Quality of life of caregivers of end-stage kidney disease patients: Caregivers or care recipients?

BACKGROUND

End-stage kidney disease (ESKD) patients require specific and continuous care, which affects caregivers' quality of life (QOL). It is necessary to define the basic problems and restrictions upon family caregivers of renal patients affecting their physical and psychological status.

OBJECTIVES

The main objectives of this narrative review were to examine the literature over the past 10 years, to describe factors associated with QOL of caregivers of patients with ESKD, and to identify the level of subjective burden reported by caregivers.

METHODS

A literature search was carried out using the following electronic databases: PubMed, Medscape, Science Direct, Scopus, PsychINFO and other scientific sources. Keywords included 'quality of life', 'caregivers', 'end stage kidney or renal disease patients', 'burden' and a combination of these terms. Only studies from January 2010 to December 2020 were included in this study.

RESULTS

The results found that there was significant burden and distress experienced by caregivers that affected their QOL. Patients' QOL is associated with caregivers' QOL. The hours of caring per day and the long-term replacement therapy are associated with great burden.

CONCLUSIONS

More awareness to caregivers' QOL is required to meet their needs, reduce anxiety and to improve patients' QOL. Caregiver support could empower and prepare them for initiation of replacement therapy. This can potentially enhance their diseased family members' QOL and could also restrict the use of health care system resources. Given how difficult it is to conceptualize QOL, a holistic approach to patients and caregivers require QOL assessment in each stage of the kidney disease.

The Associations Between Illness Perceptions and Expectations About Return to Work of Workers With Chronic Diseases and Their Significant Others: A Dyadic Analysis

Purpose To examine the associations between illness perceptions and expectations about full return to work (RTW) of workers with chronic diseases and their significant others. Methods This study used cross-sectional data of 94 dyads consisting of workers with chronic diseases and their significant others. We performed dyadic analyses based on the Actor-Partner Interdependence Model (APIM), estimating associations of illness perceptions of the two members of the dyad with their own expectations about the worker's full RTW within six months (actor effect) as well as with the other dyad member's expectations about the worker's RTW (partner effect). Results Illness perceptions of one dyad member were significantly associated with his or her own RTW expectations (actor effect composite illness perceptions score; B = -0.05, p < .001; r_d = .37) and with the other dyad member's RTW expectations (partner effect composite illness perceptions score; B = -0.04, p < .001; r_d = .35). That is, more negative illness perceptions of one member of the dyad were associated with more negative RTW expectations in both dyad members. For most illness perception domains, we found small to moderate actor and partner effects on RTW expectations (r_d range: .23-.44). Conclusions This study suggests that illness perceptions and RTW expectations should be considered at a dyadic level as workers and their significant others influence each other's beliefs. When trying to facilitate adaptive illness perceptions and RTW expectations, involving significant others may be more effective than an individualistic approach targeted at the worker only.

A prospective cohort study of decision-making role preferences of patients with advanced cancer and their family caregivers

BACKGROUND

This study aimed to examine (1) the evolution of patients-caregiver dyad decision-making role preferences over 3 years and the predictors of these preferences; and (2) discordance in decision-making role preferences among dyads.

METHODS

A total of 311 patients with advanced solid cancer and their caregivers in Singapore reported their preferences for decision-making roles every 3 months. The predictors for decision-making role preferences among dyads were identified via the actor-partner interdependence framework using a mixed-effect ordered logistic model.

RESULTS

The proportion of patients and caregivers preferring patient-led decision-making was higher at the end of third year compared to baseline (patients: 40% vs. 20%, p value <.01; caregivers: 33% vs. 21%, p value = .03). Patients with female (odds ratio [OR], 1.74; p value <.01) and older (1-year OR, 1.02; p value <.01) caregivers and younger patients (1-year OR, 0.97; p value <.01) preferred higher involvement in decision-making. Caregivers with tertiary education (vs. lower education) (OR, 1.59; p value = .02) and those who accurately understood patients' treatment goals (OR, 1.37; p value = .01) preferred greater patient involvement in decision-making. Conversely, caregivers of female patients (OR, 0.68; p value = .03) and younger patients (1-year OR, 0.98; p value <.01) preferred lesser patient involvement in decision-making. The proportion of patient-caregiver dyads with discordance in preferred decision-making was lower at the end of the third year (51%) compared to baseline (68%) (p value <.01).

CONCLUSION

Despite a reduction in the proportion of dyads with discordance toward the end-of-life, the percentage with discordance remained high throughout the illness trajectory. Interventions facilitating open communication between dyads should be pursued in efforts to decrease dyadic discordance.

The Mediating Role of Illness Cognitions in the Relationship Between Caregiving Demands and Caregivers' Psychological Adjustment

OBJECTIVE

The present study investigated whether illness cognitions mediated the relationship between caregiving demands and positive and negative indicators of adjustment in partners of patients with chronic pain.

METHODS

The sample of this cross-sectional study consisted of 151 partners (mean age=61.4 y, SD=13.6 y, 57% male) of patients with chronic pain (eg, back pain). The study was conducted in the Pain Centre of the University Medical Centre Groningen, The Netherlands, during November 2014 to June 2015. Participants completed questionnaires that assessed caregiving demands, illness cognitions, perceived burden, distress, positive affect, and life satisfaction.

RESULTS

The results showed that among illness cognitions, acceptance of the illness mediated the association between caregiving demands and burden (b=0.16, 95% confidence interval [CI]: 0.05-0.28) and positive affect (b=-0.21, CI: -0.41 to -0.06). Helplessness mediated the association between caregiving demands and burden (b=0.46, CI: 0.26-0.69) and distress (b=0.35, CI: 0.19-0.53). Perceived benefits did not mediate any of these associations. The findings indicate that partners who experience more demands tend to appraise the consequences of the patients' pain condition more negatively, which in turn is associated with their emotional adjustment.

DISCUSSION

The results suggest that illness cognitions play an important role in the psychological adjustment of partners. Enhancing acceptance of the illness and reducing feelings of helplessness could form the basis of interventions aiming at promoting psychological adjustment in partners, especially when it is difficult to reduce the demands.

Understanding the problem of long-term treatment adherence: a phenomenological framework

In light of the large burden of chronic disease and the low rates of long-term treatment adherence contributing to high rates of morbidity and mortality worldwide, this paper contributes to better understanding the particular kind of challenge that living with chronic illness and adhering to long-term treatment can imply. Both literature on the concept of chronic disease and the experience of illness suggest going outside specific diagnostic categories to better understand the problem of adherence. After introducing the distinction of a thin understanding of chronicity-merely as long duration-and a thick one-chronicity in a phenomenological sense, this paper analyses academic literature on the experience of illness and specifies it to the case of chronic diseases, introducing an original conceptual framework describing some main challenges arising from the experience of chronic disease. The framework is organised in three dimensions: failing to recover as a failure to belong, being at a loss and breaking-up with oneself. This work suggests a particular subjective state in which struggling to follow long-term treatment may seem understandable and reasonable, offering a phenomenological perspective that feeds into the ethical problems arising in chronic diseases, and shedding light on how to increase adherence without reproducing patterns of disadvantage.

The association of cognitive representations with psychological adjustment in experience of infertility and fertility treatment: A systematic review

INTRODUCTION

The aim of this systematic review was to examine studies describing the association of cognitive representations with psychological adjustment or maladjustment during the experience of infertility and its treatment in light of the Common-Sense Model. According to this theoretical model cognitive perceptions about an illness can be associated with emotional adaptation.

METHODS

A systematic search of four electronic databases (PubMed, APA PsycINFO, SCOPUS, ScienceDirect) was performed. This review considered only quantitative, primary studies in the English language without geographical limitations, published during the period 1996–2020 and relevant to the objective. The population of interest was infertile individuals who are having or not having infertility treatment. Only studies that examined the association between independent variables, such as perceived causes, timeline, controllability, consequences, symptoms, illness coherence and emotional representations, with psychological variables, such as anxiety, worry, distress, depression and well-being, were included. Two authors performed an independent extraction of articles using predefined data fields. Relevant articles were critically appraised and a narrative synthesis was conducted.

RESULTS

Seven cross-sectional studies met the inclusion and methodological criteria and were included in the review. The review results revealed that all components of cognitive representations of infertility and its treatment may correlate with psychological adaptation of people who deal with a fertility problem, at intrapersonal and interpersonal level.

CONCLUSIONS

This systematic review suggested that the Common-Sense Model is an appropriate theoretical model to be applied in the experience of infertility and health professionals can make interventions based on modifying cognitive perceptions of a fertility problem that may increase levels of psychological well-being and decrease levels of distress.

The actor-partner interdependence model in shared decision-making: an illustrative example of its application to the physician-patient dyad in primary care consultations

OBJECTIVES

We applied the actor-partner interdependence model, a method used to evaluate the relationship process between two related persons, to patient-physician data about the effect of shared decision-making behaviors on patient and physician uncertainty. We discuss measurement and interpretation problems.

STUDY DESIGN AND SETTING

The EXACKTE² project was a cross-sectional study of 263 unique patient-physician dyads in 17 primary care clinics in Canada. Participants independently completed self-administered questionnaires postconsultation to measure patients' and physicians' perceptions of shared decision-making behaviors and their uncertainty about whether the decision was the best one for the patient. We used the actor-partner interdependence model to explore the effect of shared decision-making behaviors on patient and physician uncertainty.

RESULTS

Application of the actor-partner interdependence model to our data showed significant actor effects only. Our exploratory analysis suggested that an appropriate dyadic pattern for this context would be the couple-oriented model.

CONCLUSION

Each actor's perception of the physicians' shared decision-making behaviors appeared only to affect their own uncertainty (actor effects), but the questionnaire may have been inadequate for identifying partner effects. Researchers should further explore using the actor-partner interdependence model to analyze actor-partner interdependence in the physician-patient relationship, and format questions tailored precisely to the model.

The Relationship between Burden and Depression in Spouses of Chronic Kidney Disease Patients

The purpose of the present study was to investigate the burden and depression in spouses of patients with chronic kidney disease (CKD). The interrelation between burden and depression in family caregivers has been pointed out by previous researches in several chronic diseases and researchers agree that they clearly go together and one cannot talk about one without considering the other. More particularly, in the present study, the caregiver burden, the depression, anxiety, and also health-related quality of life and demographic factors of spouses of patients with CKD were examined, using self-report questionnaires. Participants were 50 spouses of patients with CKD, 29 of whom were dialysis dependent and 21 were not dialysis dependent. Group differences were examined for participants. Results confirm the interrelation between caregiver burden and depression in spouses. The increased perceived burden related to higher levels of depression. Low levels of caregiver burden, depression, anxiety, and satisfactory quality of life were found in spouses, with no differences between them relevant to whether the patients were dialysis dependent or not. All the above parameters interrelated. Implications for the findings and future research directions are discussed.

Distress in significant others of patients with chronic fatigue syndrome: A systematic review of the literature

PURPOSE

The objective of this study was to systematically review existing empirical research assessing levels and correlates of distress in significant others of patients with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME).

METHODS

Systematic searches in CINAHL, Web of Science and PsycINFO were conducted in August 2014. The search was repeated in January 2015 to check for newly published articles. Studies published in English with quantitative, qualitative, or mixed designs exploring distress, poor subjective health, poor mental health, reduced quality of life and well-being, and symptoms of depression and anxiety in significant others (>18 years) of children and adults with CFS/ME were included. Quality appraisal of included studies was carried out. Quantitative and qualitative studies were summarized separately.

RESULTS

Six articles met eligibility criteria. Two quantitative studies with significant others of adult patients, and one quantitative and two mixed-methods studies with significant others of child patients showed moderate to high levels of distress. One qualitative study (adult patients) found minimal evidence of distress and that acceptance of CFS/ME was related to better adjustment. In the quantitative and mixed-methods studies, significant others who attributed some level of responsibility for symptoms to the patient, or who were female, or whose partners had poorer mental health, had higher levels of distress.

CONCLUSIONS

The small number of studies to date, the contrary evidence from a qualitative study, and the limited data available on levels of distress in significant others of patients with CFS/ME mean that our conclusion that distress levels are elevated is provisional. We recommend that future qualitative studies focus on this particular topic. Further longitudinal studies exploring correlates of distress within the context of a predictive theoretical model would be helpful. Statement of contribution What is already known on this subject? Chronic fatigue syndrome (CFS/ME) entails considerable economic, social, and personal costs. Uncertainties exist around diagnosis and management. This may lead to particular difficulties for significant others trying to support patients. What does this study add? Few studies have examined distress and its correlates in significant others of people with CFS/ME. Significant others report elevated levels of distress on quantitative measures.

Psychosocial functioning in adults with beta-thalassaemia major: Evidence for resilience

Our aims were to compare the psychosocial functioning of a sample of adults with beta-thalassaemia major to that of a control sample and to examine the protective role of quality of relationship with parents during adolescence and perceived quality of care. A total of 85 Italian beta-thalassaemia major participants and 73 controls completed an ad hoc questionnaire. Compared with controls, beta-thalassaemia major participants did not differ on relationships with significant others and coping strategies. Beta-thalassaemia major participants reported higher scores on job satisfaction, self-esteem and self-description. The relationship with parents during adolescence and the perceived quality of care significantly predicted higher well-being and psychosocial functioning.