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Ellis KR, Furgal A, Wayas F, Contreras A, Jones C, Perez S, Raji D, Smith M, Vincent C, Song L, Northouse L, Langford AT. Symptom burden and quality of life among patient and family caregiver dyads in advanced cancer. Qual Life Res 2024:10.1007/s11136-024-03743-8. [PMID: 39046614 DOI: 10.1007/s11136-024-03743-8] [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] [Accepted: 07/16/2024] [Indexed: 07/25/2024]
Abstract
PURPOSE Symptom management among patients diagnosed with advanced cancer is a high priority in clinical care that often involves the support of a family caregiver. However, limited studies have examined parallel patient and caregiver symptom burden and associations with their own and each other's quality of life (QOL). This study seeks to identify patient and caregiver symptom clusters and investigate associations between identified clusters and demographic, clinical, and psychosocial factors (cognitive appraisals and QOL). METHODS This study was a secondary analysis of self-reported baseline survey data collected from a randomized clinical trial of 484 adult advanced cancer patients and their caregivers. Latent class analysis and factor analysis were used to identify symptom clusters. Bivariate statistics tested associations between symptom clusters and demographic, clinical, and psychosocial variables. RESULTS The most prevalent symptom for patients was energy loss/fatigue and for caregivers, mental distress. Low, moderate, and high symptom burden subgroups were identified at the patient, caregiver, and dyad level. Age, gender, race, income, chronic conditions, cancer type, and treatment type were associated with symptom burden subgroups. Higher symptom burden was associated with more negative appraisals of the cancer and caregiving experience, and poorer QOL (physical, social, emotional, functional, and overall QOL). Dyads whose caregivers had more chronic conditions were more likely to be in the high symptom burden subgroup. CONCLUSION Patient and caregiver symptom burden influence their own and each other's QOL. These findings reinforce the need to approach symptom management from a dyadic perspective.
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Affiliation(s)
- Katrina R Ellis
- School of Social Work, University of Michigan, 1080 South University Avenue, Ann Arbor, MI, 48109, USA.
- School of Public Health, University of Michigan, Ann Arbor, MI, USA.
- Research Center for Group Dynamics, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA.
| | - Allison Furgal
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Feyisayo Wayas
- School of Social Work, University of Michigan, 1080 South University Avenue, Ann Arbor, MI, 48109, USA
- Research Centre for Health Through Physical Activity, Lifestyle and Sport (HPALS), Division of Physiological Sciences, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Alexis Contreras
- School of Social Work, University of Michigan, 1080 South University Avenue, Ann Arbor, MI, 48109, USA
| | - Carly Jones
- Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Sierra Perez
- School of Social Work, University of Michigan, 1080 South University Avenue, Ann Arbor, MI, 48109, USA
| | - Dolapo Raji
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Madeline Smith
- School of Social Work, University of Michigan, 1080 South University Avenue, Ann Arbor, MI, 48109, USA
| | - Charlotte Vincent
- School of Social Work, University of Michigan, 1080 South University Avenue, Ann Arbor, MI, 48109, USA
| | - Lixin Song
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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Fei M, Zheng Y. Comment on 'effectiveness of dyadic interventions among cancer dyads: An overview of systematic reviews and meta-analyses'. J Clin Nurs 2024. [PMID: 39041485 DOI: 10.1111/jocn.17390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Accepted: 07/16/2024] [Indexed: 07/24/2024]
Affiliation(s)
- Mingfeng Fei
- Department of Gerontology, NO.903 Hospital of the PLA Joint Logistics Support Force, Hangzhou, China
| | - Yun Zheng
- Department of Thoracic Oncology, Shulan (Hangzhou) Hospital, Shulan International Medical College, Zhejiang Shuren University, Hangzhou, China
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Carberry S, MacConaill S, Fortune DG. Couples' experiences of coping with Multiple Sclerosis: a qualitative systematic review and metasynthesis. Disabil Rehabil 2024:1-13. [PMID: 38859675 DOI: 10.1080/09638288.2024.2361804] [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: 01/17/2024] [Accepted: 05/25/2024] [Indexed: 06/12/2024]
Abstract
PURPOSE This systematic review sought to synthesise the qualitative literature exploring couples' experiences of dyadic coping, when one partner has Multiple Sclerosis (MS). METHODS The review protocol was pre-registered with PROSPERO. Five databases (PubMed, EMBASE, CINAHL, PsycINFO and Scopus) were searched for relevant papers from inception to January 2024. Seven hundred and ninety three papers were screened against pre-defined inclusion criteria. Data from 11 studies (n = 204) were quality assessed using the Critical Appraisal Skills Programme qualitative checklist and included in the metasynthesis. RESULTS The synthesis resulted in four themes related to couples' experiences of coping with MS: dance of accommodation, a sense of unity, outside of us and evolving as a unit. Communication attunement was perceived as key for couples to maintain cohesion in the relationship. Developing a shared narrative around MS helped couples to align their perspectives and co-ordinate their coping. The findings suggest that many couples coped by consciously maintaining a focus in the present. The wider system of social supports also appeared to frame the couples unique dyadic coping process in specific ways. CONCLUSIONS The findings from this synthesis provide support for the conceptualisation of MS as a shared experience to support couples' rehabilitation efforts.
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Affiliation(s)
- Serena Carberry
- Department of Psychology, University of Limerick, Limerick, Ireland
| | - Susan MacConaill
- Department of Psychology, University of Limerick, Limerick, Ireland
| | - Donal G Fortune
- Department of Psychology, University of Limerick, Limerick, Ireland
- Health Service Executive, CHO 3, Mid West Region, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
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Richardson DR, Mhina CJ, Teal R, Cole AC, Adapa K, Bryant AL, Crossnohere N, Wheeler SC, Bridges JFP, Wood WA. Experiences of treatment decision-making among older newly diagnosed adults with acute myeloid leukemia: a qualitative descriptive study. Support Care Cancer 2024; 32:197. [PMID: 38416230 DOI: 10.1007/s00520-024-08397-3] [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: 08/16/2023] [Accepted: 02/18/2024] [Indexed: 02/29/2024]
Abstract
PURPOSE Treatment decision-making for older adults with acute myeloid leukemia (AML) is complex and preference-sensitive. We sought to understand the patient experience of treatment decision-making to identify specific challenges in shared decision-making to improve clinical care and to inform the development of directed interventions. METHODS We conducted in-depth interviews with newly diagnosed older (≥ 60 years) adults with AML and their caregivers following a semi-structured interview guide at a public safety net academic hospital. Interviews were digitally recorded, and qualitative thematic analysis was employed to synthesize findings. RESULTS Eighteen in-depth interviews were conducted. Age ranged from 62 to 78 years. Patients received intermediate- (50%) or high-intensity (44%) chemotherapy or best supportive care only (6%). Six themes of patient experiences emerged from the analysis: patients (1) felt overwhelmed and in shock at diagnosis, (2) felt powerless to make decisions, (3) felt rushed and unprepared to make a treatment decision, (4) desired to follow oncologist recommendations for treatment, (5) balanced multiple competing factors during treatment decision-making, and (6) desired for ongoing engagement into their care planning. Patients reported many treatment outcomes that were important in treatment decision-making. CONCLUSIONS Older adults with newly diagnosed AML feel devastated and in shock at their diagnosis which appears to contribute to a feeling of being overwhelmed, unprepared, and rushed into treatment decisions. Because no one factor dominated treatment decision-making for all patients, the use of strategies to elicit individual patient preferences is critical to inform treatment decisions. Interventions are needed to reduce distress and increase a sense of participation in treatment decision-making.
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Affiliation(s)
- Daniel R Richardson
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA.
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Carl J Mhina
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Duke University Department of Population Health Sciences, Durham, NC, USA
| | - Randall Teal
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
- The Connected Health Applications and Interventions (CHAI) Core, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Amy C Cole
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Karthik Adapa
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ashley L Bryant
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | | | - William A Wood
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Zhou J, Chen X, Wang Z, Lin C, Zhao J, Loke AY, Li Q. Mutual communication processes within Chinese colorectal cancer patient-spousal caregiver dyads: A qualitative study of taking gender into account. Eur J Oncol Nurs 2023; 67:102427. [PMID: 37879197 DOI: 10.1016/j.ejon.2023.102427] [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: 07/22/2023] [Revised: 09/23/2023] [Accepted: 09/29/2023] [Indexed: 10/27/2023]
Abstract
PURPOSE Mutual communication within cancer couples is a complex process. More research is needed to explore the complex process of mutual communication and its nuances presented by various factors in different culture contexts. Gender, a factor embedded in marital relationships, is an important consideration. We thus aim to explore the mutual communication process within Chinese colorectal cancer couples and take gender into account. METHODS A qualitative study was conducted by interviewing 20 colorectal cancer patients and 15 spousal caregivers. Inductive thematic analysis was used to analyze the transcripts. RESULTS Three themes (mutual communication and support interaction, communication quality, and foundation of mutual communication and collaboration) were developed. Gender was found to have specific impact on emotional disclosure and communication challenges. A preliminary framework of "smile" was constructed to demonstrate the relationship among the three themes and the relationships between the three themes and dyads' psychosocial adaptation to colorectal cancer. CONCLUSIONS Study findings demonstrate complex mutual communication processes within colorectal cancer couples and the impact of gender. The findings will contribute to developing more effective colorectal cancer couple-based mutual communication interventions. Health practitioners are suggested to improve mutual communication within colorectal cancer couples in three aspects: relational topics, emotional disclosure and communication skills. Guiding couples to deal with each theme and the relationship among the themes simultaneously is helpful for them to return and smile to their normal life.
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Affiliation(s)
- Junrui Zhou
- Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu Province, China
| | - Xuan Chen
- Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu Province, China
| | - Zhiming Wang
- Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu Province, China
| | - Chunyan Lin
- Affiliated Hospital, Jiangnan University, Wuxi, Jiangsu Province, China
| | - Jie Zhao
- Affiliated Hospital, Jiangnan University, Wuxi, Jiangsu Province, China
| | - Alice Yuen Loke
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon Hong Kong, China
| | - Qiuping Li
- Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu Province, China; Affiliated Hospital, Jiangnan University, Wuxi, Jiangsu Province, China.
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Odom JN, Applebaum A, Bakitas MA, Bryant T, Currie E, Curry K, Donovan H, Fernandez ME, Ferrell B, Azuero A, Gray TF, Hendricks BA, Meier D, Nightingale C, Reinhard S, Sannes TS, Sterba K, Young HM. Availability of Family Caregiver Programs in US Cancer Centers. JAMA Netw Open 2023; 6:e2337250. [PMID: 37819661 PMCID: PMC10568368 DOI: 10.1001/jamanetworkopen.2023.37250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 08/29/2023] [Indexed: 10/13/2023] Open
Abstract
Importance Family caregivers provide the majority of health care to the 18 million patients with cancer in the US. Yet despite providing complex medical and nursing care, a large proportion of caregivers report no formal support or training. In recognition of this gap, many interventions to support cancer caregivers have been developed and tested over the past 2 decades. However, there are few system-level data on whether US cancer centers have adopted and implemented these interventions. Objective To describe and characterize the availability of family caregiver support programs in US cancer centers. Design, Setting, and Participants This cross-sectional national survey study was conducted between September 1, 2021, and April 30, 2023. Participants comprised clinical and administrative staff of Commission on Cancer-accredited US cancer centers. Data analysis was performed in May and June 2023. Main Outcomes and Measures Survey questions about the availability of 11 types of family caregiver programs (eg, peer mentoring, education classes, and psychosocial programs) were developed after literature review, assessment of similar program evaluation surveys, and discussions among a 13-member national expert advisory committee. Family caregiver programs were defined as structured, planned, and coordinated groups of activities and procedures aimed at specifically supporting family caregivers as part of usual care. Survey responses were tabulated using standard descriptive statistics, including means, proportions, and frequencies. Results Of the surveys sent to potential respondents at 971 adult cancer centers, 238 were completed (response rate, 24.5%). After nonresponse weight adjustment, most cancer centers (75.4%) had at least 1 family caregiver program; 24.6% had none. The most common program type was information and referral services (53.6%). Cancer centers with no programs were more likely to have smaller annual outpatient volumes (χ2 = 11.10; P = .011). Few centers had caregiver programs on training in medical and/or nursing tasks (21.7%), caregiver self-care (20.2%), caregiver-specific distress screening (19.3%), peer mentoring (18.9%), and children caregiving for parents (8.3%). Very few programs were developed from published evidence in a journal (8.1%). The top reason why cancer centers selected their programs was community members requesting the program (26.3%); only 12.3% of centers selected their programs based on scientific evidence. Most programs were funded by the cancer center or hospital (58.6%) or by philanthropy (42.4%). Conclusions and Relevance In this survey study, most cancer centers had family caregiver programs; however, a quarter had none. Furthermore, the scope of programming was limited and rarely evidence based, with few centers offering caregiving education and training. These findings suggest that implementation strategies are critically needed to foster uptake of evidence-based caregiver interventions.
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Affiliation(s)
- J. Nicholas Odom
- School of Nursing, The University of Alabama at Birmingham, Birmingham
- Division of Geriatrics, Gerontology, and Palliative Care, Department of Medicine, The University of Alabama at Birmingham, Birmingham
- Center for Palliative and Supportive Care, The University of Alabama at Birmingham, Birmingham
| | - Allison Applebaum
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Marie A. Bakitas
- School of Nursing, The University of Alabama at Birmingham, Birmingham
- Division of Geriatrics, Gerontology, and Palliative Care, Department of Medicine, The University of Alabama at Birmingham, Birmingham
- Center for Palliative and Supportive Care, The University of Alabama at Birmingham, Birmingham
| | | | - Erin Currie
- School of Nursing, The University of Alabama at Birmingham, Birmingham
| | - Kayleigh Curry
- School of Nursing, The University of Alabama at Birmingham, Birmingham
| | - Heidi Donovan
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- National Rehabilitation Research and Training Center on Family Support, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Maria E. Fernandez
- Department of Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston School of Public Health, Houston
| | | | - Andres Azuero
- School of Nursing, The University of Alabama at Birmingham, Birmingham
| | - Tamryn F. Gray
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | | | - Diane Meier
- Mount Sinai Medical Center, New York, New York
| | - Chandylen Nightingale
- Department of Social Sciences and Health Policy, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | | | | | - Katherine Sterba
- Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | - Heather M. Young
- Betty Irene Moore School of Nursing, University of California, Davis
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Porter LS, Ramos K, Baucom DH, Steinhauser K, Erkanli A, Strauman TJ, Zafar SY, Check DK, Leo K, Liu E, Keefe FJ. Evaluating a couple communication skills training (CCST) intervention for advanced cancer: study protocol for a randomized controlled trial. Trials 2022; 23:712. [PMID: 36028908 PMCID: PMC9419413 DOI: 10.1186/s13063-022-06656-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 08/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND For patients and their intimate partners, advanced cancer poses significant challenges that can negatively impact both individuals and their relationship. Prior studies have found evidence that couple-based communication skills interventions can to be beneficial for patients and partners. However, these studies have been limited by reliance on in-person treatment delivery and have not targeted couples at high risk for poor outcomes. This study tests the efficacy of a Couples Communication Skills Training (CCST) intervention delivered via videoconference for couples reporting high levels of holding back from discussing cancer-related concerns, a variable associated with poorer psychological and relationship functioning. METHODS This RCT is designed to evaluate the efficacy of CCST in improving patient and partner relationship functioning (primary outcome). Secondary outcomes include patient and partner psychological functioning and patient symptoms and health care use. We also examine the role of objective and self-reported communication behaviors as mediators of treatment effects. Two hundred thirty patients with advanced lung, gastrointestinal, genitourinary, and breast cancer and their partners will be randomized to CCST or an education control intervention. Participants in both conditions complete self-reported outcome measures at baseline, mid-treatment, post-treatment, and 3 months post-treatment. Objective measures of communication are derived from video-recorded couple conversations collected at baseline and post-treatment. An implementation-related process evaluation (assessing implementation outcomes and potential barriers to/facilitators of implementation) will be conducted to inform future efforts to implement CCST in real-world settings. DISCUSSION This trial can yield important new knowledge about effective ways to improve patient and partner adjustment to advanced cancer. TRIAL REGISTRATION This study trial is registered at clinicaltrials.gov (Trial # NCT04590885); registration date: October 19, 2020.
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Affiliation(s)
- Laura S Porter
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, DUMC 102506, Durham, NC, 27710, USA.
| | - Katherine Ramos
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, DUMC 102506, Durham, NC, 27710, USA
| | - Donald H Baucom
- Department of Psychology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Karen Steinhauser
- Population Health Sciences Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Alaattin Erkanli
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | | | - S Yousuf Zafar
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Devon K Check
- Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Karena Leo
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, DUMC 102506, Durham, NC, 27710, USA
| | - Evan Liu
- Trinity College of Arts & Sciences, Duke University, Durham, NC, USA
| | - Francis J Keefe
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, DUMC 102506, Durham, NC, 27710, USA
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