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Sawatzky R, Sajobi TT, Russell L, Awosoga OA, Ademola A, Böhnke JR, Lawal O, Brobbey A, Lix LM, Anota A, Sebille V, Sprangers MAG, Verdam MGE. Response shift results of quantitative research using patient-reported outcome measures: a descriptive systematic review. Qual Life Res 2024; 33:293-315. [PMID: 37702809 PMCID: PMC10850024 DOI: 10.1007/s11136-023-03495-x] [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] [Accepted: 07/21/2023] [Indexed: 09/14/2023]
Abstract
PURPOSE The objective of this systematic review was to describe the prevalence and magnitude of response shift effects, for different response shift methods, populations, study designs, and patient-reported outcome measures (PROM)s. METHODS A literature search was performed in MEDLINE, PSYCINFO, CINAHL, EMBASE, Social Science Citation Index, and Dissertations & Theses Global to identify longitudinal quantitative studies that examined response shift using PROMs, published before 2021. The magnitude of each response shift effect (effect sizes, R-squared or percentage of respondents with response shift) was ascertained based on reported statistical information or as stated in the manuscript. Prevalence and magnitudes of response shift effects were summarized at two levels of analysis (study and effect levels), for recalibration and reprioritization/reconceptualization separately, and for different response shift methods, and population, study design, and PROM characteristics. Analyses were conducted twice: (a) including all studies and samples, and (b) including only unrelated studies and independent samples. RESULTS Of the 150 included studies, 130 (86.7%) detected response shift effects. Of the 4868 effects investigated, 793 (16.3%) revealed response shift. Effect sizes could be determined for 105 (70.0%) of the studies for a total of 1130 effects, of which 537 (47.5%) resulted in detection of response shift. Whereas effect sizes varied widely, most median recalibration effect sizes (Cohen's d) were between 0.20 and 0.30 and median reprioritization/reconceptualization effect sizes rarely exceeded 0.15, across the characteristics. Similar results were obtained from unrelated studies. CONCLUSION The results draw attention to the need to focus on understanding variability in response shift results: Who experience response shifts, to what extent, and under which circumstances?
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Affiliation(s)
- Richard Sawatzky
- School of Nursing, Trinity Western University, 22500 University Drive, Langley, BC, V2Y 1Y1, Canada.
- Centre for Advancing Health Outcomes, St. Paul's Hospital, Vancouver, Canada.
- University of Gothenburg Centre for Person‑Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Tolulope T Sajobi
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
| | - Lara Russell
- School of Nursing, Trinity Western University, 22500 University Drive, Langley, BC, V2Y 1Y1, Canada
- Centre for Advancing Health Outcomes, St. Paul's Hospital, Vancouver, Canada
| | | | - Ayoola Ademola
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
| | - Jan R Böhnke
- School of Health Sciences, University of Dundee, Dundee, UK
| | - Oluwaseyi Lawal
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
| | - Anita Brobbey
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
| | - Lisa M Lix
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Amelie Anota
- Methodology and Quality of Life Unit in Oncology, University Hospital of Besançon, Besançon, France
| | - Véronique Sebille
- INSERM, MethodS in Patient-Centered Outcomes and HEalth ResEarch, SPHERE, Nantes Université, Université de Tours, CHU Nantes, 44000, Nantes, France
| | - Mirjam A G Sprangers
- Medical Psychology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Mental Health, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Mathilde G E Verdam
- Medical Psychology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Mental Health, Amsterdam Public Health, Amsterdam, The Netherlands
- Department of Methodology and Statistics, Institute of Psychology, Leiden University, Leiden, The Netherlands
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Kustanti CY, Chu H, Kang XL, Pien LC, Chen R, Tsai HT, Chou KR. Anticipatory grief prevalence among caregivers of persons with a life-threatening illness: A meta-analysis. BMJ Support Palliat Care 2024; 13:e1074-e1083. [PMID: 35149523 DOI: 10.1136/bmjspcare-2021-003338] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 01/24/2022] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Caring for a family member with a life-threatening illness may lead to increased levels of psychological morbidity. Given the lack of recognition of caregivers' grief, this study aimed to determine the prevalence of anticipatory grief disorders in caregivers of persons with a life-threatening illness for better intervention and management. METHODS CINAHL, Cochrane, Embase, Medline, PubMed, Scopus, PsycINFO and Web of Science were searched up to 21 March 2021 without language and time restrictions. The quality of the included studies was assessed with Hoy's criteria. A random-effects model was applied to calculate pooled prevalence rates, and multi-regression was performed to examine heterogeneity among studies. RESULTS A total of 3278 citations were retrieved, and 18 studies met the eligibility criteria involving 5470 caregivers. The pooled prevalence of anticipatory grief was 24.78% (95% CI 19.04% to 30.99%). The prevalence rates were significantly higher in female caregivers (16.64%; 95% CI 12.24% to 21.53%) compared with male caregivers (6.11%; 95% CI 4.55% to 7.87%). The married group also had a higher risk (14.66%; 95% CI 10.66% to 19.16%) than single group (5.47%; 95% CI 4.31% to 6.76%). CONCLUSIONS The overall pooled prevalence is substantially higher compared with after-loss grief in the general population and supported the presumptions that preloss grief has a greater magnitude compared with after-loss grief. Bereavement support, educational programmes and relevant resources should be delivered even before the actual loss to address the burden of caregivers.
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Affiliation(s)
- Christina Yeni Kustanti
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Sekolah Tinggi Ilmu Kesehatan Bethesda Yakkum, Yogyakarta, Indonesia
| | - Hsin Chu
- Institute of Aerospace and Undersea Medicine, School of Medicine, National Defense Medical Center, Taipei, Taiwan
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Xiao Linda Kang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- School of Nursing, University of Pennsylvania, PA, Pennsylvania, USA
| | - Li-Chung Pien
- Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Psychiatric Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Ruey Chen
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Department of Nursing, Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan
| | - Hsiu-Ting Tsai
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Kuei-Ru Chou
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Department of Nursing, Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan
- Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
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Nekrasova JY, Kanarsky MM, Borisov IV, Pradhan P, Yankevich DS, Roshka SF, Petrova MV, Grechko AV. Post-Discharge Plight Of Patients With Chronic Disorders Of Consciousness: A Systematic Review Of Socioeconomic And Health Aspects. RUSSIAN OPEN MEDICAL JOURNAL 2022. [DOI: 10.15275/rusomj.2022.0412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Objective — the presented study aims to systematize and structure significant information regarding the problems of patients with disorders of consciousness (DOC) and their families after discharge from the hospital, and to search for possible solutions. Material and Methods — to identify eligible studies, we searched the Medline database (via PubMed) for studies on socioeconomic and medical issues of patients with chronic DOC at the post-hospital stage of rehabilitation for the last 20 years. Results — we included 28 studies with 21 cohorts of patients from 7 different countries in our study. The components of informal caregiver burden and their impact on the quality of life were identified and systematized. These components include high physical load, high economic costs, vast time expenditures, strong emotional involvement, and a top level of expertise in caregiving, all of which are required from the relatives. Conclusion — It was affirmed, that the lack of healthcare system support was a major contributing factor to the overall burden. Our research also showed that delivering care without receiving information, advice, and training is extremely painful for family caregivers.
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Affiliation(s)
- Julia Yu. Nekrasova
- Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russia
| | - Mikhail M. Kanarsky
- Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russia
| | - Ilya V. Borisov
- Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russia
| | - Pranil Pradhan
- Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russia; Peoples’ Friendship University of Russia (RUDN University), Moscow, Russia
| | - Dmitry S. Yankevich
- Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russia
| | - Stanislav F. Roshka
- Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russia
| | - Marina V. Petrova
- Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russia; Peoples’ Friendship University of Russia (RUDN University), Moscow, Russia
| | - Andrey V. Grechko
- Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russia
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Boissel A, Leblond F, Pinel-Jacquemin S, Petit P, Tasseau F, Vérin É. Caregivers of people with disorders of consciousness: Relationship continuity and rupture. EVOLUTION PSYCHIATRIQUE 2022. [DOI: 10.1016/j.evopsy.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Family caregiver grief and post-loss adjustment: A longitudinal cohort study. Palliat Support Care 2021; 20:348-356. [PMID: 34162460 DOI: 10.1017/s147895152100095x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE In order to better understand the different grieving trajectories of the family caregivers (FCs), this study aims to examine the evolution of prolonged grief disorder (PGD) symptoms and the predictive role of the caregiving-related factors in the FCs' grieving trajectory from pre- to post-death. METHOD A prospective cohort study was carried out with advanced cancer FCs evaluated before death (T1) and 6-12 months post-loss (T2). RESULTS Participants in T1 (n = 156) were mostly female, adult child, or spouse of the care recipient, with a mean age of 51.78 (SD = 13.29). At T2, 87 FCs participated in the survey. PGD prevalence was higher pre-death (38.6%) than in bereavement (33.7%). Of those who met the PGD criteria before death, most also met these criteria after death (n = 26, 61.9%). Psychological distress and caregiver burden were highly correlated with pre-death grief, which in turn played a critical role in mediating the link between psychological distress and bereavement outcome. Great emotional closeness in the relationship was predictive of PGD symptoms persistence. In contrast, the long-term consequences of caregiver burden were not confirmed. SIGNIFICANCE OF RESULTS This study provides evidence for the diversity of individual FC responses and the complex pattern of interactions between caregiving-related factors, relationship quality, and PGD symptoms evolution from pre- to post-death.
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Boissel A, Leblond F, Pinel-Jacquemin S, Petit P, Tasseau F, Vérin É. Les proches aidants des personnes en état de conscience altérée : ruptures et continuité dans les relations. EVOLUTION PSYCHIATRIQUE 2021. [DOI: 10.1016/j.evopsy.2020.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Gonzalez-Lara LE, Munce S, Christian J, Owen AM, Weijer C, Webster F. The multiplicity of caregiving burden: a qualitative analysis of families with prolonged disorders of consciousness. Brain Inj 2021; 35:200-208. [PMID: 33385307 DOI: 10.1080/02699052.2020.1865565] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objective: To understand the multiple and sometimes conflicting roles substitute decision makers (SDMs) of individuals in a vegetative state (VS), minimally conscious state (MCS), or with locked-in syndrome (LIS) perform while caring for a loved one and the competing priorities derived from these roles.Methods: We conducted semi-structured qualitative interviews using a constructive-grounded theory design. Twelve SDMs, who were also family members for 11 patients, were interviewed at two time points (except one) for a total of 21 in-depth interviews.Results: Participants described that caregiving is often the central role which they identify as their top priority and around which they coordinate and to some extent subordinate their other roles. In addition to caregiving, they participated in a wide variety of roles, which were sometimes in conflict, as they became caregivers for a loved one with chronic and complex needs. SDMs described the caregiver role as complex and intense that lead to physical, emotional, social, and economic burdens.Conclusion: SDMs report high levels of burdens in caring for a person with a prolonged disorder of consciousness. Lack of health system support that recognized the broader context of SDMs lives, including their multiple competing priorities, was a major contributing factor.
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Affiliation(s)
| | - Sarah Munce
- Toronto Rehabilitation Institute - University Health Network
| | | | - Adrian M Owen
- The Brain and Mind Institute, Western University, London, Ontario, Canada
| | | | - Fiona Webster
- Labatt Family School of Nursing, Western University, London, Ontario, Canada
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Sanches Slusarski Martins R, Pipek LZ, Mesquita GHAD, Nii F, Medeiros KADA, Carvalho BJ, Martines DR, D'Albuquerque LAC, Meyer A, Andraus W. The impact of stressors and overload on informal caregivers of patients with cirrhosis: The first use of the Burden Scale for Family Caregivers in Brazil. J Health Psychol 2020; 27:408-421. [PMID: 32927996 DOI: 10.1177/1359105320953464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Cirrhosis affects liver functions and compromises much of the body's organs. The significant increase in chronic diseases, including cirrhosis, has led to changes in medical practice and health systems, leading the informal caregiver to play a major role because of family ties or some level of proximity to the patient, assuming daily care function. However, the burden generated by informal caregivers for uninterrupted care is present at different levels (physical, mental, social, professional, and financial) and even in the prognosis of the patient. OBJECTIVE The present study aims to evaluate the impact of stressors and overload on informal caregivers of cirrhosis patients. METHOD Cross-sectional study, conducted with 54 informal caregivers of cirrhosis patients, followed up at the Liver Transplant Service Outpatient Clinic of the University of São Paulo School of Medicine Hospital das Clínicas, where they had access to a sociodemographic questionnaire, history of the patient's disease and the scale Burden Scale for Family Caregivers. RESULTS It was observed that higher levels of education and income of the caregiver correlates with a lower degree of stress. In addition, there is a significant difference found in the caregiver's age variable, which indicates that the youngest are those who have the highest degree of stress. The variable Na mEg/l of the patient also presents a statistically significant difference. CONCLUSION Our study was a precursor using the BSFC scale of worldwide coverage and that had not yet been applied in any study in Brazil, thus allowing a look at the various aspects that affect the quality of life of caregivers of patients with cirrhosis. Our results and the literature corroborate the importance not only of the patient, but also the informal caregiver's health.
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Affiliation(s)
- Raquel Sanches Slusarski Martins
- Departamento de Gastroenterologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brazil
| | | | | | - Fernanda Nii
- Faculdade de Medicina FMUSP, Universidade de São Paulo, SP, Brazil
| | | | | | | | | | - Alberto Meyer
- Departamento de Gastroenterologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brazil
| | - Wellington Andraus
- Departamento de Gastroenterologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brazil
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Caregiver anticipatory grief: phenomenology, assessment and clinical interventions. Curr Opin Support Palliat Care 2019; 12:52-57. [PMID: 29206700 DOI: 10.1097/spc.0000000000000321] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW This review aims to synthesize recent findings on anticipatory grief in caregivers, referring to its phenomenology, assessment and clinical interventions. RECENT FINDINGS Recent literature illustrates the wide scope of the current use of the term anticipatory grief, reflecting caregivers' experiences in different end-of-life trajectories. The anticipation of death is the distinctive aspect of anticipatory grief in the predeath grief continuum, encompassing several progressive losses, past and future. Recently developed assessment instruments capture key aspects of this experience, such as separation anxiety, anticipation of death and future absence of the person, denial and relational losses. Recent findings on prevalence of clinically significant predeath symptoms in caregivers range from 12.5 to 38.5%. Beyond personal and relational factors, difficult circumstances of end-of-life care significantly interfere in adjustment to anticipatory grief. Useful therapeutic interventions were identified, such as validation of grief feelings, increased coping and self-care, anticipation of future losses and reframing roles. However, rigorous interventional studies are needed to create guidelines and the manualization of specific therapeutic approaches to caregiver anticipatory grief. SUMMARY Findings suggest that anticipatory grief dynamics in different end-of-life trajectories should be recognized and adequately assessed. Clinical interventions considered useful to support anticipatory grief caregivers are presented, but further research is needed to verify effectiveness.
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Yehene E, Zaksh Y, Davidian M, Bar-Nadav O, Elyashiv M. Locked-in your heart-shaped box: Familial-role and attachment orientation as predictors of grief in prolonged disorders of consciousness vs. death. DEATH STUDIES 2019; 44:510-520. [PMID: 30938582 DOI: 10.1080/07481187.2019.1586795] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Death or prolonged disorders of consciousness (DOC) of a loved one are both considered relational-losses that severely disrupt attachment-bonds. Grief in both conditions was compared by exploring the impact of familial-role and attachment-orientation. In DOC, caregivers' grief was found significantly intensified relative to Death. Familial-role impacted grief in both conditions alike, with partners' heightened grief in DOC reflecting the complexity of their stagnant bonds. In Death, avoidance-attachment mitigated grief, while in DOC anxiety-attachment accentuated grief, we suggest that while physical-separation in death facilitates the modification of continuing attachment-schema, in DOC, modification may be required while the patient is still alive.
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Affiliation(s)
- Einat Yehene
- School of Behavioral Sciences, The Academic College of Tel Aviv - Yafo, Tel-Aviv-Yafo, Israel
| | - Yael Zaksh
- School of Behavioral Sciences, The Academic College of Tel Aviv - Yafo, Tel-Aviv-Yafo, Israel
| | - Meital Davidian
- School of Behavioral Sciences, The Academic College of Tel Aviv - Yafo, Tel-Aviv-Yafo, Israel
| | - Ofri Bar-Nadav
- International Center for the Study of Loss, Bereavement and Human Resilience, Department of Psychology, University of Haifa, Haifa, Israel
| | - Maya Elyashiv
- Respiratory Rehabilitation Division, Reut Medical-Rehabilitation Center, Tel-Aviv-Yafo, Israel
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Steppacher I, Kissler J. A problem shared is a problem halved? Comparing burdens arising for family caregivers of patients with disorders of consciousness in institutionalized versus at home care. BMC Psychol 2018; 6:58. [PMID: 30547843 PMCID: PMC6295043 DOI: 10.1186/s40359-018-0272-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 11/28/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Disorders-of-consciousness (DOC) are rare conditions leading to very severe physical and mental disabilities. Providing care for DOC patients has been described as a stressful experience, eroding the physical and psychological health of the caregiver. Different forms of care may have different impacts on the caregivers and institutionalized care has been suggested to have an unburdening effect, but this possibility has never been empirically studied. To address this issue, in this study caregiver-burden between family-caregivers who provide home care themselves and those who have placed their patients in a specialized care unit is compared. METHOD The demographics of the caregivers, life satisfaction, coping strategies, meaning in life, and grief reactions were assessed with questionnaires in 81 long term (m = 7.9 years) caregivers (44 patients in specialized care-units, 37 patients taken care of at home). RESULTS Caregiver groups were similar on the vast majority of demographic factors. Remarkably, there were no major differences in self-assessed burden and distress between the two caregiver groups. They both demonstrated generally reduced life satisfaction, were especially dissatisfied with their amount of spare time, and many caregivers in both groups demonstrated long lasting grief reactions, as well as a somewhat enhanced crisis of meaning. However, caregivers with patients in institutionalized care exhibited enhanced self-accusation as well as reduced satisfaction with their own health. Home care caregivers, on the other hand, report below average opportunities to care for themselves. CONCLUSION Surprisingly, placement in institutionalized care in itself does not seem to disburden caregivers as much as expected as the amount of subjective care-giving burden and reported distress is on average similarly high, although profiles differ somewhat according to type of care. Moreover, vast inter-individual variability can be observed. Further research should address the mechanisms that foster positive adjustment and reduce negative impacts for care providers regardless of type of care, enabling the health care system, institutions and self-aid groups alike, to provide more specific support for caregivers by addressing the topics of quality-of-life, own health, self care, and grief reactions.
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Affiliation(s)
- Inga Steppacher
- Department of Psychology, University of Bielefeld, Bielefeld, Germany
| | - Johanna Kissler
- Department of Psychology, University of Bielefeld, Bielefeld, Germany
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Løvstad M, Solbrække KN, Kirkevold M, Geard A, Hauger SL, Schanke AK. "It gets better. It can´t be worse than what we have been through." Family accounts of the minimally conscious state. Brain Inj 2018; 32:1659-1669. [PMID: 30351974 DOI: 10.1080/02699052.2018.1539244] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVES The aim of this qualitative study was to explore family life when a family member is in a chronic minimally conscious state (MCS). Experiences with the health care system were also explored. METHODS As part of a larger qualitative study of family life after a family member suffers severe physical injury, we conducted a focus group interview with five family members of three patients in a chronic MCS. The participants included three mothers, one father, and one sibling. The length of time since the brain injuries was four, four, and ten years. A thematic analysis was conducted. RESULTS Three main themes emerged. Each family reflected on the challenges of maintaining family unity. They also revealed how they had dealt with the ambiguity and severity of the situation, including the communication with the health care system. Finally, they described their journeys back toward a normal, everyday family life. CONCLUSIONS The findings demonstrate challenges faced by family members but also their capacity to withstand and overcome adversity. Clinicians are reminded to maintain a long-term perspective and understand the importance of helping families adjust, maintain hope for a better future, and mitigate their psychological pain.
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Affiliation(s)
- Marianne Løvstad
- a Department of Research , Sunnaas Rehabilitation Hospital , Nesoddtangen , Norway.,b Department of Psychology , University of Oslo , Oslo , Norway
| | - Kari Nyheim Solbrække
- c Department of Health Sciences, Institute of Health and Society , University of Oslo , Oslo , Norway
| | - Marit Kirkevold
- d Dept. of Nursing Science, Inst. of Health and Society , University of Oslo , Oslo , Norway.,e Research Center for Habilitation and RehabilitationModels andServices, Institute of Health and Society , Institute of Health and Society, University of Oslo , Oslo , Norway
| | - Anne Geard
- a Department of Research , Sunnaas Rehabilitation Hospital , Nesoddtangen , Norway
| | | | - Anne-Kristine Schanke
- a Department of Research , Sunnaas Rehabilitation Hospital , Nesoddtangen , Norway.,b Department of Psychology , University of Oslo , Oslo , Norway
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Soeterik SM, Connolly S, Riazi A. “Neither a wife nor a widow”: an interpretative phenomenological analysis of the experiences of female family caregivers in disorders of consciousness. Neuropsychol Rehabil 2018; 28:1392-1407. [DOI: 10.1080/09602011.2018.1529603] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Sonja M. Soeterik
- Department of Psychology, Royal Holloway University of London, Egham, UK
- Institute of Neuro-palliative Rehabilitation, Royal Hospital for Neuro-disability, London, UK
| | - Sarah Connolly
- Institute of Neuro-palliative Rehabilitation, Royal Hospital for Neuro-disability, London, UK
- Ascot Rehab, Surrey, UK
| | - Afsane Riazi
- Department of Psychology, Royal Holloway University of London, Egham, UK
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Zaksh Y, Yehene E, Elyashiv M, Altman A. Partially dead, partially separated: establishing the mechanism between ambiguous loss and grief reaction among caregivers of patients with prolonged disorders of consciousness. Clin Rehabil 2018; 33:345-356. [PMID: 30255716 DOI: 10.1177/0269215518802339] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES: To trace the psychological mechanism underlying caregivers' emotional experience in prolonged disorders of consciousness, by examining the mediating role of boundary ambiguity in the relationship between ambiguous loss and grief. DESIGN: Cross-sectional design. SETTING: The Respiratory Rehabilitation Division of a long-term medical and rehabilitation institute. SUBJECTS: A total of 64 primary caregivers (69% female) of patients in a vegetative state ( n = 49) or minimally conscious state ( n = 15), with a mean age of 55.5 (SD = 12.3) years. Participants were mostly the patient's children (62%) or partners (27%). The mean caregiving duration was 4.9 (SD = 5.1) years. MAIN MEASURES: The Boundary Ambiguity Scale, the Revised Need for Closure Scale, an adapted version of the multifactor Two-Track Bereavement Questionnaire, and a sociodemographic questionnaire, which included items regarding caregiving: frequency of visits and perception of the patient's psychological presence. RESULTS: (1) Caregivers' grief scores (total TTBQ: mean = 2.97; SD = 0.55) did not significantly differ from those exhibited by a normative bereavement sample. (2) Time since injury did not affect caregivers' grief scores (three-year cut-point; P > .05). (3) Mediation analyses revealed that boundary ambiguity (mean = 34.03; SD = 7.55) significantly mediates the relationship between need for closure ( B = .11; confidence interval (CI) = .04-.23) and grief; frequency of visits ( B = .05, CI = .02-.10) and grief and perception of psychological presence ( B = .26, CI = .00-.61) and grief in three separate models. CONCLUSION: Ambiguity concerning relational boundaries hinders caregivers' ongoing grief reaction and impedes their ability to integrate the loss. High frequency of visits, belief in the patient's psychological presence and difficulties in tolerating uncertainty are all clinical manifestations of caregivers' entangled experience.
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Affiliation(s)
- Yael Zaksh
- 1 School of Behavioral Sciences, The Academic College of Tel Aviv-Yaffo, Tel Aviv-Yaffo, Israel
| | - Einat Yehene
- 1 School of Behavioral Sciences, The Academic College of Tel Aviv-Yaffo, Tel Aviv-Yaffo, Israel
| | - Maya Elyashiv
- 2 Respiratory Rehabilitation Division, Reut Medical-Rehabilitation Center, Tel Aviv-Yaffo, Israel
| | - Arie Altman
- 2 Respiratory Rehabilitation Division, Reut Medical-Rehabilitation Center, Tel Aviv-Yaffo, Israel
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Gill-Thwaites H, Elliott KE, Munday R. SMART - Recognising the value of existing practice and introducing recent developments: leaving no stone unturned in the assessment and treatment of the PDOC patient. Neuropsychol Rehabil 2017; 28:1242-1253. [PMID: 28420294 DOI: 10.1080/09602011.2017.1310113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Over the last 25 years there have been a number of papers highlighting the issues of high rates of misdiagnosis in prolonged disorders of consciousness (PDOC) (Andrews, K., Murphy, L., Munday, R., & Littlewood, C. (1996). Misdiagnosis of the vegetative state: Retrospective study in a rehabilitation unit. BMJ, 313(7048), 13-16; Childs, N. L., Mercer, W. N., & Childs, H. W. (1993). Accuracy of diagnosis of persistent vegetative state. Neurology, 43(8), 1465-1467). Surprisingly, these rates still remain at the same level despite defined criteria for diagnosis (Schnakers, C., Vanhaudenhuyse, A., Giacino, J., Ventura, M., Boly, M., Majerus, S.,…Laureys, S. (2009). Diagnostic accuracy of the vegetative and minimally conscious state: Clinical consensus versus standardized neurobehavioral assessment. BMC Neurology, 9(35), 1-5; Van Erp, W., Larvrijsen, J., Vos, P., Bor, H., Laureys, S., & Koopmans, R. (2015). The vegetative state: Prevalence, misdiagnosis and treatment limitations. JAMDA, 85, e9-85.e14. doi: 10.1016/j.jamda.2014.10.014 ). This indicates the continued need for careful standardised assessment by skilled assessors to identify all potential meaningful responses and to establish a correct and incontrovertible diagnosis. The Sensory Modality Assessment and Rehabilitation Technique (SMART) is one of three assessments identified for the assessment of PDOC in the Royal College of Physician guidelines (Royal College of Physicians, 2013). The RCP guidelines and recent publications have highlighted and substantiated the value of some of the existing practices and unique features of the SMART. In recognition of the need to keep SMART current, SMART Version 3 is being developed and will be launched shortly. The interim SMART developments will be introduced in this paper and applied to practice through the illustration of a case study. Evidence suggests that SMART is a current and invaluable tool for the clinical and medico-legal assessment and treatment of the PDOC patient.
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Affiliation(s)
- H Gill-Thwaites
- a Brain Injury Services , Royal Hospital for Neuro-disability , London , UK.,b Gill-Thwaites & Elliott Consultants , London , UK
| | - K E Elliott
- b Gill-Thwaites & Elliott Consultants , London , UK
| | - R Munday
- c Wolfson Neurorehabilitation Centre , St George's University Hospitals NHS Foundation Trust , London , UK
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Corallo F, Bonanno L, Lo Buono V, De Salvo S, Allone C, Palmeri R, La Gattuta E, Rifici C, Alagna A, Todaro A, Bramanti P, Marino S. Evolution of psychological condition in caregivers of patients with disorders of consciousness: a longitudinal study. Neurol Sci 2017; 38:1249-1253. [DOI: 10.1007/s10072-017-2941-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 03/29/2017] [Indexed: 10/19/2022]
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Soeterik SM, Connolly S, Playford ED, Duport S, Riazi A. The psychological impact of prolonged disorders of consciousness on caregivers: a systematic review of quantitative studies. Clin Rehabil 2017; 31:1374-1385. [PMID: 28933608 DOI: 10.1177/0269215517695372] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Systematic review of the nature, frequency and severity of psychological experiences of people who have a close relationship with a person with a prolonged disorder of consciousness. DATA SOURCES Cochrane Library, Web of Science, PsycINFO, PubMed, Embase®, MEDLINE®, Allied and Complementary Medicine™, were searched from inceptions until December 2016 with additional hand searching of reference lists of included articles. REVIEW METHODS Studies were included that used quantitative methodologies and psychological measures to investigate experiences. The PRISMA statement was followed with inclusion criteria set a priori. A data synthesis summarized psychological constructs studied. RESULTS A total of 18 studies (ranging between n = 16-487 participants) met the inclusion criteria with 15 of 18 studies focused on the primary caregiver. A total of 23 standardized psychological measures were identified to assess four primary psychological constructs: Loss and grief, psychological wellbeing changes, burden and use of coping strategies. CONCLUSIONS Small sample sizes, limited variables and reliance on observational methods affected quality. Caregivers do find ways to manage independently, but some exhibit clinically significant psychological distress that does not change over time alone and may get worse.
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Affiliation(s)
- Sonja M Soeterik
- 1 Department of Psychology, Royal Holloway University of London, Egham, UK.,2 Institute of Neuro-palliative Rehabilitation, Royal Hospital for Neuro-disability, London, UK
| | - Sarah Connolly
- 3 Ascot Rehab, Royal Hospital for Neuro-disability London, Surrey, UK
| | - E Diane Playford
- 2 Institute of Neuro-palliative Rehabilitation, Royal Hospital for Neuro-disability, London, UK.,4 Warwick Medical School, University of Warwick, Coventry, UK
| | - Sophie Duport
- 2 Institute of Neuro-palliative Rehabilitation, Royal Hospital for Neuro-disability, London, UK
| | - Afsane Riazi
- 1 Department of Psychology, Royal Holloway University of London, Egham, UK
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Portuguese validation of the Prolonged Grief Disorder Questionnaire–Predeath (PG–12): Psychometric properties and correlates. Palliat Support Care 2017; 15:544-553. [DOI: 10.1017/s1478951516001000] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
ABSTRACTObjective:This study aimed to contribute to the validation of the Portuguese version of the Prolonged Grief Disorder Questionnaire–Predeath (PG–12), examining its psychometric properties, including factorial, discriminant, and predictive validity. The prevalence of predeath prolonged grief disorder (PGD) and its psychosocial correlates were also analyzed.Method:The PG–12 was assessed in a sample of family caregivers (FCs) of oncological patients in palliative care. The factorial and discriminant validity of the PG–12 were evaluated by confirmatory factor analysis. The prevalence of predeath PGD was calculated and correlated with sociodemographic characteristics, perception of illness, intensity of care, coping, and caregiver burden. Prospective data were used to assess predictive validity.Results:The sample was composed of 94 FCs, mostly female (78.8%) and daughters (61.3%), with a mean age of 52.02 (SD = 12.87). The PG–12 has been shown to be reliable, to have high internal consistency, to be monofactorial in structure, and to be independent from depression, anxiety, and burden, although predeath grief influences these symptoms. In our sample, 33% met the criteria for predeath PGD. The circumstances and coping mechanisms are also correlated with predeath grief. The PG–12 has also been shown to be predictive of postdeath outcome.Significance of results:The PG–12 can be a useful screening tool for early identification of risk for maladjustment to loss among family caregivers.
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Emotional Burden, Quality of Life, and Coping Styles in Care Givers of Patients with Disorders of Consciousness Living in Italy: Preliminary Data. BRAIN IMPAIR 2016. [DOI: 10.1017/brimp.2016.26] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The literature about the care givers of patients with Disorders of Consciousness (DOCs) has highlighted the impact on both mental and physical dimensions of quality of life. This study aimed to: (1) describe emotional burden, quality of life, and coping styles in care givers of hospitalized patients with DOCs, compared to Italian normative data; (2) explore the relationships between these variables and their associations with socio-demographic features; and (3) describe their changes over time.Fifteen care givers of patients with DOCs, mostly middle-aged women, were assessed using the Family Strain Questionnaire, the SF-36 Health Survey, and the Coping Orientation to Problems Experienced – Nuova Versione Italiana. Eleven subjects were also assessed after 6 and 12 months. Data were analysed through descriptive statistics, correlations, and nonparametric tests of group differences.Compared to the Italian normative data, our sample showed a worse outcome in mental health, social functioning, global mental component, and emotional role functioning. Furthermore, subjects with high emotional burden had more thoughts of death compared to subjects with low emotional burden. Follow-up analyses revealed no variables changed over time.These results highlight the need for psychological interventions and support, since care givers represent an important part of an all-embracing support and care network for patients with DOCs.
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Covelli V, Sattin D, Giovannetti AM, Scaratti C, Willems M, Leonardi M. Caregiver's burden in disorders of consciousness: a longitudinal study. Acta Neurol Scand 2016; 134:352-359. [PMID: 26748540 DOI: 10.1111/ane.12550] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To study the changes in the burden of informal caregivers of patients with disorders of consciousness (DOC) over time. MATERIALS AND METHODS Short Form-12, Family Strain Questionnaire, Beck Depression Inventory and Coping Orientations to Problem Experiences were administered. RESULTS Data collected on 216 informal caregivers of patients with DOC (59.6% females, mean age 53.4 ± 12.7 years old) were analysed at two time-points (mean distance is 2.7 years). Results of the national study revealed that caregivers' mental health improved (T0: M = 41.1, SD = 11.8; T1: M = 45.8, SD = 11.7), whereas the emotional burden (T0: M = 7.4, SD = 3.6; T1: M = 6.6, SD = 3.9) and the presence of depressive symptoms (T0: M = 14.3, SD = 9.3; T1: M = 11.7, SD = 10.2) as well as the need for information about the disease (T0: M = 2.7, SD = 1.2; T1: M = 2.2, SD = 1.4), thoughts of death (T0: M = 3.6, SD = 1.5; T1: M = 3.1, SD = 1.6) and the use of avoiding coping strategy (T0: M = 7.8, SD = 1.0; T1: M = 6.0, SD = 1.3) decreased at T1. Furthermore, depressive symptoms positively correlated with the emotional burden (0.580) and negatively with the mental health component of caregivers' self-perceived health condition (-0.473). Physical (-0.308) and mental health (-0.444) negatively correlated with emotional burden. Finally, the acute event and patients' health condition still have a deep impact on the economic situation of the family. CONCLUSION Although high level of burden was observed, it tends to decrease over time, except for financial burden. Hence, this study suggests the importance to plan strategies or targeted interventions in order to reduce the psychosocial and financial burden associated with caregiving.
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Affiliation(s)
- V. Covelli
- Department of Psychology; e-Campus University; Milan Italy
| | - D. Sattin
- Neurology; Public Health and Disability Unit and Coma Research Centre - Scientific Directorate; Neurological Institute C. Besta IRCCS Foundation; Milan Italy
| | - A. M. Giovannetti
- Neuroimmunology Unit; Neurological Institute C. Besta IRCCS Foundation; Milan Italy
| | - C. Scaratti
- Neurology; Public Health and Disability Unit and Coma Research Centre - Scientific Directorate; Neurological Institute C. Besta IRCCS Foundation; Milan Italy
| | - M. Willems
- Neurology; Public Health and Disability Unit and Coma Research Centre - Scientific Directorate; Neurological Institute C. Besta IRCCS Foundation; Milan Italy
| | - M. Leonardi
- Neurology; Public Health and Disability Unit and Coma Research Centre - Scientific Directorate; Neurological Institute C. Besta IRCCS Foundation; Milan Italy
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Cipolletta S, Pasi M, Avesani R. Vita tua, mors mea: The experience of family caregivers of patients in a vegetative state. J Health Psychol 2014; 21:1197-206. [PMID: 25253627 DOI: 10.1177/1359105314550348] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study aims to understand whether, and possibly how, caregivers of patients in a vegetative state experience an emotional paradox between life and death. Individual semi-structured interviews were conducted with 24 (19 females and 5 males) caregivers of vegetative state patients living in northern Italy. Data were analysed using interpretative phenomenological analysis. Caregivers felt they were the only ones able to understand and give answer to patients' needs, but neglected their own lives in their total commitment to the patient. The findings highlight the importance for vegetative state caregivers in considering new possibilities of life that go beyond the assistance of vegetative state patients.
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