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Alshammari B, Noble H, McAneney H, Alshammari F, O’Halloran P. Factors Associated with Burden in Caregivers of Patients with End-Stage Kidney Disease (A Systematic Review). Healthcare (Basel) 2021; 9:healthcare9091212. [PMID: 34574986 PMCID: PMC8468425 DOI: 10.3390/healthcare9091212] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 09/07/2021] [Accepted: 09/07/2021] [Indexed: 02/01/2023] Open
Abstract
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.
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Affiliation(s)
- Bushra Alshammari
- Medical Biology Centre, School of Nursing and Midwifery, Queen’s University Belfast, 97 Lisburn Rd, Belfast BT9 7BL, UK; (H.N.); (P.O.)
- College of Nursing, University of Hail, Hail 2440, Saudi Arabia
- Correspondence: or
| | - Helen Noble
- Medical Biology Centre, School of Nursing and Midwifery, Queen’s University Belfast, 97 Lisburn Rd, Belfast BT9 7BL, UK; (H.N.); (P.O.)
| | - Helen McAneney
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems, School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland;
| | - Farhan Alshammari
- Department of Pharmaceutics, College of Pharmacy, University of Hail, Hail 2440, Saudi Arabia;
| | - Peter O’Halloran
- Medical Biology Centre, School of Nursing and Midwifery, Queen’s University Belfast, 97 Lisburn Rd, Belfast BT9 7BL, UK; (H.N.); (P.O.)
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Van Pilsum Rasmussen SE, Eno A, Bowring MG, Lifshitz R, Garonzik-Wang JM, Al Ammary F, Brennan DC, Massie AB, Segev DL, Henderson ML. Kidney Dyads: Caregiver Burden and Relationship Strain Among Partners of Dialysis and Transplant Patients. Transplant Direct 2020; 6:e566. [PMID: 32766421 PMCID: PMC7339348 DOI: 10.1097/txd.0000000000000998] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 02/18/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Caring for dialysis patients is difficult, and this burden often falls on a spouse or cohabiting partner (henceforth referred to as caregiver-partners). At the same time, these caregiver-partners often come forward as potential living kidney donors for their loved ones who are on dialysis (henceforth referred to as patient-partners). Caregiver-partners may experience tangible benefits to their well-being when their patient-partner undergoes transplantation, yet this is seldom formally considered when evaluating caregiver-partners as potential donors. METHODS To quantify these potential benefits, we surveyed caregiver-partners of dialysis patients and kidney transplant (KT) recipients (N = 99) at KT evaluation or post-KT. Using validated tools, we assessed relationship satisfaction and caregiver burden before or after their patient-partner's dialysis initiation and before or after their patient-partner's KT. RESULTS Caregiver-partners reported increases in specific measures of caregiver burden (P = 0.03) and stress (P = 0.01) and decreases in social life (P = 0.02) and sexual relations (P < 0.01) after their patient-partner initiated dialysis. However, after their patient-partner underwent KT, caregiver-partners reported improvements in specific measures of caregiver burden (P = 0.03), personal time (P < 0.01), social life (P = 0.01), stress (P = 0.02), sexual relations (P < 0.01), and overall quality of life (P = 0.03). These improvements were of sufficient impact that caregiver-partners reported similar levels of caregiver burden after their patient-partner's KT as before their patient-partner initiated dialysis (P = 0.3). CONCLUSIONS These benefits in caregiver burden and relationship quality support special consideration for spouses and partners in risk-assessment of potential kidney donors, particularly those with risk profiles slightly exceeding center thresholds.
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Affiliation(s)
| | - Ann Eno
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Mary G. Bowring
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | | | - Fawaz Al Ammary
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Daniel C. Brennan
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Allan B. Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - Dorry L. Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Acute and Chronic Care, Johns Hopkins University School of Nursing, Baltimore, MD
| | - Macey L. Henderson
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Acute and Chronic Care, Johns Hopkins University School of Nursing, Baltimore, MD
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3
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Cipolletta S, Entilli L, Nucci M, Feltrin A, Germani G, Cillo U, Volpe B. Psychosocial Support in Liver Transplantation: A Dyadic Study With Patients and Their Family Caregivers. Front Psychol 2019; 10:2304. [PMID: 31649602 PMCID: PMC6795706 DOI: 10.3389/fpsyg.2019.02304] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 09/27/2019] [Indexed: 12/17/2022] Open
Abstract
Background and aims: Liver transplantation provides an opportunity of survival for patients with liver failure; however, this procedure is known to be psychologically and physically fatiguing for patients and their informal caregivers. The aim of this study was to investigate how perceived social support and the distribution of dependency were associated with the psychological wellbeing of patients waiting for liver transplantation and their caregivers, as a dyad. Methods: The present was a cross-sectional study. Ninety-five participants were recruited at a hospital in Northern Italy, during the psychological evaluation for inclusion in the transplantation list: 51 patients (19 with alcohol-related illness) and 44 family caregivers. Both patients and caregivers filled in a Symptom Checklist and Kelly’s Dependency Grids. Patients also compiled the Medical Outcome Study Social-Support Survey, and caregivers compiled the Family Strain Questionnaire Short-Form. Results: Caregivers reported important levels of strain and strongly related to a worsening of their own and patients’ symptoms. Patients with alcohol-related pathologies had a narrower social network, which corresponded to an increase in family strain. On the sample as a whole, regression analyses showed that perceived social support and dependency measures did not predict patients’ and caregivers’ symptoms. Nevertheless, cluster analysis identified a group of caregivers who distributed their dependency more and experienced lower levels of depression, anxiety, and strain. Conclusions: These results suggest the usefulness of a dyadic approach in the research, prevention, and care of liver diseases. A deeper comprehension of the functioning of dyads will help practitioners in the identification of situations at risk.
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Affiliation(s)
| | - Lorenza Entilli
- Department of General Psychology, University of Padua, Padua, Italy
| | - Massimo Nucci
- Department of General Psychology, University of Padua, Padua, Italy
| | | | - Giacomo Germani
- Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
| | - Umberto Cillo
- Hepatobiliary Surgery and Liver Transplantation Unit, Department of General Surgery and Organ Transplantation, Padua University Hospital, Padua, Italy
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4
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Nagarathnam M, Sivakumar V, Latheef SAA. Characteristics of Burden, Coping Strategies, and Quality of Life: The Effect of Age, Gender, and Social Variables in Caregivers of Renal Transplanted Patients from Southern Andhra Pradesh, India. Indian J Palliat Care 2019; 25:407-413. [PMID: 31413457 PMCID: PMC6659532 DOI: 10.4103/ijpc.ijpc_34_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background: Evaluation of burden, coping strategies, and quality of life (QOL) in caregivers may lead to specific interventions to reduce the burden among caregivers. Methods: In this prospective study, characteristics of burden, coping strategies, and QOL in caregivers was investigated and also studied the effect of age, gender, and social variables on these concepts. Results: Mean burden score of the caregivers was 28.66 ± 2.02. Thirty percent of caregivers had mild-to-moderate burden followed by moderate-to-severe burden (20%). Seeking social support was the dominant coping strategy used by the caregivers. Role limitations due to the physical health (RLDPH) and role limitations due to emotional problem (RLDEP) were compromised subscales of QOL. The mean score of RLDPH (P = 0.007) and RLDEP (P = 0.014) were found to be significantly higher in males than that of females. Marital status, education, type of relationship with the patient, religion, occupation, and duration of care giving showed significant effect on burden, coping strategies, and QOL. Lower emotional well-being (P = 0.003) and escape avoidance (P = 0.000) in males and lower physical component (PC) (P = 0.002) in females and lower PC (P = 0.000) and escape avoidance (P = 0.001) were found to be the significant predictors of burden in caregivers of renal transplanted patients. Conclusion: Predictors of burden and QOL subscales varies by gender. Social and clinical variables influence the QOL subscales. Gender- and social group-specific interventions rather than global interventions may reduce the burden of caregivers.
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Affiliation(s)
- M Nagarathnam
- Department of Medical and Surgical Nursing, Sri venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - V Sivakumar
- Department of Nephrology, Sri venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - S A A Latheef
- Department of Biochemistry, School of Life Sciences, University of Hyderabad, Hyderabad, Telangana, India
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5
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Nagarathnam M, Sivakumar V, Latheef SAA. Burden, coping mechanisms, and quality of life among caregivers of hemodialysis and peritoneal dialysis undergoing and renal transplant patients. Indian J Psychiatry 2019; 61:380-388. [PMID: 31391642 PMCID: PMC6657553 DOI: 10.4103/psychiatry.indianjpsychiatry_401_18] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
CONTEXT Investigations on burden, coping, and quality of life (QOL) in caregivers of hemodialysis (HD) and peritoneal dialysis (PD) undergoing and renal transplant (RT) patients may lead to the well-being of caregivers, and these studies are sparse and nil in Indian context. AIM This study aims to comparatively evaluate the burden, coping mechanisms, and QOL among caregivers of HD and PD undergoing and RT patients. SETTING AND DESIGN Tertiary care hospital, cross-sectional and descriptive study. SUBJECTS AND METHODS Burden, coping mechanisms, and QOL in caregivers of HD and PD undergoing and RT patients were investigated using Zarit burden interview, revised ways of coping and short-form 36 in 30 each caregivers of HD and PD undergoing and RT patients. RESULTS Moderate to severe burden, mild to moderate burden, and no burden were observed in the majority of caregivers of HD and PD undergoing and RT patients. Significantly higher mean burden score in caregivers of HD undergoing than RT patients (P < 0.01); accepting responsibility in caregivers of RT than PD undergoing patients; social functioning in caregivers of HD than PD undergoing patients; and general health in caregivers of RT than HD undergoing patients, was observed. Lower physical component was common in each group, whereas accepting responsibility in HD, self-controlling in PD, and age and escape avoidance in RT were found to be the specific predictors of the burden score. CONCLUSIONS Caregivers of HD and PD undergoing and RT patients have different levels of burden, use different mechanisms to cope, and showed different predictors of burden score.
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Affiliation(s)
- M Nagarathnam
- Department of Medical and Surgical Nursing, College of Nursing, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - Vishnubotla Sivakumar
- Department of Nephrology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - S A A Latheef
- Department of Biochemistry, School of Life Sciences, University of Hyderabad, Hyderabad, Telangana, India
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6
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Van Pilsum Rasmussen SE, Henderson ML, Kahn J, Segev D. Considering Tangible Benefit for Interdependent Donors: Extending a Risk-Benefit Framework in Donor Selection. Am J Transplant 2017; 17:2567-2571. [PMID: 28425206 PMCID: PMC6108434 DOI: 10.1111/ajt.14319] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 04/06/2017] [Accepted: 04/12/2017] [Indexed: 01/25/2023]
Abstract
From its infancy, live donor transplantation has operated within a framework of acceptable risk to donors. Such a framework presumes that risks of living donation are experienced by the donor while all benefits are realized by the recipient, creating an inequitable distribution that demands minimization of donor risk. We suggest that this risk-tolerance framework ignores tangible benefits to the donor. A previously proposed framework more fully considers potential benefits to the donor and argues that risks and benefits must be balanced. We expand on this approach, and posit that donors sharing a household with and/or caring for a potential transplant patient may realize tangible benefits that are absent in a more distantly related donation (e.g. cousin, nondirected). We term these donors, whose well-being is closely tied to their recipient, "interdependent donors." A flexible risk-benefit model that combines risk assessment with benefits to interdependent donors will contribute to donor evaluation and selection that more accurately reflects what is at stake for donors. In so doing, a risk-benefit framework may allow some donors to accept greater risk in donation decisions.
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Affiliation(s)
| | - Macey L. Henderson
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jeffrey Kahn
- Johns Hopkins Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD
| | - Dorry Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD,Department of Epidemiology, Johns Hopkins University School of Medicine, Baltimore, MD
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7
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Low JK, Crawford K, Manias E, Williams A. Stressors and coping resources of Australian kidney transplant recipients related to medication taking: a qualitative study. J Clin Nurs 2017; 26:1495-1507. [PMID: 27323293 DOI: 10.1111/jocn.13435] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2016] [Indexed: 11/29/2022]
Abstract
AIM AND OBJECTIVE To understand the stressors related to life post kidney transplantation, with a focus on medication adherence, and the coping resources people use to deal with these stressors. BACKGROUND Although kidney transplantation offers enhanced quality and years of life for patients, the management of a kidney transplant post surgery is a complex process. DESIGN A descriptive exploratory study. METHOD Participants were recruited from five kidney transplant units in Victoria, Australia. From March-May 2014, patients who had either maintained their kidney transplant for ≥8 months or had experienced a kidney graft loss due to medication nonadherence were interviewed. All audio-recordings of interviews were transcribed verbatim and underwent Ritchie and Spencer's framework analysis. RESULTS Participants consisted of 15 men and 10 women aged 26-72 years old. All identified themes were categorised into: (1) Causes of distress and (2) Coping resources. Post kidney transplantation, causes of distress included the regimented routine necessary for graft maintenance, and the everlasting fear of potential graft rejection, contracting infections and developing cancer. Coping resources used to manage the stressors were first, a shift in perspective about how easy it was to manage a kidney transplant than to be dialysis-dependent and second, receiving external help from fellow patients, family members and health care professionals in addition to using electronic reminders. CONCLUSION An individual well-equipped with coping resources is able to deal with stressors better. It is recommended that changes, such as providing regular reminders about the lifestyle benefits of kidney transplantation, creating opportunities for patients to share their experiences and promoting the usage of a reminder alarm to take medications, will reduce the stress of managing a kidney transplant. RELEVANCE TO CLINICAL PRACTICE Using these findings to make informed changes to the usual care of a kidney transplant recipient is likely to result in better patient outcomes.
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Affiliation(s)
- Jac Kee Low
- Faculty of Medicine, Nursing & Health Sciences, School of Nursing & Midwifery, Monash University, Clayton, Vic., Australia
| | - Kimberley Crawford
- Faculty of Medicine, Nursing & Health Sciences, School of Nursing & Midwifery, Monash University, Clayton, Vic., Australia
| | - Elizabeth Manias
- Royal Melbourne Hospital, The University of Melbourne, Parkville, Vic., Australia.,Melbourne School of Health Sciences, The University of Melbourne, Parkville, Vic., Australia.,School of Nursing and Midwifery, Deakin University, Burwood, Vic., Australia
| | - Allison Williams
- Faculty of Medicine, Nursing & Health Sciences, School of Nursing & Midwifery, Monash University, Clayton, Vic., Australia
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8
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Avşar U, Avşar UZ, Cansever Z, Yucel A, Cankaya E, Certez H, Keles M, Aydınlı B, Yucelf N. Caregiver Burden, Anxiety, Depression, and Sleep Quality Differences in Caregivers of Hemodialysis Patients Compared With Renal Transplant Patients. Transplant Proc 2016; 47:1388-91. [PMID: 26093725 DOI: 10.1016/j.transproceed.2015.04.054] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND We compared the caregivers of hemodialysis (HD) patients and caregivers of patients with renal transplantation (Tx) in terms of anxiety, depression, sleep quality, and caregiver burden. We believe that caregivers of HD have more difficult conditions than caregivers of the patients with Tx. METHODS This cross-sectional study analyzed the psychological status of caregivers of Tx patients compared with those of HD patients with using the Hospital Anxiety and Depression Scale, Zarit Burden Interview, and Pittsburg Sleep Quality Indexes. We recruited 133 caregivers-65 caregivers in the Tx group and 68 in the HD group. RESULTS Mean age was 43.1 ± 8.5 years. The age, sex, income level, and education level were similar between the 2 groups. Caregivers in the HD group had significantly higher rates of anxiety and depression compared with the Tx group (P = .007 and P < .001, respectively). Good sleep quality rates for caregivers in the Tx group and caregivers in the HD group were 92% (n = 60) and 63% (n = 43), respectively. Poor sleep quality was significantly higher in caregivers in the HD group compared with caregivers in the Tx group (P < .001). Caregiver burden scores were significantly higher for caregivers in the HD group compared with caregivers in the Tx group (P < .001). CONCLUSIONS We suggest that Tx is the more appropriate renal replacement therapy for caregivers who undertake the care of patients with end-stage renal disease and chronic kidney disease.
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Affiliation(s)
- U Avşar
- Department of Family Medicine, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - U Z Avşar
- Department of Medical Education, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Z Cansever
- Department of Medical Education, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - A Yucel
- Department of Psychiatry, Faculty of Medicine, Ataturk University, Erzurum, Turkey.
| | - E Cankaya
- Department of Nephrology, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - H Certez
- Department of Nephrology, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - M Keles
- Department of Nephrology, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - B Aydınlı
- Department of General Surgery, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - N Yucelf
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Ataturk University, Erzurum, Turkey
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9
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Serur D, Charlton M, Bretzlaff G, Sinacore J, Christos P, Gordon-Elliott J. Is donating a kidney to a friend bad for your marriage? Nephrology (Carlton) 2015; 20:434-6. [PMID: 25900385 DOI: 10.1111/nep.12426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Studies have shown that kidney donation to a spouse has a positive impact on marriage. This study was done to evaluate the impact on marriage when donation occurs to someone other than the spouse. Two groups of donors from our centre who donated around the same period were studied: donation to a spouse (spouse donor (SD)) or to someone other than the spouse (non-spouse donor (ND)). A survey, the Revised Dyadic Adjustment Scale, was used to evaluate the effect of donation on the marriage. This tool consists of 14 questions that measure how satisfying and stable the relationship is. The results showed equal or better marriage scores in the ND group compared with the SD group. The NDs scored higher on two questions, one regarding agreement or disagreement on career choices (P = 0.05) and the other regarding the frequency of having stimulating exchanges of ideas with one's spouse (P = 0.02). With the highest possible total score of 69, NDs scored 53.4 and SDs scored 47.7 (P = 0.16). Scores of 47 and below indicate marital distress. In one final additional question, 97% of NDs reported 'no change or good effect' on the marriage, similar to 91% for SDs (P = 0.46). This is the first study to evaluate the effect of kidney donation on the state of marriage when the spouse is not the recipient. It appears that marriage is not impacted negatively when kidney donation occurs to someone other than the spouse.
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Affiliation(s)
- David Serur
- Division of Nephrology and the Rogosin Institute, New York Presbyterian Weill Cornell, New York, USA
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10
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Malik P, Kohl C, Holzner B, Kemmler G, Graziadei I, Vogel W, Sperner-Unterweger B. Distress in primary caregivers and patients listed for liver transplantation. Psychiatry Res 2014; 215:159-62. [PMID: 24210743 DOI: 10.1016/j.psychres.2013.08.046] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Revised: 03/26/2013] [Accepted: 08/18/2013] [Indexed: 10/26/2022]
Abstract
Orthotopic liver transplantation (LTx) has become a routine procedure in the treatment of end-stage liver disease. During the waiting period for transplantation, the patient's family members are also highly affected. We examined the course of distress and quality of life (QOL) in 47 patients awaiting LTx and distress in 24 caregivers at baseline and in intervals of 4-6 weeks, using The Hospital Anxiety and Depression Scale (HADS) and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). All subscales of the EORTC QLQ-C30, except emotional functioning, were lower than normal at baseline. Little change in patients' QOL was observed during the waiting period. In the HADS, there were significantly higher anxiety scores in caregivers than in patients both at baseline and after 1-2 months and the third assessment, with the difference after 3-5 months reaching almost significance. Caregivers' anxiety levels increased significantly. Relatives showed more depression than patients only at month 1-2 and a significant increase in depression from baseline to month 1-2. In patients, depression scores remained relatively stable throughout all visits. Our results emphasize the importance of evaluation of psychic stress especially in relatives during the waiting period for LTx.
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Affiliation(s)
- Peter Malik
- Department of Biological Psychiatry, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.
| | - Claudia Kohl
- Department of Biological Psychiatry, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Bernhard Holzner
- Department of Biological Psychiatry, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Georg Kemmler
- Department of General Psychiatry, Medical University Innsbruck, Innsbruck, Austria
| | - Ivo Graziadei
- Department of Internal Medicine II, Medical University Innsbruck, Innsbruck, Austria
| | - Wolfgang Vogel
- Department of Internal Medicine II, Medical University Innsbruck, Innsbruck, Austria
| | - Barbara Sperner-Unterweger
- Department of Biological Psychiatry, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
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11
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Avsar U, Avsar UZ, Cansever Z, Set T, Cankaya E, Kaya A, Gozubuyuk H, Saatci F, Keles M. Psychological and emotional status, and caregiver burden in caregivers of patients with peritoneal dialysis compared with caregivers of patients with renal transplantation. Transplant Proc 2013; 45:883-6. [PMID: 23622578 DOI: 10.1016/j.transproceed.2013.03.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES We sought to examine the relationship between caregivers of continuous ambulatory peritoneal dialysis (CAPD) and of renal transplant (Tx) patients with regard to sleep quality, anxiety, depression, and overall burden. METHODS This cross-sectional study of prevalent caregivers of CAPD patients and of renal Tx patients used a multidimensional instrument to assess the association of sleep quality, depression and anxiety symptoms, as well as burden using a Zarit Burden Interview. Among the 113 caregivers who participated in this study, 53 were in the Tx and 60 in the CAPD group. RESULTS The overall mean age was 40.7 ± 13.6 years. The proportions of age, gender, income, and education level were similar between the 2 groups. Caregivers of peritoneal dialysis patients had significantly higher rates of anxiety and depression compared with the Tx group (P = .039 and P = .003, respectively). Good sleep quality rates for caregivers of Tx versus CAPD patients were 88.7% (n = 47) and 61.7% (n = 37), respectively. Poor sleep quality was significantly higher among caregivers of CAPD compared with those for Tx patients (P = .001). Caregiver burden scores were significantly higher in caregivers of CAPD patients compared with Tx patients (P < .001). Upon logistic regression analysis, caregivers of CAPD patients were 2.61 times (95% confidence interval, 1.03-6.59; P = .043) higher than the caregiver burden risk than those for Tx patients. CONCLUSIONS This study indirectly indicated that renal Tx improves the life quality and decreases psychiatric symptoms among caregivers of ESRD patients.
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Affiliation(s)
- U Avsar
- Department of Family Medicine, Faculty of Medicine, Ataturk University, Erzurum, Turkey.
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12
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Myaskovsky L, Posluszny DM, Schulz R, DiMartini AF, Switzer GE, Dabbs AD, McNulty ML, Kormos RL, Toyoda Y, Dew MA. Predictors and outcomes of health-related quality of life in caregivers of cardiothoracic transplant recipients. Am J Transplant 2012; 12:3387-97. [PMID: 22958758 PMCID: PMC3513563 DOI: 10.1111/j.1600-6143.2012.04243.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Cardiothoracic transplant programs generally require that transplant recipients have family caregivers to assist them posttransplant. The burden of caregiving on the family members remains poorly understood. If caregivers' well-being is compromised by caregiving, it may bode poorly for transplant recipients' own health in the long-term posttransplant. We examined caregiver health-related quality of life (HRQOL) during the first year after their family member's transplant, its predictors and its relationship to subsequent patient survival. Adult (aged 18+) caregivers of 242 cardiothoracic transplant recipients (lung = 134; heart = 108) completed assessments of demographics, psychosocial characteristics and caregiver burden at 2 months posttransplant, and HRQOL at 2, 7 and 12 months posttransplant. Recipients' survival time was obtained from medical records. Caregiver HRQOL was generally high across the first-year posttransplant in emotional and social functioning; caregiver physical functioning significantly worsened. There were no differences by type of recipient transplant. Greater caregiver burden predicted poorer caregiver HRQOL in several physical domains at 12 months posttransplant. Transplant recipients whose caregivers had lower perceived general health at 12 months posttransplant showed poorer survival rates during the subsequent 7 years of follow up. Transplant teams should identify those caregivers at risk for poorer general health posttransplant to maximize positive outcomes for the entire family.
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Affiliation(s)
- Larissa Myaskovsky
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System,Department of Medicine, University of Pittsburgh, School of Medicine,Department of Psychiatry, University of Pittsburgh, School of Medicine
| | | | - Richard Schulz
- Department of Psychiatry, University of Pittsburgh, School of Medicine,Department of Psychology, University of Pittsburgh,Department of Sociology, Community Health, and Health and Rehabilitation Sciences, University of Pittsburgh
| | - Andrea F. DiMartini
- Department of Psychiatry, University of Pittsburgh, School of Medicine,Department of Surgery, University of Pittsburgh, School of Medicine
| | - Galen E. Switzer
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System,Department of Medicine, University of Pittsburgh, School of Medicine,Department of Psychiatry, University of Pittsburgh, School of Medicine
| | - Annette DeVito Dabbs
- Department of Acute & Tertiary Care, University of Pittsburgh, School of Nursing
| | - Mary L. McNulty
- Department of Psychiatry, University of Pittsburgh, School of Medicine
| | - Robert L. Kormos
- Department of Surgery, University of Pittsburgh, School of Medicine
| | - Yoshiya Toyoda
- Department of Surgery, Temple University, School of Medicine
| | - Mary Amanda Dew
- Department of Psychiatry, University of Pittsburgh, School of Medicine,Department of Psychology, University of Pittsburgh,Department of Epidemiology, University of Pittsburgh,Department of Biostatistics, University of Pittsburgh
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13
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Delbanco T, Walker J, Bell SK, Darer JD, Elmore JG, Farag N, Feldman HJ, Mejilla R, Ngo L, Ralston JD, Ross SE, Trivedi N, Vodicka E, Leveille SG. Inviting patients to read their doctors' notes: a quasi-experimental study and a look ahead. Ann Intern Med 2012; 157:461-70. [PMID: 23027317 PMCID: PMC3908866 DOI: 10.7326/0003-4819-157-7-201210020-00002] [Citation(s) in RCA: 450] [Impact Index Per Article: 37.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Little information exists about what primary care physicians (PCPs) and patients experience if patients are invited to read their doctors' office notes. OBJECTIVE To evaluate the effect on doctors and patients of facilitating patient access to visit notes over secure Internet portals. DESIGN Quasi-experimental trial of PCPs and patient volunteers in a year-long program that provided patients with electronic links to their doctors' notes. SETTING Primary care practices at Beth Israel Deaconess Medical Center (BIDMC) in Massachusetts, Geisinger Health System (GHS) in Pennsylvania, and Harborview Medical Center (HMC) in Washington. PARTICIPANTS 105 PCPs and 13,564 of their patients who had at least 1 completed note available during the intervention period. MEASUREMENTS Portal use and electronic messaging by patients and surveys focusing on participants' perceptions of behaviors, benefits, and negative consequences. RESULTS 11,155 [corrected] of 13,564 patients with visit notes available opened at least 1 note (84% at BIDMC, 82% [corrected] at GHS, and 47% at HMC). Of 5219 [corrected] patients who opened at least 1 note and completed a postintervention survey, 77% to 59% [corrected] across the 3 sites reported that open notes helped them feel more in control of their care; 60% to 78% of those taking medications reported increased medication adherence; 26% to 36% had privacy concerns; 1% to 8% reported that the notes caused confusion, worry, or offense; and 20% to 42% reported sharing notes with others. The volume of electronic messages from patients did not change. After the intervention, few doctors reported longer visits (0% to 5%) or more time addressing patients' questions outside of visits (0% to 8%), with practice size having little effect; 3% to 36% of doctors reported changing documentation content; and 0% to 21% reported taking more time writing notes. Looking ahead, 59% to 62% of patients believed that they should be able to add comments to a doctor's note. One out of 3 patients believed that they should be able to approve the notes' contents, but 85% to 96% of doctors did not agree. At the end of the experimental period, 99% of patients wanted open notes to continue and no doctor elected to stop. LIMITATIONS Only 3 geographic areas were represented, and most participants were experienced in using portals. Doctors volunteering to participate and patients using portals and completing surveys may tend to offer favorable feedback, and the response rate of the patient surveys (41%) may further limit generalizability. CONCLUSION Patients accessed visit notes frequently, a large majority reported clinically relevant benefits and minimal concerns, and virtually all patients wanted the practice to continue. With doctors experiencing no more than a modest effect on their work lives, open notes seem worthy of widespread adoption. PRIMARY FUNDING SOURCE The Robert Wood Johnson Foundation, the Drane Family Fund, the Richard and Florence Koplow Charitable Foundation, and the National Cancer Institute.
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Affiliation(s)
- Tom Delbanco
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
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14
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Kadioglu Z, Kacar S, Eroglu A, Guven B, Tilif S. Dyadic Adjustment and Psychological Concordance of Kidney Transplant Recipients and Donors after Spousal Transplantation. Transplant Proc 2012; 44:1608-13. [DOI: 10.1016/j.transproceed.2012.04.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Goetzmann L, Scholz U, Dux R, Roellin M, Boehler A, Muellhaupt B, Noll G, Wüthrich RP, Klaghofer R. Life Satisfaction and Burnout Among Heart, Lung, Liver, and Kidney Transplant Patients and Their Spouses. SWISS JOURNAL OF PSYCHOLOGY 2012. [DOI: 10.1024/1421-0185/a000079] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Objective: While a number of studies have dealt with the psychosocial consequences of transplantation for patients, we know comparatively little about the strains faced by their spouses. The present study investigates the psychosocial health of transplant patients and their spouses, as well as the link between these groups’ physical and psychosocial status, on the one hand, and their degree of burnout and level of life satisfaction on the other. Design: In a cross-sectional study, 121 patients and their spouses are surveyed by questionnaire following heart, lung, liver, or kidney transplant. Methods: The psychosocial parameters investigated in both patients and spouses are sense of coherence, quality of life, quality of the relationship, life satisfaction, and burnout. Results: Patients rate the quality of the relationship higher than their partners do, and they are more satisfied with the relationship than their spouses are (p < .001). Regression analyses show that patients’ life satisfaction is associated with quality of the relationship. Evidence of a full burnout syndrome can be found in three of the patients and two of the spouses. Burnout in the case of both patients and their partners is associated with limitations in one’s own sense of coherence and in one’s mental and physical health (multiple R2 = 0.79 for patients and 0.76 for spouses). Conclusion: Because of the importance of the couple’s relationship, psychosocial counseling should pay more attention to relationship satisfaction. Psychotherapeutic techniques should be used to improve the sense of coherence in both patient and spouse.
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Affiliation(s)
- Lutz Goetzmann
- Department of Psychosomatic Medicine and Psychotherapy, Segeberger Kliniken, Bad Segeberg, Germany
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