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Biney A, Sarfo JO, Poku CA, Deegbe DA, Atibila F, Ti-Enkawol Nachinab G, Anaba E, Dzansi G, Attafuah PYA. Challenges and coping strategies when caring for terminally ill persons with cancer: perspectives of family caregivers. BMC Palliat Care 2024; 23:175. [PMID: 39020352 PMCID: PMC11253565 DOI: 10.1186/s12904-024-01518-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 07/12/2024] [Indexed: 07/19/2024] Open
Abstract
INTRODUCTION Terminal illness is an irreversible illness that, without life-sustaining procedures, usually results in death or permanent disability from which recovery is unlikely. When involved, family caregivers are believed to improve health outcomes, such as reduced hospitalization, and establishing a patient's initial access to professional treatment services. However, caring for a patient with a terminal illness is viewed as one of the most difficult aspects of providing care. This study aimed to identify the challenges, and coping strategies developed by family caregivers to cope with the care of the terminally ill person. METHODS An exploratory descriptive qualitative approach was used. Twenty (20) family caregivers voluntarily participated in the study from the Korle-Bu Teaching Hospital. Semi-structured interviews were conducted with the participants. The transcribed interviews were then analysed using thematic analysis. RESULTS From the analysis, three main themes emerged: challenges, coping strategies, and social support. These themes encompassed sixteen subthemes including financial burden, bad health conditions, faith and prayer, and support from health professionals. From the study, both male and female family caregivers narrated that providing care for sick relatives undergoing terminal disease is characterized as a daily duty demanding one's time and fraught with emotional strain. In addition, even though it was a difficult job, family members who provided care for ailing relatives never gave up, citing responsibility, the importance of family, and religious beliefs as the primary motivations for doing so. CONCLUSION The difficulties and demands of family caregiving roles for terminally ill relatives are complex and multifactorial. The findings call for multidisciplinary professional attention for family caregivers and policies that will support their lives holistically.
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Affiliation(s)
| | - Jacob Owusu Sarfo
- Department of Health, Physical Education and Recreation, University of Cape Coast, Cape Coast, Ghana
| | - Collins Atta Poku
- School of Nursing and Midwifery, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - David Atsu Deegbe
- School of Nursing and Midwifery, University of Ghana, Legon, Accra, Ghana
| | - Fidelis Atibila
- School of Life and Medical sciences Centre for postgraduate medicine and Public Health, University of Hertfordshire UK, College Lane Campus, Hertfordshire, UK
| | - Gilbert Ti-Enkawol Nachinab
- Department of General Nursing, School of Nursing and Midwifery, University for Development Studies, Tamale, Ghana
| | - Emmanuel Anaba
- School of Public Health, University of Ghana, Accra, Ghana
| | - Gladys Dzansi
- Ghana College of Nurses and Midwives, Accra, Ghana
- School of Nursing and Midwifery, University of Ghana, Legon, Accra, Ghana
| | - Priscilla Yeye Adumoah Attafuah
- Ghana College of Nurses and Midwives, Accra, Ghana.
- School of Nursing and Midwifery, University of Ghana, Legon, Accra, Ghana.
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Teo I, Paramasivam K, Chee WY, Ng C, Neo PSH, Lee GL. Deathbed experiences and meaning-making: Perspectives of family caregivers of patients who received cancer palliative care. Palliat Support Care 2024; 22:444-450. [PMID: 38053407 DOI: 10.1017/s1478951523001670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
OBJECTIVES The deathbed symbolizes a time when the patient is dangerously ill and where death is imminent. The memories of family caregivers during this time can potentially shape their meaning-making of the patient's death and bereavement adjustment. We aimed to understand the experiences of family caregivers at the deathbed of patients receiving palliative care. We also examined caregiver's meaning-making that occurred after the patient's death. METHODS In this retrospective qualitative study, family caregivers of cancer patients who received palliative care in Singapore were recruited through purposive sampling. In-person, semi-structured interviews were individually conducted with study participants to understand their experiences from a caregiver's perspective before and after the death of the patient. Thematic content analysis method was conducted. RESULTS A total of 25 bereaved family caregivers were interviewed, with spouses, adult children, and others comprising one-third each of the sample. Six themes emerged from caregivers' recollected experiences around the patient deathbed: Lasting image of the patient, A time of intense emotions, Healthcare providers prepare caregivers, A time for saying goodbye, Rituals provide comfort, and Impact on family ties. Four themes emerged surrounding post-loss meaning-making: An end to the pain and suffering, "Have I done enough?," Significance in the timing of events, and Gaining strength and personal growth. SIGNIFICANCE OF RESULTS The deathbed is a salient time for family caregivers as they prepare for patient's death. There are opportunities to provide support to the family based on the study findings.
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Affiliation(s)
- Irene Teo
- Department of Psychosocial Oncology, National Cancer Centre Singapore, Singapore
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore
| | | | | | - Carolyn Ng
- Portland Institute for Loss and Transition, Portland, OR, USA
| | | | - Geok Ling Lee
- Department of Social Work, National University of Singapore, Singapore
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La IS, Johantgen M, Storr CL, Zhu S, Cagle JG, Ross A. Spirituality moderates the relationship between cancer caregiver burden and depression. Palliat Support Care 2024; 22:470-481. [PMID: 38131143 DOI: 10.1017/s1478951523001785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
OBJECTIVES Cancer has become a chronic disease that requires a considerable amount of informal caregiving, often quite burdensome to family caregivers. However, the influence of spirituality on the caregivers' burden and mental health outcomes has been understudied. This study was to examine how caregiver burden, spirituality, and depression change during cancer treatment and investigate the moderating role of spirituality in the relationship between caregiver burden and depression for a sample of caregivers of persons with cancer. METHODS This secondary analysis used a longitudinal design employing 3 waves of data collection (at baseline, 3 months, and 6 months). Family caregivers completed the Caregiver Reaction Assessment, Spiritual Perspective Scale, and the PROMIS® depression measure. Linear mixed model analyses were used, controlling for pertinent covariates. RESULTS Spirituality, total caregiver burden, and depression remained stable over 6 months. More than 30% of the caregivers had mild to severe depressive symptoms at 3 time points. There was evidence of overall burden influencing depression. Of note was a protective effect of caregivers' spirituality on the relationship between depression and caregiver burden over time (b = -1.35, p = .015). The lower the spirituality, the stronger the relationship between depression and burden, especially regarding subscales of schedule burden, financial burden, and lack of family support. SIGNIFICANCE OF RESULTS Spirituality was a significant resource for coping with caregiving challenges. This study suggests that comprehensive screening and spiritual care for cancer caregivers may improve their cancer caregiving experience and possibly influence the care recipients' health.
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Affiliation(s)
- In Seo La
- College of Nursing Science, Kyung Hee University, Seoul, South Korea
| | - Meg Johantgen
- University of Maryland School of Nursing, Baltimore, MD, USA
| | - Carla L Storr
- University of Maryland School of Nursing, Baltimore, MD, USA
| | - Shijun Zhu
- University of Maryland School of Nursing, Baltimore, MD, USA
| | - John G Cagle
- University of Maryland School of Social Work, Baltimore, MD, USA
| | - Alyson Ross
- Wisdom of the Whole Coaching Academy, Asheville, NC, USA
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Norinder M, Årestedt K, Axelsson L, Grande G, Ewing G, Alvariza A. Increased preparedness for caregiving among family caregivers in specialized home care by using the Carer Support Needs Assessment Tool Intervention. Palliat Support Care 2024; 22:236-242. [PMID: 37278216 DOI: 10.1017/s1478951523000639] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
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.
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Affiliation(s)
- Maria Norinder
- Department of Health Care Sciences, Palliative Research Centre, Marie Cederschiöld University, Stockholm, Sweden
- Capio Palliative Care, Dalen Hospital, Stockholm, Sweden
| | - Kristofer Årestedt
- Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden
- Department of Research, Region Kalmar County, Kalmar, Sweden
| | - Lena Axelsson
- Department of Nursing Science, Sophiahemmet University, Stockholm, Sweden
| | - Gunn Grande
- Division of Nursing, Midwifery & Social Care, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Gail Ewing
- Centre for Family Research, University of Cambridge, Cambridge, UK
| | - Anette Alvariza
- Department of Health Care Sciences, Palliative Research Centre, Marie Cederschiöld University, Stockholm, Sweden
- Research and Development Unit/Palliative Care, Stockholms Sjukhem, Stockholm, Sweden
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Freitas MJ, Remondes-Costa S, Veiga E, Macedo G, Teixeira RJ, Leite M. Life beyond Loss: A Retrospective Analysis of the Impact of Meaning of Life Therapy on the Grieving Process of Cancer Patients' Family Caregivers. Healthcare (Basel) 2024; 12:471. [PMID: 38391846 PMCID: PMC10887668 DOI: 10.3390/healthcare12040471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 01/18/2024] [Accepted: 02/10/2024] [Indexed: 02/24/2024] Open
Abstract
Oncological disease in the palliative stage is a huge challenge for patients and their family caregivers (FCs) due to the fact that it confronts them with death, as well as physical, psychological, and existential suffering. Meaning of Life Therapy (MLT) is a brief structured psycho-existential intervention aiming to help patients in a meaning-making life review process, promoting end-of-life adaptation. The Life Letter (LL) resulting from MLT is an element that facilitates communication between the patient and their caregivers. The goal of this study was to understand the impact of MLT on the grieving processes of eight FCs and to study their perceptions of the role of the LL on grief through semi-structured interviews. The results of our qualitative analysis indicate that MLT was perceived by the FCs as a positive experience despite the conspiracy of silence being identified as a drawback. The LL was interpreted as a communicational element, promoting emotional closeness with the cancer patients and serving as a valuable tool in the FCs' adaptation to loss. Our research findings show that the needs of FCs, especially after experiencing the loss of their relative, are dynamic and specific. This is why it is urgent to develop interventions that consider the idiosyncrasies of end-of-life cancer patients and their FCs in order to avoid frustrated farewells, lonely deaths, and maladaptive grieving processes. This is the direction in which MLT should evolve.
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Affiliation(s)
- Maria João Freitas
- Department of Social and Behavioural Sciences, University Institute of Health Sciences (IUCS-CESPU), 4585-116 Gandra, Portugal
| | - Sónia Remondes-Costa
- Department of Education and Psychology, University of Trás-os-Montes e Alto Douro, 5000-622 Vila Real, Portugal
| | - Elisa Veiga
- Research Centre for Human Development, Faculty of Education and Psychology, Universidade Católica Portuguesa, 4169-005 Porto, Portugal
| | - Gerly Macedo
- Clinical and Health Psychology Unit, Psychiatry and Mental Health Service, Hospital da Senhora da Oliveira, 4835-044 Guimarães, Portugal
| | - Ricardo João Teixeira
- REACH-Mental Health Clinic, 4000-138 Porto, Portugal
- CINEICC (Center for Research in Neuropsychology and Cognitive and Behavioral Intervention), Faculty of Psychology and Education Sciences, University of Coimbra, 3004-531 Coimbra, Portugal
| | - Manuela Leite
- Department of Social and Behavioural Sciences, University Institute of Health Sciences (IUCS-CESPU), 4585-116 Gandra, Portugal
- iHealth4Well-Being-Innovation in Health and Well-Being-Research Unit, Instituto Politécnico de Saúde do Norte, CESPU, 4560-462 Penafiel, Portugal
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Mroz EL, Kastrinos A, Bacharz K, Fisher CL, Applebaum AJ. "A little bit different now": Impacts of caregiving for parent with cancer on psychosocial development in emerging and young adulthood. DEATH STUDIES 2024:1-12. [PMID: 38293809 PMCID: PMC11289163 DOI: 10.1080/07481187.2024.2309488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
Serving as a family caregiver for, and ultimately losing, a parent with advanced cancer in emerging and young adulthood has substantial, life phase-specific implications for psychosocial development. This qualitative study characterizes domains of psychosocial development impacted by cancer caregiving and parental death in this life phase. As part of a larger study, 33 bereaved emerging/young adult caregivers of parents who died following advanced cancer completed semi-structured interviews. A thematic analysis leveraging the constant comparative method was conducted by two coders and generated three themes, which described impacts of caregiving on: identity, life path, and relational intimacy and roles. Analyses also defined specific outcomes within these domains. Findings suggest that cancer caregiving-loss experiences can greatly influence developmental pursuits in this life phase. Findings validate a range of possible psychosocial impacts these caregivers may experience and can guide development of supportive resources for this growing subgroup of bereaved family caregivers.
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Affiliation(s)
- Emily L Mroz
- Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Amanda Kastrinos
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Kelsey Bacharz
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Carla L Fisher
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Allison J Applebaum
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Chow R, Mathews JJ, Cheng EY, Lo S, Wong J, Alam S, Hannon B, Rodin G, Nissim R, Hales S, Kavalieratos D, Quinn KL, Tomlinson G, Zimmermann C. Interventions to improve outcomes for caregivers of patients with advanced cancer: a meta-analysis. J Natl Cancer Inst 2023; 115:896-908. [PMID: 37279594 PMCID: PMC10407714 DOI: 10.1093/jnci/djad075] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 04/04/2023] [Accepted: 05/01/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Family caregivers of patients with advanced cancer often have poor quality of life (QOL) and mental health. We examined the effectiveness of interventions offering support for caregivers of patients with advanced cancer on caregiver QOL and mental health outcomes. METHODS We searched Ovid MEDLINE, EMBASE, Cochrane CENTRAL, and Cumulative Index to Nursing and Allied Health Literature databases from inception through June 2021. Eligible studies reported on randomized controlled trials for adult caregivers of adult patients with advanced cancer. Meta-analysis was conducted for primary outcomes of QOL, physical well-being, mental well-being, anxiety, and depression, from baseline to follow-up of 1-3 months; secondary endpoints were these outcomes at 4-6 months and additional caregiver burden, self-efficacy, family functioning, and bereavement outcomes. Random effects models were used to generate summary standardized mean differences (SMD). RESULTS Of 12 193 references identified, 56 articles reporting on 49 trials involving 8554 caregivers were eligible for analysis; 16 (33%) targeted caregivers, 19 (39%) patient-caregiver dyads, and 14 (29%) patients and their families. At 1- to 3-month follow-up, interventions had a statistically significant effect on overall QOL (SMD = 0.24, 95% confidence interval [CI] = 0.10 to 0.39); I2 = 52.0%), mental well-being (SMD = 0.14, 95% CI = 0.02 to 0.25; I2 = 0.0%), anxiety (SMD = 0.27, 95% CI = 0.06 to 0.49; I2 = 74.0%), and depression (SMD = 0.34, 95% CI = 0.16 to 0.52; I2 = 64.4) compared with standard care. In narrative synthesis, interventions demonstrated improvements in caregiver self-efficacy and grief. CONCLUSIONS Interventions targeting caregivers, dyads, or patients and families led to improvements in caregiver QOL and mental health. These data support the routine provision of interventions to improve well-being in caregivers of patients with advanced cancer.
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Affiliation(s)
- Ronald Chow
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jean J Mathews
- Division of Palliative Medicine, Department of Medicine and Department of Oncology, Queen’s University, Kingston, ON, Canada
| | - Emily YiQin Cheng
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Samantha Lo
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Joanne Wong
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Sorayya Alam
- Palliative Medicine, Sobell House, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Breffni Hannon
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Medicine, University Health Network, Toronto, ON, Canada
| | - Gary Rodin
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Centre for Mental Health, University Health Network, Toronto, ON, Canada
| | - Rinat Nissim
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Centre for Mental Health, University Health Network, Toronto, ON, Canada
| | - Sarah Hales
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Centre for Mental Health, University Health Network, Toronto, ON, Canada
| | - Dio Kavalieratos
- Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University, Atlanta, GA, USA
| | - Kieran L Quinn
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Division of General Internal Medicine and Palliative Care, Department of Medicine, Sinai Health System, Temmy Latner Centre for Palliative Care, Toronto, ON, Canada
| | - George Tomlinson
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Medicine, University Health Network, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Camilla Zimmermann
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Medicine, University Health Network, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Häger Tibell L, Årestedt K, Holm M, Wallin V, Steineck G, Hudson P, Kreicbergs U, Alvariza A. Preparedness for caregiving and preparedness for death: Associations and modifiable thereafter factors among family caregivers of patients with advanced cancer in specialized home care. DEATH STUDIES 2023; 48:407-416. [PMID: 37441803 DOI: 10.1080/07481187.2023.2231388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Abstract
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.
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Affiliation(s)
- Louise Häger Tibell
- The Department of Health Care Science/Palliative Research Centre, Marie Cederschiöld University, Stockholm, Sweden
- Tema Cancer, BES: Breast-Endocrine Tumours and Sarcoma, Karolinska University Hospital, Stockholm, Sweden
| | - Kristofer Årestedt
- Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden
- Department of Research, Region Kalmar County, Kalmar, Sweden
| | - Maja Holm
- The Department of Health Care Science/Palliative Research Centre, Marie Cederschiöld University, Stockholm, Sweden
- Department of Nursing Science, Sophiahemmet University, Stockholm, Sweden
| | - Viktoria Wallin
- The Department of Health Care Science/Palliative Research Centre, Marie Cederschiöld University, Stockholm, Sweden
| | - Gunnar Steineck
- Department of Clinical Cancer Epidemiology, Karolinska Institutet, Stockholm, Sweden
- Division of Clinical Cancer Epidemiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Peter Hudson
- Centre for Palliative Care, St Vincent´s Hospital and The University of Melbourne, Melbourne, Australia
- Vrije University Brussels, Brussels, Belgium
| | - Ulrika Kreicbergs
- The Department of Health Care Science/Palliative Research Centre, Marie Cederschiöld University, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Anette Alvariza
- Research and Development-Unit/Palliative Care, Stockholms Sjukhem, Stockholm, Sweden
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Hsiao CC, Hsieh SI, Kao CY, Chu TP. Factors affecting nurses' willingness and competency to provide anticipatory grief counseling for family caregivers of patients with terminal cancer. J Clin Nurs 2023; 32:1053-1064. [PMID: 35437821 DOI: 10.1111/jocn.16335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 03/20/2022] [Accepted: 03/30/2022] [Indexed: 01/17/2023]
Abstract
AIM AND OBJECTIVES To explore factors associated with nurses' willingness and competency to provide anticipatory grief counselling for the family caregivers of patients with terminal cancer. BACKGROUND Family caregivers often experience anticipatory grief due to the imminence of a loved one's death. However, few studies have identified factors associated with nurses' willingness or competency to provide anticipatory grief counselling for the family caregivers of patients with terminal cancer. METHODS This descriptive correlational study recruited a convenience sample of nurses from cancer-related wards at a regional teaching hospital in Taiwan. The Anticipatory Grief Counseling Willingness Scale and Anticipatory Grief Counseling Competency Scale were employed. This cross-sectional study followed the STROBE checklist. RESULTS The nurses' average scores for willingness and competency to provide anticipatory grief counselling for the family caregivers of patients with terminal cancer were 44.28 ± 8.36 and 171.84 ± 30.83, respectively. Multivariate linear regression revealed that interest in participating in anticipatory grief counselling for the family caregivers of patients with terminal cancer was significantly associated with the nurses' willingness to provide such counselling. Similarly, their willingness to provide such counselling was significantly associated with their counselling competency. CONCLUSIONS Nurses' willingness and competency to provide anticipatory grief counselling for the family caregivers of patients with terminal cancer can be enhanced through in-service education programmes, including bedside teaching and scenario simulation. RELEVANCE TO CLINICAL PRACTICE To improve nurses' competency in anticipatory grief counselling for the family caregivers of patients with terminal cancer, factors related to nurses' willingness to provide such grief counselling must be addressed. Diverse strategies of in-service education can be adopted to promote nurses' competency in anticipatory grief counselling.
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Affiliation(s)
- Chia-Chi Hsiao
- Department of Nursing, Chiayi Chang Gung Memorial Hospital, Chang Gung Medical Foundation, Puzi City, Taiwan.,College of Nursing, Taipei Medical University, Taipei City, Taiwan
| | - Suh-Ing Hsieh
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan City, Taiwan.,Department of Nursing, Taoyuan Chang Gung Memorial Hospital, Chang Gung Medical Foundation, Taoyuan City, Taiwan
| | - Chen-Yi Kao
- Hospice Care Ward, Nursing Home, Taoyuan Chang Gung Memorial Hospital, Chang Gung Medical Foundation, Taoyuan City, Taiwan
| | - Tsui-Ping Chu
- Department of Nursing, Chiayi Chang Gung Memorial Hospital, Chang Gung Medical Foundation, Puzi City, Taiwan
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Weiss CR, Baker C, Gillespie A, Jones J. Ambiguous loss in family caregivers of loved ones with cancer, a synthesis of qualitative studies. J Cancer Surviv 2023; 17:484-498. [PMID: 36396909 DOI: 10.1007/s11764-022-01286-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 10/24/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE The purpose of this synthesis of qualitative studies is to explore manifestations of ambiguous loss within the lived experiences of family caregivers (FCG) of loved ones with cancer. Grief and loss are familiar companions to the family caregivers of loved ones with cancer. Anticipatory loss, pre-loss grief, complicated grief, and bereavement loss have been studied in this caregiver population. It is unknown if family caregivers also experience ambiguous loss while caring for their loved ones along the uncertain landscape of the cancer illness and survivorship trajectory. METHODS We conducted a four-step qualitative meta-synthesis of primary qualitative literature published in three databases between 2008 and 2021. Fourteen manuscripts were analyzed using a qualitative appraisal tool and interpreted through thematic synthesis and reciprocal translation. RESULTS Five themes were derived, revealing FCGs appreciate change in their primary relationship with their loved ones with cancer, uncertainty reconciling losses, an existence that is static in time, living with paradox, and disenfranchised grief. The results of this synthesis of qualitative studies complement the descriptors of ambiguous loss presented in previous research. CONCLUSIONS The results of this synthesis of qualitative studies complement the descriptors of ambiguous loss presented in previous theoretical and clinical research. By understanding ambiguous loss as a complex and normal human experience of cancer FCGs, oncology and palliative care healthcare providers can introduce interventions and therapeutics to facilitate caring-healing and resiliency. IMPLICATIONS FOR CANCER SURVIVORS Untreated ambiguous loss can result in a decrease in wellbeing, loss of hope, and loss of meaning in life. It is imperative that cancer FCGs experiencing ambiguous loss are recognized and supported so that they may live well in the family disease of cancer.
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Affiliation(s)
- Charlotte R Weiss
- College of Nursing, University of Colorado, Denver-Anschutz Medical Campus, Denver, CO, USA.
- , Wilmington, USA.
| | - Christina Baker
- College of Nursing, University of Colorado, Denver-Anschutz Medical Campus, Denver, CO, USA
| | - Anne Gillespie
- College of Nursing, University of Colorado, Denver-Anschutz Medical Campus, Denver, CO, USA
| | - Jacqueline Jones
- College of Nursing, University of Colorado, Denver-Anschutz Medical Campus, Denver, CO, USA
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11
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McCann BR, Roberto KA, Blieszner R, Savla J, Atkinson E. Vigilance, risk, and service use among caregivers of people living with dementia. DEMENTIA 2023; 22:727-742. [PMID: 36790090 DOI: 10.1177/14713012231156856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
OBJECTIVE The purpose of this investigation was to understand the dynamics among dementia caregiving, vigilance, and home and community-based service use. METHODS This paper is derived from a larger, mixed-methods study on caregiving. We used a descriptive qualitative approach to analyze interview data of 30 family caregivers of relatives with dementia. RESULTS We found five domains of vigilance in which caregivers felt "on duty": ensuring attentiveness, ensuring safety, ensuring resources, ensuring healthcare, and ensuring closeness. Formal service use did not necessarily give caregivers relief from vigilance, with the language of risk often employed by caregivers. CONCLUSION Because service use could contribute to feelings of vigilance, rather than give caregivers a break from a sense of watchfulness, these findings support calls for dementia-specific training for service providers. In future caregiving research, the relationship between vigilance, caregiver distress, and role captivity should be explored.
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Affiliation(s)
| | - Karen A Roberto
- Institute for Society, Culture and Environment and Center for Gerontology, 1757Virginia Tech, Blacksburg, VA, USA
| | - Rosemary Blieszner
- College of Architecture, Arts, and Design and Center for Gerontology, 1757Virginia Tech, Blacksburg, VA, USA
| | - Jyoti Savla
- Center for Gerontology and Department of Human Development and Family Science, 1757Virginia Tech, Blacksburg, VA, USA
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12
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Starr LT, Washington KT, McPhillips MV, Pitzer K, Demiris G, Oliver DP. "It was terrible, I didn't sleep for two years": A mixed methods exploration of sleep and its effects among family caregivers of in-home hospice patients at end-of-life. Palliat Med 2022; 36:1504-1521. [PMID: 36151698 PMCID: PMC10168118 DOI: 10.1177/02692163221122956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Due to overnight caregiving demands; exacerbation of high rates of anxiety, depression, and distress; and inadequate support, millions of family caregivers of patients receiving in-home hospice are at risk of poor sleep and negative health effects. AIM To describe sleep experiences of family caregivers of in-home hospice patients and perceptions of these experiences on caregivers' wellbeing in the context of caregiver health and live-in status. DESIGN Developed using the Symptom Management Model, this mixed methods study featured a concurrent nested design prioritizing qualitative reflexive thematic analysis. SETTING/PARTICIPANTS About 47 family caregivers of in-home hospice patients from two randomized clinical trials (NCT03712410, NCT02929108) were interviewed (United States, 2021). Anxiety (GAD-7), depression (PHQ-9), quality-of-life (QOL) (CQLI-R), and self-rated health and energy were reported prior to interviews. RESULTS Qualitative analysis revealed three themes: compromised sleep quality, factors influencing sleep, effects of sleep. 72.5% of hospice family caregivers described "fair" or "poor" sleep quality, with "interrupted" sleep and frequent night-waking due to "on-call" "vigilance" and anxiety. Negative effects included exhaustion, mental and physical health decline, and reduced caregiver function. Live-in caregivers reported higher mean depression scores (8.4 vs 4.3, p = 0.08), higher mean anxiety scores (7.7 vs 3.3, p = 0.06), and lower mean QOL scores (24.8 vs 33.6, p < 0.001) than live-out caregivers. Anxiety, depression, and QOL worsened as self-reported caregiver sleep quality decreased. Few caregivers had adequate support. CONCLUSION End-of-life family caregivers experience disrupted sleep with negative effects and inadequate support. Clinicians must assess sleep, offer sleep interventions, and provide more supports to hospice family caregivers.
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Affiliation(s)
- Lauren T Starr
- NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Karla T Washington
- Division of Palliative Medicine, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Miranda V McPhillips
- NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Kyle Pitzer
- Division of Palliative Medicine, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - George Demiris
- NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Debra Parker Oliver
- Division of Palliative Medicine, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
- Goldfarb School of Nursing, Barnes Jewish College, St. Louis, MO, USA
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13
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Young J, Snowden A, Kyle RG, Stenhouse R. Men's perspectives of caring for a female partner with cancer: A longitudinal narrative study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e5346-e5355. [PMID: 35946441 PMCID: PMC10087334 DOI: 10.1111/hsc.13956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 06/19/2022] [Accepted: 07/16/2022] [Indexed: 06/15/2023]
Abstract
Increasing evidence on men's involvement in informal, unpaid care has not transferred to the research literature around men's experiences. The aim was to explore the perspectives of men who are caring for a female partner with cancer over 1 year. Longitudinal narrative interviews (n = 22) were conducted with eight men in the UK from 2018 to 2019. Participants were aged from 32 to 76 years old, were all white British and in heterosexual relationships with women diagnosed with a range of cancer types. Interviews were transcribed and then analysed using a structural and performance approach to narrative analysis. We present, across four scenes, a process of change, transition and emotion management as the men were launched into a role that came with new responsibilities and expectations. Our study advances knowledge by highlighting the way that men perform and reflect on their negotiation with masculine discourses while supporting their partner, with implications for policy, research and practice.
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14
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LaTourette L, Williams K, Wong M, Thomas J, Pennarola A, Liantonio J. Evaluation of Bereavement Assessment Within Inpatient Palliative Care Consultation. Am J Hosp Palliat Care 2022:10499091221128256. [PMID: 36154714 DOI: 10.1177/10499091221128256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
It is crucial for palliative care teams to evaluate practices in assessing the risk of developing complicated grief among family members and caregivers of patients. A retrospective chart review of 99 patients seen by an inpatient palliative care team at an academic medical center was conducted to assess for documentation and prevalence of complicated grief risk factors. Factors included patients whose family are their primary caregiver, involvement of young children, mental health or substance use diagnoses in patients or their family members, a history of multiple losses, traumatic or sudden death. 64% of charts did not formally document bereavement assessment while 45% of families exhibited at least one risk factor for prolonged grief. This work suggests the need for increased education for PC providers on grief risk factors as well as the implementation of a formal screening assessment in order to best utilize limited psychosocial support resources to address needs.
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Affiliation(s)
- Lauren LaTourette
- Division of Geriatric Medicine and Palliative Care, Department of Family and Community Medicine, 23217Thomas Jefferson University Hospital (TJUH), Philadelphia, PA, USA
| | - Kaitlyn Williams
- Division of Geriatric Medicine and Palliative Care, Department of Family and Community Medicine, 23217Thomas Jefferson University Hospital (TJUH), Philadelphia, PA, USA
| | - Michael Wong
- Sidney Kimmel Medical College, 12313Thomas Jefferson University, Philadelphia, PA, USA
| | - Jillian Thomas
- Division of Geriatric Medicine and Palliative Care, Department of Family and Community Medicine, 23217Thomas Jefferson University Hospital (TJUH), Philadelphia, PA, USA
| | - Adam Pennarola
- Division of Geriatric Medicine and Palliative Care, Department of Family and Community Medicine, 23217Thomas Jefferson University Hospital (TJUH), Philadelphia, PA, USA
| | - John Liantonio
- Division of Geriatric Medicine and Palliative Care, Department of Family and Community Medicine, 23217Thomas Jefferson University Hospital (TJUH), Philadelphia, PA, USA
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15
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Urbutienė E, Pukinskaitė R. Fear of Cancer Recurrence as Reminder About Death: Lived Experiences of Cancer Survivors' Spouses. OMEGA-JOURNAL OF DEATH AND DYING 2022:302228221123152. [PMID: 35995573 DOI: 10.1177/00302228221123152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Fear of cancer recurrence is the most prevalent and burdensome emotional concern among cancer survivors' spouses after treatment. This qualitative study aimed to reveal death-related experiences of spouses of cancer survivors in remission, in the context of fear of cancer recurrence. Seven spouses (aged 35-56), four women and three men were explored. Data were obtained using an unstructured interview and analyzed by inductive thematic analysis. The spouses associate cancer relapse with death, risk of losing their spouse. The threat of death triggers not only the feelings of insecurity, uncertainty about the future and loss of control, but also appreciation of life, focus on positive aspects in relationships. Planning for the "worst" scenarios and avoidance helped spouses to reduce tension and enhance control. Interventions for spouses should focus on promotion of emotional expression of death related concerns underlying fear of relapse, also developing new coping strategies to accept and tolerate uncertainty.
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Affiliation(s)
- Eglė Urbutienė
- Institute of Psychology, Mykolas Romeris University, Vilnius, Lithuania
| | - Rūta Pukinskaitė
- Institute of Psychology, Mykolas Romeris University, Vilnius, Lithuania
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16
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Knihs NDS, Schuantes-Paim SM, Bellaguarda MLDR, Treviso P, Pessoa JLE, Magalhães ALP, Martins MDS, Bittencourt I, Ramos SF, Koerich C, da Silva EL. Family Interview Evaluation for Organ Donation: Communication of Death and Information About Organ Donation. Transplant Proc 2022; 54:1202-1207. [PMID: 35760625 DOI: 10.1016/j.transproceed.2022.02.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 02/09/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND The aim of this study was to identify variables related to organ donation that can contribute to the development of best practices in planning and conducting family interviews by health professionals. METHODS This descriptive and prospective study of quantitative approach was conducted at 2 southern Brazil health institutions referenced in organ donation. Data collection occurred between 2018 and 2019 by health professionals who conduct family interviews using validated instruments that assessed the stages of the interview. Analysis was performed by means of the proportions of the studied variables associated with the donation authorization categories per the χ2 test. The significance level adopted was 0.05. RESULTS The variables that presented the highest level of significance in the correlation with the prevalence of family authorization for organ donation included the following: communication with the family about the results of each test in the brain death diagnostic protocol; identification of whether the family understood the information about the death; presence of a member of the transplantation commission who had training to communicate information about organ donation; presence of a family member who had power to authorize the donation; and the interval between the communication of death and information about organ donation. CONCLUSIONS The study presents important gaps that can be filled by health teams and hospitals in order to improve the welcoming and respect for families, as well as the organ donation rates. It is important to understand that each family is unique when facing mourning, and to distance the communication of death from the discussion about organ donation is an act of respect and empathy.
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Affiliation(s)
- Neide da Silva Knihs
- Nursing Department, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil.
| | | | | | - Patrícia Treviso
- Vale dos Sinos University, Porto Alegre, Rio Grande do Sul, Brazil
| | - João Luis Erbs Pessoa
- Health State Agency of São Paulo, Transplantation Central of São Paulo, São Paulo, São Paulo, Brazil
| | | | - Marisa da Silva Martins
- Nursing Department, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | | | - Saulo Fábio Ramos
- Nursing Department, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Clarice Koerich
- Polydoro Ernani de São Thiago Hospital, Florianópolis, Santa Catarina, Brazil
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17
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Urbutienė E, Pukinskaitė R. Fear of Cancer Recurrence: Lived Experiences of Cancer Survivors’ Spouses. PSICHOLOGIJA 2022. [DOI: 10.15388/psichol.2022.50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Fear of cancer recurrence is the most prevalent and burdensome emotional concern among cancer survivors’ spouses after treatment. This qualitative study aimed to disclose, what are cancer survivors’ spouses lived experiences of fear of cancer recurrence. Seven adult spouses were explored. Data were obtained using a semi-structured interview and analyzed by inductive thematic analysis. Analysis revealed that fear of cancer recurrence is interpersonal experience and fear transmits in a couple. The spouses associate cancer recurrence with death and risk of losing their spouse. The threat of cancer recurrence triggers not only the feelings of insecurity, uncertainty about the future and loss of control, but also appreciation of life. Planning and control, religiosity, avoidance and awareness of fear helped spouses to reduce concerns about relapse. Interventions for spouses should focus on promotion of emotional expression of cancer recurrence concerns, also learning to accept and tolerate uncertainty.
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18
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Singer J, Roberts KE, McLean E, Fadalla C, Coats T, Rogers M, Wilson MK, Godwin K, Lichtenthal WG. An examination and proposed definitions of family members' grief prior to the death of individuals with a life-limiting illness: A systematic review. Palliat Med 2022; 36:581-608. [PMID: 35196915 PMCID: PMC10098140 DOI: 10.1177/02692163221074540] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Research has extensively examined family members' grief prior to the death of an individual with a life-limiting illness but several inconsistencies in its conceptualization of related constructs, yet significant conceptualization issues exist. AIM This study aimed to identify and characterize studies published on family members grief before the death of an individual with a life-limiting illness, and propose definitions based on past studies in order to initiate conceptual clarity. DESIGN A mixed-method systematic review utilized six databases and was last conducted July 10, 2021. The search strategy was developed using Medical Subject Headings. This study was prospectively registered on PROSPERO (CRD42020166254). RESULTS One hundred thirty-four full-text articles met inclusion criteria. This review revealed across studies a wide variation in terminology, conceptualization, and characterization of grief before the death. More than 18 terms and 30 definitions have been used. In many cases, the same term (e.g. anticipatory grief) was defined differently across studies. CONCLUSIONS We found grief occurring before the death of a person with a life-limiting illness, which we termed pre-death grief, is comprised of two distinct constructs: anticipatory grief and illness-related grief. Anticipatory grief is future-oriented and is characterized by separation distress and worry about a future without the person with the life-limiting illness being physically present. Illness-related grief is present-oriented and is characterized by grief over current and ongoing losses experienced during the illness trajectory. These definitions provide the field with uniform constructs to advance the study of grief before the death of an individual with a life-limiting illness.
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Affiliation(s)
- Jonathan Singer
- Department of Psychological Science, Texas Tech University, Lubbock, TX, USA
| | - Kailey E Roberts
- Ferkauf Graduate School of Psychology, Yeshiva University, New York, NY, USA
| | - Elisabeth McLean
- Department of Psychological Science, Texas Tech University, Lubbock, TX, USA
| | - Carol Fadalla
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Taylor Coats
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Madeline Rogers
- Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, NY, USA
| | | | - Kendra Godwin
- Medical Library, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Wendy G Lichtenthal
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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19
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Benites AC, Arantes de Oliveira-Cardoso É, Dos Santos MA. Spirituality in Brazilian family caregivers of patients with cancer from the end-of-life care to bereavement. DEATH STUDIES 2022; 47:249-258. [PMID: 35300583 DOI: 10.1080/07481187.2022.2051095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Although spirituality can be a source of support during end-of-life and engage a transformative experience after loss, few studies report family members' spiritual and existential needs considering their experiences over time. We conducted a longitudinal interpretative phenomenological analysis from audio-recorded interviews of 10 family caregivers while providing end-of-life care for cancer patients and during bereavement. Participants' spirituality experiences were presented in three superordinate themes: connectedness with religious beliefs and the deceased; re-signifying relationships, life, and loss; suffering and the family caregiver's needs. Finding connection through relationships, greater existential and spiritual suffering post-loss were important issues involved in expressing their spirituality.
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Affiliation(s)
- Andrea Carolina Benites
- Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto, Departamento de Psicologia, Universidade de São Paulo. Ribeirao Preto, Brazil
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Érika Arantes de Oliveira-Cardoso
- Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto, Departamento de Psicologia, Universidade de São Paulo. Ribeirao Preto, Brazil
| | - Manoel Antônio Dos Santos
- Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto, Departamento de Psicologia, Universidade de São Paulo. Ribeirao Preto, Brazil
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20
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Li J, Sun D, Zhang X, Zhao L, Zhang Y, Wang H, Ni N, Jiang G. The relationship between anticipatory grief and illness uncertainty among Chinese family caregivers of patients with advanced lung cancer: a cross-sectional study. Palliat Care 2022; 21:30. [PMID: 35255876 PMCID: PMC8902770 DOI: 10.1186/s12904-022-00925-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 03/03/2022] [Indexed: 11/29/2022] Open
Abstract
Background Anticipatory grief has been shown to be highly prevalent among family caregivers of patients with advanced illness. Qualitative study suggests that illness uncertainty may be one of the core characteristics of anticipatory grief, but it has not been confirmed in quantitative studies. Therefore, the purpose of this study was to explore the relationship between anticipatory grief and illness uncertainty among Chinese family caregivers of patients with advanced lung cancer and to determine the factors influencing anticipatory grief. Methods This descriptive cross-sectional study used a convenience sampling method and recruited 254 inpatient family caregivers from the thoracic medicine ward of Liaoning Cancer Hospital & Institute in Shenyang, mainland China. Anticipatory grief (Anticipatory Grief Scale (AGS), illness uncertainty (Uncertainty in Illness Scale Family Caregiver Version) and sociodemographic information (Self-compiled general information questionnaire) were measured using validated self-report measures. Results Chinese family caregivers of patients with advanced lung cancer had high levels of anticipatory grief (73.5 ± 16.1). The results of the correlation analysis showed a positive association between anticipatory grief and illness uncertainty (r = 0.580, P < 0.001). The final linear regression model with anticipatory grief as the dependent variable included four variables: illness uncertainty (β = 0.674, P < 0.001), lack of informativeness (β = − 0.168, P = 0.08), monthly income (β = 0.139, P = 0.006), and caregiving burden (β = − 0.196, P < 0.001). Conclusions Illness uncertainty is probably an important factor affecting anticipatory grief. Excessive caregiving burden is associated with high levels of anticipatory grief. Improving illness uncertainty and caregiving burden may effectively reduce anticipatory grief among Chinese family caregivers.
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21
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Sun D, Mao Z, Zhang X, Li J, Zhang L. Relationship Between Post-traumatic Stress Symptoms and Anticipatory Grief in Family Caregivers of Patients With Advanced Lung Cancer: The Mediation Role of Illness Uncertainty. Front Psychiatry 2022; 13:914862. [PMID: 35757209 PMCID: PMC9218190 DOI: 10.3389/fpsyt.2022.914862] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 05/19/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To explore the interrelationship between post-traumatic stress symptoms (PTSS), illness uncertainty (IU), and anticipatory grief (AG). METHODS Structural equation modeling with bootstrapping estimation was conducted using data from a convenience sample of 254 family caregivers of patients with advanced lung cancer in China. Participants were recruited from a public cancer hospital in Shenyang, China. The family caregivers completed the Impact of Events Scale-Revised, Uncertainty in Illness Scale Family Caregiver Version, and Anticipatory Grief Scale. RESULTS The measurement model has good reliability and validity, and the final model fit the data well. PTSS positively influenced AG (direct effect estimate = 0.391, p = 0.002). Moreover, IU was found to mediate the relationship between PTSS and AG (Indirect effects estimate = 0.168, p = 0.005). The mediating effect of IU accounted for up to 30.1% of the total effect. CONCLUSION IU mediated the relationship between PTSS and AG. Healthcare professionals should continuously assess PTSS, IU and AG levels in FCs and provide effective intervention options for mitigation.
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Affiliation(s)
- Di Sun
- School of Nursing, Liaoning University of Traditional Chinese Medicine, Shenyang, China
| | - Zhihui Mao
- School of Nursing, Liaoning University of Traditional Chinese Medicine, Shenyang, China
| | - Xu Zhang
- School of Nursing, China Medical University, Shenyang, China
| | - Jiaojiao Li
- Department of Thoracic Medicine, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, China
| | - Lijuan Zhang
- School of Nursing, Liaoning University of Traditional Chinese Medicine, Shenyang, China
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22
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Skantharajah N, Barrie C, Baxter S, Carolina Borja M, Butters A, Dudgeon D, Haque A, Mahmood I, Mirhosseini M, Mirza RM, Ankita A, Thrower C, Vadeboncoeur C, Wan A, Klinger CA. The Grief and Bereavement Experiences of Informal Caregivers: A Scoping Review of the North American Literature. J Palliat Care 2021; 37:242-258. [PMID: 34860618 PMCID: PMC9109594 DOI: 10.1177/08258597211052269] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background: Informal caregivers are a significant part of the
hospice and palliative care landscape as members of the interdisciplinary care
team. Despite this, little is known about the impact this responsibility has on
informal caregivers’ experiences of grief and bereavement.
Objective: To address this, a scoping review of the literature
was conducted to explore the current state of knowledge toward grief and
bereavement of informal caregivers of adult/geriatric patients in the hospice
and palliative/end-of-life care realm within North America.
Methods: Using Arksey and O’Malley's 5-step framework, key
electronic health care and social sciences databases (eg, CINAHL, MEDLINE,
ProQuest Sociological Abstracts, PsycINFO) alongside gray literature sources
were searched and screened against inclusion and exclusion criteria. A thematic
content analysis was used to identify key themes. Results: 29
articles met the final inclusion criteria with 3 central themes emerging: (1)
mediators of grief, (2) grief experiences, and (3) types of grief.
Discussion: Informal caregivers encounter unique grief and
bereavement experiences: The range of psychosocial outcomes, both negative and
positive, can be affected by various mediators such as caregiver burden,
demographics, disease type of the patient being cared for, etc. Bereavement
interventions must be designed with the mediators of grief in mind.
Conclusions: Understanding the nuances of informal caregivers’
experiences with grief and bereavement will inform and advance practice, policy,
and research. Practitioners/clinicians should be further educated on how to
properly acknowledge the complexity of grief and bereavement for informal
caregivers, specifically paying attention to mediators. Further research needs
to consider the role of culture.
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Affiliation(s)
| | - Carol Barrie
- Canadian Frailty Network (CFN), Kingston, Ontario, Canada.,Quality End-of-Life Care Coalition of Canada (QELCCC), Ottawa, Ontario, Canada
| | - Sharon Baxter
- Quality End-of-Life Care Coalition of Canada (QELCCC), Ottawa, Ontario, Canada.,Canadian Hospice Palliative Care Association (CHPCA), Ottawa, Ontario, Canada
| | | | | | - Deborah Dudgeon
- Quality End-of-Life Care Coalition of Canada (QELCCC), Ottawa, Ontario, Canada.,Canadian Partnership Against Cancer (CPAC), Toronto, Ontario, Canada.,Queen's University, Kingston, Ontario, Canada
| | | | | | - Mehrnoush Mirhosseini
- Quality End-of-Life Care Coalition of Canada (QELCCC), Ottawa, Ontario, Canada.,College of Family Physicians of Canada (CFPC), Mississauga, Ontario, Canada.,University of Alberta, Edmonton, Alberta, Canada
| | - Raza M Mirza
- University of Toronto, Toronto, Ontario, Canada.,National Initiative for the Care of the Elderly (NICE), Toronto, Ontario, Canada
| | | | | | - Christina Vadeboncoeur
- Quality End-of-Life Care Coalition of Canada (QELCCC), Ottawa, Ontario, Canada.,Canadian Network of Palliative Care for Children (CNPCC), Ottawa, Ontario, Canada.,University of Ottawa, Ottawa, Ontario, Canada
| | - Andrew Wan
- University of Toronto, Toronto, Ontario, Canada
| | - Christopher A Klinger
- University of Toronto, Toronto, Ontario, Canada.,Quality End-of-Life Care Coalition of Canada (QELCCC), Ottawa, Ontario, Canada.,National Initiative for the Care of the Elderly (NICE), Toronto, Ontario, Canada.,Pallium Canada, Ottawa, Ontario, Canada.,McMaster University, Hamilton, Ontario, Canada
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23
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"You begin to give more value in life, in minutes, in seconds": spiritual and existential experiences of family caregivers of patients with advanced cancer receiving end-of-life care in Brazil. Support Care Cancer 2021; 30:2631-2638. [PMID: 34817692 PMCID: PMC8611251 DOI: 10.1007/s00520-021-06712-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 11/18/2021] [Indexed: 11/18/2022]
Abstract
Purpose Facing the end of life may trigger significant distress in family caregivers of patients with advanced cancer. However, few studies have addressed the spiritual and existential concerns of these family caregivers in their end-of-life care journey. This study aimed to understand the spiritual and existential experience of family caregivers of patients with advanced cancer facing the end of life in Brazil. Methods A purposive sample of 16 family caregivers of hospitalized terminally ill cancer patients in Brazil participated in in-depth interviews. Data collection and analysis were based on interpretative phenomenological analysis. Results Three superordinate themes in their spiritual and existential experience were identified: (i) connectedness through caregiving, personal relationships, and spiritual beliefs; (ii) shifting hope: from death as a possibility to preparation for impending death; (iii) reframing suffering and meaning. For these caregivers, the relationship with the patient and with others, their spiritual beliefs, and hope were significant sources of meaning. Hope was sustained by death avoidance, oscillating with death acceptance and hope that it would occur with comfort. Family caregivers also experienced existential and spiritual suffering in the form of guilt, suppressed emotions, and loneliness. Conclusion Health care providers should address and support caregivers’ spiritual needs and their relationships with the patient and others during end-of-life care and facilitate reflection regarding existential concerns, meaning, and preparation for impending death.
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24
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Fee A, Hanna J, Hasson F. Pre-loss grief experiences of adults when someone important to them is at end-of-life: A qualitative systematic review. DEATH STUDIES 2021; 47:1-15. [PMID: 34751635 DOI: 10.1080/07481187.2021.1998935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Pre-loss grief can be experienced by relatives before impending death; however, limited understanding exists about the impact of pre-loss grief on bereavement. This systematic review aimed to synthesize qualitative research evidence reporting adults' experiences of pre-loss grief within cancer care. Thirteen studies were selected, and three key themes identified. Findings indicate that relatives transitioned through lived experiences during end-stage cancer, and that meanings attached to these experiences influenced how they experienced pre-loss grief. Limited formal support was identified to navigate these experiences; however, context was seen as important, and skilled healthcare practitioners and physical environment were key to facilitating preparedness.
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Affiliation(s)
- Anne Fee
- Institute of Nursing and Health Research, Ulster University, Northern Ireland, UK
| | - Jeff Hanna
- School of Nursing and Midwifery, Queen's University Belfast, Northern Ireland, UK
| | - Felicity Hasson
- Institute of Nursing and Health Research, Ulster University, Northern Ireland, UK
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Seyedfatemi N, Ghezeljeh TN, Bolhari J, Rezaei M. Effects of family-based dignity intervention and expressive writing on anticipatory grief of family caregivers of patients with cancer: a study protocol for a four-arm randomized controlled trial and a qualitative process evaluation. Trials 2021; 22:751. [PMID: 34711262 PMCID: PMC8552199 DOI: 10.1186/s13063-021-05718-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 10/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Family caregivers of dying cancer patients are affected by grief experiences and bereavement complications. Several approaches such as psycho-emotional care and an increase in spirituality have been suggested to diminish these complications. However, the knowledge about the effects of family-based dignity intervention and expressive writing on anticipatory grief in family caregivers of dying cancer patients is limited. This is a study protocol describing a hospital-based mixed-methods study on the effects of family-based dignity intervention and expressive writing on anticipatory grief in family caregivers of dying cancer patients. METHODS This mixed-methods study will be done in an embedded explanatory design with two quantitative and qualitative phases. In the first phase (quantitative), a randomized clinical trial will be done, in which 200 family caregivers of dying cancer patients will be randomly assigned to one of the four groups: family-based single dignity intervention (group 1), expressive writing intervention (group 2), combined family-based single dignity intervention and expressive writing (group 3), and control (group 4). At baseline, 1 week and 2 weeks after the interventions, anticipatory grief will be assessed by a 13-item anticipatory grief scale. After the quantitative phase, the qualitative phase will be conducted through the conventional content analysis approach of Granheim and Lundman, in which an individual semi-structured interview will be taken from participants in the first phase to collect data on their experiences on interventions. Finally, data from the quantitative and qualitative phases will be analyzed and discussed. DISCUSSION Family caregivers of dying cancer patients usually experience depression, anxiety, and psychological distress due to isolation and inadequate social support. Psychological interventions such as dignity and expressive writing interventions may help caregivers to obtain a better understanding of themselves and to increase their abilities to cope with caregiving difficulties. Therefore, there is a need for a comprehensive study confirming the effects of mentioned interventions on family caregivers of dying cancer patients. TRIAL REGISTRATION Iranian Registry of Clinical Trials ( www.irct.ir ) identifier: IRCT20210111050010N1. Date of trial registration: Feb 6, 2021. This is the first version of this protocol.
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Affiliation(s)
- Naima Seyedfatemi
- Nursing Care Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Tahereh Najafi Ghezeljeh
- Nursing Care Research Center, Iran University of Medical Sciences, Tehran, Iran.,Nursing Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Jafar Bolhari
- Spiritual Health Research Center, School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran
| | - Masoud Rezaei
- Nursing Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran.
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The conscious state of the dying patient: An integrative review. Palliat Support Care 2021; 20:731-743. [PMID: 34615571 DOI: 10.1017/s1478951521001541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The cognitive state of the dying in the last days of life may deteriorate, resulting in a reduced ability to communicate their care needs. Distressing symptoms, physical and existential, may go unrecognized and untreated. The objectives of this integrative review were to systematically interrogate the literature to determine the changing conscious state of dying adults and to identify changes in their care needs. METHODS An integrative review protocol was registered with PROSPERO (CRD42020160475). The World Health Organization definition of palliative care informed the review. CINAHL, MEDLINE (OVID), Scopus, PsycINFO, Cochrane Library, and PubMed were searched from inception to October 2019 using search strategies for each database. Inclusion and exclusion criteria were applied. Methodological quality was appraised using the Joanna Briggs Institute Checklist for the Case Series appraisal tool. Extracted data were synthesized using a narrative approach. RESULTS Of 5,136 papers identified, 11 quantitative case series studies were included. Six themes were identified: conscious state and change over time, awareness, pain, absence of holistic care, the voiceless patient, and signs and symptoms of dying. SIGNIFICANCE OF RESULTS In the last days of life, the physical and conscious state of the dying patient declines, resulting in an inability to express their care needs. Dignity in dying and freedom from pain and suffering are both an imperative and a human right; and unvoiced care needs can result in unnecessary suffering and distress. This review revealed that little is known about how healthcare professionals assess holistic care needs at this vulnerable time. Although much has been written about palliative and end-of-life care, the assessment of care needs when patients are no longer able to voice their own needs has largely been ignored, with little attention from clinical, educational, or research perspectives. This gap in evidence has important implications for the dying and their families.
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Vajawat B, Hegde PR, Malathesh BC, Kumar CN, Sivakumar PT, Math SB. Palliative Care and Legal Issues in Geriatric Psychiatry. Indian J Psychol Med 2021; 43:S31-S36. [PMID: 34732952 PMCID: PMC8543619 DOI: 10.1177/02537176211031077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
There is an increased risk of debilitating illnesses that often have no curative treatment with aging. The mainstay of treatment in many such conditions is palliative care: a holistic approach focused on preventing and relieving physical, psychosocial, legal, ethical, and spiritual problems. It involves the facilitation of end-of-life care decisions aimed at relieving distress and improving quality of life. In this article, the authors discuss the role of mental health professionals in legal issues related to palliative care in the elderly around decision-making, right to autonomy, euthanasia, and advanced directive. The cognitive decline associated with aging and mental health issues in the palliative care setting of an individual such as dementia, depression, and hopelessness, and impact on the family members like burnout may influence the overall capacity of that individual to make decisions about their treatment. While an individual has a right to self-determination and autonomy, withholding or withdrawing treatment has many legal and ethical implications, more so in those with incapacity, especially in India due to the absence of uniform legislation. The decision to withhold or withdraw treatment might be a restrictive choice due to limited options in a setting with a lack of palliative care options, poor psychosocial support, nonaddress of mental health issues, and lack of awareness. As the right to health is a constitutional right, and the right to mental health is legally binding under Section 18 of the Mental Health Care Act 2017, systematic efforts should be made to scale up services and reach out to those in need.
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Lumpkin ST, Harvey E, Mihas P, Carey T, Fichera A, Stitzenberg K. Understanding Patients' Decisions to Obtain Unplanned, High-Resource Health Care After Colorectal Surgery. QUALITATIVE HEALTH RESEARCH 2021; 31:1582-1595. [PMID: 33840284 PMCID: PMC8438771 DOI: 10.1177/10497323211002479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Readmissions and emergency department (ED) visits after colorectal surgery (CRS) are common, burdensome, and costly. Effective strategies to reduce these unplanned postdischarge health care visits require a nuanced understanding of how and why patients make the decision to seek care. We used a purposefully stratified sample of 18 interview participants from a prospective cohort of adult CRS patients. Thirteen (72%) participants had an unplanned postdischarge health care visit. Participant decision-making was classified by methodology (algorithmic, guided, or impulsive), preexisting rationale, and emotional response to perceived health care needs. Participants voiced clear mental algorithms about when to visit an ED. In addition, participants identified facilitators and barriers to optimal health care use. They also identified tangible targets for health care utilization reduction efforts, such as improved care coordination with streamlined discharge instructions and improved communication with the surgical team. Efforts should be directed at improving postdischarge communication and care coordination to reduce CRS patients' high-resource health care utilization.
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Affiliation(s)
- Stephanie T. Lumpkin
- The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Eileen Harvey
- The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Paul Mihas
- The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Timothy Carey
- The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Karyn Stitzenberg
- The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Kochen EM, Boelen PA, Teunissen SCCM, Jenken F, de Jonge RR, Grootenhuis MA, Kars MC. Health Care Professionals' Experiences With Preloss Care in Pediatrics: Goals, Strategies, Obstacles, and Facilitators. J Pain Symptom Manage 2021; 62:107-116. [PMID: 33186732 DOI: 10.1016/j.jpainsymman.2020.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 11/02/2020] [Accepted: 11/02/2020] [Indexed: 10/23/2022]
Abstract
CONTEXT Although parents experience grief when confronted with their child's deterioration and imminent death, most bereavement care is focused on supporting parents after child loss. Insight into intentions and strategies of the health care professionals (HCPs) in preloss care during the end of life is still lacking. OBJECTIVES To create a starting point for improvement of preloss care, this study explores HCPs' experiences with providing support aimed at parental feelings of grief during the child's end of life. METHODS Exploratory qualitative research using individual semistructured interviews with clinicians in pediatrics and neonatology in hospital and homecare settings. Data were thematically analyzed by a multidisciplinary team. RESULTS Nineteen HCPs participated. HCPs tried to ensure that parents could reflect on the care received as concordant to their preferences and were not hindered in their bereavement as a consequence of their professional actions. Strategies included maximizing parental presence, enabling parental involvement in decision making, and ensuring a dignified death. While using these strategies, HCPs faced several difficulties: uncertainty about the illness course, unpredictability of parental grief responses, and being affected themselves by the child's imminent death. It helped HCPs to develop a bond with parents, find comfort with colleagues, and making joint decisions with colleagues. CONCLUSION HCPs strive to improve parental coping after the child's death, yet apply strategies that positively influence parental preparedness and well-being during the end of life as well. Individual HCPs are left with many uncertainties. A more robust approach based on theory, evidence, and training is needed to improve preloss care in pediatrics.
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Affiliation(s)
- Eline M Kochen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
| | - Paul A Boelen
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands; Arq Psychotrauma Expert Group, Diemen, The Netherlands
| | - Saskia C C M Teunissen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Floor Jenken
- Department Woman and Baby, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Roos R de Jonge
- Center for Research and Development of Education, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Martha A Grootenhuis
- Department of Psycho-Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Marijke C Kars
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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Bijnsdorp FM, Onwuteaka-Philipsen BD, Boot CR, van der Beek AJ, Klop HT, Pasman HRW. Combining paid work and family care for a patient at the end of life at home: insights from a qualitative study among caregivers in the Netherlands. BMC Palliat Care 2021; 20:93. [PMID: 34167518 PMCID: PMC8228921 DOI: 10.1186/s12904-021-00780-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 05/25/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Population ageing, an emphasis on home-based care of palliative patients and policies aimed at prolonging participation in the labour market are placing a growing demand on working family caregivers. This study aimed to provide insight into experiences with combining paid work and family care for patients at the end of life, factors facilitating and hindering this combination, and support needs. METHOD Semi-structured interviews were held between July 2018 and July 2019 with 18 working family caregivers of patients with a life-threatening illness who were living at home. Transcripts were analysed following the principles of thematic analysis. RESULTS Some family caregivers could combine paid work and family care successfully, while this combination was burdensome for others. Family caregivers generally experienced a similar process in which four domains - caregiver characteristics, the care situation, the work situation and the context - influenced their experiences, feelings and needs regarding either the combination of paid work and care or the care situation in itself. In turn, experiences, feelings and needs sometimes affected health and wellbeing, or prompted caregivers to take actions or strategies to improve the situation. Changes in health and wellbeing could affect the situation in the four domains. Good health, flexibility and support at work, support from healthcare professionals and sharing care tasks were important in helping balance work and care responsibilities. Some caregivers felt 'sandwiched' between work and care and reported physical or mental health complaints. CONCLUSIONS Experiences with combining paid work and family care at the end of life are diverse and depend on several factors. If too many factors are out of balance, family caregivers experience stress and this impacts their health and wellbeing. Family caregivers could be better supported in this by healthcare professionals, employers and local authorities.
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Affiliation(s)
- Femmy M. Bijnsdorp
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, Expertise Center for Palliative Care, Amsterdam, the Netherlands
| | - Bregje D. Onwuteaka-Philipsen
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, Expertise Center for Palliative Care, Amsterdam, the Netherlands
| | - Cécile R.L. Boot
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - Allard J. van der Beek
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - Hanna T. Klop
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, Expertise Center for Palliative Care, Amsterdam, the Netherlands
| | - H. Roeline W. Pasman
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, Expertise Center for Palliative Care, Amsterdam, the Netherlands
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Yu W, Lu Q, Lu Y, Yang H, Zhang L, Guo R, Hou X. Anticipatory Grief among Chinese Family Caregivers of Patients with Advanced Cancer: A Cross-Sectional Study. Asia Pac J Oncol Nurs 2021; 8:369-376. [PMID: 34159229 PMCID: PMC8186392 DOI: 10.4103/apjon.apjon-214] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 04/10/2021] [Indexed: 11/04/2022] Open
Abstract
Objective The objective of this study was to explore the interrelationship between anticipatory grief (AG), caregiver burden, communication, preparation for death, and coping style. Methods A convenience sample of 256 Chinese family caregivers of patients with advanced cancer were recruited from an academic cancer hospital between April 2018 and May 2019. This cross-sectional survey included the AG Scale, caregiver burden (Caregiver Reaction Assessment), communication (Caregivers' Communication with Patients about Illness and Death Scale), preparation for death, and coping style (Simplified Coping Style Questionnaire). Structural equation modeling tested the interrelation between them. Results The final model fitted the data acceptably (χ2 = 25.79, degrees of freedom = 17, P = 0.08, root mean square error of approximation = 0.05, goodness-of-fit index [GFI] = 0.98, adjusted GFI [AGFI] = 0.95, parsimony GFI [PGFI] = 0.46, normed fit index = 0.94, comparative fit index = 0.98). Poor communication contributed to less preparation for death and caregiver burden, which further aggravate AG. Communication was positively associated with AG. In addition, communication and positive coping style interacted to further influence caregiver burden. Conclusions Preliminary results supported the model and showed that poor communication, less preparation for death, and caregiver burden contributed to AG while positive coping alleviated AG. Findings suggest the need for further studies to explore effective intervention for communication, preparation for death, burden, and coping style of caregivers to ultimately alleviate AG.
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Affiliation(s)
- Wenhua Yu
- Department of Thoracic Surgical Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing, China
| | - Qian Lu
- School of Nursing, Peking University, Beijing, China
| | - Yuhan Lu
- Department of Nursing, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing, China
| | - Hong Yang
- Department of Nursing, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing, China
| | - Lichuan Zhang
- School of Nursing, Peking University, Beijing, China
| | - Renxiu Guo
- Department of Digestive Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing, China
| | - Xiaoting Hou
- Department of Thoracic Medical Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing, China
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"It's Always Been a Second Class Cancer": An Exploration of the Experiences and Journeys of Bereaved Family Carers of People with Sarcoma. Cancers (Basel) 2021; 13:cancers13112670. [PMID: 34071478 PMCID: PMC8198001 DOI: 10.3390/cancers13112670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/09/2021] [Accepted: 05/25/2021] [Indexed: 12/24/2022] Open
Abstract
Sarcomas are a group of rare and aggressive cancers, which develop in bones and connective tissue throughout the body. Sarcomas account for only 1-2% of all cancers worldwide; however, mortality rates for sarcoma are high with approximately two in four sarcoma patients dying following a diagnosis. Delays in diagnosis, poor management of symptoms, patients' high symptom loads and high carer burden are all associated with carer distress, which may lead to complications after bereavement. The experience of having a family member referred for palliative care is also distressing for carers, with the realisation that their family member is dying. This study aimed to explore the experiences of bereaved family carers of people diagnosed with sarcoma. A qualitative descriptive design using a social constructionist framework was adopted. Interviews were conducted with sixteen participants, and thematic analysis was used to identify patterns in the data. Four overarching themes emerged: beginning the journey; moving through treatment; transitioning to palliative care; and experiencing bereavement. The narratives were coherent and potent, and people reflected on their journeys. Interventions and supports for bereaved carers could include opportunities for counselling to support reflections, supports for developing a narrative such as writing therapy, and preparation for the death of the family member.
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Fringer A, Stängle S, Bischofberger I, Büche D, Praxmarer R, Ch Ott S, Schnepp W. Experiences of relatives with outpatient palliative care: a cross-sectional study. Int J Palliat Nurs 2021; 26:230-237. [PMID: 32584687 DOI: 10.12968/ijpn.2020.26.5.230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM The authors aimed to evaluate the experiences of the relatives of dying people, both in regard to benefits and special needs, when supported by a mobile palliative care bridging service (MPCBS), which exists to enable dying people to stay at home and to support patients' relatives. DESIGN A cross-sectional survey. METHODS A standardised survey was performed, asking 106 relatives of dying people about their experiences with the MPCBS (response rate=47.3%). Descriptive statistics were analysed using SPSS 23. FINDINGS Many relatives (62.5%) reported that their dying relations when discharged from a facility to stay at home were not symptom-free. The MPCBS helped relatives maintain home care, and this was reported to be helpful. Support provided by the MPCBS made it easier for 77.6% of relatives to adjust care as soon as situations changed, and helped ensure that symptoms could be better controlled, at least for 68.2% of relatives. Younger relatives felt more encouraged by the MPCBS to care for their relatives dying at home.
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Affiliation(s)
- André Fringer
- Professor for Family-Centered Care; Co-Head MSc Nursing and Co-Head Research Unit Nursing, ZHAW Zurich University of Applied Sciences, School of Health Professions, Institute of Nursing, Winterthur, Switzerland and Witten/Herdecke University, Faculty of Health, Department of Nursing Science, Witten, Germany
| | - Sabrina Stängle
- Research Associate, ZHAW Zurich University of Applied Sciences, School of Health Professions, Institute of Nursing, Winterthur, Switzerland and Witten/Herdecke University, Faculty of Health, Department of Nursing Science, Witten, Germany
| | - Iren Bischofberger
- Professor for Applied Research and Clinical Excellence in Nursing, Kalaidos University of Applied Sciences, Department of Health Science, Zurich, Switzerland
| | - Daniel Büche
- Head Physician Palliative Care Centre, Cantonal Hospital St.Gallen, St. Gallen, Switzerland
| | - Renate Praxmarer
- Co-Head of Palliative Bridge Service, Cancer League of Eastern Switzerland, Bern, Switzerland
| | - Stefan Ch Ott
- Professor of Economics, FHS St.Gallen University of Applied Sciences, Department of Economics, St.Gallen, Switzerland
| | - Wilfried Schnepp
- Head of the Department for Family-Oriented and Community Care, Witten/Herdecke University, Faculty of Health, Department of Nursing Science, Witten, Germany
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Reciprocal burden: Adults with drug-resistant epilepsy reflect upon informal caregiver support. Seizure 2021; 89:85-92. [PMID: 34034062 DOI: 10.1016/j.seizure.2021.04.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/19/2021] [Accepted: 04/27/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To explore how a sample of people with uncontrolled seizures describe their experiences of receiving informal supportive care. METHODS Using constructivist grounded theory, in-person, semi-structured interviews were conducted in 35 adults with drug-resistant epilepsy. These 20 (57%) women and 15 (43%) men were aged 18-68 years (mean= 35.6 years), with a range of verbal comprehension scores. The majority, 28 (80%) lived in nuclear family settings. RESULTS Unpredictable seizures disrupted personal autonomy and generated unique challenges for everyday life. While supportive care was deemed necessary to survival, subjective reflections around the implications of care-receiving and caregiving, were ultimately experienced as mutually burdensome. Four dynamic and interactive dimensions revealed a mirrored, interactive perspective of what it meant to be a care-recipient: assuming responsibility; protecting and supervising; acknowledging reliance and setting boundaries. Care-recipience was not one-sided, but included actively hiding personal struggles as a way to shield the caregiver from the emotional and physical demands of caregiving. Relationship dynamics between caregivers and care-recipients played a major role in treatment decision-making. A clinically useful Theory of Reciprocal Burden resulted from our study. CONCLUSIONS This study adds an explanatory dimension to the concept of illness burden from the perspective of care-recipients. Relationship dynamics play a key role in patient-centered epilepsy care, with clinical implications for guiding supportive caregiving, fostering independence and promoting self-management strategies.
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