Caregiver burden and associated factors amongst carers of women with advanced breast cancer attending a radiation oncology clinic in Nigeria

The Social Reality of Meaning Making: The Dichotomy in the Illness Narratives of Women With Breast Cancer and Biomedical Practitioners in Nigeria

BACKGROUND

Despite the increasing burden of breast cancer in the developing world, there is a misunderstanding of the complex and multifaceted relationship between culture and cancer, particularly breast cancer. Hence, a dichotomy of illness narratives exists due to differential meaning making concerning breast cancer. While clinicians always recommend biomedical treatment, women with breast cancer often seek alternative treatment pathways.

AIMS

To explore the experiences of women with breast cancer and clinicians in Nigeria on the dichotomy in the illness narratives.

METHODS

This qualitative study used in-depth interviews and focus group discussion to explore the experiences of 22 women with breast cancer and 7 clinicians in Nigeria on the dichotomy in the illness narratives using grounded theory method analysis.

RESULTS

This study revealed that many women living with breast cancer (WLBC) hold health beliefs that are contradictory to the biomedical norm. They mostly sought treatment based on the perceived aetiology of breast cancer. The treatment pathway follows faith and traditional healing as alternatives or sometimes in combination with biomedicine. WLBC reported a constant fear of biomedical treatment, perceived to be harmful to women's sexuality, fertility and body image. Hence, after perceived treatment failure from alternative care, biomedical care becomes the last resort, usually at an advanced stage of breast cancer, often responsible for poor prognosis.

CONCLUSION

There is a dichotomy of illness construction between sufferers and health practitioners. To guide women with breast cancer on the path of care, modern care practitioners should consider some cultural norms and practices without compromising professional ethos.

Spiritual Well-Being and Care Burden in Caregivers of Patients with Breast Cancer in Turkey

This research was carried out to identify the relationship between the spiritual well-being and caregiver burden in caregivers of patients with breast cancer. The study was conducted with family caregivers of patients with breast cancer who presented to the oncology clinic of a university hospital for treatment. The study sample included a total of 138 family caregivers who met the criteria for participation and agreed to participate in the study. The data were collected using a participant information form, caregiver burden scale and three-dimensional spiritual well-being scale. The caregivers have a moderate level of caregiver burden and their spiritual well-being was quite high. The caregiver burden of female caregivers was found to be significantly higher than that of male caregivers (p = 0.040). There is a negatively significant relationship between caregiver burden and spiritual well-being (p = 0.000, r =  - 0.357). The caregiver burden is significantly higher among the 24-h caregivers compared to that among the 3-h and 4-6-h caregivers (p = 0.003). The spiritual well-being of the caregivers who provide care between 3 h and 4-6 h a day was significantly higher than that of those who provide 24-h care (p = 0.001). Increasing spiritual well-being may help to reduce caregiver burden in caregivers of those with breast cancer.

Preparedness, resilience and unmet needs of informal caregivers of advanced cancer patients in a Regional Mission Hospital in Kenya: Qualitative Study

BACKGROUND

Cancer is the third highest cause of death in Kenya. Eighty percent of cancer cases arrive at advanced stages, when there is nothing that can be done to cure them, and palliative care is the best alternative. Although the majority of end-of-life care in Kenya is provided at home, little is known about the caregivers' preparedness, resilience and continued unmet needs. The goal of this qualitative study was to explore caregivers' perceived preparedness, resilience and continued unmet needs in their caregiving role to patients with advanced stages of cancer.

METHODS

A purposive sampling method was used to identify and recruit twelve informal, home-based caregivers of patients with advanced cancer from Kijabe Palliative Clinic data base. Interviews were conducted in patients' homes. The data was analyzed using interpretive phenomenological analysis approach. Ethical considerations were observed. Participants were kept anonymous and confidentiality.

RESULTS

Competing tasks, lack of preparedness in handling end-of-life care for patients in advanced stages of cancer were the main concerns. Continued unmet needs and financial stresses, and vulnerability for female caregivers all contributed to increased caregiver burden in this study. Caregivers were however determined and resilient amidst challenges that faced them, they exhibited hope against hopelessness. Some caregivers were vulnerable and faced potential for abuse following anticipated loss of their family member exacerbated psychosocial stress and needs CONCLUSION: Informal caregivers had common unmet needs related to caring for their advanced cancer patients. Whilst family caregivers had huge caregiver burden, insurmountable practical challenges related to role overload and competing tasks, they remained resilient though unprepared in giving end of life care.

RECOMMENDATIONS

Caregivers should also be examined, prepared, and supported during clinic reviews. More research is needed on the use of telephones for caregiver follow-up, the impact of introducing caregiver-targeted screening tools on caregiver quality of life and their impact on enhancing caregiver well-being in order to prepare & support them adequately for the caregiving role.

Access to Radiation Therapy and Related Clinical Outcomes in Patients With Cervical and Breast Cancer Across Sub-Saharan Africa: A Systematic Review

PURPOSE

To better understand the barriers to accessing standard-of-care radiation therapy (RT) for breast and cervical cancer in sub-Saharan Africa and their impact on outcomes.

METHODS

A comprehensive literature search was completed with a medical librarian. Articles were screened by title, abstract, and full text. Included publications were analyzed for data describing barriers to RT access, available technology, and disease-related outcomes, and further grouped into subcategories and graded according to predefined criteria.

RESULTS

A total of 96 articles were included: 37 discussed breast cancer, 51 discussed cervical cancer, and eight discussed both. Financial access was affected by health care system payment models and combined burdens of treatment-related costs and lost wages. Staffing and technology shortages limit the ability to expand service locations and/or increase capacity within existing centers. Patient factors including use of traditional healers, fear of stigma, and low health literacy decrease the likelihood of early presentation and completion of therapies. Survival outcomes are worse than most high- and middle-income countries and are affected by many factors. Side effects are similar to other regions, but these findings are limited by poor documentation capabilities. Access to palliative RT is more expeditious than definitive management. RT was noted to lead to feelings of burden, lower self-esteem, and worsened quality of life.

CONCLUSION

Sub-Saharan Africa represents a diverse region with barriers to RT that differ on the basis of funding, available technology and staff, and community populations. Although long-term solutions must focus on building capacity by increasing the number of treatment machines and providers, short-term improvements should be implemented, such as interim housing for traveling patients, increased community education to reduce late-stage diagnoses, and use of virtual visits to avoid travel.

Assessment of psychological stress among family care takers of cancer subjects in India- A cross-sectional study

Introduction and Aim: A rapid increase in cancer rate is one of major concerns in India. It is a well-known fact that family caretakers play an essential part in aiding cancer subjects who are in critical stage. But the psychological strain and economic impact on caretakers are not widely known. The present cross-sectional study assesses the relationship between various factors and higher burden among family caretakers of cancer subjects.   Materials and Methods:  One hundred and ninety family caretakers of cancer patients who met inclusion criteria were recruited for study. A proforma was collected regarding the age, gender, social and economic status according to Modified Kuppuswamy Scale 2019, the type of family or the caregiver and their relation to the patient.   Results: Monthly income had an inter quartile range of Rs.10,000-25,000 with the median being Rs.14,000. Higher number of males participated (58.4%) as compared to the females (41.6%). Moderate to severe stress (53.3%), and severe stress (6.7%) was maximum in class 5 of the socio-economic classification. Lower income was found to be related to higher burden scores.   Conclusion: Present study showed that the burden was more among class 5 of the Kuppuswamy Socioeconomic classification. The findings suggest that education levels, occupation and monthly income are the major contribution for the burden among the caregivers.

COVID-19 pandemic in Nigeria: Caregivers lived experiences in health care management of older adult

Aging is a natural occurrence often associated with decline in body functioning and common health conditions. With the emergency of new diseases, vulnerable groups like older adults are prone and more possibly to be infected. In the era of COVID-19 pandemic and beyond, health management of older adults becomes demanding with increasing ill-health, morbidity and mortality. This paper aims to investigate caregivers' lived experiences in health care management of older adults amid and post COVID-19 pandemic for quality of life and wellbeing in Nigeria. With the phenomenological approach in qualitative research, we sourced our data using focus group discussions (FGDs) and in-depth interviews (IDI) from 21 caregivers purposively selected from three health institutions based on their ownership in Nsukka. Data were analyzed thematically. Results revealed that though care-giving is perceived to be filial, it is no longer effectively provided owing to financial and health status of the care recipient. Other findings indicated that factors predicting responds to preventive measures in older adults' health care include disregard of information, inadequate geriatric knowledge and noncompliance of health information. Suggestions to ease challenges in health care demand of older adults were brought to fore. Recommendations were on aligning geriatric professionals in health institutions and health care financing for all older adults in Nigeria.

Extremely Distant and Incredibly Close: Physical Proximity, Emotional Attachment and Caregiver Burden

Informal caregivers are at risk of caregiver burden, and physical proximity to the care recipient may add to this negative outcome. Yet, individual differences in emotional proximity to the care recipient such as attachment orientations may contribute to caregivers’ comfort towards different degrees of physical proximity, leading to varying levels of burden. The current study is the first to explore the role of physical proximity on caregiver burden as moderated by attachment orientations. A sample of 162 Israeli caregivers who are active users of the Camoni website completed our online survey. Sociodemographic characteristics, including a self-reported questionnaire on the physical proximity to the care recipient, were collected. Caregivers’ attachment orientations were assessed with the Experiences in Close Relationships–Relationship Structures questionnaire. Caregiver burden was assessed using the Caregiver Burden Inventory. Multiple regression and simple slope analyses were conducted. Attachment anxiety and avoidance were positively associated with burden, whereas physical proximity was not. Attachment avoidance, but not attachment anxiety, moderated the association between physical proximity and caregiver burden, with caregivers who live closer to their care recipient experiencing greater burden when high levels of avoidance were present. Our findings reveal the complex dynamics between attachment orientations and physical proximity in the context of informal care, highlighting the need for better integration of these two interlinked constructs in both care research and practice.