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Singer J, Roberts KE, McLean E, Fadalla C, Coats T, Rogers M, Wilson MK, Godwin K, Lichtenthal WG. An examination and proposed definitions of family members' grief prior to the death of individuals with a life-limiting illness: A systematic review. Palliat Med 2022; 36:581-608. [PMID: 35196915 PMCID: PMC10098140 DOI: 10.1177/02692163221074540] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Research has extensively examined family members' grief prior to the death of an individual with a life-limiting illness but several inconsistencies in its conceptualization of related constructs, yet significant conceptualization issues exist. AIM This study aimed to identify and characterize studies published on family members grief before the death of an individual with a life-limiting illness, and propose definitions based on past studies in order to initiate conceptual clarity. DESIGN A mixed-method systematic review utilized six databases and was last conducted July 10, 2021. The search strategy was developed using Medical Subject Headings. This study was prospectively registered on PROSPERO (CRD42020166254). RESULTS One hundred thirty-four full-text articles met inclusion criteria. This review revealed across studies a wide variation in terminology, conceptualization, and characterization of grief before the death. More than 18 terms and 30 definitions have been used. In many cases, the same term (e.g. anticipatory grief) was defined differently across studies. CONCLUSIONS We found grief occurring before the death of a person with a life-limiting illness, which we termed pre-death grief, is comprised of two distinct constructs: anticipatory grief and illness-related grief. Anticipatory grief is future-oriented and is characterized by separation distress and worry about a future without the person with the life-limiting illness being physically present. Illness-related grief is present-oriented and is characterized by grief over current and ongoing losses experienced during the illness trajectory. These definitions provide the field with uniform constructs to advance the study of grief before the death of an individual with a life-limiting illness.
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Affiliation(s)
- Jonathan Singer
- Department of Psychological Science, Texas Tech University, Lubbock, TX, USA
| | - Kailey E Roberts
- Ferkauf Graduate School of Psychology, Yeshiva University, New York, NY, USA
| | - Elisabeth McLean
- Department of Psychological Science, Texas Tech University, Lubbock, TX, USA
| | - Carol Fadalla
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Taylor Coats
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Madeline Rogers
- Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, NY, USA
| | | | - Kendra Godwin
- Medical Library, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Wendy G Lichtenthal
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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2
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Sun D, Mao Z, Zhang X, Li J, Zhang L. Relationship Between Post-traumatic Stress Symptoms and Anticipatory Grief in Family Caregivers of Patients With Advanced Lung Cancer: The Mediation Role of Illness Uncertainty. Front Psychiatry 2022; 13:914862. [PMID: 35757209 PMCID: PMC9218190 DOI: 10.3389/fpsyt.2022.914862] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 05/19/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To explore the interrelationship between post-traumatic stress symptoms (PTSS), illness uncertainty (IU), and anticipatory grief (AG). METHODS Structural equation modeling with bootstrapping estimation was conducted using data from a convenience sample of 254 family caregivers of patients with advanced lung cancer in China. Participants were recruited from a public cancer hospital in Shenyang, China. The family caregivers completed the Impact of Events Scale-Revised, Uncertainty in Illness Scale Family Caregiver Version, and Anticipatory Grief Scale. RESULTS The measurement model has good reliability and validity, and the final model fit the data well. PTSS positively influenced AG (direct effect estimate = 0.391, p = 0.002). Moreover, IU was found to mediate the relationship between PTSS and AG (Indirect effects estimate = 0.168, p = 0.005). The mediating effect of IU accounted for up to 30.1% of the total effect. CONCLUSION IU mediated the relationship between PTSS and AG. Healthcare professionals should continuously assess PTSS, IU and AG levels in FCs and provide effective intervention options for mitigation.
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Affiliation(s)
- Di Sun
- School of Nursing, Liaoning University of Traditional Chinese Medicine, Shenyang, China
| | - Zhihui Mao
- School of Nursing, Liaoning University of Traditional Chinese Medicine, Shenyang, China
| | - Xu Zhang
- School of Nursing, China Medical University, Shenyang, China
| | - Jiaojiao Li
- Department of Thoracic Medicine, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, China
| | - Lijuan Zhang
- School of Nursing, Liaoning University of Traditional Chinese Medicine, Shenyang, China
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3
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Increasing our understanding of nonphysical suffering within palliative care: A scoping review. Palliat Support Care 2021; 20:417-432. [DOI: 10.1017/s1478951521001127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Objective
Nonphysical suffering is emotional, psychological, existential, spiritual, and/or social in nature. While palliative care is a discipline dedicated to the prevention and relief of suffering — both physical and nonphysical — little is known about existing research specific to nonphysical suffering within the context of palliative care. This scoping review helps to fill this gap.
Method
Three hundred and twenty-eight unique records were identified through a systematic search of three databases (MEDLINE, CINAHL, and PsycINFO). The following keywords were used: (suffering) AND (palliative OR “end of life” OR “end-of-life” OR hospice OR dying OR terminal* ill*). Thirty studies published between 1998 and 2019 met the inclusion criteria.
Results
Losses, worries, and fears comprise patients’ primary sources of nonphysical suffering. Patients face numerous barriers in expressing their nonphysical suffering to healthcare providers. The idea that patients can choose how they perceive their circumstances, thereby minimizing their nonphysical suffering, is pervasive in the research. The nature of nonphysical suffering experienced by family caregivers and palliative care clinicians is revealed in the review. The unique and sensitive interplay between nonphysical suffering and both palliative sedation and requests for hastened death is also evident. Overall, seven themes can be identified: (i) patients’ experiences of nonphysical suffering; (ii) patient coping mechanisms; (iii) efforts to measure nonphysical suffering; (iv) palliative sedation; (v) requests for hastened death; (vi) family suffering; and (vii) clinician suffering.
Significance of results
This is the first scoping review to map palliative care's research specific to suffering that is social, emotional, spiritual, psychological, and/or existential in nature. Its findings expand our understanding of the nature of nonphysical suffering experienced by patients, families, and palliative care clinicians. The review's findings have significant implications for front-line practice and future research.
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Beng TS, Ying YK, Xin CA, Jane LE, Lin DC, Khuen LP, Capelle DP, Zainuddin SI, Chin LE, Loong LC. The experiences of well-being of family caregivers in palliative care: A qualitative study using thematic analysis. PROGRESS IN PALLIATIVE CARE 2021. [DOI: 10.1080/09699260.2021.1872135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Tan Seng Beng
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Yeoh Kee Ying
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Cheah Ai Xin
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Lim Ee Jane
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Dong Chooi Lin
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Lim Poh Khuen
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - David Paul Capelle
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Sheriza Izwa Zainuddin
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Loh Ee Chin
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Lam Chee Loong
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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5
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Broady TR. Carers’ Experiences of End‐of‐Life Care: A Scoping Review and Application of Personal Construct Psychology. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12278] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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6
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Coelho A, de Brito M, Teixeira P, Frade P, Barros L, Barbosa A. Family Caregivers' Anticipatory Grief: A Conceptual Framework for Understanding Its Multiple Challenges. QUALITATIVE HEALTH RESEARCH 2020; 30:693-703. [PMID: 31526106 DOI: 10.1177/1049732319873330] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The end-of-life trajectory of cancer patients in palliative care (PC) elicits an anticipatory grief (AG) process in family caregivers (FCs). Although widely recognized, AG lacks conceptual clarification. This study aims to qualitatively explore the experience of FCs of patients with terminal cancer to identify the core characteristics and the specific adaptive challenges related to AG in the context of end-of-life caregiving. Data were collected through in-depth semi-structured interviews conducted in a clinical sample of 26 FCs of cancer patients in PC. Findings from thematic analysis suggest that the AG experience is characterized by traumatic distress from being exposed to life-threatening conditions and the separation distress induced by loss anticipation and current relational losses, challenging the FCs to long-term emotional regulation effort demands. These results contribute to the conceptualization of AG and may inform intervention programs for the main challenges the FCs face when adjusting to loss during end-of-life caregiving.
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Affiliation(s)
- Alexandra Coelho
- Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Centro Hospitalar Universitário Lisboa Norte, EPE, Lisboa, Portugal
| | - Maja de Brito
- Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal
| | - Pedro Teixeira
- Escola de Medicina, Universidade do Minho, Braga, Portugal
| | - Pedro Frade
- Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Centro Hospitalar Universitário Lisboa Norte, EPE, Lisboa, Portugal
| | - Luísa Barros
- Faculdade de Psicologia, Universidade de Lisboa, Lisboa, Portugal
| | - António Barbosa
- Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Centro Hospitalar Universitário Lisboa Norte, EPE, Lisboa, Portugal
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7
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Tan SB, Ching HC, Chia YL, Yee A, Ng CG, Hasan MSB, Lim KS, Ahmad SB, Capelle DP, Loh EC, Lam CL. The Effect of 20-Minute Mindful Breathing on the Perception of Suffering and Changes in Bispectral Index Score (BIS) in Palliative Care Informal Caregivers: A Randomized Controlled Study. Am J Hosp Palliat Care 2019; 37:606-612. [DOI: 10.1177/1049909119894507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Informal caregivers are at risk of being overwhelmed by various sources of suffering while caring for their significant others. It is, therefore, important for caregivers to take care of themselves. In the self-care context, mindfulness has the potential to reduce caregiver suffering. We studied the effect of a single session of 20-minute mindful breathing on the perceived level of suffering, together with the changes in bispectral index score (BIS) among palliative care informal caregivers. This was a randomized controlled study conducted at the University of Malaya Medical Centre, Malaysia. Forty adult palliative care informal caregivers were recruited and randomly assigned to either 20-minute mindful breathing or 20-minute supportive listening. The changes in perceived suffering and BIS were measured preintervention and postintervention. The reduction in suffering score in the intervention group was significantly more than the control group at minute 20 ( U = 124.0, n1 = n2 = 20, mean rank1 = 24.30, mean rank2 = 16.70, z = −2.095, P = .036). The reduction in BIS in the intervention group was also significantly greater than the control group at minute 20 ( U = 19.5, n1 = n2 = 20, mean rank1 = 29.52, mean rank2 = 11.48, z = −4.900, P < .0001). Twenty minutes of mindful breathing was more efficacious than 20 minutes of supportive listening in the reduction in suffering among palliative care informal caregivers.
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Affiliation(s)
- Seng Beng Tan
- Department of Medicine, Faculty of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Hui Chi Ching
- Department of Medicine, Faculty of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Yuik Ling Chia
- Department of Medicine, Faculty of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Anne Yee
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Chong Guan Ng
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Mohd Shahnaz bin Hasan
- Department of Anaesthesiology, Faculty of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Kheng Seang Lim
- Department of Medicine, Faculty of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Sherrini Bazir Ahmad
- Department of Medicine, Faculty of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - David Paul Capelle
- Department of Medicine, Faculty of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Ee Chin Loh
- Department of Medicine, Faculty of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Chee Loong Lam
- Department of Medicine, Faculty of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
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Kristanti MS, Effendy C, Utarini A, Vernooij-Dassen M, Engels Y. The experience of family caregivers of patients with cancer in an Asian country: A grounded theory approach. Palliat Med 2019; 33:676-684. [PMID: 30916614 PMCID: PMC6537031 DOI: 10.1177/0269216319833260] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Strong family bonds are part of the Indonesian culture. Family members of patients with cancer are intensively involved in caring, also in hospitals. This is considered "normal": a societal and religious obligation. The values underpinning this might influence families' perception of it. AIM To explore and model experiences of family caregivers of patients with cancer in Indonesia in performing caregiving tasks. DESIGN A grounded theory approach was applied. The constant comparative method was used for data analysis and a paradigm scheme was employed for developing a theoretical model. SETTING/PARTICIPANTS The study was conducted in three hospitals in Indonesia. The participants were family caregivers of patients with cancer. RESULTS A total of 24 family caregivers participated. "Belief in caregiving" appeared to be the core phenomenon. This reflects the caregivers' conviction that providing care is an important value, which becomes the will power and source of their strength. It is a combination of spiritual and religious, value and motivation to care, and is influenced by contextual factors. It influences actions: coping mechanisms, sharing tasks, and making sacrifices. Social support influences the process of the core phenomenon and the actions of the caregivers. Both positive and negative experiences were identified. CONCLUSION We developed a model of family caregivers' experiences from a country where caregiving is deeply rooted in religion and culture. The model might also be useful in other cultural contexts. Our model shows that the spiritual domain, not only for the patient but also for the family caregivers, should be structurally addressed by professional caregivers.
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Affiliation(s)
- Martina Sinta Kristanti
- Radboud University Medical Center, IQ Healthcare, Nijmegen, The Netherlands
- School of Nursing, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Christantie Effendy
- School of Nursing, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Adi Utarini
- Department of Health Policy and Management, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | | | - Yvonne Engels
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
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9
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Delalibera M, Coelho A, Presa J, Barbosa A, Leal I. Circunstâncias e consequências do cuidar: estudo prospetivo em cuidados paliativos. CIENCIA & SAUDE COLETIVA 2018; 23:2351-2362. [DOI: 10.1590/1413-81232018237.09512016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 08/04/2016] [Indexed: 11/22/2022] Open
Abstract
Resumo As várias circunstâncias que afetam a prestação de cuidados em fim-de-vida podem ter um papel determinante no resultado desta experiência, nomeadamente nos níveis de morbilidade psicológica antes e depois da perda. Este estudo tem por objetivos descrever a prevalência da sobrecarga e sintomatologia psicopatológica dos cuidadores familiares em cuidados paliativos e identificar as circunstâncias que lhe estão associadas. Pretendemos ainda avaliar a evolução da sintomatologia, identificando os fatores circunstanciais que interferem na fase aguda do luto. A amostra foi constituída por 75 cuidadores portugueses, a maioria do sexo feminino e filhas do doente. Os resultados revelam que as pessoas mais envolvidas nos cuidados ao doente apresentam mais sobrecarga e estão mais propensas a sintomatologia psicopatológica, a qual tem tendência a manter-se no luto. Ficou também demonstrada a existência de sintomas peritraumáticos que parecem contribuir significativamente para o estado geral de distress no luto agudo. O suporte social tem efeito protetor nos diferentes quadros sintomatológicos e está relacionado com o funcionamento familiar. Estes resultados sugerem a possibilidade de identificar precocemente os cuidadores mais vulneráveis e as circunstâncias adversas que os afetam.
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Affiliation(s)
| | | | | | | | - Isabel Leal
- Instituto Superior de Psicologia Aplicada, Portugal
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10
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Abstract
Compassion fatigue is a concept used to describe how various stressors affect individuals who work in health care and other caregiving professions. The results of compassion fatigue may include decreased work productivity, poor quality of care, safety concerns, job dissatisfaction, and job turnover. The NICU professionals are at an increased risk for experiencing compassion fatigue because of the nature of working with critically ill infants, their families, and the additional stress of the workplace. The purpose of this article is for the NICU professional to understand compassion fatigue, identify the risk factors, recognize the signs and symptoms, and offer strategies to implement within the NICU environment.
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11
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Johnson J, Lodhi MK, Cheema U, Stifter J, Dunn-Lopez K, Yao Y, Johnson A, Keenan GM, Ansari R, Khokhar A, Wilkie DJ. Outcomes for End-of-Life Patients with Anticipatory Grieving: Insights from Practice with Standardized Nursing Terminologies within an Interoperable Internet-based Electronic Health Record. J Hosp Palliat Nurs 2017; 19:223-231. [PMID: 28943805 DOI: 10.1097/njh.0000000000000333] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Julie Johnson
- Dept. of Biobehavioral Health Science, College of Engineering, University of Illinois at Chicago, Chicago, IL
| | - Muhammad Kamran Lodhi
- Dept. of Computer Science, College of Engineering, University of Illinois at Chicago, Chicago, IL
| | - Umer Cheema
- Dept. of Electrical and Computer Engineering, College of Engineering, University of Illinois at Chicago, Chicago, IL
| | - Janet Stifter
- Dept. of Biobehavioral Health Science, College of Engineering, University of Illinois at Chicago, Chicago, IL
| | - Karen Dunn-Lopez
- Dept. of Health System Science, College of Nursing, College of Engineering, University of Illinois at Chicago, Chicago, IL
| | - Yingwei Yao
- Dept. of Biobehavioral Health Science, College of Engineering, University of Illinois at Chicago, Chicago, IL
| | - Andrew Johnson
- Dept. of Computer Science, College of Engineering, University of Illinois at Chicago, Chicago, IL
| | - Gail M Keenan
- College of Nursing, University of Florida, Gainesville, FL
| | - Rashid Ansari
- Dept. of Electrical and Computer Engineering, College of Engineering, University of Illinois at Chicago, Chicago, IL
| | - Ashfaq Khokhar
- Dept. of Electrical and Computer Engineering, Iowa State University, Ames, IA
| | - Diana J Wilkie
- Dept. of Biobehavioral Health Science, College of Engineering, University of Illinois at Chicago, Chicago, IL.,Dept. of Electrical and Computer Engineering, College of Engineering, University of Illinois at Chicago, Chicago, IL.,College of Nursing, University of Florida, Gainesville, FL
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12
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Anderson EW, Frazer MS, Schellinger SE. Expanding the Palliative Care Domains to Meet the Needs of a Community-Based Supportive Care Model. Am J Hosp Palliat Care 2017; 35:258-265. [PMID: 28423918 PMCID: PMC5768266 DOI: 10.1177/1049909117705061] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: Whole person care is appropriate for seriously ill persons. The current framework of palliative care domains in the National Consensus Project (NCP) Guidelines for Quality Palliative Care offers an opportunity to reassess the domains of care delivered at home, earlier in the course of illness. Objective: This qualitative study was used to test the applicability of a proposed, expanded set of domains. The results were used to inform a home-based, upstream model of supportive care for serious illness. Methods: Quotes relating to the experience of late-life serious illness were derived from transcripts of 12 semi-structured group interviews conducted with patients, family, and professionals. Quotes originally coded to the NCP domains of palliative care were then coded to the proposed domain set, which included new categories of family/caregiver, legal/financial, and legacy/bereavement domains. Results: A total of 489 quotes were assigned to the proposed expanded set of domains. One hundred one (19%) coded to the family/caregiver domain, 28 (5%) to the legacy/bereavement domain, and 27 (5%) to the legal/financial domain. Ninety-seven (87%) of the 111 quotes coded to family/caregiver had been initially coded to the NCP social aspects of care. Family/caregiver themes included challenges, rewards, insights, and family growth. Conclusion: The preponderance of family-related issues suggests that including the family domain may promote recognition and support of family caregivers and the services they provide. Although this study provides some support for including the legacy/bereavement and legal/financial domains, additional research is needed to determine whether there is a basis for including them in the domain structure.
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Affiliation(s)
- Eric W Anderson
- 1 Division of Applied Research, Allina Health, Minneapolis, MN, USA
| | - Monica S Frazer
- 1 Division of Applied Research, Allina Health, Minneapolis, MN, USA
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13
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Anderson EW, White KM. "It Has Changed My Life": An Exploration of Caregiver Experiences in Serious Illness. Am J Hosp Palliat Care 2017; 35:266-274. [PMID: 28413927 PMCID: PMC5768253 DOI: 10.1177/1049909117701895] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background: Informal, unpaid caregivers shoulder much of the care burden for individuals with serious illness. As part of a project to create an innovative model of supportive care for serious illness, a series of user interviews were conducted, forming the basis for this article. Objective: To understand both individual and interpersonal aspects of caregiving for serious illness. Methods: Twelve semistructured group interviews were conducted with patients, families, and professionals as part of a larger study of late-life serious illness. Transcript data were analyzed with descriptive coding, and then coded material was analyzed to elicit major themes and subthemes. Results: A total of 73 individuals participated in group interview sessions. Using descriptive coding, quotes were assigned to first-order codes of rewards, challenges, and a category of learnings and adaptations. Subthemes of reward included gratitude, a sense of accomplishment or mastery, and closeness in personal relationships. The most oft-cited challenges included emotional and physical stresses of caregiving and feeling unprepared or unsupported in caregiving. Reflecting on their experiences, caregivers cited new ways in which they had learned to be creative, to show assertiveness and advocacy, and to create personal balance in a demanding situation. Conclusions: The experience of caregiving is a life-altering journey as individuals rise to challenges and reflect on the rewards. Caregivers described intensive caregiving, often without acknowledgment or understanding of their role from the health-care system. This invisibility created its own iatrogenic caregiving challenge. The identified themes suggest avenues of meaningful caregiver support that bear further exploration.
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Affiliation(s)
- Eric W Anderson
- 1 Late Life Supportive Care, Division of Applied Research, Allina Health, Minneapolis, MN, USA
| | - Katie M White
- 2 Division of Health Policy & Management, University of Minnesota School of Public Health, Minneapolis, MN, USA
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14
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Rattner M, Berzoff J. Rethinking Suffering: Allowing for Suffering that is Intrinsic at End of Life. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2016; 12:240-258. [PMID: 27462954 DOI: 10.1080/15524256.2016.1200520] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The dilemma so central to the work of providers of palliative and end-of-life care is the paradox of their professional and ethical duty to try to relieve suffering and the limitations of so doing. While the capacity to sit with suffering at the end of life is critical to clinical work, the idea that some intrinsic suffering cannot necessarily always be relieved may model for patients and families that suffering can be borne. Clinicians who encounter unrelievable suffering may feel a sense of failure, helplessness, moral distress, and compassion fatigue. While tolerating suffering runs counter to the aims of palliative care, acknowledging it, bearing it, and validating it may actually help patients and families to do the same. "Sitting with suffering" signals a paradigm shift within the discipline of palliative care, as it asks clinicians to rethink their role in being able to relieve some forms of psychosocial suffering intrinsic to dying.
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Affiliation(s)
| | - Joan Berzoff
- b Smith College School for Social Work , Northampton , Massachusetts , USA
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15
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Coelho A, Barbosa A. Family Anticipatory Grief: An Integrative Literature Review. Am J Hosp Palliat Care 2016; 34:774-785. [DOI: 10.1177/1049909116647960] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Despite all the investment in research, uncertainty persists in anticipatory grief (AG) literature, concerning its nuclear characteristics and definition. This review aimed to synthesize recent research in order to develop further knowledge about the family experience of AG during a patient’s end of life. An integrative review was performed using standard methods of analysis and synthesis. The electronic databases Medline, Web of Knowledge, and EBSCO and relevant journals were systematically searched since 1990 to October 2015. Twenty-nine articles were selected, the majority with samples composed of caregivers of terminally ill patients with cancer. From systematic comparison of data referring to family end-of-life experience emerged 10 themes, which correspond to AG nuclear characteristics: anticipation of death, emotional distress, intrapsychic and interpersonal protection, exclusive focus on the patient care, hope, ambivalence, personal losses, relational losses, end-of-life relational tasks, and transition. For the majority of family caregivers in occidental society, AG is a highly stressful and ambivalent experience due to anticipation of death and relational losses, while the patient is physically present and needed of care, so family must be functional and inhibit grief expressions. The present study contributes to a deeper conceptualization of this term and to a more sensitive clinical practice.
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Affiliation(s)
- Alexandra Coelho
- Palliative Medicine Unit, Santa Maria Hospital, Lisbon, Portugal
| | - António Barbosa
- Medicine Faculty, Palliative Medicine Unit, Santa Maria Hospital, University of Lisbon, Lisbon, Portugal
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16
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Abstract
Anticipatory grief (AG) has been studied, debated, and written about for several decades. This type of grief is also recognized in hospice and palliative care (HPC). The question, however, is whether the reality of AG is sufficiently upheld by professionals at the point of concrete service delivery. In other words, is AG a mere concept or is everyday practice of HPC duly informed of AG as evidenced by the resulting care delivery?
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Affiliation(s)
- Paul J. Moon
- Alacare Home Health & Hospice, Birmingham, AL, USA
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17
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Abstract
OBJECTIVE Caregiving partners constitute a unique group, who provide both physical and emotional care for patients. There has been extensive research conducted on caregivers during either the caregiving or bereavement phase; however, these phases are often treated as separate entities rather than as part of a continuum. METHOD In this paper, utilizing relevant literature and clinical observations, we map the emotional journey and lived experience of caregivers moving from disease progression, to the end of life, to the dying process itself, and then through life after the death of a partner. Along this journey, we identify the links between pre-death caregiving and bereavement. RESULTS Our illustration raises awareness regarding the unmet needs experienced by caregiving partners across the continuum and provides an alternative framework through which clinicians can view this course. SIGNIFICANCE of Results We bolster arguments for improved palliative care services and early interventions with distressed caregiving partners by emphasizing continuity of care both before and after a patient's death.
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18
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Beng TS, Chin LE, Guan NC, Yee A, Wu C, Jane LE, Meng CBC. Mindfulness-Based Supportive Therapy (MBST). Am J Hosp Palliat Care 2013; 32:144-60. [DOI: 10.1177/1049909113508640] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: To develop a mindfulness-based palliative psychotherapy to address psychoexistential suffering in palliative care. Conceptualization: First, a theory of suffering was formulated by merging 2 models of suffering from 2 thematic analyses of 20 palliative care patients and 15 informal caregivers. Second, the results from a secondary thematic analysis of suffering caused by health care interactions were conceptualized into a psychotherapy framework. Third, principles of mindfulness were incorporated into the framework to form a mindfulness-based psychotherapy. Results: Mindfulness-based supportive therapy (MBST) was developed with the following 5 components of presence, listening, empathy, compassion, and boundary awareness. Conclusion: We believe that MBST is a potentially useful psychological intervention in palliative care, specifically designed to address psychoexistential suffering of terminally ill patients.
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Affiliation(s)
- Tan Seng Beng
- Department of Medicine, Faculty of Medicine, University Malaya Medical Center, Kuala Lumpur, Malaysia
| | - Loh Ee Chin
- Department of Medicine, Faculty of Medicine, University Malaya Medical Center, Kuala Lumpur, Malaysia
| | - Ng Chong Guan
- Department of Psychological Medicine, Faculty of Medicine, University Malaya Medical Center, Kuala Lumpur, Malaysia
| | - Anne Yee
- Department of Psychological Medicine, Faculty of Medicine, University Malaya Medical Center, Kuala Lumpur, Malaysia
| | - Cathie Wu
- Department of Psychological Medicine, Faculty of Medicine, University Malaya Medical Center, Kuala Lumpur, Malaysia
| | - Lim Ee Jane
- Department of Medicine, Faculty of Medicine, University Malaya Medical Center, Kuala Lumpur, Malaysia
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