Explaining Caregivers' Perceptions of Palliative Care Unmet Needs in Iranian Alzheimer's Patients: A Qualitative Study

Needs Assessment and the Identification of Palliative Care Dimensions of the Essential Service Package for the Elderly with Alzheimer's Disease: A Mixed Exploratory Study

AIM

This study was conducted with the aim of assessing the needs and determining the care dimensions of the essential palliative care service package for the elderly with Alzheimer's disease.

METHOD

The mixed exploratory study was conducted in three phases. The first phase of the study was conducted in the form of a qualitative study and a literature review. This qualitative research was done through in-depth and semi-structured interviews with 19 qualified caregivers (11 informal caregivers and 8 formal caregivers) The samples were selected using the purposive sampling method by referring to hospitals, nursing homes, and active branches of the Alzheimer's Association in some provinces. In the second phase, the dimensions of palliative care were codified, and in the third phase, the prioritization and the validation of the dimensions of palliative care were performed in the form of two Delphi rounds.

RESULTS

Based on the results of the first phase of the study, the care dimensions of the service package were placed in eight categories based on National Consensus Project. In the second phase, the needs of Alzheimer's patients were arranged in the form of a questionnaire consisting of 8 parts, with 180 indicators. Then, in the third phase, the dimensions of the palliative care essential package were designed with 74 items in the form of 4 dimensions.

CONCLUSION

The dimensions of the essential service package of palliative care included a series of interventions as well as physical, psychological, cognitive, and spiritual support.

Development and validation of the care challenge scale in family caregivers of people with Alzheimer's disease

Background

Alzheimer's disease (AD) is a progressive and debilitating disorder that strongly affects people with AD and their families. The changes in signs of the disease and its treatment lead to many challenges in people with AD that affect the performance and the ability of caregivers, their social life, and physical, emotional, and psychological aspects of caregivers' health. Therefore, this study was designed to develop and validate the Care Challenge Scale (CCS) for family caregivers of people with AD in the care context of Iran.

Method

This is a cross-sectional study, and the primary scale was based on 14 semi-structured interviews with family caregivers of Iranian people with AD. In the next phase, the psychometric features were assessed, including the face validity (qualitative and quantitative), content validity (qualitative and quantitative), item analysis, structural validity (exploratory and confirmatory factors), and construct validity (convergent and discriminant validity). Finally, the reliability was assessed using internal consistency (Cronbach's alpha, McDonald's omega coefficient, and the average inter-item correlation), stability (intraclass correlation coefficient), and absolute reliability.

Results

Totally, 435 Iranian family caregivers filled out online questionnaires, with a mean age of 50.26(±13.24) years. Based on the results of the qualitative phase, an item pool was generated with 389 items, and after deleting overlapping and unrelated items, the CCS with 14 items was created. The results of the quantitative phase showed that the CCS consists of two factors with 10 items each, which are named effective role-play challenge and lack of social–financial support, and they explained 42.23% of the total variance. Furthermore, the results of confirmatory factor analysis showed a good fitness of the scale structure model, and it had convergent and discriminant validity. The reliability indexes showed this scale has internal consistency and stability.

Conclusion

The most care challenge among Iranian family caregivers of people with AD is effective role-play challenges and lack of social–financial support. The scale as designed has good validity, internal consistency, and stability that can be used by therapists, nurses, and researchers for the assessment of the challenges of this population.

A web-based information intervention for family caregivers of patients with Dementia: A randomized controlled trial

This study aimed to evaluate the efficacy of a web-based health information intervention on knowledge, care burden and attitudes of family caregivers of patients with dementia. This study is a unblinded randomised controlled trial. The study population consisted of family caregivers of patients with dementia ( n = 50) which were randomly allocated to the intervention group (access to the web-based health information) or control group (access to information as usual). The participants completed knowledge, care burden and attitude questionnaire at baseline and at two months follow-up. A total of 50 caregivers participated in this study. Before the intervention, there was no statistically significant difference between the knowledge, care burden and attitude score between the two groups ( p > 0.001). In comparison to the control group after the intervention, participants in the intervention group showed significant improvements in all outcomes ( p < 0.001). These findings provide further evidence that web-based information interventions helped caregivers feel more confident, empathetic and concerned about dementia care with less care burden.