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Coumoundouros C, Farrand P, Sanderman R, von Essen L, Woodford J. "Systems seem to get in the way": a qualitative study exploring experiences of accessing and receiving support among informal caregivers of people living with chronic kidney disease. BMC Nephrol 2024; 25:7. [PMID: 38172754 PMCID: PMC10765659 DOI: 10.1186/s12882-023-03444-3] [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: 09/20/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND The well-being of informal caregivers of people living with chronic kidney disease is influenced by their experiences with support, however, few studies have focused on exploring these experiences. This study aimed to explore informal caregivers' experiences accessing and receiving support while caring for someone living with chronic kidney disease. METHODS Informal caregivers of people living with chronic kidney disease (n = 13) in the United Kingdom were primarily recruited via community organisations and social media adverts to participate in semi-structured interviews. Interviews explored support needs, experiences of receiving support from different groups (e.g. healthcare professionals, family/friends), and barriers and facilitators to accessing support. Support was understood as including emotional, practical, and informational support. Data were analysed using reflexive thematic analysis. RESULTS Three themes were generated: (1) "Systems seem to get in the way" - challenges within support systems, illustrating the challenges informal caregivers encountered when navigating complex support systems; (2) Relying on yourself, describing how informal caregivers leveraged their existing skills and networks to access support independently, while recognising the limitations of having to rely on yourself to find support; and (3) Support systems can "take the pressure off", showing how support systems were able to help informal caregivers cope with the challenges they experienced if certain conditions were met. CONCLUSIONS In response to the challenges informal caregivers experienced when seeking support, improvements are needed to better consider informal caregiver needs within healthcare systems, and to develop interventions tailored to informal caregiver needs and context. Within the healthcare system, informal caregivers may benefit from system navigation support and better integration within healthcare teams to ensure their informational support needs are met. New interventions developed to support informal caregivers should fit within their existing support systems and incorporate the qualities of support, such as empathy, that were valued. Additionally, use of an equity framework and user-centered design approaches during intervention development could help ensure interventions are accessible and acceptable.
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Affiliation(s)
- Chelsea Coumoundouros
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Dag Hammarskjölds väg 14B, Uppsala, 751 05, Sweden
- Clinical Education, Development and Research (CEDAR); Psychology, University of Exeter, Exeter, UK
| | - Paul Farrand
- Clinical Education, Development and Research (CEDAR); Psychology, University of Exeter, Exeter, UK
| | - Robbert Sanderman
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Louise von Essen
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Dag Hammarskjölds väg 14B, Uppsala, 751 05, Sweden
| | - Joanne Woodford
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Dag Hammarskjölds väg 14B, Uppsala, 751 05, Sweden.
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2
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Solberg M, Berg GV, Andreassen HK. An emotional roller coaster - family members' experiences of being a caregiver throughout a cancer trajectory. Int J Qual Stud Health Well-being 2022; 17:2137965. [PMID: 36264025 PMCID: PMC9586637 DOI: 10.1080/17482631.2022.2137965] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Purpose To explore family members’ experiences of caregiving throughout a cancer trajectory from diagnosis until around one year after chemotherapy and radiation treatment ended. Method We conducted a longitudinal qualitative study using in-depth interviews with 13 family members at one to three points of time: before, during, and after treatment. To analyse the interviews, we leaned on Braun and Clark procedure for thematic analysis. Result The analysis revealed three themes in family members’ experiences of being a caregiver to a cancer patient throughout a cancer trajectory. These were: (1) From the time of diagnosis—overwhelming and uncertain; (2) During and after treatment—invisible and not involved; (3) Throughout the cancer trajectory—an emotional roller coaster. Conclusion The results indicated that the family members felt invisible and not involved and they experienced being a caregiver throughout the cancer trajectory as an emotional roller coaster. Our empirical findings thus indicate that in cancer care, family perspectives are yet to be implemented in daily practice. This is in contrast to explicit goals in current health policies underlining support and involvement of family members as a core aspect in cancer care.
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Affiliation(s)
- Monica Solberg
- Department of Health Siences in Gjøvik, Norwegian University of Science and Technology, Trondheim, Norway,Innlandet Hospital Trust, Norway,CONTACT Monica Solberg Norwegian University of Science and Technology and Innlandet Hospital Trust
| | - Geir Vegard Berg
- Department of Health Siences in Gjøvik, Norwegian University of Science and Technology, Trondheim, Norway,Innlandet Hospital Trust, Norway
| | - Hege Kristin Andreassen
- Department of Health Siences in Gjøvik, Norwegian University of Science and Technology, Trondheim, Norway,Technoligy and the Artic University of Norway, Tromsø, Norway
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3
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Sathiananthan MK, Crawford GB, Eliott J. Healthcare professionals' perspectives of patient and family preferences of patient place of death: a qualitative study. BMC Palliat Care 2021; 20:147. [PMID: 34544398 PMCID: PMC8454022 DOI: 10.1186/s12904-021-00842-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 08/30/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Home death is one of the key performance indicators of the quality of palliative care service delivery. Such a measure has direct implications on everyone involved at the end of life of a dying patient, including a patient's carers and healthcare professionals. There are no studies that focus on the views of the team of integrated inpatient and community palliative care service staff on the issue of preference of place of death of their patients. This study addresses that gap. METHODS Thirty-eight participants from five disciplines in two South Australian (SA) public hospitals working within a multidisciplinary inpatient and community integrated specialist palliative care service, participated in audio-recorded focus groups and one-on-one interviews. Data were transcribed and thematically analysed. RESULTS Two major and five minor themes were identified. The first theme focused on the role of healthcare professionals in decisions regarding place of death, and consisted of two minor themes, that healthcare professionals act to: a) mediate conversations between patient and carer; and b) adjust expectations and facilitate informed choice. The second theme, healthcare professionals' perspectives on the preference of place of death, comprised three minor themes, identifying: a) the characteristics of the preferred place of death; b) home as a romanticised place of death; and c) the implications of idealising home death. CONCLUSION Healthcare professionals support and actively influence the decision-making of patients and family regarding preference of place of death whilst acting to protect the relationship between the patient and their family/carer. Further, according to healthcare professionals, home is neither always the most preferred nor the ideal place for death. Therefore, branding home death as the ideal and hospital death as a failure sets up families/carers to feel guilty if a home death is not achieved and undermines the need for and appropriateness of death in institutionalised settings.
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Affiliation(s)
| | - Gregory B Crawford
- Northern Adelaide Palliative Services, Northern Adelaide Local Health Network, Adelaide, South Australia.,Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Jaklin Eliott
- School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia.
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4
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Moss KO, Douglas SL, Lipson AR, Blackstone E, Williams D, Aaron S, Wills CE. Understanding of Health-related Decision-making Terminology Among Cancer Caregivers. West J Nurs Res 2021; 43:649-659. [PMID: 33063642 PMCID: PMC8050115 DOI: 10.1177/0193945920965238] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Research on understanding health-related decision-making terminology among family caregivers of adults living with advanced cancer is lacking. The purpose of this study was to examine interpretations of the meaning of health-related decision-making terminology such as quality-of-life and end-of-life among caregivers of adults living with advanced cancer as a basis for improved understanding of caregiver decision support needs. Interviews were conducted with a purposive sub-sample of 10 caregivers of adults diagnosed with advanced cancer who completed a longitudinal, descriptive study (NRO14856) of factors influencing cancer care decisions. Audio transcripts were analyzed using qualitative descriptive methods. Caregivers described interpretations of the meaning and process of decision-making and decision-related distress. Caregivers were uncertain about the meaning of end-of-life-related terminology, and a placed high value on quality-of-life and faith/spirituality in the decision-making process. Improvements in information and decision support interventions are needed to better support caregivers and subsequently patients towards informed cancer care decisions.
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Affiliation(s)
- Karen O Moss
- Center for Healthy Aging, Self-Management and Complex Care, College of Nursing, The Ohio State University, Columbus, OH, USA
| | - Sara L Douglas
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Amy R Lipson
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Eric Blackstone
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Dionne Williams
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Siobhan Aaron
- Interdisciplinary Training in Cancer, Caregiving, and End-of-Life Care, College of Nursing, University of Utah, USA
| | - Celia E Wills
- Center for Healthy Aging, Self-Management and Complex Care, College of Nursing, The Ohio State University, Columbus, OH, USA
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5
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Chen HL, Annie Kao TS, Reuille KM, Northouse L. FOCUS Program: Treating Patients With Cancer and Family Caregivers as a Unit of Care. Clin J Oncol Nurs 2021; 25:E17-E25. [PMID: 34019018 DOI: 10.1188/21.cjon.e17-e25] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Studies indicate that patients' and caregivers' responses to illness are interdependent; each person affects the other. Existing evidence reinforces the need to recognize family caregivers as equal recipients of care and support. OBJECTIVES This evidence-based pilot study evaluated the feasibility and preliminary efficacy of the nurse-guided, psychoeducational, family-based FOCUS program intervention at a local oncology outpatient clinic. METHODS 30 patient-caregiver dyads were recruited from a local oncology clinic. Intervention delivery occurred using home visits and telephone calls. Self-administered questionnaires were used to assess participants' self-efficacy, quality of life (QOL), and coping pre- and postintervention, and intervention satisfaction postintervention. Three tailored psychosocial education sessions were held during a 6- to 9-week period. FINDINGS Significant changes in outcomes were found, including increased self-efficacy in both patients and caregivers, higher QOL in caregivers, and decreased use of substances for coping in patients. There was a trend for patients' emotional well-being to improve over time; other aspects of QOL showed little change. There were no significant changes in caregivers' coping.
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Abstract
OBJECTIVE The aim of this article was to provide new knowledge on how next of kin are co-creators of resilient performance, as seen from the viewpoint of the healthcare personnel and managers. The following research question guided the study: How are next of kin involved in shaping resilience within cancer care in hospitals? METHODS The design of the study is a case study of cancer departments in two Norwegian hospitals. Data collection included a total of 32 qualitative semistructured interviews at two organizational levels (managers and staff). The data were analyzed by ways of a directed content analysis according to Hollnagel's Resilience in Health Care framework of resilience potentials (anticipate, monitor, respond, learn). RESULTS Next of kin are involved in creating and maintaining resilience in cancer care by different kind of activities and in-depth insight into the patient's condition, which strengthen all resilience potentials of responding, anticipation, monitoring, and learning. We have identified nine areas in which next of kin are co-creators in shaping resilience. Next of kin are important stakeholders, both as safety experts and as safety resources, helping healthcare professionals provide quality and safety in the patient care process under difficult conditions. Next of kin's knowledge of the patient's history, their observation of the patient over time within the hospital, at home, and across care transitions are key elements of their contribution. CONCLUSIONS Next of kin complement healthcare professionals in all four potentials for resilient performance. The study suggests that the Resilience in Health Care framework takes into account the role of next of kin, as a stakeholder potential, because this has not previously been sufficiently considered.
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Hagedoorn EI, Paans W, van der Schans CP, Jaarsma T, Luttik MLA, Keers JC. Family caregivers' perceived level of collaboration with hospital nurses: A cross-sectional study. J Nurs Manag 2021; 29:1064-1072. [PMID: 33404173 PMCID: PMC8359371 DOI: 10.1111/jonm.13244] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 12/13/2020] [Accepted: 12/30/2020] [Indexed: 01/23/2023]
Abstract
Aim To describe the extent of perceived collaboration between family caregivers of older persons and hospital nurses. Background Collaboration between hospital nurses and family caregivers is of increasing importance in older patient's care. Research lacks a specific focus on family caregiver's collaboration with nurses. Method Using a cross‐sectional design, 302 caregivers of older patients (≥70 years) completed the 20‐item Family Collaboration Scale with the subscales: trust in nursing care, accessible nurse and influence on decisions. Data were analysed with descriptive statistics and bivariate correlations. Results Family caregivers rated their level of trust in nurses and nurses' accessibility higher than the level of their influence on decisions. Family caregivers who had more contact with nurses perceived higher levels of influence on decisions (p ≤ .001) and overall collaboration (p ≤ .001). Conclusion Family caregivers' collaboration with nurses can be improved, especially in recognizing and exploiting family caregivers as partner in the care for older hospitalized persons and regarding their level of influence on decisions. Implications for Nursing Management Insight into family caregivers' collaboration with nurses will help nurse managers to jointly develop policy with nurses on how to organise more family caregivers' involvement in the standard care for older persons.
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Affiliation(s)
- Ellen I Hagedoorn
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands.,Department of Health Psychology, University Medical Center, University of Groningen, Groningen, The Netherlands.,Research Group Nursing Diagnostics, Hanze University of Applied Sciences, Groningen, The Netherlands.,Department of Critical Care, University Medical Center, University of Groningen, Groningen, The Netherlands
| | - Wolter Paans
- Research Group Nursing Diagnostics, Hanze University of Applied Sciences, Groningen, The Netherlands.,Department of Critical Care, University Medical Center, University of Groningen, Groningen, The Netherlands
| | - Cees P van der Schans
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands.,Department of Health Psychology, University Medical Center, University of Groningen, Groningen, The Netherlands.,Department of Rehabilitation, University Medical Center, University of Groningen, Groningen, The Netherlands
| | - Tiny Jaarsma
- Department of Social and Welfare Studies (ISV), Linköping University, Linköping, Sweden
| | - Marie Louise A Luttik
- Research Group Nursing Diagnostics, Hanze University of Applied Sciences, Groningen, The Netherlands
| | - Joost C Keers
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands.,Martini Hospital, Groningen, The Netherlands
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Lemetti T, Partanen E, Hupli M, Haavisto E. Cancer patients' experiences of realization of relatives' participation in hospital care: a qualitative interview study. Scand J Caring Sci 2020; 35:979-987. [PMID: 33107636 DOI: 10.1111/scs.12918] [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: 02/12/2020] [Accepted: 10/05/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Relatives' participation in the care of patients with cancer in hospital is essential to both patients and relatives. Although the meaning of relatives' participation has been recognized, knowledge about how patients experience this participation is rare. AIMS To describe the experiences of patients with cancer of the realization of relatives' participation in the hospital care. MATERIALS & METHODS A qualitative study with semi-structured interviews of patients with cancer (n=21) were conducted. Data was analyzed using inductive thematic analysis. RESULTS Three main themes were identified among patients' experiences: Relative as part of the patient's care, Relative supporting patient's coping process, and Hospital enabling or preventing relatives' participation. The relatives were available for patients in seeking information and in the decision-making process. They helped with the daily needs of the patient, and supported patients emotionally and by managing everyday life at home. The behavior and attitudes of the healthcare professionals and the special nature of the hospital played a central role in the experiences. CONCLUSION The role of relatives is an important part of the coping process and care of patients with cancer in the hospital.
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Affiliation(s)
- Terhi Lemetti
- Department of Nursing Science, University of Turku, Turku, Finland.,Helsinki University Hospital, Helsinki, Finland
| | - Elli Partanen
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Maija Hupli
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Elina Haavisto
- Department of Nursing Science, University of Turku, Turku, Finland.,Hospital District of Satakunta, Pori, Finland
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9
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Abstract
Background In hospital cancer care, there is no set standard for next-of-kin involvement in improving the quality of care and patient safety. There is therefore a growing need for tools and methods that can guide this complex area. Objective The aim of this study was to present the results from a consensus-based participatory process of designing a guide for next-of-kin involvement in hospital cancer care. Method A consensus process based on a modified Nominal group technique was applied with 20 stakeholder participants from 2 Norwegian university hospitals. Result The participants agreed on the 5 most important priorities for hospital cancer care services when involving next-of-kin. The results showed that next-of-kin stakeholders, when proactively involved, are important resources for the patient and healthcare professionals in terms of contribution to quality and safety in hospitals. Suggested means of involving next-of-kin were closer interaction with external support bodies, integration in clinical pathways, adjusted information, and training healthcare professionals. Conclusion In this study, we identified topics and elements to include in a next-of-kin involvement guide to support quality and safety in hospital cancer care. The study raises awareness of the complex area of next-of-kin involvement and contributes with theory development and knowledge translation in an involvement guide tailored for use by healthcare professionals and managers in everyday clinical practice. Implications for Practice Service providers can use the guide to formulate intentions and make decisions with suggestions and priorities or as a reflexive tool for organizational improvement.
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10
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Factors affecting quality of end-of-life hospital care - a qualitative analysis of free text comments from the i-CODE survey in Norway. BMC Palliat Care 2020; 19:98. [PMID: 32635903 PMCID: PMC7341649 DOI: 10.1186/s12904-020-00609-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 06/28/2020] [Indexed: 12/30/2022] Open
Abstract
Background The ERANet-LAC CODE (Care Of the Dying Evaluation) international survey assessed quality of care for dying cancer patients in seven countries, by use of the i-CODE questionnaire completed by bereaved relatives. The aim of this sub study was to explore which factors improve or reduce quality of end-of-life (EOL) care from Norwegian relatives’ point of view, as expressed in free text comments. Methods 194 relatives of cancer patients dying in seven Norwegian hospitals completed the i-CODE questionnaire 6–8 weeks after bereavement; recruitment period 14 months; response rate 58%. Responders were similar to non-responders in terms of demographic details.104 participants (58% spouse/partner) added free text comments, which were analyzed by systematic text condensation. Results Of the 104 comments, 45% contained negative descriptions, 27% positive and 23% mixed. 78% described previous experiences, whereas 22% alluded to the last 2 days of life. 64% of the comments represented medical/surgical/oncological wards and 36% palliative care units. Four main categories were developed from the free text comments: 1) Participants described how attentive care towards the practical needs of patients and relatives promoted dignity at the end of life, which could easily be lost when this awareness was missing. 2) They experienced that lack of staff, care continuity, professional competence or healthcare service coordination caused uncertainty and poor symptom alleviation. 3) Inadequate information to patient and family members generated unpredictable and distressing final illness trajectories. 4) Availability and professional support from healthcare providers created safety and enhanced coping in a difficult situation. Conclusions Our findings suggest that hospitals caring for cancer patients at the end of life and their relatives, should systematically identify and attend to practical needs, as well as address important organizational issues. Education of staff members ought to emphasize how professional conduct and communication fundamentally affect patient care and relatives’ coping.
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11
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Roles of Family Caregivers and Perceived Burden When Caring for Hospitalized Adult Cancer Patients: Perspective From a Low-Income Country. Cancer Nurs 2020; 42:208-217. [PMID: 29601362 DOI: 10.1097/ncc.0000000000000591] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Family caregivers (FCGs) of adult cancer patients (ACPs) are typically involved in the entire trajectory of cancer disease, from diagnosis to survivorship or end of life. In developing countries, FCGs are more intensely involved in the process of providing care to the hospitalized ACPs because of lack of adequate cancer care resources. Active performance of tasks to meet the needs of ACPs in the hospital setting is likely to elicit significant caregiver burden. OBJECTIVE The aim of this study was to explore the tasks performed and the caregiver burden experienced by FCGs of hospitalized ACPs in a sub-Saharan country. METHODS A cross-sectional descriptive design was used to collect data from 168 FCGs of ACPs. The Caregiver Burden Scale was used to measure burden. RESULTS The most common cancer diagnosis in male and female ACPs was Kaposi's sarcoma (32.1%) and breast cancer (37.9%), respectively. The tasks regularly performed by most FCGs for the ACPs were providing emotional support (79.8%), feeding (68.5%), transporting to other appointments (62.5%), preparing meals (55%), and giving medications (46.4%). Most FCGs (75%) were experiencing severe or very severe general caregiver burden. The dimensions of caregiver burden that were most severely impacted were general strain (70.6%), disappointment (85.8%), and isolation (72%). Predictors of caregiver burden are reported. CONCLUSION Family caregivers of hospitalized ACPs experience severe caregiver burden. The main forms of burden experienced were general strain, disappointment, and isolation. IMPLICATIONS FOR PRACTICE Cancer care services in developing countries should be strengthened with services that address FCGs' emotional needs and human resources to curtail the strain imposed on FCGs.
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12
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Bergerød IJ, Dalen I, Braut GS, Gilje B, Wiig S. Measuring next of kin satisfaction with hospital cancer care: Using a mixed-method approach as basis for improving quality and safety. J Adv Nurs 2020; 76:1232-1246. [PMID: 32026486 DOI: 10.1111/jan.14315] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 01/02/2020] [Accepted: 01/23/2020] [Indexed: 12/16/2022]
Abstract
AIM/S To explore next of kin satisfaction with cancer care, map next of kin suggestions for involvement and combine this information to create a basis for improving quality and safety in hospitals. DESIGN Convergent parallel mixed-methods design applying the 20-item FAMCARE Scale survey instrument for quantitative measurement of satisfaction with care and with an open-ended question used for qualitative analysis. DATA SOURCES Responses from 238 next of kin (November 2016-November 2017). METHODS Exploratory factor analysis, regression analysis and qualitative content analysis were combined. RESULTS Both hospitals scored better in medical treatment (median, interquartile range: 1.5, 1.1-2.0), than in satisfaction with information and involvement of next of kin (1.9, 1.3-2.4), p < .001 (Wilcoxon signed ranks test). After adjusting for differences in demographical and clinical variables, the total FAMCARE scores were 13% higher (95% confidence interval: 1%-27%, Wald p = .029) at one of the hospitals. Qualitative findings support that the hospitals are not providing an equal offer to next of kin involvement in hospital cancer care that includes a proactive approach. CONCLUSION As a basis for quality and safety improvement, next of kin satisfaction and involvement in cancer care should be addressed in a two-sided perspective, balancing the next of kin's need for involvement in cancer treatment with the patient's perspective. IMPACT There is limited knowledge of next of kin satisfaction with hospital cancer care and how next of kin would like to be involved in this trajectory. Several aspects of satisfaction with cancer care can prompt change to improve service quality and safety (e.g. information, involvement, practical care), but this is an underused source of information. Next of kin are key in cancer care and our study demonstrates a potential large impact on future practical ways of improving cancer care service provision in an integrative perspective including next of kin.
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Affiliation(s)
- Inger J Bergerød
- Department of Hematology and Oncology, Stavanger University Hospital, Stavanger, Norway.,SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | | | - Geir S Braut
- Stavanger University Hospital, Stavanger, Norway
| | - Bjørnar Gilje
- Department of Hematology and Oncology, Stavanger University Hospital, Stavanger, Norway
| | - Siri Wiig
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
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13
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Rathnayake S, Jones C, Calleja P, Moyle W. Family carers' perspectives of managing activities of daily living and use of mHealth applications in dementia care: A qualitative study. J Clin Nurs 2019; 28:4460-4470. [DOI: 10.1111/jocn.15030] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 07/01/2019] [Accepted: 08/04/2019] [Indexed: 12/26/2022]
Affiliation(s)
- Sarath Rathnayake
- Menzies Health Institute Queensland Griffith University Nathan QLD Australia
- School of Nursing and Midwifery Griffith University Nathan QLD Australia
- Department of Nursing, Faculty of Allied Health Sciences University of Peradeniya Peradeniya Sri Lanka
| | - Cindy Jones
- Menzies Health Institute Queensland Griffith University Nathan QLD Australia
- Faculty of Health Sciences and Medicine Bond University Robina QLD Australia
| | - Pauline Calleja
- Menzies Health Institute Queensland Griffith University Nathan QLD Australia
- School of Nursing and Midwifery Griffith University Nathan QLD Australia
| | - Wendy Moyle
- Menzies Health Institute Queensland Griffith University Nathan QLD Australia
- School of Nursing and Midwifery Griffith University Nathan QLD Australia
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Abstract
BACKGROUND Patients with lung cancer often undergo surgery shortly after diagnosis. Despite undergoing extensive operation, many patients are transferred to a local hospital a few days after surgery. Transitions between different levels of care are risky due to common medication and follow-up errors. OBJECTIVE The study purpose was to explore patients' experiences of transfer between hospitals after lung cancer surgery. The study aim was to improve the quality of transitional care. METHODS In-depth interviews with 14 patients with lung cancer (6 men, 8 women) were conducted in the patients' homes. Interviews were audiotaped, transcribed, and analyzed using the hermeneutic analysis method. RESULTS Patients' experience of transfer between hospitals after lung cancer surgery is one of being in a caregiver gap characterized by feeling unprepared and uncertain, feeling unprotected and not being cared for, and suffering because of inadequate organization. Patients are vulnerable and at risk of injury before and during transfer, as well as after arrival at local hospitals. CONCLUSIONS Study findings highlight a rarely considered risk of inadequate care before, during, and after hospital transfer of vulnerable patients. Transition between hospitals after lung cancer surgery is a part of patient care for which there are no policies or care plans and a time during which the borders of responsibility between caregivers are unclear. IMPLICATIONS FOR PRACTICE It is important to develop guidelines for clearly defined responsibilities during transfer between hospitals. Healthcare providers need to plan transfers with the same rigor as they do hospital care.
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15
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Preisler M, Rohrmoser A, Goerling U, Kendel F, Bär K, Riemer M, Heuse S, Letsch A. Early palliative care for those who care: A qualitative exploration of cancer caregivers’ information needs during hospital stays. Eur J Cancer Care (Engl) 2019; 28:e12990. [DOI: 10.1111/ecc.12990] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 10/08/2018] [Accepted: 12/16/2018] [Indexed: 01/02/2023]
Affiliation(s)
- Martina Preisler
- Medical Department, Division of Hematology and Oncology; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health; Berlin Germany
| | - Amy Rohrmoser
- Medical Department, Charité Comprehensive Cancer Center; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health; Berlin Germany
| | - Ute Goerling
- Medical Department, Charité Comprehensive Cancer Center; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health; Berlin Germany
| | - Friederike Kendel
- Institute of Medical Psychology; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Berlin Germany
| | - Konrad Bär
- Medical Department, Division of Hematology and Oncology; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health; Berlin Germany
| | - Manuel Riemer
- Wilfrid Laurier University; Department of Psychology; Waterloo Ontario Canada
| | - Silke Heuse
- Institute of Medical Psychology; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Berlin Germany
| | - Anne Letsch
- Medical Department, Division of Hematology and Oncology; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health; Berlin Germany
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16
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Muliira JK, Kizza IB. The other untold burden of cancer in sub-Saharan Africa: Anxiety and depressive symptoms among family caregivers of adult cancer patients. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2019. [DOI: 10.1016/j.ijans.2019.100166] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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17
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Not a Straight Line—Patients’ Experiences of Prostate Cancer and Their Journey Through the Healthcare System. Cancer Nurs 2019; 42:E36-E43. [DOI: 10.1097/ncc.0000000000000559] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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18
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Hopeck P. Care Providers' Integration of Family Requests in End-of-life Communication: Understanding What to Do and Why to Do It. HEALTH COMMUNICATION 2018; 33:1277-1283. [PMID: 28820620 DOI: 10.1080/10410236.2017.1351273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
End-of-life situations are fraught with challenges for patients, family members, and individuals working at the patient's bedside. Care workers must address needs of the patient, as well as his or her distressed family members. This article is an inductive investigation of care workers' (nurses, patient advocates, and clergy) experiences with end-of-life discussions when the family asks to "do everything." Participants also noted resistance to hospice in some of these encounters based on pre-existing connotations of hospice held by the family members. The article concludes with a discussion about how identifying end-of-life terms may be transformed to be more accessible for family members.
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Affiliation(s)
- Paula Hopeck
- a Department of Communication Studies , Bloomsburg University of Pennsylvania
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19
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Koren D, Laidsaar-Powell R, Tilden W, Latt M, Butow P. Health care providers' perceptions of family caregivers' involvement in consultations within a geriatric hospital setting. Geriatr Nurs 2018; 39:419-427. [DOI: 10.1016/j.gerinurse.2017.12.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 12/11/2017] [Accepted: 12/18/2017] [Indexed: 11/25/2022]
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20
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Bergerød IJ, Gilje B, Braut GS, Wiig S. Next-of-kin involvement in improving hospital cancer care quality and safety - a qualitative cross-case study as basis for theory development. BMC Health Serv Res 2018; 18:324. [PMID: 29724207 PMCID: PMC5934831 DOI: 10.1186/s12913-018-3141-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 04/22/2018] [Indexed: 12/04/2022] Open
Abstract
Background Next-of-kin are an extension of healthcare professionals in all stages of cancer care. They offer care activities such as interpretations of symptoms, and reporting of negative or adverse effects of treatment, without any professional knowledge or skills. Their participation is often expected from healthcare professionals, managers, or the patient. However, there is limited knowledge of next-of-kin’s role in and contribution to quality and safety improvement in hospital cancer care. The aim of this study was to explore how managers and healthcare professionals understand the role of next-of-kin in cancer care, and what methods they use for next-of-kin involvement. Methods The study design was a comparative multiple embedded case study of cancer departments in two Norwegian university hospitals. Data collection methods consist of qualitative interviews with managers (13) and healthcare professionals (19) collected in 2016, and document analysis of policy documents and regulation. The interviews were analyzed according to a directed content analysis approach guided by the theoretical framework ‘Organizing for Quality’. Results Both hospitals have a strategy to involve next-of-kin in treatment and care but have no formal way of doing so. Managers and healthcare professionals in the two hospitals illuminated nine areas where next-of-kin are important stakeholders in improving quality and safety. These nine areas (e.g. nutrition, observations, transitions, pain treatment, information, palliative and terminal care) are common across the two hospitals. Key challenges in the next-of-kin involvement pertain to insufficient physical working conditions and room facilities, and lack of continuity of experienced nurses and consultants. Conclusion Hospital employees and managers regard next-of-kin as a safety net or a buffer that cannot be replaced by other stakeholders. This study shows a close collaboration between patient, next-of-kin and healthcare professionals in cancer care, but more effort should be invested in more systematic approaches for next-of-kin involvement in quality and safety improvement such as a guide for managers and healthcare professionals on methods and areas of involvement.
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Affiliation(s)
- Inger Johanne Bergerød
- Stavanger University Hospital, Gerd-Ragna Bloch Thorsens gate 8, 4011, Stavanger, Norway. .,SHARE - Center for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway.
| | - Bjørnar Gilje
- Stavanger University Hospital, Gerd-Ragna Bloch Thorsens gate 8, 4011, Stavanger, Norway
| | - Geir S Braut
- Stavanger University Hospital, Gerd-Ragna Bloch Thorsens gate 8, 4011, Stavanger, Norway
| | - Siri Wiig
- SHARE - Center for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
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21
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Partanen E, Lemetti T, Haavisto E. Participation of relatives in the care of cancer patients in hospital-A scoping review. Eur J Cancer Care (Engl) 2018; 27:e12821. [PMID: 29337413 DOI: 10.1111/ecc.12821] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2017] [Indexed: 11/29/2022]
Abstract
The purpose of the review was to describe what kind of research has been conducted concerning relatives' participation in the care of cancer patients in hospital and how relatives have participated in the care. Data (n = 9) were identified through a manual search and by searching the electronic databases (n = 8) Cinahl, PubMed and Cochrane Library and analysed with deductive content analysis. According to the review, participation in the concrete care appeared as taking care of comprehensive care and the quality of care, helping with daily activities and helping the healthcare professionals. Emotional support appeared as protecting, supporting and visiting the patient and discussing with the patient. Participation in decision-making appeared as acting as an advocate for the patient, participating in the discussion concerning the decision-making and participating in the discussion concerning the decisions of end of life. According to the review, research concerning this topic seems to be rare. While hospital periods are shortening and homecare is increasing, the role of relatives as a supporter of the cancer patient is becoming even stronger. In the future, more research should be conducted how the patients experience participation and what are their wishes.
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Affiliation(s)
- E Partanen
- Department of Nursing Science, University of Turku, Turku, Finland.,Helsinki University Hospital, Helsinki, Finland
| | - T Lemetti
- Department of Nursing Science, University of Turku, Turku, Finland.,Helsinki University Hospital, Helsinki, Finland
| | - E Haavisto
- Department of Nursing Science, Hospital District of Satakunta, University of Turku, Turku, Finland
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22
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Aspects of family caregiving as addressed in planned discussions between nurses, patients with chronic diseases and family caregivers: a qualitative content analysis. BMC Nurs 2017; 16:37. [PMID: 28701898 PMCID: PMC5504762 DOI: 10.1186/s12912-017-0231-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 06/29/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Caregiving by family members of elderly with chronic conditions is currently intensifying in the context of an aging population and health care reform in the Netherlands. It is essential that nurses have attention for supporting roles of family caregivers of older patients and address family caregiving aspects on behalf of the continuity of care. This study aims to explore what aspects of family caregiving were addressed during planned discussions between nurses, patients and family caregivers in the hospital. METHODS Qualitative descriptive research was conducted using non-participant observation and audio-recordings of planned discussions between nurses, older patients and their family caregivers as they took place in the hospital. Through purposive sampling eligible patients (≥ 65 years) with one or more chronic conditions were included. These patients were admitted to the hospital for diagnostics or due to consequences of their chronic illness. Retrospective chart review was done to obtain patient characteristics. Data were collected in November/December 2013 and April/May 2014 in four hospitals. Qualitative content analysis was performed using the inductive approach in order to gain insight into addressed aspects of family caregiving. RESULTS A total of 62 patients (mean age (SD) 76 years (7.2), 52% male) were included in the study, resulting in 146 planned discussions (62 admission and discharge discussions and 22 family meetings). Three themes were identified regarding addressed aspects of family caregiving. Two themes referred to aspects addressing the patients' social network, and included 'social network structure' and 'social network support'. One theme referred to aspects addressing coordination of care issues involving family caregiving, referred to as 'coordination of care'. CONCLUSIONS During discussions nurses mostly addressed practical information on the patients' social network structure. When specific family caregiving support was addressed, information was limited and nurses did not seem to explore the nature of the family support. Patients discharge and after care needs were addressed occasionally as aspects of coordination of care. Current nursing policies could be evaluated on nursing and family oriented theories. Implications for education could include mirroring study findings with nurses in a group discussion to enhance their awareness on family caregiving aspects.
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23
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Johnstone MJ, Hutchinson AM, Rawson H, Redley B. Nursing Strategies for Engaging Families of Older Immigrants Hospitalized for End-of-Life Care: An Australian Study. J Patient Exp 2016; 3:57-63. [PMID: 28725839 PMCID: PMC5513648 DOI: 10.1177/2374373516667004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Engaging with families of older non-English-speaking background (NESB) immigrants hospitalized for end-of-life (EOL) care can be challenging, especially when their cultures, lifeways, and family decision-making processes are unfamiliar to the nurses caring for them. Despite the recognized importance of family engagement when providing EOL care, the issue of ethnic minority family engagement has received little attention in the field. AIM To explore and describe the strategies nurses use to facilitate engagement with families of older immigrant NESB patients hospitalized for EOL care. METHODS A qualitative descriptive approach was used. Data were collected via in-depth interviews conducted with 22 registered nurses recruited from 4 Australian health services. FINDINGS Using thematic analysis processes, 5 key strategies were identified: listening and understanding families, encouraging family members to speak first, dealing with angst, redressing naive views about the dying process, and managing intergenerational differences. Underpinning these strategies was a profound "will to engage" with the families and their cultural worldviews. CONCLUSION Further cross-cultural comparative research is required to inform evidence-based policies, practice, and education on this issue.
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Affiliation(s)
- Megan-Jane Johnstone
- School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia
| | - Alison M Hutchinson
- School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia
| | - Helen Rawson
- School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia
| | - Bernice Redley
- School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia
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24
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Zaider TI, Banerjee SC, Manna R, Coyle N, Pehrson C, Hammonds S, Krueger CA, Bylund CL. Responding to challenging interactions with families: A training module for inpatient oncology nurses. FAMILIES, SYSTEMS & HEALTH : THE JOURNAL OF COLLABORATIVE FAMILY HEALTHCARE 2016; 34:204-212. [PMID: 27632541 PMCID: PMC5213594 DOI: 10.1037/fsh0000159] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Sustaining the well-being of the caregiving family is a critical agenda in cancer care. In the multidisciplinary team, nurses often serve as a bridge between the family and oncology team. Evidence suggests that dealing with difficult family dynamics is a common source of stress for oncology nurses, yet nurses typically receive very little guidance on how to achieve an effective partnership with families under these circumstances. We report on the application and preliminary evaluation of a new training module for improving nurses' skills in responding collaborative to challenging family situations. METHOD Training was delivered to 282 inpatient oncology nurses at a comprehensive cancer center over 2 years. Posttraining surveys measured perceived changes in confidence working with families, as well as the utility and relevance of this training. A 6-month follow-up survey measured continued use of skills. RESULTS Of the nurses, 75%-90% reported that the skills learned were useful and relevant to their setting. Retrospective pre-post ratings suggested increased confidence in managing stressful encounters with families. DISCUSSION Further investigation is needed to observe how nurses transport these skills into their practice settings and to understand the role of the nurse-as-family champion within the larger multidisciplinary team. (PsycINFO Database Record
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Affiliation(s)
- Talia I Zaider
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center
| | - Smita C Banerjee
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center
| | - Ruth Manna
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center
| | - Nessa Coyle
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center
| | - Cassandra Pehrson
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center
| | - Stacey Hammonds
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center
| | - Carol A Krueger
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center
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Aldaz BE, Treharne GJ, Knight RG, Conner TS, Perez D. Oncology healthcare professionals’ perspectives on the psychosocial support needs of cancer patients during oncology treatment. J Health Psychol 2016; 22:1332-1344. [DOI: 10.1177/1359105315626999] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This study explored oncology healthcare professionals’ perspectives on the psychosocial support needs of diverse cancer patients during oncology treatment. Six themes were identified using thematic analysis. Healthcare professionals highlighted the importance of their sensitivity, respect and emotional tact during appointments in order to effectively identify and meet the needs of oncology patients. Participants also emphasised the importance of building rapport that recognises patients as people. Patients’ acceptance of treatment-related distress and uncertainty was described as required for uptake of available psychosocial supportive services. We offer some practical implications that may help improve cancer patients’ experiences during oncology treatment.
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