1
|
McAndrew NS, Gray TF, Wallace L, Calkins K, Guttormson J, Harding ES, Applebaum AJ. Existential distress in family caregivers: scoping review of meaning-making interventions. BMJ Support Palliat Care 2024; 13:e676-e685. [PMID: 37604657 PMCID: PMC11040498 DOI: 10.1136/spcare-2023-004448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 08/03/2023] [Indexed: 08/23/2023]
Abstract
OBJECTIVES Family and friend caregivers often feel overwhelmed by and ill-prepared for their responsibilities. Many feel helpless living with uncertainty about the outcome of the patient's illness, which leads to existential distress. Supportive care interventions that address existential distress by promoting meaning and purpose buffer the negative effects of caregiver burden and promote resilience and growth. The purpose of this scoping review is to describe the depth and breadth of available interventions targeting caregiver existential distress. METHODS We followed the Joanna Briggs Institute's scoping review methods and applied the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension checklist. SCOPUS, Ovid MEDLINE and PsycINFO databases were searched for interventions that targeted existential distress by promoting meaning-making, spiritual well-being, post-traumatic growth and/or benefit finding for caregivers of seriously ill adult patients. RESULTS We screened 1377 titles/abstracts and 42 full-text articles. Thirty-one articles (28 unique studies) met inclusion criteria. Most interventions were designed for caregivers supporting patients with cancer (n=14) or patients receiving palliative care (n=9). Promising interventions included Meaning-Centered Psychotherapy for Cancer Caregivers, Meaning-Based Intervention for Patients and their Partners, Legacy Intervention for Family Enactment, Family Participatory Dignity Therapy and Existential Behavioural Therapy. More than half of the studies (n=20, 64%) were in the feasibility/acceptability/pilot stage of intervention testing. CONCLUSION Large randomised controlled trials with more diverse samples of caregivers are needed. Future research should explore the impact of delivering meaning-making interventions to caregivers throughout the illness trajectory. Developing strategies for scaling up and conducting cost analyses will narrow the research and practice gap for meaning-making interventions.
Collapse
Affiliation(s)
- Natalie S McAndrew
- School of Nursing, College of Health Professions & Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
- Department of Patient Care Research, Froedtert & the Medical College of Wisconsin, Froedtert Hospital, Milwaukee, Wisconsin, USA
| | - Tamryn F Gray
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Lyndsey Wallace
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Kelly Calkins
- College of Nursing, Marquette University, Milwaukee, Wisconsin, USA
| | - Jill Guttormson
- College of Nursing, Marquette University, Milwaukee, Wisconsin, USA
| | - Eric S Harding
- Medical College of Wisconsin Libraries, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Allison J Applebaum
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Psychiatry, Weill Cornell Medicine, New York, New York, USA
| |
Collapse
|
2
|
Butcher HK. Originating Research Ideas. Nurs Sci Q 2024; 37:9-17. [PMID: 38054320 DOI: 10.1177/08943184231207371] [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] [Indexed: 12/07/2023]
Abstract
Research aimed at generating new knowledge is the heart of the scholarship of discovery. The author of this paper explores how original research ideas can be generated for formal investigations and artsciencing. Curiosity and creativity are presented as "seeds" for originating ideas, and seven patterns (adjacent possible, liquid networks, the slow hunch, serendipity, error, exaptation, and platforms) are described as synergistic potentiators for geminating original research ideas.
Collapse
Affiliation(s)
- Howard K Butcher
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL, USA
| |
Collapse
|
3
|
Anderson MS, Bankole A, Homdee N, Mitchell BA, Byfield GE, Lach J. Dementia Caregiver Experiences and Recommendations for Using the Behavioral and Environmental Sensing and Intervention System at Home: Usability and Acceptability Study. JMIR Aging 2021; 4:e30353. [PMID: 34874886 PMCID: PMC8691404 DOI: 10.2196/30353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/14/2021] [Accepted: 09/26/2021] [Indexed: 01/26/2023] Open
Abstract
Background Caregiver burden associated with dementia-related agitation is one of the most common reasons for a community-dwelling person living with dementia to transition to a care facility. The Behavioral and Environmental Sensing and Intervention (BESI) for the Dementia Caregiver Empowerment system uses sensing technology, smartwatches, tablets, and data analytics to detect and predict agitation in persons living with dementia and to provide just-in-time notifications and dyad-specific intervention recommendations to caregivers. The BESI system has shown that there is a valid relationship between dementia-related agitation and environmental factors and that caregivers prefer a home-based monitoring system. Objective The aim of this study is to obtain input from caregivers of persons living with dementia on the value, usability, and acceptability of the BESI system in the home setting and obtain their insights and recommendations for the next stage of system development. Methods A descriptive qualitative design with thematic analysis was used to analyze 10 semistructured interviews with caregivers. The interviews comprised 16 questions, with an 80% (128/160) response rate. Results Postdeployment caregiver feedback about the BESI system and the overall experience were generally positive. Caregivers acknowledged the acceptability of the system by noting the ease of use and saw the system as a fit for them. Functionality issues such as timeliness in agitation notification and simplicity in the selection of agitation descriptors on the tablet interface were identified, and caregivers indicated a desire for more word options to describe agitation behaviors. Agitation intervention suggestions were well received by the caregivers, and the resulting decrease in the number and severity of agitation events helped confirm that the BESI system has good value and acceptability. Thematic analysis suggested several subjective experiences and yielded the themes of usefulness and helpfulness. Conclusions This study determined preferences for assessing caregiver strain and burden, explored caregiver acceptance of the technology system (in-home sensors, actigraph or smart watch technology, and tablet devices), discerned caregiver insights on the burden and stress of caring for persons living with dementia experiencing agitation in dementia, and solicited caregiver input and recommendations for system changes. The themes of usefulness and helpfulness support the use of caregiver knowledge and experience to inform further development of the technology.
Collapse
Affiliation(s)
- Martha Smith Anderson
- Department of Health Care Innovation and Implementation Science, Virginia Tech Carilion School of Medicine, Roanoke, VA, United States
| | - Azziza Bankole
- Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA, United States
| | - Nutta Homdee
- Center for Research and Innovation, Faculty of Medical Technology, Mahidol University, Bangkok, Thailand
| | - Brook A Mitchell
- Virginia Tech Carilion School of Medicine, Roanoke, VA, United States
| | - Grace E Byfield
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - John Lach
- Department of Electrical and Computer Engineering, The George Washington University, Washington, DC, United States
| |
Collapse
|
4
|
Isene TA, Kjørven Haug SH, Stifoss-Hanssen H, Danbolt LJ, Ødbehr LS, Thygesen H. Meaning in Life for Patients With Severe Dementia: A Qualitative Study of Healthcare Professionals' Interpretations. Front Psychol 2021; 12:701353. [PMID: 34539501 PMCID: PMC8440833 DOI: 10.3389/fpsyg.2021.701353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 08/05/2021] [Indexed: 11/13/2022] Open
Abstract
The need for meaning in life is a key aspect of being human, and a central issue in the psychology of religion. Understanding experience of meaning for persons with severe dementia is challenging due to the impairments associated with the illness. Despite these challenges, this article argues that meaning in life is as important for a person with severe dementia as it is for everyone else. This study was conducted in a Norwegian hospital and nursing home context and was part of a research project on meaning in life for persons with severe dementia. The study builds on two other studies which focused on how meaning-making and experience of meaningfulness appeared in patients with severe dementia. By presenting the findings from these two studies for a group of healthcare professionals and introducing them to research on meaning in life, the aim of this study was to explore how healthcare professionals interpret the patients' experience of meaning in life in practise for patients with severe dementia in a hospital and nursing home context, and to highlight its clinical implications. The study was conducted using a qualitative method with exploratory design. The data were collected at a round table conference, a method inspired by a mode of action research called "co-operative inquiry." Altogether 27 professional healthcarers, from a variety of professions, with high competence in dementia care participated together with six researchers authoring this article. This study revealed that healthcare professionals were constantly dealing with different forms of meaning in their everyday care for people with dementia. The findings also showed clear connexions between understanding of meaning and fundamental aspects of good dementia care. Meaning corresponded well with the principles of person-centred care, and this compatibility allowed the healthcare professionals to associate meaning in life as a perspective into their work without having much prior knowledge or being familiar with the use of this perspective. The study points out that awareness of meaning in life as an integrated perspective in clinical practise will contribute to a broader and enhanced repertoire, and hence to improved dementia care. Facilitating experience of meaning calls for increased resources in personnel and competence in future dementia care.
Collapse
Affiliation(s)
- Tor-Arne Isene
- Centre for Psychology of Religion, Innlandet Hospital Trust, Hamar, Norway.,Centre of Diakonia and Professional Practise, VID Specialised University, Oslo, Norway
| | - Sigrid Helene Kjørven Haug
- Centre for Psychology of Religion, Innlandet Hospital Trust, Hamar, Norway.,Faculty of Social and Health Sciences, Department of Health and Nursing Sciences, Inland Norway University of Applied Sciences, Elverum, Norway
| | - Hans Stifoss-Hanssen
- Centre of Diakonia and Professional Practise, VID Specialised University, Oslo, Norway
| | - Lars J Danbolt
- Centre for Psychology of Religion, Innlandet Hospital Trust, Hamar, Norway.,MF Norwegian School of Theology, Oslo, Norway
| | - Liv S Ødbehr
- Faculty of Social and Health Sciences, Department of Health and Nursing Sciences, Inland Norway University of Applied Sciences, Elverum, Norway
| | - Hilde Thygesen
- Faculty of Health Sciences, Department of Occupational Therapy, Prosthetics and Orthotics, Oslo Metropolitan University, Oslo, Norway.,Faculty of Health Studies, VID Specialised University, Oslo, Norway
| |
Collapse
|
5
|
Peacock S, Bayly M, Gibson K, Holtslander L, Thompson G, O'Connell M. Development of a bereavement intervention for spousal carers of persons with dementia: The Reclaiming Yourself tool. DEMENTIA 2020; 20:653-671. [PMID: 32126810 DOI: 10.1177/1471301220909604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A dearth of supportive interventions exists for bereaved spouses who were carers of persons with dementia, despite an identified need for such supports. The purpose of the current work was to develop and evaluate a supportive writing intervention for this population that was informed by the experiences of spouses who were bereaved and was specific to the unique context of dementia. Following development of the Reclaiming Yourself tool, a mixed methods design was utilized to assess its effects on grief, depressive symptoms, and balance between restoration and loss. Fifteen participants residing in Saskatchewan and Manitoba were provided the writing intervention and visited three times approximately four weeks apart, completing quantitative measures (for grief, depressive symptoms, and finding balance) at each visit and an exit interview about the intervention. Paired-sample t-tests illustrated trivial effect sizes and no significant differences in grief, depressive symptoms, or balance orientation, with overall means suggesting low levels of depressive symptoms and grief, and a slight orientation towards restoration. Thematic analysis illustrated benefits from the tool, with participants reporting that it provided a structured approach to grief, was a catalyst for emotional expression, and facilitated reflection. The format and timing of the intervention was not ideal for all participants. Although Reclaiming Yourself did not affect quantitatively measured grief, depressive symptoms, and balance, carers accrued benefits from the tool that align with beneficial processes observed in other writing interventions. While more research on the effectiveness of this tool is needed, such interventions are valuable to support the well-being of carers who are bereaved following the death of a spouse with dementia.
Collapse
Affiliation(s)
| | - Melanie Bayly
- Centre for Canadian Health and Safety in Agriculture, College of Medicine, University of Saskatchewan, Canada
| | - Kirstian Gibson
- Department of Psychology, College of Arts & Science, University of Saskatchewan, Canada
| | - Lorraine Holtslander
- College of Nursing, University of Saskatchewan, Canada; University of the Witwatersrand, South Africa
| | | | - Megan O'Connell
- Department of Psychology, University of Saskatchewan, Canada
| |
Collapse
|
6
|
Flaherty LB, Mast BT. Clinician Word Use in Dementia Evaluation Reports as a Function of Cognitive Impairment. Gerontol Geriatr Med 2020; 6:2333721420961888. [PMID: 33150194 PMCID: PMC7585877 DOI: 10.1177/2333721420961888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 08/24/2020] [Accepted: 09/07/2020] [Indexed: 11/20/2022] Open
Abstract
Objectives: To examine the extent to which levels of cognitive status influence patterns of word use in dementia evaluation reports. Methods: We utilized neuropsychological evaluation reports from 61 geriatric primary care patients referred for suspected dementia. Linguistic Inquiry Word Count analysis was utilized to examine clinician language use in patient reports and whether language use differs dependent on the diagnosis rendered. ANOVA analyses were used to analyze group differences in LIWC word counts across clinical indices of cognitive functioning: dementia diagnosis. Results: Our analysis revealed significant differences in language use across diagnostic categories. ANOVA analyses yielded differences in broad negative emotion, F(2,58) = 4.010, p = .023 as well as other subgroups; anxiety-related word groups, F(2,58) = 4.706, p = .013; insight words, F(2,58) = 3.815, p = .028; causation words, F(2,58) = 3.497, p = .037; certainty words, F(2,58) = 6.581, p = .003; negation words, F(2,58) = 3.165, p = .05; time-related words; F(2, 58) = 7.521, p < .001; and human-related words, F(2,58) = 6.512, p = .003. Conclusion: The differences in clinician language use across different diagnostic groups may be reflections of implicit emotional reactions. Many of the patterns found in this study can be linked to previous research concerning word use and underlying thought processes. Clinical Implications: Awareness of language use is helpful in clinical relationships to attenuate stigma and facilitate treatment and research.
Collapse
|