Physical and socioeconomic burden of caregiving on family caregivers of children with cancer at a tertiary Hospital in Ghana

Psychological adaptation profiles are associated with coping style, social support, and family intimacy in caregivers of children with hematologic malignancies: a cross-sectional study

BACKGROUND

Caregivers of children with hematologic malignancies face significant physical and psychological challenges. Identifying psychological adaptation profiles and their influencing factors is essential for developing targeted interventions to support this vulnerable population.

OBJECTIVE

This study aimed to identify distinct psychological adaptation profiles among caregivers of children with hematologic malignancies and explore the roles of family intimacy, social support and coping styles in psychological adaptation.

METHODS

A cross-sectional study was conducted among caregivers of children with hematologic malignancies. Participants completed questionnaires focusing on sociodemographic information, medical information, coping style, social support, and family intimacy. Latent profile analysis was used to identify distinct psychological adaptation profiles. Mediation analysis was performed to explore the role of positive coping strategies in the relationship between family intimacy and psychological adaptation.

RESULTS

Three psychological adaptation profiles were identified: the well-adapted group (35.8%), the general adaptation group (54.9%), and the maladaptive group (9.3%). Caregivers in the maladaptive group were more likely to have lower education levels and weaker family support networks. Mediation analysis revealed that family intimacy had both direct and indirect effects on psychological adaptation through positive coping strategies, with the indirect effect accounting for 31.62% of the total effect. These findings highlight the dynamic interplay between environmental factors and individual behaviors in shaping psychological adaptation.

CONCLUSION

This study emphasizes the importance of designing interventions tailored to different psychological adaptation profiles. For caregivers in the maladaptive group, interventions should focus on improving coping skills. For the general adaptation group, enhancing family support and coping strategies could further improve their adaptation. Family-centered approaches and coping skills training are critical to promoting psychological resilience in caregivers.

Mediating Role of Parent-Child Conflict in the Association Between Parental Anxiety and Emotional Behavioral Problems Among Children With Leukemia

BACKGROUND

There is a documented risk of emotional and behavioral disorders in children with leukemia. Assessing the factors contributing to their behavioral disorders is particularly important from a prevention perspective.

OBJECTIVE

The aim of this study was to study the influencing factors of internalizing and externalizing behaviors in children with leukemia from the perspective of adult family members.

METHODS

Cluster sampling was utilized to recruit a sample of 219 children diagnosed with leukemia. The caregivers of these children completed assessments on parental anxiety, parent-child conflict, and internalizing and externalizing child behavior problems.

RESULTS

Study findings indicate that children diagnosed with leukemia exhibit significant internalizing and externalizing behavior problems. Parental anxiety has a positive direct impact on both the internalizing and externalizing behavioral difficulties experienced by their children. Furthermore, parental anxiety indirectly influences the occurrence of internalizing and externalizing behavior problems through parent-child conflict.

CONCLUSION

Findings underscore the potential for enhancing the parent-child relationship as a means to mitigate children's internalizing and externalizing problems by reducing parent-child conflict and parental anxiety.

IMPLICATIONS FOR PRACTICE

The child and family-centered care approach in pediatric nursing is fundamental in assessing and addressing the needs of the child and family. To ameliorate emotional behavior issues in children with leukemia, the quality of the parent-child relationship needs to be considered as a pivotal component of family-based interventions and clinical practice.

Health and economic impact of caregiving on informal caregivers of people with chronic diseases in sub-Saharan Africa: A systematic review

With a disproportionate burden of chronic diseases and severe shortage of health workers in sub-Saharan Africa, the region implicitly relies on informal caregivers (ICGs) to support the patients both within and outside the health facilities. The aim of this review is to systematically summarise evidence on the health and economic impact of caregiving on informal caregivers of patients with chronic diseases in sub-Saharan Africa. Medline (Ovid), CINAHL (EBSCOhost), PsycINFO (Ovid), Embase (Ovid), Global Health, and Web of Science databases were systematically searched to identify original articles that considered the economic and/or health impacts of caregiving in sub-Saharan Africa. The results from the included studies were synthesised narratively. After screening 4,951 records, 47 studies were included for synthesis. The articles were from all sub-regions of sub-Saharan Africa with more than half (25/47) of the studies focussing on caregivers for patients with cancer. Although the primary motivation for becoming caregivers was love and responsibility, the caring responsibilities described in twenty studies, had profound effects on the caregiver's lives. Healthwise, the informal caregivers experienced changes in their physical and mental health like developing musculoskeletal problems and depression. Economically, caregiving was expensive, and financially draining. The opportunity cost of caregiving included loss of jobs, loss of income, foregoing planned important activities and missed education opportunities. Informal caregivers reported a range of mainly negative health and economic effects of the work they do. Health care systems should consider how to better support caregivers in terms of their own physical and mental wellbeing. Also, governments should develop strategies to financially support informal caregivers.

Financial strain and resilience: a qualitative exploration of parental perspectives on caring for children with sickle cell disease in Ghana

BACKGROUND

In Ghana, nearly one in four (25%) of the population are sickle cell disease carriers. Furthermore, 2% of all babies born (20 for every 1000 live births) has sickle cell disease. However, little is known about how parents negotiate the financial challenges facing parents of a child with sickle cell disease. This study explores the financial difficulties of parents and children living with sickle cell disease.

METHODS

The study adopted a qualitative approach. Twenty-seven parents were purposively selected from a sickle cell clinic in Accra, Ghana. Data collection was through an in-depth, face-to-face interview, using an interview guide based on the research objectives, and analyzed using thematic analysis.

RESULT

The findings showed that parents faced multiple financial difficulties (both direct and indirect) as they met the direct cost of medications, routine laboratory investigations, and hospital admissions. The National Health Insurance scheme does not wholly cover these costs. Families also describe more indirect costs, such as those associated with maintaining their child's well-being alongside those connected to their caring responsibilities, including the impact of giving up work and reducing working hours. Findings highlight the most pressing challenge, including the lack of access to financial support and a more general lack of understanding of the difficulties they faced on the part of policymakers.

CONCLUSION

Supporting sickle cell parents' financial needs would improve their emotional and social well-being, enabling them to be more effective family carers.

A qualitative study on the experiences of family caregivers of children with End Stage Kidney Disease (ESKD)

BACKGROUND

Family caregivers, mostly parents, are greatly involved in the care of their children with end stage kidney disease (ESKD) globally. Yet, the experiences of these caregivers and the demands placed on them by the caregiving role have not been explored or documented in Ghana. This study explored how caregiving affects the psychological, physical, social, and spiritual well-being of family caregivers of children with end stage kidney disease (ESKD) in Ghana.

METHODS

A phenomenological approach with the purposive sampling technique was used to gather data from 12 family caregivers of children with ESKD at a pediatric renal unit in Ghana. A semi-structured interview guide was constructed based on the constructs of the City of Hope Quality of Life (QoL) Family Caregiver Model and the research objectives. Colaizzi's thematic analysis approach was utilized to analyze data for this study. Themes were organized under the domains of the chosen model, and a new theme outside these domains was also generated.

RESULTS

The majority of the family caregivers experienced anxiety, fear, uncertainty, and hopelessness in response to the children's diagnosis and care. The thought of the possibility of the children dying was deeply traumatizing for our participants. Most participants reported bodily pains and physical ailments because of lifting and caring for the children. Financial constraint was also a key issue for all the family caregivers. Most of them received diverse support from their families and loved ones. Due to the demanding nature of the care, most family caregivers had to change or quit their jobs. They coped with the challenges through prayers, participating in religious activities, and being hopeful in God for healing.

CONCLUSION

All the family caregivers had their psychological well-being compromised as a result of the challenges they encountered physically, socially, and spiritually. Continuous psychosocial support, funding support, and review of policies on leave for civil workers with children diagnosed with ESKD are urgently required.

Exploring the burden on family caregivers in providing care for their mentally ill relatives in the Upper East Region of Ghana

Caring for the mentally ill involves numerous challenges, including financial difficulties, stigma, and psychosocial issues, among others. Unpaid family caregivers must endure these challenges as they continue their care for their relatives with mental illness. Despite these burdens and their concomitant effects on both the patients and their caregivers, there is no evidence of this burden in the Bolgatanga municipality. This study explored the burden on family caregivers providing care for mentally ill relatives in the Bolgatanga Municipality of the Upper East Region of Ghana. The study employed a phenomenological research design. Fifteen family caregivers were purposively sampled from two secondary-level health facilities. In-depth interviews were conducted, audio-recorded, and transcribed verbatim. NVivo 12 pro software was used for data analysis. Thematic analysis was conducted following Braun and Clarke's approach. The study identified three themes including social, physical, and psychological burdens. Under social burden, financial challenges and stigma were identified, weight loss was identified as a physical burden, and poor concentration as a psychological burden. These themes represent the challenges encountered by the family caregivers as they provided care for their mentally ill relatives. There is a need to provide support for family caregivers including respite, formation of support groups, and financial support to alleviate family caregivers of the burdens they endure. Additionally, it is imperative to integrate mental health services into the national health insurance scheme to alleviate the financial burden on family caregivers.

Experiences of caregivers of children with cancer in Malawi: A qualitative study

BACKGROUND

Studies have shown that caregivers of children with cancer experience challenges when caring for their children. To date, no studies have examined the experience of caregivers of children with cancer in Malawi, a low-income country in sub-Saharan Africa. Hence, this study aimed to explore the experiences of caregivers of Malawian children receiving cancer treatment.

METHODS

This explorative qualitative study used semi-structured interviews to collect data from 22 caregivers of children receiving cancer treatment. The data were analysed using qualitative content analysis.

RESULTS

Five themes emerged from the QCA. The caregivers perceived their children's cancer as a burden, a form of psychological torture and a disruptor of family routines and social lifestyles. They also reported self-isolation due to the stigma that they faced in the course of caring for their children and a need for informational, psychosocial, spiritual and financial support.

CONCLUSION

Caregivers of Malawian children with cancer experience physical and psychosocial challenges as they are caring for their children with cancer. Developing appropriate interventions would enable nurses to offer optimal support to these caregivers in dealing with these challenges and meeting their needs effectively.

Impact of childhood and adolescence cancer on family caregivers: a qualitative analysis of strains, resources and coping behaviours

BACKGROUND

The physical demands of caring for children and adolescents diagnosed with cancer, over a lengthy period, exert significant strain on the health and well-being of family caregivers. The capacity of family caregivers to surmount and cope with the various strains they experience due to the diagnosis and treatment trajectory is essential to the quality of life of the child and adolescent who has been diagnosed with cancer. However, the experiences of family caregivers have been under-explored. This study explored the strains, resources, and coping strategies of family caregivers of children and adolescents diagnosed with cancer in Ghana.

METHODS

Guided by a descriptive phenomenological design, 20 semi-structured interviews with family caregivers were conducted at a tertiary health facility that provides paediatric oncology services. The study was conducted between June and October 2022. The interviews were transcribed verbatim, translated and coded using NVivo software. An inductive thematic analysis approach using Vaismoradi et al.'s thematic analysis framework was followed in analysing the data.

RESULTS

The study revealed that family caregivers of children diagnosed with cancer experienced three main strains: somatic strains (poor sleep quality, loss of appetite, and unintended weight loss), economic strains (financial burden and loss of economic livelihood), and psychosocial strains (isolation from social activities and network, frustration and helplessness, and balancing multiple family needs). The following themes emerged as coping resources: family cohesiveness, community support, and support from health care providers. Coping strategies that emerged included trusting in God and being self-motivated.

CONCLUSION

The study concludes that family caregivers experience somatic, economic, and psychosocial strains. However, they can leverage available resources (family cohesiveness, community support, and support from healthcare providers) to cope with these strains. There is a need to educate and sensitize family caregivers about the potential strains that they are likely to experience prior to the assumption of care roles. Also, the formal inclusion of non-governmental organizations and religious bodies will ensure that family caregivers receive sufficient community support to cope with the strains of caregiving.

A burden shared: the financial, psychological, and health-related consequences borne by family members and caregivers of people with cancer in India

In India, approximately 1.4 million new cases of cancer are recorded annually, with 26.7 million people living with cancer in 2021. Providing care for family members with cancer impacts caregivers' health and financial resources. Effects on caregivers' health and financial resources, understood as family and caregiver "financial toxicity" of cancer, are important to explore in the Indian context, where family members often serve as caregivers, in light of cultural attitudes towards family. This is reinforced by other structural issues such as grave disparities in socioeconomic status, barriers in access to care, and limited access to supportive care services for many patients. Effects on family caregivers' financial resources are particularly prevalent in India given the increased dependency on out-of-pocket financing for healthcare, disparate access to insurance coverage, and limitations in public expenditure on healthcare. In this paper, we explore family and caregiver financial toxicity of cancer in the Indian context, highlighting the multiple psychosocial aspects through which these factors may play out. We suggest steps forward, including future directions in (1) health services research, (2) community-level interventions, and (3) policy changes. We underscore that multidisciplinary and multi-sectoral efforts are needed to study and address family and caregiver financial toxicity in India.