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Benini S, Pellegrini E, Descovich C, Lugaresi A. Burden and resources in caregivers of people with multiple sclerosis: A qualitative study. PLoS One 2023; 18:e0265297. [PMID: 37068110 PMCID: PMC10109507 DOI: 10.1371/journal.pone.0265297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 03/27/2023] [Indexed: 04/18/2023] Open
Abstract
BACKGROUND Caregivers of people with Multiple Sclerosis are required to provide ongoing assistance especially during the advanced stages of the disease. They have to manage interventions and assume responsibilities which significantly impact both their personal quality of life and family's dynamics. OBJECTIVE A qualitative phenomenological study was carried out to understand the experience of burden in caregivers and their resources to manage it. The study also explores how healthcare services involved in the Multiple Sclerosis Clinical Pathway respond to the needs of well-being of patients and family members. METHODS 17 caregivers were involved in focus groups and in semi-structured individual interviews. RESULTS Fatigue is experienced by all respondents and it starts when physical disabilities increase or when people become aware of them. Many caregivers declare that they refer to intrinsic (love towards their relatives, patience and dedication) or extrinsic (family members, hobbies) resources to cope with the burden of assistance. Patient associations and the Multiple Sclerosis Clinical Pathway play a significant role in supporting caregivers. CONCLUSIONS Fatigue, loneliness, and isolation are experienced by caregivers and strongly affect their quality of life and health status. The study highlights caregivers' need to reconcile working times with care times, to give more space to self-care and to have moments to share their experiences with someone else. These needs should be at the core of health policies in order to avoid physical and emotional breakdowns which could lead to the rupture of the relational balance on which home care is based.
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Affiliation(s)
| | | | | | - Alessandra Lugaresi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italia
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italia
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Abstract
Neurogenic bowel dysfunction ranks as one of the most frequent problems experienced by people with multiple sclerosis (MS); it is one of the first symptoms to appear at disease onset and continues throughout the course of the disease. This review, based on literature searches of Medline and PubMed, examines bowel dysfunction causes and cofactors (ie, impaired mobility, fatigue, depression and anxiety, childbirth) that occur over the course of the disease. Coverage includes management of bowel dysfunction with noninvasive methods, including diet and fluid intake, together with pharmacologic treatments for constipation and fecal incontinence as well as more advanced treatments (ie, biofeedback, abdominal massage, transanal irrigation, posterior tibial nerve stimulation), caregiver-provided treatments and extended care facilities. Bowel dysfunction problems and related cofactors impact quality of life throughout the MS disease course, requiring appropriate interventions to improve and/or maintain the quality of life of the individual with MS.
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Affiliation(s)
- Elsie E Gulick
- School of Nursing, Rutgers, The State University of New Jersey, Newark, NJ, USA (EEG)
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3
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Zauszniewski JA, Burant CJ, Martin RJ, Sweetko JS, DiFranco E. Caregivers' Use of Personal and Social Resourcefulness: Differences by Care Recipient Condition. West J Nurs Res 2021; 44:288-295. [PMID: 34622720 DOI: 10.1177/01939459211050951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Although family caregivers who use both the personal and social resourcefulness skills have the best health outcomes, it is unknown whether their tendency toward personal or social resourcefulness varies by their care recipient's condition. This cross-sectional study of existing data from 234 caregivers of persons with various conditions examined five item pairs from the Resourcefulness Scale© with responses capturing personal and social resourcefulness in relation to anxiety, anger, sadness, indecision, and financial distress. Caregivers were categorized by the recipient's condition (amyotrophic lateral sclerosis, cancer, dementia, mental illness, Parkinson's disease, stroke, traumatic brain injury, other, or multiple conditions). Findings showed that across most groups, caregivers used both personal and social resourcefulness when angry, sad, or indecisive and personal resourcefulness when anxious or managing money. Caregivers of persons with cancer, traumatic brain injury, stroke, and mental illness differed. The findings provide a basis for future clinical trials across diverse caregiver groups.
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Affiliation(s)
- Jaclene A Zauszniewski
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Christopher J Burant
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Richard J Martin
- The Breen School of Nursing and Health Professions, Ursuline College, Cleveland, OH, USA
| | - John S Sweetko
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Evelina DiFranco
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
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Douglas SL, Plow M, Packer T, Lipson AR, Lehman MJ. Psychoeducational Interventions for Caregivers of Persons With Multiple Sclerosis: Protocol for a Randomized Trial. JMIR Res Protoc 2021; 10:e30617. [PMID: 34435971 PMCID: PMC8430872 DOI: 10.2196/30617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 06/28/2021] [Accepted: 07/06/2021] [Indexed: 11/13/2022] Open
Abstract
Background Of the approximately 1 million people living with multiple sclerosis in the United States, more than half receive informal, unpaid care or support from family or friends (caregivers). These caregivers report high levels of stress, anxiety, and negative emotions. Few researchers have conducted psychoeducational interventions for these caregivers. Objective This paper presents a protocol for a randomized clinical trial that aims to test the efficacy of two interventions for improving stress, anxiety, depression, and negative emotions for caregivers of persons with multiple sclerosis. Methods Participants included any self-identified family or friend caregiver of a person with multiple sclerosis. Data collection began in April 2021 and is expected to continue until November 2021. Participants will be randomized to receive either a website-only or a website-coaching intervention delivered for 6 weeks. Data will be collected at baseline, 6 weeks after baseline (after delivery of intervention), and 6 weeks later. Results The protocol was approved by the institutional review board of the Case Western Reserve University on January 21, 2021 (protocol 20201484). As of May 2021, 66 participants were enrolled. Conclusions Our findings will have implications for identifying the efficacy of two types of interventions developed for caregivers of persons with multiple sclerosis to reduce negative psychological outcomes associated with caregiving. Trial Registration ClinicalTrials.gov NCT04662008; http://clinicaltrials.gov/ct2/show/NCT04662008 International Registered Report Identifier (IRRID) DERR1-10.2196/30617
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Affiliation(s)
- Sara L Douglas
- School of Nursing, Case Western Reserve University, Cleveland, OH, United States
| | - Matthew Plow
- School of Nursing, Case Western Reserve University, Cleveland, OH, United States
| | - Tanya Packer
- School of Occupational Therapy, Dalhousie University, Halifax, NS, Canada.,School of Health Administration, Dalhousie University, Halifax, NS, Canada
| | - Amy R Lipson
- School of Nursing, Case Western Reserve University, Cleveland, OH, United States
| | - Michelle J Lehman
- School of Occupational Therapy, Dalhousie University, Halifax, NS, Canada
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Morrison EH, Sorkin D, Mosqueda L, Ayutyanont N. Validity and Reliability of the Scale to Report Emotional Stress Signs–Multiple Sclerosis (STRESS-MS) in Assessing Abuse and Neglect of Adults With Multiple Sclerosis. Int J MS Care 2021; 24:18-24. [DOI: 10.7224/1537-2073.2020-016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Abstract
Background:
Approximately 30% of people with multiple sclerosis (MS) require caregiving, with unknown prevalence of abuse and neglect. To explore these issues, we created the Scale to Report Emotional Stress Signs–Multiple Sclerosis (STRESS-MS). The objective was to develop, validate, and field-test a self-report questionnaire for screening people with MS for mistreatment.
Methods:
We developed the STRESS-MS questionnaire and administered it to 102 adults with advanced MS-related disability and 97 primary informal caregivers, correlating responses with direct observation of mistreatment, conducting an item analysis, and evaluating validity using a Longitudinal, Expert, All Data (LEAD) panel.
Results:
Most STRESS-MS subscales correlated highly with criterion-standard LEAD panel evaluations of mistreatment, with strong concurrent and discriminant validity. Nearly 53% of participants with MS reported experiencing psychological abuse; 9.8%, financial exploitation; 6.9%, physical abuse; 4.9%, neglect; and 3.9%, sexual abuse. Protective factors for people with MS included social support and older age; risk factors included depression and aggressiveness. The greatest risk factor was an informal caregiver who spent 20 or more hours per week caring for the person with MS.
Conclusions:
The STRESS-MS questionnaire is reasonably reliable and valid for detecting caregiver mistreatment in adults with MS. Although most informal caregivers are not abusive, this study highlights an underrecognized need to detect and prevent abuse and neglect of people with MS.
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Affiliation(s)
- Elizabeth H. Morrison
- From the Department of Psychiatry and Neuroscience, University of California, Riverside School of Medicine, Riverside, CA, USA (EHM)
| | - Dara Sorkin
- Departments of Medicine, Public Health, and Psychology and Social Behavior, University of California, Irvine School of Medicine, Irvine, CA, USA (DS)
| | - Laura Mosqueda
- Department of Family Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA (LM)
| | - Napatkamon Ayutyanont
- Graduate Medical Education–Far West Division, Hospital Corporation of America, Las Vegas, NV, USA (NA)
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Abstract
Purpose of Review In spite of recent advances in treatment, many people with multiple sclerosis (MS) require ongoing care and support. Informal caregivers can experience burden as a result of their role, with possible implications for quality of life (QOL). We review recent research examining MS caregiver experience to (1) understand current risk factors for caregiver burden and (2) identify possible strategies for increasing carer well-being. Recent Findings MS caregiver experience is highly variable and can be predicted by a variety of care recipient, caregiver and contextual factors. Burden is not the only characteristic associated with care, with positive consequences also reported. Emerging research suggests a number of ways in which carers can be better supported. Summary Identifying and meeting the needs of MS caregivers offers the best way of delivering tailored support. Future research should focus on the development of psychosocial supports, while acknowledging the needs of those caring for different MS patient populations.
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Affiliation(s)
- Rebecca Maguire
- Department of Psychology, Maynooth University, Maynooth, Co. Kildare, Ireland.
| | - Phil Maguire
- Department of Computer Science, Maynooth University, Maynooth, Co. Kildare, Ireland
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Younus Z, Vaughn CB, Sanai SA, Kavak KS, Gupta S, Nadeem M, Teter BE, Noyes K, Zivadinov R, Edwards K, Coyle PK, Goodman A, Weinstock-Guttman B. Fatigue and Mood States in Nursing Home and Nonambulatory Home-Based Patients with Multiple Sclerosis. Int J MS Care 2017; 19:297-302. [PMID: 29270087 DOI: 10.7224/1537-2073.2016-058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Multiple sclerosis (MS) is a chronic, progressively disabling condition of the central nervous system. We sought to evaluate and compare mood states in patients with MS with increased disability residing in nursing homes and those receiving home-based care. Methods We conducted a cross-sectional analysis of the New York State Multiple Sclerosis Consortium to identify patients with MS using a Kurtzke Expanded Disability Status Scale (EDSS) score of 7.0 or greater. The nursing home group was compared with home-based care patients regarding self-reported levels of loneliness, pessimism, tension, panic, irritation, morbid thoughts, feelings of guilt, and fatigue using independent-samples t tests and χ2 tests. Multivariate logistic regression analyses were used to investigate risk-adjusted differences in mood states. Results Ninety-four of 924 patients with EDSS scores of at least 7.0 lived in a nursing home (10.2%). Nursing home patients were less likely to use disease-modifying therapy and had higher mean EDSS scores compared with home-based patients. However, nursing home patients were less likely than home-based patients to report fatigue (odds ratio [OR] for no fatigue, 3.8; 95% CI, 2.1-7.2), feeling tense (OR for no tension, 1.7; 95% CI, 1.1-2.7), and having feelings of pessimism (OR for no pessimism, 1.8; 95% CI, 1.2-2.8). Conclusions The nursing home patients with MS were less likely to report fatigue, pessimism, and tension than those receiving home-based care. Further studies should examine ways of facilitating a greater degree of autonomy and decision-making control in MS patients receiving home-based care.
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Díaz-Agea JL, Jiménez-Rodríguez D, García-Méndez JA, Hernández-Sánchez E, Sáez-Jiménez A, Leal-Costa C. Patient-Oriented Debriefing: Impact of Real Patients’ Participation during Debriefing. Clin Simul Nurs 2017. [DOI: 10.1016/j.ecns.2017.04.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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