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Gregory C, Gellis Z. Problem Solving Therapy for Home-Hospice Caregivers: A Pilot Study. J Soc Work End Life Palliat Care 2020; 16:297-312. [PMID: 32865148 DOI: 10.1080/15524256.2020.1800554] [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] [Indexed: 06/11/2023]
Abstract
This pilot study examined the effects of Brief Problem-Solving Therapy on caregiver quality of life, depression, and problem-solving in family caregivers of hospice patients. Thirty-seven family caregivers to home-based hospice patients (mean age 62.8 [SD = 12.32]) were randomized to the study group (PST-Hospice), for a 45 minute per week/5 week intervention or comparison group of usual care plus caregiver education (UC + CE). The severity of depressive symptoms, caregiver quality of life and problem-solving functioning were assessed at baseline and follow-up. At post-test, the PST-Hospice condition had significantly higher scores on caregiver quality of life compared to UC + CE. On the Social Problem Solving Inventory-Revised Short Form (SPSI-R) measure, PST-Hospice scores clinically improved as compared to UC + CE on Positive Problem Orientation and Rational Problem-Solving subscales. In addition, this pilot study found that brief problem-solving treatment delivered by a hospice social worker appears to be an acceptable and feasible tool for routine use in the home-hospice setting.
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Affiliation(s)
- Christin Gregory
- Center for Mental Health and Aging, School of Social Policy and Practice, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Zvi Gellis
- Center for Mental Health and Aging, School of Social Policy and Practice, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Morrissey Stahl KA, Bower KL, Seponski DM, Lewis DC, Farnham AL, Cava-Tadik Y. A Practitioner's Guide to End-of-Life Intimacy: Suggestions for Conceptualization and Intervention in Palliative Care. Omega (Westport) 2017; 77:15-35. [PMID: 29285977 DOI: 10.1177/0030222817696540] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Sexuality and intimacy, including contact, tenderness, and love, are important at every life stage. Intimate expression is especially vital at the end of life, when relationships with loved ones are time limited. Unfortunately, care providers often ignore the potential need for sexual expression, especially at the end of life. In this article, we consider current research on sexuality and end-of-life care and situate these two fields in an ecological framework. We explore how end-of-life sexuality and intimacy can be supported by practitioners in multiple nested contexts and provide suggestions for theoretically-driven interventions. We also provide reflexive considerations for practitioners.
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Nicholas DB, Beaune L, Barrera M, Blumberg J, Belletrutti M. Examining the Experiences of Fathers of Children with a Life-Limiting Illness. J Soc Work End Life Palliat Care 2016; 12:126-144. [PMID: 27143577 DOI: 10.1080/15524256.2016.1156601] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Families who have a child diagnosed with a life-limiting illness (LLI) face substantial challenges resulting from the complexity and devastating impact of the condition and potential closeness of death. The experiences of fathers of a child with LLI have been understudied; therefore, this study explored the stresses, experiences, and strategies of these fathers, including their perceptions about support needs. Based on grounded theory, in-depth semi-structured interviews were conducted with 18 fathers of children with LLI. Six fathers had experienced the death of their child. The overarching themes were stresses, means of coping, and perceived needs for support. Generally, fathers in this study struggled relative to discursive and internalized notions of fathers as providers and protectors for their children, combined with an inability to ease their child's vulnerability to LLI. Participants were engaged in the care of their child with LLI, but several felt marginalized by health care providers in care planning and staff/family communication. Some fathers recognized and valued their support network while others had few supports. Some described personal growth and desired to help other fathers. Practice implications and recommendations include renewed application of family-centered care, overcoming presumptions about fathers' roles, and recognizing the impact of LLI beyond physical health.
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Affiliation(s)
- David B Nicholas
- a Faculty of Social Work, Central and Northern Alberta Region , University of Calgary , Edmonton , Alberta , Canada
| | - Laura Beaune
- b Department of Social Work , The Hospital for Sick Children , Toronto , Ontario , Canada
| | - Maru Barrera
- c Department of Psychology , The Hospital for Sick Children , Toronto , Ontario , Canada
- d Institute of Medical Sciences, DLSPH and OISE , University of Toronto , Toronto , Ontario , Canada
| | - Jonathan Blumberg
- e The Hospital for Sick Children Family Advisory Network , Toronto , Ontario , Canada
| | - Mark Belletrutti
- f Stollery Children's Hospital , Edmonton , Alberta , Canada
- g Department of Pediatrics , University of Alberta , Edmonton , Alberta , Canada
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Abstract
Population aging and longevity due to medical advances over the past few decades have meant that the approximately 44 million caregivers in the United States and eight million caregivers in Canada must provide more intensive levels of care and for longer periods of time. Consequently, caregivers are often profoundly affected by their caregiving role in emotional, psychological, physical, and financial ways. Thirty years of research on this population have helped to create a caregiver profile and identify the significant challenges for caregivers. One area explored to a much lesser extent is the postcaregiving period, when the caregiver transitions into a period of bereavement. This period can be particularly challenging for caregivers given the commitment inherent in the caregiving process. Research has shown that the emotional reactions of caregivers as well as practical challenges do not end with the death of the care recipient. In fact, complex realities, tensions, and responses continue well after the death into the postcaregiving period. This study of bereaved women caregivers explored their lived experiences in the postcaregiving phase. One central theme emerged and suggested that the experience of caregiving had an effect on the caregivers' identities, which then influenced their bereavement processes and experiences.
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Affiliation(s)
- Pam Orzeck
- a CIUSSS West-Central Montreal Health/CLSC René-Cassin, Centre for Research and Expertise in Social Gerontology (CREGES) , Québec , Canada
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Abstract
In this article, we examine skipped-generation caregivers who foster their grandchildren orphaned by HIV/AIDS in Vietnam. We investigated the challenges facing this population and the ways in which grandparents handled their trials on behalf of their families. Specifically, how did caregivers make sense of their roles, and how did these meanings inform their coping strategies? We conducted in-depth qualitative interviews with 21 older caregivers and 7 key informants and selected 5 caregivers from the sample to complete participant observations. The participants understood coping as problem-focused coping; for example, by considering a set of caregiving-related activities that included providing childcare, making money, borrowing money, cooking, and doing other daily chores. The voices of older caregivers must be a vital component to influence and inform service organizations and HIV sectors working in Vietnam. Based on a deeper understanding of the caregiving process, we outline implications for service development within the area of HIV caregiving.
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Affiliation(s)
| | - Bum Jung Kim
- University of Hawaii at Manoa, Honolulu, Hawaii, USA
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Azuero CB, Harris GM, Allen RS, Williams BR, Kvale E, Ritchie CS. Team-based volunteerism with the seriously ill: a qualitative analysis from 10 volunteers' perspectives. J Soc Work End Life Palliat Care 2014; 10:282-295. [PMID: 25148454 DOI: 10.1080/15524256.2014.938893] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 06/03/2023]
Abstract
Volunteers offer means through which social workers may extend their ability to support individuals with serious illnesses near the end of life. This study explored the experience of volunteers on teams organized initially as a grassroots movement in response to stigmatized and often socially isolated people with HIV/AIDS dying in the community. Volunteer care teams later expanded to individuals with other serious illnesses. This model spread as a means of meeting the growing need for practical support for seriously ill homebound individuals. Yet, little has been reported in the scientific literature about the interworkings of these teams and their optimal level of functioning. Qualitative inquiry, in the form of semi-structured interviews, explored perspectives of 10 volunteers with experience in volunteer team caring and identified the social processes that shaped their work. The volunteers discussed balance between positive life meaning gained from volunteer work, lessons learned, and negative aspects of a volunteer team approach to caring for the seriously ill in the community. Further investigation is warranted to validate the volunteer care team approach as a cost-effective tool to help seriously ill individuals and caregivers.
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Affiliation(s)
- Casey B Azuero
- a Department of Psychology , Center for Mental Health and Aging, University of Alabama , Tuscaloosa , Alabama , USA
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Nkulu Kalengayi FK, Hurtig AK, Ahlm C, Ahlberg BM. "It is a challenge to do it the right way": an interpretive description of caregivers' experiences in caring for migrant patients in Northern Sweden. BMC Health Serv Res 2012; 12:433. [PMID: 23194441 PMCID: PMC3557194 DOI: 10.1186/1472-6963-12-433] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Accepted: 11/25/2012] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Experiences from nations with population diversity show extensive evidence on the need for cultural and linguistic competence in health care. In Sweden, despite the increasing diversity, only few studies have focused on challenges in cross-cultural care. The aim of this study was to explore the perspectives and experiences of caregivers in caring for migrant patients in Northern Sweden in order to understand the challenges they face and generate knowledge that could inform clinical practice. METHODS We used an interpretive description approach, combining semi-structured interviews with 10 caregivers purposively selected and participant observation of patient-provider interactions in caring encounters. The interviews were transcribed and analyzed using thematic analysis approach. Field notes were also used to orient data collection and confirm or challenge the analysis. RESULTS We found complex and intertwined challenges as indicated in the three themes we present including: the sociocultural diversity, the language barrier and the challenges migrants face in navigating through the Swedish health care system. The caregivers described migrants as a heterogeneous group coming from different geographical areas with varied social, cultural and religious affiliations, migration histories and statuses, all of which influenced the health care encounter, whether providing or receiving. Participants also described language as a major barrier to effective provision and use of health services. Meanwhile, they expressed concern over the use of interpreters in the triad communication and over the difficulties encountered by migrants in navigating through the Swedish health care system. CONCLUSIONS The study illuminates complex challenges facing health care providers caring for migrant populations and highlights the need for multifaceted approaches to improve the delivery and receipt of care. The policy implications of these challenges are discussed in relation to the need to (a) adapt care to the individual needs, (b) translate key documents and messages in formats and languages accessible and acceptable to migrants, (c) train interpreters and enhance caregivers' contextual understanding of migrant groups and their needs, (d) and improve migrants' health literacy through strategies such as community based educational outreach.
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Affiliation(s)
- Faustine Kyungu Nkulu Kalengayi
- Department of Public Health and Clinical Medicine, Division of Epidemiology and Global Health, Umeå University, SE- 901 85, Umeå, Sweden
| | - Anna-Karin Hurtig
- Department of Public Health and Clinical Medicine, Division of Epidemiology and Global Health, Umeå University, SE- 901 85, Umeå, Sweden
| | - Clas Ahlm
- Department of Clinical Microbiology, Division of Infectious Diseases, Umeå University, SE- 901 85, Umeå, Sweden
| | - Beth Maina Ahlberg
- Department of Women’s and Child Health, Uppsala University, SE- 751 85, Uppsala, Sweden
- Skaraborg Institute of Research and Development, SE-541 30, Skövde, Sweden
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Abstract
Care interventions are not routinely provided for hospice caregivers, despite widespread documentation of the burden and toll of the caregiving experience. Assessing caregivers for team interventions (ACT) proposes that holistic patient and family care includes ongoing caregiver needs assessment of primary, secondary, and intrapsychic stressors. In this study, our goal was to describe the variance in stressors for caregivers to establish evidence for the ACT theoretical framework. We used secondary interview data from a randomized controlled trial to analyze hospice caregiver discussions about concerns. We found variances in stress types, suggesting that caregiver interventions should range from knowledge and skill building to cognitive-behavioral interventions that aid in coping. Family members who assume the role of primary caregiver for a dying loved one need to be routinely assessed by hospice providers for customized interventions.
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