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Carolan C, Smith A, Davies G, Forbat L. Seeking, accepting and declining help for emotional distress in cancer: A systematic review and thematic synthesis of qualitative evidence. Eur J Cancer Care (Engl) 2017; 27:e12720. [DOI: 10.1111/ecc.12720] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2017] [Indexed: 11/27/2022]
Affiliation(s)
- C.M. Carolan
- Faculty of Health Sciences and Sport; University of Stirling (Western Isles Campus); Stornoway UK
- NHS Western Isles; Stornoway UK
| | - A. Smith
- Faculty of Health Sciences and Sport; University of Stirling (Western Isles Campus); Stornoway UK
| | - G.R. Davies
- PGT Tertiary & Higher Education; Faculty of Arts, Humanities and Business; Lews Castle College UHI; Stornoway UK
| | - L. Forbat
- Palliative Care; Australian Catholic University and Calvary Health Care; Australian Catholic University; Canberra ACT Australia
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152
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Paul C, Hall A, Oldmeadow C, Lynagh M, Campbell S, Bradstock K, Williamson A, Carey M, Sanson-Fisher R. Dyadic interdependence of psychosocial outcomes among haematological cancer survivors and their support persons. Support Care Cancer 2017; 25:3339-3346. [PMID: 28550441 DOI: 10.1007/s00520-017-3751-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 05/12/2017] [Indexed: 12/01/2022]
Abstract
PURPOSE This study aimed to explore the dyadic relationships between unmet need, depression, and anxiety in people diagnosed with haematological cancer and their support persons. METHODS Adult survivors (18 years+) who had been diagnosed with a haematological cancer were recruited to a cross-sectional mailed survey via five state cancer registries in Australia. Participating survivors invited a support person to also complete a survey. Structural equation modelling was used to explore the relationships among survivor and support person self-reported depression, anxiety, and unmet needs. RESULTS Of the 4299 eligible haematological cancer survivors contacted by the registries, 1511 (35%) returned a completed survey as did 1004 support persons. There were 787 dyads with complete data. After adjusting for age, gender, rurality, cancer type, and whether the support person was a relative, positive correlations were found between survivor and support person scores for depression (p = 0.0029) and unmet needs (p < 0.001), but not anxiety scores (p = 0.075). Survivor unmet needs were significantly related to support person depression (p = 0.0036). Support person unmet needs were significantly related to a higher depression score for survivors (p = 0.0067). Greater support person unmet needs were significantly related to a higher anxiety score for survivors (p = 0.0083). Survivor unmet needs did not have a significant relationship to support person anxiety (p = 0.78). CONCLUSION Unmet needs may mediate the interdependence of psychosocial experiences for survivors and support persons, although a longitudinal study is required to confirm causality. Addressing unmet needs may be a potential target for improving outcomes for both groups.
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Affiliation(s)
- Christine Paul
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia.
- Priority Research Centre for Health Behaviour, Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia.
| | - Alix Hall
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia
- Priority Research Centre for Health Behaviour, Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Christopher Oldmeadow
- Clinical Research Design Information Technology and Statistical Support, Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Marita Lynagh
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia
- Priority Research Centre for Health Behaviour, Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Sharon Campbell
- School of Public Health and Health Systems, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Ken Bradstock
- Westmead Clinical School & The Westmead Institute for Medical Research, Sydney Medical School, University of Sydney, Westmead, NSW, Australia
| | | | - Mariko Carey
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia
- Priority Research Centre for Health Behaviour, Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Rob Sanson-Fisher
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia
- Priority Research Centre for Health Behaviour, Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
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153
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Mindfulness and Coping Are Inversely Related to Psychiatric Symptoms in Patients and Informal Caregivers in the Neuroscience ICU: Implications for Clinical Care. Crit Care Med 2017; 44:2028-2036. [PMID: 27513536 DOI: 10.1097/ccm.0000000000001855] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess the correlation of psychosocial resiliency factors (mindfulness and coping) with symptoms of posttraumatic stress, anxiety, and depression in patients recently admitted to the neuroscience ICU and their primary informal caregivers. DESIGN A descriptive, cross-sectional correlational study. SETTING Neuroscience ICU in a major medical center. PARTICIPANTS A total of 78 dyads of patients (total n = 81) and their primary caregivers (total n = 92) from June to December 2015. Study enrollment occurred within the first 2 weeks of patient admission to the neuroscience ICU. INTERVENTION None. MEASUREMENTS AND MAIN RESULTS Dyads completed self-report measures of mindfulness (Cognitive and Affective Mindfulness Scale-Revised), coping (Measure of Coping Status-A), posttraumatic stress (Posttraumatic Checklist-Specific Stressor), anxiety (Hospital Anxiety and Depression Scale-A), and depression (Hospital Anxiety and Depression Scale-D). Rates of clinically significant posttraumatic stress, anxiety, and depressive symptoms were high and comparable between patient and caregiver samples. Own psychological resilience factors and psychiatric symptoms were strongly correlated for both patients and caregivers. Depressive symptoms were interdependent between patients and their caregivers, and one's own mindfulness was independently related to one's partner's depressive symptoms. CONCLUSIONS Rates of clinically significant psychiatric symptoms were high, equally prevalent in patients and caregivers, and interdependent between patients and their caregivers. For both patients and caregivers, psychological resiliency factors were associated with both self and partner psychiatric symptoms. Findings suggest that attending to the psychiatric health of both patients and caregivers in the neuroscience ICU is a priority and that patients and their caregivers must be considered together in a system to fully address either individual's psychiatric symptoms.
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154
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Abstract
BACKGROUND As cancer survival rates increase, so does the imperative for a satisfying quality of life, including a fulfilling sexual life. OBJECTIVE The feasibility and effectiveness of a newly formed Sexual Health Clinic were determined using a nurse-led format, which provided support to survivors in a cancer care setting. METHODS Twenty-one cancer survivors received assessment, education, and tailored sexual health support by an oncology nurse with specialized skills in sexual health. Two months later, semistructured interviews focused on patients' personal experiences. Questionnaires were also administered to healthcare providers involved in providing the follow-up care. RESULTS Participants presented with sexual concerns that were psychological, physical, and/or relational. Scores on validated measures of sexual functioning were in the range comparable to those with a sexual dysfunction. Participants were open to being asked about sexual health and wanted professionals available who were skilled in dealing with sexual health services. Most participants experienced an improvement in their well-being and/or sexual life following participation. Some noted more confidence when speaking with their partner about sexual concerns. CONCLUSION Our pilot Sexual Health Clinic was feasible, and evidence for its effectiveness was based on qualitative feedback. Participants and providers identified a strong need for the inclusion of sexual health services in cancer care. IMPLICATIONS FOR PRACTICE Oncology nurses are in a key position to initiate discussions surrounding sexual health issues related to cancer treatment. Self-awareness, sensitivity, and a nonjudgmental approach are required to address this dimension of holistic cancer care.
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155
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Kugimoto T, Katsuki R, Kosugi T, Ohta A, Sato H. Significance of Psychological Stress Response and Health-related Quality of Life in Spouses of Cancer Patients When Given Bad News. Asia Pac J Oncol Nurs 2017; 4:147-154. [PMID: 28503648 PMCID: PMC5412153 DOI: 10.4103/2347-5625.204494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objective: This study illuminates the degree of psychological stress response experienced by spouses of cancer patients when given bad news at three different times (notification of the name of the disease, notification of recurrence, and notification of terminality) as well as the factors that influence the response and the health status of the spouse as measured by health-related quality of life (QOL). Methods: A total of 203 individuals (57 men and 146 women) who had received the three types of news were surveyed using a self-report questionnaire on psychological stress response, marital satisfaction, and health-related QOL scales. Results: The degree of the psychological stress response was the highest for notification of terminality, followed by notification of the name of the disease, and notification of recurrence. The influencing factors varied depending on the notification period. Although no significant difference was observed for health-related QOL among the three notification types, significant differences were observed for certain items when compared with national standard values. Conclusions: When a notification of terminality, which produced the highest psychological stress response, is given, providing care that considers health-related QOL is necessary not only for patients but also for their spouses.
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Affiliation(s)
| | - Ryo Katsuki
- Deptartment of Anesthesiology, NHO Ureshino Medical Center, Ureshino, Japan
| | - Toshifumi Kosugi
- Deptartment of Palliative Care, Saga-ken Medical Center, Koseikan, Saga, japan
| | | | - Hidetoshi Sato
- Department of Comprehensive Community-based Palliative Care, Faculty of Medicine, Saga University Hospital, Saga University, Saga, Japan
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156
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The influence of psychological factors on the burden of caregivers of patients with advanced cancer: Resiliency and caregiver burden. Palliat Support Care 2017; 16:269-277. [DOI: 10.1017/s1478951517000268] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
ABSTRACTObjective:The aim of our study was to identify the influence of such psychological factors as emotional intelligence and perceived competence on caregiver burden in those who care for patients with advanced cancer.Method:A total of 50 informal caregivers completed self-report assessments of resilience, perceived competence, emotional regulation, positive aspects of care, emotional distress, and burden. We conducted a quantitative study with a cross-sectional design. Descriptive statistics were obtained. Associations between the different variables were assessed using nonparametric and multiple regression analyses.Results:Participants were mainly female (88%) and had an average of 20 months of caregiving. Their mean age was 47 years (range = 20–79). More than half of scored high on resilience, positive aspects of caring, and emotional distress, moderately on perceived competence, and low on burden. Most caregivers used cognitive restructuring and social support as coping strategies. Inverse negative correlations were observed among emotional distress, emotional state, and burden with perceived competence and positive aspects of caring (p < 0.05). Significant differences were obtained for emotional distress, cognitive restructuring, and resiliency. Multiple regression analyses demonstrated that perceived competence, resiliency, and positive aspects of caring were the main predictors of burden.Significance of Results:Resilience, perceived competence, emotional regulation, and positive aspects of care constitute protective factors against caregiver burden. Taken together, these aspects should be promoted by the healthcare staff in order to facilitate caregiver adaptation and well-being.
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157
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Sterba KR, Zapka J, Armeson KE, Shirai K, Buchanan A, Day TA, Alberg AJ. Physical and emotional well-being and support in newly diagnosed head and neck cancer patient-caregiver dyads. J Psychosoc Oncol 2017; 35:646-665. [PMID: 28459393 DOI: 10.1080/07347332.2017.1323817] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The purpose of this study was to examine the physical and emotional well-being and social support in newly diagnosed head and neck cancer (HNC) patients and caregivers and identify sociodemographic, clinical, and behavioral risk factors associated with compromised well-being in patients and caregivers. Newly diagnosed HNC patients and their primary caregivers (N = 72 dyads) completed questionnaires before treatment assessing physical and mental well-being, depression, cancer worry, and open-ended support questions. Patients reported worse physical well-being than caregivers (p < 0.05) but similar levels of mental well-being. Caregivers reported providing emotional and instrumental support most frequently with an emphasis on nutrition and assistance with speech, appearance, and addictions. Both patients and their caregivers reported suboptimal mental well-being and depression. Smoking was associated with compromised well-being in patients, caregivers, and dyads. Compromised well-being in patients and their caregivers was more likely when patients were younger, had worse symptoms, and smoked/consumed alcohol (p < 0.05). While patients face more physical strain than caregivers, both equally confront emotional challenges. Results highlight risk factors for compromised well-being in both patients and their caregivers that should be assessed at diagnosis to guide identification of needed dyadic-focused supportive care resources.
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Affiliation(s)
- Katherine R Sterba
- a Hollings Cancer Center , Medical University of South Carolina , Charleston , SC , USA
| | - Jane Zapka
- a Hollings Cancer Center , Medical University of South Carolina , Charleston , SC , USA
| | - Kent E Armeson
- a Hollings Cancer Center , Medical University of South Carolina , Charleston , SC , USA
| | - Keisuke Shirai
- a Hollings Cancer Center , Medical University of South Carolina , Charleston , SC , USA
| | - Amy Buchanan
- a Hollings Cancer Center , Medical University of South Carolina , Charleston , SC , USA
| | - Terry A Day
- a Hollings Cancer Center , Medical University of South Carolina , Charleston , SC , USA
| | - Anthony J Alberg
- a Hollings Cancer Center , Medical University of South Carolina , Charleston , SC , USA
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158
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Kim HS, Ahn HJ. Effects of stress, dyadic communication and adaptation on prostatectomy patients' quality of life. INTERNATIONAL JOURNAL OF UROLOGICAL NURSING 2017. [DOI: 10.1111/ijun.12115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Hae Sook Kim
- Department of Nursing; Cheong Ju University; Cheong Ju Korea
| | - Han Jong Ahn
- Department of Urology, Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
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159
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Beattie S, Lebel S, Petricone-Westwood D, Wilson KG, Harris C, Devins G, Huebsch L, Tay J. Balancing give and take between patients and their spousal caregivers in hematopoietic stem cell transplantation. Psychooncology 2017; 26:2224-2231. [DOI: 10.1002/pon.4340] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 11/15/2016] [Accepted: 12/02/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Sara Beattie
- Tom Baker Cancer Centre; Alberta Health Services; Calgary AB Canada
| | - Sophie Lebel
- School of Psychology; University of Ottawa; Ottawa ON Canada
| | | | - Keith G. Wilson
- School of Psychology; University of Ottawa; Ottawa ON Canada
- Department of Psychology; The Ottawa Hospital Rehabilitation Centre; Ottawa ON Canada
- The Ottawa Hospital Research Institute; Ottawa ON Canada
| | - Cheryl Harris
- School of Psychology; University of Ottawa; Ottawa ON Canada
- Department of Psychology; The Ottawa Hospital; Ottawa ON Canada
- The Ottawa Hospital Research Institute; Ottawa ON Canada
| | - Gerald Devins
- Princess Margaret Cancer Centre, University Health Network; Toronto ON Canada
- Ontario Cancer Institute; Toronto ON Canada
- University of Toronto; Toronto ON Canada
| | - Lothar Huebsch
- The Ottawa Hospital Research Institute; Ottawa ON Canada
| | - Jason Tay
- Tom Baker Cancer Centre; Alberta Health Services; Calgary AB Canada
- The Ottawa Hospital Research Institute; Ottawa ON Canada
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160
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Goldzweig G, Baider L, Andritsch E, Rottenberg Y. Hope and social support in elderly patients with cancer and their partners: an actor–partner interdependence model. Future Oncol 2016; 12:2801-2809. [DOI: 10.2217/fon-2016-0267] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Aim: Assess relationships between oldest-old (minimum 86 years) patients’ perceived social support to their own and their spousal caregivers’ hope through application of the actor–partner interdependence model (APIM). Patients & methods: 58 dyads of patients and their spousal caregivers completed standardized self-report measures of depression, distress, hope and social support. Results: Patients presented high distress levels. Among patients and spouses, perceived social support was positively correlated to their own level of hope (β = 0.44, p < 0.0001; β = 0.56, p < 0.0001, respectively) and negatively correlated to the other's level of hope (β = -0.25, p < 0.024; β = -0.44, p < 0.0001, respectively). Conclusion: The actor–partner interdependence model was found to be adequate for describing relationships between social support and hope among dyads of oldest-old patients and their spousal caregivers. Patients and caregiver seem to utilize social support to enhance hope.
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Affiliation(s)
- Gil Goldzweig
- School of Behavioral Sciences, The Academic College of Tel-Aviv-Yafo, Tel Aviv, Israel
| | - Lea Baider
- Oncology Institute, Assuta Medical Center, Tel Aviv, Israel
| | - Elisabeth Andritsch
- Division of Clinical Oncology, The Medical University of Graz, Graz, Austria
| | - Yakir Rottenberg
- Sharett Oncology Institute, Hadassah Medical Center, Jerusalem, Israel
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161
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Rottenberg Y, Baider L, Jacobs JM, Peretz T, Goldzweig G. Double-Edged Sword: Women with Breast Cancer Caring for a Spouse with Cancer. J Womens Health (Larchmt) 2016; 25:1270-1275. [DOI: 10.1089/jwh.2015.5683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
- Yakir Rottenberg
- Sharett Oncology Institute, Hadassah University Hospital, Jerusalem, Israel
| | - Lea Baider
- Assuta Medical Center, Oncology Institute, Tel-Aviv, Israel
| | - Jeremy M. Jacobs
- Geriatrics and Geriatric Rehabilitation Department, Hadassah University Hospital, Jerusalem, Israel
| | - Tamar Peretz
- Sharett Oncology Institute, Hadassah University Hospital, Jerusalem, Israel
| | - Gil Goldzweig
- School of Behavioral Sciences, Tel-Aviv-Yaffo Academic College, Tel-Aviv, Israel
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162
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Shaffer KM, Jacobs JM, Nipp RD, Carr A, Jackson VA, Park ER, Pirl WF, El-Jawahri A, Gallagher ER, Greer JA, Temel JS. Mental and physical health correlates among family caregivers of patients with newly-diagnosed incurable cancer: a hierarchical linear regression analysis. Support Care Cancer 2016; 25:965-971. [PMID: 27866337 DOI: 10.1007/s00520-016-3488-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 11/07/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE Caregiver, relational, and patient factors have been associated with the health of family members and friends providing care to patients with early-stage cancer. Little research has examined whether findings extend to family caregivers of patients with incurable cancer, who experience unique and substantial caregiving burdens. We examined correlates of mental and physical health among caregivers of patients with newly-diagnosed incurable lung or non-colorectal gastrointestinal cancer. METHODS At baseline for a trial of early palliative care, caregivers of participating patients (N = 275) reported their mental and physical health (Medical Outcome Survey-Short Form-36); patients reported their quality of life (Functional Assessment of Cancer Therapy-General). Analyses used hierarchical linear regression with two-tailed significance tests. RESULTS Caregivers' mental health was worse than the U.S. national population (M = 44.31, p < .001), yet their physical health was better (M = 56.20, p < .001). Hierarchical regression analyses testing caregiver, relational, and patient factors simultaneously revealed that younger (B = 0.31, p = .001), spousal caregivers (B = -8.70, p = .003), who cared for patients reporting low emotional well-being (B = 0.51, p = .01) reported worse mental health; older (B = -0.17, p = .01) caregivers with low educational attainment (B = 4.36, p < .001) who cared for patients reporting low social well-being (B = 0.35, p = .05) reported worse physical health. CONCLUSIONS In this large sample of family caregivers of patients with incurable cancer, caregiver demographics, relational factors, and patient-specific factors were all related to caregiver mental health, while caregiver demographics were primarily associated with caregiver physical health. These findings help identify characteristics of family caregivers at highest risk of poor mental and physical health who may benefit from greater supportive care.
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Affiliation(s)
- Kelly M Shaffer
- Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Jamie M Jacobs
- Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Division of Hematology/Oncology, Massachusetts General Hospital Cancer Center, 55 Fruit Street, Yawkey 7B, Boston, MA, 02114, USA
| | - Ryan D Nipp
- Harvard Medical School, Boston, MA, USA.,Division of Hematology/Oncology, Massachusetts General Hospital Cancer Center, 55 Fruit Street, Yawkey 7B, Boston, MA, 02114, USA
| | - Alaina Carr
- Division of Hematology/Oncology, Massachusetts General Hospital Cancer Center, 55 Fruit Street, Yawkey 7B, Boston, MA, 02114, USA
| | - Vicki A Jackson
- Harvard Medical School, Boston, MA, USA.,Division of Hematology/Oncology, Massachusetts General Hospital Cancer Center, 55 Fruit Street, Yawkey 7B, Boston, MA, 02114, USA
| | - Elyse R Park
- Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - William F Pirl
- Harvard Medical School, Boston, MA, USA.,Division of Hematology/Oncology, Massachusetts General Hospital Cancer Center, 55 Fruit Street, Yawkey 7B, Boston, MA, 02114, USA
| | - Areej El-Jawahri
- Harvard Medical School, Boston, MA, USA.,Division of Hematology/Oncology, Massachusetts General Hospital Cancer Center, 55 Fruit Street, Yawkey 7B, Boston, MA, 02114, USA
| | - Emily R Gallagher
- Division of Hematology/Oncology, Massachusetts General Hospital Cancer Center, 55 Fruit Street, Yawkey 7B, Boston, MA, 02114, USA
| | - Joseph A Greer
- Harvard Medical School, Boston, MA, USA.,Division of Hematology/Oncology, Massachusetts General Hospital Cancer Center, 55 Fruit Street, Yawkey 7B, Boston, MA, 02114, USA
| | - Jennifer S Temel
- Harvard Medical School, Boston, MA, USA. .,Division of Hematology/Oncology, Massachusetts General Hospital Cancer Center, 55 Fruit Street, Yawkey 7B, Boston, MA, 02114, USA.
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163
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Black DS, Li MJ, Ihenacho U, Nguyen NT, de Fatima Reyes M, Milam J, Pentz MA, Figueiredo JC. Shared health characteristics in Hispanic colorectal cancer patients and their primary social support person following primary diagnosis. Psychooncology 2016; 25:1028-35. [PMID: 26291178 PMCID: PMC4925318 DOI: 10.1002/pon.3938] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 06/02/2015] [Accepted: 07/15/2015] [Indexed: 11/07/2022]
Abstract
PURPOSE The aim of this paper was to determine individual and shared levels of psychosocial, behavioral, and symptomological health characteristics among Hispanics with recent history of cancer and their primary social support person (PSSP) in the years following diagnosis. PATIENTS AND METHODS Recruited from a population-based cohort study were 409 Hispanic patients with a previous diagnosis of colorectal cancer. Forty-seven patients identified a PSSP, who assists with medical decision-making and health-related matters, who also participated in the study. Current behavioral (smoking, alcohol use, physical activity, and complementary and alternative medicine use), psychosocial (stress and mindfulness), and physical symptom (fatigue) data were obtained using validated instruments. Analyses tested the individual and shared (between patients and PSSPs) variance in these health measures. RESULTS The sample was diagnosed on average 3.1 years (standard deviation = 1.7) prior to assessment. PSSPs were mainly spouses/partners (63%) or children (28%) of patients. Among patients, stress was positively associated with being a current smoker (p < 0.01) and with fatigue (r = 0.45, p < 0.001); stress was negatively correlated with mindfulness (r = -0.41, p < 0.001); mindfulness was negatively associated with smoking (odds ratio (OR) = 0.72, p < 0.01) and alcohol consumption (OR = 0.83, p < 0.05); the inverse relationship between mindfulness and fatigue was partially mediated through lower levels of stress (β = -0.17, p < 0.001). Similar patterns were observed among PSSPs. Patient mindfulness was negatively correlated with PSSP stress (r = -0.45, p < 0.01). Complementary and alternative medicine use showed interdependence between patients and PSSPs for use of herbal remedies (OR = 6.2; p < 0.01) and bodywork (OR = 8.3, p < 0.05). CONCLUSION Hispanic colorectal cancer patients and their PSSP share a common health milieu in the years following a cancer diagnosis, offering opportunities for advancing interpersonal intervention approaches in cancer care. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- David S. Black
- Department of Preventive Medicine, Keck School of Medicine of University of Southern California, Los Angeles CA
- Norris Comprehensive Cancer Center, Keck School of Medicine of University of Southern California, Los Angeles CA
| | - Michael J. Li
- Department of Preventive Medicine, Keck School of Medicine of University of Southern California, Los Angeles CA
| | - Ugonna Ihenacho
- Department of Preventive Medicine, Keck School of Medicine of University of Southern California, Los Angeles CA
- Norris Comprehensive Cancer Center, Keck School of Medicine of University of Southern California, Los Angeles CA
| | - Nathalie T. Nguyen
- Department of Preventive Medicine, Keck School of Medicine of University of Southern California, Los Angeles CA
- Norris Comprehensive Cancer Center, Keck School of Medicine of University of Southern California, Los Angeles CA
| | - Maria de Fatima Reyes
- Department of Preventive Medicine, Keck School of Medicine of University of Southern California, Los Angeles CA
| | - Joel Milam
- Department of Preventive Medicine, Keck School of Medicine of University of Southern California, Los Angeles CA
| | - Mary Ann Pentz
- Department of Preventive Medicine, Keck School of Medicine of University of Southern California, Los Angeles CA
- Norris Comprehensive Cancer Center, Keck School of Medicine of University of Southern California, Los Angeles CA
| | - Jane C. Figueiredo
- Department of Preventive Medicine, Keck School of Medicine of University of Southern California, Los Angeles CA
- Norris Comprehensive Cancer Center, Keck School of Medicine of University of Southern California, Los Angeles CA
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164
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Shaffer KM, Riklin E, Jacobs JM, Rosand J, Vranceanu AM. Psychosocial resiliency is associated with lower emotional distress among dyads of patients and their informal caregivers in the neuroscience intensive care unit. J Crit Care 2016; 36:154-159. [PMID: 27546765 DOI: 10.1016/j.jcrc.2016.07.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 06/13/2016] [Accepted: 07/05/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE The purpose of the study is to examine the associations of patients' and their informal caregivers' psychosocial resiliency factors with their own and their partners' emotion domains (distress, anxiety, depression, and anger) after admission to the neuroscience intensive care unit (Neuro-ICU). MATERIALS AND METHODS Eighty-three dyads of patients (total n = 87) and their informal caregivers (total n = 99) participated in this observational, cross-sectional study by self-reporting demographics and measures of resiliency factors (mindfulness [Cognitive and Affective Mindfulness Scale Revised], coping [Measure of Coping Status-A], intimate bond [Intimate Bond Measure], self-efficacy [patients: General Self-Efficacy Scale; caregivers: Revised Caregiver Self-Efficacy Scale]) and emotion domains (Emotion Thermometers) within 2 weeks of Neuro-ICU admission. RESULTS There were no differences between patients' and caregivers' levels of psychosocial resiliency, distress, or anxiety. Patients reported greater depression and anger relative to their caregivers. Overall, roughly half of patients (50.6%) and caregivers (42.4%) reported clinically significant emotional distress. Patients' and caregivers' own psychosocial resiliency factors were associated with their own, but not their partner's, emotion domains. CONCLUSIONS Findings of high distress among both patients and caregivers at admission emphasize the importance of attending to the mental health of both patients and caregivers in the Neuro-ICU. As modifiable psychosocial resiliency factors were associated with emotion domains for both patients and caregivers, interventions to enhance these factors may ameliorate emotional distress among these vulnerable populations.
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Affiliation(s)
- Kelly M Shaffer
- Psychiatry Department, Massachusetts General Hospital, Boston, MA, USA; Psychology Department, University of Miami, Coral Gables, FL, USA
| | - Eric Riklin
- Psychiatry Department, Massachusetts General Hospital, Boston, MA, USA
| | - Jamie M Jacobs
- Psychiatry Department, Massachusetts General Hospital, Boston, MA, USA
| | - Jonathan Rosand
- Division of Neurocritical and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
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A tailored Web-based psychoeducational intervention for cancer patients and their family caregivers. Cancer Nurs 2016; 37:321-30. [PMID: 24945270 DOI: 10.1097/ncc.0000000000000159] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Most programs addressing psychosocial concerns of cancer survivors are in-person programs that are expensive to deliver, have limited availability, and seldom deal with caregivers' concerns. OBJECTIVE This study examined the feasibility of translating an efficacious nurse-delivered program (FOCUS Program) for patients and their caregivers to a tailored, dyadic Web-based format. Specific aims were to (1) test the preliminary effects of the Web-based intervention on patient and caregiver outcomes, (2) examine participants' program satisfaction, and (3) determine the feasibility of using a Web-based delivery format. METHODS A phase 2 feasibility study was conducted with cancer patients (lung, breast, colorectal, prostate) and their family caregivers (N = 38 dyads). The Web-based intervention provided information and support tailored to the unique characteristics of each patient, caregiver, and their dyadic relationship. Primary outcomes were emotional distress and quality of life. Secondary outcomes were benefits of illness/caregiving, communication, support, and self-efficacy. Analyses included descriptive statistics and repeated-measures analysis of variance. RESULTS Dyads had a significant decrease in emotional distress, increase in quality of life, and perceived more benefits of illness/caregiving. Caregivers also had significant improvement in self-efficacy. There were no changes in communication. Participants were satisfied with program usability, but recommended additional content. CONCLUSIONS It was possible to translate a clinician-delivered program to a Web-based format that was easy to use and had positive effects on dyadic outcomes. IMPLICATIONS FOR PRACTICE The Web-based program is a promising way to provide psychosocial care to more patients and caregivers using fewer personnel. It needs further testing in a larger randomized clinical trial.
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166
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Lee VYW, Seah WY, Kang AWC, Khoo EYH, Mooppil N, Griva K. Managing multiple chronic conditions in Singapore - Exploring the perspectives and experiences of family caregivers of patients with diabetes and end stage renal disease on haemodialysis. Psychol Health 2016; 31:1220-36. [PMID: 27356152 DOI: 10.1080/08870446.2016.1203921] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Diabetes mellitus (DM) is the commonest cause of end stage renal disease (ESRD). Despite increasing DM-ESRD prevalence and high dependency on care, there is a lack of literature on DM-ESRD caregivers. We sought to explore the perspectives and experiences of caregivers of patients with DM undergoing haemodialysis in Singapore. DESIGN This study employed an exploratory, qualitative design comprising in-depth interviews with caregivers of DM-ESRD patients. METHODS Semi-structured interviews were conducted with a sample of 20 family caregivers (54.2 ± 12.6 years; 75% female) of DM-ESRD patients. Data were analysed using Thematic Analysis. RESULTS Key caregiving challenges identified were managing diet, care recipients' emotions and mobility dependence. Patients' emotional reactions caused interpersonal conflicts and hindered treatment management. Difficulties in dietary management were linked to patients' erratic appetite, caregivers' lack/poor understanding of the dietary guidelines and caregivers' low perceived competence. Limited resources in terms of social support and finances were also noted. Physical and psychological well-being and employment were adversely affected by caregiving role. CONCLUSION This study highlights distinctive aspects of the DM-ESRD caregiving experience, which impact on caregivers' health and challenge care. Disease management programmes should be expanded to support caregivers in dealing with multimorbidity.
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Affiliation(s)
- Vanessa Y W Lee
- a Department of Psychology , National University of Singapore , Singapore , Singapore
| | - Wei Ying Seah
- a Department of Psychology , National University of Singapore , Singapore , Singapore
| | - Augustine W C Kang
- a Department of Psychology , National University of Singapore , Singapore , Singapore
| | - Eric Y H Khoo
- b Department of Medicine , Yong Loo Lin School of Medicine , National University of Singapore , Singapore , Singapore
| | | | - Konstadina Griva
- a Department of Psychology , National University of Singapore , Singapore , Singapore.,d Health Services Research Group , City University London , London , UK
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167
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Clark K, Willis A, Byfieldt N. An Observational Study to Explore the Feasibility of Assessing Bereaved Relatives' Experiences Before and After a Quality Improvement Project to Improve Care of Dying Medical Inpatients. Am J Hosp Palliat Care 2016; 34:263-268. [PMID: 26746878 DOI: 10.1177/1049909115625280] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Although hospitals are the most likely place of death, the quality of care received by dying inpatients remains variable. This is concerning for both the dying person and their relatives, with poorer bereavement outcomes likely for those who perceived their family member suffered unduly. There is a real need to consider how this situation can be improved. This work was conducted with the aim of exploring the feasibility of including bereaved relatives' experiences as part of a larger project exploring the use of a care bundle to improve care of the dying inpatients. Fifty relatives of inpatients who had died previously in hospital were contacted by letter with a request for interview before the implementation of a care bundle for the dying, with a care bundle being a collection of care processes that are implemented together. After this project had been in place for 6 months, a further 50 families were contacted who had died on the bundle. Ten families responded initially to the first request and 10 the second, with the interviews based on the Quality of Dying and Death (QODD) tool and a final open-ended question. Although all families who agree to be interviewed completed the session, with regard to the QODD, some families indicated that they would rather talk than provide numeric scores. No major differences in the prescores and postscores were noted. When invited to share their experiences, without prompting, families spoke of consistent concerns that included communication, place of death, and symptom control. This work confirms that it is highly feasible to incorporate assessments of bereaved family members' opinions as part of the wider assessment of research into end-of-life care.
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Affiliation(s)
- Katherine Clark
- 1 Department of Palliative Care, Calvary Mater Newcastle, Newcastle, New South Wales, Australia.,2 The University of Newcastle, Newcastle, New South Wales, Australia
| | - Abby Willis
- 1 Department of Palliative Care, Calvary Mater Newcastle, Newcastle, New South Wales, Australia
| | - Naomi Byfieldt
- 1 Department of Palliative Care, Calvary Mater Newcastle, Newcastle, New South Wales, Australia
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168
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Gesselman AN, Bigatti SM, Garcia JR, Coe K, Cella D, Champion VL. Spirituality, emotional distress, and post-traumatic growth in breast cancer survivors and their partners: an actor-partner interdependence modeling approach. Psychooncology 2016; 26:1691-1699. [PMID: 27280320 DOI: 10.1002/pon.4192] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 05/18/2016] [Accepted: 06/06/2016] [Indexed: 12/24/2022]
Abstract
BACKGROUND The association between spirituality and emotional health has been well documented in healthy individuals. A small literature has shown that spirituality plays a role in well-being for some breast cancer (BC) survivors; however, this link is virtually unexplored in partners/spouses of survivors. The current study aimed to assess the relationship between spirituality, emotional distress, and post-traumatic growth for BC survivors and their partners using a dyadic analyses approach. METHODS A total of 498 couples who were 3-8 years post-BC diagnosis were recruited from the Eastern Oncology Group database. RESULTS For BC survivors and their partners, greater levels of spirituality were associated with increases in their own post-traumatic growth. There was no relation between BC and partner spirituality and their own emotional distress, but partner's spirituality was associated with reduced occurrence of intrusive thoughts in the BC survivor. In contrast, BC survivors' spirituality was found to be wholly unrelated to partner's mental health and adjustment. CONCLUSIONS Following diagnosis and treatment, spirituality appears to associate with positive growth in BC survivors and their partners. However, BC survivor and partner spirituality seem to be ineffective at impacting the other's post-traumatic growth or emotional distress, with the exception of intrusive thoughts. Dyadic analysis takes into account the reciprocal influence of close relationships on health and is an important and under-utilized methodology in behavioral oncology research and clinical practice. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Amanda N Gesselman
- The Kinsey Institute, Indiana University, Bloomington, IN, USA.,IU Richard M. Fairbanks School of Public Health at IUPUI, Indianapolis, IN, USA
| | - Silvia M Bigatti
- IU Richard M. Fairbanks School of Public Health at IUPUI, Indianapolis, IN, USA
| | - Justin R Garcia
- The Kinsey Institute, Indiana University, Bloomington, IN, USA.,Department of Gender Studies, Indiana University, Bloomington, IN, USA
| | - Kathryn Coe
- IU Richard M. Fairbanks School of Public Health at IUPUI, Indianapolis, IN, USA
| | - David Cella
- Northwestern University, Chicago, IL, USA.,NorthShore University, Evanston, IL, USA
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169
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Janz NK, Li Y, Beesley LJ, Wallner LP, Hamilton AS, Morrison RA, Hawley ST. Worry about recurrence in a multi-ethnic population of breast cancer survivors and their partners. Support Care Cancer 2016; 24:4669-78. [PMID: 27378380 DOI: 10.1007/s00520-016-3314-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 06/13/2016] [Indexed: 01/05/2023]
Abstract
PURPOSE The objectives of this study are to describe racial/ethnic differences and clinical/treatment correlates of worry about recurrence and examine modifiable factors in the health care experience to reduce worry among breast cancer survivors, partners, and pairs. METHODS Women with non-metastatic breast cancer identified by the Detroit and Los Angeles SEER registries between 6/05 and 2/07 were surveyed at 9 months and 4 years. Latina and Black women were oversampled. Partners were surveyed at time 2. Worry about recurrence was regressed on sociodemographics, clinical/treatment, and modifiable factors (e.g., emotional support received by providers) among survivors, partners, and pairs. RESULTS The final sample included 510 pairs. Partners reported more worry about recurrence than survivors. Compared to Whites, Latinas(os) were more likely to report worry and Blacks were less likely to report worry (all p < 0.05). Partners of survivors who received chemotherapy reported more worry (OR = 2.47 [1.45, 4.22]). Among modifiable factors, survivors and pairs who received more emotional support from providers were less likely to report worry than those survivors and pairs who did not receive such support (OR = 0.56 [0.32, 0.97]) and (OR = 0.45 [0.23,0.85]), respectively. CONCLUSIONS Early identification of survivors and partners who are reporting considerable worry about recurrence can lead to targeted culturally sensitive interventions to avoid poorer outcomes. Interventions focused on health care providers offering information on risk and emotional support to survivors and partners is warranted.
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Affiliation(s)
- Nancy K Janz
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109-2029, USA.
| | - Yun Li
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Lauren J Beesley
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | | | - Ann S Hamilton
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Sarah T Hawley
- University of Michigan Medical School, Ann Arbor, MI, USA.,Ann Arbor VA Medical Center, Ann Arbor, MI, USA
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170
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Badr H, Herbert K, Reckson B, Rainey H, Sallam A, Gupta V. Unmet needs and relationship challenges of head and neck cancer patients and their spouses. J Psychosoc Oncol 2016; 34:336-46. [PMID: 27269579 PMCID: PMC4951153 DOI: 10.1080/07347332.2016.1195901] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
In head and neck cancer (HNC), couple-based interventions may be useful for facilitating treatment completion, patient rehabilitation, and improving both partners' quality of life. With the goal of identifying targets for future interventions, we conducted a qualitative study to understand patient and spouse unmet needs and relationship challenges during curative radiotherapy for HNC. Semistructured interviews were conducted with six HNC patients (83% male) and six spouses (83% female) within 6 months of completing treatment. Interviews were audiotaped and transcribed using grounded theory analysis. Patients and spouses identified several unmet needs including better preparation regarding the severity of physical side effects, a clearer timeline for recovery, and strategies for dealing with their own and each other's emotional reactions. Caregiver's unmet needs included balancing competing roles/responsibilities, making time for self-care, and finding effective strategies for encouraging patient's self-care. Eighty-three percent of spouses and all patients reported increased conflict during treatment. Other relationship challenges included changes in intimacy and social/leisure activities. Findings suggest that couple-based interventions that emphasize the importance of managing physical and psychological symptoms through the regular practice of self-care routines may be beneficial for both patients and spouses. Likewise, programs that teach spouses ways to effectively motivate and encourage patients' self-care may help minimize conflict and help couples navigate HNC treatment and recovery together as a team.
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Affiliation(s)
- Hoda Badr
- Department of Oncological Sciences, New York, USA
- Icahn School of Medicine at Mount Sinai, New York, USA
| | - Krista Herbert
- Department of Oncological Sciences, New York, USA
- Icahn School of Medicine at Mount Sinai, New York, USA
| | - Batya Reckson
- Department of Otolaryngology, New York, USA
- Icahn School of Medicine at Mount Sinai, New York, USA
| | - Hope Rainey
- Department of Oncological Sciences, New York, USA
- Icahn School of Medicine at Mount Sinai, New York, USA
| | - Aminah Sallam
- Department of Oncological Sciences, New York, USA
- Icahn School of Medicine at Mount Sinai, New York, USA
| | - Vishal Gupta
- Department of Radiation Oncology, New York, USA
- Icahn School of Medicine at Mount Sinai, New York, USA
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171
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Abbasnezhad M, Rahmani A, Ghahramanian A, Roshangar F, Eivazi J, Azadi A, Berahmany G. Cancer Care Burden among Primary Family Caregivers of Iranian Hematologic Cancer Patients. Asian Pac J Cancer Prev 2016. [PMID: 26225701 DOI: 10.7314/apjcp.2015.16.13.5499] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Providing care for hematologic cancer patients may lead to many negative complications in different aspects of life in their family caregivers. Based on a wide review of relevant literature, there are limited data about the burden of giving care for hematologic cancer patients on their primary family caregivers in Iran or other Middle Eastern countries. Therefore, the aim of this study was to investigate the cancer care burden on primary family caregivers of hematologic cancer patients, in terms of physical, psychological, social, spiritual, and financial aspects. MATERIALS AND METHODS In this descriptive study, 151 primary family caregivers of hematologic cancer patients referred to two cancer care centers in East Azerbaijan Province in northwest of Iran participated. The Financial Distress/Financial Well-being Scale, Hospital Anxiety and Depression Scale, Vaux Social Support Questionnaire, Spiritual Well-being Scale, and SF-36 were used for data collection. Data analysis was performed with SPSS software. RESULTS The findings of this study indicated that the primary family caregivers experience a high level of financial distress and a significant percentage of them suffered from anxiety and depression. In addition, the physical quality of life in these caregivers was moderate. On the other hand, spiritual health and social support of participants was at an acceptable level. CONCLUSIONS Iranian primary family caregivers of hematologic cancer patients experience many problems in physical, psychological, and financial aspects of their life. Therefore, developing care plans for reducing these problems appears necessary.
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Affiliation(s)
- Masoomeh Abbasnezhad
- Medical and Surgical Department, Nursing and Midwifery Faculty, Tabriz University of Medical Sciences, Tabriz, Iran E-mail :
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172
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Jho HJ, Choi JY, Kwak KS, Chang YJ, Ahn EM, Park EJ, Paek SJ, Kim KM, Kim SH. Prevalence and Associated Factors of Anxiety and Depressive Symptoms Among Bereaved Family Members of Cancer Patients in Korea: A Nation-Wide Cross-Sectional Study. Medicine (Baltimore) 2016; 95:e3716. [PMID: 27258497 PMCID: PMC4900705 DOI: 10.1097/md.0000000000003716] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Bereaved family members of cancer patient are at risk of having psychological problems such as anxiety and depression. However, prevalence and associated factors of anxiety and depressive symptoms among this population have not been explored in Korea.We conducted a nation-wide cross-sectional questionnaire survey of 3522 bereaved family members of cancer patients who died at 44 hospice palliative care unit (HPCU) in Korea in 2012. The questionnaire comprised the Hospital Anxiety and Depression Scale (HADS) and Good Death Inventory (GDI). Deceased patient's age, sex, primary site of cancer, duration of stay at HPCU, awareness of terminal status, bereaved family member's age, sex, and relation to the deceased were collected from Korean Terminal Cancer Patients Information System.1121 returned questionnaires were analyzed (response rate, 31.8%). Using a cut-off value of 8 for HADS subscale, the prevalence of anxiety and depressive symptoms was 48.0% and 57.6%, respectively. Mean scores for HADS-A and HADS-D were 7.88 ± 4.87 and 8.91 ± 4.82, respectively. Among the bereaved, older age, being a spouse to the deceased, family members of younger patient, and negative score for a few GDI items were significantly associated with an increased risk of having anxiety or depressive symptoms in the multivariate logistic analysis.In conclusion, we noted the high prevalence of anxiety and depressive symptoms among the bereaved of cancer patients and identified associated factors for these psychological morbidities. Systematic efforts are needed to improve the mental health of the bereaved family members of cancer patients.
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Affiliation(s)
- Hyun Jung Jho
- From the Palliative Care Clinic, Hospital (HJJ), Hospice & Palliative Care Branch, National Cancer Control Institute, National Cancer Center, Goyang (HJJ, JYC, KSK, YJC, EMA, EJP, SJP, KMK), and Department of Nursing (SHK), Inha University, Incheon, Republic of Korea
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173
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Attitudes and experiences of family involvement in cancer consultations: a qualitative exploration of patient and family member perspectives. Support Care Cancer 2016; 24:4131-40. [DOI: 10.1007/s00520-016-3237-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 04/17/2016] [Indexed: 10/21/2022]
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174
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Polley MJ, Jolliffe R, Boxell E, Zollman C, Jackson S, Seers H. Using a Whole Person Approach to Support People With Cancer: A Longitudinal, Mixed-Methods Service Evaluation. Integr Cancer Ther 2016; 15:435-445. [PMID: 27060342 PMCID: PMC5739159 DOI: 10.1177/1534735416632060] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 12/23/2015] [Accepted: 01/14/2016] [Indexed: 12/29/2022] Open
Abstract
Introduction. Improved models of care are needed to meet all the support needs of people with cancer, which encompass psychological, emotional, physical, spiritual, sexual, occupational, social and existential needs. The aim of this article is to (a) evaluate short- and long-term impacts of using a whole person approach to support people with cancer on the Living Well with the Impact of Cancer Course (LWC) and (b) use these data to inform strategic decisions about future service provision at Penny Brohn UK. Methods. Longitudinal mixed-methods service evaluation (n = 135). Data collected included health-related quality of life (HRQoL) (FACIT-SpEx); Concerns (types and severity–MYCaW); lifestyle behavior (bespoke questionnaire), and participants’ experiences over 12 months postcourse. Results. Statistically and clinically significant improvements from baseline to 12 months in severity of MYCaW Concerns (n = 64; P < .000) and mean total HRQoL (n = 66; P < .000). The majority of MYCaW concerns were “psychological and emotional” and about participants’ well-being. Spiritual, emotional, and functional well-being contributed most to HRQoL improvements at 12 months. Barriers to maintaining healthy lifestyle changes included lack of support from family and friends, time constraints, and returning to work. Three to 6 months postcourse was identified as the time when more support was most likely to be needed. Conclusions. Using a whole person approach for the LWC enabled the needs of participants to be met, and statistically and clinically significant improvements in HRQoL and MYCaW Concerns were reported. Qualitative data analysis explored how experiencing whole person support enabled participants to make and sustain healthy lifestyle changes associated with improved survivorship. Barriers experienced to making health behavior change were also identified. These data then informed wider and more person-centered clinical provision to increase the maintenance of positive long-term behavior changes. Comparison of whole person approaches to cancer treatment and support and standard care are now urgently needed.
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175
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When cancer cannot be cured: A qualitative study on relationship changes in couples facing advanced melanoma. Palliat Support Care 2016; 14:652-663. [PMID: 26975832 DOI: 10.1017/s1478951516000055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The aim of this qualitative study was to gain a deeper understanding about couples' relationship changes over time (the first six months) after one partner is diagnosed with an incurable advanced melanoma (stage III or IV). METHOD In semistructured interviews, eight patients and their partners were asked separately about potential changes in their relationship since diagnosis. The same questions were asked again six months later, but focusing on relationship changes over the preceding six months. Some 32 audiotaped interviews were analyzed applying qualitative content analysis. RESULTS At baseline (t1), relationship changes were mostly reported in terms of caring, closeness/distance regulation, and communication patterns. While changes in caregiving and distance/closeness regulation remained main issues at six months follow-up (t2), greater appreciation of the relationship and limitations in terms of planning spare time also emerged as major issues. Unexpectedly, 50% of patients and partners reported actively hiding their negative emotions and sorrows from their counterparts to spare them worry. Furthermore, qualitative content analysis revealed relationship changes even in those patients and partners who primarily reported no changes over the course of the disease. SIGNIFICANCE OF RESULTS Our findings revealed a differentiated and complex picture about relationship changes over time, which also might aid in the development of support programs for couples dealing with advanced cancer, focusing on the aspects of caring, closeness/distance regulation, and communication patterns.
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176
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Dionne-Odom JN, Hull JG, Martin MY, Lyons KD, Prescott AT, Tosteson T, Li Z, Akyar I, Raju D, Bakitas MA. Associations between advanced cancer patients' survival and family caregiver presence and burden. Cancer Med 2016; 5:853-62. [PMID: 26860217 PMCID: PMC4864814 DOI: 10.1002/cam4.653] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 12/18/2015] [Accepted: 01/03/2016] [Indexed: 12/25/2022] Open
Abstract
We conducted a randomized controlled trial (RCT) of an early palliative care intervention (ENABLE: Educate, Nurture, Advise, Before Life Ends) for persons with advanced cancer and their family caregivers. Not all patient participants had a caregiver coparticipant; hence, we explored whether there were relationships between patient survival, having an enrolled caregiver, and caregiver outcomes prior to death. One hundred and twenty‐three patient‐caregiver dyads and 84 patients without a caregiver coparticipant participated in the ENABLE early versus delayed (12 weeks later) RCT. We collected caregiver quality‐of‐life (QOL), depression, and burden (objective, stress, and demand) measures every 6 weeks for 24 weeks and every 3 months thereafter until the patient's death or study completion. We conducted survival analyses using log‐rank and Cox proportional hazards models. Patients with a caregiver coparticipant had significantly shorter survival (Wald = 4.31, HR = 1.52, CI: 1.02–2.25, P = 0.04). After including caregiver status, marital status (married/unmarried), their interaction, and relevant covariates, caregiver status (Wald = 6.25, HR = 2.62, CI: 1.23–5.59, P = 0.01), being married (Wald = 8.79, HR = 2.92, CI: 1.44–5.91, P = 0.003), and their interaction (Wald = 5.18, HR = 0.35, CI: 0.14–0.87, P = 0.02) were significant predictors of lower patient survival. Lower survival in patients with a caregiver was significantly related to higher caregiver demand burden (Wald = 4.87, CI: 1.01–1.20, P = 0.03) but not caregiver QOL, depression, and objective and stress burden. Advanced cancer patients with caregivers enrolled in a clinical trial had lower survival than patients without caregivers; however, this mortality risk was mostly attributable to higher survival by unmarried patients without caregivers. Higher caregiver demand burden was also associated with decreased patient survival.
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Affiliation(s)
| | - Jay G Hull
- Departments of Psychological and Brain Sciences, Dartmouth College, Hanover, New Hampshire
| | - Michelle Y Martin
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama.,Department of Preventive Medicine, University of Tennessee Health Science Cente, Memphis, Tennessee
| | - Kathleen Doyle Lyons
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Anna T Prescott
- Departments of Psychological and Brain Sciences, Dartmouth College, Hanover, New Hampshire
| | - Tor Tosteson
- Biostatistics Shared Resource, Norris Cotton Cancer Center, Lebanon, New Hampshire
| | - Zhongze Li
- Biostatistics Shared Resource, Norris Cotton Cancer Center, Lebanon, New Hampshire
| | - Imatullah Akyar
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama.,School of Nursing, Hacettepe University, Ankara, Turkey
| | - Dheeraj Raju
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama
| | - Marie A Bakitas
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama.,Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama
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177
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Shaffer KM, Kim Y, Carver CS. Physical and mental health trajectories of cancer patients and caregivers across the year post-diagnosis: a dyadic investigation. Psychol Health 2016; 31:655-74. [PMID: 26680247 DOI: 10.1080/08870446.2015.1131826] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Evidence suggests interdependence between cancer patients' and their caregivers' physical and mental health. However, the extent to which caregivers' health relates to their patients' recovery, or patients' health affects their caregivers' outcomes, is largely unknown. This dyadic investigation reports the relations between cancer patients' and their caregivers' physical and mental health trajectories during the year following diagnosis. DESIGN Ninety-two colorectal cancer patient-caregiver dyads completed questionnaires at 2, 6 and 12 months post-diagnosis. OUTCOME MEASURES Self-reported physical and mental health using the Medical Outcomes Study Short Form Health Survey-12. RESULTS Patients reported improved physical health over the year following their diagnosis, whereas caregivers reported declining physical health. Patients with lower mental health at diagnosis had stagnated physical health recovery. Caregivers' physical health declined most noticeably among those reporting low mental health at diagnosis and whose patients reported low physical health at diagnosis. CONCLUSION Findings suggest targeting health interventions to cancer patients and caregivers reporting poor mental health at diagnosis may mitigate their long-term physical morbidity. Limited evidence of dyadic interdependence between patients' and caregivers' physical and mental health trajectories suggests future studies are warranted to identify psychosocial and medical characteristics moderating the relations between patients' and caregivers' health.
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Affiliation(s)
- Kelly M Shaffer
- a Department of Psychology , University of Miami , Coral Gables , FL , USA.,b Department of Psychiatry , Massachusetts General Hospital , Boston , MA , USA
| | - Youngmee Kim
- a Department of Psychology , University of Miami , Coral Gables , FL , USA.,c Center for Advanced Study in the Behavioral Sciences , Stanford University , Stanford , CA , USA
| | - Charles S Carver
- a Department of Psychology , University of Miami , Coral Gables , FL , USA.,c Center for Advanced Study in the Behavioral Sciences , Stanford University , Stanford , CA , USA
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178
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A psychosocial oncology program: perceptions of the telephone-triage assessment. Support Care Cancer 2016; 24:2937-44. [PMID: 26847449 DOI: 10.1007/s00520-016-3091-8] [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] [Received: 09/02/2015] [Accepted: 01/17/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE Cancer can be a significant source of distress for patients and family members, which led to the creation of psychosocial oncology (PSO) programs across Canada. To access the PSO program at this institution, individuals are first triaged over the telephone by a clinical nurse specialist (CNS) who also provides psychosocial support during the call. In our study, we explored the perceptions of cancer patients or family members about their psychosocial telephone-triage assessment conducted by a CNS for a PSO program. METHODS A qualitative descriptive design was used to explore the perceptions of nine cancer patients and family members triaged by the CNS for the PSO program. Audiotaped in-person interviews were transcribed verbatim and analyzed for themes and categories using a constant comparative method. RESULTS Three major themes emerged: (1) Triage as a bridge to care, referred to the structure of telephone-triage and link to psychosocial services; (2) feeling a supportive presence, referred to the CNS' actions to foster a therapeutic relationship; and (3) different paths to tailored care, referred to the individualized strategies targeted to the participant's unique needs. As most participants described trusting the CNS, these three themes were found to emerge through a lens of trust. CONCLUSION Overall, the telephone triage was able to address the concerns of many participants and provide individualized coping strategies and support. This study further demonstrates that psychosocial support can be provided during triage over the telephone.
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179
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Hopkinson J. Food connections: A qualitative exploratory study of weight- and eating-related distress in families affected by advanced cancer. Eur J Oncol Nurs 2016; 20:87-96. [DOI: 10.1016/j.ejon.2015.06.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 05/31/2015] [Accepted: 06/01/2015] [Indexed: 10/23/2022]
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180
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D'Souza V, Blouin E, Zeitouni A, Muller K, Allison P. Multimedia information intervention and its benefits in partners of the head and neck cancer patients. Eur J Cancer Care (Engl) 2016; 26. [DOI: 10.1111/ecc.12440] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2015] [Indexed: 11/27/2022]
Affiliation(s)
- V. D'Souza
- Faculty of Dentistry; McGill University st; Montreal QC Canada
| | - E. Blouin
- Department of Otolaryngology-Head and Neck Surgery; McGill University Hospital Center; Montreal QC Canada
| | - A. Zeitouni
- Department of Otolaryngology-Head and Neck Surgery; McGill University Hospital Center; Montreal QC Canada
| | - K. Muller
- Faculty of Dentistry; McGill University st; Montreal QC Canada
| | - P.J. Allison
- Faculty of Dentistry; McGill University st; Montreal QC Canada
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181
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Freeman S, Hirdes JP, Stolee P, Garcia J. A Cross-Sectional Examination of the Association Between Dyspnea and Distress as Experienced by Palliative Home Care Clients and Their Informal Caregivers. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2016; 12:82-103. [PMID: 27143575 DOI: 10.1080/15524256.2016.1156604] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This study examined the association between dyspnea and distress as experienced by both palliative home care clients and their informal caregivers as a unit of care. Cross-sectional analysis was conducted using the interRAI Palliative Care Assessment database. Responses from 6,655 individual palliative home care clients across six regional jurisdictions in Ontario, Canada were included. This study found that clients experiencing dyspnea were more likely to show overall signs of distress; report one or more signs of self-reported distress; and be at risk for depression when compared to clients who do not experience dyspnea. Caregivers of clients experiencing dyspnea were more likely to exhibit distress than caregivers of clients not reporting dyspnea. When indicators of caregiver distress and client distress were combined, 53% of the caregiver-client units exhibited distress. Social work practitioners should include a focus on distress within the care unit as a priority when care planning to meet the needs of persons nearing the end of life. Members of the care team should consider available treatment and management options tailored to meet both the client and their informal caregiver's needs.
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Affiliation(s)
- Shannon Freeman
- a School of Health Sciences , University of Northern British Columbia , Prince George , British Columbia , Canada
| | - John P Hirdes
- b School of Public Health and Health Systems , University of Waterloo , Waterloo , Ontario , Canada
| | - Paul Stolee
- b School of Public Health and Health Systems , University of Waterloo , Waterloo , Ontario , Canada
| | - John Garcia
- b School of Public Health and Health Systems , University of Waterloo , Waterloo , Ontario , Canada
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182
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Dionne-Odom JN, Lyons KD, Akyar I, Bakitas M. Coaching Family Caregivers to Become Better Problem Solvers When Caring for Persons with Advanced Cancer. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2016; 12:63-81. [PMID: 27143574 PMCID: PMC5410626 DOI: 10.1080/15524256.2016.1156607] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Family caregivers of persons with advanced cancer often take on responsibilities that present daunting and complex problems. Serious problems that go unresolved may be burdensome and result in negative outcomes for caregivers' psychological and physical health and affect the quality of care delivered to the care recipients with cancer, especially at the end of life. Formal problem-solving training approaches have been developed over the past several decades to assist individuals with managing problems faced in daily life. Several of these problem-solving principles and techniques were incorporated into ENABLE (Educate, Nurture, Advise, Before Life End), an "early" palliative care telehealth intervention for individuals diagnosed with advanced cancer and their family caregivers. A hypothetical case resembling the situations of actual caregiver participants in ENABLE that exemplifies the complex problems that caregivers face is presented, followed by presentation of an overview of ENABLE's problem-solving key principles, techniques, and steps in problem-solving support. Though more research is needed to formally test the use of problem-solving support in social work practice, social workers can easily incorporate these techniques into everyday practice.
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Affiliation(s)
| | - Kathleen D. Lyons
- Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, NH and Cancer Control Program of the Norris Cotton Cancer Center, Lebanon, NH
| | - Imatullah Akyar
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL
| | - Marie Bakitas
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, AL
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183
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The impact of risk-reducing gynaecological surgery in premenopausal women at high risk of endometrial and ovarian cancer due to Lynch syndrome. Fam Cancer 2015; 14:51-60. [PMID: 25342222 DOI: 10.1007/s10689-014-9761-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Women with Lynch syndrome (LS) have a significantly increased lifetime risk of endometrial cancer (40-60 %) and ovarian cancer (7-12 %). Currently there is little evidence to support the efficacy of screening for the early detection of these cancers. Another option is risk-reducing hysterectomy and/or bilateral salpingo-oophorectomy (BSO). Research on the impact of BSO in premenopausal women with a non-LS associated family history cancer has generally shown that women have a high level of satisfaction about their decision to undergo surgery. However, debilitating menopausal symptoms and sexual dysfunction are common post-surgical problems. We used a mixed methods study to explore the impact of risk-reducing gynaecological surgery in women with LS: 24 women were invited to take part; 15 (62.5 %) completed validated questionnaires and 12 (50 %) participated in semi-structured interviews. Our results suggest that risk reducing surgery does not lead to significant psychological distress and the women tend not to think or worry much about developing cancer. However, they tend to be distressed about the physical and somatic symptoms associated with menopause; their social well-being is somewhat affected, but sexual difficulties are minimal. The women reported being overwhelmingly satisfied with their decision to have surgery and with the quality of information they received prior to the operation. However, they felt underprepared for menopausal symptoms and received conflicting advice about whether or not to use HRT. Recommendations from the study include that professionals discuss the menopause, its side effects and HRT in detail prior to surgery.
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184
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Graham L, Dempster M, McCorry NK, Donnelly M, Johnston BT. Change in psychological distress in longer‐term oesophageal cancer carers: are clusters of illness perception change a useful determinant? Psychooncology 2015; 25:663-9. [DOI: 10.1002/pon.3993] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 08/24/2015] [Accepted: 08/25/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Lisa Graham
- School of PsychologyQueen's University Belfast Belfast UK
| | | | | | - Michael Donnelly
- Centre of Excellence for Public HealthQueen's University Belfast Belfast UK
| | - Brian T. Johnston
- Department of GastroenterologyRoyal Victoria Hospital Belfast Belfast UK
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185
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Donovan KA, Walker LM, Wassersug RJ, Thompson LMA, Robinson JW. Psychological effects of androgen-deprivation therapy on men with prostate cancer and their partners. Cancer 2015; 121:4286-99. [PMID: 26372364 DOI: 10.1002/cncr.29672] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 07/24/2015] [Accepted: 07/29/2015] [Indexed: 01/07/2023]
Abstract
The clinical benefits of androgen-deprivation therapy (ADT) for men with prostate cancer (PC) have been well documented and include living free from the symptoms of metastases for longer periods and improved quality of life. However, ADT comes with a host of its own serious side effects. There is considerable evidence of the adverse cardiovascular, metabolic, and musculoskeletal effects of ADT. Far less has been written about the psychological effects of ADT. This review highlights several adverse psychological effects of ADT. The authors provide evidence for the effect of ADT on men's sexual function, their partner, and their sexual relationship. Evidence of increased emotional lability and depressed mood in men who receive ADT is also presented, and the risk of depression in the patient's partner is discussed. The evidence for adverse cognitive effects with ADT is still emerging but suggests that ADT is associated with impairment in multiple cognitive domains. Finally, the available literature is reviewed on interventions to mitigate the psychological effects of ADT. Across the array of adverse effects, physical exercise appears to have the greatest potential to address the psychological effects of ADT both in men who are receiving ADT and in their partners.
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Affiliation(s)
- Kristine A Donovan
- Supportive Care Medicine Department, Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Lauren M Walker
- Department of Psychosocial Resources and Rehabilitation Oncology, Tom Baker Cancer Center, Calgary, Alberta, Canada.,Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Richard J Wassersug
- Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada.,Australian Research Center in Sex, Health, and Society, La Trobe University, Melbourne, Victoria, Australia
| | - Lora M A Thompson
- Supportive Care Medicine Department, Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - John W Robinson
- Department of Psychosocial Resources and Rehabilitation Oncology, Tom Baker Cancer Center, Calgary, Alberta, Canada.,Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Psychology, University of Calgary, Calgary, Alberta, Canada
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186
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Kobayakawa M, Okamura H, Yamagishi A, Morita T, Kawagoe S, Shimizu M, Ozawa T, An E, Tsuneto S, Shima Y, Miyashita M. Family caregivers require mental health specialists for end‐of‐life psychosocial problems at home: a nationwide survey in Japan. Psychooncology 2015; 25:641-7. [DOI: 10.1002/pon.3982] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 08/17/2015] [Accepted: 08/18/2015] [Indexed: 11/11/2022]
Affiliation(s)
| | - Hitoshi Okamura
- Graduate School of Health SciencesHiroshima University Hiroshima Japan
| | | | - Tatsuya Morita
- Department of Palliative and Supportive CareSeirei Mikatahara General Hospital Hamamatsu Japan
| | | | - Megumi Shimizu
- School of Health ScienceTohoku University Sendai Japan
- Department of Palliative Nursing, Graduate School of MedicineTohoku University Sendai Japan
| | | | - Emi An
- Hananotani Clinic Minamibouso Japan
| | - Satoru Tsuneto
- Department of Multidisciplinary Cancer Treatment, Graduate School of MedicineKyoto University Kyoto Japan
| | - Yasuo Shima
- Department of Palliative MedicineTsukuba Medical Center Hospital Tsukuba Ibaraki Japan
| | - Mitsunori Miyashita
- School of Health ScienceTohoku University Sendai Japan
- Department of Palliative Nursing, Graduate School of MedicineTohoku University Sendai Japan
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187
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Zavagli V, Miglietta E, Varani S, Pannuti R, Brighetti G, Pannuti F. Associations between caregiving worries and psychophysical well-being. An investigation on home-cared cancer patients family caregivers. Support Care Cancer 2015. [PMID: 26201751 DOI: 10.1007/s00520-015-2854-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE Caregiving to a family member with cancer might have health implications. However, limited research has investigated the psychophysical health of home-cared cancer patients family caregivers. In a previous study, we have found that a prolonged worry in daily life is a crucial variable compared to caregivers' psychophysical symptomatology. This investigation was designed to further examine the well-being of family caregivers, explore the domains of worry, and assess to what extent "content-dependent" worry could be associated with the caregivers' health METHODS The sample consisted of 100 family caregivers of oncological patients assisted at home. Participants completed a battery of self-report questionnaires (Penn State Worry Questionnaire, Worry Domain Questionnaire, Hospital Anxiety and Depression Scale, Family Strain Questionnaire Short Form, and Psychophysiological Questionnaire of the Battery CBA 2.0). RESULTS The level of worry was medium-high among participants, and caregivers worry more about their occupation and future. Depression, anxiety, and somatic symptomatology levels resulted mild, while strain level resulted high. Statistical analyses confirm the conclusions of the previous study, revealing a significant positive correlation between worry levels and caregivers' psychophysical health. Innovatively, it has been highlighted that who has higher scores of content-dependent worry shows also higher levels of strain, somatic symptoms, anxiety, and depression CONCLUSIONS Not only trait-worry ("content-free" measure) but also content-dependent worry is associated with strain and negative health outcomes. People may worry about different targets, and it might be useful to further investigate what are the specific worriers of family caregivers in order to promote their physical and emotional well-being.
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Affiliation(s)
| | - Elisabetta Miglietta
- Department of Psychology, University of Bologna, viale Berti Pichat 5, Bologna, Italy
| | - Silvia Varani
- ANT Italia Foundation, via Jacopo di Paolo 36, Bologna, Italy
| | | | - Gianni Brighetti
- Department of Psychology, University of Bologna, viale Berti Pichat 5, Bologna, Italy
| | - Franco Pannuti
- ANT Italia Foundation, via Jacopo di Paolo 36, Bologna, Italy
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188
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Skeppner E, Fugl-Meyer K. Dyadic Aspects of Sexual Well-Being in Men with Laser-Treated Penile Carcinoma. Sex Med 2015; 3:67-75. [PMID: 26185671 PMCID: PMC4498823 DOI: 10.1002/sm2.59] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Coping with cancer, its treatment and recovery are dyadic processes within a relationship. Sexual dysfunctions and problems of penile cancer may add to the demands of coping. AIM The prospective study aimed to describe the dyadic aspects of sexual well-being and life satisfaction before and 1 year after organ-sparing laser treatment of penile carcinoma. METHODS A consecutive series of 29 patients with penile carcinoma suitable for laser treatment were included together with their partners, median age 60 (37-73) years and 57 (30-72) years, respectively. Median length of relationship was 29 years (1-54 years). The participants completed structured interviews before treatment, at 6 months' and 12 months' follow-up. The interview addressed sexual activities, sexual functions, verbal (sexual) communication, and life satisfaction. MAIN OUTCOME MEASURES Three well-validated instruments were included: Hospital Anxiety and Depression Scale, International Index of Erectile Function-5, and Life Satisfaction checklist, LiSat-11. The interviews contained the same questions for patients and partners at all three measuring points. RESULTS There was a high level of within-couple agreement on sexual activities, sexual function, and life satisfaction before and after organ-sparring treatment. No significant differences between interview data at 6 and 12 months' follow-up occurred. Before treatment, sexual dysfunctions were common among men, especially decreased sexual interest and dyspareunia. At follow-up, increased sexual function was found, with the exception of erectile function and women's orgasm. A rather high proportion was being unsatisfactory sexually inactive. Few had an ongoing verbal (sexual) mutual communication. Couples with an active sexual life at follow-up showed coherence in high satisfaction with life as a whole. CONCLUSION A high level of within-couple agreement concerning sexuality and life satisfaction points to the necessity of including an adequate sexological case history, counseling, and treatment for this group of patients and their partners.
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Affiliation(s)
- Elisabet Skeppner
- Department of Urology, Faculty of Medicine and Health, Örebro University Hospital Örebro, Sweden
| | - Kerstin Fugl-Meyer
- Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet and Department of Social Work, Karolinska University Hospital Stockholm, Sweden
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189
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Park EY, Kim JH. Predictors of Sexual Adjustment in Cancer Patients Receiving Chemotherapy. J Psychosoc Oncol 2015; 33:488-503. [DOI: 10.1080/07347332.2015.1067278] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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190
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Cancer and quality of life in spousal dyads: spillover in couples with and without cancer-related health problems. Support Care Cancer 2015; 24:763-771. [PMID: 26143040 DOI: 10.1007/s00520-015-2840-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 06/22/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Poor health of one spouse can adversely influence the partner's health outcomes ("spillover"). This study aimed to estimate quality of life spillover among spouses and to determine how presence of cancer influenced these effects. METHODS We examined data on husband-wife dyads with cancer-related health problems, medical events, or disabilities (n = 910) and matched comparison dyads from the 2004-2012 Medical Expenditures Panel Survey, a population-based survey of the USA. Mental and physical health-related quality of life and depressed mood were reported at two time points (T1 and T2, 11 months apart on average). Dyadic multilevel models evaluated the cross-lagged impact of HRQoL and depressed mood at T1 on spouses' HRQoL at T2, controlling for sociodemographics and health conditions. RESULTS Small but statistically significant spillover was observed for mental and physical HRQoL among couples with cancer. Spillover occurred from both the spouse to the survivor and from survivor to spouse. Depressed mood, in particular, showed stronger spillover effects from the spouse to the survivor than the inverse. Similar effects were not observed in dyads without cancer. CONCLUSIONS Screening for and treating poor HRQoL and depressed mood concurrently in both cancer survivors, and their spouses may positively influence HRQoL outcomes. Future research is needed to further elucidate these findings and determine whether a concurrent approach to psychosocial care in survivors and their spouses may improve long-term outcomes.
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191
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Carolan CM, Smith A, Forbat L. Conceptualising psychological distress in families in palliative care: Findings from a systematic review. Palliat Med 2015; 29:605-32. [PMID: 25802323 DOI: 10.1177/0269216315575680] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Adult palliative care patients and their family members experience significant psychological distress and morbidity. Psychosocial interventions adopting a systemic approach may provide a cogent model to improve the psychosocial care of families in palliative care. To facilitate design of these interventions, the construct of psychological distress in families in palliative care should be empirically derived. AIM To ascertain how psychological distress is conceptualised in families receiving palliative care. DESIGN A systematic review of the literature; this was followed by a thematic analysis and narrative synthesis. DATA SOURCES Using pre-defined search terms, four electronic databases (MEDLINE, CINAHL, PsycINFO and Behavioural Sciences collections) were searched with no date restrictions imposed. Pre-determined inclusion and exclusion criteria were then applied. RESULTS A total of 32 papers were included in the review. Two findings emerged from data synthesis. First, distress is conceptualised as a multi-dimensional construct but little consensus exists as to how to capture and measure distress. Second, distress in the families within these studies can be conceptualised using a tiered approach, moving from individual non-interactive depictions of distress through gradations of interaction to convey a systemic account of distress within the family system. Thus, distress shifts from a unitary to a systemic construct. CONCLUSION Currently, there is a paucity of research examining distress informed by family systems theories. This review proposes that distress in families in palliative care can be conceptualised and illustrated within a tiered model of distress. Further research is merited to advance current explanatory frameworks and theoretical models of distress.
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Affiliation(s)
- Clare M Carolan
- School of Health Sciences, University of Stirling (Western Isles Campus), Stornoway, UK
| | - Annetta Smith
- School of Health Sciences, University of Stirling (Western Isles Campus), Stornoway, UK
| | - Liz Forbat
- School of Health Sciences, University of Stirling (Stirling Campus), Stirling, UK
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192
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Improving psychosocial outcomes for caregivers of people with poor prognosis gastrointestinal cancers: a randomized controlled trial (Family Connect). Support Care Cancer 2015; 24:585-595. [PMID: 26111955 DOI: 10.1007/s00520-015-2817-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Accepted: 06/15/2015] [Indexed: 12/18/2022]
Abstract
PURPOSE This study investigated the effectiveness of a structured telephone intervention for caregivers of people diagnosed with poor prognosis gastrointestinal cancer to improve psychosocial outcomes for both caregivers and patients. METHODS Caregivers of patients starting treatment for upper gastrointestinal or Dukes D colorectal cancer were randomly assigned (1:1) to the Family Connect telephone intervention or usual care. Caregivers in the intervention group received four standardized telephone calls in the 10 weeks following patient hospital discharge. Caregivers' quality of life (QOL), caregiver burden, unmet supportive care needs and distress were assessed at 3 and 6 months. Patients' QOL, unmet supportive care needs, distress and health service utilization were also assessed at these time points. RESULTS Caregivers (128) were randomized to intervention or usual care groups. At 3 months, caregiver QOL scores and other caregiver-reported outcomes were similar in both groups. Intervention group participants experienced a greater sense of social support (p = .049) and reduced worry about finances (p = .014). Patients whose caregiver was randomized to the intervention also had fewer emergency department presentations and unplanned hospital readmissions at 3 months post-discharge (total 17 vs. 5, p = .01). CONCLUSIONS This standardized intervention did not demonstrate any significant improvements in caregiver well-being but did result in a decrease in patient emergency department presentations and unplanned hospital readmissions in the immediate post-discharge period. The trend towards improvements in a number of caregiver outcomes and the improvement in health service utilization support further development of telephone-based caregiver-focused supportive care interventions.
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193
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Hendrix CC, Bailey DE, Steinhauser KE, Olsen MK, Stechuchak KM, Lowman SG, Schwartz AJ, Riedel RF, Keefe FJ, Porter LS, Tulsky JA. Effects of enhanced caregiver training program on cancer caregiver's self-efficacy, preparedness, and psychological well-being. Support Care Cancer 2015; 24:327-336. [PMID: 26062925 DOI: 10.1007/s00520-015-2797-3] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 06/02/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE We examined the effects of an enhanced informal caregiver training (Enhanced-CT) protocol in cancer symptom and caregiver stress management to caregivers of hospitalized cancer patients. METHODS We recruited adult patients in oncology units and their informal caregivers. We utilized a two-armed, randomized controlled trial design with data collected at baseline, post-training, and at 2 and 4 weeks after hospital discharge. Primary outcomes were self-efficacy for managing patients' cancer symptoms and caregiver stress and preparedness for caregiving. Secondary outcomes were caregiver depression, anxiety, and burden. The education comparison (EDUC) group received information about community resources. We used general linear models to test for differences in the Enhanced-CT relative to the EDUC group. RESULTS We consented and randomized 138 dyads: Enhanced-CT = 68 and EDUC = 70. The Enhanced-CT group had a greater increase in caregiver self-efficacy for cancer symptom management and stress management and preparation for caregiving at the post-training assessment compared to the EDUC group but not at 2- and 4-week post-discharge assessments. There were no intervention group differences in depression, anxiety, and burden. CONCLUSION An Enhanced-CT protocol resulted in short-term improvements in self-efficacy for managing patients' cancer symptoms and caregiver stress and preparedness for caregiving but not in caregivers' psychological well-being. The lack of sustained effects may be related to the single-dose nature of our intervention and the changing needs of informal caregivers after hospital discharge.
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Affiliation(s)
- Cristina C Hendrix
- Duke University School of Nursing, 307 Trent Drive, DUMC 3322, Room 3080, Durham, NC, 27710, USA.,Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs Medical GRECC, 508 Fulton St. Durham VA Medical Center, Durham, NC, 27705, USA.,Center for the Study of Aging and Human Development, Duke University, Box 3003 DUMC, Room 3502 Busse Building, Blue Zone, Duke South Durham, NC, 27710, USA
| | - Donald E Bailey
- Duke University School of Nursing, 307 Trent Drive, DUMC 3322, Room 3080, Durham, NC, 27710, USA.,Center for the Study of Aging and Human Development, Duke University, Box 3003 DUMC, Room 3502 Busse Building, Blue Zone, Duke South Durham, NC, 27710, USA
| | - Karen E Steinhauser
- Center of Excellence for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, 508 Fulton Street, Durham, NC, 27705, USA.,Duke Palliative Care, Duke University Health System, DUMC 2706, Durham, NC, 27710, USA.,Department of Medicine, Duke University School of Medicine, DUMC 2706, Durham, NC, 27710, USA
| | - Maren K Olsen
- Center of Excellence for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, 508 Fulton Street, Durham, NC, 27705, USA.,Department of Medicine, Duke University School of Medicine, DUMC 2706, Durham, NC, 27710, USA
| | - Karen M Stechuchak
- Center of Excellence for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, 508 Fulton Street, Durham, NC, 27705, USA
| | - Sarah G Lowman
- Department of Medicine, Duke University School of Medicine, DUMC 2706, Durham, NC, 27710, USA
| | - Abby J Schwartz
- Center for the Study of Aging and Human Development, Duke University, Box 3003 DUMC, Room 3502 Busse Building, Blue Zone, Duke South Durham, NC, 27710, USA.
| | - Richard F Riedel
- Division of Medical Oncology, Duke University Medical Center, DUMC 3198, Durham, NC, 27710, USA
| | - Francis J Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, DUMC 3159, Durham, NC, 27710, USA
| | - Laura S Porter
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, DUMC 3159, Durham, NC, 27710, USA
| | - James A Tulsky
- Duke Palliative Care, Duke University Health System, DUMC 2706, Durham, NC, 27710, USA.,Department of Medicine, Duke University School of Medicine, DUMC 2706, Durham, NC, 27710, USA
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194
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Association between the emotional status of family caregivers and length of stay in a palliative care unit: A retrospective study. Palliat Support Care 2015; 13:1695-700. [PMID: 26063338 DOI: 10.1017/s1478951515000619] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Several factors associated with referral time to hospice and/or palliative care services have been identified, but there is no literature on the association between these services and the emotional status of the family caregivers (FCs). This article is intended to address that issue. METHOD A semistructured interview was employed to collect data for a retrospective cohort study. The primary FCs of terminally ill cancer patients were interviewed at the time of the patient's referral to the palliative care unit. Interview data were combined with patients' medical record data for our analysis. The emotional status of the FCs was categorized into one of three groups according to their responses to the anticipated death of their family member: acceptance, anxious/depressed, and denial/angry. A Cox proportional hazard model was used to examine and identify the factors related to the length of stay (LOS) in the palliative care unit. RESULTS A total of 198 patient-FC pairs were identified. The median LOS was 18 days. A multivariate analysis with adjustment for potential variables revealed significant differences in LOS according to cancer type and time since cancer diagnosis. The denial/angry FC category was independently associated with a shorter LOS (vs. acceptance, adjusted hazard ratio (aHR) 2.11; 95% confidence interval (CI), 1.11-4.03). SIGNIFICANCE OF RESULTS We found that terminally ill cancer patients who were referred late had FCs who were in denial or were angry about the anticipated death of their loved one. The emotional status of FCs should be considered when patients with terminal cancer are referred to palliative care.
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195
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Trevino KM, Maciejewski PK, Epstein AS, Prigerson HG. The lasting impact of the therapeutic alliance: Patient-oncologist alliance as a predictor of caregiver bereavement adjustment. Cancer 2015; 121:3534-42. [PMID: 26042653 DOI: 10.1002/cncr.29505] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 04/23/2015] [Accepted: 05/13/2015] [Indexed: 12/30/2022]
Abstract
BACKGROUND Caregivers of patients with advanced cancer provide extensive care and experience high levels of psychosocial distress. The patient-oncologist therapeutic alliance may be a modifiable factor that can prevent or reduce negative caregiver outcomes. METHODS Coping with Cancer (CwC) was a prospective, longitudinal, multisite cohort study of terminally ill cancer patients (life expectancy ≤6 months) and their informal caregivers, who were followed into bereavement (n = 68). Trained raters interviewed patients and caregivers upon study entry and also interviewed caregivers 6 months after the patient's death. Patients answered quantitative questions assessing their perception of the patient-oncologist therapeutic alliance (The Human Connection scale), and caregivers completed a measure of health-related quality of life (Medical Outcomes Study Short Form-36). Interviewers rated caregivers' level of emotional well being. Associations between therapeutic alliance and caregiver outcomes were analyzed using univariate analysis of variance and logistic regression analyses, controlling for baseline caregiver measures and confounding sample characteristics. RESULTS A strong patient-oncologist therapeutic alliance was bivariately associated with caregiver self-report of less role limitation because of emotional problems, better social function and mental and general health-related quality of life, and better interviewer-rated emotional well being after the patient's death. After controlling for baseline measures and confounding sample characteristics, the correlation between patient-perceived therapeutic alliance and bereaved caregivers' mental health and interviewer ratings of bereaved caregivers' emotional well being remained significant. CONCLUSIONS The influence of the patient-oncologist alliance may generalize beyond the patient to positively impact the caregiver. By developing a strong relationship with the patient, the oncologist may benefit the caregiver and the patient. This caregiver benefit may extend into bereavement.
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Affiliation(s)
- Kelly M Trevino
- Department of Medicine, Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College, New York, New York.,Department of Medicine, New York Presbyterian Hospital, New York, New York
| | - Paul K Maciejewski
- Department of Medicine, Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College, New York, New York.,Department of Medicine, Weill Cornell Medical College, New York, New York
| | | | - Holly G Prigerson
- Department of Medicine, Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College, New York, New York.,Department of Medicine, New York Presbyterian Hospital, New York, New York
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196
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Rouleau CR, Garland SN, Carlson LE. The impact of mindfulness-based interventions on symptom burden, positive psychological outcomes, and biomarkers in cancer patients. Cancer Manag Res 2015; 7:121-31. [PMID: 26064068 PMCID: PMC4457221 DOI: 10.2147/cmar.s64165] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Research on the use of mindfulness-based stress reduction and related mindfulness-based interventions (MBIs) in cancer care has proliferated over the past decade. MBIs have aimed to facilitate physical and emotional adjustment to life with cancer through the cultivation and practice of mindfulness (ie, purposeful, nonjudgmental, moment-to-moment awareness). This descriptive review highlights three categories of outcomes that have been evaluated in MBI research with cancer patients - namely, symptom reduction, positive psychological growth, and biological outcomes. We also examine the clinical relevance of each targeted outcome, while describing recently published original studies to highlight novel applications of MBIs tailored to individuals with cancer. Accumulating evidence suggests that participation in a MBI contributes to reductions in psychological distress, sleep disturbance, and fatigue, and promotes personal growth in areas such as quality of life and spirituality. MBIs may also influence markers of immune function, hypothalamic-pituitary-adrenal axis regulation, and autonomic nervous system activity, though it remains unclear whether these biological changes translate to clinically important health benefits. We conclude by discussing methodological limitations of the extant literature, and implications of matching MBIs to the needs and preferences of cancer patients. Overall, the growing popularity of MBIs in cancer care must be balanced against scientific evidence for their impact on specific clinical outcomes.
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Affiliation(s)
- Codie R Rouleau
- Department of Psychology, Faculty of Arts, University of Calgary, Calgary, AB, Canada
| | - Sheila N Garland
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Linda E Carlson
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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197
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Christophe V, Duprez C, Congard A, Fournier E, Lesur A, Antoine P, Vanlemmens L. Evaluate the subjective experience of the disease and its treatment in the partners of young women with non-metastatic breast cancer. Eur J Cancer Care (Engl) 2015; 25:734-43. [DOI: 10.1111/ecc.12327] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2015] [Indexed: 12/01/2022]
Affiliation(s)
- V. Christophe
- UMR CNRS 9193 Cognitives and Affectives Sciences; Université de Lille; F-59653 Villeneuve d'Ascq Cedex
- SIRIC ONCOLille - Maison Régionale de la Recherche Clinique; 59037 Lille Cedex France
| | - C. Duprez
- UMR CNRS 9193 Cognitives and Affectives Sciences; Université de Lille; F-59653 Villeneuve d'Ascq Cedex
- SIRIC ONCOLille - Maison Régionale de la Recherche Clinique; 59037 Lille Cedex France
| | - A. Congard
- Centre de Recherche PsyCLÉ (EA 3273); Aix-Marseille Université; F-13621 Aix en Provence Cedex 1 France
| | - E. Fournier
- UMR CNRS 9193 Cognitives and Affectives Sciences; Université de Lille; F-59653 Villeneuve d'Ascq Cedex
| | - A. Lesur
- Institut de Cancérologie de Lorraine; Centre Alexis Vautrin; 54519 Vandoeuvre-lès-Nancy France
| | - P. Antoine
- UMR CNRS 9193 Cognitives and Affectives Sciences; Université de Lille; F-59653 Villeneuve d'Ascq Cedex
| | - L. Vanlemmens
- Département de Sénologie; Centre Oscar Lambret; F-59020 Lille Cedex France
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198
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Dionne-Odom JN, Azuero A, Lyons KD, Hull JG, Tosteson T, Li Z, Li Z, Frost J, Dragnev KH, Akyar I, Hegel MT, Bakitas MA. Benefits of Early Versus Delayed Palliative Care to Informal Family Caregivers of Patients With Advanced Cancer: Outcomes From the ENABLE III Randomized Controlled Trial. J Clin Oncol 2015; 33:1446-52. [PMID: 25800762 PMCID: PMC4404423 DOI: 10.1200/jco.2014.58.7824] [Citation(s) in RCA: 325] [Impact Index Per Article: 36.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
PURPOSE To determine the effect of early versus delayed initiation of a palliative care intervention for family caregivers (CGs) of patients with advanced cancer. PATIENTS AND METHODS Between October 2010 and March 2013, CGs of patients with advanced cancer were randomly assigned to receive three structured weekly telephone coaching sessions, monthly follow-up, and a bereavement call either early after enrollment or 3 months later. CGs of patients with advanced cancer were recruited from a National Cancer Institute cancer center, a Veterans Administration Medical Center, and two community outreach clinics. Outcomes were quality of life (QOL), depression, and burden (objective, stress, and demand). RESULTS A total of 122 CGs (early, n = 61; delayed, n = 61) of 207 patients participated; average age was 60 years, and most were female (78.7%) and white (92.6%). Between-group differences in depression scores from enrollment to 3 months (before delayed group started intervention) favored the early group (mean difference, -3.4; SE, 1.5; d = -.32; P = .02). There were no differences in QOL (mean difference, -2; SE, 2.3; d = -.13; P = .39) or burden (objective: mean difference, 0.3; SE, .7; d = .09; P = .64; stress: mean difference, -.5; SE, .5; d = -.2; P = .29; demand: mean difference, 0; SE, .7; d = -.01; P = .97). In decedents' CGs, a terminal decline analysis indicated between-group differences favoring the early group for depression (mean difference, -3.8; SE, 1.5; d = -.39; P = .02) and stress burden (mean difference, -1.1; SE, .4; d = -.44; P = .01) but not for QOL (mean difference, -4.9; SE, 2.6; d = -.3; P = .07), objective burden (mean difference, -.6; SE, .6; d = -.18; P = .27), or demand burden (mean difference, -.7; SE, .6; d = -.23; P = .22). CONCLUSION Early-group CGs had lower depression scores at 3 months and lower depression and stress burden in the terminal decline analysis. Palliative care for CGs should be initiated as early as possible to maximize benefits.
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Affiliation(s)
- J Nicholas Dionne-Odom
- J. Nicholas Dionne-Odom, Andres Azuero, Imatullah Akyar, and Marie A. Bakitas, University of Alabama at Birmingham, Birmingham, AL; Kathleen D. Lyons, Jay G. Hull, Zhigang Li, and Mark T. Hegel, Dartmouth College; Tor Tosteson and Zhongze Li, Norris Cotton Cancer Center, Hanover; and Jennifer Frost and Konstantin H. Dragnev, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Andres Azuero
- J. Nicholas Dionne-Odom, Andres Azuero, Imatullah Akyar, and Marie A. Bakitas, University of Alabama at Birmingham, Birmingham, AL; Kathleen D. Lyons, Jay G. Hull, Zhigang Li, and Mark T. Hegel, Dartmouth College; Tor Tosteson and Zhongze Li, Norris Cotton Cancer Center, Hanover; and Jennifer Frost and Konstantin H. Dragnev, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Kathleen D Lyons
- J. Nicholas Dionne-Odom, Andres Azuero, Imatullah Akyar, and Marie A. Bakitas, University of Alabama at Birmingham, Birmingham, AL; Kathleen D. Lyons, Jay G. Hull, Zhigang Li, and Mark T. Hegel, Dartmouth College; Tor Tosteson and Zhongze Li, Norris Cotton Cancer Center, Hanover; and Jennifer Frost and Konstantin H. Dragnev, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Jay G Hull
- J. Nicholas Dionne-Odom, Andres Azuero, Imatullah Akyar, and Marie A. Bakitas, University of Alabama at Birmingham, Birmingham, AL; Kathleen D. Lyons, Jay G. Hull, Zhigang Li, and Mark T. Hegel, Dartmouth College; Tor Tosteson and Zhongze Li, Norris Cotton Cancer Center, Hanover; and Jennifer Frost and Konstantin H. Dragnev, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Tor Tosteson
- J. Nicholas Dionne-Odom, Andres Azuero, Imatullah Akyar, and Marie A. Bakitas, University of Alabama at Birmingham, Birmingham, AL; Kathleen D. Lyons, Jay G. Hull, Zhigang Li, and Mark T. Hegel, Dartmouth College; Tor Tosteson and Zhongze Li, Norris Cotton Cancer Center, Hanover; and Jennifer Frost and Konstantin H. Dragnev, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Zhigang Li
- J. Nicholas Dionne-Odom, Andres Azuero, Imatullah Akyar, and Marie A. Bakitas, University of Alabama at Birmingham, Birmingham, AL; Kathleen D. Lyons, Jay G. Hull, Zhigang Li, and Mark T. Hegel, Dartmouth College; Tor Tosteson and Zhongze Li, Norris Cotton Cancer Center, Hanover; and Jennifer Frost and Konstantin H. Dragnev, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Zhongze Li
- J. Nicholas Dionne-Odom, Andres Azuero, Imatullah Akyar, and Marie A. Bakitas, University of Alabama at Birmingham, Birmingham, AL; Kathleen D. Lyons, Jay G. Hull, Zhigang Li, and Mark T. Hegel, Dartmouth College; Tor Tosteson and Zhongze Li, Norris Cotton Cancer Center, Hanover; and Jennifer Frost and Konstantin H. Dragnev, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Jennifer Frost
- J. Nicholas Dionne-Odom, Andres Azuero, Imatullah Akyar, and Marie A. Bakitas, University of Alabama at Birmingham, Birmingham, AL; Kathleen D. Lyons, Jay G. Hull, Zhigang Li, and Mark T. Hegel, Dartmouth College; Tor Tosteson and Zhongze Li, Norris Cotton Cancer Center, Hanover; and Jennifer Frost and Konstantin H. Dragnev, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Konstantin H Dragnev
- J. Nicholas Dionne-Odom, Andres Azuero, Imatullah Akyar, and Marie A. Bakitas, University of Alabama at Birmingham, Birmingham, AL; Kathleen D. Lyons, Jay G. Hull, Zhigang Li, and Mark T. Hegel, Dartmouth College; Tor Tosteson and Zhongze Li, Norris Cotton Cancer Center, Hanover; and Jennifer Frost and Konstantin H. Dragnev, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Imatullah Akyar
- J. Nicholas Dionne-Odom, Andres Azuero, Imatullah Akyar, and Marie A. Bakitas, University of Alabama at Birmingham, Birmingham, AL; Kathleen D. Lyons, Jay G. Hull, Zhigang Li, and Mark T. Hegel, Dartmouth College; Tor Tosteson and Zhongze Li, Norris Cotton Cancer Center, Hanover; and Jennifer Frost and Konstantin H. Dragnev, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Mark T Hegel
- J. Nicholas Dionne-Odom, Andres Azuero, Imatullah Akyar, and Marie A. Bakitas, University of Alabama at Birmingham, Birmingham, AL; Kathleen D. Lyons, Jay G. Hull, Zhigang Li, and Mark T. Hegel, Dartmouth College; Tor Tosteson and Zhongze Li, Norris Cotton Cancer Center, Hanover; and Jennifer Frost and Konstantin H. Dragnev, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Marie A Bakitas
- J. Nicholas Dionne-Odom, Andres Azuero, Imatullah Akyar, and Marie A. Bakitas, University of Alabama at Birmingham, Birmingham, AL; Kathleen D. Lyons, Jay G. Hull, Zhigang Li, and Mark T. Hegel, Dartmouth College; Tor Tosteson and Zhongze Li, Norris Cotton Cancer Center, Hanover; and Jennifer Frost and Konstantin H. Dragnev, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
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199
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Influence of caregiver personality on the burden of family caregivers of terminally ill cancer patients. Palliat Support Care 2015; 14:5-12. [DOI: 10.1017/s1478951515000073] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
AbstractObjective:To determine the influence of caregiver personality and other factors on the burden of family caregivers of terminally ill cancer patients.Method:We investigated a wide range of factors related to the patient–family caregiver dyad in a palliative care setting using a cross-sectional design. Caregiver burden was assessed using the seven-item short version of the Zarit Burden Interview (ZBI–7). Caregiver personality was assessed using the 10-item short version of the Big Five Inventory (BFI–10), which measures the following five personality dimensions: extroversion, agreeableness, conscientiousness, neuroticism, and openness. Patient- and caregiver-related sociodemographic and psychological factors were included in the analysis because of their potential association with caregiver burden. Clinical patient data were obtained from medical charts or by using other measures. Multivariate linear regression analysis was performed to identify the independent factors associated with caregiver burden.Results:We analyzed 227 patient–family caregiver dyads. The multivariate analysis revealed that caregiver extroversion was protective against caregiver burden, whereas depressive symptoms in caregivers were related to increased burden. Neuroticism was positively correlated with caregiver burden, but this relationship was nonsignificant following adjustment for depressive symptoms. Patient-related factors were not significantly associated with caregiver burden.Significance of Results:Evaluating caregiver personality traits could facilitate identification of individuals at greater risk of high burden. Furthermore, depression screening and treatment programs for caregivers in palliative care settings are required to decrease caregiver burden.
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Wood AW, Gonzalez J, Barden SM. Mindful caring: using mindfulness-based cognitive therapy with caregivers of cancer survivors. J Psychosoc Oncol 2015; 33:66-84. [PMID: 25397963 DOI: 10.1080/07347332.2014.977418] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Caregivers of cancer survivors face many burdens that often require treatment by mental health professionals. One intervention, mindfulness-based cognitive therapy, aims to help individuals change the ways in which they relate to their thoughts rather than changing their thoughts. In this manuscript, we discuss the use and adaption of mindfulness-based cognitive therapy with caregivers of cancer survivors as a way to decrease caregiver burden and increase caregiver quality of life. A session-by-session breakdown of how to tailor mindfulness-based cognitive therapy to caregivers of cancer survivors is provided.
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Affiliation(s)
- Andrew W Wood
- a Department of Child , Family, and Community Sciences, University of Central Florida , Orlando , FL , USA
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