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Malhotra C, Chaudhry I, Shah SU. Caregivers' Burden and Anticipatory Grief Increases Acute Health Care Use in Older Adults With Severe Dementia. J Am Med Dir Assoc 2024:S1525-8610(24)00205-6. [PMID: 38599241 DOI: 10.1016/j.jamda.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 02/12/2024] [Accepted: 03/05/2024] [Indexed: 04/12/2024]
Abstract
OBJECTIVES To assess the bidirectional association of caregivers' burden and anticipatory grief with acute health care use (inpatient or emergency admission) among older adults with severe dementia. DESIGN Prospective cohort. SETTING AND PARTICIPANTS A total of 215 family caregivers of older adults with severe dementia in Singapore were surveyed every 4 months for 3 years (up to 10 surveys). We measured caregiver burden using the Caregiver Reaction Assessment scale and anticipatory grief using the Marwit Meuser Caregiver Grief Inventory-Short Form. METHODS Using separate multivariable mixed-effects logistic regressions, controlling for relevant confounders, we assessed the association of caregiver burden and anticipatory grief (independent variables measured at time t) with older adults' acute health care use in the next 4 months (outcome measured at time t + 1). We also performed separate multivariable mixed-effects linear regressions to assess the association of older adults' acute health care use in the past 4 months (independent variable measured at time t) with caregiver burden and anticipatory grief (outcomes measured at time t). RESULTS At baseline, 33% of the older adults had an inpatient or emergency admission in the past 4 months. Regression results showed that higher caregiver burden (odds ratio [OR], 1.58; 95% CI, 1.15-2.16) and anticipatory grief (OR, 1.02; 95% CI, 1.00-1.04) significantly increased the likelihood of older adults experiencing acute health care use in the next 4 months. However, older adults' acute health care use in the past 4 months did not significantly change their caregivers' burden or anticipatory grief. CONCLUSIONS AND IMPLICATIONS Higher caregiver burden and anticipatory grief increase the likelihood of older adults having acute health care use. Addressing caregivers' well-being has implications for reducing acute health care use in older adults and the economic burden of severe dementia.
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Affiliation(s)
- Chetna Malhotra
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore; Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore.
| | - Isha Chaudhry
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore
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Hadler RA, Weeks S, Rosa WE, Choate S, Goldshore M, Julião M, Mergler B, Nelson J, Soodalter J, Zhuang C, Chochinov HM. Top Ten Tips Palliative Care Clinicians Should Know About Dignity-Conserving Practice. J Palliat Med 2024; 27:537-544. [PMID: 37831928 DOI: 10.1089/jpm.2023.0544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023] Open
Abstract
The acknowledgment and promotion of dignity is commonly viewed as the cornerstone of person-centered care. Although the preservation of dignity is often highlighted as a key tenet of palliative care provision, the concept of dignity and its implications for practice remain nebulous to many clinicians. Dignity in care encompasses a series of theories describing different forms of dignity, the factors that impact them, and strategies to encourage dignity-conserving care. Different modalities and validated instruments of dignity in care have been shown to lessen existential distress at the end of life and promote patient-clinician understanding. It is essential that palliative care clinicians be aware of the impacts of dignity-related distress, how it manifests, and common solutions that can easily be adapted, applied, and integrated into practice settings. Dignity-based constructs can be learned as a component of postgraduate or continuing education. Implemented as a routine component of palliative care, they can provide a means of enhancing patient-clinician relationships, reducing bias, and reinforcing patient agency across the span of serious illness. Palliative care clinicians-often engaging patients, families, and communities in times of serious illness and end of life-wield significant influence on whether dignity is intentionally integrated into the experience of health care delivery. Thus, dignity can be a tangible, actionable, and measurable palliative care goal and outcome. This article, written by a team of palliative care specialists and dignity researchers, offers 10 tips to facilitate the implementation of dignity-centered care in serious illness.
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Affiliation(s)
- Rachel A Hadler
- Department of Anesthesiology, Department of Family and Preventive Medicine, Emory University, Atlanta, Georgia, USA
- Emory Critical Care Center, Department of Family and Preventive Medicine, Emory University, Atlanta, Georgia, USA
| | - Seth Weeks
- University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - William E Rosa
- Department of Psychiatry and Behavioral Sciences, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Stephanie Choate
- Emory Palliative Care Center, Department of Family and Preventive Medicine, Emory University, Atlanta, Georgia, USA
| | - Matthew Goldshore
- Division of Pediatric General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Miguel Julião
- Equipa Comunitária de Suporte em Cuidados Paliativos de Sintra, Sintra, Portugal
| | - Blake Mergler
- Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Judith Nelson
- Division of Supportive Care, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
- Department of Medicine, Weill-Cornell Medical College, New York, New York, USA
| | - Jesse Soodalter
- Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University, Atlanta, Georgia, USA
| | - Caywin Zhuang
- Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Harvey Max Chochinov
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
- CancerCare Manitoba Research Institute, University of Manitoba, Winnipeg, Manitoba, Canada
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Zhang N, Li H, Kang H, Wang Y, Zuo Z. Relationship between self-disclosure and anticipatory grief in patients with advanced lung cancer: the mediation role of illness uncertainty. Front Psychol 2023; 14:1266818. [PMID: 38144996 PMCID: PMC10748434 DOI: 10.3389/fpsyg.2023.1266818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 11/23/2023] [Indexed: 12/26/2023] Open
Abstract
Objective To study the relationship between self-disclosure, illness uncertainty (IU) and anticipatory grief (AG) in patients with advanced lung cancer. Methods This is a cross-sectional study using convenience sampling method, in which 316 patients with advanced lung cancer who were hospitalized in a tertiary hospital in Wuxi City, China, from November 2022 to April 2023 were sampled. The Preparatory Grief in Advanced Cancer Patients, Mishel Uncertainty in Illness Scale, and the Distress Disclosure Index Scale (DDI) were selected to analyse the status quo, correlations, and the mediating effect of illness uncertainty on the relationship between self-disclosure and anticipatory grief in advanced lung cancer patients. Results The total self-disclosure score of advanced lung cancer patients was (36.35 ± 9.25), the total score of IU was (56.92 ± 15.65), and the score of AG was (52.29 ± 9.08); the results of correlation analyses showed that IU was negatively correlated with self-disclosure in advanced lung cancer patients (p < 0.05) and positively correlated with AG (p < 0.05), and self-disclosure was negatively correlated with AG (p < 0.05);the mediating effect rate of IU between self-disclosure and AG in advanced lung cancer patients was 49%. Conclusion The AG of advanced lung cancer patients was at a medium-high level, and IU had a significant mediating effect between self-disclosure and AG of advanced lung cancer patients; by increasing the level of patients' self-disclosure, IU could be effectively alleviated, and ultimately the AG of the patients could be reduced.
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Affiliation(s)
- Nan Zhang
- Wuxi School of Medicine, Jiangnan University, Wuxi, China
| | - Han Li
- Wuxi School of Medicine, Jiangnan University, Wuxi, China
| | - Huaxin Kang
- Wuxi School of Medicine, Jiangnan University, Wuxi, China
| | - Yinglan Wang
- Department of Respiratory Medicine, Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Zhitong Zuo
- Department of Respiratory Medicine, Affiliated Hospital of Jiangnan University, Wuxi, China
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Wang H, Yue H, Wang Z, Lu M, Feng D, Wang H, Yue H. The relationship between patient-family caregiver congruence/incongruence in acceptance of illness and family caregivers' anticipatory grief. Psychooncology 2023; 32:751-759. [PMID: 36890764 DOI: 10.1002/pon.6121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 02/12/2023] [Accepted: 03/03/2023] [Indexed: 03/10/2023]
Abstract
OBJECTIVE Cancer is a family affair that negatively impacts the lives of patients and their family caregivers. This study takes a dyadic perspective to investigate the effect of patient-family caregiver illness acceptance congruence/incongruence on family caregivers' anticipatory grief (AG) and examine whether caregivers' resilience moderates the abovementioned relationship. METHODS For the study, 304 dyads of advanced lung cancer patients and their family caregivers from three tertiary hospitals in Jinan, Shandong Province, China were recruited. The data were analyzed using polynomial regressions and response surface analyses. RESULTS Family caregivers' AG was lower when patient-family caregiver illness acceptance was congruent rather than incongruent. Lower patient-caregiver illness acceptance congruence was associated with higher AG in family caregivers compared with higher illness acceptance congruence. Family caregivers reported significantly higher AG only if their illness acceptance was lower than that of their patients. In addition, caregivers' resilience moderated the effects of patient-caregiver illness acceptance congruence/incongruence on family caregivers' AG. CONCLUSIONS Patient-family caregiver illness acceptance congruence was beneficial to family caregivers' AG; resilience can be a protective factor for buffering the impact of illness acceptance incongruence on family caregivers' AG.
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Affiliation(s)
- Hui Wang
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Haorun Yue
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Zenghui Wang
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Mengxin Lu
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Danjun Feng
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
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Duplantier SC, Williamson FA. Barriers and Facilitators of Health and Well-Being in Informal Caregivers of Dementia Patients: A Qualitative Study. Int J Environ Res Public Health 2023; 20:4328. [PMID: 36901336 PMCID: PMC10001898 DOI: 10.3390/ijerph20054328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/20/2023] [Accepted: 02/23/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Given the dramatic projected increase in Alzheimer's disease globally and the increased risk of morbidity and mortality for family caregivers of these patients, there is an urgent need to provide more targeted, timely resources to support the health and well-being of these informal caregivers. Few studies have investigated the barriers to health and well-being and potential strategies to facilitate better self-care from the unique perspective of the caregivers themselves. PURPOSE This qualitative study aimed to identify barriers and facilitators to health and well-being for informal caregivers of family members with Alzheimer's. METHOD We conducted semi-structured interviews with eight informal caregivers, including daughters, wives, and one husband, ages 32 to 83. Using Reflexive Thematic Analysis, we identified three main themes and subthemes across caregivers' experiences. FINDINGS We found that caregivers (1) prioritized mental and social well-being over physical health or health behaviors; (2) characterized the subjective burden of caregiving as a "mantle of responsibility" that could not easily be shed due to the complex subjective burden of loss, grief, guilt, resentment, isolation, loneliness, and lack of agency; (3) sought to be recognized as "additional patients", instead of being viewed as invisible patients, with support services tailored to their life stage and challenges. CONCLUSIONS The findings suggest that the subjective burden of strain experienced by family caregivers of Alzheimer's patients has a profound impact on their health and well-being, even more so than the objective burden of strain that is the result of their day-to-day caregiving activities.
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Affiliation(s)
- Sally C. Duplantier
- Department of Counseling and Educational Psychology, School of Education, Indiana University, 201 Rose Avenue, Bloomington, IN 47405, USA
| | - Francesca A. Williamson
- Department of Pediatrics, School of Medicine, Indiana University, 340 W. 10th Street, Fairbanks Hall, Suite 6200, Indianapolis, IN 46202, USA
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Li C, Tang N, Yang L, Zeng Q, Yu T, Pu X, Wang J, Zhang H. Effect of caregiver burden on anticipatory grief among caregivers of elderly cancer patients: Chain mediation role of family functioning and resilience. Front Psychol 2023; 13:1020517. [PMID: 36704702 PMCID: PMC9872027 DOI: 10.3389/fpsyg.2022.1020517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 12/16/2022] [Indexed: 01/11/2023] Open
Abstract
This study aimed to explore the relationship between caregiver burden and anticipatory grief among caregivers of elderly cancer patients, and to examine the chain mediation effects of family functioning and resilience. A total of 624 valid questionnaires were collected. The Structural Equation Model was established to test the mediating effects of family functioning and resilience. Results showed that caregiver burden has a direct positive effect on anticipatory grief, both family functioning and resilience have negative effects on caregiver burden and anticipatory grief, and that resilience moderates the mediating effect of family functioning. Our findings suggest that reducing the caregiver burden among caregivers of elderly cancer patients, improving family functioning, and enhancing resilience have important effects in alleviating the anticipatory grief of caregivers. Our findings provide some references for further research. Medical staff should better understand the grief experience of caregivers and implement interventions to enable caregivers to better cope with anticipatory grief and psychological stress, so as to promote the quality of care for elderly cancer patients.
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Affiliation(s)
- Caiyue Li
- School of Nursing, Lanzhou University, Lanzhou, China
| | - Nan Tang
- School of Nursing, Lanzhou University, Lanzhou, China
| | - Lili Yang
- School of Nursing, Lanzhou University, Lanzhou, China
| | - Qing Zeng
- School of Nursing, Lanzhou University, Lanzhou, China
| | - Tana Yu
- School of Nursing, Lanzhou University, Lanzhou, China
| | - Xiaojin Pu
- Lanzhou University First Hospital, Lanzhou, China
| | - Juan Wang
- Lanzhou University Second Hospital, Lanzhou, China
| | - Hongchen Zhang
- School of Nursing, Lanzhou University, Lanzhou, China,*Correspondence: Hongchen Zhang,
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7
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Abstract
OBJECTIVES Informal caregivers of dependants with dementia commence their bereavement experience long before the physical death of their dependant, a process referred to as "anticipatory grief". This represents an ambiguous state that has been acknowledged as a measurable variable among informal caregivers. The use of assessment tools for the identification of anticipatory grief is important for timely intervention to promote well-being and positive bereavement experiences. The aim of this systematic review is to identify and examine existing tools for assessing anticipatory grief among caregivers of dependants with dementia. METHODS MEDLINE, EMBASE, PsychINFO, CINAHL and Web of Science were searched to July 2021. Studies focusing on the development/evaluation of instruments for measuring anticipatory grief in dementia caregivers were eligible. The quality of each measurement was graded as positive, fair, poor or no information based on defined criteria. RESULTS 100 studies were identified. 33 papers were selected for full-text assessment and 12 papers met the eligibility criteria. Seven assessment tools were identified for measurement of pre-death grief caregivers - the Anticipatory Grief Scale (AGS), Marwit-Meuser Caregiver Grief Inventory (MM-CGI), MM-CGI-short-form (MM-CGI-SF), MM-CGI-brief (MM-CGI-BF), Prolonged Grief Scale (PG-12), Caregiver Grief Scale (CGS) and Caregiver Grief Questionnaire (CGQ). Based on content/construct validity, internal consistency and test-retest reliability the MM-CGI/MM-CGI-SF scored highest for quality followed by the CGS. CONCLUSION Anticipatory grief in dementia has multiple facets that can be measured using self-scoring questionnaires. Our findings provide support for different measures of anticipatory grief. Further research is needed for the evaluation of the responsiveness and interpretability of these instruments.
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Affiliation(s)
- Tara Dehpour
- Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Jonathan Koffman
- Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
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8
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Bilić J, Skokandić L, Puljak L. Anticipatory grief and experience of providing at-home palliative care among informal caregivers of spouses in Croatia: a qualitative study. BMC Palliat Care 2022; 21:199. [PMID: 36397096 PMCID: PMC9672539 DOI: 10.1186/s12904-022-01093-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 10/31/2022] [Indexed: 11/19/2022] Open
Abstract
Background In palliative care, caring for spouses suffering from incurable diseases can provoke a range of reactions in informal caregivers that are part of the grieving process, as well as other reactions and ways of coping with a current role, which is often challenging. Anticipatory grief occurs before death and is often present in people who face the eventual loss of a loved one or their own death. This study aimed to gain insight into the anticipatory grief of informal caregivers who are providing at-home palliative care for their ill spouse. Our research questions focus on investigating the meanings caregivers ascribe to the experience of providing palliative care and the impending loss of a spouse. Methods A qualitative study was conducted in Zagreb, Croatia, from April to June of 2021. Eight participants took part in the study. Participants in the study were informal caregivers of a spouse suffering from an incurable, terminal disease that receives at-home palliative care. Data were collected through semi-structured face-to-face interviews. Transcripts were analyzed by interpretive phenomenological analysis. Results The analysis provided several meanings that represent caregivers’ experiences and coping strategies. The caregivers bravely face the challenges of “living with an illness” by maintaining optimism, strong cohesion with their partner and a sense of joint destiny. They tend to repress their own personal needs and feelings while carrying the burden of care. Caregivers tend to stay positive and focus on living in the present by taking an active role in providing care for the ill spouse and family. Conclusions Anticipatory grief presents emotional, cognitive, and spiritual challenges to spouse caregivers in palliative care. The contribution of this study was to gain insight into the meaning that caregivers ascribe to the experience and challenges they face while providing everyday care for their ill spouse. Confirming prior results, the experiences are generally similar to all caregivers, pointing to the need for substantial improvement in the quality of the support and help from the healthcare workers and other experts who provide palliative care and support for the patients’ family members. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-022-01093-1.
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Abstract
The diagnosis of potentially fatal diseases, such as COVID-19, may cause many critical reactions in dying patients and their relatives. Grief and fear of anticipatory death are natural, especially in the case of COVID-19. Although several studies have been conducted on anticipatory grief (AG) caused by cancer and dementia, the outbreak of COVID-19 could potentially intensify the AG rate among dying patients, their families and healthcare professionals. Therefore, mental health support, palliative and psychiatric care, and similar strategies should be taken into account when planning the treatment process and allocating resources during the COVID-19 pandemic. This commentary highlights the importance of addressing anticipatory grief during the COVID-19 pandemic and provides some recommendations for grief management for healthcare professionals.
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Affiliation(s)
- Ali Khanipour-Kencha
- Master's Student, Medical Surgical Department, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Alun C Jackson
- Director, Australian Centre for Heart Health, Honorary Professor, Faculty of Health, Deakin University, Honorary Professorial Fellow, Melbourne Graduate School of Education, University of Melbourne, and Honorary Professor, Centre on Behavioral Health, Hong Kong University
| | - Fatemeh Bahramnezhad
- Assistant Professor, Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran, and Spiritual Health Group, Research Center of Quran, Hadith and Medicine, Tehran University of Medical Sciences, Tehran, Iran
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10
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Sun D, Mao Z, Zhang X, Li J, Zhang L. Relationship Between Post-traumatic Stress Symptoms and Anticipatory Grief in Family Caregivers of Patients With Advanced Lung Cancer: The Mediation Role of Illness Uncertainty. Front Psychiatry 2022; 13:914862. [PMID: 35757209 PMCID: PMC9218190 DOI: 10.3389/fpsyt.2022.914862] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 05/19/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To explore the interrelationship between post-traumatic stress symptoms (PTSS), illness uncertainty (IU), and anticipatory grief (AG). METHODS Structural equation modeling with bootstrapping estimation was conducted using data from a convenience sample of 254 family caregivers of patients with advanced lung cancer in China. Participants were recruited from a public cancer hospital in Shenyang, China. The family caregivers completed the Impact of Events Scale-Revised, Uncertainty in Illness Scale Family Caregiver Version, and Anticipatory Grief Scale. RESULTS The measurement model has good reliability and validity, and the final model fit the data well. PTSS positively influenced AG (direct effect estimate = 0.391, p = 0.002). Moreover, IU was found to mediate the relationship between PTSS and AG (Indirect effects estimate = 0.168, p = 0.005). The mediating effect of IU accounted for up to 30.1% of the total effect. CONCLUSION IU mediated the relationship between PTSS and AG. Healthcare professionals should continuously assess PTSS, IU and AG levels in FCs and provide effective intervention options for mitigation.
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Affiliation(s)
- Di Sun
- School of Nursing, Liaoning University of Traditional Chinese Medicine, Shenyang, China
| | - Zhihui Mao
- School of Nursing, Liaoning University of Traditional Chinese Medicine, Shenyang, China
| | - Xu Zhang
- School of Nursing, China Medical University, Shenyang, China
| | - Jiaojiao Li
- Department of Thoracic Medicine, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, China
| | - Lijuan Zhang
- School of Nursing, Liaoning University of Traditional Chinese Medicine, Shenyang, China
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Skantharajah N, Barrie C, Baxter S, Carolina Borja M, Butters A, Dudgeon D, Haque A, Mahmood I, Mirhosseini M, Mirza RM, Ankita A, Thrower C, Vadeboncoeur C, Wan A, Klinger CA. The Grief and Bereavement Experiences of Informal Caregivers: A Scoping Review of the North American Literature. J Palliat Care 2021; 37:242-258. [PMID: 34860618 PMCID: PMC9109594 DOI: 10.1177/08258597211052269] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background: Informal caregivers are a significant part of the
hospice and palliative care landscape as members of the interdisciplinary care
team. Despite this, little is known about the impact this responsibility has on
informal caregivers’ experiences of grief and bereavement.
Objective: To address this, a scoping review of the literature
was conducted to explore the current state of knowledge toward grief and
bereavement of informal caregivers of adult/geriatric patients in the hospice
and palliative/end-of-life care realm within North America.
Methods: Using Arksey and O’Malley's 5-step framework, key
electronic health care and social sciences databases (eg, CINAHL, MEDLINE,
ProQuest Sociological Abstracts, PsycINFO) alongside gray literature sources
were searched and screened against inclusion and exclusion criteria. A thematic
content analysis was used to identify key themes. Results: 29
articles met the final inclusion criteria with 3 central themes emerging: (1)
mediators of grief, (2) grief experiences, and (3) types of grief.
Discussion: Informal caregivers encounter unique grief and
bereavement experiences: The range of psychosocial outcomes, both negative and
positive, can be affected by various mediators such as caregiver burden,
demographics, disease type of the patient being cared for, etc. Bereavement
interventions must be designed with the mediators of grief in mind.
Conclusions: Understanding the nuances of informal caregivers’
experiences with grief and bereavement will inform and advance practice, policy,
and research. Practitioners/clinicians should be further educated on how to
properly acknowledge the complexity of grief and bereavement for informal
caregivers, specifically paying attention to mediators. Further research needs
to consider the role of culture.
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Affiliation(s)
| | - Carol Barrie
- Canadian Frailty Network (CFN), Kingston, Ontario, Canada.,Quality End-of-Life Care Coalition of Canada (QELCCC), Ottawa, Ontario, Canada
| | - Sharon Baxter
- Quality End-of-Life Care Coalition of Canada (QELCCC), Ottawa, Ontario, Canada.,Canadian Hospice Palliative Care Association (CHPCA), Ottawa, Ontario, Canada
| | | | | | - Deborah Dudgeon
- Quality End-of-Life Care Coalition of Canada (QELCCC), Ottawa, Ontario, Canada.,Canadian Partnership Against Cancer (CPAC), Toronto, Ontario, Canada.,Queen's University, Kingston, Ontario, Canada
| | | | | | - Mehrnoush Mirhosseini
- Quality End-of-Life Care Coalition of Canada (QELCCC), Ottawa, Ontario, Canada.,College of Family Physicians of Canada (CFPC), Mississauga, Ontario, Canada.,University of Alberta, Edmonton, Alberta, Canada
| | - Raza M Mirza
- University of Toronto, Toronto, Ontario, Canada.,National Initiative for the Care of the Elderly (NICE), Toronto, Ontario, Canada
| | | | | | - Christina Vadeboncoeur
- Quality End-of-Life Care Coalition of Canada (QELCCC), Ottawa, Ontario, Canada.,Canadian Network of Palliative Care for Children (CNPCC), Ottawa, Ontario, Canada.,University of Ottawa, Ottawa, Ontario, Canada
| | - Andrew Wan
- University of Toronto, Toronto, Ontario, Canada
| | - Christopher A Klinger
- University of Toronto, Toronto, Ontario, Canada.,Quality End-of-Life Care Coalition of Canada (QELCCC), Ottawa, Ontario, Canada.,National Initiative for the Care of the Elderly (NICE), Toronto, Ontario, Canada.,Pallium Canada, Ottawa, Ontario, Canada.,McMaster University, Hamilton, Ontario, Canada
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12
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Pérez-González A, Vilajoana-Celaya J, Guàrdia-Olmos J. Alzheimer's Disease Caregiver Characteristics and Their Relationship with Anticipatory Grief. Int J Environ Res Public Health 2021; 18:8838. [PMID: 34444587 PMCID: PMC8392352 DOI: 10.3390/ijerph18168838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 08/17/2021] [Accepted: 08/18/2021] [Indexed: 11/27/2022]
Abstract
In Alzheimer's disease, two fundamental aspects become important for caregivers: ambiguity and ambivalence. Thus, anticipatory grief is considered an active psychological process that is very different from the mere anticipation of death. The present study aims to determine which characteristics of family caregivers of people with dementia, such as age, gender, educational level, relationship with the person with dementia, years with dementia or years as a caregiver, are related to the presence of anticipatory grief. A cross-sectional design was employed. The sample consisted of a total of 129 subjects who cared for a family member with dementia. A sociodemographic data sheet and a battery of tests measure the presence of anticipatory grief, caregiver burden and/or psychopathology. The results obtained allowed us to confirm some of the hypotheses regarding the anticipatory grief construct, the importance of the care time factor, in years and per day, as well as the relevance of the previous demographic and psychopathological profile (being female, spouse function and possible depressive symptomatology). Likewise, from the prediction analyzes performed, it seems that these variables can predict anticipatory grief. These results propose interesting opportunities to formulate care proposals to professionals and family caregivers in relation to care tasks and caregiver skills.
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Affiliation(s)
- Alba Pérez-González
- Faculty of Psychology and Education Sciences, Universitat Oberta de Catalunya (UOC), 08018 Barcelona, Spain
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, 08035 Barcelona, Spain
| | | | - Joan Guàrdia-Olmos
- Department of Social Psychology and Quantitative Psychology, Faculty of Psychology, University of Barcelona, 08035 Barcelona, Spain;
- Institute of Neuroscience, University of Barcelona, 08035 Barcelona, Spain
- Institute of Complex Systems, University of Barcelona, 08028 Barcelona, Spain
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Yap JFC, Garcia LL, Alfaro RA, Sarmiento PJD. Anticipatory grieving and loss during the COVID-19 pandemic. J Public Health (Oxf) 2021; 43:e279-e280. [PMID: 33428757 PMCID: PMC7928796 DOI: 10.1093/pubmed/fdaa258] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 12/05/2020] [Accepted: 12/13/2020] [Indexed: 11/13/2022] Open
Abstract
Recent correspondence shows that death and burial practices deem significant in understanding the meaning and acceptance of the untimely and unexpected death of a family member afflicted with the coronavirus (COVID-19) disease. These, in turn, raise the need to address the anticipatory grieving process of the family. This paper examines the importance of anticipatory grieving that ultimately affects the lives of the family of the bereaved.
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Affiliation(s)
- John Federick C Yap
- School of Nursing and Allied Medical Sciences, Holy Angel University, Angeles City 2009, Philippines
| | - Louiegi L Garcia
- School of Nursing and Allied Medical Sciences, Holy Angel University, Angeles City 2009, Philippines
- Nursing Department, Pampanga Premier Medical Center, Apalit, Pampanga 2016, Philippines
| | - Ramilyn A Alfaro
- Nursing Department, Pampanga Premier Medical Center, Apalit, Pampanga 2016, Philippines
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Breen LJ, Aoun SM, O'Connor M, Howting D, Halkett GKB. Family Caregivers' Preparations for Death: A Qualitative Analysis. J Pain Symptom Manage 2018; 55:1473-1479. [PMID: 29499235 DOI: 10.1016/j.jpainsymman.2018.02.018] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 02/20/2018] [Accepted: 02/20/2018] [Indexed: 10/17/2022]
Abstract
CONTEXT Many family caregivers are not prepared for the death of their family member or friend. Palliative care services tend to emphasize the patients' preparation for death rather than caregivers' preparation for, or living after, death. Caregivers' perspectives on anticipating and preparing for death are under-researched, despite preparation being associated with better bereavement outcomes. OBJECTIVES The objective was to explore family caregivers' preparations for death. METHODS A total of 16 family caregivers of people in receipt of palliative care participated in semi-structured, face-to-face interviews. Transcripts were coded and analyzed using grounded theory techniques. RESULTS Analysis yielded two overarching themes: Here and Now centered on the caregivers' focus on the multidimensional and all-consuming nature of caregiving for someone who is near death. Negotiating the Here/After described the tension the caregivers faced in vacillating between focusing on the care during the illness trajectory (Here) and worries and plans for the future (After). CONCLUSION This exploratory study is the first to focus solely on family caregivers' experiences of preparing for a death. The caregivers described the complexities of trying to prepare while feeling overwhelmed with demands of caregiving throughout an unpredictable illness trajectory. The caregivers in the present study were cognitively prepared, some were behaviorally prepared, but emotional preparedness was challenging. Services should not assume that all family caregivers are well-prepared for the death. Caregivers would likely benefit from the assessment and promotion of their death preparedness.
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Affiliation(s)
- Lauren J Breen
- School of Psychology, Curtin University, Perth, Australia.
| | - Samar M Aoun
- Palliative Care Unit, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Moira O'Connor
- School of Psychology, Curtin University, Perth, Australia
| | - Denise Howting
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Australia
| | - Georgia K B Halkett
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Australia
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Abstract
All mental health professionals will inevitably serve clients who face the expected death of a loved one. Prominent theories on the grieving process tend to begin after a death or other loss has occurred. Many individuals experience anticipatory grief prior to the physical death. Participants in this study consisted of 120 adults who were anticipating the death of a loved one due to terminal illness. The purpose of this investigation was to assess the relationship between the positive disposition of proactive coping and two forms of growth. Both personal and posttraumatic growth were present to a significant degree, and proactive coping illustrated unique predictive power in personal growth. Social support was a significant mediator of proactive coping and growth and was determined to be an outcome of the assertive nature of this disposition. Implications for helping professionals who serve anticipatory grievers as well as directions for future research are discussed.
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16
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Burke LA, Clark KA, Ali KS, Gibson BW, Smigelsky MA, Neimeyer RA. Risk Factors for Anticipatory Grief in Family Members of Terminally Ill Veterans Receiving Palliative Care Services. J Soc Work End Life Palliat Care 2015; 11:244-266. [PMID: 26654060 DOI: 10.1080/15524256.2015.1110071] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Anticipatory grief is the process associated with grieving the loss of loved ones in advance of their inevitable death. Because anticipatory grief has been associated with a variety of outcomes, risk factors for this condition deserve closer consideration. Fifty-seven family members of terminally ill, hospice-eligible veterans receiving palliative care services completed measures assessing psychosocial factors and conditions. Elevated anticipatory grief was found in families characterized by relational dependency, lower education, and poor grief-specific support, who also experienced discomfort with closeness and intimacy, neuroticism, spiritual crisis, and an inability to make sense of the loss. Thus, in this sample, anticipatory grief appears to be part of a cluster of factors and associated distress that call for early monitoring and possible intervention.
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Affiliation(s)
- Laurie A Burke
- a Memphis Veterans Affairs Medical Center and Department of Psychology , University of Memphis , Memphis , Tennessee , USA
| | - Karen A Clark
- b Memphis Veterans Affairs Medical Center , Memphis , Tennessee , USA
| | - Khatidja S Ali
- b Memphis Veterans Affairs Medical Center , Memphis , Tennessee , USA
| | - Benjamin W Gibson
- c Department of Psychology , University of Memphis , Memphis , Tennessee , USA
| | - Melissa A Smigelsky
- a Memphis Veterans Affairs Medical Center and Department of Psychology , University of Memphis , Memphis , Tennessee , USA
| | - Robert A Neimeyer
- c Department of Psychology , University of Memphis , Memphis , Tennessee , USA
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Abstract
Feelings of loss and grief are frequent companions for current Alzheimer's family caregivers. Increased acknowledgment and understanding of caregiver grief among researchers has led to more comprehensive explorations of the multifaceted nature of caregiver grief and loss. Absent from the literature, however, is an exploration of anticipatory grief as an actual barrier to the task of caregiving. Through an analysis of 353 open-ended survey responses, the present article explores links between anticipatory grief, ambiguous loss, and principal barriers that family members face as dementia caregivers across the state of Indiana. By drawing parallels between caregiver responses and the Marwit-Meuser Caregiver Grief Inventory subscales, this article illustrates that the fundamental barrier experienced by current Alzheimer's caregivers appears to be a combination of anticipatory grief and ambiguous loss rather than hands-on care issues. The implications of this finding for future caregiver research and interventions are discussed.
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Affiliation(s)
- Jacquelyn B Frank
- Center for Aging & Community, University of Indianapolis, Indianapolis, IN 46203, USA.
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Damore-Petingola S, Lightfoot N, Vaillancourt C, Mayer C, Steggles S, Gauthier-Frohlick D. Hear How I Feel. J Psychosoc Oncol 2002; 20:57-69. [PMID: 29016276 DOI: 10.1300/J077v20n04_04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In an effort to heighten the awareness of the high school population, a support group program for young people whose parents were diagnosed with cancer received funding to produce an educational video titled Hear How I Feel. This article reports on the evaluation of the video by 146 high school teachers, guidance counselors, and students; elementary school teachers; university undergraduate social work students; and health care and social service providers. A qualitative analysis of the evaluations indicated that high school teachers and guidance counselors were reluctant to use the video in the high school setting because they could not respond expertly to emotions that might be elicited. The findings suggest that youths desire a forum in which difficult issues can be addressed, teachers and guidance counselors need training that would enhance their skill in responding to students' emotional responses, and cancer patients and their families have psychosocial needs that must be met.
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