1
|
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.
Collapse
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
| |
Collapse
|
2
|
Garcia ACM, Maia LO, Reed PG. Exploring Psychedelics for Alleviating Existential and Spiritual Suffering in People With Serious Illnesses: Links to the Theory of Self-Transcendence. J Holist Nurs 2024:8980101241257836. [PMID: 38809663 DOI: 10.1177/08980101241257836] [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: 05/31/2024]
Abstract
The fields of palliative and holistic Nursing are dedicated to providing comprehensive care for the person, emphasizing special attention to the existential and spiritual aspects of care. Psychedelic-assisted therapy has emerged as a promising approach for symptom management in individuals with serious illnesses, particularly those of existential and spiritual origin. People who undergo challenging experiences, as is the case with serious illnesses, often undergo an identity crisis and question the purpose of their lives. Psychedelic therapy, when conducted properly by trained professionals, can facilitate self-exploration and self-transcendence, opening doors to states of expanded consciousness and fostering a profound connection with oneself. This experience can help patients develop a greater sense of self-awareness and a deeper understanding of their existential and spiritual issues, enabling them to find meaning and inner peace. The Theory of Self-Transcendence theory provides a Nursing framework for understanding how psychedelic-assisted therapy can facilitate, through self-transcendence, the journey of spiritual and existential healing, offering the possibility of achieving wellbecoming from a state of vulnerability.
Collapse
Affiliation(s)
| | - Lucas Oliveira Maia
- Federal University of Alfenas University of Campinas Federal University of Rio Grande do Norte
| | | |
Collapse
|
3
|
Üstündağ S, Çekiç Y, Kurtoğlu Y, Ünver G. A Comparative Analysis of Spiritual Care Needs Among Cancer Patients Receiving Home Care and Their Caregivers in Turkey. JOURNAL OF RELIGION AND HEALTH 2024; 63:1490-1503. [PMID: 38305825 DOI: 10.1007/s10943-023-01988-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/14/2023] [Indexed: 02/03/2024]
Abstract
This study was conducted to determine and compare the spiritual care needs of cancer patients and their caregivers. A comparative descriptive, cross-sectional design was employed in this study. The study comprised 102 patients who were registered in the hospital's home care unit, as well as their caregivers (total number = 204). The data were collected using a personal information form and the Spiritual Care Needs Inventory. The cancer patients had a mean age of 69.5 years, while their caregivers' mean age was 53.1 years. According to the results, the cancer patients needed more spiritual care than their caregivers (p < 0.01). Patients' spiritual care needs differed significantly by employment status (p < 0.05). However, gender, educational level, and marital status did not have a significant difference in the spiritual care needs of the patients and their caregivers (p > 0.05). Moderately positive and significant (p < 0.05) correlations between patients and their caregivers were found for the total Spiritual Care Needs Inventory scores (r = 0.449), the meaning and hope subscale (r = 0.378), and the caring and respect subscale (r = 0.546). It is important to evaluate the spiritual needs of patients with cancer and their caregivers. In this evaluation, it is essential to elicit the perspectives of cancer patients and their caregivers concerning spiritual needs and religion. Effective spiritual care for patients and their caregivers can only be provided if their beliefs and priorities are taken into consideration.
Collapse
Affiliation(s)
- Sema Üstündağ
- Nursing Department, Faculty of Health Sciences, Kütahya Health Sciences University, Kütahya, Turkey.
| | - Yasemin Çekiç
- Psychiatric Nursing Department, Ankara University, Ankara, Turkey
| | - Yasemin Kurtoğlu
- Department of Family Medicine, Faculty of Medicine, Kütahya Health Sciences University, Kütahya, Turkey
| | - Gamze Ünver
- Nursing Department, Faculty of Health Sciences, Kütahya Health Sciences University, Kütahya, Turkey
| |
Collapse
|
4
|
Qi W, Deng J, Guo W, Chen F, Liu X, Zhang Y, Cui J. Spiritual Coping in Family Caregivers of Patients With Advanced Cancer: A Cross-Sectional Study. J Pain Symptom Manage 2024; 67:e177-e184. [PMID: 38016507 DOI: 10.1016/j.jpainsymman.2023.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 11/10/2023] [Accepted: 11/20/2023] [Indexed: 11/30/2023]
Abstract
CONTEXT Family caregivers face significant challenges when providing care to individuals with advanced cancer. Spiritual coping strategies may support caregivers in addressing these challenges. OBJECTIVES We evaluated spiritual coping levels among Chinese family caregivers of patients with advanced cancer and explored associated factors. METHODS This cross-sectional study recruited 358 family caregivers of patients with advanced cancer. The Spiritual Coping Scale was used to evaluate spiritual coping levels, while various scales, including the Caregiver Reaction Assessment Scale, General Self-Efficacy Scale-Schwarzer, and Perceived Social Support Scale, were used to identify influencing factors. T-tests and analysis of variance were used for group comparisons. Pearson's correlation and multivariate linear regression were used to analyze the associated factors. RESULTS Chinese family caregivers of patients with advanced cancer had moderate spiritual coping levels. Differences in spiritual coping levels were observed in sex, religion, and the presence or absence of anxiety and depression (p < 0.05). Women and caregivers who identified as religious had higher levels, while those with anxiety or depression had lower levels. Spiritual coping was positively correlated with self-efficacy and spiritual health (p < 0.01). Multiple linear regression analysis revealed that religion, anxiety, depression, self-efficacy, and spiritual health were statistically significant associated factors for spiritual coping scores, explaining 43.3% of the variance in scores (F = 53.769, p < 0.001). CONCLUSION The spiritual coping of Chinese family caregivers should be considered by health care providers, who should focus on alleviating their anxiety and depression while improving self-efficacy and spiritual health, especially among nonreligious caregivers.
Collapse
Affiliation(s)
- Wenqian Qi
- School of Nursing, Naval Medical University (W.Q., J.D., W.G., X.L., J.C.), Shanghai, China
| | - Jiajia Deng
- School of Nursing, Naval Medical University (W.Q., J.D., W.G., X.L., J.C.), Shanghai, China
| | - Wei Guo
- School of Nursing, Naval Medical University (W.Q., J.D., W.G., X.L., J.C.), Shanghai, China
| | - Fengyi Chen
- The Marine Corps Hospital of PLA (F.C.), Guangdong, China
| | - Xue Liu
- School of Nursing, Naval Medical University (W.Q., J.D., W.G., X.L., J.C.), Shanghai, China
| | - Yi Zhang
- The 940th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army (Y.Z.), Gansu, China
| | - Jing Cui
- School of Nursing, Naval Medical University (W.Q., J.D., W.G., X.L., J.C.), Shanghai, China.
| |
Collapse
|
5
|
Torres-Blasco N, Peña-Vargas C, Costas-Muñiz R, Rosario-Ramos L, Shen MJ, Castro E. Psychosocial symptoms associated with spiritual well-being in Latino patients and caregivers coping with advanced cancer. Support Care Cancer 2024; 32:195. [PMID: 38411749 DOI: 10.1007/s00520-024-08360-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 02/09/2024] [Indexed: 02/28/2024]
Abstract
PURPOSE The objective of this study was to investigate the relationship among hopelessness, anxiety, and depression, with spiritual well-being in patients and family caregivers. METHODS A cross-sectional survey was administered to patients (n = 57) and caregivers (n = 57) that incorporated assessments that measured spiritual well-being, depression, anxiety, hopelessness, quality of life, family relationship, burden, fatalism, religiosity, and distress. Logistic regression and cross-tabulation analyses were conducted to examine the relationship between hopelessness, anxiety, and depression, with spiritual well-being. Logistic regression was used to quantify the impact of spiritual well-being on anxiety, depression, and hopelessness. Additionally, cross-tabulations with chi-square tests were conducted to explore associations between severity of hopelessness and severity of anxiety and depression. RESULTS Logistic regression analyses showed negative associations between spiritual well-being and mental health outcomes, although not all findings were statistically significant. Among caregivers, a significant negative relationship was observed for depression (B = - 0.161, p = 0.022). Hopelessness also exhibited a negative association with spiritual well-being among caregivers (B = - 0.099, p = 0.054) and patients (B = - .152, p = 0.038). Cross-tabulations highlighted significant associations in the severity of hopelessness symptoms with anxiety and depression levels among caregivers (p < .001). CONCLUSION Results reveal a relationship among psychosocial symptoms among Latino patient-caregivers coping with cancer. By emphasizing spiritual well-being, hopelessness, and anxiety and involving family patients and caregivers in the treatment process as a unit of care. Also, it indicates the need to develop culturally tailored interventions that aim to provide valuable assistance to Latino patients and caregivers coping with cancer.
Collapse
Grants
- 5G12MD007579, 5R25MD007607, R21MD013674, and 5U54MS007579-35 National Institute of Minority Health and Health Disparities
- 5G12MD007579, 5R25MD007607, R21MD013674, and 5U54MS007579-35 National Institute of Minority Health and Health Disparities
- 5G12MD007579, 5R25MD007607, R21MD013674, and 5U54MS007579-35 National Institute of Minority Health and Health Disparities
- 5G12MD007579, 5R25MD007607, R21MD013674, and 5U54MS007579-35 National Institute of Minority Health and Health Disparities
- 5G12MD007579, 5R25MD007607, R21MD013674, and 5U54MS007579-35 National Institute of Minority Health and Health Disparities
- 5G12MD007579, 5R25MD007607, R21MD013674, and 5U54MS007579-35 National Institute of Minority Health and Health Disparities
- 2U54CA163071 and 2U54CA163068), R21CA180831-02 , , 5K08CA234397-01A1 National Cancer Institute National Cancer Institute
- 2U54CA163071 and 2U54CA163068), R21CA180831-02 , , 5K08CA234397-01A1 National Cancer Institute National Cancer Institute
- 2U54CA163071 and 2U54CA163068), R21CA180831-02 , , 5K08CA234397-01A1 National Cancer Institute National Cancer Institute
- 2U54CA163071 and 2U54CA163068), R21CA180831-02 , , 5K08CA234397-01A1 National Cancer Institute National Cancer Institute
- P30CA008748 Memorial Sloan Kettering Cancer Center
- P30CA008748 Memorial Sloan Kettering Cancer Center
- P30CA008748 Memorial Sloan Kettering Cancer Center
- P30CA008748 Memorial Sloan Kettering Cancer Center
- 133798-PF-19-120-01-CPPB American Cancer Society
- 133798-PF-19-120-01-CPPB American Cancer Society
- 133798-PF-19-120-01-CPPB American Cancer Society
- 133798-PF-19-120-01-CPPB American Cancer Society
- 133798-PF-19-120-01-CPPB American Cancer Society
- 5U54MS007579-35 by National Institute of Minority Health and Health Disparities
- 5U54MS007579-35 by National Institute of Minority Health and Health Disparities
- 5U54MS007579-35 by National Institute of Minority Health and Health Disparities
- 5U54MS007579-35 by National Institute of Minority Health and Health Disparities
- 5U54MS007579-35 by National Institute of Minority Health and Health Disparities
Collapse
Affiliation(s)
- Normarie Torres-Blasco
- School of Behavioral and Brain Sciences, Ponce Health Sciences University, Ponce, Puerto Rico.
- Ponce's Research Institute, Ponce Health Sciences University, Ponce, Puerto Rico.
| | - Cristina Peña-Vargas
- Ponce's Research Institute, Ponce Health Sciences University, Ponce, Puerto Rico
| | - Rosario Costas-Muñiz
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Lianel Rosario-Ramos
- School of Behavioral and Brain Sciences, Ponce Health Sciences University, Ponce, Puerto Rico
| | - Megan J Shen
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Eida Castro
- School of Behavioral and Brain Sciences, Ponce Health Sciences University, Ponce, Puerto Rico
- Ponce's Research Institute, Ponce Health Sciences University, Ponce, Puerto Rico
| |
Collapse
|
6
|
Bybee SG, Waters AR, Smith K, Warner EL. Misalignment of social support in the social media posts of young adult cancer caregivers. Cancer Rep (Hoboken) 2024; 7:e1998. [PMID: 38389399 PMCID: PMC10884617 DOI: 10.1002/cnr2.1998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 01/05/2024] [Accepted: 01/25/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Compared with older cancer caregivers, young adult cancer caregivers (YACC) experience greater stress and depression during the first 6 months of caregiving. Social support can buffer the negative psychological effects associated with cancer caregiving. However, the misalignment of social support is associated with increased distress and worse emotional well-being. As YACC are more likely to utilize social media (SM) to seek social support compared with older cancer caregivers, they may be at greater risk of experiencing the misalignment of social support and related negative outcomes. OBJECTIVE The purpose of this study was to identify ways that SM posts containing support for YACC's were potentially misaligned with the social support desired by YACC. METHODS In this secondary analysis, cancer-related SM posts (N = 760) from 34 YACC's SM accounts were extracted for 6 months following the day of cancer diagnosis and imported into NVivo qualitative analysis software. Open coding of posts from four YACC identified a pattern of SM posts containing responses that may misalign with social support requests, and could be perceived as dismissive of YACC's emotions. Similar posts were grouped together, forming categories which were used to create a codebook and applied in coding all posts from the remaining 30 YACC. RESULTS Content analysis identified three categories of social support misalignment originating from YACC's SM posts: supplications (n = 251, 33%), prevailing (n = 7, 10.1%), and consolations (n = 16, 2.1%). Supplications involved prayer or trust in god, prevailing posts compared dealing with cancer to a fight and suggested that the person would overcome cancer, and consolations used quotes, song lyrics, and or general reassurances in SM posts. CONCLUSIONS Findings suggest that when YACC use SM during cancer experiences, they may interpret SM posts as social support or as misalignment of social support requests, which in turn can lead to either improved quality of life or additional distress (respectively). This study adds to the body of knowledge regarding how YACC use social media for social support and may inform future interventions designed to match YACC's desired support with support offered.
Collapse
Affiliation(s)
- Sara G. Bybee
- College of Nursing, University of UtahSalt Lake CityUtahUSA
| | - Austin R. Waters
- Huntsman Cancer Institute at the University of UtahSalt Lake CityUtahUSA
| | - Keely Smith
- The University of Arizona, College of NursingTucsonArizonaUSA
| | - Echo L. Warner
- College of Nursing, University of UtahSalt Lake CityUtahUSA
| |
Collapse
|
7
|
Heidaranlu E, Moayed MS, Parandeh A. Spiritual-Cultural Needs as the Main Causative Factor of Death Anxiety in Iranian COVID-19 Patients: A Qualitative Study. JOURNAL OF RELIGION AND HEALTH 2024; 63:817-837. [PMID: 38160442 DOI: 10.1007/s10943-023-01972-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/26/2023] [Indexed: 01/03/2024]
Abstract
COVID-19 patients have been reported to more than likely experience a variety of difficult physical and psychological problems. This qualitative study aims to perceive psychological experiences in COVID-19 patients in Iran. The study method is qualitative, with a conventional content analysis approach adopted. Purposive sampling was applied to 20 COVID-19 patients admitted to medical wards at hospitals in Tehran, Iran. Additionally, data were collected using semi-structured interviews. All data were analyzed based on the method proposed by Lindgren et al. (Int J Nurs Stud 108:103632, 2020). Data analysis identified the main theme to be "death fear and anxiety" with five main categories. These categories included the feelings of death panic and apprehension, uncertainty and ambiguity, fear of abandonment, fear of an unknown future for the family, and fear of unmet spiritual-cultural needs. Accordingly, the patients' experiences of COVID-19 contraction were unique. Against this backdrop, understanding COVID-19 patients' complexities, experiences, beliefs, and attitudes about anxiety and death, can lead to an improved awareness and understanding of the psychological consequences of COVID-19 by executive decision-makers, healthcare personnel and mental health professionals.
Collapse
Affiliation(s)
- Esmail Heidaranlu
- Trauma Research Center, Clinical Sciences Institute, Faculty of Nursing, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Malihe Sadat Moayed
- Trauma Research Center, Clinical Sciences Institute, Faculty of Nursing, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Akram Parandeh
- Medicine, Quran and Hadith Research Center, Faculty of Nursing, Baqiyatallah University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
8
|
Seshadri S, Sugiura K, Mirham M, Aamodt WW, Kluger BM. Spirituality and Spiritual Distress in Parkinson's Disease Caregivers: A Scoping Review. JOURNAL OF RELIGION AND HEALTH 2023; 62:4222-4243. [PMID: 37702853 DOI: 10.1007/s10943-023-01913-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/25/2023] [Indexed: 09/14/2023]
Abstract
Despite recognition that spiritual concerns contribute to caregiver burden, little is known about spirituality, spiritual well-being, and spiritual distress in Parkinson's disease caregivers. In this scoping review of the literature through October 2022, we searched PubMed, PsychINFO, Embase, and CINAHL. From an initial pool of 328 studies, 14 were included. Caregiver factors (e.g., depression, age) and patient factors (e.g., faith, motor function) affected caregiver spirituality and spiritual well-being. Caregivers experienced loss of meaning, existential guilt, and loneliness, and coped through acquiescence, cultural beliefs, prayer, and gratitude. Future research should focus on the specific spiritual needs of Parkinson's disease caregivers and interventions to address them.
Collapse
Affiliation(s)
- Sandhya Seshadri
- Department of Neurology, University of Rochester, 265 Crittenden Boulevard, CU 420694, Rochester, NY, 14642, USA.
| | - Kei Sugiura
- Department of Neurology, University of Rochester, 265 Crittenden Boulevard, CU 420694, Rochester, NY, 14642, USA
| | - Miray Mirham
- School of Medicine, University of Rochester, Rochester, NY, USA
| | - Whitley W Aamodt
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - Benzi M Kluger
- Department of Neurology, University of Rochester, 265 Crittenden Boulevard, CU 420694, Rochester, NY, 14642, USA
| |
Collapse
|
9
|
Kurtgöz A, Edis EK. Spiritual care from the perspective of family caregivers and nurses in palliative care: a qualitative study. BMC Palliat Care 2023; 22:161. [PMID: 37884938 PMCID: PMC10601296 DOI: 10.1186/s12904-023-01286-2] [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: 04/18/2023] [Accepted: 10/16/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND The palliative care period not only affects patients but also family caregivers in many ways. Palliative care units are places where the spiritual needs of family caregivers become important. According to a holistic care approach, palliative care nurses should determine the spiritual needs of family caregivers and help meet these needs. OBJECTIVE This study aims at exploring nurses' and family caregivers' experiences of spiritual care. METHODS A phenomenological study was designed in this qualitative research. A total of 10 nurses working in palliative care and 11 family caregivers participated in the study. Nurses' experiences of delivering spiritual care and family caregivers' experiences of receiving spiritual care were examined through the in-depth interviewing method on a one-to-one basis. The data were examined using thematic analysis. RESULTS Four main themes were obtained by the data analysis: (I) Impacts of being in a palliative care unit; (II) Coping methods; (III) Importance of spirituality and spiritual care; (IV) Spiritual care. The results were presented according to the COREQ criteria. CONCLUSION Although spiritual care is very necessary for family caregivers, it is not offered sufficiently due to nurse-and institution-related reasons. Palliative care nurses should determine the spiritual needs of family caregivers in line with the holistic care approach. Nurse managers should determine factors preventing nurses from offering spiritual care and create solutions for these factors. The lack of nurses' knowledge about spiritual care should be resolved by providing continuous training and therefore, nurses' competencies in spiritual care should be improved.
Collapse
Affiliation(s)
- Aslı Kurtgöz
- Department of Therapy and Rehabilitation, Sabuncuoglu Serefeddin Health Services Vocational School, Amasya University, Amasya, 05100, Türkiye.
| | - Elif Keten Edis
- Department of Nursing, Health Science Faculty, Amasya University, Amasya, Türkiye
| |
Collapse
|
10
|
Miccinesi G, Ripamonti C, Leoni S, Gandelli M, Di Pede P, Visani V, Ambrosini P, De Feo G, Bellandi L, Toffolatti L, Chelazzi C, Trinci C, Chiesi F. Assessing suffering of patients on cancer treatment and of those no longer treated using ESAS-Total Care (TC). Support Care Cancer 2023; 31:579. [PMID: 37715838 PMCID: PMC10505109 DOI: 10.1007/s00520-023-08035-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 09/02/2023] [Indexed: 09/18/2023]
Abstract
AIM The aim of the study was to assess the suffering of patients on oncologic treatment and of those no longer on treatment. Preliminarily, we aimed to confirm the psychometric properties of Edmonton Symptom Assessment System-Total Care (ESAS-TC) in different stages of the disease. The ESAS-TC screens physical and psychological symptoms, but also spiritual pain, discomfort deriving from financial problems associated with illness, and suffering related to social isolation. METHODS A sample of consecutive advanced cancer patients on oncologic therapies treated at the Internistic and Geriatric Supportive Care Unit (IGSCU) of Istituto Nazionale dei Tumori, Milano, and of terminal patients no longer on treatment and cared for by the Fondazione ANT palliative home care team were asked to fill the ESAS-TC. In order to strengthen the previous validation study of the ESAS-TC, 3-ULS (to assess social isolation), JSWBS (to assess spiritual well-being), COST-IT (to assess financial distress), and KPS (to assess functional status) were administered too. RESULTS The questionnaires were self-reported by 108 patients on treatment (52% >60 years old, female 53%, and 61% with KPS 90-100) and by 94 home care patients (71% >60 years old, female 51%, and 68% with KPS 10-50). The sound psychometric characteristics of ESAS-TC were confirmed. Patients on treatment showed lower total ESAS-TC score (19.3 vs 52.7, p<.001) after controlling for age and functional status, and lower financial distress (p.<001). Financial distress, spiritual suffering, and social isolation, after controlling for age, showed a significantly higher score in home care patients. CONCLUSIONS Only through an adequate routine assessment with validated tools is it possible to detect total suffering, the "Total pain" of patients, and treat it through a multidisciplinary approach. The study confirms the reliability and validity of the Italian version of ESAS-TC and the importance of supportive and early palliative care fully integrated with oncological treatment.
Collapse
Affiliation(s)
- Guido Miccinesi
- Clinical Epidemiology Unit, Oncological Network Prevention and Research Institute (ISPRO), Florence, Italy
| | - Carla Ripamonti
- Palliative Medicine, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Universita' degli Studi di Brescia, Brescia, Italy.
| | | | - Monica Gandelli
- Internistic and Geriatric Supportive Care Unit, Fondazione IRCCS, Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Patricia Di Pede
- Internistic and Geriatric Supportive Care Unit, Fondazione IRCCS, Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | | | - Paolo Ambrosini
- Department of Medical Oncology, IRCCS Fondazione Istituto Nazionale dei Tumori, Milan, Italy
| | - Giulia De Feo
- Internistic and Geriatric Supportive Care Unit, Fondazione IRCCS, Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | | | - Luisa Toffolatti
- Internistic and Geriatric Supportive Care Unit, Fondazione IRCCS, Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Cosimo Chelazzi
- Palliative Medicine, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Universita' degli Studi di Brescia, Brescia, Italy
| | | | - Francesca Chiesi
- Department of Neuroscience, Psychology, Drug, and Child's Health (NEUROFARBA), Section of Psychology, University of Florence, Florence, Italy
| |
Collapse
|
11
|
Goni-Fuste B, Pergolizzi D, Monforte-Royo C, Julià-Torras J, Rodríguez-Prat A, Crespo I. What makes the palliative care initial encounter meaningful? A descriptive study with patients with cancer, family carers and palliative care professionals. Palliat Med 2023; 37:1252-1265. [PMID: 37421148 PMCID: PMC10604432 DOI: 10.1177/02692163231183998] [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: 07/09/2023]
Abstract
BACKGROUND The palliative care initial encounter can have a positive impact on the quality of life of patients and family carers if it proves to be a meaningful experience. A better understanding of what makes the encounter meaningful would reinforce the provision of person-centred, quality palliative care. AIM To explore the expectations that patients with cancer, family carers and palliative care professionals have of this initial encounter. DESIGN Qualitative descriptive study with content analysis of transcripts from 60 semi-structured interviews. SETTING/PARTICIPANTS Twenty patients with cancer, 20 family carers and 20 palliative care professionals from 10 institutions across Spain. RESULTS Four themes were developed from the analysis of interviews: (1) the initial encounter as an opportunity to understand what palliative care entails; (2) individualised care; (3) professional commitment to the patient and family carers: present and future; and (4) acknowledgement. CONCLUSION The initial encounter becomes meaningful when it facilitates a shared understanding of what palliative care entails and acknowledgement of the needs and/or roles of patients with cancer, family carers and professionals. Further studies are required to explore how a perception of acknowledgement may best be fostered in the initial encounter.
Collapse
Affiliation(s)
- Blanca Goni-Fuste
- Department of Nursing, School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallés, Barcelona, Spain
| | - Denise Pergolizzi
- School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallés, Barcelona, Spain
| | - Cristina Monforte-Royo
- Department of Nursing, School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallés, Barcelona, Spain
| | - Joaquim Julià-Torras
- School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallés, Barcelona, Spain
- Department of Palliative Care, Institut Català d’Oncologia Badalona, Badalona, Spain
| | - Andrea Rodríguez-Prat
- Department of Humanities, School of Humanities, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Iris Crespo
- Department of Basic Sciences, School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
| |
Collapse
|
12
|
Reina-Gamba NC, Medellin-Olaya J, Burbano-Rivera DV, Miranda-Rojas HM, Vargas-Escobar LM, Colmenares-Tovar C. Health-Related Quality of Life in Primary Caregivers of People Receiving Palliative Home Care. J Hosp Palliat Nurs 2022; 24:E41-E47. [PMID: 35019891 DOI: 10.1097/njh.0000000000000832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Primary caregivers face constant challenges because of changes in the clinical situation of the person receiving palliative home care. These changes can alter the health-related quality of life and all its dimensions. This study aimed to describe the health-related quality of life of 137 primary caregivers of people enrolled in a palliative home care program in Bogotá, Colombia, applying a quantitative, descriptive, and cross-sectional research design. The Caregiver's Quality of Life Instrument, initially developed by Ferrell, and the sociodemographic characteristics form for caregivers of people with chronic disease, both previously validated in the Colombian population, were used. The results showed that the primary caregivers have a good and adequate overall health-related quality of life; however, they presented some alterations in the physical, psychological, and social dimensions. Therefore, nursing and interdisciplinary palliative care teams should aim their interventions not only at patients but also at primary caregivers during palliative home care.
Collapse
|
13
|
Antunes ML, Reis-Pina P. The Physician and End-of-Life Spiritual Care: The PALliatiVE Approach. Am J Hosp Palliat Care 2022; 39:1215-1226. [PMID: 35044883 DOI: 10.1177/10499091211068819] [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: 11/16/2022] Open
Abstract
Spiritual care is universally acknowledged as a cornerstone of palliative care, yet most healthcare professionals find it difficult to address. The present work aims to provide a simple educational tool that may help physicians address spirituality in their clinical practice. We found articles written in both Portuguese and English through PubMed, using the combination of MeSH terms: "Spirituality" and "Palliative Care." The research was complemented by relevant monographs previously known to the authors, consultation of selected references of the main bibliography, and interviews to an experienced spiritual care provider. In order to help physicians to incorporate spiritual care in their clinical practice, a flexible yet standardized approach is long overdue. This is the aim of the PALliatiVE approach, which compiles the literature in a set of 5 attitudes that may aid the clinician in the delivery of spiritual care: Prepare (P), Ask (A), Listen (L), Validate (V), and consult an Expert (E). This approach is based on a synthesis of a broad literature review, which motivated the five-layered approach. There is a significant literature coverage supporting each attitude of this five-layered approach, including at least one randomized control trial or systematic review per attitude. Though still requiring external validation, the PALliatiVE approach can be a guide to the physician on how to provide spiritual care, a practice rooted in compassion and in simply being-with the one who suffers.
Collapse
Affiliation(s)
| | - Paulo Reis-Pina
- Palliative Care Unit, Casa de Saúde da Idanha, Sintra, Portugal.,Faculty of Medicine, Ringgold:37809University of Lisbon, Lisboa, Portugal
| |
Collapse
|
14
|
Kestenbaum A, McEniry KA, Friedman S, Kent J, Ma JD, Roeland EJ. Spiritual AIM: assessment and documentation of spiritual needs in patients with cancer. J Health Care Chaplain 2021; 28:566-577. [PMID: 34866556 DOI: 10.1080/08854726.2021.2008170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The chaplain is an essential member of the palliative care (PC) team, yet, standard methods to document chaplain assessments are lacking. The study team performed a retrospective analysis of chaplaincy documentation in an outpatient PC clinic at an academic medical center over 6 months (April 2017 to October 2017). The study team identified unique adult patients with cancer, then manually extracted variables from the electronic medical record. The primary objective was to assess the number of spiritual assessments documented by the chaplain. Secondary objectives included descriptive analysis of identified spiritual needs. Out of the 376 total patient encounters, 292 (77.8%) included documentation of a chaplain's spiritual assessment. The most frequent spiritual need was self-worth/community (n = 163, 55.8%).This study demonstrates that chaplains can effectively document Spiritual AIM-based screening and assessment. Moreover, this may be an effective documentation method across institutions to facilitate chaplain-based data.
Collapse
Affiliation(s)
| | - Kelly A McEniry
- Spiritual Care Services. UC San Diego Health System, La Jolla, CA, USA
| | - Sarah Friedman
- Health Sciences Research, UC Los Angeles Health, Los Angeles, CA, USA
| | - Jennifer Kent
- NewYork-Presbyterian/Morgan Stanley Children's and NYP/Columbia University Irving Medical Center
| | - Joseph D Ma
- Division of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, UC San Diego, San Diego, CA, USA
| | - Eric J Roeland
- Oregon Health and Sciences Center, Knight Cancer Institute, Portland, OR, USA
| |
Collapse
|
15
|
Ripamonti C, Leporati R, De Feo G, Di Pede P, Toffolatti L, Guglielmo M, La Carpia D, Miccinesi G, Chiesi F. Italian version of the Edmonton Symptom Assessment System (ESAS)-Total Care (TC): development and psychometric validation in patients undergoing cancer treatment or follow-up. Support Care Cancer 2021; 30:1923-1933. [PMID: 34623487 DOI: 10.1007/s00520-021-06594-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 09/23/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The routine use of patient-reported outcomes (PROs) in clinical practice improves quality of care, it helps in reducing the access to emergency services and unscheduled visits, and it can improve cancer patients' time survival. The Edmonton Symptom Assessment System (ESAS) is a PRO largely used in different care settings to monitor physical and psychological symptoms. Nonetheless, along with these symptoms, literature also highlighted the presence and effect of spiritual pain, financial distress, and social isolation on quality of care, treatment effectiveness, and survival. AIM The aims of the current study were (a) to complete the Italian version of the ESAS validation process by adding the missing symptom "insomnia" and (b) to develop and validate the ESAS-Total Care (ESAS-TC) that is intended to evaluate and screen not only physical and psychological symptoms but also spiritual pain, discomfort deriving from financial problems associated with illness, and suffering related to social isolation. METHODS A sample of Italian native outpatients, who referred to the dedicated Supportive Care Unit of the Fondazione IRCCS, Istituto Nazionale deiTumori (INT), Milano, were asked to fill the ESAS-TC to assess item properties, factorial structure, internal consistency, test-retest reliability (patients were asked to retake the scale after 2-6 weeks), and external validity. Concerning the latter, other self-administered scales were employed to assess perceived stress (Perceived Stress Scale), unmet needs (using theNeed Evaluation Questionnaire that describes informative, assistance/care, relational, needs for psycho-emotional support, material needs), and perceived social support (administering the Multidimensional Scale of Perceived Social Support that evaluates perceived support of family, friends, and significant others in the wider social field). RESULTS The scales were administered to 243 patients with solid (90%) and hematologic (10%) cancers, mean age 62.6, female 76.5%. Analysis suggested that a single factor better represents the structure of the ESAS scales, their internal consistency and test-retest reliability were good, and evidence of construct and criterion validity were provided. Additionally, incremental validity of the ESAS-TC was proved showing that the added items offer a unique contribution in predicting the patient's stress. Finally, known groups validity was confirmed testing the differences in the ESAS scores due to the Karnofsky Performance Status. CONCLUSIONS The current study allowed to complete the validation of the Italian version of the ESAS and to develop a psychometrically sound scale, the ESAS-Total Care, that potentially helps in moving cancer research toward personalized total cancer care.
Collapse
Affiliation(s)
- Carla Ripamonti
- Department of Medical Oncology and Haematology, Oncology-Supportive Care Unit, Fondazione IRCCS, Istituto Nazionale Tumori Di Milano, 20133, Milan, Italy.
| | - Rita Leporati
- Medical Oncology Unit, Fondazione IRCCS, Istituto Nazionale Tumori Di Milano, 20133, Milan, Italy
| | - Giulia De Feo
- Department of Medical Oncology and Haematology, Oncology-Supportive Care Unit, Fondazione IRCCS, Istituto Nazionale Tumori Di Milano, 20133, Milan, Italy
| | - Patricia Di Pede
- Department of Medical Oncology and Haematology, Oncology-Supportive Care Unit, Fondazione IRCCS, Istituto Nazionale Tumori Di Milano, 20133, Milan, Italy
| | - Luisa Toffolatti
- Department of Medical Oncology and Haematology, Oncology-Supportive Care Unit, Fondazione IRCCS, Istituto Nazionale Tumori Di Milano, 20133, Milan, Italy
| | - Mauro Guglielmo
- Department of Medical Oncology and Haematology, Oncology-Supportive Care Unit, Fondazione IRCCS, Istituto Nazionale Tumori Di Milano, 20133, Milan, Italy
| | - Domenico La Carpia
- Azienda USL Toscana Centro, UDS Cure Palliative Prato Pistoia, Firenze, Italy
| | - Guido Miccinesi
- Epidemiologia Clinica e Di Supporto Al Governo Clinico, Istituto Per lo Studio, la Prevenzione e la Rete Oncologica-ISPRO, Firenze, Italy
| | - Francesca Chiesi
- Department of Neuroscience and Child's Health (NEUROFARBA), University of Florence, Florence, Italy
| |
Collapse
|
16
|
Testoni I, Sicari G, Ronconi L, Biancalani G, Franco C, Cottone P, Crupi R. Dehumanization and burden of care among caregivers of terminally ill patients. Health Psychol Res 2021; 9:29052. [DOI: 10.52965/001c.29052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 10/04/2021] [Indexed: 11/06/2022] Open
Affiliation(s)
- Ines Testoni
- Department of Philosophy, Sociology, Education and Applied Psychology (FISPPA), University of Padova; Emili Sagol Creative Arts Therapies Research Center, University of Haifa
| | | | | | | | | | | | | |
Collapse
|
17
|
Mercadante S, Adile C, Ricci M, Maltoni M, Bonanno G, Casuccio A. The Role of Religiosity in Symptom Expression of Advanced Cancer Patients. Am J Hosp Palliat Care 2021; 39:705-709. [PMID: 34493072 DOI: 10.1177/10499091211041349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AIM The aim of this study was to assess the religious pattern and its impact on symptom expression in patients with advanced cancer. METHODS A consecutive sample of advanced cancer patients screened at admission to palliative care. Standard epidemiological data were recorded. Patients were asked about their religious beliefs, the degree of social relationship to existing religions, the role of religion in their life, and the frequency of their prayer. The Edmonton Symptom Assessment Scale (ESAS) and Hospital Anxiety Depression scale (HADS) were assessed. RESULTS Two-hundred-eighty-three patients were screened. Age and gender were found to be independently correlated with religious belief (p = 0.042 and p = 0.016, respectively). Gender (females, p = 0.026), age (p = 0.003), lower Karnofsky performance status (KPS) (p = 0.022), and higher values of HADS-A (p = 0.003) were independently correlated with the degree of social relationship to existing religions. Gender (females, p = 0.002), lower KPS (p = 0.005), and higher values of HADS-A (p = 0.04) were independently correlated with a more relevant role of religiosity. Gender (females, p < 0.0005), lower KPS (p = 0.001), and drowsiness (p = 0.05) were independently correlated with frequency of prayer. CONCLUSION The more the patients have demanding religious issues, the greater the state of anxiety, particularly in older and female patients with a lower KPS. The religious pattern did not have relevant role in the expression of other symptoms included in the ESAS.
Collapse
Affiliation(s)
| | - Claudio Adile
- Private Hospital La Maddalena Palermo, Sicilia, Italy
| | - Marianna Ricci
- Palliative Care Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Marco Maltoni
- Palliative Care Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | | | | |
Collapse
|
18
|
Cipta A, Turner B, Haupt EC, Werch H, Reinke L, Mularski RA, Nguyen HQ. Spiritual distress: symptoms, quality of life and hospital utilisation in home-based palliative care. BMJ Support Palliat Care 2021; 11:322-328. [PMID: 34088743 DOI: 10.1136/bmjspcare-2021-003090] [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] [Received: 03/30/2021] [Accepted: 05/21/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVES The purpose of this study was to use a spiritual screening question to quantify the prevalence of spiritual distress (SD) in a large cohort of seriously ill patients at admission to home-based palliative care (HBPC) and to examine the associations between SD with symptom burden, quality of life and hospital-based utilisation up to 6 months after admission to HBPC. METHODS Data for this cohort study (n=658) were drawn from a pragmatic comparative-effectiveness trial testing two models of HBPC. At admission to HBPC, SD was measured using a global question (0-10-point scale: none=0; mild=1-4; moderate-to-severe=5+); symptoms and quality of life were measured with the Edmonton Symptom Assessment Scale (ESAS) and PROMIS-10. Hospital utilisation was captured using electronic records and claims. Median regression and proportional hazard competing risk models assessed the association between SD with symptoms and quality of life, and hospital utilisation, respectively. RESULTS Nearly half of the patients/proxies reported some level of SD. Increasing SD was significantly associated with higher symptom burden (increase of 7-14 points on ESAS) and worse mental well-being (decrease of 2.7 to 4.6 points on PROMIS-10-mental) in adjusted models. Compared with patients/proxies who reported no SD, those with at least some level of SD were not at increased risk for hospital-based utilisation over a median follow-up period of 2 months. CONCLUSION While SD is cross-sectionally associated with worse symptoms and mental well-being, it did not predict downstream hospital-based utilisation. Our results highlight the importance of assessing for and managing SD in patients with serious illness.
Collapse
Affiliation(s)
- Andre Cipta
- West Los Angeles Medical Center, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Bethany Turner
- San Diego Medical Center, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Eric C Haupt
- Department of Research and Evaluation, Kaiser Permanente Southern California Research and Evaluation, Pasadena, California, USA
| | | | - Lynn Reinke
- VA Puget Sound Health Care System Seattle Division, Seattle, Washington, USA
| | - Richard A Mularski
- Kaiser Permanente Center for Health Research Northwest Region, Portland, Oregon, USA
| | - Huong Q Nguyen
- Department of Research and Evaluation, Kaiser Permanente Southern California Research and Evaluation, Pasadena, California, USA
| |
Collapse
|
19
|
Asano R, Kellogg A, Sulmasy D, Anderson KM, Nolan MT. Religious Involvement, Depressive Symptoms, and Burden in Caregivers of Terminally Ill Patients. J Hosp Palliat Nurs 2021; 23:271-276. [PMID: 33911059 PMCID: PMC8095715 DOI: 10.1097/njh.0000000000000754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Caring for terminally ill patients can be emotionally burdensome. Previous research has demonstrated that caregiving is associated with anxiety and depression. Research on caregivers of terminally ill patients is limited by retrospective studies with small samples. This study aimed to (1) describe religiosity, religious coping, and depressive symptoms in caregivers of persons with amyotrophic lateral sclerosis or advanced cancer; (2) examine the relationship between religiosity and depressive symptoms in caregivers of persons with amyotrophic lateral sclerosis or advanced cancer; (3) examine the relationship between religious coping and depressive symptoms in caregivers of persons with amyotrophic lateral sclerosis or advanced cancer. A descriptive exploratory design was used to analyze data from a larger 5-year National Institutes of Health-funded multisite randomized controlled trial (the TAILORED study). Nearly half of the caregivers screened positive for depressive symptoms, and negative religious coping was associated with higher depressive symptoms (P < .001). Spouse caregivers reported higher depressive symptoms than nonspouse caregivers. Many caregivers experienced depression, which was mitigated by positive religious coping.
Collapse
|
20
|
Krakauer EL, Kane K, Kwete X, Afshan G, Bazzett-Matabele L, Ruthnie Bien-Aimé DD, Borges LF, Byrne-Martelli S, Connor S, Correa R, Devi CRB, Diop M, Elmore SN, Gafer N, Goodman A, Grover S, Hasenburg A, Irwin K, Kamdar M, Kumar S, Truong QXN, Randall T, Rassouli M, Sessa C, Spence D, Trimble T, Varghese C, Fidarova E. Essential Package of Palliative Care for Women With Cervical Cancer: Responding to the Suffering of a Highly Vulnerable Population. JCO Glob Oncol 2021; 7:873-885. [PMID: 34115527 PMCID: PMC8457866 DOI: 10.1200/go.21.00026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/19/2021] [Accepted: 05/04/2021] [Indexed: 11/25/2022] Open
Abstract
Women with cervical cancer, especially those with advanced disease, appear to experience suffering that is more prevalent, complex, and severe than that caused by other cancers and serious illnesses, and approximately 85% live in low- and middle-income countries where palliative care is rarely accessible. To respond to the highly prevalent and extreme suffering in this vulnerable population, we convened a group of experienced experts in all aspects of care for women with cervical cancer, and from countries of all income levels, to create an essential package of palliative care for cervical cancer (EPPCCC). The EPPCCC consists of a set of interventions, medicines, simple equipment, social supports, and human resources, and is designed to be safe and effective for preventing and relieving all types of suffering associated with cervical cancer. It includes only inexpensive and readily available medicines and equipment, and its use requires only basic training. Thus, the EPPCCC can and should be made accessible everywhere, including for the rural poor. We provide guidance for integrating the EPPCCC into gynecologic and oncologic care at all levels of health care systems, and into primary care, in countries of all income levels.
Collapse
Affiliation(s)
- Eric L. Krakauer
- Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, MA
- Departments of Medicine and of Global Health & Social Medicine, Harvard Medical School, Boston, MA
- Department of Palliative Care, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
| | - Khadidjatou Kane
- Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | | | - Gauhar Afshan
- Department of Anaesthesiology, Aga Khan University Medical College, Karachi, Pakistan
| | - Lisa Bazzett-Matabele
- Department of Obstetrics and Gynecology, University of Botswana, Gaborone, Botswana
- Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, CT
| | - Danta Dona Ruthnie Bien-Aimé
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA
- Université Episcopale d'Haiti, Port-au-Prince, Haiti
- Faculté des Sciences Infirmières de Leogane, Leogane, Haiti
| | - Lawrence F. Borges
- Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Sarah Byrne-Martelli
- Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, MA
| | | | - Raimundo Correa
- Gynecologic Oncology Unit and Palliative Care Service, Clínica Las Condes, Santiago, Chile
| | | | - Mamadou Diop
- Cancer Institute of Cheikh Anta Diop University, Dakar, Senegal
| | - Shekinah N. Elmore
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Nahla Gafer
- Radiation and Isotope Centre, Oncology Hospital, Khartoum, Sudan
- Comboni College of Science and Technology, Khartoum, Sudan
| | - Annekathryn Goodman
- Division of Gynecologic Oncology, Massachusetts General Hospital, Boston, MA
- Department of Obstetrics and Gynecology, Harvard Medical School, Boston, MA
| | - Surbhi Grover
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Botswana-UPenn Partnership, Gaborone, Botswana
| | - Annette Hasenburg
- Department of Gynecology and Obstetrics, Johannes Gutenberg University Medical Center, Mainz, Germany
| | - Kelly Irwin
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Mihir Kamdar
- Department of Medicine, Harvard Medical School, Boston, MA
- Division of Palliative Care and Geriatrics, Department of Anesthesiology and Pain Medicine, Massachusetts General Hospital, Boston, MA
| | - Suresh Kumar
- Institute of Palliative Medicine, Medical College, Kerala, India
| | - Quynh Xuan Nguyen Truong
- College of Public Health Science, Chulalongkorn University, Bangkok, Thailand
- School of Social Work, Boston College, Boston, MA
- University Medical Center, Ho Chi Minh City, Vietnam
| | - Tom Randall
- Division of Gynecologic Oncology, Massachusetts General Hospital, Boston, MA
- Department of Obstetrics and Gynecology, Harvard Medical School, Boston, MA
| | - Maryam Rassouli
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Cristiana Sessa
- Department of Medical Oncology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Dingle Spence
- Hope Institute Hospital, Kingston, Jamaica
- University of the West Indies, Kingston, Jamaica
| | | | - Cherian Varghese
- Department of Non-communicable Diseases, World Health Organization, Geneva, Switzerland
| | - Elena Fidarova
- Department of Non-communicable Diseases, World Health Organization, Geneva, Switzerland
| |
Collapse
|
21
|
Goni-Fuste B, Crespo I, Monforte-Royo C, Porta-Sales J, Balaguer A, Pergolizzi D. What defines the comprehensive assessment of needs in palliative care? An integrative systematic review. Palliat Med 2021; 35:651-669. [PMID: 33648403 DOI: 10.1177/0269216321996985] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND The comprehensive assessment of needs in palliative care identifies where patients most want attention to guide clinical decisions that tailor care provision from their first encounters. AIM To define how and what needs are identified by the comprehensive assessment of needs in the original peer-reviewed articles in the field of palliative care. DESIGN An integrative systematic review as outlined by Whittemore and Knafl. Quality appraisal performed using the Mixed Methods Appraisal Tool. DATA SOURCES PubMed, CINAHL, PsycINFO, Web of Science databases searched through May 2019 and updated in July 2020. RESULTS Forty-nine articles met inclusion criteria for original articles in English or Spanish reporting comprehensive assessment of needs of adult patients receiving palliative care. The majority (41/49) of studies were moderate to high quality. Two themes were identified: (1) How a comprehensive assessment of needs should be carried out in palliative care, which reflected a preference to develop structured tools for assessment; (2) What needs of patients should be assessed in the comprehensive assessment of needs in palliative care, which conveyed a trend to assess beyond core domains - physical, psychological, social, spiritual - with information and practical most prevalent, but with substantial variation in specifying and classifying needs into domains. CONCLUSIONS The assessment of needs in palliative care is comprehensive but lacks consensus on the needs and domains that should be assessed by the palliative care team. Future studies should better define what needs can be standardized into the assessment to improve process of care and patient satisfaction.
Collapse
Affiliation(s)
- Blanca Goni-Fuste
- Nursing Department, School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallés, Barcelona, Spain
| | - Iris Crespo
- Department of Basic Sciences, School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Cristina Monforte-Royo
- Nursing Department, School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallés, Barcelona, Spain
| | - Josep Porta-Sales
- School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallés, Barcelona, Spain.,Institut Català d'Oncologia Girona, Girona, Spain
| | - Albert Balaguer
- School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallés, Barcelona, Spain.,Universitat Internacional de Catalunya, Hospital Universitari General de Catalunya, Barcelona, Spain
| | - Denise Pergolizzi
- School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallés, Barcelona, Spain
| |
Collapse
|
22
|
How does spirituality manifest in family caregivers of terminally ill cancer patients? A qualitative secondary analysis. Palliat Support Care 2021; 20:45-54. [PMID: 33781355 DOI: 10.1017/s1478951521000353] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Considering the risk of spiritual distress among terminally ill patients, experts long agree that spiritual care has to be an integral component of palliative care. Despite this consensus, the role of spirituality among family caregivers remains largely unexplored. We aimed to describe how spirituality manifests in the lived experience of family caregivers (FCs) in a palliative care context. METHOD As part of a secondary analysis, data derived from two qualitative primary studies on FCs' burdens and needs in the context of caring for a patient with a diagnosis of incurable cancer. Previously transcribed interviews were examined by means of a thematic analysis, transcending the focus of the primary studies to examine how spirituality arises and/or persists in the life of FCs from the time of diagnosis of incurable cancer up until bereavement. RESULTS Twenty-nine narratives were explored and all included spirituality as a relevant theme. Analysis revealed four aspects associated with the presence of spirituality among FCs' experiences: "Connectedness," "Religious Faith," "Transcendence," "Hope," and a fifth overarching aspect which we named "Ongoing integration of spiritual experience." Spirituality appeared as a multilayered phenomenon and was shaped individually among FCs' narratives. SIGNIFICANCE OF RESULTS In view of the results, exploring and discussing spirituality and underlying experiences in the situation as an FC seems likely to widen the perspective on FCs' problems and needs. Further research on spiritual needs among FCs of patients with incurable life-limiting cancer is deemed necessary.
Collapse
|
23
|
Røen I, Brenne AT, Brunelli C, Stifoss-Hanssen H, Grande G, Solheim TS, Kaasa S, Knudsen AK. Spiritual quality of life in family carers of patients with advanced cancer-a cross-sectional study. Support Care Cancer 2021; 29:5329-5339. [PMID: 33661369 PMCID: PMC8295139 DOI: 10.1007/s00520-021-06080-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 02/17/2021] [Indexed: 12/25/2022]
Abstract
Purpose Caring affects carers’ psychological and physical health, mortality, and quality of life (QoL) negatively. Lower spiritual QoL is associated with anxiety and depression, but the spiritual dimension is rarely investigated in carers. The present study aimed to explore which patient- and carer-related characteristics were associated with spiritual QoL in carers of patients with advanced cancer. Methods Secondary analyses were conducted using data from a prospective study investigating integration between oncology and palliative care. Adult patients with advanced cancer and their carers were included, and baseline data considering demographics, clinical characteristics, symptoms, social support, and religious meaning-making were registered. Spiritual QoL was measured using the Functional Assessment of Chronic Illness Therapy - Spiritual well-being (FACIT-Sp-12) questionnaire. Associations to spiritual QoL were explored by bivariate and multivariate regression models. Results In total, 84 carers were included, median age was 62.5 years, 52 (62%) were female, and the average spiritual QoL score was 23.3. In bivariate analyses, higher education, social support, and lower patients’ symptom burden were significantly associated with higher spiritual QoL. The multivariate regression model (n=77) had an explained variance (R2) = 0.34 and showed a significant association for social support, higher education, having children < 18 years living at home, and patient’s age. Conclusion The study indicates that spiritual QoL in carers were low and were negatively affected by several factors related to both carers and patients. However, there could be other important factors not yet described. Health care professionals should be aware of the known associated factors, as carers who hold these may need extra support.
Collapse
Affiliation(s)
- Ingebrigt Røen
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
- St. Olavs Hospital, Trondheim University Hospital, 4. etg. Kunnskapssenteret vest, St. Olavs Hospital, 7006, Trondheim, Norway.
- Chaplaincy, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
| | - Anne-Tove Brenne
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- St. Olavs Hospital, Trondheim University Hospital, 4. etg. Kunnskapssenteret vest, St. Olavs Hospital, 7006, Trondheim, Norway
- Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Cinzia Brunelli
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Hans Stifoss-Hanssen
- Center of diakonia and professional practice, VID Specialized University, Oslo, Norway
| | - Gunn Grande
- Division of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, England
| | - Tora Skeidsvoll Solheim
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- St. Olavs Hospital, Trondheim University Hospital, 4. etg. Kunnskapssenteret vest, St. Olavs Hospital, 7006, Trondheim, Norway
| | - Stein Kaasa
- European Palliative Care Research Centre (PRC), Oslo University Hospital and University of Oslo, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Oncology, Oslo University Hospital, Oslo, Norway
- University of Oslo, Oslo, Norway
| | - Anne Kari Knudsen
- European Palliative Care Research Centre (PRC), Oslo University Hospital and University of Oslo, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
24
|
Yik LL, Ling LM, Ai LM, Ting AB, Capelle DP, Zainuddin SI, Beng TS, Chin LE, Loong LC. The Effect of 5-Minute Mindfulness of Peace on Suffering and Spiritual Well-Being Among Palliative Care Patients: A Randomized Controlled Study. Am J Hosp Palliat Care 2020; 38:1083-1090. [PMID: 33078627 DOI: 10.1177/1049909120965944] [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: 11/15/2022] Open
Abstract
BACKGROUND Mindfulness practices may have a role in reducing suffering and improving spiritual well-being among patients with serious illness. The efficacy, feasibility and acceptability of such interventions warrant further exploration in the palliative care population. OBJECTIVE To investigate the effect of a brief mindfulness practice, the 5-minute mindfulness of peace intervention, on suffering and spiritual well-being among palliative care patients. METHODS A randomized controlled study was conducted on adult palliative care patients with moderate to severe levels of suffering. Participants in the intervention arm were guided through a 5-minute mindfulness of peace exercise while participants in the control arm received 5 minutes of active listening. Pre- and post-intervention suffering and spiritual well-being were measured using the Suffering Pictogram and the FACIT-Sp-12 questionnaire, respectively. RESULTS 40 participants completed the study. 5-minute mindfulness of peace significantly reduced suffering (median = -3.00, IQR = 2.00) more than 5 minutes of active listening (median = -1.00, IQR = 1.75), U = 73.50, z = -3.48, p = 0.001, η2 = 0.31. FACIT-Sp-12 score also significantly improved in the intervention arm (median = +5.00, IQR = 2.75) compared with the control arm after 5 minutes (median = +1.00, IQR = 3.00), U = 95.50, z = -2.85, p = 0.004, η2 = 0.21. CONCLUSIONS A brief 5-minute mindfulness of peace exercise is effective in providing immediate relief of suffering and improving spiritual well-being. It is a useful and feasible intervention among patients receiving palliative care for rapidly and momentarily reducing spiritual suffering.
Collapse
Affiliation(s)
- Lim Liang Yik
- Palliative Care Unit, Faculty of Medicine, Department of Medicine, 37447University of Malaya, Kuala Lumpur, Malaysia
| | - Look Mei Ling
- Palliative Care Unit, Faculty of Medicine, Department of Medicine, 37447University of Malaya, Kuala Lumpur, Malaysia
| | - Lim Min Ai
- Palliative Care Unit, Faculty of Medicine, Department of Medicine, 37447University of Malaya, Kuala Lumpur, Malaysia
| | - Ang Bin Ting
- Palliative Care Unit, Faculty of Medicine, Department of Medicine, 37447University of Malaya, Kuala Lumpur, Malaysia
| | - David Paul Capelle
- Palliative Care Unit, Faculty of Medicine, Department of Medicine, 37447University of Malaya, Kuala Lumpur, Malaysia
| | - Sheriza Izwa Zainuddin
- Palliative Care Unit, Faculty of Medicine, Department of Medicine, 37447University of Malaya, Kuala Lumpur, Malaysia
| | - Tan Seng Beng
- Palliative Care Unit, Faculty of Medicine, Department of Medicine, 37447University of Malaya, Kuala Lumpur, Malaysia
| | - Loh Ee Chin
- Palliative Care Unit, Faculty of Medicine, Department of Medicine, 37447University of Malaya, Kuala Lumpur, Malaysia
| | - Lam Chee Loong
- Palliative Care Unit, Faculty of Medicine, Department of Medicine, 37447University of Malaya, Kuala Lumpur, Malaysia
| |
Collapse
|
25
|
Prizer LP, Kluger BM, Sillau S, Katz M, Galifianakis NB, Miyasaki JM. The presence of a caregiver is associated with patient outcomes in patients with Parkinson's disease and atypical parkinsonisms. Parkinsonism Relat Disord 2020; 78:61-65. [DOI: 10.1016/j.parkreldis.2020.07.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 06/26/2020] [Accepted: 07/03/2020] [Indexed: 10/23/2022]
|
26
|
Milbury K, Li Y, Durrani S, Liao Z, Tsao AS, Carmack C, Cohen L, Bruera E. A Mindfulness-Based Intervention as a Supportive Care Strategy for Patients with Metastatic Non-Small Cell Lung Cancer and Their Spouses: Results of a Three-Arm Pilot Randomized Controlled Trial. Oncologist 2020; 25:e1794-e1802. [PMID: 32621630 DOI: 10.1634/theoncologist.2020-0125] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 06/12/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Although mindfulness-based interventions have been widely examined in patients with nonmetastatic cancer, the feasibility and efficacy of these types of programs are largely unknown for those with advanced disease. We pilot-tested a couple-based meditation (CBM) relative to a supportive-expressive (SE) and a usual care (UC) arm targeting psychospiritual distress in patients with metastatic lung cancer and their spousal caregivers. PATIENTS AND METHODS Seventy-five patient-caregiver dyads completed baseline self-report measures and were then randomized to one of the three arms. Couples in the CBM and SE groups attended four 60-minute sessions that were delivered via videoconference. All dyads were reassessed 1 and 3 months later. RESULTS A priori feasibility benchmarks were met. Although attendance was high in both groups, dyads in the CBM group indicated greater benefit of the sessions than those in the SE group (patients, CBM mean = 2.63, SE mean = 2.20, p = .003; spouses, CBM mean = 2.71, SE mean = 2.00, p = .005). Compared with the UC group, patients in the CBM group reported significantly lower depressive symptoms (p = .05; d = 0.53) and marginally reduced cancer-related stress (p = .07; d = 0.68). Medium effect sizes in favor of the CBM compared with the SE group for depressive symptoms (d = 0.59) and cancer-related stress (d = 0.54) were found. Spouses in the CBM group reported significantly lower depressive symptoms (p < .01; d = 0.74) compared with those in the UC group. CONCLUSION It seems feasible and possibly efficacious to deliver dyadic interventions via videoconference to couples coping with metastatic lung cancer. Mindfulness-based interventions may be of value to managing psychological symptoms in the palliative care setting. Clinical trial identification number. NCT02596490 IMPLICATIONS FOR PRACTICE: The current randomized controlled trial has established that a mindfulness approach to the management of patients' and spouses' psychospiritual concerns is acceptable and subjectively deemed more beneficial than a supportive-expressive treatment for patients with metastatic non-small cell lung cancer (NSCLC). We also revealed that videoconference delivery, here FaceTime, is an acceptable approach even for geriatric patients with metastatic NSCLC and that patients and their spousal caregivers prefer a dyadic delivery of this type of supportive care strategy. Lastly, this trial has laid the foundation for the role of mindfulness-based interventions in the palliative care setting supporting patients with advanced NSCLC and their spousal caregivers.
Collapse
Affiliation(s)
- Kathrin Milbury
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Yisheng Li
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sania Durrani
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Zhongxing Liao
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Anne S Tsao
- Department of Head and Neck/Thoracic Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Cindy Carmack
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Lorenzo Cohen
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| |
Collapse
|
27
|
Puchalski C, Jafari N, Buller H, Haythorn T, Jacobs C, Ferrell B. Interprofessional Spiritual Care Education Curriculum: A Milestone toward the Provision of Spiritual Care. J Palliat Med 2020; 23:777-784. [DOI: 10.1089/jpm.2019.0375] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Christina Puchalski
- George Washington Institute for Spirituality and Health (GWish), George Washington University, Washington, DC, USA
| | - Najmeh Jafari
- George Washington Institute for Spirituality and Health (GWish), George Washington University, Washington, DC, USA
| | - Haley Buller
- City of Hope Medical Center, Duarte, California, USA
| | - Trace Haythorn
- The Association for Clinical Pastoral Education, Decatur, Georgia, USA
| | - Carolyn Jacobs
- Smith College School for Social Work, Northampton, Massachusetts, USA
| | - Betty Ferrell
- City of Hope Medical Center, Duarte, California, USA
| |
Collapse
|
28
|
Lee Wong C, Choi KC, Mei Nok Lau, Lam KL, Wei So WK. Caregiving burden and sleep quality amongst family caregivers of Chinese male patients with advanced cancer: A cross-sectional study. Eur J Oncol Nurs 2020; 46:101774. [PMID: 32460141 DOI: 10.1016/j.ejon.2020.101774] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 03/15/2020] [Accepted: 05/10/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE To examine the level of caregiving burden and sleep quality as well as their interrelationship amongst family caregivers of Chinese male patients with advanced cancer. METHOD A cross-sectional study was conducted in Hong Kong. The Caregiver Reaction Assessment (CRA) and the Pittsburgh Sleep Quality Index (PSQI) were used to measure caregiving burden and sleep quality of the family caregivers. RESULTS A total of 96 family caregivers were recruited. Disrupted schedule (3.8; SD = 0.8) was rated as the most affected consequence of caregiving burden. Around 78.1% of the caregivers suffered from sleep problems. Hierarchical multiple regression revealed that health problems due to caregiving burden was independently associated with poor sleep quality after controlling for socio-demographic characteristics of both patients and caregivers (regression coefficient, B = 2.09, P = 0.012). CONCLUSIONS Caregiving burden amongst family caregivers of male patients with advanced cancer was remarkably high and associated with poor sleep quality. Strategies aiming to alleviate caregiving burden of caregivers may help break this vicious cycle to enhance the sleep quality of caregivers. Results also underscore the need to assess and develop intervention to relieve caregiving burden for family caregivers of cancer patients.
Collapse
Affiliation(s)
- Cho Lee Wong
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
| | - Kai Chow Choi
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
| | - Mei Nok Lau
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
| | - Ka Ling Lam
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
| | - Winnie Kwok Wei So
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
| |
Collapse
|
29
|
Peh CX, Liu J, Mahendran R. Quality of life and emotional distress among caregivers of patients newly diagnosed with cancer: Understanding trajectories across the first year post-diagnosis. J Psychosoc Oncol 2020; 38:557-572. [PMID: 32367769 DOI: 10.1080/07347332.2020.1760994] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE The cancer caregiving experience is multifaceted and dynamic across different phases of the cancer care continuum. This longitudinal study examined the trajectories of CQOL and caregiver emotional distress across the first year post-diagnosis. METHODS Participants were 111 caregivers of newly diagnosed patients who completed baseline, 6-month, and 12-month follow-ups. Trajectories of CQOL, CQOL domains, caregiver depression, anxiety, and stress, were estimated using linear and quadratic mixed models. RESULTS The trajectory of overall CQOL followed an inverse U-shape trend, while caregiver depression, anxiety, and stress remained stable. For CQOL domains, physical/practical needs followed a gradual trend of improvement, while social support followed an inverse U-shape trend; caregiver burden, emotional reactivity, and responsibility/duty remained stable. CONCLUSIONS The multidimensional needs of caregivers of newly diagnosed patients appeared to follow different trajectories across the first year post-diagnosis. While most CQOL domains remained stable, caregivers may experience adjustment difficulties in terms of relational concerns and social support.
Collapse
Affiliation(s)
- Chao Xu Peh
- Department of Psychology, National University of Singapore, Singapore, Singapore.,Department of Psychological Medicine, National University Health System, Singapore, Singapore
| | - Jianlin Liu
- Department of Psychological Medicine, National University Health System, Singapore, Singapore.,Research Division, Institute of Mental Health, Singapore, Singapore
| | - Rathi Mahendran
- Department of Psychological Medicine, National University Health System, Singapore, Singapore.,Academic Development Department, Duke-NUS Medical School, Singapore, Singapore
| |
Collapse
|
30
|
Wu LF, Lin C, Hung YC, Chang LF, Ho CL, Pan HH. Effectiveness of palliative care consultation service on caregiver burden over time between terminally ill cancer and non-cancer family caregivers. Support Care Cancer 2020; 28:6045-6055. [PMID: 32296981 DOI: 10.1007/s00520-020-05449-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 04/01/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE The responsibility of taking care of terminal patients is accepted as a role of family members in Taiwan. Only a few studies have focused on the effect of palliative care consultation service (PCCS) on caregiver burden between terminal cancer family caregivers (CFCs) and non-cancer family caregivers (NCFCs). Therefore, the purpose of this study is to address the effect of PCCS on caregiver burden between CFC and NCFC over time. METHODS A prospective longitudinal study was conducted in a medical center in northern Taiwan from July to November 2017. The participants were both terminally ill cancer and non-cancer patients who were prepared to receive PCCS, as well as their family caregivers. Characteristics including family caregivers and terminal patients and Family Caregiver Burden Scale (FCBS) were recorded pre-, 7, and 14 days following PCCS. A generalized estimating equation model was used to analyze the change in the level of family caregiver burden (FCB) between CFC and NCFC. RESULTS The study revealed that there were no statistically significant differences in FCB between CFC and NCFC 7 days and 14 days after PCCS (p > 0.05). However, FCB significantly decreased in both CFC and NCFC from pre-PCCS to 14 days after PCCS (β = - 12.67, p = 0.013). PPI of patients was the key predictor of FCB over time following PCCS (β = 1.14, p = 0.013). CONCLUSIONS This study showed that PCCS can improve FCB in not only CFC but also NCFC. We suggest that PCCS should be used more widely in supporting family caregivers of terminally ill patients to reduce caregiver burden.
Collapse
Affiliation(s)
- Li-Fen Wu
- Department of Nursing, Tri-Service General Hospital, Taipei City, Taiwan
- School of Nursing, National Defense Medical Center, Taipei City, Taiwan
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Chin Lin
- School of Public Health, National Defense Medical Center, Taipei City, Taiwan
| | - Yu-Chun Hung
- Department of Nursing, Tri-Service General Hospital, Taipei City, Taiwan
- School of Nursing, National Defense Medical Center, Taipei City, Taiwan
| | - Li-Fang Chang
- Department of Nursing, Tri-Service General Hospital, Taipei City, Taiwan
- School of Nursing, National Defense Medical Center, Taipei City, Taiwan
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Ching-Liang Ho
- Division of Hematology and Oncology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan
| | - Hsueh-Hsing Pan
- Department of Nursing, Tri-Service General Hospital, Taipei City, Taiwan.
- School of Nursing, National Defense Medical Center, Taipei City, Taiwan.
| |
Collapse
|
31
|
Greer JA, Applebaum AJ, Jacobsen JC, Temel JS, Jackson VA. Understanding and Addressing the Role of Coping in Palliative Care for Patients With Advanced Cancer. J Clin Oncol 2020; 38:915-925. [PMID: 32023161 DOI: 10.1200/jco.19.00013] [Citation(s) in RCA: 91] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Advanced cancer, with its considerable physical symptoms and psychosocial burdens, represents an existential threat and major stressor to patients and their caregivers. In response to such stress, patients and their caregivers use a variety of strategies to manage the disease and related symptoms, such as problem-focused, emotion-focused, meaning-focused, and spiritual/religious coping. The use of such coping strategies is associated with multiple outcomes, including quality of life, symptoms of depression and anxiety, illness understanding, and end-of-life care. Accumulating data demonstrate that early palliative care, integrated with oncology care, not only improves these key outcomes but also enhances coping in patients with advanced cancer. In addition, trials of home-based palliative care interventions have shown promise for improving the ways that patients and family caregivers cope together and manage problems as a dyad. In this article, we describe the nature and correlates of coping in this population, highlight the role of palliative care to promote effective coping strategies in patients and caregivers, and review evidence supporting the beneficial effects of palliative care on patient coping as well as the mechanisms by which improved coping is associated with better outcomes. We conclude with a discussion of the limitations of the state of science, future directions, and best practices on the basis of available evidence.
Collapse
Affiliation(s)
- Joseph A Greer
- Massachusetts General Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | | | - Juliet C Jacobsen
- Massachusetts General Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | - Jennifer S Temel
- Massachusetts General Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | - Vicki A Jackson
- Massachusetts General Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| |
Collapse
|
32
|
Psychological and spiritual wellbeing of family caregivers of children with cancer at a teaching hospital in Ghana. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2020. [DOI: 10.1016/j.ijans.2020.100231] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
33
|
O'Callaghan C, Brooker J, de Silva W, Glenister D, Melia Cert A, Symons X, Kissane D, Michael N. Patients' and Caregivers' Contested Perspectives on Spiritual Care for Those Affected by Advanced Illnesses: A Qualitative Descriptive Study. J Pain Symptom Manage 2019; 58:977-988. [PMID: 31404641 DOI: 10.1016/j.jpainsymman.2019.08.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 08/02/2019] [Accepted: 08/05/2019] [Indexed: 10/26/2022]
Abstract
CONTEXT Spiritual care refers to practices and rituals addressing spiritual/religious concerns. It supports coping with loss and finding hope, meaning, and peace. Although integral to palliative care, its implementation is challenging. OBJECTIVE To understand an Australian cohort of patients' and caregivers' perspectives about experiencing and optimizing spiritual care in the context of advanced illness. METHODS Patients and caregivers of patients with ≤12 month prognosis were recruited from a broader spiritual study via criterion sampling and agreed to opt-in interviews. Participants from an Australian, metropolitan health service received a spiritual care definition and were interviewed. Transcripts were analyzed using qualitative description. RESULTS 30 patients (17 male; mean age 70 years) and 10 caregivers (six male; mean age 58.9 years) participated. 27 identified as Christian, and 10 had no religion. Participants described multifaceted and contested beliefs about spirituality. Many queried the tangibility of spirituality, but all valued respectful staff who affirmed personhood, that is, each individual's worth, especially when care exceeded expectations. They also resonated with positive organizational and environmental tones that improved holistic well-being. Participants stressed the importance of the hospital's welcoming context and skilled care, which comforted and reassured. CONCLUSION Although many patients and caregivers did not resonate with the term "spiritual care," all described how the hospital's hospitality could affirm their values and strengthen coping. The phrase "spiritual care and hospitality" may optimally articulate and guide care in similar, pluralist inpatient palliative care contexts, recognizing that such care encompasses an interplay of generalist and specialist pastoral care staff and organizational and environmental qualities.
Collapse
Affiliation(s)
- Clare O'Callaghan
- Palliative and Supportive Care Research Department, Cabrini Health, Malvern, Victoria, Australia; Institute for Ethics & Society, The University of Notre Dame Australia, New South Wales, Australia; Departments of Psychosocial Cancer Care and Medicine, St. Vincent's Hospital Fitzroy, The University of Melbourne, Victoria, Australia.
| | - Joanne Brooker
- School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - William de Silva
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - David Glenister
- Centre for Clinical Pastoral Education, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Adelaide Melia Cert
- Palliative and Supportive Care Research Department, Cabrini Health, Malvern, Victoria, Australia
| | - Xavier Symons
- Institute for Ethics & Society, The University of Notre Dame Australia, New South Wales, Australia
| | - David Kissane
- Palliative and Supportive Care Research Department, Cabrini Health, Malvern, Victoria, Australia; Szalmuk Family Psycho-oncology Research Unit, Cabrini Health, Malvern, Melbourne, Victoria, Australia; School of Medicine, The University of Notre Dame Australia, New South Wales, Australia
| | - Natasha Michael
- Palliative and Supportive Care Research Department, Cabrini Health, Malvern, Victoria, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia; School of Medicine, The University of Notre Dame Australia, New South Wales, Australia
| |
Collapse
|
34
|
Lalani N, Duggleby W, Olson J. Spirituality among family caregivers in palliative care: an integrative literature review. Int J Palliat Nurs 2019; 24:80-91. [PMID: 29469645 DOI: 10.12968/ijpn.2018.24.2.80] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Family caregivers experience spiritual and existential concerns while caring for their terminally ill family members. AIM To evaluate and synthesise studies on spirituality among family caregivers in palliative care. DESIGN An integrative literature review of peer-reviewed articles published between 2000 and 2016. SAMPLE Participants were family caregivers (parents, spouses, relatives or friends) caring for an adult (age>18 years) family member with a terminal illness in a palliative care setting. RESULTS Data from 26 published research papers were systematically analysed. Five themes were identified regarding spirituality and family caregiving: a close and meaningful connection, spirituality as a way of coping, spiritual needs and expressions among family caregivers, spirituality to transcend fears, and spirituality in family caregivers' decision-making. IMPLICATIONS FOR PRACTICE Nurses are encouraged to explore the spirituality and spiritual experiences of family caregivers to support their spiritual wellbeing while caring for their terminally ill family members.
Collapse
Affiliation(s)
- Nasreen Lalani
- PhD Candidate, Faculty of Nursing, University of Alberta, Canada
| | - Wendy Duggleby
- Professor; Associate Dean of Research; Nursing Research Chair in Aging and Quality of Life; Director of Innovations in Senior Care Research Unit, University of Alberta, Canada
| | | |
Collapse
|
35
|
O'Callaghan C, Seah D, Clayton JM, Welz M, Kissane D, Georgousopoulou EN, Michael N. Palliative Caregivers' Spirituality, Views About Spiritual Care, and Associations With Spiritual Well-Being: A Mixed Methods Study. Am J Hosp Palliat Care 2019; 37:305-313. [PMID: 31550902 DOI: 10.1177/1049909119877351] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Spiritual care is integral to palliative care. It engenders a sense of purpose, meaning, and connectedness to the sacred or important and may support caregiver well-being. AIM To examine caregivers' spirituality, religiosity, spiritual well-being, and views on spiritual/religious support. DESIGN A mixed-methods study across 4 Australian sites, recruiting caregivers of patients with a life expectancy of under 12 months. The anonymous semistructured questionnaire used included research team developed and adapted questions examining religion/spirituality's role and support and views on hospitals supporting spiritual/religious requirements. It additionally included the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp-12). RESULTS One hundred nine caregivers participated (47.4% responded). Median spiritual well-being was 30.5 on FACIT-Sp-12. Religious affiliation was associated with higher Faith subscores (P < .001). Spirituality was very important to 24.5%, religiosity to 28.2%, and unimportant to 31.4% and 35.9%, respectively. Caregivers prayed (P = .005) and meditated (P = .006) more following patients' diagnoses, gaining comfort, guidance, and strength. Caregivers whose spiritual/religious needs were met to moderate/full extent by external religious/faith communities (23.8%) reported greater spiritual well-being (P < .001). Hospitals supported moderate/full caregiver spiritual needs in 19.3%. Pastoral care visits comforted 84.4% of those who received them (n = 32) but elicited discomfort in 15.6%. Caregivers also emphasized the importance of humane staff and organizational tone in supporting spiritual care. CONCLUSIONS Hospital-based spiritual care providers should seek to identify those who seek pastoral or religiously orientated care. Genuine hospitality of showing concern for the other ensures the varied yet inevitably humanist requirements of the caregiver community are met.
Collapse
Affiliation(s)
- Clare O'Callaghan
- Palliative and Supportive Care Research Department, Cabrini Health, Melbourne, Victoria, Australia
- Institute for Ethics and Society, University of Notre Dame Australia, Sydney, New South Wales, Australia
- Department of Psychosocial Cancer Care and Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, Victoria, Australia
| | - Davinia Seah
- Sacred Heart Health Service, St Vincent's Hospital Sydney, New South Wales, Australia
- School of Medicine, University of Notre Dame Australia Sydney, New South Wales, Australia
| | - Josephine M Clayton
- HammondCare, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, New South Wales, Australia
| | - Martina Welz
- Department of Geriatric Medicine, Cabrini Health, Melbourne, Victoria, Australia
| | - David Kissane
- Palliative and Supportive Care Research Department, Cabrini Health, Melbourne, Victoria, Australia
- School of Medicine, University of Notre Dame Australia Sydney, New South Wales, Australia
- Szalmuk Family Psycho-Oncology Research Unit, Cabrini Health, Melbourne, Victoria, Australia
| | | | - Natasha Michael
- Palliative and Supportive Care Research Department, Cabrini Health, Melbourne, Victoria, Australia
- School of Medicine, University of Notre Dame Australia Sydney, New South Wales, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
36
|
Doumit MA, Rahi AC, Saab R, Majdalani M. Spirituality among parents of children with cancer in a Middle Eastern country. Eur J Oncol Nurs 2019; 39:21-27. [DOI: 10.1016/j.ejon.2018.12.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 11/30/2018] [Accepted: 12/21/2018] [Indexed: 10/27/2022]
|
37
|
Abstract
Spiritual issues play a prominent role for patients with cancer. Studies have demonstrated a positive connection between a patient's spirituality and health outcomes, including quality of life, depression and anxiety, hopefulness, and the ability to cope with illness. Spiritual or existential distress is prominent in patients with cancer. Models are described that identify ways for clinicians to identify or diagnose spiritual or existential distress, and to attend to that distress. It is critical that all clinicians assess for spiritual distress as part of a routine distress assessment, identify appropriate treatment strategies, and work closely with trained spiritual care professionals.
Collapse
Affiliation(s)
- Christina M Puchalski
- Department of Medicine and Health Sciences, Health Leadership and Management, The George Washington Institute for Spirituality & Health, The George Washington University School of Medicine & Health Sciences, The George Washington University School of Public Health, MFA-GWU Supportive and Palliative Care Clinic, 2600 Virginia Avenue, Northwest, Suite 300, Washington, DC 20037, USA.
| | - Stephen D W King
- Chaplaincy, Child Life, Seattle Cancer Care Alliance, PO Box 19023, Mail Stop K-231, Seattle, WA 98109, USA
| | - Betty R Ferrell
- Division of Nursing Research and Education, Department of Population Sciences, City of Hope Medical Center, 1500 East Duarte Road, Duarte, CA 91010, USA
| |
Collapse
|
38
|
Bruera E. Patient Evaluation and delivery of Care at the Bedside: Increasing Well-Being. J Palliat Care 2018. [DOI: 10.1177/082585971403000413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Eduardo Bruera
- Department of Palliative Care and Rehabilitation Medicine, University of Texas, MD Anderson Cancer Center, Unit 1414, 1515 Holcombe Boulevard, Houston, Texas, USA 77030
| |
Collapse
|
39
|
Goudarzian AH, Jafari A, Beik S, Bagheri Nesami M. Are Religious Coping and Pain Perception Related Together? Assessment in Iranian Cancer Patients. JOURNAL OF RELIGION AND HEALTH 2018; 57:2108-2117. [PMID: 28856490 DOI: 10.1007/s10943-017-0471-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Pain of cancer had various significant side effects that based on the literature it can reduced by religious coping methods. This study aimed to investigate the relationship between religious coping and pain perception in Iranian cancer patients. In this cross-sectional study (October-December, 2015), 380 hospitalized cancer patients were entered to the study using accessible sampling. Data were collected by socio-demographic, Religious Coping and McGill pain questionnaires. Males (48.39 ± 13 ± 39; CI95: 46.41-50.38) are older than females (45.33 ± 18.44; CI95: 42.79-47.87). According to results, there was a significant relationship between pain perception and positive religious coping in cancer patients. Also there was a significant relationship between pain perception and family history of cancer (P < 0.05). It seems that improving the level and quality of positive religious affiliation can be effective on the amount of stimulation and pain of cancer patients. Of course, more comprehensive studies are needed to be achieved more reliable results about the effects of religious coping on pain perception in these patients.
Collapse
Affiliation(s)
| | - Azar Jafari
- Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran
| | - Sima Beik
- Mazandaran University of Medical Sciences, Sari, Iran
| | - Masoumeh Bagheri Nesami
- Infectious Diseases Research Center with Focus on Nosocomial Infection, Mazandaran University of Medical Sciences, Sari, Iran.
| |
Collapse
|
40
|
Abstract
Cancer affects individuals in all human dimensions. Cancer patients are more susceptible to spiritual distress. Several studies have addressed spiritual distress using quantitative designs; however, a qualitative approach to the experience of spiritual distress could provide a deeper understanding of the phenomenon. This study aims to synthesis the experience of spiritual distress as lived by cancer patients in qualitative primary studies. This is a literature review based on electronic databases search. A total of 4075 citations was identified and 23 studies were included. The most frequent qualitative research method was phenomenology (n = 15), and interviews were the main data collection method (n = 20). Two major themes have been identified related to the experience of spiritual distress: suffering and coping. Spiritual distress is an intimate, deep and suffering experience in life, which requires coping strategies and involves spiritual values and beliefs. Healthcare providers should be aware of this experience and recognize spiritual distress in cancer patients, as it is critical in providing holistic nursing care.
Collapse
|
41
|
Liang SY, Chang TT, Wu WW, Wang TJ. Caring for patients with oral cancer in Taiwan: The challenges faced by family caregivers. Eur J Cancer Care (Engl) 2018; 28:e12891. [PMID: 30015996 DOI: 10.1111/ecc.12891] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 05/14/2018] [Accepted: 06/15/2018] [Indexed: 12/30/2022]
Abstract
Family caregivers face multiple challenges when caring for patients with oral cancer at home. Understanding the difficulties they face may assist health professionals to better organise and provide support for family caregivers of oral cancer patients. The aim of this study was to describe the caregivers' primary tasks and the difficulties they encounter when caring for a family member with oral cancer. This qualitative study included a purposeful sample of 22 primary family caregivers ranging in age from 25 to 71 years old. The researchers used face-to-face, semi-structured and tape-recorded interviews to collect data and employed qualitative content analysis to elicit caregiving-related themes. Six task-related themes and associated challenges were identified. These included managing the patient's nutritional issues, investigating and making decisions about patient care, managing sudden and unpredictable changes in the patient's condition, managing emotional distress, adjusting their attitudes towards patient care, and seeking resources. Family caregivers handle such essential tasks when they care for patients in home settings and they face specific challenges related to them. This study identified several challenges related to each task. From the outset, healthcare providers should actively offer caregiving information and strategies. Health professionals can incorporate strategies for supporting caregivers' ability to carry out these tasks into their treatment model and can help caregivers manage difficulties that can impede them from doing so.
Collapse
Affiliation(s)
- Shu-Yuan Liang
- College of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Tzu-Ting Chang
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wei-Wen Wu
- School of Nursing, National Taiwan University, Taipei, Taiwan
| | - Tsae-Jyy Wang
- College of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| |
Collapse
|
42
|
|
43
|
Exploring the associations between spiritual well-being, burden, and quality of life in family caregivers of cancer patients. Palliat Support Care 2018; 17:294-299. [PMID: 29749317 DOI: 10.1017/s1478951518000160] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The spiritual dimension is important in the process of coping with stress and may be of special relevance for those caring for cancer patients in the various phases of caregivership, although current attention is most prevalent at the end of life. This study explores the associations among spiritual well-being (SWB), caregiver burden, and quality of life (QoL) in family caregivers of patients with cancer during the course of the disease. METHOD This is a cross-sectional study. All participants (n = 199) underwent the following self-report questionnaires: the SWB-Index, the Medical Outcomes Study Short Form, and the Caregiver Burden Inventory (CBI). SWB scores were dichotomized at a cutoff corresponding to the 75th percentile. Statistical analyses were made using the Student t or by chi-square test to compare high and low SWB groups.ResultThe high SWB group reported significantly better Medical Outcomes Study Short Form scores in bodily pain (p = 0.035), vitality (p < 0.001), social activities (p = 0.001), mental health (p < 0.001), and in standardized mental component subscales (p < 0.001) than the low SWB group. No significant differences were detected between the two SWB groups in physical activity, physical role, general health, emotional status, and standardized physical component scale. The high SWB group also had better CBI scores in the physical (p = 0.049) and developmental burden (p = 0.053) subscales. There were no significant differences in the other CBI scores (overall and sections).Significance of resultsThis study points out that high SWB caregivers have a more positive QoL and burden. Knowledge of these associations calls for more attention on the part of healthcare professionals toward spiritual resources among family cancer caregivers from the moment of diagnosis and across the entire cancer trajectory.
Collapse
|
44
|
Arrieira ICDO, Thoferhn MB, Schaefer OM, Fonseca ADD, Kantorski LP, Cardoso DH. O sentido do cuidado espiritual na integralidade da atenção em cuidados paliativos. Rev Gaucha Enferm 2018. [DOI: 10.1590/1983-1447.2017.03.58737] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo Compreender o sentido do cuidado espiritual para a integralidade da atenção à pessoa e para a equipe interdisciplinar de cuidados paliativos. Métodos Pesquisa qualitativa com referencial teórico de Viktor Frankl. Os participantes foram nove pessoas em cuidados paliativos e seis profissionais do Programa de Internação Domiciliar Interdisciplinar que atendiam a estes. As informações foram coletadas no domicílio dos participantes, por meio da observação, e entrevistas fenomenológicas realizadas no período de junho a outubro de 2014, gravadas, transcritas e transformadas em texto interpretado, com abordagem fenomenológica hermenêutica. Resultados Surgiram as seguintes categorias: Sentido da integralidade do cuidado e O sentido da espiritualidade para os profissionais que cuidam de pessoas em tratamento paliativo, com suas subcategorias. Conclusão O cuidado espiritual proporciona conforto e o encontro existencial entre a pessoa em cuidados paliativos e os profissionais da equipe que o cuidam.
Collapse
|
45
|
Delgado-Guay MO. Developing a Healing Environment for Broken Souls of Patients With Life-Threatening Illnesses and Their Caregivers. J Pain Symptom Manage 2018; 55:1231-1236. [PMID: 29253528 DOI: 10.1016/j.jpainsymman.2017.12.477] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 12/08/2017] [Indexed: 12/16/2022]
Abstract
What a privilege it is to be able to touch those sacred spaces in the soul of each person that we encounter everyday. Patients with life-threatening illnesses can struggle with physical, emotional, and existential and spiritual concerns and the suffering of caregivers. A key goal of our supportive and palliative care teams is to alleviate patient and caregiver suffering. When caring for patients with advanced and terminal illness, the spirituality of each member of the palliative care team becomes a single collective spirituality or soul with common goals, values, and belonging, with a main goal of providing the best care for patients and caregivers in the alleviation of suffering. Embracing the spiritual care into our daily practice is a common effort and a service provided by each member of the team. Our role as members of the collective soul is to preserve human dignity and raise up the broken souls of patients living with life-threatening illness by creating healing environments.
Collapse
Affiliation(s)
- Marvin Omar Delgado-Guay
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
| |
Collapse
|
46
|
Kruizinga R, Scherer-Rath M, Schilderman HJBAM, Puchalski CM, van Laarhoven HHWM. Toward a Fully Fledged Integration of Spiritual Care and Medical Care. J Pain Symptom Manage 2018; 55:1035-1040. [PMID: 29169995 DOI: 10.1016/j.jpainsymman.2017.11.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 11/09/2017] [Accepted: 11/12/2017] [Indexed: 11/21/2022]
Abstract
In this article, we aimed to set out current problems that hinder a fully fledged integration of spiritual and medical care, which address these obstacles. We discuss the following five statements: 1) spiritual care requires a clear and inclusive definition of spirituality; 2) empirical evidence for spiritual care interventions should be improved; 3) understanding patients' experiences of contingency is paramount to deliver effective spiritual care; 4) attention to spiritual needs of patients is a task for every health care practitioner; 5) courses on spirituality and spiritual care should be mandatory in the medical curriculum. Current problems might be overcome by speaking each other's language, which is crucial in interdisciplinary research and in good interdisciplinary collaboration. Using a clear and inclusive definition of spirituality and substantiating spiritual care using medical standards of evidence-based practice is a way to speak each other's language and to increase mutual understanding. Furthermore, including spirituality in the medical curriculum would raise awareness of medical practitioners for their task of attending to patients' spiritual needs and, subsequently, to better and more appropriate referral for spiritual care.
Collapse
Affiliation(s)
- Renske Kruizinga
- Medical Oncology, Academic Medical Center, Amsterdam, The Netherlands.
| | - Michael Scherer-Rath
- Faculty of Philosophy, Theology and Religious Studies, Radboud University Nijmegen, Nijmegen, The Netherlands, The Netherlands
| | - Hans J B A M Schilderman
- Faculty of Philosophy, Theology and Religious Studies, Radboud University Nijmegen, Nijmegen, The Netherlands, The Netherlands
| | - Christina M Puchalski
- Department of Medicine and Health Science, The George Washington Institute for Spirituality and Health, The George Washington University, Washington, District of Columbia, USA
| | | |
Collapse
|
47
|
Milbury K, Engle R, Tsao A, Liao Z, Owens A, Chaoul A, Bruera E, Cohen L. Pilot Testing of a Brief Couple-Based Mind-Body Intervention for Patients With Metastatic Non-Small Cell Lung Cancer and Their Partners. J Pain Symptom Manage 2018; 55:953-961. [PMID: 29208478 PMCID: PMC6620018 DOI: 10.1016/j.jpainsymman.2017.11.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 11/21/2017] [Accepted: 11/22/2017] [Indexed: 10/18/2022]
Abstract
CONTEXT Given the generally incurable nature of metastatic lung cancer, patients and their spouses/partners are at risk for psychological and spiritual distress. To address this concern, we developed a couple-based mind-body (CBMB) intervention. OBJECTIVES This formative research aimed at examining the intervention's acceptability and initial efficacy in patients with metastatic lung cancer undergoing treatment and their spouses. METHODS Intervention content evaluation sessions and an ensuing single-arm trial were conducted. To evaluate intervention content, participants performed intervention exercises and then participated in semistructured interviews and completed written evaluations. In the single-arm trial, four intervention sessions were delivered over two weeks, focusing on cultivating mindfulness, interpersonal connection, gratitude, and purpose. Newly recruited couples completed measures of depressive symptoms, cancer distress, spiritual well-being, and sleep disturbances before and after the intervention. RESULTS Content evaluations by seven dyads of patients and their partners revealed high acceptability ratings for the CBMB intervention (e.g., all participants would recommend the intervention). Consent and adherence rates (54% and 67%, respectively) were acceptable in the single-arm trial. All patients (n = 7 dyads; 67% male; mean age, 55 years) and partners (33% male; mean age, 59 years) rated the intervention as useful. Paired t-test analyses revealed large effect sizes for reduced sleep disturbances (d = 1.83) and medium effect sizes for cancer-specific distress (d = 0.61) for patients and large effect sizes for depressive symptoms (d = 0.90) for partners. CONCLUSION Based on these results, the CBMB intervention appears to be acceptable and subjectively useful. In addition, we observed preliminary evidence of quality of life gains in both patients and their partners.
Collapse
Affiliation(s)
- Kathrin Milbury
- Department of Palliative, Rehabilitative & Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
| | - Rosalinda Engle
- Department of Palliative, Rehabilitative & Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Anne Tsao
- Department of Thoracic/Head & Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Zhongxing Liao
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - April Owens
- Department of Palliative, Rehabilitative & Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Alejandro Chaoul
- Department of Palliative, Rehabilitative & Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Eduardo Bruera
- Department of Palliative, Rehabilitative & Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Lorenzo Cohen
- Department of Palliative, Rehabilitative & Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| |
Collapse
|
48
|
A research protocol for a pilot randomized controlled trial designed to examine the feasibility of a couple-based mind-body intervention for patients with metastatic lung cancer and their partners. Pilot Feasibility Stud 2018; 4:37. [PMID: 29416870 PMCID: PMC5784695 DOI: 10.1186/s40814-018-0231-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 01/10/2018] [Indexed: 11/10/2022] Open
Abstract
Background Given the generally incurable nature of metastatic non-small cell lung cancer (mNSCLC), patients and their romantic partners are at risk for existential/spiritual distress. Although a handful of dyadic psychosocial interventions for lung cancer patients and their caregivers exist, none of them target spiritual well-being. Informed by the mindfulness-based intervention literature and our pilot work in couples affected by lung cancer, we developed a brief couple-based mind-body (CBMB) intervention. The primary aim of this research protocol is to determine the feasibility of implementing the CBMB intervention versus an active control (AC) or wait list control (WLC) group in patients with mNSCLC and their partners using a randomized controlled trial design. Methods Seventy-five patients with mNSCLC receiving treatment and their partners are randomized to the CBMB intervention, an AC or a WLC group. Those in the CBMB intervention and AC groups receive four intervention sessions of 60 min each over 4 weeks and complete weekly homework assignments. The first session is delivered in person, and the remaining sessions are delivered via videoconference. The dyads in the AC group discuss cancer-related and personal growth concerns with the interventionist but are not taught coping skills. Patients and partners in all groups complete baseline assessments of quality of life (QOL) prior to randomization. Follow-up assessments are performed 4 weeks and then again 3 months later. The primary outcome is feasibility (i.e., ≥ 30% of eligible couples consent, ≥ 70% of enrolled couples are retained, and ≥ 50% of all CBMB and AC sessions are attended). We will also perform primarily descriptive analyses of the self-reported outcomes (e.g., spiritual well-being and psychological distress) and explore potential intervention mediators (i.e., compassion, communication, mindfulness, and closeness) to inform a larger, future trial. Discussion This trial will provide important information regarding the feasibility of a behavioral intervention in a vulnerable yet understudied population using videoconferencing and descriptive data regarding spiritual well-being and other indices of QOL in both mNSCLC patients and their partners. Trial registration ClinicalTrials.gov NCT02596490
Collapse
|
49
|
Abstract
A person living with cancer will potentially have some degree of physical, cognitive, and/or psychological impairment, periods of unemployment, financial concerns, social isolation, and existential questions, any or all of which can impact the family and friends who surround them. In our current era of health care, patients with cancer receive invasive diagnostic studies and aggressive treatment as outpatients, and then convalesce at home. As such, cancer family caregivers are de facto partners with the healthcare team. The cancer family caregiver role is demanding and may lead to increased morbidity and mortality-in effect, the cancer family caregiver can become a second patient in need of care. This chapter discusses the consequences cancer family caregivers may accrue. The topics covered include caregiver mood disturbance and psychological impairment and some of the mutable factors that contribute to these states (i.e., sleep disturbance, decline in physical health, restriction of activities, and financial concerns), uncertainty, spiritual concerns, and caregiver witnessing. There is a discussion of the factors that influence the caregiving experience (caregiver characteristics, patient characteristics, and social supports). The chapter concludes with comments on intervention studies that have been conducted to ameliorate the burden of caregiving, and the state of caregiver research.
Collapse
Affiliation(s)
- Anna-Leila Williams
- Frank H. Netter MD School of Medicine, Quinnipiac University, Hamden, CT, USA.
| |
Collapse
|
50
|
Ellington L, Billitteri J, Reblin M, Clayton MF. Spiritual Care Communication in Cancer Patients. Semin Oncol Nurs 2017; 33:517-525. [PMID: 29107530 DOI: 10.1016/j.soncn.2017.09.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To provide a definition of spirituality, define the scope and nature of spiritual care communication, describe how to initiate communication about, and elicit, a spiritual history, and introduce the AMEN protocol to support patient/family hopes for a miracle. DATA SOURCES Literature review. CONCLUSION Spiritual communication is important throughout cancer care. Nurses can assess and integrate patient and family caregivers' spiritual needs in clinical care by practicing self-awareness and engaging in spiritual care communication strategies. IMPLICATIONS FOR NURSING PRACTICE Spirituality is recognized as an essential component of quality care. Spiritual conversations can increase patients' satisfaction with care and improve well-being.
Collapse
|