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Oliver DP, Washington KT, Benson J, Mayhara M, Pitzer K, White P, Demiris G. Depressive Symptoms in Caregivers of Hospice Cancer Patients. Am J Hosp Palliat Care 2024; 41:786-791. [PMID: 37537930 DOI: 10.1177/10499091231194359] [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: 08/05/2023] Open
Abstract
Objectives: Family members and close friends provide countless hours of care for patients enrolled in hospice care. They do so without pay, often sacrificing their own financial well-being and health in the process. This study asks 4 research questions: (1) What is the prevalence and severity of depressive symptoms among caregivers of hospice cancer patients? (2) What demographic and contextual factors (such as relationship with patient) are related to the severity of depressive symptoms among caregivers of hospice cancer patients? (3) Are caregiver quality of life and caregiver burden associated with depressive symptoms? and (4) Is baseline depression associated with change in depression over time? Methods: This was a secondary analysis of data collected in a cluster randomized controlled trial. Results: Thirty-five percent of caregivers reported depressive symptoms of moderate or greater severity. These depressive symptoms were found to increase depending on the relationship of the caregiver to the patient. Caregivers with higher reported burden and lower reported quality of life were also found to have higher depressive symptoms. Significance of Results: Hospice agencies are encouraged to assess caregiver depressive symptoms and have protocols in place to assist caregivers with high depressive symptoms.
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Affiliation(s)
- Debra Parker Oliver
- Ira Kodner Professor of Research in Supportive Care, Goldfarb School of Nursing, Division of Palliative Medicine, Department of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Karla T Washington
- Division of Palliative Medicine, Department of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Jacquelyn Benson
- Division of Palliative Medicine, Department of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Masako Mayhara
- Goldfarb School of Nursing, Division of Palliative Medicine, Washington University in St Louis, St. Louis, MO, USA
| | - Kyle Pitzer
- Division of Palliative Medicine, Department of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Patrick White
- Stokes Family Endowed Chair and Chief, Division of Palliative Medicine, Department of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - George Demiris
- Penn Integrates Knowledge University Professor, Department of Biobehavioral and Health Sciences, School of Nursing and Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Bharadwaj A, Oliver DP, Washington KT, Benson J, Pitzer K, White P, Demiris G. Family Caregiver Communication and Perceptions of Involvement in Hospice Care. J Palliat Med 2024; 27:614-621. [PMID: 38271546 DOI: 10.1089/jpm.2023.0576] [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: 01/27/2024] Open
Abstract
Background: The burden of caregiving for family members is significant and becomes particularly challenging at end of life, with negative effects on mental health, including anxiety and depression. Research has shown caregivers need better communication with their health care team. Objectives: To evaluate the relationship between hospice team communication with caregivers and caregiver involvement in care. Methods: The purpose of this secondary analysis of data collected from a U.S.-based cluster crossover randomized trial was to evaluate whether caregiver-centered communication (Caregiver-Centered Communication Questionnaire) is associated with a caregiver's perceptions of involvement in care (Perceived Involved in Care Scale). A block-wise approach was used to estimate linear models, which were created using total scores and subscale scores. Results: Caregiver-centered communication was positively associated with perceptions of involvement in care. Conclusion: Skilled communication between hospice clinicians and family caregivers is critical in helping family members perception they are involved in the care of their loved one. There could be similar benefit in caregiver-centered communication during cancer treatment as well.
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Affiliation(s)
- Archana Bharadwaj
- Department of Anesthesiology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Debra Parker Oliver
- Division of Palliative Medicine, Department of Medicine, Goldfarb School of Nursing, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Karla T Washington
- Division of Palliative Medicine, Department of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Jacquelyn Benson
- Division of Palliative Medicine, Department of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Kyle Pitzer
- Division of Palliative Medicine, Department of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Patrick White
- Division of Palliative Medicine, Department of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - George Demiris
- Department of Biobehavioral and Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Starr LT, Washington K, Pitzer K, Oliver DP, Demiris G. Close but Not Close Enough: How Distance Caregiving is Associated with Hospice Family Caregiver Hospice Communication Experiences. HEALTH COMMUNICATION 2024; 39:482-492. [PMID: 36683376 PMCID: PMC10362092 DOI: 10.1080/10410236.2023.2170199] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Half of hospice family caregivers report having unmet information needs, which can contribute to poor pain and symptom management, emergency department use, and hospice disenrollment for care-recipients and to caregiver strain and stress. Effective communication between hospice teams and family caregivers is critical yet communication inadequacies persist. Despite the growing prevalence of distance caregiving, including in hospice care, and the relationship between caregiver proximity and communication effectiveness, little is known about how caregiver proximity is associated with caregiver perceptions of hospice communication. In this secondary analysis of quantitative data from two multisite randomized clinical trials (NCT03712410 and NCT02929108) for hospice family caregivers (N = 525), multivariate linear models with demographic and contextual controls were used to analyze caregivers' perceptions of caregiver-centered communication with hospice providers based on caregiver proximity to the hospice care-recipient. In multivariate models, "local" hospice family caregivers who lived within 1 hour of the hospice care-recipient reported less effective communication with the hospice team than co-residing caregivers; and older caregivers rated communication more favorably than younger caregivers. To improve communication and collaboration between hospice teams and caregivers, regardless of proximity, distance communication training for hospice teams and interventions such as telehealth communication and virtual tools that enable triadic collaboration are recommended. Research is needed to understand why local caregivers, specifically, perceive communication quality less favorably and how hospice teams can better meet local and distance caregiver communication needs.
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Affiliation(s)
- Lauren T. Starr
- NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Department of Biobehavioral Health Sciences, Philadelphia, Pennsylvania
| | - Karla Washington
- Washington University in St. Louis School of Medicine, Division of Palliative Medicine, St. Louis, Missouri
| | - Kyle Pitzer
- Washington University in St. Louis School of Medicine, Division of Palliative Medicine, St. Louis, Missouri
| | - Debra Parker Oliver
- Washington University in St. Louis School of Medicine, Division of Palliative Medicine, St. Louis, Missouri
- Barnes Jewish College, Goldfarb School of Nursing, St. Louis, Missouri
| | - George Demiris
- NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Department of Biobehavioral Health Sciences, Philadelphia, Pennsylvania
- University of Pennsylvania Perelman School of Medicine, Department of Biostatistics and Epidemiology, Philadelphia, Pennsylvania
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Oliver DP, Demiris G, Benson JJ, White P, Wallace AS, Pitzer K, Washington KT. Family caregiving experiences with hospice lung cancer patients compared to other cancer types. J Psychosoc Oncol 2022; 41:210-225. [PMID: 35930381 PMCID: PMC9899294 DOI: 10.1080/07347332.2022.2101907] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Family caregivers of cancer patients are very involved in communication with healthcare teams; however, little is known about their experiences. Limited information is known about how the type of cancer patients have impact caregiving experiences. OBJECTIVES This study seeks to compare the caregiving experience of caregivers of hospice lung cancer patients with hospice caregivers of patients with all other cancer types. METHOD This study is based on a secondary analysis of data generated from a parent study evaluating a behavioral intervention with caregivers of hospice cancer patients. RESULTS When comparing caregiving experiences by patient diagnosis, significant differences were found in caregivers of hospice lung cancer demographics and experiences with caregiver-centered communication. Specifically, caregivers of lung cancer patients have significantly more trouble with exchange of information, fostering relationships, and decision making with their hospice team. CONCLUSION More research is needed to understand the impact of lung cancer on caregiver centered communication and the necessary interventions required to address these issues.
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Affiliation(s)
- Debra Parker Oliver
- Division of Palliative Medicine, Department of Medicine, Washington University in St. Louis, Goldfarb School of Nursing, 4590 Children’s Place, Mailstop 90-29-931, St. Louis, MO. 63110
| | - George Demiris
- Department of Biobehavioral Health Sciences, School of Nursing, Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania
| | - Jacquelyn J. Benson
- Division of Palliative Medicine, Department of Medicine, Washington University in St. Louis
| | - Patrick White
- Division of Palliative Medicine, Department of Medicine, Washington University in St. Louis
| | - Audrey S. Wallace
- Radiation Oncology, St. Louis Veteran Health Administration Medical Center, St. Louis, Missouri
| | - Kyle Pitzer
- Division of Palliative Medicine, Department of Medicine, Washington University in St. Louis
| | - Karla T. Washington
- Division of Palliative Medicine, Department of Medicine, Washington University in St. Louis
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Remote activity monitoring for family caregivers of persons living with dementia: a mixed methods, randomized controlled evaluation. BMC Geriatr 2021; 21:715. [PMID: 34922475 PMCID: PMC8684277 DOI: 10.1186/s12877-021-02634-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 11/09/2021] [Indexed: 11/10/2022] Open
Abstract
Background The goal of the present study was to determine whether a remote activity monitoring (RAM) system benefited caregivers who aided relatives with Alzheimer’s disease or related dementias (ADRD) living at home. We hypothesized that over 18 months, families randomly assigned to receive RAM technology in the home of the person with ADRD would experience statistically significant (p < .05): 1) improvements in caregiver self-efficacy and sense of competence when managing their relative’s dementia; and 2) reductions in caregiver distress (e.g., burden, role captivity, and depression). Methods An embedded mixed methods design was utilized, where 179 dementia caregivers were randomly assigned to receive RAM or not. Caregivers were surveyed bi-annually over an 18-month period to collect quantitative and qualitative data on RAM’s effects. Semi-structured interviews with 30 caregivers were completed following the 18-month data collection period to explore more in-depth how and why RAM was perceived as helpful or not. Results Growth curve models showed no direct or moderation effect of RAM on dementia caregiver outcomes. The qualitative data revealed a complex utilization process of RAM influenced by the care environment/context as well as the temporal progression of ADRD and the caregiving trajectory. Conclusions The findings suggest the need for developing more effective mechanisms to match appropriate technologies with the heterogeneous needs and care contexts of people living with ADRD and their caregivers. A triadic approach that incorporates professional care management alongside passive monitoring systems such as RAM may also enhance potential benefits. Trial registration ClinicalTrials.govNCT03665909, retrospectively registered on 11 Sept 2018. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02634-8.
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Cruz-Oliver DM, Abshire M, Budhathoki C, deCardi Hladek M, Volandes A, Jorgensen L, Oliver DP. Comparison of Traditional Videos With Telenovelas for Hospice Family Caregivers Education. Am J Hosp Palliat Care 2021; 38:1230-1237. [PMID: 33550835 PMCID: PMC9058977 DOI: 10.1177/1049909121991524] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND While research has shown that hospice family caregivers (HFCG) seek additional information related to patient care, pain and symptom management, and self-care, it is unknown how the use of telenovela videos for education in hospice would be received by HFCG. OBJECTIVE To explore HFCG perceived benefits and challenges with the use of telenovelas as compared to traditional educational videos during online support group. METHODS A mixed methods study with a concurrent triangulated design that analyzed qualitative interviews and YouTube analytics report to identify how viewers responded (number of views and their feedback) to telenovela videos as compared to traditional educational videos. RESULTS Among 39 (n = 39) HFCGs, most participants were female (80%) of White/Caucasian race, with more than high school education (85%) and they were adult children of hospice cancer patient (49%). Comparing HFCG that viewed traditional videos with HFCG that viewed telenovela videos, the telenovela video was watched more (12% longer viewing duration) and caregivers reported better content recall with informative benefits, more follow up actions and reflection about their own hospice experience. CONCLUSION Caregiver feedback indicated that watching the telenovela was engaging, acceptable and produced more conversations about patient care, than watching a non-telenovela format video. Further research is needed to test telenovela efficacy in enhancing HFCG outcomes.
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Affiliation(s)
- Dulce M. Cruz-Oliver
- Internal Medicine, Palliative Medicine Program, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Martha Abshire
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | | | | | - Angelo Volandes
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Lucas Jorgensen
- Division of Palliative Medicine, Washington University, St. Louis, MO, USA
| | - Debra Parker Oliver
- Division of Palliative Medicine, Washington University, St. Louis, MO, USA
- Goldfarb School of Nursing, Barnes Jewish Hospital, Columbia, MO, USA
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Motswasele-Sikwane LK, Madumo MM, Tlapu MM, Govender I. The experiences of home-based care workers when rendering services in the communities in Northern Tshwane and Madibeng districts. S Afr Fam Pract (2004) 2020; 62:e1-e8. [PMID: 33179952 PMCID: PMC8377804 DOI: 10.4102/safp.v62i1.5155] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/24/2020] [Accepted: 07/27/2020] [Indexed: 11/15/2022] Open
Abstract
Background Despite the provision of the policy for Ward-based Primary Healthcare Outreach Teams, which requires home-based care workers to be supported by different categories of health professionals, home-based care workers continue to experience challenges during service provision in the communities. Home-based care workers form an integral part of the Ward-based Primary Healthcare Outreach Teams that form part of the streams of primary healthcare re-engineering. The aim of the study was to explore and describe the experiences of home-based care workers (HBCWs) when rendering services in the communities of Northern Tshwane district in Gauteng province and Madibeng district in the North West province. Methods The study design was qualitative, exploratory and descriptive. Purposive sampling was used from the population of HBCWs in Gauteng and North West. Focus group interviews were conducted. Tesch’s data analysis method was used. Themes and subthemes were identified by the researcher and co-coder, and these were summarised into subjects that were interrelated. Results Diverse experiences of participants emerged. These experiences included lack of human and material resources, poor funding, lack of knowledge, lack of support and respect and the need for psychological support. Conclusion There is a need for a collaborative approach amongst the National Department of Health, non-governmental organisations (NGOs) and HBCWs in patient care. Policies and support structures should be strengthened or reformed to promote comprehensive and integrated care to sustain HBCWs.
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Affiliation(s)
- Lily K Motswasele-Sikwane
- Department Nursing, Faculty of Health Care Sciences, Sefako Makgatho Health Sciences University, Pretoria.
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Parast L, Elliott MN, Haas A, Teno J, Bradley M, Weech-Maldonado R, Anhang Price R. Association between Receipt of Emotional Support and Caregivers' Overall Hospice Rating. J Palliat Med 2020; 24:689-696. [PMID: 33021460 DOI: 10.1089/jpm.2020.0324] [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: 11/13/2022] Open
Abstract
Background: A major goal of hospice care is to provide individually tailored emotional and spiritual support to caregivers of hospice patients. Objectives: Examine the association between reported emotional support and caregivers' overall rating of hospice care, overall and by race/ethnicity/language. Subjects: We analyzed survey data corresponding to 657,805 decedents/caregivers who received care from 3160 hospice programs during January 2017-December 2018. Measurements: Linear regression models examined the association between caregiver-reported receipt of emotional and spiritual support ("too little" vs. "right amount" vs. "too much") and overall rating of the hospice (0 vs. 100 rating). Interaction terms assessed variation in this association by race/ethnicity/language. Results: "Too much" emotional support was less common than "too little," except for caregivers of Hispanic decedents responding in Spanish. "Too little" support was strongly associated with lower hospice ratings for all groups (compared to "right amount" of support, p < 0.001). In contrast, the negative association between "too much" support and hospice rating was much smaller (p < 0.001) among caregivers of white and black decedents. "Too much" support was associated with more positive ratings among caregivers of Hispanic decedents (p < 0.001). Conclusions: Receipt of "too much" support is a less common and much weaker driver of poor hospice ratings than receipt of "too little" support for all groups, and is not always viewed negatively. This suggests that for hospice evaluation, "too much" support should not be scored equivalently to "too little" support and that providing enough support should be a hospice priority.
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Affiliation(s)
| | | | - Ann Haas
- RAND Corporation, Pittsburgh, Pennsylvania, USA
| | - Joan Teno
- Oregon Health and Science University, Portland, Oregon, USA
| | | | - Robert Weech-Maldonado
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Griffin JM, Riffin C, Havyer RD, Biggar VS, Comer M, Frangiosa TL, Bangerter LR. Integrating Family Caregivers of People With Alzheimer's Disease and Dementias into Clinical Appointments: Identifying Potential Best Practices. J Appl Gerontol 2019; 39:1184-1194. [PMID: 31603041 PMCID: PMC7454004 DOI: 10.1177/0733464819880449] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Family caregiver engagement in clinical encounters can promote relationship-centered care and optimize outcomes for people with Alzheimer's disease and related dementias (ADRD). Little is known, however, about effective ways for health care providers to engage family caregivers in clinical appointments to provide the highest quality care. We describe what caregivers of people with ADRD and people with mild cognitive impairment (MCI) consider potential best practices for engaging caregivers as partners in clinical appointments. Seven online focus groups were convened. Three groups included spousal caregivers (n = 42), three included non-spousal caregivers (n = 36), and one included people with MCI (n = 15). Seven potential best practices were identified, including the following: "acknowledge caregivers' role and assess unmet needs and capacity to care" and "communicate directly with person with ADRD yet provide opportunities for caregivers to have separate interactions with providers." Participants outlined concrete steps for providers and health care systems to improve care delivery quality for people with ADRD.
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Innovative Tools to Support Family Caregivers of Persons with Cancer: The Role of Information Technology. Semin Oncol Nurs 2019; 35:384-388. [PMID: 31229338 DOI: 10.1016/j.soncn.2019.06.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To describe the current evidence of studies examining the use of information technology for family caregivers of persons with cancer. We highlight emerging technologies and trends and discuss ethical and practical implications. DATA SOURCES Review scientific studies and systematic reviews of technology use to support caregivers of persons with cancer. CONCLUSION The evidence base is growing; however, more studies are needed to test the effectiveness of technology. IMPLICATIONS FOR NURSING PRACTICE Several tools have potential to provide support to family caregivers but the selection of such tools needs to address access, privacy, interoperability, and usability considerations.
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Chi NC, Han S, Barani E, Parker Oliver D, Washington KT, Lewis FM, Walker A, Demiris G. Development and Preliminary Evaluation of a Pain Management Manual for Hospice Providers to Support and Educate Family Caregivers. Am J Hosp Palliat Care 2018; 36:207-215. [PMID: 30304938 DOI: 10.1177/1049909118804984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Family caregivers encounter many barriers to managing patients' pain in the home hospice setting. However, there are limited clinically applicable resources for hospice providers to help family caregivers identify and address these barriers. AIM To develop a pain management manual for hospice providers to support family caregivers and conduct a preliminary providers' evaluation of the manual. DESIGN AND PARTICIPANTS A pain management manual was developed and structured into 3 parts: (1) 5 common pain management case scenarios based on a secondary data analysis of a hospice clinical trial; (2) a list of suggested assessment questions and strategies for each case scenario was developed based on a caregiver framework; and (3) pain educational material was included from established clinical guidelines. The manual was vetted by 5 experts and then was evaluated by interviewing 25 hospice providers. Interview data were analyzed using thematic analysis. RESULTS The hospice providers found that the manual could potentially serve as a reference in their practice and be a source for their continuing education. They suggested enhancing the clarity of the case scenarios and adding additional strategies to the manual. Moreover, they suggested expanding the paper-based version and developing a web-based platform to deliver the content would maximize its utility. CONCLUSIONS The manual has the potential to be integrated into routine hospice care to improve the quality of pain management.
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Affiliation(s)
- Nai-Ching Chi
- College of Nursing, University of Iowa, Iowa City, IA, USA
| | - Soojeong Han
- Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, WA, USA
| | - Emelia Barani
- Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, WA, USA
| | - Debra Parker Oliver
- Department of Family and Community Medicine, School of Medicine, University of Missouri, Columbia, MO, USA
| | - Karla T Washington
- Department of Family and Community Medicine, School of Medicine, University of Missouri, Columbia, MO, USA
| | - Frances Marcus Lewis
- Department of Family and Child Nursing, School of Nursing, University of Washington, Seattle, WA, USA.,Public Health and Clinical Sciences Divisions, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Amy Walker
- Department of Family and Child Nursing, School of Nursing, University of Washington, Seattle, WA, USA
| | - George Demiris
- Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
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Parker Oliver D, Washington K, Smith J, Uraizee A, Demiris G. The Prevalence and Risks for Depression and Anxiety in Hospice Caregivers. J Palliat Med 2016; 20:366-371. [PMID: 27912042 DOI: 10.1089/jpm.2016.0372] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Depression and anxiety are common concerns for hospice caregivers. OBJECTIVE This study looked at the prevalence and variables associated with hospice caregiver depression and anxiety, as well as the relationship between the two conditions. SUBJECTS We did a secondary analysis of preexisting data. MEASUREMENTS Measures included the PHQ-9 and GAD-7. RESULTS Nearly one-quarter of caregivers were moderately to severely depressed, and nearly one-third reported moderate to severe symptoms of anxiety. Risk factors for both depression and anxiety included younger age and poorer self-rated global health. Depression-specific risk factors included being married and caring for a patient with a diagnosis other than cancer. The sole anxiety-specific risk factor identified was geographic location, as caregivers living in the Southeast were found to have greater anxiety than those in the Midwest. CONCLUSION Hospice providers' recognition of family caregivers as both coproviders and corecipients of care underscores the need to more fully assess and respond to depression and anxiety among caregivers.
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Affiliation(s)
- Debra Parker Oliver
- 1 Department of Family and Community Medicine, University of Missouri , Columbia, Missouri
| | - Karla Washington
- 1 Department of Family and Community Medicine, University of Missouri , Columbia, Missouri
| | - Jamie Smith
- 1 Department of Family and Community Medicine, University of Missouri , Columbia, Missouri
| | - Aisha Uraizee
- 2 University of Missouri School of Medicine , Columbia, Missouri
| | - George Demiris
- 3 Biobehavioral Nursing and Health Systems, School of Nursing & Biomedical and Health Informatics, School of Medicine, University of Washington , Seattle, Washington
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Abstract
AbstractObjective:Caregivers often are unprepared for their role yet serve as the frontline in the provision of palliative care services. The aim of our study was to explore family caregivers' experiences from their perspective as they cared for dying relatives.Method:Using the Photovoice methodology, ten unpaid family caregivers took photographs depicting issues they experienced as informal caregivers of an ill family member who had less than a year to live. Each participant met with the first author individually four to six times and explained their role as caregiver through photographs and stories.Results:The results were clustered into seven themes: physical demands, emotional/spiritual stress, preparing for the future, securing help, medication management, navigating the agencies, and relationships.Significance of results:Caregivers perform a variety of tasks, often under stress. This study highlights the main areas where problems lie and the areas that palliative care health professionals need to be aware of so they can assist and educate caregivers, with the goal of finding solutions to the burdens of care. The themes were found to be intertwined, showing the complexity of the caregiving role.
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Albright DL, Oliver DP, Demiris G. Reaction to Caregiving by Hospice Caregivers Upon Enrollment. Am J Hosp Palliat Care 2014; 32:641-6. [PMID: 24744399 DOI: 10.1177/1049909114531327] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Significant research exists demonstrating the challenges faced by informal family caregivers as they care for their loved ones. How caregivers react to this experience, especially in the case of a terminal illness, is less understood. This study explores the reactions of hospice caregivers to their caregiving experience prior to enrollment in hospice and identifies potential stressors associated with those reactions. Results found anxiety to be a significant predictor in the reaction of caregivers to their caregiving experience upon hospice enrollment.
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Affiliation(s)
- David L Albright
- MU School of Social Work, University of Missouri, Columbia, MO, USA
| | - Debra Parker Oliver
- Curtis W. and Ann H. Department of Family and Community Medicine, University of Missouri, Columbia, MO, USA
| | - George Demiris
- Biobehavioral Nursing and Health Systems, School of Nursing & Biomedical and Health Informatics, School of Medicine, University of Washington, Seattle, WA, USA
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Wittenberg-Lyles E, Kruse RL, Oliver DP, Demiris G, Petroski G. Exploring the collective hospice caregiving experience. J Palliat Med 2013; 17:50-5. [PMID: 24351126 DOI: 10.1089/jpm.2013.0289] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Collective caregiving, performed by caregivers working in pairs (informal primary and secondary caregivers working together), is common in the hospice setting. Research suggests that caregiving pairs may experience different caregiver outcomes. However, little is known about how caregiving pairs differ from solo caregivers (informal primary caregivers) on outcome measures. OBJECTIVE The goal of this study was to determine whether being in a caregiver pair affected caregiver anxiety and depression and how outcomes changed over time. DESIGN A mixed model analysis was used. SETTING/SUBJECTS Hospice caregivers (260 solo caregivers and 44 caregivers in 22 pairs) who participated in a larger, randomized controlled trial completed caregiver measures upon hospice admission and periodically until the death of the patient or hospice decertification. MEASUREMENTS Measured were caregiver quality of life, social support, anxiety, and depression. RESULTS Caregiver pairs had higher anxiety and depression scores than solo caregivers. Emotional, financial, and physical quality of life were associated with decreased depression, whereas only emotional and financial quality of life were correlated with lower levels of anxiety. Social support was associated with lower levels of depression and anxiety. CONCLUSIONS Despite assumptions that social support is positively facilitated vis-a-vis collective caregiving, caregiving pairs may be at higher risk for anxiety and depression. Future research is needed to address why individuals become anxious and/or depressed when working as part of a caregiving pair.
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Olshever A. Integration of groupwork theory and hospice interdisciplinary team practice. ACTA ACUST UNITED AC 2012. [DOI: 10.1921/095182411x636536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Woitha K, Van Beek K, Ahmed N, Hasselaar J, Mollard JM, Colombet I, Radbruch L, Vissers K, Engels Y. Development of a set of process and structure indicators for palliative care: the Europall project. BMC Health Serv Res 2012; 12:381. [PMID: 23122255 PMCID: PMC3529116 DOI: 10.1186/1472-6963-12-381] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Accepted: 10/31/2012] [Indexed: 01/27/2023] Open
Abstract
Background By measuring the quality of the organisation of palliative care with process and structure quality indicators (QIs), patients, caregivers and policy makers are able to monitor to what extent recommendations are met, like those of the council of the WHO on palliative care and guidelines. This will support the implementation of public programmes, and will enable comparisons between organisations or countries. Methods As no European set of indicators for the organisation of palliative care existed, such a set of QIs was developed. An update of a previous systematic review was made and extended with more databases and grey literature. In two project meetings with practitioners and experts in palliative care the development process of a QI set was finalised and the QIs were categorized in a framework, covering the recommendations of the Council of Europe. Results The searches resulted in 151 structure and process indicators, which were discussed in steering group meetings. Of those QIs, 110 were eligible for the final framework. Conclusions We developed the first set of QIs for the organisation of palliative care. This article is the first step in a multi step project to identify, validate and pilot QIs.
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Affiliation(s)
- Kathrin Woitha
- Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Centre, Geert Grote Plein 10, Nijmegen 6500 HB, The Netherlands.
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Wittenberg-Lyles E, Demiris G, Parker Oliver D, Washington K, Burt S, Shaunfield S. Stress variances among informal hospice caregivers. QUALITATIVE HEALTH RESEARCH 2012; 22:1114-25. [PMID: 22673093 PMCID: PMC3559181 DOI: 10.1177/1049732312448543] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Care interventions are not routinely provided for hospice caregivers, despite widespread documentation of the burden and toll of the caregiving experience. Assessing caregivers for team interventions (ACT) proposes that holistic patient and family care includes ongoing caregiver needs assessment of primary, secondary, and intrapsychic stressors. In this study, our goal was to describe the variance in stressors for caregivers to establish evidence for the ACT theoretical framework. We used secondary interview data from a randomized controlled trial to analyze hospice caregiver discussions about concerns. We found variances in stress types, suggesting that caregiver interventions should range from knowledge and skill building to cognitive-behavioral interventions that aid in coping. Family members who assume the role of primary caregiver for a dying loved one need to be routinely assessed by hospice providers for customized interventions.
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Hui D, Mori M, Parsons HA, Kim SH, Li Z, Damani S, Bruera E. The lack of standard definitions in the supportive and palliative oncology literature. J Pain Symptom Manage 2012; 43:582-92. [PMID: 22104619 PMCID: PMC3818788 DOI: 10.1016/j.jpainsymman.2011.04.016] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2011] [Revised: 04/20/2011] [Accepted: 04/21/2011] [Indexed: 01/10/2023]
Abstract
CONTEXT Multiple organizations have raised concerns about the lack of standard definitions for terminology in the supportive and palliative oncology literature. OBJECTIVES We aimed to determine 1) the frequency of 10 commonly used terms in the supportive and palliative oncology literature, 2) the proportion of articles that provided definitions for each term, and 3) how each term was defined. METHODS We systematically searched MEDLINE, PubMed, PsycINFO, the Cochrane Library, Embase, ISI Web of Science, and Cumulative Index to Nursing and Allied Health Literature for original studies, review articles, and systematic reviews related to palliative care and cancer in the first six months of 2004 and 2009. We counted the number of occurrences for "palliative care," "supportive care," "best supportive care," "hospice care," "terminal care," "end-of-life," "terminally ill," "goals of care," "actively dying," and "transition of care" in each article, reviewed them for the presence of definitions, and documented the journal characteristics. RESULTS Among the 1213 articles found, 678 (56%) were from 2009. "Palliative care" and "end-of-life" were the most frequently used terms. "Palliative care," "end-of-life," and "terminally ill" appeared more frequently in palliative care journals, whereas "supportive care" and "best supportive care" were used more often in oncology journals (P<0.001). Among 35 of 601 (6%) articles with a definition for "palliative care," there were 16 different variations (21 of 35 articles used the World Health Organization definition). "Hospice care" had 13 definitions among 13 of 151 (9%) articles. "Supportive care" and other terms were rarely defined (less than 5% of articles that used the term). CONCLUSION Our findings highlight the lack of definitional clarity for many important terms in the supportive and palliative oncology literature. Standard definitions are needed to improve administrative, clinical, and research operations.
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Affiliation(s)
- David Hui
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA.
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Abstract
OBJECTIVES To describe the current level of utilization of informatics systems in hospice and palliative care and to discuss two projects that highlight the role of informatics applications for hospice informal caregivers. DATA SOURCES Published articles, Web resources, clinical practice, and ongoing research initiatives. CONCLUSION There are currently few informatics interventions designed specifically for palliative and hospice care. Challenges such as interoperability, user acceptance, privacy, the digital divide, and allocation of resources all affect the diffusion of informatics tools in hospice. IMPLICATIONS FOR NURSING PRACTICE Caregiver support through use of information technology is feasible and may enhance hospice care.
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Lusardi P, Jodka P, Stambovsky M, Stadnicki B, Babb B, Plouffe D, Doubleday N, Pizlak Z, Walles K, Montonye M. The Going Home Initiative: Getting Critical Care Patients Home With Hospice. Crit Care Nurse 2011; 31:46-57. [DOI: 10.4037/ccn2011415] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Although considerable effort is being directed at providing patients and their families with a “good death,” most patients in intensive care units, if given the choice, would prefer to die at home. With little guidance from the literature, the palliative care committee of an intensive care unit developed guidelines to get patients home from the intensive care unit to die. In the past few years, the unit has transferred many patients home with hospice care, much to the delight of their families. Although several obstacles to achieving this goal exist, the unit has achieved success in a small-scale implementation of its Going Home Initiative.
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Affiliation(s)
- Paula Lusardi
- Paula Lusardi is a clinical nurse specialist in the adult intensive care unit, cochair of the intensive care unit’s palliative care committee, and director of nursing research at Baystate Medical Center, Springfield, Massachusetts
| | - Paul Jodka
- Paul Jodka is attending physician in the critical care division, director of anesthesia/critical care fellowship, and cochair of the intensive care unit’s palliative care committee at Baystate Medical Center and an assistant professor of medicine at Tufts University School of Medicine, Boston, Massachusetts
| | - Mark Stambovsky
- Mark Stambovsky is a staff nurse in the intensive care unit at Baystate Medical Center
| | - Beth Stadnicki
- Beth Stadnicki is a staff nurse in the intensive care unit and cochair of the intensive care unit’s palliative care committee at Baystate Medical Center
| | - Betty Babb
- Betty Babb is a staff nurse in the intensive care unit at Baystate Medical Center
| | - Danielle Plouffe
- Danielle Plouffe is a staff nurse in the intensive care unit and cochair of the intensive care unit’s palliative care committee at Baystate Medical Center
| | - Nancy Doubleday
- Nancy Doubleday is an adult nurse practitioner with Baystate Medical Practices, Adult Medicine, Springfield, Massachusetts
| | - Zophia Pizlak
- Zophia Pizlak is a staff nurse in the intensive care unit at Baystate Medical Center
| | - Katherine Walles
- Katherine Walles is a staff nurse in the intensive care unit at Baystate Medical Center
| | - Martin Montonye
- Martin Montonye is the vice president of academic affairs at HealthCare Chaplaincy, New York, New York
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Wittenberg-Lyles E, Demiris G, Oliver DP, Burt S. Reciprocal suffering: caregiver concerns during hospice care. J Pain Symptom Manage 2011; 41:383-93. [PMID: 21146356 PMCID: PMC3053049 DOI: 10.1016/j.jpainsymman.2010.04.026] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2010] [Revised: 04/29/2010] [Accepted: 05/05/2010] [Indexed: 11/28/2022]
Abstract
CONTEXT For many hospice caregivers, the constancy and difficulty of caregiving impact their physical quality of life and cause depression, psychological distress, guilt, loneliness, and restrictions on social activities. OBJECTIVES Deviating from traditional unidimensional research on hospice caregivers, this study explored the transactional nature of reciprocal suffering by examining caregiver concerns through four dimensions: physical, psychological, social, and spiritual. METHODS Researchers analyzed audiotapes of intervention discussions between hospice caregivers and research social workers. RESULTS Results indicated that, of the 125 pain talk utterances, most referenced psychological concern (49%), followed by physical (28%), social (22%), and spiritual (2%) concerns. Reflections on concerns revealed a global perspective of caregiving, which highlighted the patient's needs juxtaposed to the caregiver's recognized limitations. CONCLUSION By examining the reciprocal nature of suffering for caregivers, this study reinforced the need for assessing caregivers in hospice care, with specific emphasis on the importance of providing caregiver education on pain management.
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Affiliation(s)
- Elaine Wittenberg-Lyles
- Department of Communication Studies, University of North Texas, Denton, Texas 76203-5268, USA.
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