Evaluating Burden and Quality of Life among Caregivers of Patients Receiving Peritoneal Dialysis

The Burden of Home Dialysis: An Overlooked Challenge

Home dialysis offers several clinical and quality-of-life benefits for patients with kidney failure. However, it is important to recognize that home dialysis may place an increased burden on patients and their care partners. Sources of burden may include concerns about the ability to adequately and safely perform dialysis at home, physical symptoms, impairment of life participation, psychosocial challenges, and care partner burnout. Overlooking or failing to address these issues may lead to adverse events that negatively affect health and quality of life and reduce longevity of home dialysis. This study will explore aspects of home dialysis associated with burden, emphasize the need for increased awareness of potential challenges, and elaborate on strategies to overcome sources of burden. Future research should actively involve patients and care partners to better understand their motivation, experiences, and needs to better inform support strategies.

Assessment of Burden in Caregivers of Patients Undergoing Hemodialysis and Peritoneal Dialysis: A Cross-Sectional Study in Riyadh, Saudi Arabia

A caregiver attends to the needs or concerns of someone limited by disease, injury, or disability to enhance the patient's quality of life, which can be assessed in three areas: social, physical, and psychological. This cross-sectional study assessed the extent of burden experienced by the caregivers of patients undergoing hemodialysis (HD) and peritoneal dialysis (PD) therapy in King Fahad Medical City in Riyadh, Saudi Arabia. The Zarit Burden Interview Arabic Abridged version (ZBI-A) was used to assess the level of burden experienced by caregivers. The data was collected and examined by professionals using the SPSS version 23. Based on the data of 50 participants, a mean ZBI-12 score of 12.22 ± 7.2 was reported. According to the ZBI scale, "No to mild burden," "Mild to moderate burden," and "High burden" were reported as 46% (n = 23), 38% (n = 19), and 16% (n = 8) of participants, respectively. The internal consistency of the ZBI-12 scale, assessed using Cronbach's alpha, was 0.664, indicating a satisfactory level of internal consistency. It was determined that caregivers of individuals undergoing PD and HD encounter different degrees of burden, with a significant proportion of caregivers experiencing a substantial burden.

Patient delay in chronic kidney disease: A qualitative study

This study aimed to investigate the reasons for patient delay in chronic kidney disease (CKD) and provide a scientific basis for implementing effective interventions. With the adoption of the phenomenological method in qualitative research, semi-structured, face-to-face interviews were conducted with 14 cases, and the Colaizzi seven-step analysis method was used to analyze the interview data and refine the themes. A total of 4 themes were obtained, namely, a cognitive explanation of illness, negative psychological emotions, socioeconomic levels, and limited medical resources. The current status of patient delay in chronic kidney disease is serious, and there are various reasons for it. Health management departments and healthcare providers at all levels should pay attention to this situation and provide targeted supportive interventions and health education to help patients establish the correct awareness of medical consultation and effectively improve their quality of survival.

Factors influencing cancer patients' caregivers' burden and quality of life: An integrative review

This integrative review assessed the factors influencing cancer patients' caregivers' burden and quality of life (QoL). Relevant studies were retrieved from five electronic databases and screened. After systematic screening by title, abstract, and full text, the review included 15 studies published between 2000 and 2022 and used an interpretive thematic synthesis design for analysis. Age (older), sex (male), high work requirements, relationships with patients, low-income levels, high subjective stress, patient dependency level, and trait anxiety were significantly associated with higher caregiver burden. Factors associated with the low QoL of caregivers were age (less than 35 years), caregiving role (more responsibility), relationship with patients (first-degree relative), low income, living in the same home with the patient, and higher social and family responsibilities. A moderate negative correlation (n = 6) was identified between the sum of the QoL scores and the burden. Future research should be integrated into identifying appropriate means to support caregivers of patients with chronic diseases, including cancer by segregating interventions to target specific caregiver populations.

Comparison Between Burden of Care Partners of Individuals with Alzheimer's Disease Versus Individuals with Other Chronic Diseases

BACKGROUND

Caregiving in Alzheimer's disease (AD) is often provided by informal care partners, who spend more hours per week on average than care partners of individuals with conditions other than AD. However, the burden of care in partners of individuals with AD has not been systematically compared to that of other chronic diseases.

OBJECTIVE

The current study therefore aims to compare the care partner burden of AD to that of other chronic diseases through a systematic literature review.

METHODS

Data was collected from journal articles published in the last 10 years, using two unique search strings in PubMed and analysed using pre-defined patient-reported outcome measures (PROMs) including the EQ-5D-5L, GAD-7, GHQ-12, PHQ-9, WPAI and the ZBI. The data was grouped according to the included PROMs and the diseases studied. The number of participants in the studies reporting burden of caregiving in AD was adjusted to reflect the number of participants in studies reporting care partner burden in other chronic diseases.

RESULTS

All results in this study are reported as a mean value and standard deviation (SD). The ZBI measurement was the most frequently used PROM to collect care partner burden (15 studies) and showed a moderate burden (mean 36.80, SD 18.35) on care partners of individuals with AD, higher than most of the other included diseases except for those characterized by psychiatric symptoms (mean scores 55.92 and 59.11). Other PROMs such as PHQ-9 (six studies) and GHQ-12 (four studies) showed a greater burden on care partners of individuals with other chronic diseases such as heart failure, haematopoietic cell transplantations, cancer and depression compared to AD. Likewise, GAD-7 and EQ-5D-5L measurements showed a lesser burden on care partners of individuals with AD compared to care partners of individuals with anxiety, cancer, asthma and chronic obstructive pulmonary disease. The current study suggests that care partners of individuals with AD experience a moderate burden, but with some variations depending on the PROMs used.

CONCLUSION

The results of this study were mixed with some PROMs indicating a greater burden for care partners of individuals with AD versus other chronic diseases, and other PROMs showing a greater burden for care partners of individuals with other chronic diseases. Psychiatric disorders imposed a greater burden on care partners compared to AD, while somatic diseases in the musculoskeletal system resulted in a significantly smaller burden on care partners compared to AD.

Quality of life of caregivers of end-stage kidney disease patients: Caregivers or care recipients?

BACKGROUND

End-stage kidney disease (ESKD) patients require specific and continuous care, which affects caregivers' quality of life (QOL). It is necessary to define the basic problems and restrictions upon family caregivers of renal patients affecting their physical and psychological status.

OBJECTIVES

The main objectives of this narrative review were to examine the literature over the past 10 years, to describe factors associated with QOL of caregivers of patients with ESKD, and to identify the level of subjective burden reported by caregivers.

METHODS

A literature search was carried out using the following electronic databases: PubMed, Medscape, Science Direct, Scopus, PsychINFO and other scientific sources. Keywords included 'quality of life', 'caregivers', 'end stage kidney or renal disease patients', 'burden' and a combination of these terms. Only studies from January 2010 to December 2020 were included in this study.

RESULTS

The results found that there was significant burden and distress experienced by caregivers that affected their QOL. Patients' QOL is associated with caregivers' QOL. The hours of caring per day and the long-term replacement therapy are associated with great burden.

CONCLUSIONS

More awareness to caregivers' QOL is required to meet their needs, reduce anxiety and to improve patients' QOL. Caregiver support could empower and prepare them for initiation of replacement therapy. This can potentially enhance their diseased family members' QOL and could also restrict the use of health care system resources. Given how difficult it is to conceptualize QOL, a holistic approach to patients and caregivers require QOL assessment in each stage of the kidney disease.

Muslim caregivers' experiences in caring for patients receiving peritoneal dialysis

BACKGROUND

Fulfilling the role of a family caregiver has a substantial effect on the lives of those involved. However, existing information on family caregivers of patients receiving peritoneal dialysis is insufficient-especially Muslim caregivers, whose practice is unique.

OBJECTIVES

The aim of this study was to understand the experiences of Muslim family caregivers looking after patients receiving peritoneal dialysis in an Islamic context.

DESIGN

A descriptive qualitative approach was employed.

PARTICIPANTS

Thirteen Muslim family caregivers who have cared for patients undergoing peritoneal dialysis for at least 1 month.

APPROACH

Data were collected through face-to-face in-depth interviews and a focus group discussion. Content analysis was used to analyse the data with initial codes grouped into sub-categories, generic categories, and main categories.

FINDINGS

The experiences of Muslim family caregivers looking after patients receiving peritoneal dialysis generated two main categories: overwhelmed with suffering and learning to live as a caregiver.

CONCLUSIONS

Caregiving has a substantial impact on Muslim family caregivers. They need to be cared for holistically. The recognition of Islamic beliefs, doctrine of Allah, and religious practices are clear spiritual anchors for caregiving. The findings provide a deeper understanding of the experiences of Muslim family caregivers looking after patients receiving peritoneal dialysis. These findings could serve as the basis for developing a specific nursing intervention for such caregivers.

Burden, depression and anxiety effects on family caregivers of patients with chronic kidney disease in Greece: a comparative study between dialysis modalities and kidney transplantation

INTRODUCTION

Burden of caregivers is a status that was identified as a consequence of daily care. Anxiety and depression are probably related to complex tasks interwined with the care of a family member suffering from chronic kidney disease (CKD).

PURPOSE

To examine the experienced burden, anxiety and depression of Greek caregivers of patients with End-Stage CKD on dialysis as well as kidney transplant recipients (TX) in relation to their demographic profile and to compare among the groups.

METHODS

A total of 396 participants (198 couples of patients and caregivers) were recruited. Structured interviews and self-completed questionnaires were obtained from patients undergoing dialysis modalities as well as TX (28 peritoneal dialysis patients, 137 hemodialysis patients, 33 TX) and their caregivers. Zarit Burden Interview, Beck Depression Inventory and the Generalized Anxiety Disorder-2 scales were used as screening tools.

RESULTS

The majority of caregivers were females (67.2%), with a median age of 58 years. Total burden was indicated as mild to moderate (Mdn = 36 (24-51)). Caregivers of haemodialysis (HD) patients showed the highest burden (Mdn = 40 (26-53)) followed by peritoneal dialysis(PD) (Mdn = 29 (25-51)) and TX group (Mdn = 28 (21-43)) (p = 0.022). Caregivers' depression and anxiety were related to the type of patients' treatment, as well. Caregivers of HD and PD patients reported significantly higher depression (Mdn = 11 (5-18)) and anxiety scores (Mdn = 3 (2-5)) in comparison to TX caregivers (Mdn = 6 (2-13) and Mdn = 2 (2-4)) (p = 0.045 and p = 0.04, respectively).

CONCLUSION

Caregivers of TX patients appeared to have less burden, depression and anxiety levels compared with caregivers of patients on dialysis modalities. Caregivers' burden is significantly associated with anxiety, depressive symptoms, gender, duration of caregiving, educational level, financial status and caregivers' age.

Incremental peritoneal dialysis after unplanned start initiation

Incremental peritoneal dialysis (PD) is characterized as less than a "standard dose" PD prescription. Compared to standard treatment, it has many potential advantages, including better preservation of residual renal function, a lower risk of peritonitis, and a decreased care delivery burden while reducing the environmental impact and economic cost. Unplanned PD can be defined when treatment starts up to 14 days after catheter insertion and is recognized as a safe and feasible clinical approach. In this perspective paper, we briefly discuss both strategies and share our experience and clinical routine in managing incremental PD after unplanned initiation.

El hogar recinto para sostener la vida sujeta a diálisis peritoneal: experiencia de cuidadores familiares

Introducción: Cuidar en el hogar a una persona con tratamiento de diálisis peritoneal implica esfuerzo, aprendizaje, lograr habilidades, controlar el entorno, así como ser rigurosos en la realización del procedimiento. Sin embargo, se necesita el seguimiento permanente de las enfermeras para evitar complicaciones y lograr la participación familiar para que el cuidador no se agote.Objetivo: Analizar las experiencias de los cuidadores familiares de pacientes sujetos a diálisis peritoneal en el hogar.Material y Método: Investigación cualitativa, descriptiva en la cual participaron 12 cuidadores familiares de adultos jóvenes con tratamiento de diálisis peritoneal, muestra obtenida por criterios de saturación, redundancia y por conveniencia. Para la recogida de datos se utilizó la entrevista semiestructurada validada por juicio de expertos y aprobada por Comité de Ética. Los datos recogidos fueron procesados por análisis de contenido temático de forma artesanal.Resultados: a) Capacitación, adquisición de habilidades y satisfacción, b) Cuidados para la diálisis peritoneal: ambiente, materiales, bioseguridad y complicaciones, c) Beneplácitos y disconformidades en la permanencia del apoyo familiar.Conclusiones: Los cuidadores familiares valoran de forma positiva la capacitación recibida por las enfermeras, adecuan la habitación del paciente y utilizan algunos materiales propios del hogar y conforme pasa el tiempo logran habilidades para realizar la diálisis peritoneal. Mantienen el orden, la limpieza, las medidas de bioseguridad y siguen el procedimiento para evitar complicaciones. Algunos cuidadores reconocen el apoyo de la familia ya sea emocional, espiritual, económico o con las tareas del hogar.

Evaluating the feasibility and effectiveness of a mindfulness-based intervention on stress and anxiety of family caregivers managing peritoneal dialysis

Background

Mindfulness-based intervention (MBI) has not been evaluated for its feasibility and effectiveness in reducing stress and anxiety among family caregivers of patients on peritoneal dialysis (PD).

Objectives

(1) To evaluate the feasibility to include MBI during PD training for family caregivers. (2) To determine the effect of MBI on the caregivers’ levels of stress (perceived stress scale, PSS), anxiety state-trait anxiety inventory, STAI), QOL (short-form 36) and reactions to caregiving (caregiver reaction assessment, CRA). (3) To determine differences in the health-related QOL (Kidney Disease Quality of Life Instrument-Short Form, KDQOL PCS and SF-36 MCS) of care recipients with caregivers receiving MBI at 1 month, 3 months and 6 months when compared to those with caregivers receiving routine training. (4) To gather the caregiver’s feedback on the MBI.

Methods

This feasibility study recruited family caregivers to receive either mindfulness training (MT) or treatment-as-usual (TAU) group. Both groups received 4.5-days of structured PD training, but only caregivers in the MT group received 4 days of MT sessions, audio-guided mindfulness practice at home and weekly telephone follow-up.

Results

Forty-four family caregivers participated in this study. Including MBI as part of the PD training was feasible. There was a trend towards lower scores for PSS and T-STAI in the MT group compared to the TAU group. The baseline score of both PSS and T-STAI were positively correlated with post-intervention outcome scores.

Conclusions

Mindfulness-based intervention has the potential to improve psychological symptoms among caregivers of patients with PD.

Factors Associated with Burden in Caregivers of Patients with End-Stage Kidney Disease (A Systematic Review)

BACKGROUND

Caring for a patient with end-stage kidney disease (ESKD) is highly stressful and can impact negatively on the physical and psychological well-being of caregivers. To accurately assess caregiver burden (CB), health care providers (HCPs) need to identify characteristics associated with an increase in CB.

AIM

The aim of this review is to explore CB in caregivers of adult patients with ESKD and to identify characteristics associated with any increase in CB.

METHOD

A comprehensive literature search was completed using five electronic databases. Medline, Embase, CINHAL, PsycINFO, and Scopus. The Joanna Briggs Institute checklist (JBI) was used to quality appraise full text papers included in the review. No time limit for the date of publication of studies was employed, to enable the inclusion of more extensive literature.

RESULTS

A total of 38 relevant studies from 18 countries were identified and included in the review. A variety of patient and caregiver factors can impact positively or negatively on CB, including socio-demographic factors of patients and caregivers, disease-related factors, situational and relational factors, environmental factors, and psychological factors.

CONCLUSION

This review provides awareness to HCPs of the important factors associated with CB, when assessing or targeting interventions for caregivers experiencing burden.

Interventions to improve the well-being of family caregivers of patients on hemodialysis and peritoneal dialysis: a systematic review

Background

The family caregivers of patients on hemodialysis (HD) and peritoneal dialysis (PD) typically experience higher burden than the general population because of the nature of tasks these caregivers need to carry out as a part of homecare. This fact influences both the caregivers’ quality of life and the quality of their care toward the patient. Thus, this study aimed to review the effectiveness and limitations of interventions in improving the well-being of family caregivers of patients on HD and PD.

Methodology

A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the Cochrane Handbook for Systematic Reviews of Interventions (version 5.1.0). The Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, Embase, MEDLINE, VHL Regional Portal, Scopus, and Web of Science databases were searched queried for randomized controlled trials that developed interventions aimed at improving the well-being of family caregivers of patients undergoing HD and/or PD from 2009 to 2020. The study protocol was registered at the International Prospective Register of Systematic Reviews (registration no. CRD42020151161).

Results

Six studies met the inclusion criteria, all of which addressed caregivers of patients undergoing HD. All interventions reported in the included studies were carried out in group sessions, which addressed topics such as patient assistance and care, treatment complications, coping strategies, caregiver self-care practices, problem solving, and self-efficacy. The studies found significant improvement in the caregiver’s well-being.

Conclusions

Group session interventions are effective in improving the well-being of family caregivers of patients undergoing HD. In regard to PD, there is insufficient evidence to make recommendations for caregivers of patients with this treatment.

Quality of life in primary caregivers of patients in peritoneal dialysis and hemodialysis

BACKGROUND

Peritoneal dialysis (PD) is gaining track as an efficient/affordable therapy in poor settings. Yet, there is little data regarding differences in quality of life (QoL) of primary caregivers (PCG) of patients in PD and hemodialysis (HD).

AIM

To compare the QoL of PCG of patients in PD and HD from an upper middle-income population in a Mexican city.

METHODS

Cross-sectional study was carried out with PCG of patients in PD (n=42) and HD (n=95) from 4 hospitals (response rate=70.2%). The SF 36-item QoL questionnaire, the Zarit burden interview, and the Goldberg anxiety/depression scale were used. Mean normalized scores for each QoL domain were compared by dialysis type. Adjusted odds were computed using logistic regression to determine the probability of low QoL (<70% of maximum possible score resulting from the added scores of the 8 dimensions).

RESULTS

The PD group had higher mean scores for emotional role functioning (+10.6; p=0.04), physical functioning (+9.2; p=0.002), bodily pain (+9.2; p=0.07), social functioning (+5.7; p=0.25), and mental health (+1.3; p=0.71); the HD group had higher scores for physical role functioning (+7.9, p=0.14), general health perception (+6.1; p=0.05), and vitality (+3.3; p=0.36). A non-significant OR was seen in multivariate regression (1.51; 95% CI 0.43-5.31). Zarit scores were similar, but workload levels were lower in the PD group (medium/high: PD 7.2%, HD 14.8%). Anxiety (HD 50.5%, PD 19%; p<0.01) and depression (HD 49.5%, PD 16.7%; p<0.01) were also lower in the PD group.

CONCLUSION

Adjusted analysis showed no differences in the probability of low QoL between the groups. These findings add to the value of PD, and strengthen its importance in resource-limited settings.

Trends in assisted peritoneal dialysis over the last decade: a cohort study from the French Peritoneal Dialysis Registry

BACKGROUND

There is limited information available on the use of assisted peritoneal dialysis (PD) over time and the impact of economic incentives on its utilization. The aim of this study was to describe the trends in assisted PD utilization and the type of assistance provided. We wanted to estimate if an economic incentive implemented in 2011 in France was associated with an increase in the utilization of nurse-assisted PD.

METHODS

This retrospective, multicentre study, based on data from the French Language Peritoneal Dialysis Registry, analysed 11 987 patients who initiated PD in France between 1 January 2006 and 31 December 2015. Adjusted Cox regression with robust variance was used to examine the initiation of assisted PD, both nurse-assisted and family-assisted, accounting for the nonlinear impact of the PD starting time.

RESULTS

There were 6149 (51%) incident patients on assisted PD, 5052 (82%) on nurse-assisted PD and 1097 (18%) on family-assisted PD over the study period. In the adjusted analysis, calendar time was associated with the assisted PD rate: it declined from 2008 until 2013 before flattening out and then it increased after 2014. Nurse-assisted PD utilization increased significantly after 2012, whereas family-assisted PD utilization decreased linearly over time (prevalence ratio = 0.94, 95% confidence interval 0.92-0.97).

CONCLUSIONS

The assisted PD rate decreased until 2013, mainly because of a decline in family-assisted PD. The uptake in nurse-assisted PD observed from 2013 reflects the effect of an economic incentive adopted in late 2011 to increase PD utilization.

The Living Donor Navigator Program Provides Support Tools for Caregivers

INTRODUCTION

The Living Donor Navigator (LDN) program is one of several initiatives designed to help transplant candidates identify living donors with the help of a friend or family member advocate to speak on their behalf. More than half of advocates in the LDN program were the spouse or parent of the candidate and served in a caregiving role. Caregivers for patients awaiting transplantation have reported poorer quality of life than the general population, suggesting more support is needed for this vulnerable group. The purpose of this study was to understand whether the LDN program met the needs of advocates who were also caregivers for the transplant candidate.

METHODS

We performed a supplementary secondary qualitative analysis of a parent study conducted December 2017-January 2018 with 9 advocates who participated in the LDN program. Transcripts were reanalyzed from focus group discussions, concentrating on comments about caregiving or made by caregivers. Using manual coding and reflexive thematic analysis, we identified broad codes and major themes.

FINDINGS

Our re-analysis revealed one theme overlapping with our previous analysis (Support) and 2 new themes specific to caregiver advocates: Quality of Life and Fear. Caregivers agreed that the LDN program equipped them with tools to address these areas and best serve their simultaneous caregiver/advocate roles.

DISCUSSION

These analyses demonstrated that those who served as advocate and caregiver derived a benefit from the LDN program but had distinct needs from other advocates. These findings can inform continued refinement of the program and expansion to support needs of caregiver.

Patient and caregiver perspectives on burnout in peritoneal dialysis

BACKGROUND

Peritoneal dialysis (PD) can offer patients more autonomy and flexibility compared with in-center hemodialysis (HD). However, burnout - defined as mental, emotional, or physical exhaustion that leads to thoughts of discontinuing PD - is associated with an increased risk of transfer to HD. We aimed to describe the perspectives of burnout among patients on PD and their caregivers.

METHODS

In this focus group study, 81 patients and 45 caregivers participated in 14 focus groups from 9 dialysis units in Australia, Hong Kong, and the United States. Transcripts were analyzed thematically.

RESULTS

We identified two themes. Suffering an unrelenting responsibility contributed to burnout, as patients and caregivers felt overwhelmed by the daily regimen, perceived their life to be coming to a halt, tolerated the PD regimen for survival, and had to bear the burden and uncertainty of what to expect from PD alone. Adapting and building resilience against burnout encompassed establishing a new normal, drawing inspiration and support from family, relying on faith and hope for motivation, and finding meaning in other activities.

CONCLUSIONS

For patients on PD and their caregivers, burnout was intensified by perceiving PD as an unrelenting, isolating responsibility that they had no choice but to endure, even if it held them back from doing other activities in life. More emphasis on developing strategies to adapt and build resilience could prevent or minimize burnout.

Cognitive impairment in patients with chronic kidney disease-Next of kin's experiences

BACKGROUND

Chronic kidney disease (CKD) has been associated with a progressive decline in cognitive functions. This may lead to significant consequences for the person with CKD physically, psychologically and socially and may affect the everyday lives of the family.

OBJECTIVES

To explore the everyday life experiences of next of kin of persons with CKD and cognitive impairment (CI).

DESIGN

A qualitative design with semi-structured individual interviews with next of kin of persons with CKD and CI to gather in-depth information about the everyday life experiences of the next of kin. Interviews were recorded, transcribed verbatim and analysed inductively based on qualitative thematic analysis.

FINDINGS

Based on the analysis, four themes were constructed: CI evolves gradually and is multifaceted; balancing everyday life challenges; finding ways to deal with their situation and knowledge enables understanding.

CONCLUSION

Next of kin took responsibility and developed strategies for making everyday life function for the person with CKD and CI, which required considerable structure and a number of actions. They needed information about the CI and developed strategies for how to protect the person with CKD from being exposed. To provide themselves a personal space, next of kin turned to family, friends and people in comparable situations. To identify and address unmet care needs, healthcare professionals must proactively demonstrate an increased focus on CI and focus on the potential care needs of the person with CKD and their next of kin.

Burden in primary family caregivers caring for uremic patients on maintenance peritoneal dialysis

BACKGROUND

Managing the burden of care for patients with chronic debilitating diseases is an important issue. Herein, we assessed the burden in primary family members caring for uremic patients on maintenance peritoneal dialysis.

METHODS

One hundred seventy caregivers and 170 patients were recruited. Self-perceived scoring along the Zarit Caregiver Burden Scale (ZCBS), World Health Organization Five-item Well-Being Index (WHO-5), and Warwick-Edinburgh Mental Well-being Scale (WEMWBS) were determined for caregivers.

RESULTS

There was an inverse relationship between ZCBS and WHO-5 or WEMWBS scores in caregivers, suggesting that the higher the burden, the lesser the self-perceived well-being. One hundred two of 170 caregivers (60%) reported mild to moderate burden, indicating a common presence of mild to moderate caring-related mental and physical stress. Moreover, 31 caregivers (18.2%) reported moderate to severe burden. Several patient disease factors, including diabetes and frailty, increased caregiver burden, while insurance coverage and out-of-pocket medical costs were also positively correlated. Caregivers who lived with patients and spent longer hours in caring-related activities had higher burden scores, while regular exercise seemed to partially alleviate the burden.

CONCLUSION

Our study clearly showed that caring for patients with maintenance peritoneal dialysis caused physical, mental, and social burden in family caregivers, with the extent of the stress being influenced by patients' disease severity and other demographic factors in both patients and caregivers.

Quality of life improved for patients after starting dialysis but is impaired, initially, for their partners: a multi-centre, longitudinal study

Background

Quality of life (QOL) is important to patients with end stage renal disease and their partners. Despite the first 12 weeks being a critical time in the treatment pathway, limited research exists which examines how the transition onto dialysis impacts QOL. In this study we measured QOL in patients and their partners at pre-dialysis and over the first 12 weeks on dialysis to investigate QOL during this crucial period.

Methods

Patients and their partners, recruited from 10 renal units in England, completed questionnaires at pre-dialysis (n = 166 participants, 83 couples), 6 weeks (n = 90 participants, 45 couples) and 12 weeks (n = 78, 39 couples) after starting dialysis. On each occasion participants completed a QOL questionnaire (WHOQOL-BREF). Multilevel modelling accommodated the nested structure of couples with repeated measures within participants. Three-level random intercept models estimated changes in WHOQOL general QOL and its four domains (Physical, Psychological, Social and Environment). Two-level random intercept models assessed the relationship between baseline clinical and socio-demographic variables with changes in general QOL.

Results

Patients reported positive changes in general QOL from pre-dialysis to 6 weeks (β = 0.42, p < 0.001, 95% CI 0.19, 0.65) and from pre-dialysis to 12 weeks (β = 0.47, p < 0.001, 95% CI 0.24, 0.71). Partners’ general QOL decreased significantly from pre-dialysis to 6 weeks (β = − 0.24, p = 0.04, 95% CI -0.47, − 0.01) but returned to its original level at 12 weeks. Patients reported improvements in the physical domain between pre-dialysis and 12 weeks (β = 6.56, p < 0.004, 95% CI 2.10, 11.03). No other domains changed significantly in patients or partners. Only in patients were there significant associations between moderator variables and general QOL. High comorbidity risk level and diabetes were associated with poorer QOL at pre-dialysis whereas being female and having an arteriovenous fistula were linked with improvements in general QOL.

Conclusions

Patients reported significant improvements in their general and physical QOL after starting dialysis. Partners’ general QOL worsened after patients started dialysis but improved by 12 weeks. Both patients and partners may benefit from additional educational and counselling services in the lead up to, and immediately after starting dialysis, which could facilitate the transition onto dialysis and improve QOL in both.

Study registration

This study was adopted on the NIHR Clinical Research Network (UK). The details of this study are registered on the Research Registry website (www.researchregistry.com). The identifier for this study is researchregistry2574.

Sobrecarga y apoyos en el cuidador familiar de pacientes con enfermedad crónica

Introducción: En el presente siglo se evidencia un incremento de la enfermedad crónica no trasmisible a nivel mundial, los pacientes presentan patologías con mayor duración y complejidad generando dependencia, requiriendo de un cuidador en el hogar; necesitando contar con diferentes para mejorar la competencia de cuidar. Objetivo: Identificar los medios de apoyo que utiliza el cuidador familiar de paciente con patología crónica no trasmisible y su relación con el nivel de sobrecarga del cuidado. Materiales y Métodos: Estudio de abordaje cuantitativo, transversal y analítico, aplicando los instrumentos de “caracterización diada paciente-cuidador y la Encuesta de Percepción de Sobrecarga del Cuidador de Zarit”. La población correspondió a 62 Diadas. Se calcularon OR en regresión logística. Resultados: El 19.35% (12) de los cuidadores presentaban un nivel de sobrecarga intensa, el 20.97%(13) leve y el 59.68%(37) no tenían sobrecarga. Los cuidadores con sobrecarga intensa refieren 0% de apoyo psicológico y social. Las variables relevantes en el nivel de sobrecarga fueron las horas diarias de cuidado OR = 1.14 (IC 95%: 1.01; 1.33), a mayor nivel de conocimiento del computador disminuye la posibilidad de aumento en el nivel de sobrecarga con OR crudo= 0.14 (IC95%: 0.02; 0.91) y OR ajustado = 0.07 (IC95%: 0.007; 0.68).  Discusión: Es básico continuar indagando en aspectos que permitan disminuir la sobrecarga del cuidador, mantenerlo sano y en condiciones para su rol. Conclusiones: Es necesario fortalecer los diferentes medios de apoyos en el cuidador familiar para disminuir el nivel de sobrecarga relacionada con su tarea. Como citar este artículo: Campos MS, Durán EY, Rivera R, Páez N, Carrillo G. Sobrecarga y apoyos en el cuidador familiar de pacientes con enfermedad crónica. Rev Cuid. 2019; 10(3): e649. http://dx.doi.org/10.15649/cuidarte.v10i3.649