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Vlckova K, Polakova K, Houska A, Zindulkova M, Loucka M. "I couldn't say goodbye": Thematic analysis of interviews with bereaved relatives who lost their loved ones during the COVID-19 pandemic. BMC Palliat Care 2024; 23:226. [PMID: 39266990 PMCID: PMC11395573 DOI: 10.1186/s12904-024-01551-y] [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: 12/16/2023] [Accepted: 08/26/2024] [Indexed: 09/14/2024] Open
Abstract
BACKGROUND Delivering serious news is usually challenging for healthcare professionals and the pandemic of COVID-19 and related restrictions brought additional challenges in this process. AIMS To explore the experience of bereaved relatives with receiving serious news from healthcare professionals during the pandemic COVID-19. DESIGN A qualitative study using thematic analysis and a codebook approach of data collected in semi-structured interviews with bereaved relatives. SETTING/PARTICIPANTS Data were collected from July to August 2022 in person/via phone with bereaved relatives who lost their relatives during the pandemic (from March 2020 to March 2022). Participants were recruited using a convenience sample and snowball method through social media and through one university hospital palliative care unit that invited bereaved relatives of deceased patients treated at the unit to participate in this study. RESULTS A total of 22 participants, consisting of 4 men and 18 women, were interviewed for this study. Most of the participants were sons or daughters of individuals who had died (5 grandchildren, 14 sons/daughters, 2 spouses, 1 great-niece). Six themes were identified: Burden caused by visit ban, Fear of COVID-19, Inappropriate behaviour and communication of healthcare professionals, High need for emotional support, Need for detailed and honest communication, Tendency to make excuses for mistakes and lapses by healthcare professionals. CONCLUSIONS Delivering serious news during a pandemic was negatively influenced by a lack of contact with patients and a lack of support and empathetic communication with staff. Overcoming these circumstances can be achieved by frequent communication using various communication tools (such as videoconferences or phone calls), and maintaining empathy and honesty in the communication process.
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Affiliation(s)
- Karolina Vlckova
- Center for Palliative Care, Dykova 15, Prague, 110 00, Czech Republic.
- Third Faculty of Medicine, Charles University, Prague, Czech Republic.
| | - Kristyna Polakova
- Center for Palliative Care, Dykova 15, Prague, 110 00, Czech Republic
- Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Adam Houska
- Center for Palliative Care, Dykova 15, Prague, 110 00, Czech Republic
- Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | | | - Martin Loucka
- Center for Palliative Care, Dykova 15, Prague, 110 00, Czech Republic
- Third Faculty of Medicine, Charles University, Prague, Czech Republic
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Panzeri A, Bottesi G, Ghisi M, Scalavicci C, Spoto A, Vidotto G. Emotional Regulation, Coping, and Resilience in Informal Caregivers: A Network Analysis Approach. Behav Sci (Basel) 2024; 14:709. [PMID: 39199105 PMCID: PMC11351438 DOI: 10.3390/bs14080709] [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: 06/30/2024] [Revised: 08/07/2024] [Accepted: 08/08/2024] [Indexed: 09/01/2024] Open
Abstract
Public health emergencies such as the COVID-19 pandemic can further strain the mental health of informal caregivers who provide unpaid assistance to family members or friends who need support due to illness, disability, or aging. However, there is a lack of research exploring the resources and adaptive strategies that promote resilience in informal caregivers. This cross-sectional study used psychometric network analysis to model the interplay between coping strategies, emotion regulation, trait resilience, and anxiety and depression symptoms in 351 Italian informal caregivers. The results showed that coping through a positive attitude, emotional reappraisal, and trait resilience were the most central and interconnected nodes in the network. These adaptive strategies buffered against the negative impact of anxiety and depression symptoms, providing valuable insights into the mechanisms underlying resilience and well-being in informal caregivers. Clinically, it is crucial to assess and foster these resilience-promoting factors (positive attitude coping, cognitive reappraisal, and trait resilience) to help mitigate the mental health challenges faced by informal caregivers, especially in the context of public health crises such as the COVID-19 pandemic.
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Affiliation(s)
- Anna Panzeri
- Department of General Psychology, University of Padova, 35131 Padua, Italy
| | - Gioia Bottesi
- Department of General Psychology, University of Padova, 35131 Padua, Italy
| | - Marta Ghisi
- Department of General Psychology, University of Padova, 35131 Padua, Italy
- Unità Operativa Complessa (UOC) Hospital Psychology, Padua University Hospital, 35131 Padua, Italy
| | - Cecilia Scalavicci
- Department of General Psychology, University of Padova, 35131 Padua, Italy
| | - Andrea Spoto
- Department of General Psychology, University of Padova, 35131 Padua, Italy
| | - Giulio Vidotto
- Department of General Psychology, University of Padova, 35131 Padua, Italy
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Musolino C, Baum F, Flavel J, Freeman T, McKee M, Chi C, Giugliani C, Falcão MZ, De Ceukelaire W, Howden-Chapman P, Huong NT, Serag H, Kim S, Dardet CA, Gesesew HA, London L, Popay J, Paremoer L, Tangcharoensathien V, Sundararaman T, Nandi S, Villar E. Caring During COVID-19: A Study of Intersectionality and Inequities in the Care Economy in 16 Countries. INTERNATIONAL JOURNAL OF SOCIAL DETERMINANTS OF HEALTH AND HEALTH SERVICES 2024:27551938241269198. [PMID: 39129232 DOI: 10.1177/27551938241269198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]
Abstract
Carers were disproportionately harmed in the COVID-19 pandemic. Despite facing an increased risk of contracting the virus, they continued in frontline roles in care services and acted as "shock absorbers" for their families and communities. In this article, we apply an intersectional lens to examine care work and the structural factors disadvantaging carers during COVID-19 through a comparative case study analysis of 16 low-, middle-, and high-income countries. Data on each country was collected through a qualitative framework during 2021-2022. We found that while carers everywhere were predominantly women with low incomes and precarious employment, other factors were at play in shaping their experiences. Moreover, government responses to mitigate the direct impact of the pandemic have created local and global disparities affecting those working in this sector. Our findings reveal how oppressive social structures such as race, class, caste, and migration status converged in contextually specific ways to shape the gendered nature of care within and between different countries. We call for a better understanding of the multiple axes of inequalities experienced by carers to inform crisis mitigations, coupled with long-term strategies to address social inequities in the care economy and to promote gender equality.
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Affiliation(s)
- Connie Musolino
- Stretton Health Equity, University of Adelaide, Adelaide, SA, 5005, Australia
| | - Fran Baum
- Stretton Health Equity, University of Adelaide, Adelaide, SA, 5005, Australia
| | - Joanne Flavel
- Stretton Health Equity, University of Adelaide, Adelaide, SA, 5005, Australia
| | - Toby Freeman
- Stretton Health Equity, University of Adelaide, Adelaide, SA, 5005, Australia
| | - Martin McKee
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, WC1H 9SH, UK
| | - Chunhuei Chi
- Center for Global Health, Oregon State University, Corvallis, OR 7331, USA
| | - Camila Giugliani
- Social Medicine Department, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcellos, 2400 CEP 90035-003, Porto Alegre, Brazil
| | - Matheus Zuliane Falcão
- Health Law Research Centre, University of São Paulo, Av. Dr. Arnaldo, 715 - 211 - Cerqueira César, São Paulo, SP 01246- 904, Brazil
| | | | | | - Nguyen Thanh Huong
- Faculty of Social Science and Behavior, Hanoi University of Public Health, 1A Duc Thang Road, Duc Thang Ward, North Tu Liem District, Hanoi, Vietnam
| | - Hani Serag
- Department of Internal Medicine, University of Texas Medical Branch (UTMB), 301 University Blvd., Galveston, Texas, 77555, USA
| | - Sun Kim
- People's Health Movement South Korea, Seoul, South Korea
| | - Carlos Alvarez Dardet
- CIBERESP, Center for Research in Epidemiology and Public Health, Public Health Research Group University of Alicante, Madrid, Spain
| | - Hailay Abrha Gesesew
- Research Centre for Public Health, Equity and Human Flourishing, Torrens University Australia, Adelaide, SA, Australia
- College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Leslie London
- School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Jennie Popay
- Division of Health Research, Faculty of Health & Medicine, Lancaster University, Bailrigg, Lancaster LA1 4YW, UK
| | - Lauren Paremoer
- Political Studies, University of Cape Town, Cape Town, South Africa
| | | | | | - Sulakshana Nandi
- Public Health Researcher, Ebertsgade 6, 2300 Copenhagen, Denmark
| | - Eugenio Villar
- Faculty of Public Health and Administration, Universidad Peruana Cayetano Heredia, San Martín de Porres 15102, Peru
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Rico-Blázquez M, Sánchez-Ruano R, Oter-Quintana C, Polentinos-Castro E, Martín-García Á, Otones-Reyes P, González-Beltrán D, Martínez-Marcos M. Family Caregivers' Experiences during the COVID-19 Pandemic: Qualitative Study. Healthcare (Basel) 2024; 12:970. [PMID: 38786382 PMCID: PMC11121002 DOI: 10.3390/healthcare12100970] [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: 03/25/2024] [Revised: 04/24/2024] [Accepted: 05/06/2024] [Indexed: 05/25/2024] Open
Abstract
Background: The COVID-19 pandemic imposed lockdown measures that affected caregiving. Understanding caregivers' context provides reveals their adaptive strategies to continue caring in this situation of uncertainty and isolation. Objective: To better understand the caregiving experiences of caregivers looking after dependent individuals living in the community during the pandemic. Design: Qualitative research, phenomenological approach. Setting: Primary healthcare centers in Madrid region (Spain). Participants: 21 family caregivers. Methods: Purposive and theoretical sampling was used to recruit caregivers across nurses from primary healthcare centers. Participants were interviewed using a semi-structured interview guide to explore the caring experience. Interview transcripts were evaluated using thematic analysis. Results: The findings were categorized into two themes: "Caregivers during lockdown-providing care in a time of adversity" and "Caregiving toward normality". The sub-themes identified were the re-structuring of before-care services and the introduction of new care approaches, managing the dependent person's health problems, looking after oneself, and dealing with adversity. To adapt to the new normal, strategies were put in place designed to recover confidence and trust, reincorporate assistance, and reconnect with others. Conclusions: Care intensified during the pandemic. Caregivers took on the task without assistance, focusing on preventing contagion and protecting themselves to be able to continue giving care.
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Affiliation(s)
- Milagros Rico-Blázquez
- Research Unit, Primary Care Assistance Management, Madrid Health Service, 28035 Madrid, Spain;
- Research Network on Chronicity, Primary Care and Health Promotion—RICAPPS-(RICORS), ISCIII, 28035 Madrid, Spain
- Gregorio Marañón Health Research Institute, Madrid Health Service, 28009 Madrid, Spain
- Doctoral Program in Epidemiology and Public Health (Interuniversity), Rey Juan Carlos University, Alcorcón, 28922 Madrid, Spain
- Nursing Department, Faculty of Nursing, Physiotherapy and Podiatry, Complutense University of Madrid, 28040 Madrid, Spain;
| | - Raquel Sánchez-Ruano
- Ciudad de los Periodistas Healthcare Centre, Primary Care Assistance Management, Madrid Health Service, 28034 Madrid, Spain;
| | - Cristina Oter-Quintana
- Nursing Department, Faculty of Medicine, Autonomous University of Madrid, 28049 Madrid, Spain; (C.O.-Q.); (M.M.-M.)
- Nursing and Healthcare Research Group, IDIPHISA, 28222 Madrid, Spain
| | - Elena Polentinos-Castro
- Research Unit, Primary Care Assistance Management, Madrid Health Service, 28035 Madrid, Spain;
- Research Network on Chronicity, Primary Care and Health Promotion—RICAPPS-(RICORS), ISCIII, 28035 Madrid, Spain
- Gregorio Marañón Health Research Institute, Madrid Health Service, 28009 Madrid, Spain
- Preventive Medicine and Public Health Area, Health Sciences Faculty, Universidad Rey Juan Carlos, Alcorcón, 28922 Madrid, Spain
| | - Ángel Martín-García
- Nursing Department, Faculty of Nursing, Physiotherapy and Podiatry, Complutense University of Madrid, 28040 Madrid, Spain;
- San Blas Healthcare Centre, Primary Care Assistance Management, Madrid Health Service, Parla, 28980 Madrid, Spain
| | - Pedro Otones-Reyes
- San Andrés Healthcare Centre, Primary Care Assistance Management, Madrid Health Service, 28021 Madrid, Spain;
| | - Damián González-Beltrán
- Barrio del Pilar Healthcare Centre, Primary Care Assistance Management, Madrid Health Service, 28029 Madrid, Spain;
| | - Mercedes Martínez-Marcos
- Nursing Department, Faculty of Medicine, Autonomous University of Madrid, 28049 Madrid, Spain; (C.O.-Q.); (M.M.-M.)
- Nursing and Healthcare Research Group, IDIPHISA, 28222 Madrid, Spain
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Ervin J, Fleitas Alfonzo L, Taouk Y, Maheen H, King T. Unpaid caregiving and mental health during the COVID-19 pandemic-A systematic review of the quantitative literature. PLoS One 2024; 19:e0297097. [PMID: 38635604 PMCID: PMC11025839 DOI: 10.1371/journal.pone.0297097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 12/19/2023] [Indexed: 04/20/2024] Open
Abstract
The COVID-19 pandemic imposed additional and specific challenges on the lives and wellbeing of informal unpaid carers. Addressing an important gap in the existing literature, this systematic review (prospectively registered with PROSPERO CRD42022376012) synthesises and evaluates the quantitative evidence examining the association between unpaid caregiving and mental health (compared to non-caring), during the pandemic. Five databases were searched (Medline, PsycInfo, EMBASE, Scopus, Web of Science) from Jan 1, 2020, to March 1, 2023. Population-based, peer-reviewed quantitative studies using any observational design were included, with screening, data extraction and quality assessment (amended NOS) independently conducted by two reviewers. Of the 3,073 records screened, 20 eligible studies (113,151 participants) were included. Overall quality of evidence was moderate. Narrative synthesis was complemented by Effect-direction and Albatross plots (given significant between-study heterogeneity precluded meta-analysis). Results indicate that the mental health of informal carers, already poorer pre-COVID compared to non-caregivers, was disproportionally impacted as a result of the pandemic and its associated public health containment measures. This review highlights the vulnerability of this group and should motivate political will and commensurate policies to ensure unpaid caregivers are better supported now, in the medium term, and crucially if, and when, another global public health emergency emerges.
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Affiliation(s)
- Jennifer Ervin
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Ludmila Fleitas Alfonzo
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Yamna Taouk
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Humaira Maheen
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Tania King
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
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Poteat T, Hall P, Adams MA, Gautam DS, Ashenden R, Horn J. Caregiving Among Older Black Same-Gender-Loving Women During the COVID-19 Pandemic: Findings From Qualitative Research. THE GERONTOLOGIST 2024; 64:gnad103. [PMID: 37480588 PMCID: PMC10943494 DOI: 10.1093/geront/gnad103] [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: 02/09/2023] [Indexed: 07/24/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Few data on caregiving during the coronavirus disease 2019 pandemic use an intersectional lens to attend to how multiple social categories, such as gender, age, race, and sexual orientation, shape caregiving experiences. This analysis sought to explore caregiving experiences of aging Black same-gender-loving women. RESEARCH DESIGN AND METHODS Sixteen focus groups were conducted with 4-8 participants each (N = 102) from across the United States. Audio-recorded discussions lasted for approximately 90 min and were transcribed verbatim. Two analysts coded transcripts for discussions related to caregiving and used content analysis to identify themes. RESULTS Participants engaged in caregiving for children, parents, family, friends, and neighbors. They provided physical, economical, instrumental, and/or secondary caregiving; and sometimes received care themselves. The pandemic heavily affected their stress level and mental health as well as their intimate partner relationships. Discussions mostly offered descriptions of increased caregiving difficulty caused by the pandemic. However, a few participants identified ways the pandemic made caregiving easier; changed caregiving without making it easier or harder; or thwarted their ability to provide care. DISCUSSION AND IMPLICATIONS Older Black same-gender-loving women described some pandemic caregiving experiences that diverged from the existing literature, demonstrating the importance of considering how gender, race, age, and sexual orientation affect caregiving experiences during a pandemic fraught with health inequities. Ensuring the multiply marginalized caregivers have access to the practical and emotional support they need is critical for advancing health equity and preparing for future pandemics.
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Affiliation(s)
- Tonia Poteat
- Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
- Division of Healthcare in Adult Populations, Duke University School of Nursing, Durham, North Carolina, USA
| | - Porsha Hall
- ZAMI NOBLA: National Organization on Black Lesbians on Aging, Atlanta, Georgia, USA
| | - Mary Anne Adams
- ZAMI NOBLA: National Organization on Black Lesbians on Aging, Atlanta, Georgia, USA
| | - Dipa Sharma Gautam
- Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Robynn Ashenden
- Department of Health Behavior, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jennifer Horn
- Family Caregiver Support Center, Pikes Peak Area Agency on Aging, Colorado Springs, Colorado, USA
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Huang YP, Chang LJ, Hsieh HF. Insisting on help, facing challenges, and maintaining balance: The lived experiences of caregivers raising a child with developmental delay in the remote islands of Kinmen. J Pediatr Nurs 2024; 75:99-107. [PMID: 38134732 DOI: 10.1016/j.pedn.2023.12.011] [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: 02/26/2023] [Revised: 11/22/2023] [Accepted: 12/09/2023] [Indexed: 12/24/2023]
Abstract
PURPOSE To explore the lived experiences of the caregivers of children with developmental delay (DD) on the remote island of Kinmen, Taiwan. DESIGN AND METHODS This descriptive phenomenological study included 14 caregivers of 16 children with DD recruited from Kinmen, Taiwan. Data were collected from September 2020 to February 2021 with face-to-face semi-structured interviews, which were transcribed verbatim and analyzed using thematic analysis. RESULTS Twelve caregivers were mothers; there was one father and one grandmother. Their mean age was 37.93 ± 5.17 years. The mean age of the children was 3.90 ± 1.49 years; 11 were male (69%). As we began our study, the COVID-19 pandemic occurred, which influenced two of the three themes: (1) focusing on their child's delayed development, which involved seeking a diagnosis and blaming themselves; (2) facing barriers to caring a child with DD on a remote island, which included ostracization of their child and limited off-island medical resources, especially during COVID-19; and (3) maintaining a healthy life balance, which involved protecting their child from physical or spiritual harm, including exposure to COVID-19, and reflecting on their strengths. CONCLUSIONS Our findings highlight the challenges of caring for a child with DD in the Kinmen islands of Taiwan, and the impact of the COVID-19 pandemic. PRACTICAL IMPLICATIONS Healthcare professionals are encouraged to provide caregivers of children with DD living in remote, island communities an opportunity to share their caregiving experiences and provide strategies for obtaining medical care, which could help reduce caregiver burden.
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Affiliation(s)
- Yu-Ping Huang
- Department of Nursing, National Quemoy University, No. 1, Dasyue Rd., Jinning Township, Kinmen County 89250, Taiwan.
| | - Li-Jung Chang
- Department of Rehabilitation, Kinmen Hospital, No. 2, Fuxin Rd., Jinhu Township, Kinmen County 891, Taiwan
| | - Hsiu-Fang Hsieh
- Department of Nursing, National Quemoy University, No. 1, Dasyue Rd., Jinning Township, Kinmen County 89250, Taiwan
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Llobera Ribera C, Ruiz-Cantero MT, García-Calvente M, Torrell G, González Bermejo D, Olmedo C, Moatassim E, Bacigalupe A. [Response to the COVID-19 Health Crisis from a Gender Perspective: Lessons Learned]. GACETA SANITARIA 2024; 38:102358. [PMID: 38359607 DOI: 10.1016/j.gaceta.2024.102358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 11/28/2023] [Indexed: 02/17/2024]
Abstract
OBJECTIVE To delve deeper from a gender perspective into the lessons learned during the COVID-19 pandemic to address future health crises. METHOD Study with key informants with experience in public health and gender from the Ministerio de Sanidad, ministries of the autonomous communities, Institut Català de la Salut, Hospital de La Princesa, Escuela Andaluza de Salud Pública and Universidad País Vasco. SOURCE OF INFORMATION individual open-ended questionnaire on health and health inequalities/gender inequalities related to COVID-19. After presenting the findings, the key informants group discussed them in a meeting until reaching a consensus on the lessons learned. RESULTS The lack of clinical statistics by sex could compromise epidemiological surveillance, losing the opportunity to characterize the disease. The performance of essential services fell more on women, exhausting them with double and triple shifts; with the differences according to sex in the clinical presentation of COVID-19, and the criteria for hospitalization/admission to the intensive care unit, their access to health care decreased. Increased: gender violence and mental health problems; delaying recognition of the second effects of vaccines in women; partially due to information biases in clinical trials. The gender perspective was lacking in academic, healthcare, and health management areas. CONCLUSIONS Women's gender dimensions determined their higher frequency of COVID-19 and played a fundamental role in its control. Broadly considering the lessons learned will strengthen prevention systems and be able to provide effective responses to future health crises.
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Affiliation(s)
- Christian Llobera Ribera
- Departamento de Enfermería Comunitaria, Medicina Preventiva y Salud Pública e Historia de la Ciencia, Universidad de Alicante, Alicante, España.
| | - María Teresa Ruiz-Cantero
- Grupo de Investigación de Salud Pública, Universidad de Alicante, Alicante, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España
| | - Mar García-Calvente
- Escuela Andaluza de Salud Pública, Granada, España; Instituto de Investigación Biosanitaria de Granada, Granada, España
| | | | | | - Carmen Olmedo
- Programa de Vacunación, Dirección General de Salud Pública, Ministerio de Sanidad, Madrid, España
| | - Emma Moatassim
- Dirección de Atención y Evaluación Sanitaria, Servicio de Salud del Principado de Asturias, Oviedo, España
| | - Amaia Bacigalupe
- Grupo de Investigación en Determinantes Sociales de la Salud y Cambio Demográfico, Leioa (Bizkaia), España; Departamento de Sociología y Trabajo Social, Universidad del País Vasco, Leioa (Bizkaia), España
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Herrero-Montes M, Parás-Bravo P, Ferrer-Pargada D, Fernández-de-las-Peñas C, Fernández-Cacho LM, Palacios-Ceña D. Coping with the hospital environment during the COVID-19 pandemic: A qualitative study of the survivors' perspective during their stay at the ICU and inpatient ward. Heliyon 2024; 10:e24661. [PMID: 38298692 PMCID: PMC10828673 DOI: 10.1016/j.heliyon.2024.e24661] [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: 07/17/2023] [Revised: 12/18/2023] [Accepted: 01/11/2024] [Indexed: 02/02/2024] Open
Abstract
The COVID-19 pandemic has significantly affected the clinical practice of healthcare professionals. This study aimed to explore the perspectives of COVID-19 survivors regarding the healthcare they received during their stay in the Intensive Care Unit (ICU) and the inpatient COVID-19 ward. A qualitative case-study approach was implemented. Participants were recruited using non-probabilistic purposeful sampling strategy. Inclusion criteria included patients aged ≥18 years who received follow-up from the Pulmonology service at a Hospital in de North of Spain, were diagnosed with COVID-19 and bilateral pneumonia, and were admitted to the ICU before being transferred to a COVID-19 inpatient ward. Data was collected through in-depth interviews and researchers' field notes, and thematic analysis was performed. Techniques such as credibility, transferability, dependability, and confirmability were employed to ensure the trustworthiness of the data. A total of 25 individuals (six women) were included in the study. Three main themes emerged from the analysis: common challenges faced in both units, coping with the hospital stay, and developing strategies. Findings highlighted the need to improve information dissemination, individualize care, and enhance direct patient interaction. Moreover, the study shed light on the psychological impact of hospitalization and ICU experience, including feelings of loneliness, confinement, and the lack of memories from the ICU stay, as well as the influence of care and healthcare language. Finally, strategies such as keeping the mind occupied and maintaining self-discipline were identified as crucial during hospitalization. These findings provide valuable insights for healthcare professionals in delivering care to individuals with COVID-19 in the ICU and hospital ward settings.
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Affiliation(s)
- Manuel Herrero-Montes
- Departamento de Enfermería, Universidad de Cantabria. Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Grupo de Investigación en Enfermería, Santander, Spain
| | - Paula Parás-Bravo
- Departamento de Enfermería, Universidad de Cantabria. Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Grupo de Investigación en Enfermería, Santander, Spain
| | - Diego Ferrer-Pargada
- Servicio de Neumología, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - César Fernández-de-las-Peñas
- Research Group of Manual Therapy, Dry Needling and Therapeutic Exercise (GITM-URJC), Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Alcorcón, Spain
| | | | - Domingo Palacios-Ceña
- Research Group of Humanities and Qualitative Research in Health Science of Universidad Rey Juan Carlos (Hum&QRinHS), Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Alcorcón, Spain
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Bailey C, Guo P, MacArtney J, Finucane A, Meade R, Swan S, Wagstaff E. "Palliative care is so much more than that": a qualitative study exploring experiences of hospice staff and bereaved carers during the COVID-19 pandemic. Front Public Health 2023; 11:1139313. [PMID: 38026434 PMCID: PMC10662348 DOI: 10.3389/fpubh.2023.1139313] [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: 05/18/2023] [Accepted: 09/25/2023] [Indexed: 12/01/2023] Open
Abstract
Background The way in which end-of-life care was provided changed significantly during the first 2 years of the COVID-19 pandemic. The national lockdown restrictions reduced formal care support services and increased the burden on many carers taking on the caring role for the first time. We aimed to explore decision-making about the place of care during the COVID-19 pandemic and the impact on experience from the perspectives of carers and hospice staff caring for people at the end-of-life. Methods A qualitative study using virtual interviews was conducted between October 2020 and April 2021. Data were analyzed thematically using framework analysis, an analytical framework that enables qualitative research to be organized into defined themes derived from the research question. Findings were presented to stakeholders in policy roundtables between March 2022 and March 2023 and discussed collaboratively with staff, stakeholders, and the public to inform policy and practice change. Findings A total of 37 participants (15 bereaved carers and 22 staff) were recruited via hospice services in England and Scotland. Four key themes were identified: (1) changing preferences relating to decision-making about the place of care and the impact at the time of death and into bereavement; (2) missed opportunities related to not being there, not having others around, and being robbed of memory-making; (3) the lone carer during a period of high intensity and reduced home support; (4) process vs. person-centered care resulting from changing rules and restrictions and prioritization of regulations over essential palliative care. Conclusion The study provides valuable global implications for all involved in end-of-life care. Despite great efforts to provide dignified, quality care, palliative care during the pandemic changed, focusing on essential 'physical care'. The psychological suffering experienced by staff and carers may need longer-term support mechanisms put in place, which will benefit from a public health approach. Policymakers should consider improving carer identification and resources for wider end-of-life care education to support the needs of carers, health and social care staff, and citizens.
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Affiliation(s)
- Cara Bailey
- School of Nursing and Midwifery, University of Birmingham, Birmingham, United Kingdom
| | - Ping Guo
- School of Nursing and Midwifery, University of Birmingham, Birmingham, United Kingdom
| | - John MacArtney
- Unit of Primary Care, University of Warwick, Coventry, United Kingdom
| | - Anne Finucane
- Clinical Psychology, University of Edinburgh, Edinburgh, United Kingdom
- Marie Curie Hospice, Edinburgh, United Kingdom
| | - Richard Meade
- Clinical Psychology, Carers UK, Edinburgh, United Kingdom
| | - Susan Swan
- Maggie's Glasgow, Glasgow, United Kingdom
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Qin VM, Visaria A, Malhotra R. Impact of a COVID-19-Related Lockdown on the Experience of Informal Caregiving in Singapore. Gerontology 2023; 70:102-114. [PMID: 37866359 PMCID: PMC10794967 DOI: 10.1159/000534723] [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: 02/15/2023] [Accepted: 10/18/2023] [Indexed: 10/24/2023] Open
Abstract
INTRODUCTION Lockdowns, while limiting COVID-19 transmission, can affect provision of care by informal caregivers and their caregiving experience. We assessed, among informal caregivers in Singapore, (a) the perceived impact of a 2-month (April to May 2020) nationwide lockdown on their care provision, (b) correlates of different perceptions of the impact of the lockdown on care provision, and (c) association of different perceptions of the impact with negative and positive experiences of caregiving. METHODS In the August 2020 wave of the Singapore Life Panel (SLP; nationally representative, longitudinal monthly survey of Singapore citizens and permanent residents aged 50-70 years at baseline), 1,094 participants identified as informal caregivers reported whether their care provision became easier, remained the same, or became harder during the lockdown, compared to before the lockdown. We used multinomial logistic regression to assess the association of caregiver, care recipient, and caregiving context characteristics with their perceptions. Linear regression models examined the association of their perceptions with negative and positive experience domains of the modified Caregiver Reaction Assessment. RESULTS Just over one-third (36.1%) of the informal caregivers reported that their care provision became harder during the lockdown compared to before the lockdown. However, nearly one-fifth (18.0%) said that it became easier, and the rest (45.9%) said that it remained the same. Care provision was more likely to be perceived as having become harder among caregivers who were male, of Chinese ethnicity, in worse health, whose care recipients had functional limitations, who did not have caregiving support from cohabiting family members before the lockdown, and who had caregiving support from non-cohabiting family members before the lockdown. The perception that care provision became easier was less likely among caregivers who were of higher age, were unemployed, were socially isolated, and whose care recipients had functional limitations. Caregivers who perceived that care provision became harder during the lockdown were worse-off in negative experiences of caregiving. CONCLUSION A nationwide lockdown did not make care provision harder for all informal caregivers. However, informal caregivers for whom it did were more likely to have greater negative experiences of caregiving. The heterogeneity of the impact of lockdowns and the possibility of offering flexibility to non-cohabiting family members who support caregiving should be important considerations when planning for such disruptions.
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Affiliation(s)
- Vicky Mengqi Qin
- Centre for Research on Successful Ageing (ROSA), Singapore Management University, Singapore, Singapore
- Centre for Ageing Research and Education (CARE), Duke-NUS Medical School, Singapore, Singapore
| | - Abhijit Visaria
- Centre for Ageing Research and Education (CARE), Duke-NUS Medical School, Singapore, Singapore
| | - Rahul Malhotra
- Centre for Ageing Research and Education (CARE), Duke-NUS Medical School, Singapore, Singapore
- Health Services and Systems Research (HSSR), Duke-NUS Medical School, Singapore, Singapore
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Fernández Villar A, Golpe Gómez R, González Montaos A, Fernández García S, Pazos Area L, Priegue Carrera A, Ruano Raviña A, Represas Represas C. The impact of the SARS-CoV-2 pandemic on the demographic, clinical and social profiles of patients admitted to the Pneumology Department for a COPD exacerbation. PLoS One 2023; 18:e0290156. [PMID: 37708160 PMCID: PMC10501653 DOI: 10.1371/journal.pone.0290156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 08/02/2023] [Indexed: 09/16/2023] Open
Abstract
INTRODUCTION Although a reduction in admissions for pathologies other than SARS-CoV-2 has been reported during the pandemic, there are hardly any specific studies in relation to COPD. The objective of this study was to analyse differences in the profile of those admitted for AEPOC and their prognosis during this period. METHODS Prospective study (SocioEPOC validation cohort) conducted in two hospitals. Demographic, clinical and social characteristics were compared among patients admitted for an AECOPD before and after the declaration of the COVID-19 healthcare emergency. Mortality and the need for hospital care in the following 3 months were analysed. RESULTS 340 patients (76.6% male, 72 years, FEV1 43.5%) were included, 174 in the post-pandemic phase. During pandemic, especially before population-level vaccination, admissions for AECOPD were in patients with more severe disease and with a higher level of eosinophils. No differences were found in social profile, except they had more informal caregivers. The mortality rate at 90 days was the same (9%), although those admitted during the pandemic came for more hospital visits in the following 3 months (53.8% vs. 42%; p = 0.003), with the pandemic phase being an independent predictor of this possibility (OR = 1.6.; 95% IC = 1.1-2.6). CONCLUSIONS In the first few months of the pandemic, the clinical profile of patients hospitalised for an AECOPD differed from that both prior to this period and during the latter months of the pandemic, with minimal changes at the social level. Although the mortality rate were similar, unscheduled hospital visits increased during the COVID-19 pandemic.
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Affiliation(s)
- Alberto Fernández Villar
- Pulmonology Department, Álvaro Cunqueiro University Hospital, Vigo, Spain
- Institute of Health Research Galicia Sur (IISGS), Neumo I + i. Research Group, Pontevedra, Spain
| | | | - Almudena González Montaos
- Pulmonology Department, Álvaro Cunqueiro University Hospital, Vigo, Spain
- Institute of Health Research Galicia Sur (IISGS), Neumo I + i. Research Group, Pontevedra, Spain
| | - Sara Fernández García
- Institute of Health Research Galicia Sur (IISGS), Neumo I + i. Research Group, Pontevedra, Spain
| | - Luis Pazos Area
- Pulmonology Department, Álvaro Cunqueiro University Hospital, Vigo, Spain
- Institute of Health Research Galicia Sur (IISGS), Neumo I + i. Research Group, Pontevedra, Spain
| | - Ana Priegue Carrera
- Institute of Health Research Galicia Sur (IISGS), Neumo I + i. Research Group, Pontevedra, Spain
| | - Alberto Ruano Raviña
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública—CIBERESP), Barcelona, Spain
| | - Cristina Represas Represas
- Pulmonology Department, Álvaro Cunqueiro University Hospital, Vigo, Spain
- Institute of Health Research Galicia Sur (IISGS), Neumo I + i. Research Group, Pontevedra, Spain
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Damian AC, Mihăilescu AI, Anghele C, Ciobanu CA, Petrescu C, Riga S, Dionisie V, Ciobanu AM. Quality of Life Predictors in a Group of Informal Caregivers during the COVID-19 Pandemic. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1486. [PMID: 37629776 PMCID: PMC10456842 DOI: 10.3390/medicina59081486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/12/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023]
Abstract
Background and Objectives: The informal caregiver's contribution to the wellbeing of dementia patients is critical since these individuals become dependent on others for all daily activities. Our goal was to investigate the dynamics of anxiety, depression, burnout, sleep, and their influence on quality of life over a 6-month period in the context of pandemic distress in a sample of informal caregivers of Alzheimer's patients. Materials and Methods: For this prospective, longitudinal study, we conducted a 6-month telephonic survey between 2021 and 2022, administering a series of questionnaires at three timepoints (baseline, 3 months and 6 months) to a group of informal caregivers of patients suffering from dementia due to Alzheimer's disease. Results: A total of 110 caregivers were included at baseline, out of which 96 continued to the second stage and 78 followed through to the last stage. The majority of the participants were female (most likely the patients' daughters), around 55 years old, living in urban areas, married, with children, having a high school degree or a higher education degree, and working in jobs that required physical presence; in the best-case scenario, they were sharing their responsibilities with another two-three caregivers. More than half of the 110 participants (50.9%) reported mild to moderate anxiety at baseline, and 27.3% reported significant anxiety, with no changes between the three timepoints, F(2, 154) = 0.551, p = 0.57; 25% reported moderate-severe depression at the start, with no changes between the three timepoints, F(2, 154) = 2.738, p = 0.068; and many reported a decrease in quality of life, poor quality of sleep, and decreased fear of COVID infection. Cynicism, professional effectiveness, anxiety, depression, and sleep quality explained up to 87.8% of the variance in quality of life. Conclusions: Caregivers' decreased quality of life during the pandemic was explained by their levels of burnout, anxiety, and depression throughout the 6-month period.
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Affiliation(s)
- Ana Claudia Damian
- Neuroscience Department, Discipline of Psychiatry, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.C.D.); (C.P.); (A.M.C.)
- Department of Psychiatry, ‘Prof. Dr. Alexandru Obregia’ Clinical Hospital of Psychiatry, 041914 Bucharest, Romania; (A.I.M.); (V.D.)
| | - Alexandra Ioana Mihăilescu
- Department of Psychiatry, ‘Prof. Dr. Alexandru Obregia’ Clinical Hospital of Psychiatry, 041914 Bucharest, Romania; (A.I.M.); (V.D.)
- Department of Medical Psychology, Faculty of Medicine, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania
| | - Cristina Anghele
- Department of Psychiatry, ‘Prof. Dr. Alexandru Obregia’ Clinical Hospital of Psychiatry, 041914 Bucharest, Romania; (A.I.M.); (V.D.)
| | | | - Cristian Petrescu
- Neuroscience Department, Discipline of Psychiatry, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.C.D.); (C.P.); (A.M.C.)
- Department of Psychiatry, ‘Prof. Dr. Alexandru Obregia’ Clinical Hospital of Psychiatry, 041914 Bucharest, Romania; (A.I.M.); (V.D.)
| | - Sorin Riga
- Department of Stress Research and Prophylaxis, ‘Prof. Dr. Alexandru Obregia’ Clinical Hospital of Psychiatry, 041914 Bucharest, Romania;
- Romanian Academy of Medical Sciences, 927180 Bucharest, Romania
| | - Vlad Dionisie
- Department of Psychiatry, ‘Prof. Dr. Alexandru Obregia’ Clinical Hospital of Psychiatry, 041914 Bucharest, Romania; (A.I.M.); (V.D.)
- Department of Psychiatry and Psychology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Adela Magdalena Ciobanu
- Neuroscience Department, Discipline of Psychiatry, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.C.D.); (C.P.); (A.M.C.)
- Department of Psychiatry, ‘Prof. Dr. Alexandru Obregia’ Clinical Hospital of Psychiatry, 041914 Bucharest, Romania; (A.I.M.); (V.D.)
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Costi C, Hollingsworth B, O'Sullivan V, Zucchelli E. Does caring for others affect our mental health? Evidence from the COVID-19 pandemic. Soc Sci Med 2023; 321:115721. [PMID: 36827903 PMCID: PMC9872568 DOI: 10.1016/j.socscimed.2023.115721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 12/14/2022] [Accepted: 01/23/2023] [Indexed: 01/26/2023]
Abstract
Despite a growing literature about the mental health effects of COVID-19, less is known about the psychological costs of providing informal care during the pandemic. We examined longitudinal data from the UK's Understanding Society Survey, including eight COVID surveys, to estimate fixed effects difference-in-differences models combined with matching, to explore the causal effects of COVID-19 among informal carers. While matching accounts for selection on observables into caregiving, multiple period difference-in-differences specifications allow investigation of heterogeneous mental health effects of COVID-19 by timing and duration of informal care. The estimates suggest that while mental health fluctuated following the imposition of social restrictions, informal carers who started caregiving during the pandemic show the largest mental health deterioration, especially during lockdowns. Policies to mitigate the psychological burden of caregiving might be more effective if targeted at those starting to provide care for the first time.
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Affiliation(s)
- Chiara Costi
- Department of Economics, Lancaster University Management School (LUMS), Lancaster University, UK.
| | | | | | - Eugenio Zucchelli
- Madrid Institute for Advanced Study (MIAS) and Department of Economic Analysis, Universidad Autónoma de Madrid (UAM), Spain; IZA, Germany; Lancaster University, UK
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