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Low CE, Loke S, Rana S, Sim B, Ho CSH. Prevalence and incidence of suicide, suicidal ideation and self-harm in caregivers of cancer patients: A systematic review and meta-analysis. Gen Hosp Psychiatry 2024; 90:35-43. [PMID: 38936297 DOI: 10.1016/j.genhosppsych.2024.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 06/19/2024] [Accepted: 06/20/2024] [Indexed: 06/29/2024]
Abstract
OBJECTIVE Caregiving burden is set to increase with the rising incidence of cancer globally. The meta-analysis seeks to investigate the prevalence of suicide, suicidal ideation and self-harm among the caregivers of patients with cancer (CPCs). METHODS This PRISMA-adherent systematic review involved a systematic search of PubMed, Embase, Cochrane and PsycINFO for all studies that evaluated the prevalence of suicide, suicidal ideation and self-harm in CPCs. Random effects meta-analyses were used for primary analysis. RESULTS Eleven studies were included. Meta-analyses indicated that the prevalence of suicidal ideation in CPCs was 11% (95%CI:6-18), suicide prevalence was 6% (95%CI:3-12), and self-harm prevalence was 15% (95%CI:8-26). Subgroup analyses revealed that CPCs above the age of 50 experienced a greater prevalence of suicidal ideation (17%, 95%CI:10-28) as compared to CPCs below 50 (6%, 95%CI:3-12). Family caregivers particularly spouses were also found to have a higher prevalence of suicidal ideation (17%, 95%CI:13-23), as compared to children (5%, 95%CI:2-10) or mothers (3%, 95%CI:1-8). Systematic review found that having a pre-existing mental health condition and lower socioeconomic status increased likelihood of suicidality. CONCLUSION We highlight the need for more support of CPCs at risk of suicidality. Additional research is warranted to identify other risk and protective factors.
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Affiliation(s)
- Chen Ee Low
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Sean Loke
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Sounak Rana
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ben Sim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Cyrus Su Hui Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Psychological Medicine, National University Hospital, Singapore.
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McCauley R, Ryan K, McQuillan R, Selman LE, Foley G. Supportive relationships between patients and family caregivers in specialist palliative care: a qualitative study of barriers and facilitators. BMJ Support Palliat Care 2024; 14:233-242. [PMID: 38050065 DOI: 10.1136/spcare-2023-004371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 11/18/2023] [Indexed: 12/06/2023]
Abstract
OBJECTIVES Patients with advanced illness and their family caregivers can be mutually supportive. However, what facilitates and/or restricts supportive relationships between patients and family caregivers in palliative care remains unclear. We aimed to identify key barriers to and facilitators of supportive relationships between people with advanced illness and family caregivers in specialist palliative care. METHODS A qualitative study using grounded theory methodology was conducted. Semistructured interviews were undertaken with 15 patients with advanced illness and 21 family caregivers purposively and theoretically sampled from a large regional specialist palliative care service. Verbatim transcripts were analysed in line with grounded theory coding procedures. RESULTS Mutual support was underpinned by mutual concern and understanding. Facilitators of supportive relationships included patients and family caregivers already having a close relationship, caregivers assuming caregiving duties by choice, caregivers feeling competent in a caregiving role, patients valuing caregiver efforts, availability of respite for the caregiver and direct support from healthcare professionals to help both patients and caregivers adjust to advanced illness. Barriers to supportive relationships included absence of support from the wider family, prior mutual conflict between the patient and caregiver, caregivers feeling constrained in their caregiving role and patient and caregiver distress induced by mutual loss. CONCLUSIONS Multiple factors at both a micro (eg, relationship based) and mesolevel (eg, assistance from services) impact patient and family caregiver ability to support one another in specialist palliative care. Supportive relationships between patients and family caregivers are mediated by feelings pertaining to both control and loss.
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Affiliation(s)
- Rachel McCauley
- Discipline of Occupational Therapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Karen Ryan
- St Francis Hospice Dublin, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Regina McQuillan
- St Francis Hospice Dublin, Dublin, Ireland
- Department of Palliative Care, Beaumont Hospital, Dublin, Ireland
| | - Lucy E Selman
- Palliative and End of Life Care Research Group, Population Health Sciences, Bristol Medical School, Bristol, UK
| | - Geraldine Foley
- Discipline of Occupational Therapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
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Benson JJ, Washington KT, Landon OJ, Chakurian DE, Demiris G, Oliver DP. When Family Life Contributes to Cancer Caregiver Burden in Palliative Care. JOURNAL OF FAMILY NURSING 2023; 29:275-287. [PMID: 37190779 PMCID: PMC10330805 DOI: 10.1177/10748407231167545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
The difficulties of caring for a family member with advanced cancer are well documented. Support from a caregiver's social network-especially other family-is vital to reducing caregiver burden and psychological distress. However, the family environment is not always supportive as reports of family conflict and dissatisfaction with support are common. Despite knowing that family relationships are complex, little is known about the types of family stress that caregivers of advanced cancer patients face in their daily lives. To address this gap, researchers applied concepts from the double ABCX model to conduct a reflexive thematic analysis of interviews with 63 caregivers of cancer patients receiving outpatient palliative care. Four themes of family stress were identified: failed support, relational tensions, denial, and additional care work. Findings inform clinical assessment and caregiver intervention development by revealing the importance of measuring the mundane machinations of family life for caregivers of adult cancer patients.
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Affiliation(s)
- Jacquelyn J. Benson
- Washington University in St. Louis, School of Medicine, Department Medicine, Division of Palliative Medicine
| | - Karla T. Washington
- Washington University in St. Louis, School of Medicine, Department Medicine, Division of Palliative Medicine
| | - Olivia J. Landon
- University of Missouri, College of Education and Human Development, Department of Human Development and Family Science
| | | | - George Demiris
- University of Pennsylvania, School of Nursing, Department of Biobehavioral and Health Sciences
- University of Pennsylvania, School of Medicine, Department of Biostatistics, Epidemiology, and Informatics
| | - Debra Parker Oliver
- Washington University in St. Louis, School of Medicine, Department Medicine, Division of Palliative Medicine
- Goldfarb School of Nursing, Barnes-Jewish College
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Laranjeira C, Dourado M. "Dignity as a Small Candle Flame That Doesn't Go Out!": An Interpretative Phenomenological Study with Patients Living with Advanced Chronic Obstructive Pulmonary Disease. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:17029. [PMID: 36554911 PMCID: PMC9778832 DOI: 10.3390/ijerph192417029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 12/10/2022] [Accepted: 12/14/2022] [Indexed: 06/17/2023]
Abstract
Long-term illness, such as chronic obstructive pulmonary disease (COPD), can expose people to existential suffering that threatens their dignity. This qualitative study explored the lived experiences of patients with advanced COPD in relation to dignity. An interpretative phenomenological approach based on lifeworld existentials was conducted to explore and understand the world of the lived experience. Twenty individuals with advanced COPD (GOLD [Global Initiative for Chronic Obstructive Lung Disease] stages III and IV) were selected using a purposive sampling strategy. In-depth interviews were used to collect data, which were then analysed using Van Manen's phenomenology of practice. The existential experience of dignity was understood, in essence, as "a small candle flame that doesn't go out!". Four intertwined constituents illuminated the phenomenon: "Lived body-balancing between sick body and willingness to continue"; "Lived relations-balancing between self-control and belongingness"; "Lived Time-balancing between past, present and a limited future"; and "Lived space-balancing between safe places and non-compassionate places". This study explains how existential life phenomena are experienced during the final phases of the COPD trajectory and provides ethical awareness of how dignity is lived. More research is needed to investigate innovative approaches to manage complex care in advanced COPD, in order to assist patients in discovering their inner resources to develop and promote dignity.
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Affiliation(s)
- Carlos Laranjeira
- School of Health Sciences, Polytechnic of Leiria, Campus 2, Morro do Lena–Alto do Vieiro, Apartado 4137, 2411-901 Leiria, Portugal
- Centre for Innovative Care and Health Technology (ciTechCare), Polytechnic of Leiria, Rua de Santo André—66–68, Campus 5, 2410-541 Leiria, Portugal
- Research in Education and Community Intervention (RECI I&D), Piaget Institute, 3515-776 Viseu, Portugal
- Center for Studies and Development of Continuous and Palliative Care (CEDCCP), Faculty of Medicine, University of Coimbra, Azinhaga de Santa Comba, Celas, 3000-548 Coimbra, Portugal
| | - Marília Dourado
- Center for Studies and Development of Continuous and Palliative Care (CEDCCP), Faculty of Medicine, University of Coimbra, Azinhaga de Santa Comba, Celas, 3000-548 Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, R. Larga, 3004-504 Coimbra, Portugal
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Cincidda C, Oliveri S, Sanchini V, Pravettoni G. The role of caregivers in the clinical pathway of patients newly diagnosed with breast and prostate cancer: A study protocol. Front Psychol 2022; 13:962634. [DOI: 10.3389/fpsyg.2022.962634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 10/17/2022] [Indexed: 11/05/2022] Open
Abstract
BackgroundCaregivers may play a fundamental role in the clinical pathway of cancer patients. They provide emotional, informational, and functional support as well as practical assistance, and they might help mediate the interaction and communication with the oncologists when care options are discussed, or decisions are made. Little is known about the impact of dyadic dynamics on patient-doctor communication, patient's satisfaction, or adherence to the therapies. This study protocol aims to evaluate the efficacy of a psychological support intervention on patients-caregivers relationship and their alignment in the treatment decision-making (TDM) process and estimate related improvement in patient' compliance/adherence to treatments.MethodsA total of 102 patients-caregivers' dyads will be involved, among breast and prostate cancer patients. The study entails a pre- post- evaluation through psychological questionnaires, with a randomization of participants in two conditions, the experimental one in which subjects participate in a psychological support consultation, and the control one, where dyads do not receive any intervention. A follow up after 6 months from the enrollment is planned.DiscussionA positive impact of the psychological support intervention on patients' anxiety, depression, distress, and perceived social support is expected. Such improvements can directly affect patients' satisfaction and adherence to treatments. Data gathered from this study may inform health care providers, policy makers, and public health managers about the importance of caregiver's involvement in the cancer care pathway, and the best way to manage it. A further impact is to develop a specific intervention protocol to support caregivers' involvement in cancer care pathway, improve patient's wellbeing, the interaction with physicians and the compliance with the cancer treatment.
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Wilson DM, Bykowski KA, Banamwana G, Bryenton FM, Dou Q, Errasti-Ibarrondo B. Intra-Family End-Of-Life Conflict: Findings of a Research Investigation to Identify Its Incidence, Cause, and Impact. OMEGA-JOURNAL OF DEATH AND DYING 2022:302228221133504. [PMID: 36216497 DOI: 10.1177/00302228221133504] [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: 11/15/2022]
Abstract
With few investigations of intra-family end-of-life conflict, this study sought to identify its incidence, cause, and impacts. A questionnaire was completed by 102 hospice/palliative nurses, physicians, and other care providers in Alberta, a Canadian province. Participants reported on how often they had observed intra-family conflict when someone in the family was dying, and the impacts of that conflict. 12 survey participants were then interviewed about the intra-family conflict that they had encountered, with interviews focused on why conflict occurred and what the impacts (if any) were. Nearly 80% of families were thought to experience end-of-life conflict, periodically or continuously, among various family members. The interviews confirmed three reasons for intra-family end-of-life conflict and three conflict outcomes that were revealed in a recent literature review. The findings indicate routine assessments for intra-family end-of-life conflict are advisable. Attention should be paid to preventing or mitigating this conflict for the good of all.
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Affiliation(s)
- Donna M Wilson
- Faculty of Nursing, University of Alberta, Edmonton, AL, CA
| | | | | | | | - Qinqin Dou
- Faculty of Nursing, University of Alberta, Edmonton, AL, CA
| | - Begoña Errasti-Ibarrondo
- Faculty of Nursing, University of Navarra and IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
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Hebdon MCT, Xu J, Reblin M, Clayton MF, Mooney K, Ellington L. Balancing Work and Hospice Caregiving-A Closer Look at Burden, Preparedness, and Mental Health. J Pain Symptom Manage 2022; 63:283-292. [PMID: 34425211 DOI: 10.1016/j.jpainsymman.2021.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 08/04/2021] [Accepted: 08/10/2021] [Indexed: 10/20/2022]
Abstract
CONTEXT Navigating end-of-life is stressful and many caregivers feel unprepared for caregiving tasks. Being employed may further increase caregiver burden. OBJECTIVES Study objectives were 1) to examine the relationships among caregiver burden (financial burden, daily schedule disruption, lack of family support) and mental health (depression and anxiety), and 2) explore if preparedness for caregiving mediates these relationships in employed hospice caregivers. METHODS This was a secondary analysis of baseline data from a prospective multi-site project of hospice family caregivers of cancer patients. Employed hospice caregivers (n = 166) completed items assessing burden, mental health, and preparedness for caregiving. Hierarchical linear regression and mediation analysis were conducted. RESULTS Caregivers were primarily White (n = 155, 93%) and female (n = 116, 70%), with a mean age of 55 (SD = 11.7). After controlling for demographic variables, financial burden was significantly related to anxiety (b =.16[.001, .32], P <.05), lack of family support was significantly related to depression (b = 1.27[.76, 1.79], P <.01), and daily schedule disruption was significantly related to both anxiety (b = 1.92[1.07, 2.77], P <.01), and depression (b =.70[.14, 1.26], P <.05) in regression analyses. In mediation analysis, financial burden, daily schedule disruption, and lack of family support were indirectly related to both depression and anxiety through preparedness for caregiving. CONCLUSION To better support employed caregivers, hospice team members should be ready to address concerns about finances, daily schedule changes, and family support and screen for preparedness for caregiving. Developing strategies to help employed hospice caregivers feel more prepared may mitigate adverse mental health outcomes.
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Affiliation(s)
- Megan C Thomas Hebdon
- University of Utah College of Nursing (M.C.T.H., M.F.C., K.M., L.E.), Salt Lake City, Utah, USA.
| | - Jiayun Xu
- Purdue University School of Nursing (J.X.), West Lafayette, Indiana, USA
| | - Maija Reblin
- University of Vermont Larner College of Medicine (M.R.), Burlington, Vermont, USA
| | - Margaret F Clayton
- University of Utah College of Nursing (M.C.T.H., M.F.C., K.M., L.E.), Salt Lake City, Utah, USA
| | - Kathi Mooney
- University of Utah College of Nursing (M.C.T.H., M.F.C., K.M., L.E.), Salt Lake City, Utah, USA
| | - Lee Ellington
- University of Utah College of Nursing (M.C.T.H., M.F.C., K.M., L.E.), Salt Lake City, Utah, USA
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8
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Michaels J, Chen C, Ann Meeker M. Navigating the caregiving abyss: A metasynthesis of how family caregivers manage end-of-life care for older adults at home. Palliat Med 2022; 36:81-94. [PMID: 34477025 DOI: 10.1177/02692163211042999] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Demographic changes (global aging, decreased fertility, increased home deaths) will present a critical need for end-of-life family caregivers of older adults at home. In order to support these family caregivers, we need to better understand their experiences, struggles, and needs. AIM To describe and explain the process of end-of-life caregiving as experienced by family caregivers of older adults residing in the home setting. DESIGN The Preferred Reporting Items for Systematic Reviews and Metaanalysis (PRISMA) guidelines and Sandelowski and Barroso's procedural steps for a metasynthesis review guided this study. DATA SOURCES Qualitative and mixed methods literature from CINAHL, Medline, PsycINFO, and EMBASE databases and information from professional organizations were reviewed for studies that focused on family caregivers providing end-of-life care to older adults residing in the home setting. RESULTS A total of 24 studies were identified. Family caregivers engaged in the process of "navigating a caregiving abyss" when providing and managing end-of-life-care for older adults at home. The "caregiving abyss" consisted of four phases: (1) managing multiple roles, (2) encountering challenges, (3) mobilizing resources, and (4) acknowledging death is near. During the process family caregivers strived to "live day by day" and "maintain normalcy" to achieve the goals of honoring life's final wishes and provide home death. CONCLUSION Family caregivers of older adults at the end of life navigate a variety of challenges. The findings provide a conceptual framework to help guide the development of education, interventions, and health policy to meet family caregivers' needs in providing quality end-of-life care.
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Affiliation(s)
- Jacqueline Michaels
- School of Nursing, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Chiahui Chen
- School of Nursing, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Mary Ann Meeker
- School of Nursing, University at Buffalo, The State University of New York, Buffalo, NY, USA
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9
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Russell D, Stoddard MD, Morgan N, McDonald MV, Dignam R, Bowles KH, Prigerson HG, Chughtai B. Nurse perspectives on the psychosocial care of patients with urinary incontinence in home hospice: A qualitative study. Palliat Med 2022; 36:135-141. [PMID: 34479463 DOI: 10.1177/02692163211043378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Urinary incontinence is prevalent among patients receiving home hospice and presents multiple care management challenges for nurses and family caregivers. AIM This study sought to understand how urinary incontinence influences the psychosocial care of patients receiving home hospice and the strategies that nurses employ to maximize patient and family comfort. DESIGN Qualitative descriptive study using semi-structured interviews. SETTING/PARTICIPANTS Nurses employed at a large not-for-profit hospice agency in New York City. RESULTS Analyses of 32 interviews revealed three primary themes. First, nurses considered urinary incontinence to be associated with multiple psychosocial issues including embarrassment for patients and caregiver burden. Second, nurses described urinary incontinence as a threat to patient dignity and took steps to preserve their continence function. Third, nurses assisted patients and their families to cope with urinary incontinence through normalization, reframing incontinence as part of the disease process, mobilizing caregiving assistance, and encouraging use of continence supplies such as diapers and liners. CONCLUSION Urinary incontinence influences the psychosocial care of patients receiving home hospice and nurses employ strategies to maximize patient and family comfort. Additional research is needed to examine the psychosocial benefits of facilitated discussions with patients and family members about incontinence, provision of caregiving support, and distribution of comprehensive incontinence supplies to patients with fewer resources.
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Affiliation(s)
- David Russell
- Department of Sociology, Appalachian State University, Boone, NC, USA.,Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, NY, USA
| | - Michelina D Stoddard
- Department of Urology, Weill Cornell Medicine/New York Presbyterian, New York, NY, USA.,Weill-Cornell/Rockefeller/Sloan Kettering Tri-Institutional MD-PhD Program, New York, NY, USA
| | - Natalie Morgan
- Department of Sociology, Appalachian State University, Boone, NC, USA
| | - Margaret V McDonald
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, NY, USA
| | | | - Kathryn H Bowles
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, NY, USA.,Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | | | - Bilal Chughtai
- Department of Urology, Weill Cornell Medicine/New York Presbyterian, New York, NY, USA
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Spatuzzi R, Vespa A, Fabbietti P, Ricciuti M, Rosati G, Guariniello L, Verrastro MAF, Attademo L, Giulietti MV. Elderly Helping Other Elderly: A Comparative Study of Family Caregiver Burden Between Patients With Dementia or Cancer at the End of Life. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2022; 18:96-108. [PMID: 35245165 DOI: 10.1080/15524256.2022.2042459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
A new reality is being observed around the world as the population ages: family caregivers, who are themselves older adults helping their ill older relatives. The aim of this study is to assess the burden of the older family caregiver assisting older patients in his or her end-of-life who are suffering from dementia or cancer. In this context, the elderly person is involved in the dual role of patient and caregiver. In this comparative study, a total of 87 older family caregivers (age ≥ 65 years) completed the Caregiver Burden Inventory (CBI) measurement. The sample was divided into 2 subgroups based on the individuals' advanced disease: Alzheimer's disease (AD) or cancer. Compared to cancer caregivers, the AD subgroup reported significantly higher scores in the CBI-emotional subscale (P = 0.006), confirmed by the evaluation of the generalized linear model (multivariate). There were no significant differences in the other CBI subscales and overall scores. According to the findings of this study, elderly who help elderly with AD are at a higher risk of experiencing an emotional burden than cancer caregivers. This data could be considered in designing interventions to reduce the caregiver burden of older family caregivers as they provide informal end-of-life care.
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Affiliation(s)
- Roberta Spatuzzi
- UOSD CSM Vulture-Melfese, Department of Mental Health, ASP Basilicata, Potenza, Italy
| | - Anna Vespa
- Clinic of Internal Medicine and Geriatrics, Scientific and Technological Area, INRCA-IRCCS National Institute of Health and Science on Aging, Ancona, Italy
| | - Paolo Fabbietti
- Biostatistical Center, INRCA-IRCCS National Institute of Health and Science on Aging, Ancona, Italy
| | | | - Gerardo Rosati
- Medical Oncology Unit, "San Carlo" Hospital, Potenza, Italy
| | - Lorella Guariniello
- UOSD CSM Vulture-Melfese, Department of Mental Health, ASP Basilicata, Potenza, Italy
| | | | - Luigi Attademo
- Department of Mental Health, Hospital Psychiatric Service of Diagnosis and Care at "San Carlo" Hospital, ASP Basilicata, Italian NHS, Italy
| | - Maria Velia Giulietti
- Clinic of Internal Medicine and Geriatrics, Scientific and Technological Area, INRCA-IRCCS National Institute of Health and Science on Aging, Ancona, Italy
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11
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Sajadi SA, Farsi Z, Akbari R, Sadeghi A, Akbarzadeh Pasha A. Investigating the relationship between quality of life and hope in family caregivers of hemodialysis patients and related factors. BMC Nephrol 2021; 22:383. [PMID: 34781888 PMCID: PMC8594219 DOI: 10.1186/s12882-021-02578-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 10/26/2021] [Indexed: 11/16/2022] Open
Abstract
Background Family caregivers of hemodialysis patients are the first and most crucial source of care at home. They experience many problems in the care of hemodialysis patients, which can affect their quality of life and hope, affecting the quality of care provided to patients. This study aimed to determine the relationship between quality of life and hope in family caregivers of hemodialysis patients. Methods A cross-sectional (descriptive-analytical) study performed on 300 family caregivers in the east of Mazandaran province in Iran. Data were collected using the Family Caregiver Quality of Life (FQOL), SF8 and adult hope scale. Data analysis was performed in SPSS version 16, and a P-value of below 0.05 was considered statistically significant. Results The results showed that, there was a direct and significant relationship between hope and quality of life. However, the quality of life was significantly lower in suburban residents, the unemployed, spouses, people with lower education and income levels, caregivers who cannot leave their patients alone, those living with their patients in the same house, and those taking care of male patients, compared to other participants (P < 0.05). Suburban residents, the unemployed, people with an insufficient level of income, and those living with their patients in the same house had significantly lower hope, compared to other subjects. Conclusion Since an increase of hope and quality of life of caregivers can cause improved quality of patient care, it is recommended that hope-based educational programs and interventions be implemented for caregivers.
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Affiliation(s)
- Seyedeh Azam Sajadi
- Department of Nursing Management, Faculty of Nursing, Aja University of Medical Sciences, Tehran, Iran
| | - Zahra Farsi
- Medical-Surgical Nursing, Research and Community Health Departments, Faculty of Nursing, Aja University of Medical Sciences, Tehran, Iran
| | - Roghayeh Akbari
- Department of Nephrology, School of Medicine, Health Research Institute, Babol University of Medical Sciences, Babol, Iran.
| | - Atefeh Sadeghi
- Dialysis Ward, Shahid Beheshti Hospital, Babol University of Medical Sciences, Babol, Iran
| | - Abazar Akbarzadeh Pasha
- Clinical Research Development Center Shahid Beheshti Hospital, Babol University of Medical Sciences, Babol, IR, Iran
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12
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Guo JW, Reblin M, Tay D, Ellington L, Beck AC, Cloyes KG. Patterns of stress and support in social support networks of in-home hospice cancer family caregivers. JOURNAL OF SOCIAL AND PERSONAL RELATIONSHIPS 2021; 38:3121-3141. [PMID: 34898795 PMCID: PMC8664070 DOI: 10.1177/02654075211024743] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Family caregivers of home hospice cancer patients often experience burden and distress, which can be mitigated by perceived social support. However, less attention has been paid to the non-family sources of support within social networks, or to how sources of support may also be sources of stress. We describe support and stress in social networks of hospice family caregivers and identify caregiving characteristics associated with classes identified in our data. We collected demographic and psychosocial self-report data from family caregivers providing in-home hospice care for advanced cancer patients (N = 90). Caregivers also reported perceived support and stress from specific family and non-family relationships. We identified three classes with unique patterns of stress and support within caregivers' support networks using a latent class analysis. Classes include: 1) high support, low stress across family and non-family network members ("supportive"; 53% of caregivers); 2) high support, high stress across family and non-family network ("ambivalent maximizers"; 26%); and 3) high support, high stress across family network only ("family-focused ambivalent"; 21%). Caregivers in the ambivalent maximizer class reported more burden than caregivers in the supportive class (p = .024). This is one of the first studies to systematically explore the role of non-family support, as well as how stress and support co-occur within relationships and across networks. As informal support networks of hospice family caregivers are complex and multifaceted, understanding the patterns of support and stress across various network members is essential to offer services to more effectively manage caregiver burden.
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Affiliation(s)
- Jia-Wen Guo
- University of Utah, College of Nursing, 10 South 2000 East, Salt Lake City, UT, USA 84112
| | - Maija Reblin
- Moffitt Cancer Centre, Health Outcomes and Behavior, 12902 Magnolia Dr, Tampa, FL, USA 33612
| | - Djin Tay
- University of Utah, College of Nursing, 10 South 2000 East, Salt Lake City, UT, USA 84112
| | - Lee Ellington
- University of Utah, College of Nursing, 10 South 2000 East, Salt Lake City, UT, USA 84112
| | - Anna C. Beck
- 1. University of Utah School of Medicine, Medical Oncology, 30 North 1900 East, Salt Lake City, UT, USA 84132; 2. University of Utah Health Huntsman Cancer Institute, Supportive Oncology and Survivorship, 1950 Circle of Hope, Salt Lake City, UT, USA 84112
| | - Kristin G Cloyes
- University of Utah, College of Nursing, 10 South 2000 East, Salt Lake City, UT, USA 84112
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The Relationship between Practitioners and Caregivers during a Treatment of Palliative Care: A Grounded Theory of a Challenging Collaborative Process. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18158081. [PMID: 34360374 PMCID: PMC8345580 DOI: 10.3390/ijerph18158081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/19/2021] [Accepted: 07/27/2021] [Indexed: 11/17/2022]
Abstract
The possibility of coming to a “good death” is a challenging issue that crosses ethical and religious beliefs, cultural assumptions, as well as medical expertise. The provision of palliative care for relieving patients’ pain is a practice that reshapes the path to the event of death and gives form to a particular context of awareness, recalling the notion proposed by Glaser and Strauss. This decision redesigns the relationships between patients, practitioners and caregivers and introduces a new pattern of collaboration between them. Our study focuses on the implications of the collaboration between practitioners and caregivers, starting from the assumption that the latter may provide support to their loved ones and to the practitioners, but need to be supported too. We provide a qualitative analysis of this collaboration based on an empirical research that took place in four different settings of provision of palliative care, reporting the contrast between the affective engagement of caregivers and the professional approach of practitioners. We claim that this ambivalent collaboration, while embedded in contingent and incommensurable experiences, brings to the fore the broader understanding of the path to a “good death,” outlining its societal representation as a collective challenge.
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Staats K, Grov EK, Husebø BS, Tranvåg O. Dignity of older home-dwelling women nearing end-of-life: Informal caregivers' perception. Nurs Ethics 2021; 28:444-456. [PMID: 33111614 PMCID: PMC8151564 DOI: 10.1177/0969733020956372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Most older people wish to live in the familiar surroundings of their own home until they die. Knowledge concerning dignity and dignity loss of home-dwelling older women living with incurable cancer should be a foundation for quality of care within municipal healthcare services. The informal caregivers of these women can help increase the understanding of sources related to dignity and dignity loss. AIM The aim of this study was to explore informal caregivers' perceptions of sources related to dignity and dignity loss in end-of-life of older home-dwelling women with incurable cancer. RESEARCH DESIGN AND METHOD The study was founded upon Gadamer's philosophical hermeneutics. In-depth interviews with 13 informal caregivers were carried out, and four participant observations were performed during home meetings. ETHICAL CONSIDERATION The study was based on voluntary participation, informed consent, confidentiality and the opportunity to withdraw at any time. The Norwegian Social Science Data Services approved the study. RESULTS Three main sources important in preserving the older women's dignity were identified: maintaining one's self-concept, remaining hopeful and sustaining freedom of choice. We also identified three main sources that lead to dignity loss: Sensing loss of human value, experiencing absence of gentleness and feelings of being treated as an object. DISCUSSION AND FINAL CONSIDERATIONS On the individual level, the opportunity to maintain one's self-concept and control in life, preserved dignity, while feelings of existential loneliness led to dignity loss. On the relational level, being confirmed as worthy human beings promoted the women's dignity, whereas dignity loss was related to uncaring behaviours from healthcare professionals. On the societal level, individual decisions concerning travel situations and the place to stay when nearing end-of-life were of crucial importance. Constituting these women's living space, these perspectives should be emphasized in healthcare professionals' educational training and in the municipal end-of-life care of these patients.
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Affiliation(s)
| | | | | | - Oscar Tranvåg
- 1657Western Norway University of Applied Sciences, Norway; Oslo University Hospital, Norway
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15
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Gottschalk S, Neubert L, König HH, Brettschneider C. Balancing care demands and personal needs: A typology on the reconciliation of informal dementia care with personal life based on narrative interviews. DEMENTIA 2021; 20:2689-2707. [PMID: 33847550 PMCID: PMC8670745 DOI: 10.1177/14713012211008306] [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] [Indexed: 11/21/2022]
Abstract
Finding a balance between care and personal needs is often challenging for individuals caring for a person with dementia. The present study aimed to understand how primary and secondary family carers of people with dementia perceive the reconciliation of informal care and their personal life throughout the course of care. Narrative interviews with 14 carers (n=10 female, mean age: 48.79) from seven care networks were conducted. The interviews were analysed using the documentary method. The result was a relational type formation which comprises different process types: ‘Respect your boundaries, stay calm, but plan ahead’, ‘Acting strategic is making it work’, ‘Reflect the situation, deal with it, and pull it through’ and ‘There is no alternative, you have to live with it’. This typology was based on two related dimensions: the way people negotiate their own needs against the demands of care (prospective, strategic, reflective and limited) and the resulting attitudes towards reconciling informal care and personal life (accepting, withstanding and enduring). The results yield implications for practice, such as considering individual needs and the care network to provide effective support and promoting the importance of self-care behaviours to achieve a balance between care and personal life.
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Affiliation(s)
- Sophie Gottschalk
- Department of Health Economics and Health Services Research, 37734University Medical Center Hamburg-Eppendorf, Hamburg Center for Health Economics, Germany
| | - Lydia Neubert
- Department of Health Economics and Health Services Research, 37734University Medical Center Hamburg-Eppendorf, Hamburg Center for Health Economics, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, 37734University Medical Center Hamburg-Eppendorf, Hamburg Center for Health Economics, Germany
| | - Christian Brettschneider
- Department of Health Economics and Health Services Research, 37734University Medical Center Hamburg-Eppendorf, Hamburg Center for Health Economics, Germany
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Silva YC, Silva KL. Constituição do sujeito cuidador na atenção domiciliar: dimensões psicoafetiva, cognitiva e moral. ESCOLA ANNA NERY 2020. [DOI: 10.1590/2177-9465-ean-2019-0335] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO Objetivo analisar o processo de subjetivação dos sujeitos cuidadores na atenção domiciliar. Método estudo qualitativo, realizado em um serviço de atenção domiciliar. Os dados foram coletados de fevereiro a junho de 2018, por meio da observação de 26 cuidadores e seis profissionais, seguida de acompanhamento aprofundado de quatro casos e entrevistas com seis profissionais e sete cuidadores informais. Utilizou-se a análise do discurso para a interpretação dos dados. Resultados os cuidadores são predominantemente mulheres com vínculo parental com o usuário. A constituição do cuidador está associada à dimensão psicoafetiva, que se refere aos valores afetuosos, sentimentos de retribuição, identidade e aptidão. A dimensão cognitiva relaciona-se à aprendizagem das atividades de cuidado e administrativas. Na dimensão moral, assumir a função de cuidador é revelada em concordância às normas socialmente construídas. Conclusão e implicações para a prática a subjetivação do cuidador deriva de uma relação do próprio eu, construída pela forma como esses sujeitos se relacionam com os discursos, as relações de poder, as experiências de cuidado e as normas sociais. Os achados podem contribuir para oportunizar momentos de reflexão com os cuidadores, em tempos e movimentos pelos quais eles aprendam sobre si e sobre o cuidado na atenção domiciliar.
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