1
|
White Makinde K, Pitzer KA, Benson JJ, Mitchell M, Oliver DP, Demiris G, Washington KT. Does Family Functioning Matter? Understanding the Relationship Between Family Interactions and Depressive Symptoms for Caregivers of Cancer Patients. Am J Hosp Palliat Care 2024:10499091241263016. [PMID: 38881044 DOI: 10.1177/10499091241263016] [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: 06/18/2024] Open
Abstract
BACKGROUND Caregivers of cancer patients are at increased risk of depression and other health challenges. There is limited understanding of the role of the caregiver's own family members in promoting or discouraging mental wellbeing. Family functioning conceptualizes how family members interact to promote a positive family environment and has the potential to impact caregiver mental health. The purpose of this study is to assess the association between family interactions and depressive symptoms among family caregivers of cancer patients. METHODS Secondary analysis of baseline data from an NIH-funded randomized control trial of family caregivers of cancer patients recruited from academic palliative care clinics at three sites (2 Midwest, 1 East). We tested for an association between caregiver responses to the Family Quality of Life in Dementia-Family Interactions Subscale and Patient-Reported Outcomes Measurement Information System Depression Short Form 8A using a block-wise approach to linear modeling. RESULTS A total of 246 caregivers were included in analysis; caregivers were mostly White (82%), not Hispanic or Latina/o (96%), and female (65%), with an average age of 55 years. Overall, participants had high family interactions (mean 57.7, sd 11.7) and an average depressive symptom burden (t-score 52.4, SD 8.57). Family interactions was significantly negatively associated with depressive symptoms (b = -.163, se = .057) when accounting for relevant covariates. CONCLUSION Family caregivers with more positive family interactions are likely to have fewer depressive symptoms, suggesting family functioning may play a key role in bolstering family caregiver mental health and wellbeing.
Collapse
Affiliation(s)
| | - Kyle A Pitzer
- Washington University in St. Louis School of Medicine, St Louis, MO, USA
| | - Jacquelyn J Benson
- Washington University in St. Louis School of Medicine, St Louis, MO, USA
| | - Maysara Mitchell
- Washington University in St. Louis School of Medicine, St Louis, MO, USA
| | - Debra Parker Oliver
- Washington University in St. Louis School of Medicine, St Louis, MO, USA
- Goldfarb School of Nursing at Barnes-Jewish College, St Louis, MO, USA
| | - George Demiris
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Karla T Washington
- Washington University in St. Louis School of Medicine, St Louis, MO, USA
| |
Collapse
|
2
|
Bahrami M, Sebzari AR, Nasiri A. Caregivers' demands: caring atmosphere expected by cancer patients' caregivers-a qualitative content analysis. Support Care Cancer 2024; 32:389. [PMID: 38802620 DOI: 10.1007/s00520-024-08575-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 05/13/2024] [Indexed: 05/29/2024]
Abstract
PURPOSE Family caregivers play a critical role in providing care for patients with cancer. However, the quality of their caregiving can be greatly impacted if the demands and expectations they experience are not identified. Therefore, this study aimed to explore the demands and perceived expectations of caregivers while caring for cancer patients. METHODS This qualitative study was conducted from June 2022 to September 2023. Face-to-face and in-depth semi-structured interviews were conducted to collect the experiences of 19 Iranian family caregivers of patients with cancer. Purposive sampling was used to select the participants. The interviews were analyzed using conventional content analysis and the rigor of the study was ensured by employing Lincoln and Guba's criteria. RESULTS Three main themes and six subthemes were identified through data analysis. The themes that emerged from the caregivers' experiences included the following: (1) ambiguity in the healthcare system, (2) need for empathetic communication, and (3) forgotten caregivers in the healthcare system. CONCLUSION Caregivers often feel overlooked, resulting in unfulfilled needs and expectations. It is imperative to explore potential solutions that provide caregivers information, empathetic communication, and support. Nurses, as key members of the healthcare team, should play a significant role in addressing this problem.
Collapse
Affiliation(s)
- Mahnaz Bahrami
- Student Research Committee, Department of Medical-Surgical Nursing, School of Nursing & Midwifery, Birjand University of Medical Sciences, Birjand, Iran
| | - Ahmad Reza Sebzari
- Department of Internal Medicine, School of Medicine, Birjand University of Medical Sciences, Birjand, Iran
| | - Ahmad Nasiri
- Department of Medical-Surgical Nursing, School of Nursing & Midwifery, Birjand University of Medical Sciences, Birjand, Iran.
| |
Collapse
|
3
|
Bahrami M, Nasiri A. Behind the scenes of caregiving in patients with advanced cancer: A qualitative study on family caregivers. Asia Pac J Oncol Nurs 2024; 11:100330. [PMID: 38179137 PMCID: PMC10764250 DOI: 10.1016/j.apjon.2023.100330] [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: 09/20/2023] [Accepted: 10/23/2023] [Indexed: 01/06/2024] Open
Abstract
Objective Family caregivers may have concerns that they do not want to disclose to others. This study aims to delve into the concealed facets of care provided by family caregivers to patients with advanced cancer. Methods A qualitative approach was conducted in Iran from June 2022 to February 2023. Face-to-face, in-depth semi-structured interviews were carried out with 16 Iranian family caregivers of patients with advanced cancer, employing purposive sampling. The gathered data were analyzed using conventional content analysis, and Lincoln and Guba's criteria for rigor were applied to ensure the study's trustworthiness. Results The analysis of the data resulted in the identification of three main themes with nine subthemes. The key themes derived from the experiences of family caregivers encompassed (1) chaotic mentalities, (2) troubling interdependence, and (3) desperational emotions. Conclusions Caregivers of patients with advanced cancer commonly experience a highly fragile psychological state and are profoundly impacted by their concerns for the patient. Healthcare systems should prioritize ensuring that caregivers receive sufficient support and care.
Collapse
Affiliation(s)
- Mahnaz Bahrami
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Student Research Committee, Birjand University of Medical Sciences, Birjand, Iran
| | - Ahmad Nasiri
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Birjand University of Medical Sciences, Birjand, Iran
| |
Collapse
|
4
|
Filipponi C, Chichua M, Masiero M, Mazzoni D, Pravettoni G. Cancer Pain Experience Through the Lens of Patients and Caregivers: Mixed Methods Social Media Study. JMIR Cancer 2023; 9:e41594. [PMID: 37399067 PMCID: PMC10365594 DOI: 10.2196/41594] [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: 08/01/2022] [Revised: 05/12/2023] [Accepted: 06/05/2023] [Indexed: 07/04/2023] Open
Abstract
BACKGROUND Cancer pain represents a challenge for cancer patients and their family members. Despite progression in pain management, pain is still underreported and undertreated, and there is limited information on the related needs that patients and caregivers may have. Online platforms represent a fundamental tool for research to reveal the unmet needs of these users and their emotions outside the medical setting. OBJECTIVE This study aimed to (1) reveal the unmet needs of both patients and caregivers and (2) detect the emotional activation associated with cancer pain by analyzing the textual patterns of both users. METHODS A descriptive and quantitative analysis of qualitative data was performed in RStudio v.2022.02.3 (RStudio Team). We analyzed 679 posts (161 from caregivers and 518 from patients) published over 10 years on the "cancer" subreddit of Reddit to identify unmet needs and emotions related to cancer pain. Hierarchical clustering, and emotion and sentiment analysis were conducted. RESULTS The language used for describing experiences related to cancer pain and expressed needs differed between patients and caregivers. For patients (agglomerative coefficient=0.72), the large cluster labeled unmet needs included the following clusters: (1A) reported experiences, with the subclusters (a) relationship with doctors/spouse and (b) reflections on physical features; and (1B) changes observed over time, with the subclusters (a) regret and (b) progress. For caregivers (agglomerative coefficient=0.80), the main clusters were as follows: (1A) social support and (1B) reported experiences, with the subclusters (a) psychosocial challenges and (b) grief. Moreover, comparison between the 2 groups (entanglement coefficient=0.28) showed that they shared a common cluster labeled uncertainty. Regarding emotion and sentiment analysis, patients expressed a significantly higher negative sentiment than caregivers (z=-2.14; P<.001). On the contrary, caregivers expressed a higher positive sentiment compared with patients (z=-2.26; P<.001), with trust (z=-4.12; P<.001) and joy (z=-2.03; P<.001) being the most prevalent positive emotions. CONCLUSIONS Our study emphasized different perceptions of cancer pain in patients and caregivers. We revealed different needs and emotional activations in the 2 groups. Moreover, our study findings highlight the importance of considering caregivers in medical care. Overall, this study increases knowledge about the unmet needs and emotions of patients and caregivers, which may have important clinical implications in pain management.
Collapse
Affiliation(s)
- Chiara Filipponi
- Applied Research Division for Cognitive and Psychological Science, IEO European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Mariam Chichua
- Applied Research Division for Cognitive and Psychological Science, IEO European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Marianna Masiero
- Applied Research Division for Cognitive and Psychological Science, IEO European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Davide Mazzoni
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Gabriella Pravettoni
- Applied Research Division for Cognitive and Psychological Science, IEO European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| |
Collapse
|
5
|
Pop RS, Payne S, Tint D, Pop CP, Mosoiu D. Instruments to assess the burden of care for family caregivers of adult palliative care patients. Int J Palliat Nurs 2022; 28:80-99. [PMID: 35446673 DOI: 10.12968/ijpn.2022.28.2.80] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND A primary caregiver shares the illness experience of the patient and undertakes vital care work, alongside managing the patient's emotions, and is actively involved in care process without being paid. When faced with the palliative care patient's needs, caregivers are affected on multiple levels (physical, psychological and socio-economic), thereby experiencing a moderate or severe burden of care. AIM To identify assessment instruments for the burden of care for family caregivers that are suitable to be used in clinical practice. METHOD A narrative review was conducted using an electronic search in Pubmed, PsychINFO, CINAHL of articles published in English between 2009-2019, using the search terms: 'caregiver/family, caregiver/carer and burden and palliative care/hospice/end of life'. An assessment grid was developed to appraise the clinical use of identified instruments. RESULTS Of the 568 articles identified, 40 quantitative studies were selected using 31 instruments to measure the caregiver burden of cancer, noncancer and terminally ill patients. Most instruments 23 (74.11%) evaluate the psycho-emotional and, 22 (70.96%) the social domain, 12 instruments (38.7%) focused on the physical domain, three (9.67%) on the spiritual field and six instruments (19.35%) on economic aspects. For the multidimensional instruments, the assessment grid scored highest for the Burden Scale for Family Caregiver (BSFC). CONCLUSION The BSFC is the tool that seems to meet the most requirements, being potentially the most useful tool in clinical practice.
Collapse
Affiliation(s)
- Rodica Sorina Pop
- Assistant Professor, Department of Family Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Faculty of Medicine, Cluj-Napoca, Romania
| | - Sheila Payne
- Professor, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Diana Tint
- Professor, Transilvania University, Faculty of Medicine, Brasov, Romania
| | | | - Daniela Mosoiu
- Associate Professor, Transilvania University, Faculty of Medicine, Brasov, Romania
| |
Collapse
|
6
|
Rincones O, Smith A’B, Naher S, Mercieca-Bebber R, Stockler M. An Updated Systematic Review of Quantitative Studies Assessing Anxiety, Depression, Fear of Cancer Recurrence or Psychological Distress in Testicular Cancer Survivors. Cancer Manag Res 2021; 13:3803-3816. [PMID: 34007213 PMCID: PMC8123967 DOI: 10.2147/cmar.s198039] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 04/09/2021] [Indexed: 12/14/2022] Open
Abstract
PURPOSE A diagnosis of testicular cancer (TC) at a relatively young age can have a dramatic impact on the psychological well-being of those affected. The aim of this review was to synthesize recent evidence to provide an updated account of the prevalence, severity and correlates of anxiety, depression, fear of cancer recurrence (FCR) and distress in TC survivors. PATIENTS AND METHODS A systematic literature review was conducted from September 2017 until June 2020 using electronic databases including Embase, MEDLINE, PsycINFO, Scopus and Web of Science. Study eligibility and quality were independently assessed by two reviewers. Narrative synthesis was used to depict the severity (mean/median scores), prevalence (proportions above standard clinical thresholds) and correlates of study outcomes. RESULTS A total of 988 articles were identified for screening after duplicate removal. Fifty-six full-text articles were screened, and eight articles met the inclusion criteria. The reported prevalence of the outcomes varied across studies (clinical levels of anxiety ranged from 6.9% to 21.1%, depression varied from 4.7% to 7%, distress was found between 25% and 41.4%, prevalence of FCR was not reported). Few studies compared TC survivors with other populations. Correlates of poorer psychological outcomes included younger age, relationship status, employment status, poorer sexual functioning, impaired masculinity and coping strategies. CONCLUSION Anxiety seems to be the most common issue for TC survivors. Men who are single or unemployed appear most at risk of poorer psychological outcomes, which seem associated with impaired masculinity and sexual function. More research is needed to identify TC survivors most likely to need one of the increasing number of psychological interventions being developed for TC survivors.
Collapse
Affiliation(s)
- Orlando Rincones
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research & University of New South Wales, Liverpool, New South Wales, Australia
| | - Allan ’Ben’ Smith
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research & University of New South Wales, Liverpool, New South Wales, Australia
| | - Sayeda Naher
- NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Rebecca Mercieca-Bebber
- NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Martin Stockler
- NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, New South Wales, Australia
| |
Collapse
|
7
|
Ahmad Zubaidi ZS, Ariffin F, Oun CTC, Katiman D. Caregiver burden among informal caregivers in the largest specialized palliative care unit in Malaysia: a cross sectional study. BMC Palliat Care 2020; 19:186. [PMID: 33292214 PMCID: PMC7722979 DOI: 10.1186/s12904-020-00691-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 11/30/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Informal caregivers (IC) are often overshadowed by the attention required by the terminally ill. This study aims to reveal the estimated proportion of caregiver burden, psychological manifestations and factors associated with caregiver burden among IC in the largest specialized Palliative Care Unit (PCU) in Malaysia. METHODS This was a cross-sectional study involving IC attending a PCU. Caregiver burden and psychological manifestations were measured using previously translated and validated Zarit Burden Interview and DASS-21 questionnaires respectively. Two hundred forty-nine samples were selected for analysis. RESULT The mean ZBI score was 23.33 ± 13.7. About half of the population 118(47.4%) was found to experienced caregiver burden whereby majority have mild to moderate burden 90(36.1%). The most common psychological manifestation among IC is anxiety 74(29.7%) followed by depression 51(20.4%) and stress 46(18.5%). Multiple logistic regression demonstrated that women who are IC to patients with non-malignancy were less likely to experience caregiver burden. IC who were highly educated and spent more than 14 h per day caregiving were at least twice likely to experience caregiver burden. Finally, those with symptoms of depression and anxiety were three times more likely to suffer from caregiver burden. CONCLUSION Caregiver burden among IC to palliative patients is prevalent in this population. IC who are men, educated, caregiving for patients with malignancy, long hours of caregiving and have symptoms of depression and anxiety are at risk of developing caregiver burden. Targeted screening should be implemented and IC well-being should be given more emphasis in local policies.
Collapse
Affiliation(s)
- Zati Sabrina Ahmad Zubaidi
- Clinical lecturer and Family Medicine Specialist, Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA (UiTM) Selayang campus, Jalan Prima 7, 68100, Batu Caves, Selangor, Malaysia.
| | - Farnaza Ariffin
- Clinical lecturer and Family Medicine Specialist, Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA (UiTM) Selayang campus, Jalan Prima 7, 68100, Batu Caves, Selangor, Malaysia
| | - Cindy Teoh Cy Oun
- Palliative Medicine Physician, Palliative Care Unit, Selayang Hospital, 68100, Batu Caves, Selangor, Malaysia
| | - Diana Katiman
- Clinical lecturer and Palliative Medicine Physician, Department of Medicine, Faculty of Medicine, Universiti Teknologi MARA (UiTM) Sg Buloh campus, Jalan Hospital, 47000, Sungai Buloh, Selangor, Malaysia
| |
Collapse
|