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Kizza IB, Muliira JK, Al Jabri KA, Al-Kindi SN. Family Caregivers of Adult Cancer Patients in Oman: Predictors of Caregivers' Self-efficacy for Cancer Pain and Related Symptom Management at Home. Cancer Nurs 2022; Publish Ahead of Print:00002820-990000000-00084. [PMID: 36729792 DOI: 10.1097/ncc.0000000000001181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Family caregivers (FCGs) contribute significantly to the management of pain and other symptoms experienced by their family member with cancer and may not receive preparation to meet the changing patient needs. OBJECTIVE The aim of this study was to identify the predictors of FCG self-efficacy (SE) for pain and related symptom management of adult family members with cancer. METHODS Data were collected from 165 Omani FCGs. The questionnaire comprised the caregiver cancer pain and related symptom management SE scale, the Katz index, Caregiver Reaction Assessment, and Family Pain Questionnaire. Electronic medical records provided data on patients' cancer diagnosis, pain, and symptoms. Predictors of SE were examined using linear regression analysis. RESULTS Most FCGs were female (58.2%) and children of the patient (53.9%). Most patients were on chemotherapy or palliative care (82.4%) and had at least stage 3 cancer (58.8%). Family caregivers reported average SE. The predictors of SE were as follows: patients' functional status (β = 40.90, P = .001), patients' pain intensity (β = -15.10, P = .036), FCGs' confidence in controlling the patients' pain (β = 28.80, P = .000), FCGs' self-rated health (β = -25.90, P = .038), and interaction of FCGs' knowledge level with patients' pain intensity (β = -1.31, P = .008), caregiving hours (β = -0.10, P = .025), and impact of caregiving on FCGs' physical health (β = 1.29, P = .031). CONCLUSION Family caregivers' health status, knowledge, caregiving demands, patient functional status, and pain intensity have a significant effect on caregivers' symptom management. IMPLICATIONS FOR PRACTICE A deliberate model of care that includes supportive interventions to enhance the abilities of FCGs with symptom management is needed in Oman.
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Affiliation(s)
- Irene B Kizza
- Author Affiliations: School of Nursing, University of Wisconsin, Madison (Ms Kizza); School of Nursing, Ball State University, Muncie, Indiana (Dr Muliira); and National Oncology Centre, Royal Hospital (Ms Al Jabri); College of Nursing, Sultan Qaboos University (Ms Al-Kindi), Muscat, Oman
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Diggle MFJ, Schutz S, Butcher D. Bereaved Caregivers' Experiences of End of Life Care For People With Advanced Heart Failure: A Narrative Synthesis. OMEGA-JOURNAL OF DEATH AND DYING 2022:302228221124636. [PMID: 36113134 DOI: 10.1177/00302228221124636] [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: 12/22/2023]
Abstract
BACKGROUND Heart Failure is a life-limiting condition with a poor and uniquely unpredictable prognosis. The aim of this review is to present and synthesise the current evidence around bereaved caregivers' experiences of end of life care for people with Heart Failure. METHODS A systematic review of the literature was conducted using four electronic databases (CINHAL, Medline, BND, PsycINFO). Data was analysed and presented using a narrative synthesis approach. RESULTS Eight articles were included within this review. Themes included: Limited and inadequate communication around the condition (including prognosis, preparations for death and the aim of palliative care), the burden of caregiving, and the limited provision of services and formal support. CONCLUSION Bereaved caregivers experience unique and significant challenges when caring for someone dying from Heart Failure. However, further research is required to greater understand the experiences of bereaved caregivers of people with Heart Failure.
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Affiliation(s)
- Melanie F J Diggle
- Oxford School of Nursing and Midwifery, Faculty of Health and Life Sciences, Oxford Brookes University, UK
| | - Sue Schutz
- Oxford School of Nursing and Midwifery, Faculty of Health and Life Sciences, Oxford Brookes University, UK
| | - Dan Butcher
- Oxford School of Nursing and Midwifery, Faculty of Health and Life Sciences, Oxford Brookes University, UK
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White CL, Barrera A, Turner S, Glassner A, Brackett J, Rivette S, Meyer K. Family caregivers' perceptions and experiences of participating in the learning skills together intervention to build self-efficacy for providing complex care. Geriatr Nurs 2022; 45:198-204. [PMID: 35533583 PMCID: PMC10019378 DOI: 10.1016/j.gerinurse.2022.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 04/07/2022] [Accepted: 04/08/2022] [Indexed: 11/04/2022]
Abstract
The purpose of this study was to describe how an intervention to teach family caregivers of persons living with dementia to provide complex care tasks contributes to their self-efficacy. This qualitative study was embedded in a pilot study evaluating the intervention. Semi-structured interviews were conducted with 15 caregivers who had completed the intervention. Content analysis was used to analyze the data. Themes identified from the interviews were: "helpfulness of the content", "if they can do it, so can I", and "applying what I have learned". Caregivers described the helpfulness of learning from expert healthcare professionals in a supportive environment. They valued the group setting, including interacting with and learning from their peers. Caregivers demonstrated mastery of the content by applying it to their caregiving situations and sharing information with other family members. These findings provide insights into successful elements in a complex care intervention that contributed to building caregiver self-efficacy.
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Affiliation(s)
- Carole L White
- School of Nursing, UT Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, United States; Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, UT Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, United States.
| | - Aleera Barrera
- School of Nursing, UT Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, United States; School of Health Professions, UT Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, United States
| | - Sarah Turner
- School of Nursing, UT Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, United States
| | - Ashlie Glassner
- School of Nursing, UT Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, United States
| | - Jennifer Brackett
- School of Nursing, UT Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, United States
| | - Sheran Rivette
- School of Nursing, UT Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, United States
| | - Kylie Meyer
- School of Nursing, UT Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, United States; Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, UT Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, United States
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Wu MP, Tsao LI, Huang SJ, Liu CY. Development of the Readiness for Home-Based Palliative Care Scale (RHBPCS) for Primary Family Caregivers. Healthcare (Basel) 2021; 9:healthcare9050608. [PMID: 34069437 PMCID: PMC8159133 DOI: 10.3390/healthcare9050608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/14/2021] [Accepted: 05/17/2021] [Indexed: 11/16/2022] Open
Abstract
In Chinese or Eastern society, most end-of-life (EOL) patients still choose to die at home. However, primary family caregivers usually do not prepare themselves to face the death of patients. Therefore, a measurement of the readiness for home-based palliative care for primary family caregivers is needed. In this study, the readiness for home-based palliative care scale (RHBPCS) for primary family caregivers was developed to assess the readiness of primary family caregivers. This study recruited 103 participants from five branches of one municipal hospital system. The reliability and validity of the RHBPCS was evaluated using expert validity examination, confirmatory factor analysis (CFA), and item analysis. The results showed that the RHBPCS had strong goodness-of-fit and good reliability and validity. In summary, the RHBPCS is suggested for assessing the readiness for home-based palliative care of primary family caregivers.
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Affiliation(s)
- Meng-Ping Wu
- Department of Nursing, Taipei City Hospital, Taipei 103, Taiwan;
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei 112, Taiwan
| | - Lee-Ing Tsao
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei 112, Taiwan (retired at 2019);
| | - Sheng-Jean Huang
- Superintendent Office, Taipei City Hospital, Taipei 103, Taiwan;
- Department of Surgery, College of Medicine, National Taiwan University, Taipei 100, Taiwan
| | - Chieh-Yu Liu
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei 112, Taiwan
- Biostatistical Consultant Laboratory, Department of Speech Language Pathology and Audiology, National Taipei University of Nursing and Health Sciences, Taipei 112, Taiwan
- Department of Teaching and Research, Taipei City Hospital, Taipei 103, Taiwan
- Correspondence: ; Tel.: +886-2-2822-7101 (ext. 3312)
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Soroka JT, Fling KJ, Heibel JM, Kutcher GR, Ward SJ. Terminal Delirium in Hospice: The Experiences and Perspectives of Caregivers Providing Care to Terminally Ill Patients in Home Settings. Am J Hosp Palliat Care 2021; 39:27-33. [PMID: 33685252 DOI: 10.1177/10499091211000729] [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: 11/16/2022] Open
Abstract
OBJECTIVES Little is known about the experiences of caregivers who provide care to persons with terminal delirium (TD) in home settings. This scarcity of information is suggestive that further research is needed about care for hospice patients with delirium in the home and community. AIM To elicit views, feelings, and end-of-life care experiences of primary caregivers assisting dying persons with TD in hospice at home. DESIGN Qualitative, exploratory, cross-sectional study design was chosen. In-depth semistructured interviews explored caregiver experiences in caring for persons with TD. Qualitative thematic framework analysis was used. PARTICIPANTS Fifteen bereaved adult primary caregivers who received services from a hospice care program affiliated with a large nonprofit health system in the US Midwest. RESULTS Caregiver experiences were broad and reflected 4 major themes: symptomology, coping, effective and noneffective interventions, and support. The most distressing factors for caregivers were behaviors and symptomology of TD. They did not know what to say, how to respond, and how best to behave with someone who had delirium. Many caregivers had the impression that medication does not lessen delirium symptoms and that nonpharmacologic interventions are effective and beneficial only when they were important and meaningful to patients before delirium onset. CONCLUSIONS This study added new knowledge from direct and personal perspectives of caregivers providing end-of-life care to patients at home. Understanding developed about provision of care to someone with TD in home hospice. Improved comprehension of caregiver experiences can help professional hospice and palliative care staff better prepare caregivers for when patients have TD.
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Affiliation(s)
- Jacek T Soroka
- Chaplain Services, Mayo Clinic Health System, Mankato, MN, USA
| | - Krista J Fling
- Hospice Care, Mayo Clinic Health System, Mankato, MN, USA
| | | | | | - Sarah J Ward
- Social Services, Mayo Clinic Health System, Mankato, MN, USA
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Pepin E, Hébert J. Besoins des proches aidants qui accompagnent une personne en soins palliatifs et de fin de vie à domicile. Can Oncol Nurs J 2020; 30:141-146. [PMID: 33118984 DOI: 10.5737/23688076302141146] [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: 11/05/2022] Open
Abstract
Le maintien à domicile d'une personne en soins palliatifs et de fin de vie (SPFV) dépend grandement de la présence quotidienne de proches aidants (PA) et de leur implication dans les soins. Or, les besoins des PA tout au long de la trajectoire d'accompagnement d'un proche en SPFV à domicile sont encore relativement méconnus. Objectifs et méthode Cette étude qualitative descriptive s'intéresse au rôle des PA qui ont accompagné une personne recevant des SPFV à domicile dans le but de décrire leurs besoins tout au long de la trajectoire d'accompagnement. Ainsi, 20 PA ont participé à des entrevues semi-dirigées. Résultats et discussion L'étude met en lumière les besoins multiples des PA qui accompagnent un proche en SPFV à domicile. Les besoins informationnels, émotionnels et psychosociaux démontrent que les PA connaissent des changements dans leur rôle auprès de la personne malade. Les besoins spirituels ont été rapportés en termes de sens donné à l'expérience d'accompagnement. Enfin, les besoins pratiques mettent de l'avant l'importance d'avoir accès aux services de SPFV 24 h/24 et le caractère essentiel du soutien de l'infirmière. Conclusion Les besoins des PA qui accompagnent une personne en SPFV à domicile sont peu satisfaits. Il importe d'en tenir compte dans la trajectoire de soins, parallèlement aux besoins de la personne malade, afin d'améliorer l'expérience d'accompagnement qui précède la période de deuil.
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Affiliation(s)
- Elizabeth Pepin
- Infirmière clinicienne, étudiante à la maîtrise, Université du Québec à Rimouski, campus de Lévis, Maison Michel-Sarrazin,
| | - Johanne Hébert
- Directrice de recherche, Université du Québec à Rimouski, campus de Lévis, Maison Michel-Sarrazin, Centre intégré de santé et de services sociaux de Chaudière-Appalaches,
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Pepin E, Hébert J. Needs of caregivers of patients receiving in-home palliative and end-of-life care. Can Oncol Nurs J 2020; 30:147-152. [PMID: 33118991 DOI: 10.5737/23688076302147152] [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: 11/05/2022] Open
Abstract
Home support for patients receiving in-home palliative and end-of-life care (PELC) is greatly dependent on the daily presence of caregivers and their involvement in care delivery. However, the needs of caregivers throughout the care trajectory of a loved one receiving in-home PELC are still relatively unknown. Objectives and methodology This descriptive qualitative study focuses on the role of caregivers who have cared for a person receiving in-home PELC with the goal of describing their needs throughout the care trajectory. As part of this process, 20 caregivers took part in semi-directed interviews. Results and discussion This study sheds light on the multiple needs of caregivers of loved ones receiving in-home PELC. These informational, emotional, and psychosocial needs show that caregivers experience changes in their relationship with their loved one. Spiritual needs were expressed through the meaning ascribed to the home support experience. And the practical needs expressed by participants highlight the importance of round-the-clock access to PELC services and the essential importance of nursing support. Conclusion The needs of caregivers of loved ones receiving in-home PELC are not being met to a satisfactory degree. It is important to consider these needs in the care trajectory, alongside the needs of the patients themselves, in order to improve the support experience leading up to the bereavement period.
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Affiliation(s)
- Elizabeth Pepin
- Nurse Clinician, Master's Student, Université du Québec à Rimouski, Lévis Campus, Maison Michel-Sarrazin,
| | - Johanne Hébert
- Research Director, Université du Québec à Rimouski, Lévis Campus, Maison Michel-Sarrazin, Centre intégré de santé et de services sociaux de Chaudière-Appalaches,
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Choo PY, Tan-Ho G, Dutta O, Patinadan PV, Ho AHY. Reciprocal Dynamics of Dignity in End-of-Life Care: A Multiperspective Systematic Review of Qualitative and Mixed Methods Research. Am J Hosp Palliat Care 2019; 37:385-398. [DOI: 10.1177/1049909119878860] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Preserving terminally ill patients’ dignity and well-being through dignified and holistic care has become the overarching goal in palliative care services. However, dignity is a multifaceted concept with a wide range of interpretations under different cultural contexts. Aim: The aim of this review is to understand the variations in subjective interpretations and constitutions of dignity in palliative or end-of-life care via an integrative worldview. Design: This systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline and used SPIDER tool to screen for appropriate and relevant articles for analysis. Data Sources: Four major databases were searched including CINAHL, ERIC, Medline, and PsycARTICLES between 2009 and 2018. Forty-eight qualitative studies that examined dignity from the perspectives of patients, family caregivers, and health-care professionals were selected for full text data analysis using thematic synthesis. Results: Analysis of the various concepts of dignity revealed 18 themes that were further categorized into 7 conceptual categories: (1) self-determination, (2) existential liberty, (3) relational connectedness, (4) caregiving revitalization, (5) mindful humanity, (6) patient–family care, and (7) sustainable culture. These 7 categories span across individual, familial, and institutional dimensions, forming a new Dynamic Reciprocity of Dignity model. Conclusions: The Dynamic Reciprocity of Dignity model highlights the importance of adopting a systemic lens to address dignity-related needs and concerns at the end of life, while providing insights on how compassionate care and self-compassion can serve as the foundation of dignified care, which in turn serve as a buffer against patients’ existential suffering as well as caregivers’ burnout and fatigue. Recommendations for clinical practice and future research directions are discussed.
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Affiliation(s)
- Ping Ying Choo
- Psychology Programme, School of Social Sciences, Nanyang Technological University, Singapore
| | - Geraldine Tan-Ho
- Psychology Programme, School of Social Sciences, Nanyang Technological University, Singapore
| | - Oindrila Dutta
- Psychology Programme, School of Social Sciences, Nanyang Technological University, Singapore
| | - Paul Victor Patinadan
- Psychology Programme, School of Social Sciences, Nanyang Technological University, Singapore
| | - Andy Hau Yan Ho
- Psychology Programme, School of Social Sciences, Nanyang Technological University, Singapore
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- The Palliative Care Centre for Excellence in Research and Education, Singapore
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Kutcher GR, Soroka JT. Deactivating a Pacemaker in Home Care Hospice: Experiences of the Family Caregivers of a Terminally Ill Patient. Am J Hosp Palliat Care 2019; 37:52-57. [DOI: 10.1177/1049909119855608] [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
Objectives: Although the experiences of family members who care for relatives at the end of life have been researched extensively, little is known about the needs and experiences of families caring for hospice patients with pacemakers. Aim: To better understand the experiences of family caregivers of a terminally ill patient who received hospice care at home and chose deactivation of a pacemaker. Design: The exploratory, cross-sectional design involved semistructured, in-depth interviews. A narrative analysis focusing on form and content was chosen to analyze the data. Participants: Five bereaved caregivers from the Midwestern United States who provided care and participated in the deactivation of their family member’s pacemaker. Results: Four storylines that described, gave meaning to, and contextualized the caregivers’ experiences were identified: “I am done. I am not doing it anymore”; “Whatever you decide, I’ll support you”; “It is really difficult to watch, but you want to be there”; and “I will not have part of this.” Caregivers struggled with lack of support, understanding, and acceptance from medical providers when their family member decided to have her pacemaker deactivated, and they believed that the hospice model of care was appropriate to support and help them in that process. Conclusions: This research aids in understanding the ramifications of family-provided end-of-life care to a patient whose pacemaker has been deactivated. This can help to increase hospice clinicians’ knowledge regarding caregivers’ experiences facing deactivation of a pacemaker, before and after the patient’s death.
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Affiliation(s)
| | - Jacek T. Soroka
- Mayo Clinic Health System Hospice in Mankat, Mankato, Minnesota MN, USA
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Prater LC, Wickizer T, Bower JK, Bose-Brill S. The Impact of Advance Care Planning on End-of-Life Care: Do the Type and Timing Make a Difference for Patients With Advanced Cancer Referred to Hospice? Am J Hosp Palliat Care 2019; 36:1089-1095. [DOI: 10.1177/1049909119848987] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Purpose: This study aimed to determine the impact of advanced care planning (ACP) on potentially avoidable hospital admissions at the end of life (EOL) among a sample of hospice-referred patients with cancer, in order to present actionable considerations for the practicing clinician. Methods: This study was designed as a retrospective cohort using electronic health record data that assessed likelihood of hospital admissions in the last 30 days of life for 1185 patients with a primary diagnosis of cancer, referred to hospice between January 1, 2014, and December 31, 2015, at a large academic medical center. Inverse probability treatment weighting based on calculated propensity scores balanced measured covariates between those with and without ACP at baseline. Odds ratios (ORs) were calculated from estimated potential outcome means for the impact of ACP on admissions in the last 30 days of life. Results: A verified do-not-resuscitate (DNR) order prior to the last 30 days of life was associated with reduced odds of admission compared to those without a DNR (OR = 0.30; P < .001). An ACP note in the problem list prior to the last 30 days of life was associated with reduced odds of admission compared to those without an ACP note (OR = 0.71, P = .042), and further reduced odds if done 6 months prior to death (OR = 0.35, P < .001). Conclusions: This study shows that dedicated ACP documentation is associated with fewer admissions in the last 30 days of life for patients with advanced cancer referred to hospice. Improving ACP processes prior to hospice referral holds promise for reducing EOL admissions.
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Affiliation(s)
- Laura C. Prater
- Department of General Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Thomas Wickizer
- The Ohio State University College of Public Health, Columbus, OH, USA
| | - Julie K. Bower
- The Ohio State University College of Public Health, Columbus, OH, USA
| | - Seuli Bose-Brill
- Department of General Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Oechsle K. Current Advances in Palliative & Hospice Care: Problems and Needs of Relatives and Family Caregivers During Palliative and Hospice Care-An Overview of Current Literature. Med Sci (Basel) 2019; 7:medsci7030043. [PMID: 30871105 PMCID: PMC6473856 DOI: 10.3390/medsci7030043] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 03/01/2019] [Accepted: 03/05/2019] [Indexed: 12/18/2022] Open
Abstract
Palliative and hospice care aims to improve quality of life of patients’ relatives, but still little is known about their specific problems and needs. We present a comprehensive literature update. Narrative review to present an expert overview of peer-reviewed, English-written original research publications and reviews on psychosocial and existential problems, supportive needs as well as interventions for relatives during the patients’ disease trajectory published between January 2017 and November 2018. A total of 64 publications were included. Relatives report high rates of psychological and existential distress, burden and psychological morbidity during the total disease trajectory of the patient. In addition, relatives report an alarmingly high number of unmet needs with information being the central issue. Relatives’ problems and needs are part of complex systems influenced by various socio-demographic factors and patient–relatives-interactions and dependency between different psychological phenomena. First support interventions for relatives during disease trajectory have proven feasible and secondary data from randomized studies suggest beneficial effects of providing early palliative care also for relatives. Relatives should be addressed to a still larger extent in the daily practice of palliative and hospice care, thus further research to reveal more detailed systematic information is needed to improve relatives’ psychological burden and quality of life.
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Affiliation(s)
- Karin Oechsle
- Palliative Care Unit, Department of Oncology, Hematology and BMT, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany.
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Teruya N, Sunagawa Y, Sunagawa H, Toyosato T. Visiting Nurses' Perspectives on Practices to Achieve End-of-Life Cancer Patients' Wishes for Death at Home: A Qualitative Study. Asia Pac J Oncol Nurs 2019; 6:389-396. [PMID: 31572759 PMCID: PMC6696802 DOI: 10.4103/apjon.apjon_18_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective: This study aimed to clarify visiting nurses’ perspectives on critical practices to ensure they could advocate for patients who prefer to die at home. Methods: Sixteen nurses, working at home-visit nursing agencies in Japan, participated in this study. Data were generated by interviews with the nurses and participant observations from nursing home-visits for six end-of-life cancer patients and were analyzed using content analysis. Results: Five themes emerged: (1) nursing assessment, (2) support for comfortable daily life of the patient and their family, (3) advocating for the patient's views about continuing homecare until death, (4) supporting the patient's preparedness for death, and (5) coordination with other health professionals and related facilities for a comfortable environment for the patient. In addition, the nurses sometimes used humorous responses to death-related work to change the patient's melancholy thoughts. Conclusion: The present study found that the participants advocated for the patient's views about continuing homecare until death while coordinating views between the patient and their family; they further supported the patient's daily life while helping them prepare for death to achieve their wish for death at home. In addition, our study uncovered the visiting nurses’ unconscious practical wisdom of using humorous responses to death-related work to alleviate the patients’ feelings of hopelessness. To develop practical wisdom for using humor effectively in end-of-life care, nurses need to verbalize unconscious practices, and accumulate empirical knowledge about nursing interventions using humor, including cultural attitudes, through case study analysis.
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Affiliation(s)
- Noriko Teruya
- School of Health Sciences, Faculty of Medicine, University of the Ryukyus, Nishihara, Okinawa Prefecture, Japan
| | - Yoko Sunagawa
- School of Health Sciences, Faculty of Medicine, University of the Ryukyus, Nishihara, Okinawa Prefecture, Japan
| | - Haru Sunagawa
- School of Health Sciences, Faculty of Medicine, University of the Ryukyus, Nishihara, Okinawa Prefecture, Japan
| | - Takehiko Toyosato
- School of Health Sciences, Faculty of Medicine, University of the Ryukyus, Nishihara, Okinawa Prefecture, Japan
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