPD) is responsible for 2.9 million deaths annually in Europe. Symptom burden and functional decline rise as patients reach advanced stages of the disease enhancing risk of vulnerability and dependency on informal caregivers (ICs).Evidence shows that hope is an important psycho-social-spiritual construct that humans use to cope with symptom burden and adversity. Hope is associated with increased quality of life (QoL) comfort and well-being for patients and ICs. A better understanding of the meaning and experience of hope over time as patients transition through chronic illness may help healthcare professionals to plan and deliver care more appropriately.

METHODS AND ANALYSIS

This is a longitudinal multicentre mixed-methods study with a convergent design. Quantitative and qualitative data will be collected from dyads of advanced COPD patients and their ICs in two university hospitals at two points in time. The Herth Hope Index, WHO Quality of Life BREF, Functional Assessment of Chronic Illness Therapy-Spiritual Well-being and the French version of the Edmonton Symptom Assessment Scale will be used to collect data. Dyadic interviews will be conducted using a semi-structured interview guide with five questions about hope and their relationship with QoL.Statistical analysis of data will be carried out using R V.4.1.0. To test whether our theoretical model as a whole is supported by the data, structural equation modelling will be used. The comparison between T1 and T2 for level of hope, symptom burden, QoL and spiritual well-being, will be carried out using paired t-tests. The association between symptom burden, QoL, spiritual well-being and hope will be tested using Pearson correlation.

ETHICS AND DISSEMINATION

This study protocol received ethical approval on 24 May 2022 from the Commission cantonale d'éthique de la recherche sur l'être humain-Canton of Vaud. The identification number is 2021-02477.

Coping in the role as next of kin of a person with a brain tumour: a qualitative metasynthesis

OBJECTIVE

Being the next of kin of a person with a brain tumour is a stressful experience. For many, being a next of kin involves fear, insecurity and overwhelming responsibility. The purpose of this study was to identify and synthesise qualitative original studies that explore coping in the role as next of kin of a person with a brain tumour.

METHODS

A qualitative metasynthesis guided by Sandelowski and Barroso's guidelines was used. The databases Medline, CHINAL and PsycINFO were searched for studies from January 2000 to 18 January 2022. Inclusion criteria were qualitative original studies that aimed to explore coping experience by the next of kin of a person with brain tumour. The next of kin had to be 18 years of age or older.

RESULTS

Of a total of 1476 screened records data from 20 studies, including 342 participants (207 females, 81 males and 54 unclassified) were analysed into metasummaries and a metasynthesis. The metasynthesis revealed that the next of kin coping experiences were characterised by two main themes: (1) coping factors within the next of kin and as a support system, such as their personal characteristics, perceiving the role as meaningful, having a support system, and hope and religion; (2) coping strategies-control and proactivity, including regaining control, being proactive and acceptance.

CONCLUSION

Next of kin of patients with brain tumours used coping factors and coping strategies gathered within themselves and in their surroundings to handle the situation and their role. It is important that healthcare professionals suggest and facilitate these coping factors and strategies because this may reduce stress and make the role of next of kin more manageable.

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.

Hopeful dying? The meanings and practice of hope in palliative care family meetings

Hope can carry considerable allure for people facing imminent mortality and for those who care for them. Yet, how hope is variously and relationally (re)produced within end-of-life care settings, remains under-researched. In this study, we aimed to better understand hope as it circulates within palliative care, drawing on video recorded family meetings and pre- and post-meeting qualitative interviews, within two hospitals in Queensland, Australia. Our findings highlight family meetings as an important site for articulations of hope and hopefulness. The results illustrate how hope is recalibrated within the transition to and through palliative care, the tensions between hope and futility, and the work of hope in discussions of goals and expectations. Through our analysis we argue that hopefulness within family meetings, and in palliative care more broadly, is collectively produced and opens up discourses of hope to the lived experience of terminality. Attending to the nuances of hope, including moving beyond the determinative (hope for more life/hope for a quick death), can elucidate the possibilities and problems of the collective negotiation of hope at the end of life, including how hope can be drawn on to express support and solidarity.

Hope in palliative care nursing: concept analysis

BACKGROUND

Hope has long been considered essential to humans in several disciplines, nursing included. At the end-of-life, hope is a complex and dynamic emotion, and there have been different interpretations and conceptions of hope.

AIM

To develop hope in palliative care as an evidenced-based nursing concept: analyse its attributes, antecedents and consequences.

METHOD

This study follows Walker and Avant's concept analysis: (a) select a concept; (b) determine the aims or purposes of analysis; (c) identify as many uses of the concept as possible; (d) determine the defining attributes; (e) identify a model case; (f) identify borderline and contrary cases; (g) identify antecedents and consequences; and finally (h) define the empirical referents.

FINDINGS

Antecedents included symptom control, existential suffering, interpersonal relationships and the establishment of realistic goals. The synthetic attributes were a positive outcome expectancy and a process oriented towards the present and future. The concept's consequences were quality of life, survival, acceptance and a peaceful death.

CONCLUSION

This study revealed a strong history of publications on the subject. The analysis of attributes, antecedents and consequences of the concept of hope contributed to understanding its relevance to palliative care nursing and provided suggestions for effective interventions and future research.

How does spirituality manifest in family caregivers of terminally ill cancer patients? A qualitative secondary analysis

OBJECTIVE

Considering the risk of spiritual distress among terminally ill patients, experts long agree that spiritual care has to be an integral component of palliative care. Despite this consensus, the role of spirituality among family caregivers remains largely unexplored. We aimed to describe how spirituality manifests in the lived experience of family caregivers (FCs) in a palliative care context.

METHOD

As part of a secondary analysis, data derived from two qualitative primary studies on FCs' burdens and needs in the context of caring for a patient with a diagnosis of incurable cancer. Previously transcribed interviews were examined by means of a thematic analysis, transcending the focus of the primary studies to examine how spirituality arises and/or persists in the life of FCs from the time of diagnosis of incurable cancer up until bereavement.

RESULTS

Twenty-nine narratives were explored and all included spirituality as a relevant theme. Analysis revealed four aspects associated with the presence of spirituality among FCs' experiences: "Connectedness," "Religious Faith," "Transcendence," "Hope," and a fifth overarching aspect which we named "Ongoing integration of spiritual experience." Spirituality appeared as a multilayered phenomenon and was shaped individually among FCs' narratives.

SIGNIFICANCE OF RESULTS

In view of the results, exploring and discussing spirituality and underlying experiences in the situation as an FC seems likely to widen the perspective on FCs' problems and needs. Further research on spiritual needs among FCs of patients with incurable life-limiting cancer is deemed necessary.

Developing a Living with Hope Program for Caregivers of Family Members with Advanced Cancer

A theory-based intervention, the Living with Hope Program (LWHP), was designed to foster hope in caregivers of family members with advanced cancer. The LWHP was developed from qualitative data and using Harding and Higginson's recommendations for family caregiver interventions as a guide. The LHWP is: a) focused specifically on the caregivers themselves, b) theory based, c) feasible, d) acceptable, and e) pilot tested. The program consists of a hope video and a hope activity titled Stories of the Present. A mixed-method, concurrent triangulation, pre- and post-test design was used to pilot test the LWHP. The results of the pilot test suggest the LWHP is easy to use, flexible, and feasible, and shows promise in increasing hope and quality of life scores in family caregivers.

Uncertainty, hope, and coping efficacy among mothers of children with Duchenne/Becker muscular dystrophy

Uncertainty is a challenging aspect of caring for children with Duchenne/Becker muscular dystrophies (DBMD). Although uncertainty is often perceived as a state to be avoided, hope may influence caregivers' perceptions of uncertainty as opportunity. The goal of this cross-sectional quantitative study was to pilot a novel measure of state-based hope, and test relationships among uncertainty, hope, spirituality, and coping efficacy in mothers of children with DBMD. Mothers (n = 202) were recruited through DuchenneConnect, Parent Project Muscular Dystrophy, and Cincinnati's Children Hospital. A one-component solution for the novel Parent Hope Scale explained 44.3% of the variance, and the measure showed high internal consistency. Higher hope (P < 0.001), further disease progression (P = 0.042), and older mother's age (P = 0.001) were significantly associated with lower perceptions of uncertainty. Mothers reporting less hope (P < 0.001), higher perceptions of uncertainty (P < 0.001), and less spirituality (P = 0.001) reported lower coping efficacy. As such, hope appears to be a key variable in shaping uncertainty appraisals and facilitating coping efficacy. While further research is needed, counseling aimed at bolstering hope, particularly among less-hopeful mothers, and interventions to reappraise uncertainty, may be helpful in promoting coping efficacy.

Transitions as experienced by persons in palliative care circumstances and their families - a qualitative meta-synthesis

Background

When receiving palliative care, patients and their families experience altered life situations in which they must negotiate challenges in daily life, increased care and new roles. With limited time, they also experience emotional changes that relate to their uncertain future. Transitions experienced in such situations are often studied by focusing on individual aspects, which are synthesized in the following study. The aim was to conduct a qualitative meta-synthesis to explore the experiences patients and their families gain during transitions in palliative care circumstances.

Methods

A qualitative meta-synthesis was conducted following an inductive approach as proposed by Sandelowski and Barroso. Inclusion criteria were studies with adult persons in palliative situations and articles published in English or German. Relevant articles were identified by researching the Pubmed and Cinahl databases, as well as by hand searches in journals and reference lists for the period 2000–2015. The findings of each study were analyzed using initial coding, followed by axial and selective coding in this order. Consequently, a conceptual model was derived from the categories.

Results

In total 2225 articles were identified in the literature search. Finally, 14 studies were included after the selection process. The central phenomenon observed among palliative care patients and their families was maintaining normality during transitions. Transitions are initially experienced unconsciously until a crisis occurs and responsive actions are necessary, which encourages patients and families to perceive the situation consciously and develop strategies for its negotiation. Patients remain caught between hopelessness and valuing their remaining time alive. As the illness progresses, informal caregivers reprioritize and balance their roles, and after death, family members inevitably find themselves in changed roles.

Conclusions

In palliative care situations, transitions are experienced differently by patients and their families in a constant phenomenon that oscillates between unconscious and conscious perceptions of transitions. The derived conceptual model offers an additional perspective to existing models and helps to clarify the phenomenon in practical settings. The study promotes a differentiated conceptual view of transitions and emphasizes patients’ and families’ perspectives.

A metasynthesis study of family caregivers' transition experiences caring for community-dwelling persons with advanced cancer at the end of life

BACKGROUND

Family caregivers (broadly defined as family and friends) experience multiple concurrent transitions when caring for a person with advanced cancer.

AIMS

To (a) explore the transition experience of family caregivers caring for persons with advanced cancer living in the community, (b) describe potential triggers for transitions, (c) identify what influences this experience, and (d) develop a conceptual framework of their transition experience.

DESIGN

Sandelowski and Barroso's methodology for synthesizing qualitative research included (a) a comprehensive search of empirical literature, (b) quality appraisal of qualitative studies, (c) classification of studies, and (d) synthesis of the findings.

DATA SOURCES

Literature was sourced from six electronic data bases. Inclusion criteria were as follows: (a) published qualitative studies (and mixed-method designs) of the caregiving experience of family caregivers of community-living persons with advanced cancer at the end of life, (b) participants (caregivers and care recipients) of 18 years of age and above, (c) studies published in English in any country, and (d) studies published between 2004 and 2014.

RESULTS

A total of 72 studies were included in the metasynthesis. Family caregivers experience a "life transition" whereby their lives are permanently altered. The participants described the process of redefining normal which consisted of coming to terms with their situation and connecting with others. Outcomes of these processes were as follows: (a) maintaining a sense of personhood, (b) reframing hope, (c) maintaining self-efficacy, (d) finding meaning, and (e) preparing for the death of their care recipient.

CONCLUSION

The findings provide a framework to guide the development of supportive programs and future research.

Family Experiences in End-of-Life Care: A Literature Review

PURPOSE

The purpose of this study was to summarize and analyze families' experiences of end-of-life care by conducting a systematic review of peer reviewed journals both in Korea and abroad.

BACKGROUND

Families play an increasingly important role in care and medical treatment, acting as caregivers or decision makers rather than just being passive observers. It is necessary to understand the experiences of family members in order to provide appropriate care for them.

METHODS

A systematic search of the literature was performed using the Cumulative Index for Nursing and Allied Health Literature (CINAHL) and the Korea Education & Research Information Service (KERIS) for the period of January 1990 through to December 2006. A total of 35 studies met the inclusion criteria.

RESULTS

Seventeen studies used a quantitative design, while 18 studies used qualitative methods. Quantitative studies reported that the family's quality of life was relatively low when the patient was in need of high medical/nursing services. The perceived burden levels were moderately high, and depression levels were high among family caregivers. Various concepts emerged from the 18 qualitative studies, including psychological issues, physical problems, burdens, needs and interpersonal relationships.

CONCLUSION

This study found that most previous research findings were focused on negative and neutral experiences. A few studies identified positive experiences. Based on the study results, we suggest that nurses need to be more aware of the experiences of patients' families and their potential needs.

Determinants of a hopeful attitude among family caregivers in a palliative care setting

OBJECTIVE

This study investigated the determinants of a hopeful attitude among family caregivers involved with palliative care.

METHOD

We investigated a broad range of factors for the patient-family dyad in a palliative care setting using a cross-sectional design. The patients' sociodemographic, clinical and psychological factors were evaluated, as well as caregiver-related sociodemographic and psychological factors, including depressive symptoms, burden, coping style and religiosity. Caregivers were divided into two groups based on a hopeful or nonhopeful attitude and assessed using the abbreviated version of the seven-item Beck Hopelessness Scale (BHS-7).

RESULTS

Of 304 analyzed dyads, 210 (69.1%) caregivers showed a hopeful attitude, with a BHS-7 score of 0. The adjusted logistic regression analyses showed that caregivers' hopeful attitude was determined by only their psychological status: less depressive symptoms [odds ratio (OR), 0.86; 95% confidence interval (CI), 0.83-0.90], active coping strategy (OR, 1.12; 95% CI, 1.07-1.18) and lower burden (OR, 0.93; 95% CI, 0.88-0.99). In a subpopulation analysis (n=200), higher religiosity was a significantly associated factor.

CONCLUSION

Healthcare providers need to pay attention to the psychological vulnerability of caregivers to encourage a hopeful attitude. Additional studies of longitudinal design for hopeful attitude throughout the trajectory of palliative care are necessary.

Hope against hope: exploring the hopes and challenges of rural female caregivers of persons with advanced cancer

BACKGROUND

This paper focuses on the qualitative component of a study evaluating a hope intervention, entitled Living with Hope Program (LWHP), designed to foster hope in female caregivers of family members living with advanced cancer. The purpose of this research is to share, in the form of a story, the experiences of rural female caregivers caring for family members with advanced cancer, focusing on what fosters their hope. Hope is a psychosocial and spiritual resource that has been found to help family caregivers live through difficult transitions and challenges.

METHODS

Twenty-three participants from rural Western Canada completed daily journal entries documenting their hopes and challenges. Cortazzi's (2001) method of narrative analysis was used to analyze the data, which was then transcribed into a narrative entitled 'hope against hope.'

RESULTS

The journal entries highlighted: the caregivers' hopes and what fostered their hope; the various challenges of caregiving; self-care strategies, and; their emotional journey. Hope was integrated throughout their entire experience, and 'hope against hope' describes how hope persists even when there is no hope for a cure.

CONCLUSIONS

This research contributes to the assessment of caregiver interventions that impact hope and quality of life, while illustrating the value of a narrative approach to both research and practice. Journaling may be particularly valuable for rural caregivers who are isolated, and may lack direct professional and peer support. There is an opportunity for health professionals and other providers to foster a relationship of trust with family caregivers, in which their story can be told openly and where practitioners pay closer attention to the psychosocial needs of caregivers.

The stress-buffering effects of hope on changes in adjustment to caregiving in multiple sclerosis

This study examined the direct and stress-buffering effects of global hope and its components (agency and pathways) on changes in adjustment to multiple sclerosis caregiving over 12 months. A total of 140 carers and their care-recipients completed questionnaires at Time 1 and 12 months later, Time 2. Focal predictors were stress, hope, agency and pathways, and the adjustment outcomes were anxiety, depression, positive affect, positive states of mind and life satisfaction. Results showed that as predicted, greater hope was associated with better adjustment after controlling for the effects of initial adjustment and caregiving and care-recipient illness variables. No stress-buffering effects of hope emerged. Regarding hope components, only the agency dimension emerged as a significant predictor of adjustment. Findings highlight hope as an important protective resource for coping with multiple sclerosis caregiving and underscore the role of agency thinking in this process.

Evaluation of the living with hope program for rural women caregivers of persons with advanced cancer

BACKGROUND

Hope has been identified as a key psychosocial resource among family caregivers to manage and deal with the caregiver experience. The Living with Hope Program is a self-administered intervention that consists of watching an international award winning Living with Hope film and participating in a two week hope activity ("Stories of the Present"). The purpose of this study was to examine the effects of the Living with Hope Program on self-efficacy [General Self-Efficacy Scale], loss and grief [Non-Death Revised Grief Experience Inventory], hope [Herth Hope Index] and quality of life [Short-Form 12 version 2 (SF-12v2)] in rural women caring for persons with advanced cancer and to model potential mechanisms through which changes occurred.

METHODS

A time-series embedded mixed method design was used, with quantitative baseline outcome measures repeated at day 7, day 14, and 3, 6 and 12 months. Qualitative data from the hope activity informed the quantitative data. Thirty-six participants agreed to participate with 22 completing all data collection. General estimating equations were used to analyze the data.

RESULTS

Herth Hope Index scores (p=0.05) had increased significantly from baseline at day 7. General Self Efficacy Scale scores were significantly higher than baseline at all data time points. To determine the mechanisms of the Living with Hope Program through which changes occurred, results of the data analysis suggested that as General Self Efficacy Scale scores increased (p<0.001) and Non-death Revised Grief Experience Inventory scores decreased (p=0.01) Herth Hope Index scores increased. In addition as Herth Hope Index scores increased (p<0.001) and Non-death Revised Grief Experience Inventory scores decreased (p=0.01), SF-12v2 mental health summary scores increased. Qualitative data suggested that through the hope activity (Stories of the Present) the participants were able to find positives and hope in their experience.

CONCLUSIONS

The Living with Hope Program has potential to increase hope and improve quality of life for rural women caregivers of persons with advanced cancer. The possible mechanisms by which changes in hope and quality of life occur are by decreasing loss and grief and increasing self-efficacy.

TRIAL REGISTRATIONS

Registration ClinicalTrials.gov, NCT01081301.

What Hope Means to Parents of Children with Cancer?

Objetivo: describir el concepto de la esperanza que tienen los padres de niños entre 0 y 15 años de edad con diagnóstico de cáncer. Método: investigación cualitativa de tipo descriptivo exploratorio; la información se recolectó en cuatro ciudades de Colombia, a través de entrevistas semiestructuradas a once padres de niños con diagnóstico de cáncer. Resultados: se identificaron doce categorías que describen las experiencias de los padres y cómo estas los llevan vivir y a describir la esperanza como virtud y estado de ánimo. Conclusiones: la esperanza termina siendo el eje fundamental que mueve la vida de los padres; las experiencias alrededor del cáncer de sus hijos transforman el significado de la enfermedad y de su propias vidas, en las cuales se redescubren estrategias y mecanismos positivos de afrontamiento.

Both maintaining hope and preparing for death: effects of physicians' and nurses' behaviors from bereaved family members' perspectives

CONTEXT

Both maintaining hope and preparing for the patient's death are important for families of terminally ill cancer patients.

OBJECTIVES

The primary aim of this study was to clarify the level of the family's achievement of maintaining hope and preparing for death and the professional's behavior related to their evaluations.

METHODS

A cross-sectional, anonymous, nationwide survey was conducted involving 663 bereaved families of cancer patients who had been admitted to 100 palliative care units throughout Japan.

RESULTS

A total of 454 family members returned the questionnaire (effective response rate, 68%). Overall, 73% of families reported that they could both maintain hope and prepare for the patient's death. The independent determinants of the family's agreement in reference to the professional's behavior are pacing the explanation with the family's preparation; coordinating patient and family discussions about priorities while the patient was in better condition; willingness to discuss alternative medicine; maximizing efforts to maintain the patient's physical strength (e.g., meals, rehabilitation); discussing specific, achievable goals; and not saying "I can no longer do anything for the patient."

CONCLUSION

About 20% of family members reported that they could neither "maintain hope nor prepare for death." A recommended care strategy for medical professionals could include 1) discussing achievable goals and preparing for the future and pacing explanation with the family's preparation, 2) willingness to discuss alternative medicine, 3) maximizing efforts to maintain the patient's physical strength, and 4) avoid saying they could do nothing further for the patient.

Association between hope and burden reported by family caregivers of patients with advanced cancer

PURPOSE

The aim of this study, in a sample of family caregivers (FCs) of patients with advanced cancer, was to describe the level of FC burden using the Caregiver Reaction Assessment (CRA). In addition, the effects of select FC and patient characteristics on each of the CRA subscales were evaluated.

METHODS

FCs and patients (n = 112) completed a demographic questionnaire, and Herth Hope Index, and the Hospital Anxiety and Depression Scale. FCs completed the CRA. Data were analyzed using multiple linear regression analyses.

RESULTS

For three of the five CRA subscales (i.e., "impact on finances", "impact on daily schedule", and "impact on health"), the mean scores were comparable to a Norwegian sample of FCs caring for patients in the late palliative phase. The variance in each of the CRA subscales was explained by different factors. Total explained variance ranged from 5.5% ("lack of family support") to 31.8% ("impact on daily schedule"). FC characteristics, such as being female and lower educational level, distress regarding the patient's pain, anxiety, depression, and level of hope, as well as the patients' number of comorbidities, depression, and hope contributed to an increase in various domains of FC burden. FCs' level of hope was a significant predictor for three of the CRA subscales (i.e., "self-esteem", "lack of family support", and "impact on health").

CONCLUSIONS

Findings suggest that FCs' and patients' level of hope are important determinants of caregiver burden and that FCs with lower levels of hope represent a high-risk group for higher levels of caregiver burden.

Survey of bereavement practices of cancer care and palliative care physicians in the Pacific Northwest United States

PURPOSE

Physicians caring for patients with cancer frequently encounter individuals who will die as a result of their disease. The primary aim of this study was to examine the frequency and nature of bereavement practices among cancer care and palliative care physicians in the Pacific Northwest United States. Secondary aims included identification of factors and barriers associated with bereavement follow-up.

METHODS

An institutional review board (IRB) -approved, anonymous online survey of cancer specialists and palliative care physicians in Alaska, Washington, Oregon, Idaho, Montana, and Wyoming was performed in fall 2010. Potential participants were identified through membership in national professional organizations. Summary statistics and logistic regression methods were used to examine frequency and predictors of bereavement practices.

RESULTS

A total of 194 (22.7%) of 856 physicians participated in the online survey, with 164 (19.1%) meeting study inclusion criteria. Overall, 70% of respondents reported always or usually making a telephone call to families, sending a condolence letter, or attending a funeral service after a patient's death. The most common perceived barriers to bereavement follow-up were lack of time and uncertainty of which family member to contact. Sixty-nine percent of respondents did not feel that they had received adequate training on bereavement follow-up during postgraduate training.

CONCLUSION

Although a significant portion of respondents engaged in some form of bereavement follow-up, the majority felt inadequately trained in these activities. Efforts to identify available resources and address bereavement activities in postgraduate training may contribute to improved multidisciplinary treatment of patients with cancer and their families.

The relationship between hope and caregiver strain in family caregivers of patients with advanced cancer

BACKGROUND

Today, family caregivers (FCs) are involved in all aspects of patient care. Hope influences one's ability to cope with stressful situations. However, little information is available on how FCs' levels of hope influence the strain they experience in their caregiving role.

OBJECTIVES

The purposes of this study were to describe the levels of hope and caregiver strain in FCs of patients with advanced cancer and examine the relationship between hope and caregiver strain in these FCs. In addition, differences in hope and caregiver strain associated with a number of demographic characteristics are described.

METHODS

Family caregivers completed a demographic questionnaire, Herth Hope Index (HHI), and Caregiver Strain Index (CSI).

RESULTS

Of the 112 FCs, the majority were female (60%) and spouses (94%), with a mean age of 63.1 (SD, 10.7) years. Mean HHI score was 36.8 (SD, 4.0). Approximately 20% of the FCs reported a high level of caregiver strain, and these FCs were younger. The prevalence of perceived strain across subscales of the CSI was highest for emotional adjustment (70%). No relationships were found between HHI total scores and any of the CSI subscale scores. However, FCs with lower HHI scores reported significantly higher levels of caregiver strain.

CONCLUSIONS

Findings from this study suggest that younger individuals may represent a high-risk group of FCs for both lower levels of hope and higher levels of caregiver strain.

IMPLICATIONS FOR PRACTICE

Oncology nurses need to identify FCs at highest risk for increased strain and provide interventions to enhance hope and decrease perceived strain.

Harmonizing hope: a grounded theory study of the experience of hope of registered nurses who provide palliative care in community settings

OBJECTIVE

The purpose of this study was to explore the hope experience of registered nurses (RNs) who provide palliative care services in community settings. The specific aims of the study were to (1) describe their hope experience, (2) develop a reflexive understanding of the processes of their hope, and (3) construct a substantive theory of hope of palliative care RNs.

METHODS

Using constructivist grounded theory methodology, purposeful theoretical sampling was used to enroll 14 practicing community palliative care RNs in the study. Twenty-seven open-ended telephone interviews were conducted and nine daily journal entries on hope were copied. Interviews and journals were transcribed verbatim and analyzed using Charmaz's grounded theory approach.

RESULTS

Participants described their hope as a positive state of being involving a perseverant and realistic understanding of future possibilities. Their hope sustained and motivated them, and helped them to strive to provide high-quality care. The main concern for participants was keeping their hope when faced with work life challenges and contrasting viewpoints (i.e., when their hopes differed from the hopes of others around them). They dealt with this through harmonizing their hope by the processes of "looking both ways," "connecting with others," "seeing the bigger picture," and "trying to make a difference." Their experience of hope was defined within the social context of their work and lives.

SIGNIFICANCE OF RESULTS

The results of this study suggest that hope is very important to palliative care RNs, in that it helps them to persevere and sustains them when faced with work life challenges in their practice. This study also highlights the need for continued research in this area as there appears to be a lack of evidence on the meaning of hope for healthcare professionals, and, in particular, understanding hope in the context of palliative and end-of-life care delivery.

An exploration of the support person's perceptions and experiences of complex regional pain syndrome and the rehabilitation process

We explored the perceptions and experiences of those who support a relative or friend with complex regional pain syndrome (CRPS), a chronic pain condition of unknown aetiology usually affecting a single limb. Semi-structured interviews were analysed using interpretative phenomenological analysis, and four superordinate themes are presented here. These themes describe the efforts of carers to make sense of CRPS and the rehabilitation process, to be sensitive to the discomfort of the person with CRPS and to respond in an attuned and helpful way. CRPS had become integrated into the carers' lives as they sought to monitor, protect and motivate the person they supported. The themes are discussed in relation to each other and to extant literature, including work on social support and adjustment to chronic illness, and the clinical implications are explored.

Protection against perceptions of powerlessness and helplessness during palliative care: The family members' perspective

Objective:

Resilience in relation to coping with stress, loss, and bereavement has recently received increased attention. The aim of the current study was to describe aspects that are experienced as a protection against powerlessness and/or helplessness during advanced palliative home care (APHC) or as a help when coping with such perceptions.

Method:

Both family members during ongoing APHC and family members 3–9 months after the patient's death responded (in total, N = 233; response rate 72%) to a postal questionnaire with mainly open-ended questions. The text responses were analyzed using Manifest Content Analysis.

Results:

Protection against powerlessness and helplessness had been facilitated by a stable patient condition, the patient coping well, a trusting relationship with the patient, practical and emotional support from family and friends, access to palliative expertise, and staff support that was both individually-focused and cooperative. Other aspects that had helped or protected family members against powerlessness and helplessness were a belief that they had their own reliable knowledge to manage the difficult situation, talking to someone, doing good for the patient, distracting activities, acceptance, meaning and hope, and an inner feeling of security.

Significance of results:

The findings are discussed in relation to existential psychology, the dual process model of coping with bereavement, and repressive coping. Clinical implications are suggested.

Walking a fine line: an exploration of the experience of finding balance for older persons bereaved after caregiving for a spouse with advanced cancer

PURPOSE OF THE RESEARCH

During the past decade, research regarding cancer patients has become more prevalent, however research regarding the needs of their family caregivers is limited. The purpose of this study was to explore the ways in which caregivers, who survive the loss of their spouse to cancer, find balance in their lives.

METHODS AND SAMPLE

A constructivist grounded theory approach was undertaken which included the analysis of in depth interviews, journal entries and the researcher's field notes and memos. Interviews were conducted with 10 bereaved caregivers (7- females, 3-males) ranging in age from 66 to 83 years old. The data included 21 interviews and 8 journals.

KEY RESULTS

For bereaved caregivers "walking a fine line" emerged as a major process, balancing between "deep grieving" and "moving forward" in order to successfully create a new life without their partner. The main concern of the participants was "losing control" of balance. The emergence of these processes reveals the importance of addressing the bereaved caregivers' need to find balance within their new lives.

CONCLUSIONS

The findings of this study highlight the unique needs of bereaved caregivers who have lost a spouse to cancer, and provides a basis for ongoing research focused on assessment and intervention. Further research is needed to determine whether the process of finding balance is similar in other groups of caregivers who are bereaved.

The dynamics of socio-connective trust within support networks accessed by informal caregivers

This article introduces the concept of socio-connective trust, the synapse between the social structures and processes that underpin relationships in supportive care networks. Data from an ethnographic case study of 18 informal caregivers providing in-home care for people with life-limiting illness were analysed drawing on theoretical concepts from the work of Giddens and writings on social capital, as well as the construction of trust in the caregiving literature. While conceptions of trust were found to contribute to understanding supportive care relationships, they did not account for the dynamic nature of the availability and use of support networks. Instead, informal caregivers undertook ongoing reflexive negotiation of relationship boundaries in response to their own conception of the current situation and their perception of trust in their relationships with the various members of the support network. The concept of socio-connective trust describes the movement and flow of the flexible bonds that influence relationships among care networks and determine the type and range of support accessed by informal caregivers. Understanding the complexities of socio-connective trust in caregiving relationships will assist health and social care workers to mobilize relevant resources to support informal caregivers.

Part 2: Home-based family caregiving at the end of life: a comprehensive review of published qualitative research (1998-2008)

Family caregivers are crucial for supporting home death. We reviewed published qualitative research on home-based family caregiving at end of life (1998-2008), synthesizing key findings and identifying gaps where additional research is needed. Multiple databases were searched and abstracts reviewed for a focus on family caregiving and palliative care; full articles were reviewed to extract data for this review. In total, 105 articles were included. Findings are presented in the following areas: the caregiving experience and contextual features; supporting family caregivers at end of life; caregiving roles and decision-making; and rewards, meaning and coping. We noted a lack of definitional clarity; a reliance on interview methods and descriptive, thematic analyses, and a relative lack of diversity of patient conditions. Research needs are identified in several areas, including the bereavement experience, caregiver ambivalence, access to services, caregiver meaning-making, and relational and contextual influences on family caregiving at end of life.

The transition experience of rural older persons with advanced cancer and their families: a grounded theory study

BACKGROUND

Transitions often occur suddenly and can be traumatic to both patients with advanced disease and their families. The purpose of this study was to explore the transition experience of older rural persons with advanced cancer and their families from the perspective of palliative home care patients, bereaved family caregivers, and health care professionals. The specific aims were to: (1) describe the experience of significant transitions experienced by older rural persons who were receiving palliative home care and their families and (2) develop a substantive theory of transitions in this population.

METHODS

Using a grounded theory approach, 27 open-ended individual audio-taped interviews were conducted with six older rural persons with advanced cancer and 10 bereaved family caregivers. Four focus group interviews were conducted with 12 palliative care health care professionals. All interviews were transcribed verbatim, coded, and analyzed using Charmaz's constructivist grounded theory approach.

RESULTS

Within a rural context of isolation, lack of information and limited accessibility to services, and values of individuality and community connectedness, older rural palliative patients and their families experienced multiple complex transitions in environment, roles/relationships, activities of daily living, and physical and mental health. Transitions disrupted the lives of palliative patients and their caregivers, resulting in distress and uncertainty. Rural palliative patients and their families adapted to transitions through the processes of "Navigating Unknown Waters". This tentative theory includes processes of coming to terms with their situation, connecting, and redefining normal. Timely communication, provision of information and support networks facilitated the processes.

CONCLUSION

The emerging theory provides a foundation for future research. Significant transitions identified in this study may serve as a focus for improving delivery of palliative and end of life care in rural areas. Improved understanding of the transitions experienced by advanced cancer palliative care patients and their families, as well as the psychological processes involved in adapting to the transitions, will help health care providers address the unique needs of this vulnerable population.

Living with hope: developing a psychosocial supportive program for rural women caregivers of persons with advanced cancer

Background

Hope is defined by caregivers as the inner strength to achieve future good and to continue care giving. Pilot test findings of a Living with Hope Program (LWHP) suggested it is an acceptable and feasible intervention for use by family caregivers. Although it shows promise in potentially increasing hope and quality of life, further testing and development is needed. Questions remain as to: a) what are the mechanisms through which the LWHP affects outcomes and b) how long it is effective? The overall purpose of this time series mixed method study is the further development and testing of the LWHP by:

a. Determining the mechanisms of the LWHP by testing a LWHP conceptual model in which self-efficacy, and loss/grief are hypothesized intermediary variables for changes in hope, and subsequently quality of life among rural women caring for persons with advanced cancer, and;

b. Exploring the longitudinal effects of the LWHP on hope, quality of life and health services utilization among rural women caring for persons with advanced cancer.

Methods/Design

Using a time-series embedded mixed method design, data will be collected from 200 rural women caregivers. Following the collection of baseline and outcome variables, the intervention (LWHP) is applied to all subjects. Subjects are followed over time with repeated measures of outcome variables (1 wk, 2 wk, 3, 6 and 12 months). The journals that are completed as part of the LWHP comprise the qualitative data. Health services utilization data will be collected from the Saskatchewan Health Administrative Database for all subjects one year prior and one year after study enrolment.

Path analysis will be used to test the model post LWHP, at 1 and 2 weeks. Two-factor ANCOVA will determine patterns over time and Cortazzi's narrative analysis will be used to analyze subjects journals completed as part of the LWHP.

Discussion

Data Collection began January 2009 and is expected to be completed within 2 years time. Monthly meetings with data collectors and site collaborators have been instrumental in revisions to the original study protocol such as identifying and adding additional study sites.

Trial Registration

Trial Registration; Clinical Trials.Gov. NCT01081301

Metasynthesis of the hope experience of family caregivers of persons with chronic illness

The purpose of this metasynthesis was to describe the hope experience of family caregivers of persons with chronic illness. Fourteen studies were included in the metasynthesis. All studies described the importance of hope to the family caregivers of relatives with chronic illness regardless of age, relationship, or setting. Several derived themes arose from the metasynthesis, including (a) transitional refocusing from a difficult present to a positive future, (b) dynamic possibilities within uncertainty, (c) pathways of hope, and (d) hope outcomes. Hope was defined as transitional dynamic possibilities within uncertainty. A new conceptual model of hope was developed that provides a foundation for future research and practice. The metasynthesis findings indicate factors influencing hope have a role in assessing hope and differing pathways of hope provide a foundation for future hope interventions.

Hope in palliative care: An integrative review

Objective: The objective of this review is to describe the current status of research on hope in palliative care.

Methods: Integrative review was conducted to determine current knowledge on the topic. CINAHL and PubMed MEDLINE databases were used to find the articles relevant to this review. The data consisted of 34 articles on hope and palliative care published in peer-reviewed journals. A qualitative approach utilizing content analysis was used in this review.

Results: There are at least two overarching themes of patients' hope in the palliative context: “living with hope” and “hoping for something” which however are not separate contents. Several instruments for measuring hope in a palliative context have been produced. However, future research is needed to gather further validity evidence for these instruments. Factors related to patients, other people (e. g. significant others), illness, care and context contribute to or threaten patient hope. Hope of the significant other was defined as an inner force. However, the main concern for caregivers was “hanging on to hope” in spite of eroding effects on hope caused by different factors, for example in the health care system. Also significant others' hope in a palliative care context has been measured, but the results of the studies appear inconsistent. Nurses' reflection in action, affirmation of the patient's worth, working with the patient, considering the patient in a holistic sense were the main hope-engendering interventions generated from this review.

Significance of the research: Hope is important in both living and dying. The majority of the hope research in a palliative context focuses on patient hope and factors influencing patient hope. Research on hope in significant others and nurses in palliative care is scant. More research is needed about the factors threatening patient hope, hope in significant others, and interventions to engender hope in palliative and their outcomes.

Renewing everyday hope: the hope experience of family caregivers of persons with dementia

The purpose of this grounded theory study was to explore the experience of hope for family members caring for a person with dementia. Seventeen family members caring for persons with dementia were interviewed. The participants described their hope as the possibility of a positive future within their daily lives and in the social context of grief and loss, stress, fatigue, and constantly dealing with challenging behaviours of the person with dementia. The main concern of the study participants was "fading hope," which they dealt with by "renewing every day hope" through (a) coming to terms, (b) finding positives, and (c) seeing possibilities.

The hope experience of older bereaved women who cared for a spouse with terminal cancer

In this study we explore the experience and processes of hope of older women who were bereaved after caring for a spouse with terminal cancer, and we develop a tentative, emerging theory of their hope experience. We used constructivist grounded theory methods. We conducted 30 open-ended, in-depth, audiotaped interviews with 13 western Canadian women, aged 60 to 79 years, within the 1st year of bereavement, and collected 12 hope diaries. Data were analyzed using constant comparative analysis. Participants defined hope as a gradual process of regaining inner strength and building self-confidence to make sense of their completely changed situations. They were learning to stay positive and move ahead with their lives. The participants' main concern was losing hope, which they dealt with by searching for new hope through finding balance, new perspectives, and new meaning and purpose. The emerging theory is conceptualized as a spiral within the complex social context of bereavement after caregiving.

Theories of hope: are they relevant for palliative care nurses and their practice?

Hope is a multidimensional construct that is gaining recognition in nursing theory, research and practice. It is evident that there are few hope theories that are specific to the work and lives of palliative care nurses. As such, little attention has been paid to analyzing the relevance of specific theories to palliative nursing practice. To address these issues, the objectives of this article are: 1) to introduce and critique selected theories of hope with evaluation of their relevance to palliative care nurses; and 2) to identify the conceptual gaps in knowledge that emerged through the critique process, and suggest future research directions for the development of hope theory in palliative nursing practice. An exploration into the dimensions of palliative care nurses' hope and the potential influence of their hope on the care they provide may have future implications for their quality of life and the quality of life of their patients.

Ways of knowing hope: Carper's fundamental patterns as a guide for hope research with bereaved palliative caregivers

Carper's ways of knowing in nursing, empirics, esthetics, personal knowing, and ethics, provide a guide to holistic practice, education, and research. The origin and evolution of the ways of knowing are discussed and applied to current and proposed hope research with bereaved palliative caregivers, with the ultimate goal of promoting healthy, positive outcomes for this unique population. Bereaved palliative caregivers have unmet needs that may be addressed by research exploring hope during grief. For example, research from an empirical perspective identifies hope as a variable in grief resolution, esthetic knowing guides qualitative research on hope, personal knowing provides a constructivist philosophy to a qualitative inquiry, and ethical knowing includes the moral obligation for evaluation research. Unknowing and sociopolitical knowing offer a critical perspective as research is developed and applied, while considering complexity and social context. Nursing research from diverse epistemological perspectives will enhance the effectiveness and appropriateness of evidence-based practice.

Family members' perceived needs for bereavement follow-up

Palliative care does not end with the death of the patient, and many palliative care services offer specific follow-up services for the bereaved. The aims of this study were to quantitate perceived bereavement needs and to qualitatively describe these needs. The study design was cross-sectional and targeted family members three to nine months after the patient's death. Two hundred and forty-eight family members responded (response rate 66%) to a postal questionnaire with Likert-type and open-ended questions. The responses to the open-ended items were analyzed with manifest content analysis, and the quantitative part was analyzed with descriptive statistics. The analysis showed that about half of the family members expressed a need for bereavement follow-up. A majority favored a personal meeting, preferably in their own home, with the staff member who had had the most contact with the patient and the family. The family members wanted to talk about what had happened during the palliative phase (e.g., if the patient had suffered or not), and also about their present situation, their feelings of loneliness, and the future. The follow-up procedure made the family member experience a feeling of being recognized as a person with their own needs and was also valuable with regard to the family members' feelings of guilt. The findings are discussed in relation to narrative theory, meaning-based coping, and the dual process model of coping with bereavement, and designing follow-up procedures.