1
|
Whisenant M, Snyder S, Weathers SP, Bruera E, Milbury K. Self and proxy symptom reporting in glioma patient-caregiver dyads: the role of psychosocial function in rating accuracy. J Patient Rep Outcomes 2024; 8:74. [PMID: 39017959 PMCID: PMC11255136 DOI: 10.1186/s41687-024-00726-8] [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: 07/31/2023] [Accepted: 04/22/2024] [Indexed: 07/18/2024] Open
Abstract
BACKGROUND Illness-related communication and depressive symptoms within families may play an important role in caregivers' ability to accurately understand patients' symptom burden. We examined the associations between these psychosocial factors and symptom accuracy in patients with glioma and their family caregivers. METHODS Patients and caregivers (n = 67 dyads) completed measures of depressive symptoms (CES-D), illness communication (CICS), and QOL (SF-36). Patients reported on their own cancer-related symptoms (MDASI-BT) while caregivers reported on their perception of the patients' symptoms (i.e., proxy reporting). Paired t-tests and difference scores were used to test for agreement (absolute value of difference scores between patients and caregiver proxy symptom and interference severity reports) and accuracy (caregiver underestimation, overestimation, or accurate estimation of patient symptom and interference severity). RESULTS Clinically significant disagreement was found for all means scores of the MDASI-BT subscales except for gastrointestinal symptoms and general symptoms. Among caregivers, 22% overestimated overall symptom severity and 32% overestimated overall symptom interference. In addition, 13% of caregivers underestimated overall symptom severity and 21% of caregivers underestimated overall symptom interference. Patient illness communication was associated with agreement of overall symptom severity (r=-0.27, p = 0.03) and affective symptom subscale (r=-0.34, p < 0.01). Caregivers' reporting of illness communication (r=-0.33, p < 0.01) and depressive symptoms (r = 0.46, p < 0.0001) were associated with agreement of symptom interference. Caregiver underestimating symptom severity was associated with lower patient physical QOL (p < 0.01); caregiver underestimating symptom interference was associated with lower patient physical QOL (p < 0.0001) and overestimating symptom interference was associated with lower patient physical QOL (p < 0.05). Patient and caregiver mental QOL was associated with caregiver underestimating (p < 0.05) and overestimating (p < 0.05) symptom severity. CONCLUSION The psychosocial context of the family plays an important role in the accuracy of symptom understanding. Inaccurately understanding patients experience is related to poor QOL for both patients and caregivers, pointing to important targets for symptom management interventions that involve family caregivers.
Collapse
Affiliation(s)
- Meagan Whisenant
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Stella Snyder
- Department of Psychology, School of Science, Indiana University-Purdue University at Indianapolis, Indianapolis, IN, USA
| | - Shiao-Pei Weathers
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kathrin Milbury
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| |
Collapse
|
2
|
Betker L, Senßfelder A, Knorrenschild JR, Volberg C, Berthold D, Seifart C, von Blanckenburg P. Difficulties of Cancer Patients' Relatives in End-of-Life Discussions: Validation of a Questionnaire. J Pain Symptom Manage 2024; 67:420-428. [PMID: 38355073 DOI: 10.1016/j.jpainsymman.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 02/02/2024] [Accepted: 02/04/2024] [Indexed: 02/16/2024]
Abstract
CONTEXT Despite the potential benefits and the desire for end-of-life communication, it rarely occurs in the familial context. Relatives play a significant role in the communication process; thus, it is crucial to understand the difficulties that they face. OBJECTIVES To develop and evaluate the relatives' version of the Difficulties in End-of-Life Discussions - Family Inventory (DEOLD-FI-r) regarding its factor structure, reliability and validity. METHODS Relatives of patients with advanced cancer were recruited in a German hospital. The factor structure of the questionnaire was explored. Construct validity was examined through correlations between the DEOLD-FI-r and measures of avoidance of cancer communication, quality of life, distress, and experienced difficulty during end-of-life discussions. Additionally, we examined the group difference between those who had and had not engaged in the conversation. RESULTS About 111 relatives completed the survey (mean age 55.5 years, 52% female). The final version of the DEOLD-FI-r contained 23 items (α = .92). The exploratory factor analysis resulted in three factors explaining 74% of the variance. Each factor described another dimension of potential communication barriers in end-of-life discussions: 1) Own emotional burden, 2) Relational and patient-related difficulties, 3) Negative attitudes. Construct validity was supported by correlations consistent with our hypotheses and less reported communication difficulty by those who had already talked about the end-of-life with their relative (t(106) = 5.38, P < .001, d = 0.8). CONCLUSION The results indicate that the DEOLD-FI-r is a valid and reliable instrument for the systematic assessment of difficulties in family end-of-life communication. By focusing on relatives, it complements the already validated patient-version.
Collapse
Affiliation(s)
- Liv Betker
- Department of Psychology, Division of Clinical Psychology and Psychotherapy (L.B., A.S., P.v.B.), Philipps-University Marburg, Marburg, Germany.
| | - Alina Senßfelder
- Department of Psychology, Division of Clinical Psychology and Psychotherapy (L.B., A.S., P.v.B.), Philipps-University Marburg, Marburg, Germany
| | - Jorge Riera Knorrenschild
- Department of Medicine, Division of Hematology and Oncology, University Hospital of Giessen and Marburg (J.R.K.), Marburg, Germany
| | - Christian Volberg
- Department of Medicine, Division of Anesthesiology and Intensive Care Medicine (C.V.), University Hospital of Giessen and Marburg, Marburg, Germany; Department of Medicine, Research Group Medical Ethics (C.V., C.S.), Philipps-University Marburg, Marburg, Germany
| | - Daniel Berthold
- Department of Medicine, Division of Medical Oncology and Palliative Care (D.B.), University Hospital of Giessen and Marburg, Giessen, Germany
| | - Carola Seifart
- Department of Medicine, Research Group Medical Ethics (C.V., C.S.), Philipps-University Marburg, Marburg, Germany
| | - Pia von Blanckenburg
- Department of Psychology, Division of Clinical Psychology and Psychotherapy (L.B., A.S., P.v.B.), Philipps-University Marburg, Marburg, Germany
| |
Collapse
|
3
|
Yuen E, Wilson C, Adams J, Kangutkar T, Livingston PM, White VM, Ockerby C, Hutchinson A. Health literacy interventions for informal caregivers: systematic review. BMJ Support Palliat Care 2024:spcare-2023-004513. [PMID: 38326015 DOI: 10.1136/spcare-2023-004513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 01/03/2024] [Indexed: 02/09/2024]
Abstract
AIM The aim of the systematic review was to identify conceptual models and interventions designed to improve health literacy in caregivers of adults with a chronic disease/disability. METHODS MEDLINE, CINAHL, PsycINFO and Embase were searched for relevant literature. Articles were included if they focused on adults who provided informal care to someone aged 18+ with a chronic disease/disability. Quantitative studies were included if they reported an intervention designed to improve caregiver health literacy (CHL) and assessed outcomes using a validated measure of health literacy. Qualitative and mixed method studies were included if they described a conceptual model or framework of CHL or developed/assessed the feasibility of an intervention. Study quality was appraised using the Mixed Methods Assessment Tool. RESULTS Eleven studies were included. Five studies used pre-post design to assess outcomes of an intervention; four described intervention development and/or pilot testing; two described conceptual models. Two of five studies reported pre-post intervention improvements in CHL; one reported an improvement in one of nine health literacy domains; two reported no improvements following intervention. Interventions predominantly aimed to improve: caregiver understanding of the disease, treatment and potential outcomes, day-to-day care, self-care and health provider engagement. Few interventions targeted broader interpersonal and health service factors identified as influencing CHL. DISCUSSION Evidence on the development and assessment of comprehensive CHL interventions is scarce. Recommendations include the development of interventions that are guided by a CHL framework to ensure they address individual, interpersonal and health service/provider factors that influence CHL.
Collapse
Affiliation(s)
- Eva Yuen
- School of Nursing and Midwifery, Centre for Quality and Patient Safety, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
- Monash Health, Clayton, Victoria, Australia
| | - Carlene Wilson
- School of Psychology and Public Health, LaTrobe University, Bundoora, Victoria, Australia
- Centre for Epidemiology and Biostatistics, University of Melbourne, Parkville, Victoria, Australia
- Psycho-Oncology Research Unit, Olivia Newton-John Cancer, Wellness and Research Centre, Austin Health, Heidelberg, Victoria, Australia
| | - Joanne Adams
- Violet Vines Marshman Centre for Rural Health Research, La Trobe University, Bendigo, Victoria, Australia
| | - Tejashree Kangutkar
- La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Patricia M Livingston
- School of Nursing and Midwifery, Centre for Quality and Patient Safety, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Victoria M White
- School of Psychology, Deakin University, Burwood, Victoria, Australia
| | | | - Alison Hutchinson
- School of Nursing and Midwifery, Centre for Quality and Patient Safety, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
- Barwon Health, Geelong, Victoria, Australia
| |
Collapse
|
4
|
Shen MJ, Prigerson HG, Maciejewski PK, Daly B, Adelman R, McConnell Trevino KM. A communication intervention to improve prognostic understanding and engagement in advance care planning among diverse advanced cancer patient-caregiver dyads: A pilot study. Palliat Support Care 2024; 22:10-18. [PMID: 37526150 PMCID: PMC10901460 DOI: 10.1017/s1478951523000901] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
OBJECTIVES Accurate prognostic understanding among patients with advanced cancer and their caregivers is associated with greater engagement in advance care planning (ACP) and receipt of goal-concordant care. Poor prognostic understanding is more prevalent among racial and ethnic minority patients. The purpose of this study was to examine the feasibility, acceptability, and impact of a patient-caregiver communication-based intervention to improve prognostic understanding, engagement in ACP, and completion of advance directives among a racially and ethnically diverse, urban sample of patients and their caregivers. METHODS Patients with advanced cancer and their caregivers (n = 22 dyads) completed assessments of prognostic understanding, engagement in ACP, and completion of advance directives at baseline and post-intervention, Talking About Cancer (TAC). TAC is a 7-session intervention delivered remotely by licensed social workers that includes distress management and communication skills, review of prognosis, and information on ACP. RESULTS TAC met a priori benchmarks for feasibility, acceptability, and fidelity. Prognostic understanding and engagement in ACP did not change over time. However, patients showed increases in completion of advance directives. SIGNIFICANCE OF RESULTS TAC was feasible, acceptable, and delivered with high fidelity. Involvement of caregivers in TAC may provide added layers of support to patients facing advanced cancer diagnoses, especially among racial and ethnic minorities. Trends indicated greater completion of advance directives but not in prognostic understanding or engagement in ACP. Future research is needed to optimize the intervention to improve acceptability, tailor to diverse patient populations, and examine the efficacy of TAC in a randomized controlled trial.
Collapse
Affiliation(s)
- Megan J Shen
- Division of Clinical Research, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Holly G Prigerson
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Paul K Maciejewski
- Department of Radiology, Weill Cornell Medical College, New York, NY, USA
| | - Bobby Daly
- Thoracic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ronald Adelman
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Kelly M McConnell Trevino
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| |
Collapse
|
5
|
Kastrinos A, Bylund C, Bacharz K, Applebaum A, Fisher CL. Understanding the role of parents' information sharing and withholding on emerging and young adults' caregiving and coping during their parents' advanced cancer. J Psychosoc Oncol 2023; 42:412-426. [PMID: 37929571 PMCID: PMC11070447 DOI: 10.1080/07347332.2023.2276940] [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] [Indexed: 11/07/2023]
Abstract
Emerging and young adult caregivers (EYACs) who provide care to their parents are a hidden, unsupported population of caregivers. Research identifies information sharing or withholding as a key aspect of caregivers' ability to cope and adjust, which may be especially critical when a parent is diagnosed with advanced cancer. The goal of this study was to examine the impact of parent information sharing/withholding on EYACs' caregiving and coping experiences. We conducted in-depth, semi-structured interviews with 33 EYACs between the ages of 18-35 who cared for a parent that died of advanced cancer. Interview transcripts were thematically analyzed. Three factors played a role in how parents' information sharing/withholding affected EYACs' caregiving/coping: 1) topic, 2) timing, and 3) who is included. Findings highlight the adaptive functioning of parents' information sharing and negative outcomes associated with information withholding, illustrating how parents' disclosure decisions function to promote or inhibit EYACs' care involvement and coping.
Collapse
Affiliation(s)
- Amanda Kastrinos
- Memorial Sloan Kettering Cancer Center, Department of Psychiatry and Behavioral Sciences, New York, NY
| | - Carma Bylund
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL
| | - Kelsey Bacharz
- Department of Clinical & Health Psychology, University of Florida, Gainesville, FL
| | - Allison Applebaum
- Memorial Sloan Kettering Cancer Center, Department of Psychiatry and Behavioral Sciences, New York, NY
| | - Carla L. Fisher
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL
| |
Collapse
|
6
|
Rothausen CS, Clausen AM, Voltelen B, Dieperink KB. Protective Buffering: Nurses Facilitating Communication Between Adults With Cancer and Their Adult Family Caregivers Who Overprotect One Another-An Integrative Review. JOURNAL OF FAMILY NURSING 2023; 29:417-436. [PMID: 36866540 DOI: 10.1177/10748407231156454] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
The aim of this study was to explore how nurses can alleviate protective buffering between adult patients with cancer and their adult family caregivers (PROSPERO No. CRD42020207072). An integrative review was conducted. PubMed, CINAHL, Embase, and Cochrane Library were searched for primary research articles published between January 2010 and April 2022. Only research conducted in oncology, hematology, or multiple settings and investigating communication between adult patients with cancer and their adult family caregivers and/or the communication between patients, family caregivers, and nurses was included. The constant comparison method outlined the approach to the analysis and synthesis of the included studies. Titles and abstracts of 7,073 references were screened; 22 articles (19 qualitative and three quantitative studies) were included in the review. Three themes emerged during data analysis: (a) family coping, (b) an isolating journey, and (c) the nurse's role. A study limitation was that "protective buffering" is not a common term in the nursing literature. There is a need for further research on protective buffering in families with cancer, particularly on psychosocial interventions that focus on the whole family across various cancer types.
Collapse
Affiliation(s)
- Camilla S Rothausen
- University of Southern Denmark, Odense, Denmark
- Odense University Hospital, Denmark
| | - Anne M Clausen
- University of Southern Denmark, Odense, Denmark
- Odense University Hospital, Denmark
| | - Barbara Voltelen
- University of Southern Denmark, Odense, Denmark
- University College Lillebælt, Vejle, Denmark
| | - Karin B Dieperink
- University of Southern Denmark, Odense, Denmark
- Odense University Hospital, Denmark
| |
Collapse
|
7
|
Jeon H, Kim S, Lee I. "The communication I had with him back then is still stuck in my mind." Bereaved families of cancer patients' experiences for end-of-life communication. Support Care Cancer 2023; 31:277. [PMID: 37071223 PMCID: PMC10111311 DOI: 10.1007/s00520-023-07753-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 04/13/2023] [Indexed: 04/19/2023]
Abstract
PURPOSE Communication with family members is important to end-of-life care for patients with cancer. It is an interactive engagement between terminally-ill cancer patients and their families through which they expand their mutual understanding to cope with losses and find meaning in death. This study aimed to describe the experiences of end-of-life communication between patients with cancer and their family members in South Korea. METHODS This is a qualitative descriptive study using in-depth semi-structured interviews. Ten bereaved family members with end-of-life communication experience with terminal cancer patients were recruited through purposive sampling. Data were analyzed using qualitative content analysis. RESULTS A total of 29 constructed meanings, 11 sub-categories, and the following 3 categories were derived: "Offering a space for patients to reminisce and reflect," "Building a bond," and "Reflections on what we need." End-of-life communication primarily centered on the patients, with families struggling to share their stories with them. Although the families coped well, they also regretted the lack of meaningful communication with the patients, indicating a need for support to facilitate effective end-of-life communication. CONCLUSION The study highlighted concrete communication for finding meaning at the end-of-life for cancer patients and their families. We found that the families have the potential to communicate appropriately to cope with the patients' end-of-life. Nevertheless, end-of-life presents a unique challenge in which families require adequate support. Given the increasing number of patients and families dealing with end-of-life care in hospitals, healthcare providers should be mindful of their needs and help them cope effectively.
Collapse
Affiliation(s)
- Heejung Jeon
- Department of Nursing, Graduate School, Yonsei University, Seoul, Republic of Korea
| | - Sanghee Kim
- College of Nursing and Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Republic of Korea
| | - Ilhak Lee
- Division of Medical Law and Ethics, Department of Medical Humanities and Social Sciences, Yonsei University College of Medicine, Asian Institute for Bioethics and Health Law, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, Republic of Korea.
| |
Collapse
|
8
|
Kastrinos A, Bacharz K, Mroz EL, Fisher CL, Applebaum AJ. A Mixed-Method Examination of Emerging and Young Adult Cancer Caregivers' Experiences during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5537. [PMID: 37107819 PMCID: PMC10138842 DOI: 10.3390/ijerph20085537] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/27/2023] [Accepted: 04/11/2023] [Indexed: 05/11/2023]
Abstract
Advanced cancer caregivers in emerging and young adulthood (EYACs; ages 18-35) are an understudied yet vulnerable caregiving population. The COVID-19 pandemic created new challenges for advanced cancer caregivers but also created unique contexts from which caregivers sometimes benefited. To understand how the pandemic may have positively and negatively impacted their caregiving and bereavement experiences, we examined EYACs' experiences of caring for and losing a parent with advanced cancer during the pandemic in comparison to those of EYACs with a parent who died outside the context of the pandemic. Eligible EYACs completed an online survey and semi-structured interview. Quantitative analyses compared responses for pre-pandemic EYACS (n = 14) and pandemic EYACs (n = 26). A thematic analysis of the interview transcripts of pandemic EYACS (n = 14) was conducted. Pandemic EYACs experienced non-significant but higher communal coping, benefit finding, negative emotional experiences, and caregiver strain than pre-pandemic EYACs. Thematic analysis revealed that the pandemic negatively affected EYACs' caregiving efficacy, personal well-being, interpersonal dynamics, and bereavement; shifts to remote work and schooling were reported as benefits. The findings can inform the design of resources to support EYACs whose parents died during the pandemic and who are navigating the healthcare system today.
Collapse
Affiliation(s)
- Amanda Kastrinos
- Memorial Sloan Kettering Cancer Center, Department of Psychiatry and Behavioral Sciences, New York, NY 10065, USA
| | - Kelsey Bacharz
- Department of Clinical & Health Psychology, University of Florida, Gainesville, FL 32601, USA
| | - Emily L. Mroz
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06520, USA
| | - Carla L. Fisher
- University of Florida Health Cancer Center, Gainesville, FL 32601, USA
| | - Allison J. Applebaum
- Memorial Sloan Kettering Cancer Center, Department of Psychiatry and Behavioral Sciences, New York, NY 10065, USA
| |
Collapse
|
9
|
Abstract
OBJECTIVES To synthesise empirical findings on the role of family in end-of-life (EOL) communication and to identify the communicative practices that are essential for EOL decision-making in family-oriented cultures. SETTING The EOL communication settings. PARTICIPANTS This integrative review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guideline. Relevant studies published between 1 January 1991 and 31 December 2021 were retrieved from four databases, including the PsycINFO, Embase, MEDLINE and Ovid nursing databases, using keywords with meanings of 'end-of-life', 'communication' and 'family'. Data were then extracted and coded into themes for analysis. The search strategy yielded 53 eligible studies; all 53 included studies underwent quality assessment. Quantitative studies were evaluated using the Quality Assessment Tool, and Joanna Briggs Institute Critical Appraisal Checklist was used for qualitative research. PRIMARY AND SECONDARY OUTCOME MEASURES Research evidence on EOL communication with a focus on family. RESULTS Four themes emerged from these studies: (1) conflicts in family decision-making in EOL communication, (2) the significance of timing of EOL communication, (3) difficulty in identification of a 'key person' who is responsible for decisions regarding EOL care and (4) different cultural perspectives on EOL communication. CONCLUSIONS The current review pointed towards the importance of family in EOL communication and illustrated that family participation likely leads to improved quality of life and death in patients. Future research should develop a family-oriented communication framework which is designed for the Chinese and Eastern contexts that targets on managing family expectations during prognosis disclosure and facilitating patients' fulfilment of familial roles while making EOL decision-making. Clinicians should also be aware of the significance of the role of family in EOL care and manage family members' expectations according to cultural contexts.
Collapse
Affiliation(s)
- Jack Pun
- Department of English, City University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - James C H Chow
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong SAR, People's Republic of China
| | - Leslie Fok
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong SAR, People's Republic of China
| | - Ka Man Cheung
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong SAR, People's Republic of China
| |
Collapse
|
10
|
Rohlfing AB, Kelly AE, Flint LA. Make the Call: Engaging Family as a Critical Intervention. J Gen Intern Med 2023; 38:523-524. [PMID: 36376624 PMCID: PMC9905348 DOI: 10.1007/s11606-022-07913-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 10/28/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Anne B. Rohlfing
- Extended Care & Palliative Medicine Service, VA Palo Alto Health Care System, Palo Alto, CA USA
- Division of Primary Care & Population Health, Stanford Medicine, Stanford, CA USA
| | - Anne E. Kelly
- Geriatrics, Palliative, and Extended Care, San Francisco VA Medical Center, San Francisco, CA USA
| | - Lynn A. Flint
- Geriatrics, Palliative, and Extended Care, San Francisco VA Medical Center, San Francisco, CA USA
- Division of Geriatrics, University of California San Francisco, San Francisco, CA USA
| |
Collapse
|
11
|
Dietz T, Tavenrath S, Schiewer V, Öztürk-Arenz H, Durakovic V, Labouvie H, Jäger RS, Kusch M. Cologne questionnaire on speechlessness: Development and validation. CURRENT PSYCHOLOGY 2022; 42:1-12. [PMID: 36531200 PMCID: PMC9741759 DOI: 10.1007/s12144-022-04102-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2022] [Indexed: 12/14/2022]
Abstract
Speechlessness forms a psychological concept that describes non-speaking or silence in different situations. Speechlessness occurs in particular during emotional stress. The Cologne Questionnaire on Speechlessness (ger.: Kölner Fragebogen zur Sprachlosigkeit) is an instrument for measuring speechlessness as a function of emotional perception and processing in situations of emotional stress or existing emotional dysregulation. The questionnaire was developed in theoretical proximity to the constructs of alexithymia and expressive suppression. Item selection was performed on a first line sample of N = 307 individuals of a normal population. Acquisition of an exploratory model to classify the phenomenon was conducted within four samples in clinical and non-clinical settings. Validation of the factorial structure was performed using an overarching dataset (N = 1293) consisting of all samples. The results of a confirmatory factor analysis (CFA) indicated the best model fit (χ2 (df, 146) = 953.856; p < .001; Tucker-Lewis-Index = .891; Comparative Fit Index = .916; Root Mean Square Error of Approximation = .065; p < .001; N = 1293) with a four-factorial structure of the questionnaire. Both the overall acceptable validity and reliability recommend the application of KFS on individuals of the normal population as well as clinical subgroups. In addition, the questionnaire can also be used in the context of research on the regulation of emotions. Supplementary Information The online version contains supplementary material available at 10.1007/s12144-022-04102-x.
Collapse
Affiliation(s)
- Thilo Dietz
- Department of Internal Medicine I, Faculty of Medicine, Cologne University Hospital, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
| | - Sally Tavenrath
- Department of Internal Medicine I, Faculty of Medicine, Cologne University Hospital, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
| | - Vera Schiewer
- Department of Internal Medicine I, Faculty of Medicine, Cologne University Hospital, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
| | - Hülya Öztürk-Arenz
- Department of Internal Medicine I, Faculty of Medicine, Cologne University Hospital, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
| | - Vanessa Durakovic
- Department of Internal Medicine I, Faculty of Medicine, Cologne University Hospital, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
| | - Hildegard Labouvie
- Department of Internal Medicine I, Faculty of Medicine, Cologne University Hospital, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
| | - Reinhold S. Jäger
- Centre for Educational Research, University Koblenz-Landau, Campus Landau, Bürgerstraße 23, 76829 Landau in der Pfalz, Germany
| | - Michael Kusch
- Department of Internal Medicine I, Faculty of Medicine, Cologne University Hospital, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
| |
Collapse
|
12
|
Bendel Y, Pinquart M, Schulz-Quach C, von Blanckenburg P. Expectations in the Communication About Death and Dying: Development and Initial Validation of the End-of-Life Conversations - Expectations Scale. OMEGA-JOURNAL OF DEATH AND DYING 2022:302228221110726. [PMID: 35749163 DOI: 10.1177/00302228221110726] [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: 11/16/2022]
Abstract
End-of-life (EOL) conversations with relatives or significant others are often avoided. One reason can be negative expectations regarding these conversations. The present study was conducted to develop and initially validate the End-of-Life Conversations - Expectations Scale (EOLC-E). An exploratory factor analysis (N = 307) resulted in a 20-item version with three distinct dimensions: expected own emotional burden (α = .92), expected other person's emotional burden (α = .94) and communication self-efficacy (α = .89). The EOLC-E total score correlated significantly with communication apprehension about death (r = .62), fear of death (r = .58), death avoidance (r = .52) as well as readiness for end-of-life conversations (r = -.38) and occurrence of previous conversations (r = -.29). Results suggest that the EOLC-E is a reliable and valid instrument to assess death and dying communication expectations. This measure has utility in communication research focusing on optimizing expectations and increasing EOL communication.
Collapse
Affiliation(s)
- Yannik Bendel
- Department of Psychology, Philipps University of Marburg, Marburg, Germany
| | - Martin Pinquart
- Department of Psychology, Philipps University of Marburg, Marburg, Germany
| | | | | |
Collapse
|
13
|
Piil K, Laegaard Skovhus S, Tolver A, Jarden M. Neuro-Oncological Symptoms: A Longitudinal Quantitative Study of Family Function, Perceived Support, and Caregiver Burden. JOURNAL OF FAMILY NURSING 2022; 28:43-56. [PMID: 34286624 DOI: 10.1177/10748407211029986] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The aim of this study was to establish preliminary quantitative evidence for the longitudinal change in family function, perceived support, and caregiver burden, acknowledging that physical and emotional symptoms are important variables for quality of life in families affected by a brain cancer diagnosis. This longitudinal quantitative study measured patient-reported and family member-reported outcomes at four different time points in 1 year. The patients reported that the symptom burden hindered their relationships with other people. Furthermore, the generally high level of strain due to the caregiver burden had an especially negative impact on close social relationships. Data indicate that family functioning was continually negatively affected as perceived by both patients and family caregivers. No significant changes over time were identified. The results underline the importance of providing systematic and ongoing support to the whole family that acknowledges their contribution as a valuable social support system for the individual experiencing high-grade glioma.
Collapse
Affiliation(s)
- Karin Piil
- Copenhagen University Hospital, Rigshospitalet, Denmark
- Aarhus University, Denmark
| | | | | | - Mary Jarden
- Copenhagen University Hospital, Rigshospitalet, Denmark
- University of Copenhagen, Denmark
| |
Collapse
|
14
|
Randomized Clinical Trial of a Self-care and Communication Intervention for Parents of Adolescent/Young Adults Undergoing High-Risk Cancer Treatment: A Report From the Children's Oncology Group. Cancer Nurs 2021; 45:316-331. [PMID: 34817419 PMCID: PMC9124731 DOI: 10.1097/ncc.0000000000001038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Parents of adolescents and young adults (AYAs) with cancer offer primary support to their children and often experience their own high levels of distress, affecting parent-AYA communication and quality of life. OBJECTIVE To reduce parent distress and improve communication during high-risk cancer treatment, we examined efficacy of a self-care and communication intervention for parents and indirect benefit for AYAs receiving a therapeutic music video (TMV) intervention. METHODS In this study, we conducted a multisite, randomized controlled trial with AYAs and parents enrolled as dyads (n = 110). Parents were randomized to intervention or low-dose control; all AYAs received TMV. Data collection occurred at baseline, 2 weeks post intervention (T2), and 90 days post intervention (T3). RESULTS There were no significant between-group differences on primary outcomes for parents or AYAs. We did find significant differences favoring the parent intervention group on parenting confidence at T2 and marginally better outcomes for family adaptability/cohesion at T3. Both groups exhibited significant within-group improvement for parent distress (state anxiety, T3; perceived stress, T2 and T3; mood, T3), state anxiety (T2) intervention only, and family strengths control group only. Qualitative data demonstrate the parent intervention raised self-awareness and parent confidence in the short term. CONCLUSION Parents found their intervention helpful. Absence of significant results may be due to short intervention duration, need for tailored content, underpowered sample, and potential indirect parent benefit from AYA participation in TMV. The parent intervention did not provide an indirect benefit for AYAs. IMPLICATIONS FOR NURSING Parents identified their own need for communication and support from nurses. Nurses can optimize AYA care by attending to parent needs through supportive listening and encouraging self-care.
Collapse
|
15
|
Kang Y. Why Are Dying Individuals Stigmatized and Socially Avoided? Psychological Explanations. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2021; 17:317-348. [PMID: 34039235 DOI: 10.1080/15524256.2021.1930330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Extant research on the topic of death and dying in modern society frequently includes the observation that death is now rendered invisible, and dying individuals are stigmatized and socially avoided. The current research speculated that lack of contact with a dying individual may promote negative perceptions of the dying, and this may in turn lead to further avoidance of them. Three studies were conducted: The first study examined how frequently the current U.S. participants had social contact with a dying individual; the second study investigated what perceptions they have of the dying, and the third study tested for potential causal links between negative perceptions of the dying and social avoidance of them. The results indicated: Only a small number of the U.S. participants ever had frequent social contact with a dying individual outside their family; they, nevertheless, shared several common negative perceptions of the dying; and those negative perceptions exerted different effects on one's avoidant attitude toward a dying individual-only making males more avoidant, especially in a physically close social relationship. Two concepts, medicalization and masculinism, were suggested as possible explanations for why dying individuals are stigmatized and avoided in modern society.
Collapse
Affiliation(s)
- Youngjin Kang
- New Mexico State University Board of Regents, Las Cruces, NM, USA
| |
Collapse
|
16
|
Betker L, Nagelschmidt K, Leppin N, Knorrenschild JR, Volberg C, Berthold D, Sibelius U, Rief W, Barke A, von Blanckenburg P, Seifart C. The Difficulties in End-of-Life Discussions - Family Inventory (DEOLD-FI): Development and Initial Validation of a Self-Report Questionnaire in a Sample of Terminal Cancer Patients. J Pain Symptom Manage 2021; 62:e130-e138. [PMID: 33933622 DOI: 10.1016/j.jpainsymman.2021.04.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 04/21/2021] [Accepted: 04/23/2021] [Indexed: 11/21/2022]
Abstract
CONTEXT Open end-of-life communication is especially important within the patient-family unit of care and can positively affect their medical, psychological, and relational outcomes. Nevertheless, end-of-life discussions are often perceived as difficult and avoided. OBJECTIVES To develop and validate the Difficulties in End-of-Life Discussions - Family Inventory (DEOLD-FI) to allow a systematic assessment of reasons why people shy away from end-of-life discussions. METHODS Patients with advanced cancer were recruited and completed the DEOLD-FI and measures of avoidance of cancer communication, quality of life and distress, and the experienced difficulty as well as the occurrence of end-of-life discussions. Standard item analyses and an exploratory factor analysis were conducted. Construct validity was analysed through associations between the DEOLD-FI and the aforementioned measures. RESULTS Questionnaires were obtained from 112 participants (53% response rate; male 54%, mean age 64.9 years [range 33-94]). In the final 23-item version two factors were extracted: 'emotional burden due to end-of-life discussions' (α = 0.90) and "negative attitudes towards end-of-life discussions" (α = 0.91) explaining 69% of the variance (total scale α = 0.93). Construct validity was supported by its significant correlations with the reported difficulty in end-of-life discussions (r = 0.42) and avoidance of cancer communication (r = 0.40 to r = 0.46) and insignificant correlations with quality of life (r = -0.11), distress (r = 0.16), and physical well-being (r = 0.02). Those who had already engaged in end-of-life discussions showed significantly fewer communication barriers. CONCLUSION Results provide evidence that the DEOLD-FI is a valid and reliable instrument for the assessment of difficulties in end-of-life discussions. Benefits for clinical practice and research are discussed.
Collapse
Affiliation(s)
- Liv Betker
- Department of Clinical Psychology and Psychotherapy (L.B., K.N., N.L., W.R., P.V.B.), Philipps-University Marburg, Marburg, Germany.
| | - Katharina Nagelschmidt
- Department of Clinical Psychology and Psychotherapy (L.B., K.N., N.L., W.R., P.V.B.), Philipps-University Marburg, Marburg, Germany
| | - Nico Leppin
- Department of Clinical Psychology and Psychotherapy (L.B., K.N., N.L., W.R., P.V.B.), Philipps-University Marburg, Marburg, Germany
| | - Jorge Riera Knorrenschild
- Department of Internal Medicine, Division Haematology and Oncology (R.K.), University Hospital of Giessen and Marburg, Marburg Site, Germany
| | - Christian Volberg
- Faculty of Medicine, Deans Office, Research Group Medical Ethics (C.V., C.S.), Philipps-University Marburg, Marburg, Germany
| | - Daniel Berthold
- Department of Clinical Oncology and Palliative Care (D.B., U.S.), University Hospital of Giessen and Marburg, Giessen Site, Germany
| | - Ulf Sibelius
- Department of Clinical Oncology and Palliative Care (D.B., U.S.), University Hospital of Giessen and Marburg, Giessen Site, Germany
| | - Winfried Rief
- Department of Clinical Psychology and Psychotherapy (L.B., K.N., N.L., W.R., P.V.B.), Philipps-University Marburg, Marburg, Germany
| | - Antonia Barke
- Department of Psychology (A.B.), Catholic University Eichstaett-Ingolstadt, Eichstaett, Germany
| | - Pia von Blanckenburg
- Department of Clinical Psychology and Psychotherapy (L.B., K.N., N.L., W.R., P.V.B.), Philipps-University Marburg, Marburg, Germany
| | - Carola Seifart
- Faculty of Medicine, Deans Office, Research Group Medical Ethics (C.V., C.S.), Philipps-University Marburg, Marburg, Germany
| |
Collapse
|
17
|
Gawinski L, Stiel S, Schneider N, Herbst FA. Communication in dyads of adult children at the end of life with their parents and parents at the end of life with their adult children: Findings from a mixed-methods study. Psychooncology 2021; 30:1535-1543. [PMID: 33982826 DOI: 10.1002/pon.5728] [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] [Received: 01/07/2021] [Revised: 03/30/2021] [Accepted: 05/10/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Patient-family member communication plays a decisive role in coping with an end-of-life situation and is strongly influenced by the dyadic relationship. There is a lack of research exploring and comparing the specifics of communication between (1) terminally ill adult children and their parents and (2) terminally ill parents and their adult children. The present study aimed at describing and comparing communication specifics within these two dyads. METHODS As part of the research project Dy@EoL on parent-adult child interactions, this mixed-methods study combined qualitative interviews and the Berlin Social Support Scales self-report questionnaire. Participants in both dyads were recruited via 12 inpatient and ambulatory palliative/hospice care providers between February 2018 and September 2019. RESULTS Participants included 65 patients (dyad 1: 19; dyad 2: 46) and 42 family members (dyad 1: 13; dyad 2: 29). Qualitative interviews revealed communication changes in the terminal illness situation and provided insight into each dyad partner's perception of openness and avoidance in the dyadic communication. The quantitative results showed that patients in both dyads provided significantly less informational support relative to family members. A strong similarity present in both dyads was the central motivation for limiting information sharing. CONCLUSIONS Individual preferences for information sharing suggest that the divergent needs of dyad partners must be carefully negotiated to ensure that patients are able to address important topics without putting too great an emotional burden on their family members. Tailored psychosocial support measures are needed to achieve this goal. The study was registered prospectively in the German Clinical Trials Register (registration N° DRKS00013206).
Collapse
Affiliation(s)
- Laura Gawinski
- Institute for General Practice, Hannover Medical School, Hannover, Germany
| | - Stephanie Stiel
- Institute for General Practice, Hannover Medical School, Hannover, Germany
| | - Nils Schneider
- Institute for General Practice, Hannover Medical School, Hannover, Germany
| | - Franziska A Herbst
- Institute for General Practice, Hannover Medical School, Hannover, Germany
| |
Collapse
|
18
|
Gasteiger C, Groom KM, Lobo M, Scholz U, Dalbeth N, Petrie KJ. Is Three a Crowd? The Influence of Companions on a Patient's Decision to Transition to a Biosimilar. Ann Behav Med 2021; 56:512-522. [PMID: 34453530 DOI: 10.1093/abm/kaab082] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Involving patients in treatment decisions is commonplace in healthcare, and patients are frequently accompanied by a companion (support person). Companions are often actively involved in medical consultations, yet their impact on decisions to change medications is unknown. PURPOSE This study examines the influence of companions on a patient's decision to transition from their bio-originator therapy to a biosimilar. METHODS A parallel, two-arm randomized controlled trial was conducted with 79 patients taking a bio-originator for rheumatic diseases who regularly attend clinic with a companion. Patients were randomized to receive an explanation about a hypothetical transition to a biosimilar alone or with their companion. Patients reported willingness to transition, risk perceptions, difficulty understanding, social support, and completed the Decisional Conflict Scale and Satisfaction with Decision Scale. RESULTS Companions did not influence decisions to transition to biosimilars or cognitive and affective risk perceptions. Accompanied patients reported more difficulty understanding the explanation (p = .006, Cohen's d = .64) but thought it was more important to receive information with companions (p = .023, Cohen's d = -.52). Companions did not impact decision satisfaction or decisional conflict. Receiving emotional, but not practical support, was associated with less decisional conflict in accompanied patients (p = .038, r 2 = 0.20). CONCLUSIONS The presence of companions does not seem to influence risk perceptions or decisions about transitioning to biosimilars. Companions, however, impact the patient's reporting of their ability to understand treatment explanations. Providers should check understanding in all patients but may need to provide additional time or educational resources to accompanied patients and companions. TRIAL REGISTRATION Australian New Zealand Clinical Trial Registry: ACTRN12619001435178.
Collapse
Affiliation(s)
- Chiara Gasteiger
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Katie M Groom
- Liggins Institute, University of Auckland, Auckland, New Zealand.,National Women's Health, Auckland District Health Board, Auckland, New Zealand
| | - Maria Lobo
- Department of Rheumatology, Auckland District Health Board, Auckland, New Zealand
| | - Urte Scholz
- University Research Priority Program "Dynamics of Healthy Aging," University of Zurich, Zurich, Switzerland.,Department of Psychology - Applied Social and Health Psychology, University of Zurich, Zurich, Switzerland
| | - Nicola Dalbeth
- Department of Rheumatology, Auckland District Health Board, Auckland, New Zealand.,Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Keith J Petrie
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| |
Collapse
|
19
|
Stuttgen Finn K, Pacyna JE, Tsou C, Samadder NJ, Sharp RR. Factors that Influence Intent to Share Genetic Information Related to Cancer Risk with Family Members. JOURNAL OF HEALTH COMMUNICATION 2021; 26:545-552. [PMID: 34473010 PMCID: PMC10869109 DOI: 10.1080/10810730.2021.1968078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
We describe factors influencing patient decisions to share positive cancer genetic test results with family members. We focused on patients who were diagnosed with several different cancer types but did not have a family history that was suggestive of an inherited risk. Participants were recruited from Mayo Clinic and had been recently diagnosed with cancer. An 80+ gene panel was performed. Before receiving genetic test results, patients completed a 49-item survey on their intent to share their results with relatives. 1,721 (57.7%) of 2,984 individuals who elected to pursue genetic testing completed the survey. Most patients planned to share cancer-related genetic results with a spouse or partner (97.0%), at least one adult child (92.2%), at least one sibling (86.2%), and with at least one parent (70.3%). Familial support scores and familial communication scores were predictive of intent to share cancer-related genetic test results. Our data highlight differences in family communication capacity and support that are important for clinicians to consider when supporting patients who wish to share cancer-related genetic test results with family members. Our data point to several potential interventional strategies that might increase the likelihood of cancer-related genetic test results being shared with family members at risk.
Collapse
Affiliation(s)
- Kelsey Stuttgen Finn
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, Minnesota, USA
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Joel E Pacyna
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, Minnesota, USA
| | - Cindy Tsou
- Center for Individualized Medicine, Mayo Clinic, Phoenix, Arizona, USA
| | - Niloy J Samadder
- Center for Individualized Medicine, Mayo Clinic, Phoenix, Arizona, USA
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Phoenix, Arizona, USA
- Department of Clinical Genomics, Mayo Clinic, Phoenix, Arizona, USA
| | - Richard R Sharp
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, Minnesota, USA
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
20
|
Holmes SN, Illing J. Breaking bad news: tackling cultural dilemmas. BMJ Support Palliat Care 2021; 11:128-132. [PMID: 33762267 DOI: 10.1136/bmjspcare-2020-002700] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 02/17/2021] [Accepted: 03/11/2021] [Indexed: 11/04/2022]
Abstract
Requesting that serious diagnoses be concealed from patients, a widespread phenomenon in many cultures, presents a professional dilemma. Practical and sensitive communication strategies are needed. METHODOLOGY In this paper, we use analysis of the existing literature to develop a communication tool for practitioners facing requests for diagnostic non-disclosure. Our approach builds on existing strategies, in providing a mnemonic communication tool, permitting more than one outcome, and focusing on the need for mutual understanding and cooperation. RESULTS Existing work on this dilemma highlights the need to appreciate the family's standpoint, affirm their benevolent intentions and correct misperceptions. To this end, we have developed a mnemonic tool, 'ARCHES', to be used in situations where the family has requested diagnostic non-disclosure. The model has six stages: acknowledge the request for non-disclosure, build the relationship, find common ground, honour the patient's preferences and outline the harm of non-disclosure, provide emotional support and devise a supportive solution. CONCLUSION Facing requests for diagnostic non-disclosure is a challenge of communication. The dilemma is particularly marked when practising across cultures. Our model gives a structure for building rapport with the family and realigning their misperceptions while upholding the patient's right to knowledge.
Collapse
Affiliation(s)
| | - Jan Illing
- Royal College of Surgeons in Ireland, Dublin, Ireland
| |
Collapse
|
21
|
Berlin P, Leppin N, Nagelschmidt K, Seifart C, Rief W, von Blanckenburg P. Development and Validation of the Readiness for End-of-Life Conversations (REOLC) Scale. Front Psychol 2021; 12:662654. [PMID: 33868137 PMCID: PMC8044973 DOI: 10.3389/fpsyg.2021.662654] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 02/23/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Engaging in end-of-life care considerations is beneficial when the time is right. The purpose of this study is to provide a valid instrument to assess peoples readiness for end-of-life conversations before they are initiated. Materials and Methods: A community sample was recruited in study one for exploratory factor analysis of a 13-item questionnaire. In study two, psychometric properties were analyzed with structural equation modeling in a population affected by cancer. Convergent and discriminant validity were assessed with questionnaires measuring distress, depression, anxiety, fear of progression, and distress of death and dying. Results: In study one (N = 349) exploratory factor analysis resulted in three subscales readiness (α = 0.84), communication (α = 0.76), and values (α = 0.56) with a possible common factor (α = 0.84) for a community sample. In study two (N = 84) the three-factor solution with 13 items was not supported for cancer patients. Factor structure was adapted to 12 items with one common factor readiness (α = 0.87). Model fit was good: χ2(50) = 59.18, p>0.05 (Satorra-Bentler-correction = 1.27), with χ2/df = 1.184, rRMSEA = 0.053 (90%-CI[0.000;0.100]), and rSRMR = 0.072. Convergent validity was supported by moderate correlations to trait gratitude, ratings of readiness to provide a living will or talk with family about the end of life. Divergent validity was supported by no or small correlation with distress, depression, general and death anxiety and fear of progression, respectively. Conclusions: Results support usage of the REOLC Scale in different settings with adapted factor structure. The questionnaire is interpreted as valid and reliable instrument to assess objective readiness for end-of-life conversations.
Collapse
Affiliation(s)
- Pia Berlin
- Clinical Psychology and Psychotherapy, Department of Psychology, Philipps University of Marburg, Marburg, Germany
| | - Nico Leppin
- Clinical Psychology and Psychotherapy, Department of Psychology, Philipps University of Marburg, Marburg, Germany
| | - Katharina Nagelschmidt
- Clinical Psychology and Psychotherapy, Department of Psychology, Philipps University of Marburg, Marburg, Germany
| | - Carola Seifart
- Department of Medicine, Research Group Clinical Ethics, Philipps University of Marburg, Marburg, Germany
| | - Winfried Rief
- Clinical Psychology and Psychotherapy, Department of Psychology, Philipps University of Marburg, Marburg, Germany
| | - Pia von Blanckenburg
- Clinical Psychology and Psychotherapy, Department of Psychology, Philipps University of Marburg, Marburg, Germany
| |
Collapse
|
22
|
Koenig Kellas J, Castle KM, Johnson AZ, Cohen MZ. Cancer as Communal: Understanding Communication and Relationships from the Perspectives of Survivors, Family Caregivers, and Health Care Providers. HEALTH COMMUNICATION 2021; 36:280-292. [PMID: 31665940 DOI: 10.1080/10410236.2019.1683952] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
With cancer increasing in prevalence and high priorities placed on concurrent oncological and palliative care to help meet the familial, spiritual, and individual needs of stakeholders in cancer, research is needed that assesses the factors that facilitate coping across stakeholders in cancer care. We were interested in synthesizing our understanding of communication and relationships among patients, caregivers, and providers based on the reasoning that illness is relational, but often conceptualized and researched from the individual perspectives of various stakeholders. The current study examined the experiences of relational and communication opportunities and challenges during cancer for current and former family caregivers, cancer survivors, and palliative and oncology health care practitioners. The thematic analysis of 30 semi-structured interviews revealed an overarching theme on the benefits of orienting toward cancer as communal, which was, in turn, facilitated or impeded by four additional themes/sets of behaviors: support, presence, perspective-taking, and reframing hope. Results of a cross-case data matrix analysis reveal that stakeholders in different roles experience qualitative differences in their experience of cancer as communal, isolated, or ambivalent. Implications for education, palliative care, and interventions are discussed.
Collapse
Affiliation(s)
| | | | - Alexis Z Johnson
- Department of Communication and Journalism, Arkansas Tech University
| | - Marlene Z Cohen
- Department of Nursing, VA Nebraska Western Iowa Healthcare System, College of Nursing, University of Nebraska Medical Center
| |
Collapse
|
23
|
Tiete J, Delvaux N, Liénard A, Razavi D. Efficacy of a dyadic intervention to improve communication between patients with cancer and their caregivers: A randomized pilot trial. PATIENT EDUCATION AND COUNSELING 2021; 104:563-570. [PMID: 33129628 DOI: 10.1016/j.pec.2020.08.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 07/27/2020] [Accepted: 08/19/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Cancer-related communication is critical for patients' and caregivers' adaptation to illness. This randomized pilot study was conducted to test the feasibility, acceptability, and efficacy of a specific dyadic intervention to improve communication. METHODS A four weekly-session intervention was developed to reinforce cancer-related patient-caregiver communication. Patients receiving treatment for any diagnosed cancer, and their caregivers, were recruited from two oncology clinics in Belgium. Sixty-four patient-caregiver dyads were assigned randomly to intervention and waitlist groups. Cancer-related dyadic communication, dyadic coping and emotional distress were assessed at baseline and post-intervention. RESULTS The intervention attrition rate was 6 %. Linear mixed models were performed on 60 dyads. Significant two-way group × time interaction indicated improvement in participants' cancer-related dyadic communication frequency (β = -1.30; SE = 0.31; p = .004), self-efficacy (β = -10.03; SE = 3.90; p = .011) and dyadic coping (β = -5.93; SE = 2.73; p = .046) after the intervention. CONCLUSION These results indicate that the brief dyadic communication intervention is feasible and acceptable, and show preliminary evidence of efficacy. PRACTICE IMPLICATIONS Encouraging patients and caregivers to discuss personal cancer-related concerns may improve their ability to cope with the illness together.
Collapse
Affiliation(s)
- Julien Tiete
- Université Libre de Bruxelles, Faculté des Sciences Psychologiques et de l'Education, 50 Avenue Franklin Roosevelt, Brussels, Belgium; Hôpital Erasme, Service de Psychologie, 808 Route de Lennik, Brussels, Belgium.
| | - Nicole Delvaux
- Université Libre de Bruxelles, Faculté des Sciences Psychologiques et de l'Education, 50 Avenue Franklin Roosevelt, Brussels, Belgium; Hôpital Erasme, Service de Psychologie, 808 Route de Lennik, Brussels, Belgium
| | - Aurore Liénard
- Université Libre de Bruxelles, Faculté des Sciences Psychologiques et de l'Education, 50 Avenue Franklin Roosevelt, Brussels, Belgium; Institut Jules Bordet, Clinique de Psycho-oncologie, 121 Boulevard de Waterloo, Brussels, Belgium
| | - Darius Razavi
- Université Libre de Bruxelles, Faculté des Sciences Psychologiques et de l'Education, 50 Avenue Franklin Roosevelt, Brussels, Belgium; Institut Jules Bordet, Clinique de Psycho-oncologie, 121 Boulevard de Waterloo, Brussels, Belgium
| |
Collapse
|
24
|
Carmel S, Singer Y, Yosef-Sela N, Bachner YG. Open communication between caregivers’ and terminally ill cancer patients about illness and death: The role of gender - A correlational study. Eur J Oncol Nurs 2020; 49:101828. [DOI: 10.1016/j.ejon.2020.101828] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 08/14/2020] [Accepted: 09/06/2020] [Indexed: 10/23/2022]
|
25
|
Eggert S, Wenzel A, Suhr R, Gellert P, Dräger D. Caregiving adult children's perceptions of challenges relating to the end of life of their centenarian parents. Scand J Caring Sci 2020; 35:1086-1095. [PMID: 33107662 DOI: 10.1111/scs.12921] [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] [Received: 10/15/2019] [Revised: 05/08/2020] [Accepted: 10/05/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND The number of centenarians in Europe is increasing; many face health impairments. Adult children often play a key role in their care, but there is a lack of research into what it means for these caregiving relatives to be confronted for many years with their parents' end of life (EOL), dying and death as well as their own advancing age. AIM This study aims to analyse the challenges of caregiving adult children regarding their parents' end of life and the related burdens and barriers they report. MATERIAL AND METHODS Semi-structured interviews were conducted with 13 caregivers following a theory-based and tested guideline. The computer-aided coding and evaluation followed the structured content analysis approach. RESULTS The analysis showed three main themes: 'Confronting EOL', 'Communicating about death and dying' and 'Assisting in the terminal phase'. The respondents commented on burdensome demands and concerns about the future. Further, a strong underlying presence of intra- and interpersonal conflicts relating to EOL became apparent. DISCUSSION The results indicate several potential burdens for centenarians' caregiving offspring. They are confronted with a double challenge resulting from the combination of their own advanced age and experiencing the burdens of their parents' very old age. Further, some participants struggled with their own unclear perspective on the future because of the relative but unclear proximity of the parent's death. Multiple conflicts and overlapping conflict dimensions emphasise the potential of the EOL topic to influence the well-being of family caregivers and care recipients. LIMITATIONS The convenience sample used for the study may cause limitations, for example, the fact that persons with a formally lower educational status are not represented. CONCLUSION The findings suggest that interventions designed for family-related care situations should include topics like 'Finiteness and grief', 'Communicating about dying and death' and 'Decisions and dispositions at EOL'.
Collapse
Affiliation(s)
- Simon Eggert
- Centre for Quality in Care (ZQP), Berlin, Germany
| | - Arlett Wenzel
- Institute of Medical Sociology, Charité - Universitätsmedizin Berlin, Institute of Medical Sociology and Rehabilitation Science, Berlin, Germany
| | - Ralf Suhr
- Centre for Quality in Care (ZQP), Berlin, Germany
| | - Paul Gellert
- Institute of Medical Sociology, Charité - Universitätsmedizin Berlin, Institute of Medical Sociology and Rehabilitation Science, Berlin, Germany
| | - Dagmar Dräger
- Institute of Medical Sociology, Charité - Universitätsmedizin Berlin, Institute of Medical Sociology and Rehabilitation Science, Berlin, Germany
| |
Collapse
|
26
|
|
27
|
Nagelschmidt K, Leppin N, Seifart C, Rief W, von Blanckenburg P. Systematic mixed-method review of barriers to end-of-life communication in the family context. BMJ Support Palliat Care 2020; 11:253-263. [DOI: 10.1136/bmjspcare-2020-002219] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 07/02/2020] [Accepted: 07/03/2020] [Indexed: 11/03/2022]
Abstract
BackgroundCommunication about the end of life is especially important in the family context, as patients and their families are considered as the care unit in palliative care. Open end-of-life communication can positively affect medical, psychological and relational outcomes during the dying process for patient and family. Regardless of the benefits of end-of-life conversations, many patients and their family caregivers speak little about relevant end-of-life issues.AimTo identify barriers that hinder or influence the discussion of end-of-life issues in the family context.DesignA systematic mixed-method review according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines.Data sourcesA systematic search of PsycInfo, CINAHL, PubMed and Web of Science was conducted and extended with a hand search. Peer-reviewed primary studies reporting on the barriers to or difficulties in end-of-life conversations experienced by terminally ill patients and/or family caregivers were included in this review.Results18 qualitative and two quantitative studies met the inclusion criteria. The experiences of n=205 patients and n=738 family caregivers were analysed qualitatively; n=293 patients and n=236 caregivers were surveyed in the questionnaire studies. Five overarching categories emerged from the extracted data: emotional, cognitive, communicative, relational and external processes can hinder end-of-life communication within the family. The most frequently reported barriers are emotional and cognitive processes such as protective buffering or belief in positive thinking.ConclusionsResearch on end-of-life communication barriers in the family context is scarce. Further research should enhance the development of appropriate assessment tools and interventions to support families with the challenges experienced regarding end-of-life conversations.
Collapse
|
28
|
Mortality communication and post-bereavement depression among Danish family caregivers of terminal cancer patients. Support Care Cancer 2020; 29:1951-1958. [DOI: 10.1007/s00520-020-05685-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 08/12/2020] [Indexed: 10/23/2022]
|
29
|
Chawak S, Chittem M, Butow P, Huilgol N. Indian Cancer Patients' Needs, Perceptions of, and Expectations from their Support Network: a Qualitative Study. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2020; 35:462-469. [PMID: 30715673 DOI: 10.1007/s13187-019-1483-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Psycho-oncology research in India reveals that family caregivers and oncologists are primary medical decision-makers frequently acting on behalf of the patient. Thus, patients are rarely asked about their wants and needs. This study aimed to understand Indian cancer patients' needs and expectations from their support network. Twenty-six cancer patients participated in semi-structured interviews exploring patients' needs, perceptions of their support network and the type of support they would prefer, and their experiences of receiving this support. The interviews were analyzed using Interpretive Phenomenological Analysis. Emergent themes included: (i) role of the oncologist: being the primary medical decision-maker, communicating in a style consistent with patient preferences; (ii) role of the immediate family: being emotionally available, helping with navigating the hospital system, aiding in medical adherence; (iii) role of relatives and friends: giving advice and providing tangible aid and services; and (iv) role of other cancer patients: helping with coping with the illness. The study highlights Indian patients' ability to define their supportive network and assign specific roles to them. The study implies the need to develop communication training programs and peer-to-peer support groups to address patients' unmet communication needs and aid in coping.
Collapse
Affiliation(s)
- Shweta Chawak
- Department of Liberal Arts, Indian Institute of Technology Hyderabad, Sangareddy District, Kandi, Telangana, 502285, India
| | - Mahati Chittem
- Department of Liberal Arts, Indian Institute of Technology Hyderabad, Sangareddy District, Kandi, Telangana, 502285, India.
| | - Phyllis Butow
- School of Psychology, University of Sydney, Sydney, New South Wales, 2006, Australia
| | - Nagraj Huilgol
- Division of Radiation Oncology, Nanavati Super Specialty Hospital, Mumbai, Maharasthra, 400056, India
| |
Collapse
|
30
|
Leppin N, Nagelschmidt K, Koch M, Riera Knorrenschild J, Rief W, Seifart C, von Blanckenburg P. Gespräche über das Lebensende erleichtern: Erkenntnisse aus der “Hand-in-Hand” Intervention. VERHALTENSTHERAPIE 2020. [DOI: 10.1159/000506111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
<b><i>Hintergrund:</i></b> Tod und Sterben sind in Psychotherapien häufig relevante Themen, besonders, wenn Menschen mit lebensbedrohlichen Erkrankungen in Behandlung kommen. Die Kommunikation über das Lebensende in der Therapie und im Alltag ist häufig mit Angst und Überforderung verknüpft. Dabei kann eine gelungene Kommunikation bedeuten, dass die Lebensqualität von Betroffenen und Angehörigen steigt, genau wie ihre Verbundenheit. Bisher existieren keine wissenschaftlich evaluierten Programme zur Anbahnung von Gesprächen über das Lebensende. Ein solches wurde im Rahmen der “Hand-in-Hand” Studie als Zugang für eine medizinische Vorausplanung entwickelt. <b><i>Fallbericht:</i></b> Zwei Krebsbetroffene, die im Rahmen einer randomisierten kontrollierten Studie an der “Hand-in-Hand” Intervention teilnahmen, werden vorgestellt. Die Interventionsbausteine aus Würde-Therapie, Wissensvermittlung und kognitiver Therapie werden beschrieben und ihre Wirkung qualitativ und quantitativ bewertet. Dabei zeigt sich eine hohe Zufriedenheit bezüglich der Intervention. Die Intervention kann die Kommunikation zwischen Betroffenen und Angehörigen verbessern, wenn auch in unterschiedlich starkem Ausmaß. <b><i>Schlussfolgerung:</i></b> Es ist wichtig, Menschen im Rahmen der psychotherapeutischen Versorgung nach lebensbedrohlichen Erkrankungen in ihrem Umfeld zu befragen. PsychotherapeutInnen besitzen dabei bereits Kompetenzen, mit denen sie Gespräche über das Lebensende fördern können. Der gezielte Einsatz dieser Kompetenzen im Rahmen der “Hand-in-Hand” Intervention hat in den beschriebenen Einzelfällen zu einer Veränderung in der Kommunikation geführt.
Collapse
|
31
|
Fukumori T, Miyazaki A, Takaba C, Taniguchi S, Asai M. Traumatic Events Among Cancer Patients That Lead to Compassion Fatigue in Nurses: A Qualitative Study. J Pain Symptom Manage 2020; 59:254-260. [PMID: 31610272 DOI: 10.1016/j.jpainsymman.2019.09.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 09/26/2019] [Accepted: 09/27/2019] [Indexed: 11/16/2022]
Abstract
CONTEXT Cancer care nurses are frequently exposed to patients' traumatic experiences and are at high risk of compassion fatigue. OBJECTIVES To describe the components and frequencies of traumatic events experienced by patients with cancer, which give rise to nurse compassion fatigue. METHODS This study is a supplementary analysis of data from a previous qualitative study. Semistructured interviews were conducted with 30 Japanese nurses, with at least two years of experience in cancer care and a history of compassion fatigue. Content analysis and constant comparison was used to identify relevant subcategories and categories. The frequencies of these subcategories and categories were then evaluated. RESULTS Eleven subcategories and four categories were identified. The kappa coefficient of these subcategories, determined by two independent raters, was 0.89. Subcategories with the highest frequencies among participants were as follows: having symptoms of cancer progression (n = 20; 67%), suffering because of insufficient pain control (n = 11; 37%), and being informed about getting cancer (n = 10; 33%). The four categories were as follows: worsening of physical condition (n = 20; 67%), bad news from doctors (n = 19; 63%), difficulty in treatment (n = 18; 60%), and emotional conflict with family (n = 6; 20%). CONCLUSION This study identified the components and frequencies of traumatic events among patients with cancer that lead to the onset of nurse compassion fatigue. Such information will aid in understanding the triggers of compassion fatigue, allowing for possible preparation to reduce the risk of this occupational hazard.
Collapse
Affiliation(s)
- Takaki Fukumori
- Graduate School of Integrated Arts and Sciences, Tokushima University, Tokushima, Japan.
| | - Atsuko Miyazaki
- Cancer Management Center, Tokushima University Hospital, Tokushima, Japan
| | - Chihiro Takaba
- Department of Psycho-Oncology, Gunma Prefectural Cancer Center, Ota, Japan
| | - Saki Taniguchi
- Cancer Management Center, Tokushima University Hospital, Tokushima, Japan
| | - Mariko Asai
- Graduate School of Clinical Psychology, Teikyo Heisei University, Tokyo, Japan
| |
Collapse
|
32
|
Wang C, Chen J, Wang Y, Hu R, Wu Y. The development of a family participatory dignity therapy programme for patients with haematologic neoplasms and their family caregivers in China: A feasibility study. Eur J Cancer Care (Engl) 2020; 29:e13204. [PMID: 31978264 DOI: 10.1111/ecc.13204] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 10/13/2019] [Accepted: 11/21/2019] [Indexed: 12/24/2022]
Affiliation(s)
- Chunfeng Wang
- School of Nursing Fujian Medical University Fuzhou China
| | - Jingyi Chen
- School of Nursing Fujian Medical University Fuzhou China
| | - Ying Wang
- School of Nursing Fujian Medical University Fuzhou China
| | - Rong Hu
- School of Nursing Fujian Medical University Fuzhou China
| | - Yong Wu
- Department of Hematology Fujian Medical University Union Hospital Fuzhou China
| |
Collapse
|
33
|
A qualitative analysis of the benefits and barriers of support groups for patients with brain tumours and their caregivers. Support Care Cancer 2019; 28:2659-2667. [PMID: 31641869 DOI: 10.1007/s00520-019-05069-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 08/30/2019] [Indexed: 12/31/2022]
Abstract
PURPOSE Brain tumours represent a significant burden for patients and caregivers. The aims of the present study were to explore the perceived benefits of support groups for patients and their caregivers, as well as the barriers to participation, and to generate suggestions for improvement. METHODS Brain tumour patients and caregivers were recruited from the brain tumour centre at Princess Margaret Cancer Centre to participate in focus groups. Focus groups were audio-recorded, transcribed, and thematically analysed using qualitative methods. Eight patients (five who had attended the support groups and three who had not) and eight caregivers (all of whom attended the groups) participated in separate focus groups. RESULTS Five major themes emerged: group cohesion (e.g., camaraderie and kinship), motivating factors to attend (e.g., loneliness), logistical factors that affected attendance (e.g., transportation), structure and content of the group (e.g., discussion topics), and suggestions for improvement (e.g., receiving personal reminders). CONCLUSIONS This study highlights the supportive needs of brain tumour patients and their caregivers. The key findings provide helpful information on how to maximise the benefits of support groups for these populations.
Collapse
|
34
|
Oh S, Ryu E. Does Holding Back Cancer-Related Concern Affect Couples' Marital Relationship and Quality of Life of Patients with Lung Cancer? An Actor–Partner Interdependence Mediation Modeling Approach. Asian Nurs Res (Korean Soc Nurs Sci) 2019; 13:277-285. [PMID: 31605768 DOI: 10.1016/j.anr.2019.10.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 10/01/2019] [Accepted: 10/01/2019] [Indexed: 11/15/2022] Open
Affiliation(s)
- Soonyoung Oh
- Department of Nursing, Kyungbok University, Pochun, Republic of Korea
| | - Eunjung Ryu
- Department of Nursing, Chung-Ang University, Seoul, Republic of Korea.
| |
Collapse
|
35
|
Lowrie D, Ray R, Plummer D, Yau M. Alignment and mismatch in role relations at end-of-life: A constructivist grounded theory study. DEATH STUDIES 2019; 45:361-370. [PMID: 31397639 DOI: 10.1080/07481187.2019.1648330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
In this Australian, constructivist grounded theory study, we undertook in-depth interviews with 11 dying people and 8 caregivers to examine their perspectives on role relations at end-of-life. We found that situations of role alignment between dying people and their family and friends support positive relational and practical outcomes, whereas role mismatch can cause considerable distress. Factors contributing to role mismatch at end-of-life were: dying people and their caregivers' efforts to shield each other from emotional harm; fear of social exclusion; and unwanted focus on the dying identity. Our findings highlight a need for flexibility and adaptability in end-of-life role relations.
Collapse
Affiliation(s)
- Daniel Lowrie
- College of Healthcare Sciences, James Cook University, Douglas, Australia
| | - Robin Ray
- College of Medicine and Dentistry, James Cook University, Douglas, Australia
| | - David Plummer
- College of Medicine and Dentistry, James Cook University, Douglas, Australia
| | - Matthew Yau
- Department of Rehabilitation and Social Sciences, Tung Wah College, Kowloon, Hong Kong
| |
Collapse
|
36
|
The role of concealment and relationship quality on patient hospitalizations, care strain and depressive symptoms in heart failure dyads. Eur J Cardiovasc Nurs 2019; 19:118-124. [DOI: 10.1177/1474515119863791] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Heart failure is one of the most common reasons for hospitalization among older adults and negatively influences person-reported outcomes of patients and their care partners. Moreover, the majority of heart failure research examines patients and care partners separately, ignoring the interdependent nature of the heart failure dyad. Aims: The aim of this study was to examine the interpersonal factors associated with depressive symptoms of heart failure patients and spouse care partners, patient hospitalizations over the last 12 months and care strain. Methods: A descriptive, cross-sectional design was used to examine 60 community-dwelling adults with heart failure and their spouse care partners. Multilevel modeling controlled for the interdependent nature of the dyadic data. Results: Patients had significantly worse depressive symptoms than their spouse care partners. More patient concealment (i.e. hiding concerns/worries) and worse relationship quality were significantly associated with greater depressive symptoms for patients, but not spouse care partners. Better relationship quality (reported by spouse care partners) was significantly associated with lower levels of care strain, whereas better relationship quality (reported by patients) was significantly associated with worse care strain. Patients who had one or more hospitalizations over the past 12 months were significantly more likely to report higher levels of concealment; relationship quality was not associated with patient hospitalizations. Conclusion: Findings highlight the interdependent nature of heart failure and the complexity of the interpersonal context. Greater focus on how the heart failure dyad navigates illness as a unit over time is needed to design and tailor innovative lines of clinical intervention to optimize dyadic and individual health.
Collapse
|
37
|
Nedjat-Haiem FR, Cadet TJ, Amatya A, Thompson B, Mishra SI. Efficacy of Motivational Interviewing to Enhance Advance Directive Completion in Latinos With Chronic Illness: A Randomized Controlled Trial. Am J Hosp Palliat Care 2019; 36:980-992. [PMID: 31122037 DOI: 10.1177/1049909119851470] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND End-of-life (EOL) care for Latinos with chronic illness is a critically important problem. Latinos with chronic illness suffer worse health outcomes and poorer quality of care due to various issues occurring in care delivery systems. Latinos are less likely than non-Hispanic whites to prepare an advance directive (AD) for health-care decision-making that impacts treatment decisions for when EOL is near. Advance care planning (ACP) interventions tailored specifically for Latinos have rarely been implemented. OBJECTIVE The primary aim examines whether a motivational interviewing (MI) intervention increased rates of AD documentation among older Latinos. The secondary aim was to examine whether MI improved communication with providers and family members. METHODS We pilot tested a randomized controlled trial with older Latinos >50 years with one or more chronic illnesses, including cancer. Participants were randomly assigned to usual care (UC) receiving ACP education alone versus treatment (TX), which received ACP education, plus MI counseling including interactive decisional support, emotional support, and barrier navigation. RESULTS Results of logistic regression indicate TX group participants were significantly more likely to document an AD than UC, however were less ready to talk with health-care providers or family members. Those reporting navigational barriers for talking about dying is difficult showed a significant negative relationship for AD completion even with significant intervention effects. CONCLUSION When using MI to motivate individuals toward ACP EOL conversations other factors are important to consider. Further research is needed, especially among Latinos to understand best practices for ACP education and counseling for EOL care.
Collapse
Affiliation(s)
| | - Tamara J Cadet
- 2 School of Social Work, Simmons University, Boston, MA, USA.,3 Harvard School of Dental Medicine, Boston, MA, USA
| | - Anup Amatya
- 4 Department of Public Health Sciences, New Mexico State University, Las Cruces, NW, USA
| | - Beti Thompson
- 5 School of Public Health, University of Washington, Seattle, WA, USA
| | - Shiraz I Mishra
- 6 University of New Mexico Health Sciences Center, Albuquerque, NM, NM, USA
| |
Collapse
|
38
|
Shin JY, Steger MF, Shin DW, Kim SY, Yang HK, Cho J, Jeong A, Park K, Kweon SS, Park JH. Patient-family communication mediates the relation between family hardiness and caregiver positivity: Exploring the moderating role of caregiver depression and anxiety. J Psychosoc Oncol 2019; 37:557-572. [DOI: 10.1080/07347332.2019.1566808] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Joo Yeon Shin
- Graduate School of Education, Inha University, Incheon, Republic of Korea
| | - Michael F. Steger
- Department of Psychology, Colorado State University, Fort Collins, Colorado, USA
- Department of Psychology, North-West University, Potchefstroom, South Africa
| | - Dong Wook Shin
- Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Digital Health, Samsung Advanced Institute of Health Science and Technology (SAIHST), Sungkyunkwan University, Seoul, Korea
| | - So Young Kim
- Cancer Policy Branch, National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea
- College of Medicine/Graduate School of Health Science Business Convergence, Chungbuk National University, Cheongju, Republic of Korea
| | - Hyung-Kook Yang
- Cancer Survivorship Branch, National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea
| | - Juhee Cho
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Center for Clinical Epidemiology, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Republic of Korea
| | - Ansuk Jeong
- Department of Psychology, The University of Utah Asia Campus, Incheon, Republic of Korea
| | - Keeho Park
- Cancer Policy Branch, National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea
| | - Sun Seog Kweon
- Department of Preventive Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Jong-Hyock Park
- Cancer Policy Branch, National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea
- College of Medicine/Graduate School of Health Science Business Convergence, Chungbuk National University, Cheongju, Republic of Korea
| |
Collapse
|
39
|
Waldrop DP, Milch RA, Skretny JA. Understanding Family Responses to Life-Limiting Illness: In-depth Interviews with Hospice Patients and Their Family Members. J Palliat Care 2019. [DOI: 10.1177/082585970502100204] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Understanding family dynamics is a key component in providing comprehensive care for persons with progressive illnesses and their caregivers. The purpose of this study was to investigate what families experience during an advancing illness and to describe their patterns of response. In-depth interviews (n=108) were conducted with families two weeks after hospice admission. Interviews were tape recorded, transcribed, and analyzed using qualitative methods. Six modes were distilled: reactive (illness generates intense responses), advocacy (vulnerability ignites assertive actions), fused (illness and decline are shared experiences), dissonant (diametrically opposed viewpoints cause struggle), resigned (decline and death are anticipated), and closed (outward responses are impassive). Three events triggered movement from one mode to another: (1) functional changes, (2) crisis events, and (3) provider communication. Providers who understand varied family reactions can ease the patient's suffering, assist relatives in providing effective care, and prepare them for the approaching death.
Collapse
Affiliation(s)
| | - Robert A. Milch
- The Center for Hospice and Palliative Care, Cheektowaga, New York, USA
| | - Judith A. Skretny
- The Center for Hospice and Palliative Care, Cheektowaga, New York, USA
| |
Collapse
|
40
|
Van Humbeeck L, Dillen L, Piers R, Grypdonck M, Verhaeghe S, Van Den Noortgate N. Cancer patients' experiences of communicating and dealing with their older parents: A qualitative study. Eur J Oncol Nurs 2019; 38:98-103. [DOI: 10.1016/j.ejon.2018.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 12/13/2018] [Accepted: 12/16/2018] [Indexed: 02/04/2023]
|
41
|
Rutkowski NA, Lebel S, Richardson K, Mutsaers B, Chasen M, Feldstain A. A little help from my friends: social support in palliative rehabilitation. ACTA ACUST UNITED AC 2019; 25:358-365. [PMID: 30607109 DOI: 10.3747/co.25.4050] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Background Social support has been shown to buffer some difficulties of living with advanced cancer. The Palliative Rehabilitation Program (prp) was an interdisciplinary outpatient program offering post-treatment palliative rehabilitation to patients with advanced cancer. Social support was directly integrated into the program. The aim of the present study was to examine the types and sources of social support that patients found most beneficial. Methods Twelve patients participated in 30-minute semi-structured interviews. Thematic content analysis was used to explore the social support experiences of those patients in the prp. Patients were eligible to participate in the interview if they had completed the 8-week prp, spoke English, and did not have cognitive or auditory impairments affecting their ability to participate. Results The main sources of support reported by participants were team members and spouse, family, or close friends; peers attending the program; and spiritual beliefs. Social support varied based on sex and age, such that, compared with women, men reported relying less on social support, and the supportive needs of younger (≤50 years of age) and older participants differed. Team members were endorsed as frequently as family as social support. Discussion Emotional support was endorsed with the greatest frequency. The members of the interdisciplinary care team were also providers of emotional and informational support for patients, bolstering the support received from caregivers. Widowed or divorced women might rely on health care providers more readily than do married men, who chose their wives as support. Future rehabilitation programs might consider the importance of an interdisciplinary team, the formal integration of caregivers, and the incorporation of spirituality to meet the unique supportive needs of patients with advanced cancer.
Collapse
Affiliation(s)
- N A Rutkowski
- School of Psychology, University of Ottawa, Ottawa, ON.,Bruyère Research Institute, Bruyère Continuing Care, Ottawa, ON
| | - S Lebel
- School of Psychology, University of Ottawa, Ottawa, ON
| | - K Richardson
- School of Psychology, University of Ottawa, Ottawa, ON
| | - B Mutsaers
- School of Psychology, University of Ottawa, Ottawa, ON
| | - M Chasen
- Bruyère Research Institute, Bruyère Continuing Care, Ottawa, ON.,Department of Medicine, William Osler Health System, Toronto, ON.,Department of Palliative Medicine, Bruyère Continuing Care, Ottawa, ON.,Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON
| | - A Feldstain
- School of Psychology, University of Ottawa, Ottawa, ON.,Bruyère Research Institute, Bruyère Continuing Care, Ottawa, ON.,Department of Psychosocial and Rehabilitation Oncology, Tom Baker Cancer Centre, Calgary, AB
| |
Collapse
|
42
|
Lyons KS, Hiatt SO, Gelow JM, Auld J, Mudd JO, Chien CV, Lee CS. Depressive symptoms in couples living with heart failure: the role of congruent engagement in heart failure management. Aging Ment Health 2018; 22:1585-1591. [PMID: 28959891 DOI: 10.1080/13607863.2017.1381945] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The life-threatening context of heart failure (HF), high variability of the illness and complexity of care place considerable demands on both the adult patient and his/her spouse. The current study examines the role of congruent engagement in HF management behaviors on the depressive symptoms of the couple living with HF. METHOD A cross-sectional design was used to examine 60 couples living with HF. Multilevel modeling was used to examine partner and within-dyad effects of engagement in HF behaviors on depressive symptoms. RESULTS Just over one quarter (27%) of couples had both members experiencing at least mild depressive symptoms. Controlling for stage of HF and one's own level of engagement, one's partner's level of engagement was significantly associated with one's level of depressive symptoms; higher levels of engagement by one's partner were associated with lower levels of depressive symptoms. Additionally, spouses had lower levels of depressive symptoms when they had similar levels of engagement to their partner with HF; spouses had higher levels of depressive symptoms when they had higher levels of engagement than their partner with HF. CONCLUSION Findings confirm the importance of screening both members of the couple for depression and fostering collaboration within the couple.
Collapse
Affiliation(s)
- Karen S Lyons
- a School of Nursing , Oregon Health and Science University , Portland , OR , USA
| | - Shirin O Hiatt
- a School of Nursing , Oregon Health and Science University , Portland , OR , USA
| | - Jill M Gelow
- b Knight Cardiovascular Institute , Oregon Health and Science University , Portland , OR , USA
| | - Jonathan Auld
- a School of Nursing , Oregon Health and Science University , Portland , OR , USA
| | - James O Mudd
- b Knight Cardiovascular Institute , Oregon Health and Science University , Portland , OR , USA
| | - Christopher V Chien
- b Knight Cardiovascular Institute , Oregon Health and Science University , Portland , OR , USA
| | - Christopher S Lee
- c School of Nursing/Knight Cardiovascular Institute , Oregon Health and Science University , Portland , OR , USA
| |
Collapse
|
43
|
von Heymann-Horan A, Bidstrup PE, Johansen C, Rottmann N, Andersen EAW, Sjøgren P, von der Maase H, Timm H, Kjellberg J, Guldin MB. Dyadic coping in specialized palliative care intervention for patients with advanced cancer and their caregivers: Effects and mediation in a randomized controlled trial. Psychooncology 2018; 28:264-270. [PMID: 30353600 DOI: 10.1002/pon.4932] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 10/10/2018] [Accepted: 10/17/2018] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Specialized palliative care (SPC) interventions increasingly include patient-caregiver dyads, but their effects on dyadic coping are unknown. We investigated whether an SPC and dyadic psychological intervention increased aspects of dyadic coping in patients with advanced cancer and their caregivers, whether dyad characteristics moderated effects and whether aspects of dyadic coping mediated significant intervention effects on caregivers' anxiety and depression. METHODS We randomized 258 patients with incurable cancer and their caregivers to care as usual or accelerated transition from oncological treatment to home-based SPC and dyadic psychological support. In secondary outcome analyses, using mixed-effects models, we estimated intervention effects and 95% confidence intervals (CIs) for communication of stress and common coping, and moderation by dyad type and demographics. In path analyses, we investigated whether stress communication and common coping mediated intervention effects on caregivers' symptoms of anxiety and depression. (Clinicaltrials.gov NCT01885637). RESULTS The intervention significantly increased common coping in patients and caregivers in couples (estimated difference, 0.68; 95% CI, 0.11 to 1.24) and stress communication by partner caregivers (0.97; 0.24 to 1.24). We found some support for different intervention effects for spouses and other dyads, but no evidence of mediation. CONCLUSIONS Specialized palliative care and dyadic psychological intervention may affect aspects of dyadic coping. Common coping and stress communication did not mediate the previously found significant intervention effects on caregiver anxiety and depression, indicating that other mechanisms may have been central in the intervention.
Collapse
Affiliation(s)
- Annika von Heymann-Horan
- Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Christoffer Johansen
- Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Nina Rottmann
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- Danish Knowledge Centre for Rehabilitation and Palliative Care, University of Southern Denmark and Odense University Hospital, Odense, Denmark
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | | | - Per Sjøgren
- Palliative Research Group, Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Hans von der Maase
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Helle Timm
- Danish Knowledge Centre for Rehabilitation and Palliative Care, University of Southern Denmark and Odense University Hospital, Odense, Denmark
| | - Jakob Kjellberg
- KORA, The Danish Institute for Local and Regional Government Research, Copenhagen, Denmark
| | - Mai-Britt Guldin
- Research Unit for General Practice, Aarhus University, Aarhus, Denmark
| |
Collapse
|
44
|
Trevino KM, Maciejewski PK, Shen MJ, Prigerson HG, Mohile S, Kamen C, Epstein RM, Duberstein P. How much time is left? Associations between estimations of patient life expectancy and quality of life in patients and caregivers. Support Care Cancer 2018; 27:2487-2496. [PMID: 30387051 PMCID: PMC6494724 DOI: 10.1007/s00520-018-4533-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 10/26/2018] [Indexed: 12/18/2022]
Abstract
PURPOSE It is unclear whether life-expectancy estimates of patients with advanced cancer and their caregivers are associated with patient existential, social, or emotional quality of life (QOL) or caregiver emotional QOL. METHODS Patients with advanced cancer and their caregivers (n = 162 dyads) reported estimates of the chance the patient would live for 2 years or more from 0% (most pessimistic) to 100% (most optimistic). They also completed self-report measures of QOL. RESULTS Adjusting for sociodemographic confounds and multiple comparisons, more pessimistic caregiver and patient life-expectancy estimates were associated with worse caregiver emotional QOL and worse patient existential QOL. Discrepancies between patient and caregiver estimates were not associated with patient or caregiver QOL. CONCLUSIONS Pessimistic life-expectancy estimates are associated with worse existential QOL in patients and worse emotional QOL in caregivers. Prospective research to establish causal relationships is needed, and interventions to address the relationship between beliefs about life expectancy and existential and emotional QOL should be considered. Providing these interventions to patients and caregivers receiving information on life expectancy may mitigate the negative impact of life-expectancy information on patient existential quality of life.
Collapse
Affiliation(s)
- Kelly M Trevino
- Weill Cornell Medicine, 525 E. 68th St., Box 39, New York, NY, 10065, USA.
| | - Paul K Maciejewski
- Weill Cornell Medicine, 525 E. 68th St., Box 39, New York, NY, 10065, USA
| | - Megan Johnson Shen
- Weill Cornell Medicine, 525 E. 68th St., Box 39, New York, NY, 10065, USA
| | - Holly G Prigerson
- Weill Cornell Medicine, 525 E. 68th St., Box 39, New York, NY, 10065, USA
| | - Supriya Mohile
- University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, 14642, USA
| | - Charles Kamen
- University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, 14642, USA
| | - Ronald M Epstein
- University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, 14642, USA
| | - Paul Duberstein
- University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, 14642, USA
| |
Collapse
|
45
|
O'Rourke DJ, Lobchuk MM, Ahmed R. Shared Attributes of Responsibility and Emotion in Patients With Lung Cancer and Family Caregivers
. Oncol Nurs Forum 2018; 45:33-44. [PMID: 29251295 DOI: 10.1188/18.onf.33-44] [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: 11/17/2022]
Abstract
OBJECTIVES To compare the attributions and emotions held by patients with lung cancer (affected individuals) and family caregivers in their management of the disease.
. SAMPLE & SETTING A secondary data analysis of 304 affected individuals and 304 family caregivers. Participants were selected from five oncology outpatient settings.
. METHODS & VARIABLES Comparative analysis and regression modeling. Variables include responsibility, anger, and pride in managing lung cancer.
. RESULTS Affected individuals reported higher self-oriented blame, fault, and anger than did family caregivers. Family caregivers reported more blame, fault, and anger toward the affected individual than toward themselves. Current smoking behavior of either the affected individual or family caregiver was associated with increased reports of self-oriented blame, fault, and anger. Additional research is needed to understand the attributional and emotional responses affected by the type of lung cancer, gender differences, and characteristics of the caregiving dyad.
. IMPLICATIONS FOR NURSING Nurses should be aware of the potential for affected individuals to experience internal (self) and external (family caregiver) sources of blame, fault, and anger. Knowledge of the reasons for current smoking behavior is important for understanding emotional responses and determining interventions.
Collapse
|
46
|
Ellington L, Cloyes KG, Xu J, Bellury L, Berry PH, Reblin M, Clayton MF. Supporting home hospice family caregivers: Insights from different perspectives. Palliat Support Care 2018; 16:209-219. [PMID: 28464961 PMCID: PMC5670030 DOI: 10.1017/s1478951517000219] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
ABSTRACTObjective:Our intention was to describe and compare the perspectives of national hospice thought leaders, hospice nurses, and former family caregivers on factors that promote or threaten family caregiver perceptions of support. METHOD Nationally recognized hospice thought leaders (n = 11), hospice nurses (n = 13), and former family caregivers (n = 14) participated. Interviews and focus groups were audiotaped and transcribed. Data were coded inductively, and codes were hierarchically grouped by topic. Emergent categories were summarized descriptively and compared across groups. RESULTS Four categories linked responses from the three participant groups (95%, 366/384 codes): (1) essentials of skilled communication (30.6%), (2) importance of building authentic relationships (28%), (3) value of expert teaching (22.4%), and (4) critical role of teamwork (18.3%). The thought leaders emphasized communication (44.6%), caregivers stressed expert teaching (51%), and nurses highlighted teamwork (35.8%). Nurses discussed teamwork significantly more than caregivers (z = 2.2786), thought leaders discussed communication more than caregivers (z = 2.8551), and caregivers discussed expert teaching more than thought leaders (z = 2.1693) and nurses (z = 2.4718; all values of p < 0.05). SIGNIFICANCE OF RESULTS Our findings suggest differences in priorities for caregiver support across family caregivers, hospice nurses, and thought leaders. Hospice teams may benefit from further education and training to help cross the schism of family-centered hospice care as a clinical ideal to one where hospice team members can fully support and empower family caregivers as a hospice team member.
Collapse
Affiliation(s)
- Lee Ellington
- College of Nursing, University of Utah, Salt Lake City, Utah, USA
| | | | - Jiayun Xu
- College of Nursing, University of Utah, Salt Lake City, Utah, USA
| | - Lanell Bellury
- Georgia Baptist College of Nursing, Mercer University, Atlanta, Georgia, USA
| | - Patricia H. Berry
- Hartford Center of Gerontological Excellence, Oregon Health & Science University, Portland, Oregon, USA
| | - Maija Reblin
- Department of Health Outcomes & Behavior, Moffitt Cancer Center, Tampa, Florida, USA
| | | |
Collapse
|
47
|
Reblin M, Heyman RE, Ellington L, Baucom BRW, Georgiou PG, Vadaparampil ST. Everyday couples' communication research: Overcoming methodological barriers with technology. PATIENT EDUCATION AND COUNSELING 2018; 101:551-556. [PMID: 29111310 DOI: 10.1016/j.pec.2017.10.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 10/12/2017] [Accepted: 10/26/2017] [Indexed: 06/07/2023]
Abstract
Relationship behaviors contribute to compromised health or resilience. Everyday communication between intimate partners represents the vast majority of their interactions. When intimate partners take on new roles as patients and caregivers, everyday communication takes on a new and important role in managing both the transition and the adaptation to the change in health status. However, everyday communication and its relation to health has been little studied, likely due to barriers in collecting and processing this kind of data. The goal of this paper is to describe deterrents to capturing naturalistic, day-in-the-life communication data and share how technological advances have helped surmount them. We provide examples from a current study and describe how we anticipate technology will further change research capabilities.
Collapse
Affiliation(s)
- Maija Reblin
- Department of Health Outcomes & Behavior, Moffitt Cancer Center, Tampa, USA.
| | - Richard E Heyman
- Family Translational Research Group, New York University, New York, USA
| | - Lee Ellington
- College of Nursing, University of Utah, Salt Lake City, USA
| | - Brian R W Baucom
- Department of Psychology, University of Utah, Salt Lake City, USA
| | - Panayiotis G Georgiou
- Ming Hsieh Department of Electrical Engineering, University of Southern California, Los Angeles, USA
| | | |
Collapse
|
48
|
Shin JY, Lim JW, Shin DW, Kim SY, Yang HK, Cho J, Jeong A, Jo D, Yim CY, Park K, Park JH. Underestimated caregiver burden by cancer patients and its association with quality of life, depression and anxiety among caregivers. Eur J Cancer Care (Engl) 2018; 27:e12814. [PMID: 29333736 DOI: 10.1111/ecc.12814] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2017] [Indexed: 11/27/2022]
Abstract
This study examined how patients with cancer estimate caregiver burden (CB) and the association between their underestimation of CB and their caregivers' self-ratings of their quality of life (CQOLC-K; Korean version of the Caregiver Quality of Life Index-Cancer), depression and anxiety (Korean version of the Hospital Anxiety and Depression Scale). Participants consisted of 990 patient-caregiver dyads recruited from a nationwide cross-sectional survey conducted in South Korea. Medical baseline data were retrieved from the hospital information systems of the participating centres. The patients with cancer who underestimated CB ranged from 18.62% (for physical CB) to 23.33% (for social CB). They had less advanced cancer, a lower income, were the caregiver's spouse, reported higher levels of family avoidance of communication about cancer, and had female caregivers. The patients' underestimation of CB was significantly related to lower CQoL and higher levels of caregiver depression and anxiety. The current study provides empirical evidence for the link between the underestimation of CB by patients with cancer and compromised caregiving experiences of cancer caregivers. Open family communication about cancer was discussed as one of several practical strategies for decreasing patients' underestimation of CB.
Collapse
Affiliation(s)
- J Y Shin
- Graduate School of Education, Inha University, Incheon, Republic of Korea
| | - J-W Lim
- College of Social Welfare, Kangnam University, Yongin, Republic of Korea
| | - D W Shin
- Department of Family Medicine, Samsung Medical Center, Seoul, Republic of Korea.,Supportive Care Center, Samsung Comprehensive Cancer Center, Seoul, Republic of Korea
| | - S Y Kim
- Cancer Policy Branch, National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea.,Department of Public Health and Preventive Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - H-K Yang
- Cancer Survivoship Branch, National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea
| | - J Cho
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea.,Departments of Epidemiology and Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Center for Clinical Epidemiology, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Republic of Korea
| | - A Jeong
- Department of Psychology, University of Utah, Incheon, Republic of Korea
| | - D Jo
- Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - C-Y Yim
- Division of Hematology-Oncology, Department of Internal Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Republic of Korea
| | - K Park
- Cancer Policy Branch, National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea
| | - J-H Park
- Cancer Policy Branch, National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea.,College of Medicine/Graduate School of Health Science Business Convergence, Chungbuk National University, Cheongju, Republic of Korea
| |
Collapse
|
49
|
Paek MS, Lim JW. Understanding the Stress Process of Chinese- and Korean-American Breast Cancer Survivors. J Immigr Minor Health 2018. [PMID: 26223968 DOI: 10.1007/s10903-015-0255-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Guided by the stress process model (SPM), this study investigated the direct and indirect pathways of primary (negative self-image and life stress), secondary stressors (family communication strain) and family coping (external and internal) on mental health outcomes among Chinese- and Korean-American breast cancer survivors (BCS). A total of 156 Chinese- and Korean-American BCS were surveyed. Results showed primary and secondary stressors had a negative effect on better mental health outcomes. External coping was associated with better mental health. Family communication strain mediated the relationship between life stress and mental health outcomes. External coping mediated the relationship between family communication strain and mental health outcomes. Multi-group analysis revealed the stress process did not differ across ethnic groups. Findings suggest the SPM may be applicable to understand the stress process of Chinese- and Korean-American BCS and provide valuable insight into the role of family communication and external coping on mental health outcomes.
Collapse
Affiliation(s)
- Min-So Paek
- Division of Public Health Sciences, Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA.
| | - Jung-Won Lim
- College of Social Welfare, Kangnam University, 111 Gugal-dong, Giheung-gu, Yongin-si, Gyeonggi-do, Korea
| |
Collapse
|
50
|
Guo Q, Chochinov HM, McClement S, Thompson G, Hack T. Development and evaluation of the Dignity Talk question framework for palliative patients and their families: A mixed-methods study. Palliat Med 2018; 32:195-205. [PMID: 29130367 PMCID: PMC5758936 DOI: 10.1177/0269216317734696] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND Effective patient-family communication can reduce patients' psychosocial distress and relieve family members' current suffering and their subsequent grief. However, terminally ill patients and their family members often experience great difficulty in communicating their true feelings, concerns, and needs to each other. AIM To develop a novel means of facilitating meaningful conversations for palliative patients and family members, coined Dignity Talk, explore anticipated benefits and challenges of using Dignity Talk, and solicit suggestions for protocol improvement. DESIGN A convergent parallel mixed-methods design. Dignity Talk, a self-administered question list, was designed to prompt end-of-life conversations, adapted from the Dignity Therapy question framework. Participants were surveyed to evaluate the Dignity Talk question framework. Data were analyzed using qualitative and quantitative methods. SETTING/PARTICIPANTS A total of 20 palliative patients, 20 family members, and 34 healthcare providers were recruited from two inpatient palliative care units in Winnipeg, Canada. RESULTS Most Dignity Talk questions were endorsed by the majority of patients and families (>70%). Dignity Talk was revised to be convenient and flexible to use, broadly accessible, clearly stated, and sensitively worded. Participants felt Dignity Talk would be valuable in promoting conversations, enhancing family connections and relationships, enhancing patient sense of value and dignity, promoting effective interaction, and attending to unfinished business. Participants suggested that patients and family members be given latitude to respond only to questions that are meaningful to them and within their emotional capacity to broach. CONCLUSION Dignity Talk may provide a gentle means of facilitating important end-of-life conversations.
Collapse
Affiliation(s)
- Qiaohong Guo
- 1 School of Nursing, Capital Medical University, Beijing, China.,2 Manitoba Palliative Care Research Unit, CancerCare Manitoba, Winnipeg, MB, Canada.,3 Department of Psychiatry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Harvey Max Chochinov
- 2 Manitoba Palliative Care Research Unit, CancerCare Manitoba, Winnipeg, MB, Canada.,3 Department of Psychiatry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Susan McClement
- 2 Manitoba Palliative Care Research Unit, CancerCare Manitoba, Winnipeg, MB, Canada.,4 Rady Faculty of Health Sciences, College of Nursing, University of Manitoba, Winnipeg, MB, Canada
| | - Genevieve Thompson
- 2 Manitoba Palliative Care Research Unit, CancerCare Manitoba, Winnipeg, MB, Canada.,4 Rady Faculty of Health Sciences, College of Nursing, University of Manitoba, Winnipeg, MB, Canada
| | - Tom Hack
- 4 Rady Faculty of Health Sciences, College of Nursing, University of Manitoba, Winnipeg, MB, Canada.,5 University of Central Lancashire, Preston, UK
| |
Collapse
|