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Sannes TS, Parmet T, Yusufov M, Sutherland J, Stefanik J, Andrade N, Gray TF, Braun IM, Pirl WF. So what I'm stressed? A qualitative study examininga caregivers' reactions to emerging biomarkers of stress. Brain Behav Immun Health 2024; 38:100783. [PMID: 38818371 PMCID: PMC11137355 DOI: 10.1016/j.bbih.2024.100783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 04/10/2024] [Accepted: 04/23/2024] [Indexed: 06/01/2024] Open
Abstract
Background Caregivers of adults with cancer often report significant distress yet remain difficult to engage in supportive services. While the field of Psychosomatic Medicine has continued to identify important markers of physiologic stress, and demonstrated disruption in these markers in caregiver populations, no research has investigated whether biomarker information on caregivers' reaction to stress could impact their willingness to address their ongoing distress. Methods Here, we report on a qualitative study (N = 17) in which we conducted individual interviews with cancer caregivers to explore their key attitudes towards, and subjective experience of, mock stress biomarker data. A total of 17 caregivers of patients (M age = 56.1 years; SD = 12.3) with primarily metastatic brain tumors (glioblastoma) were interviewed regarding four commercially available biomarkers (telomere length; hair cortisol, activity levels and heart rate variability). Once presented with information about stress biomarkers, caregivers were asked to discuss their subjective reaction as if it was their own data as well as their motivation and willingness to seek support after receiving such information. We identified and extracted relevant themes. Results Analysis utilizing the framework method revealed four emerging themes. The first theme described caregivers' ability to manage stress and willingness to engage with supportive services. Second, caregivers generally accepted the biomarker data but preferred it to be presented in a specific way. The third theme demonstrated that for some, biomarker data may actually increase their subjective distress (e.g., whether or not something could be done to improve their mental state). The last theme described how biomarkers were generally received as meaningful motivators that could increase caregivers' willingness to engage with supportive services. Conclusions In addition to the more general identified theme of CG's willingness to engage with additional support, we gained insights into caregivers' reaction to the stress biomarkers presented. Findings will set the stage for the utility of stress biomarker information and whether it influences cancer caregivers' willingness to address their distress and motivation to engage in supportive services.
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Affiliation(s)
- Timothy S. Sannes
- UMass Memorial Cancer Center, Department of Psychiatry, UMass Chan Medical School, Worcester, MA, USA
- Dana Farber Cancer Institute, Department of Psychosocial Oncology and Palliative Care, Harvard Medical School, Boston, MA, USA
| | - Tamar Parmet
- University of Colorado-Denver, Department of Psychology, Denver, CO, USA
| | - Miryam Yusufov
- Dana Farber Cancer Institute, Department of Psychosocial Oncology and Palliative Care, Harvard Medical School, Boston, MA, USA
| | - Jodi Sutherland
- Dana Farber Cancer Institute, Department of Psychosocial Oncology and Palliative Care, Harvard Medical School, Boston, MA, USA
| | - Jennifer Stefanik
- Dana Farber Cancer Institute, Department of Psychosocial Oncology and Palliative Care, Harvard Medical School, Boston, MA, USA
| | - Nicole Andrade
- Dana Farber Cancer Institute, Department of Psychosocial Oncology and Palliative Care, Harvard Medical School, Boston, MA, USA
| | - Tamryn F. Gray
- Dana Farber Cancer Institute, Department of Psychosocial Oncology and Palliative Care, Harvard Medical School, Boston, MA, USA
| | - Ilana M. Braun
- Dana Farber Cancer Institute, Department of Psychosocial Oncology and Palliative Care, Harvard Medical School, Boston, MA, USA
| | - William F. Pirl
- Dana Farber Cancer Institute, Department of Psychosocial Oncology and Palliative Care, Harvard Medical School, Boston, MA, USA
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Pohl JS, Fleury J. Behavioral activation for family caregiver connectedness: Adaptation of an evidenced based intervention. Geriatr Nurs 2024; 56:285-290. [PMID: 38412635 DOI: 10.1016/j.gerinurse.2024.02.016] [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: 11/27/2023] [Revised: 01/31/2024] [Accepted: 02/05/2024] [Indexed: 02/29/2024]
Abstract
Informal caregivers of older adults with chronic illness have unique barriers to social connection. As the older adult population increases, individualized interventions are urgently needed to address the social disconnection experienced across generations of informal caregivers. Adapting an evidenced-based intervention to target social connectedness and leverage technology-mediated communication may be a promising approach. This article describes the adaptation of the Brief Behavioral Activation Treatment for Depression-Revised intervention using elements of the Framework for Reporting Adaptations and Modifications-Enhanced. Facilitating the comprehensive documentation of modifications made, we discuss the (a) rationale for modifications, (b) timing and approach to modifications, (c) nature of context and content modifications, and (d) fidelity in modifications. The Behavioral Activation for Family Caregiver Connectedness intervention addresses unique barriers to caregiver social connection with individualized value-based plans. Modifications to content and delivery reflect the goal of improving intervention fit in the context of social connectedness experienced by informal caregivers.
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Affiliation(s)
- Janet S Pohl
- Arizona State University, Edson College of Nursing and Health Innovation, 500 N 3rd Street, Phoenix, AZ 85004, United States.
| | - Julie Fleury
- Arizona State University, Edson College of Nursing and Health Innovation, 500 N 3rd Street, Phoenix, AZ 85004, United States
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Giosa JL, Kalles E, McAiney C, Oelke ND, Aubrecht K, McNeil H, Habib-Perez O, Holyoke P. Co-designing action-oriented mental health conversations between care providers and ageing Canadians in the community: a participatory mixed-methods study protocol. BMJ Open 2024; 14:e079653. [PMID: 38296303 PMCID: PMC10831463 DOI: 10.1136/bmjopen-2023-079653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 01/16/2024] [Indexed: 02/03/2024] Open
Abstract
INTRODUCTION The mental health of ageing Canadians is a growing concern, particularly post-pandemic. Older adults face systemic ageism and mental health stigma as pervasive barriers to seeking needed mental health support, care and treatment within health and social care systems. These barriers are exacerbated when service providers focus on physical healthcare needs or lack the skills and confidence to talk about and/or address mental health during routine visits. This study aims to co-design and test an evidence-based approach to mental health conversations at the point-of-care in home and community settings with older adults, family and friend caregivers and health and social care providers that could facilitate help-seeking activities and care access. METHODS AND ANALYSIS A participatory mixed-methods study design will be applied, guided by a Working Group of experts-by-experience (n=30). Phase 1 engages ageing Canadians in four online workshops (n=60) and a national survey (n=1000) to adapt an evidence-based visual model of mental health for use with older adults in home and community care. Phase 2 includes six co-design workshops with community providers (n=90) in rural and urban sites across three Canadian provinces to co-design tools, resources and processes for enabling the use of the adapted model as a conversation guide. Phase 3 involves pilot and feasibility testing the co-designed conversations with older adult clients of providers from Phase 2 (n=180). ETHICS AND DISSEMINATION Phases 1 and 2 of this study have received ethics clearance at the University of Waterloo (ORE #44187), University of British Columbia (#H22-02306) and St. Francis Xavier University (#26075). While an overview of Phase 3 is included, details will rely on Phase 2 outcomes. Knowledge mobilisation activities will include peer-reviewed publications, conference presentations, webinars, newsletters, infographics and policy briefs. Interested audiences may include community organisations, policy and decision-makers and health and social care providers.
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Affiliation(s)
- Justine L Giosa
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
- SE Research Centre, Saint Elizabeth Health Care, Markham, Ontario, Canada
| | - Elizabeth Kalles
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
- SE Research Centre, Saint Elizabeth Health Care, Markham, Ontario, Canada
| | - Carrie McAiney
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
- Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada
| | - Nelly D Oelke
- School of Nursing, University of British Columbia Okanagan, Kelowna, British Columbia, Canada
- Rural Coordination Centre of British Columbia, Vancouver, British Columbia, Canada
| | - Katie Aubrecht
- Department of Sociology, St. Francis Xavier University, Antigonish, Nova Scotia, Canada
| | - Heather McNeil
- SE Research Centre, Saint Elizabeth Health Care, Markham, Ontario, Canada
| | - Olinda Habib-Perez
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Paul Holyoke
- SE Research Centre, Saint Elizabeth Health Care, Markham, Ontario, Canada
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Blackberry I, Rasekaba T, Morgan D, Royals K, Greenhill J, Perkins D, O’Connell M, Hamiduzzaman M, Winbolt M, Robinson A, Davis H, Wilding C. Virtual Dementia-Friendly Communities (Verily Connect) Stepped-Wedge Cluster-Randomised Controlled Trial: Improving Dementia Caregiver Wellbeing in Rural Australia. Geriatrics (Basel) 2023; 8:85. [PMID: 37736885 PMCID: PMC10514836 DOI: 10.3390/geriatrics8050085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/19/2023] [Accepted: 08/21/2023] [Indexed: 09/23/2023] Open
Abstract
Caring for people living with dementia often leads to social isolation and decreased support for caregivers. This study investigated the effect of a Virtual Dementia-Friendly Rural Communities (Verily Connect) model on social support and demand for caregivers of people living with dementia. The co-designed intervention entailed an integrated website and mobile application, peer-support videoconference, and technology learning hubs. This mixed-methods, stepped-wedge, cluster-randomised controlled trial was conducted with 113 participants from 12 rural communities in Australia. Caregiver data were collected using MOS-SSS and ZBI between 2018 and 2020. The relationship between post-intervention social support with age, years of caring, years since diagnosis, and duration of intervention were explored through correlation analysis and thin plate regression. Google Analytics were analysed for levels of engagement, and cost analysis was performed for implementation. Results showed that caregivers' perception of social support (MOS-SSS) increased over 32 weeks (p = 0.003) and there was a marginal trend of less care demand (ZBI) among caregivers. Better social support was observed with increasing caregiver age until 55 years. Younger caregivers (aged <55 years) experienced the greatest post-intervention improvement. The greatest engagement occurred early in the trial, declining sharply thereafter. The Verily Connect model improved caregivers' social support and appeared to ease caregiver demand.
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Affiliation(s)
- Irene Blackberry
- John Richards Centre for Rural Ageing Research, La Trobe Rural Health School, La Trobe University, Wodonga, VIC 3689, Australia; (T.R.); (K.R.); (C.W.)
- Care Economy Research Institute, La Trobe University, Wodonga, VIC 3689, Australia
| | - Tshepo Rasekaba
- John Richards Centre for Rural Ageing Research, La Trobe Rural Health School, La Trobe University, Wodonga, VIC 3689, Australia; (T.R.); (K.R.); (C.W.)
| | - Debra Morgan
- Canadian Centre for Rural and Agricultural Health, University of Saskatchewan, Saskatoon, SK S7N 5E5, Canada;
| | - Kayla Royals
- John Richards Centre for Rural Ageing Research, La Trobe Rural Health School, La Trobe University, Wodonga, VIC 3689, Australia; (T.R.); (K.R.); (C.W.)
| | - Jennene Greenhill
- Faculty of Health, Southern Cross University, Bilinga, QLD 4225, Australia;
| | - David Perkins
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW 2300, Australia;
- Mental Health Policy Unit, Health Services Research Institute, University of Canberra, Canberra, ACT 2617, Australia
| | - Megan O’Connell
- Department of Psychology, University of Saskatchewan, Saskatoon, SK S7N 5A5, Canada;
| | - Mohammad Hamiduzzaman
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia;
| | - Margaret Winbolt
- Australian Institute for Primary Care and Ageing, La Trobe University, Melbourne, VIC 3086, Australia;
| | | | - Hilary Davis
- Social Innovation Research Institute, Swinburne University of Technology, Melbourne, VIC 3122, Australia;
| | - Clare Wilding
- John Richards Centre for Rural Ageing Research, La Trobe Rural Health School, La Trobe University, Wodonga, VIC 3689, Australia; (T.R.); (K.R.); (C.W.)
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Runacres J, Herron D. Designing Inclusive Qualitative Research with Carers of People Living with Dementia: Methodological Insights. Healthcare (Basel) 2023; 11:2125. [PMID: 37570366 PMCID: PMC10419147 DOI: 10.3390/healthcare11152125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 07/17/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023] Open
Abstract
The support provided by carers of people living with dementia results in savings for the UK economy; however, providing this care has a significant impact on carers. Supports are needed to ensure that carers can continue to provide care, and carers should be involved in the generation of the evidence necessary to develop such support. However, this relies on their ability to meaningfully engage with research, yet current data collection methods create obstacles to engagement. In this paper, we aim to provide a critical examination of approaches to qualitative data collection with carers and produce recommendations for the design of inclusive research. First, different approaches to qualitative data collection are discussed and appraised. Following this, a case study of inclusive research is presented, illustrating how carers can be facilitated to engage in research. Finally, recommendations for inclusive research are offered, including the collection of data without the cared-for person present, building additional care into a study design, providing 'incidental funds,' offering sustenance and remuneration, and undertaking research in a neutral space. These recommendations are designed to facilitate the involvement of carers in research and promote the use of more varied or multifaceted methods to develop the current evidence base.
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Affiliation(s)
- Jessica Runacres
- Department of Midwifery and Allied Health, Staffordshire University, Staffordshire ST4 2DE, UK
| | - Daniel Herron
- Department of Psychology, Staffordshire University, Staffordshire ST4 2DE, UK;
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