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Bahramnezhad F, Jackson AC, Mousavi M, Mirmoghtadaie ZS, Asgari A. A Randomized Controlled Trial Comparing the Effect of Tracheostomy Training using Mannequin-Based Simulation and Smartphone Application on Self-Efficacy and Anxiety of Caregivers. Home Healthc Now 2024; 42:161-167. [PMID: 38709582 DOI: 10.1097/nhh.0000000000001245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
Inefficient education is a cause of anxiety and low self-efficacy among caregivers, especially for those caring for patients with tracheostomy. This randomized controlled trial aimed to compare the outcomes of tracheostomy care education by mannequin-based simulation and smartphone application. The participants were 126 primary caregivers of tracheostomy patients being discharged home from hospitals affiliated with Tehran University of Medical Sciences. The control group received routine care. Caregiver self-efficacy was assessed using the Caregiver Inventory and the Hamilton Anxiety Rating Scale prior to the education and 1 month after. There were significant differences among the three groups regarding the mean scores of self-efficacy and anxiety. There was a significant increase in self-efficacy (P ≤ .0001) and a significant decrease in anxiety (P ≤ .0001) scores after the intervention. The intergroup comparison showed a significant difference between the intervention groups and the control group in terms of changes in the anxiety and self-efficacy scores of caregivers (P < .001).
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Theißen T, Ullrich A, Oechsle K, Wikert J, Bokemeyer C, Schieferdecker A. "Being an informal caregiver - strengthening resources": mixed methods evaluation of a psychoeducational intervention supporting informal caregivers in palliative care. BMC Palliat Care 2024; 23:95. [PMID: 38600500 PMCID: PMC11007958 DOI: 10.1186/s12904-024-01428-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 04/04/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Informal caregivers are key support for patients with progressive incurable diseases. However, their own needs often remain unmet. Therefore, we developed, manualised and implemented the intervention "Being an informal caregiver - strengthening resources" aiming to support and empower informal caregivers by addressing relevant information-related, physical, psychological and social needs. METHODS In this pilot study, we evaluated the acceptance and experiences with this psychoeducational intervention. The study was conducted over two years (2019-2021). Informal caregivers were recruited from the University Medical Centre Hamburg-Eppendorf and the metropolitan region of Hamburg, Germany. The intervention was aimed at adult persons who identified themselves as an informal caregiver to an adult patient with a progressive incurable cancer and non-cancer disease. For the evaluation we used a mixed methods approach, combining a longitudinal questionnaire survey (pre-intervention, after each module, 3-months follow-up) and semi-structured interviews post-intervention. Quantitative data were analysed using descriptive statistics and a paired t-Test, interviews were analysed based on the qualitative content analysis according to Mayring. Results were triangulated using a convergent triangulation design. RESULTS Of 31 informal caregivers who received the intervention, 25 returned the follow-up questionnaire and 20 informal caregivers were interviewed. Triangulated results showed a high satisfaction with the implementation of the intervention. Of a broad range of subjective benefits, gaining knowledge, self-awareness and self-efficacy were most apparent. Informal caregivers reported improved preparedness, awareness of own needs as well as confidence regarding handling own emotions and interacting with the ill person. However, implementing the learned skills into daily life can be challenging due to internal and external factors. Motivations and challenges for participating as well as potential for improvement were identified. CONCLUSIONS This pilot study showed an overall positive evaluation and several subjective benefits of the psychoeducational intervention "Being an informal caregiver - strengthening resources". Further research is needed to measure the efficacy of this intervention on informal caregivers' outcomes. Therefore, a multicentre randomized prospective study is planned.
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Affiliation(s)
- Tabea Theißen
- Palliative Care Unit, Department of Oncology, Haematology and BMT, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Anneke Ullrich
- Palliative Care Unit, Department of Oncology, Haematology and BMT, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Karin Oechsle
- Palliative Care Unit, Department of Oncology, Haematology and BMT, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Julia Wikert
- Palliative Care Unit, Department of Oncology, Haematology and BMT, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
- Department of Palliative Medicine, LMU University Hospital, Munich, Germany
| | - Carsten Bokemeyer
- Palliative Care Unit, Department of Oncology, Haematology and BMT, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Aneta Schieferdecker
- Palliative Care Unit, Department of Oncology, Haematology and BMT, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
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Sugihara Y, Sugisawa H. Influence of medical care tasks on subjective burden and gain among older adults' family caregivers: structural equation modeling for testing the role of formal and informal support. BMC Geriatr 2023; 23:628. [PMID: 37803249 PMCID: PMC10559595 DOI: 10.1186/s12877-023-04348-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 09/25/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND The number of caregivers performing medical care tasks at home for older adults is expected to increase. Family caregivers, who are not healthcare professionals, are likely to find these activities difficult and burdensome. However, appropriate support may decrease the negative and increase the positive aspects of caregiving. This study investigated direct associations between caregivers providing medical care at home and their negative and positive appraisals of caregiving (burden and gain), indirect associations through healthcare professional support and informal support, and whether the associations between medical care tasks and caregivers' appraisals of caregiving differed based on the support received. METHODS Interview surveys were conducted in 2013, 2016, and 2019 in a Tokyo Metropolitan Area city with family caregivers of community-dwelling older adults who were certified as requiring care in Japan's long-term care insurance system. This study analyzed the combined data from each survey (n = 983). Structural equation modeling (SEM) analysis was utilized to examine direct associations between providing medical care and caregiver appraisals and indirect relationships through healthcare professional support and informal support. The modulating effects of these forms of support on the relationship between medical care and caregiver appraisals were assessed using multigroup SEM analyses. RESULTS Approximately 9% of family caregivers provided medical care at home. The results of SEM analyses, controlled for care recipients' physical and cognitive difficulties; caregivers' age, sex, and economic condition; and survey year, revealed no direct associations between providing medical care and caregivers' sense of burden and gain. They also did not reveal any indirect effects through either healthcare professional support or informal support. However, the results of multigroup SEM analyses indicated that caregivers providing medical care who used home-visit services by physicians and/or nurses, compared to those who did not, tended to exhibit a greater sense of gain. CONCLUSIONS These results suggest that family caregivers providing medical care at home can positively change their appraisals of caregiving if they receive appropriate support. Home medical care services provided by healthcare professionals can effectively support caregivers. Developing strategies and policies to make medical care services at home more accessible to caregivers is crucial.
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Affiliation(s)
- Yoko Sugihara
- Department of Urban Science and Policy, Faculty of Urban Environmental Sciences, Tokyo Metropolitan University, 1-1 Minami-Osawa, Hachioji-shi, Tokyo, 192-0397, Japan.
| | - Hidehiro Sugisawa
- Gerontology Program, J. F. Oberlin University Graduate School of International Studies, 1-1- 12 Sendagaya, Shibuya-ku, Tokyo, 151-0051, Japan
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4
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Riffin C, Brody L, Mukhi P, Herr K, Pillemer K, Rogers M, Henderson CR, Reid MC. Establishing the Feasibility and Acceptability of a Caregiver Targeted Intervention to Improve Pain Assessment Among Persons With Dementia. Innov Aging 2023; 7:igad074. [PMID: 38094933 PMCID: PMC10714902 DOI: 10.1093/geroni/igad074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Indexed: 02/01/2024] Open
Abstract
Background and Objectives Despite its prevalence and impact, pain is underdetected and undermanaged in persons with dementia. Family caregivers are well positioned to detect pain and facilitate its management in their care recipients, but they lack training in symptom recognition and communication. This study reports findings from a pilot trial evaluating the Pain Identification and Communication Toolkit (PICT), a multicomponent intervention that provides training in observational pain assessment and coaching in pain communication techniques. Research Design and Methods Family caregivers of persons with comorbid pain and moderate-to-advanced dementia were randomly assigned to PICT (n = 19) or a control condition (n = 15). Caregivers in the PICT group participated in four weekly sessions delivered by telephone with a trained interventionist; caregivers in the control group received an information pamphlet about pain and dementia. All participants completed surveys at baseline and 12 weeks. Caregivers in the intervention group also completed semistructured interviews at 12 weeks. Quantitative data were analyzed using descriptive statistics and t tests; qualitative data were analyzed using content analysis. Results All participants (100%) in the PICT group completed the intervention and most completed the 12-week assessment (94%). PICT randomized caregivers reported that the intervention helped them to feel more confident in their ability to recognize (67%) and communicate about pain symptoms (83%). At 12 weeks, caregivers in the PICT group showed a statistically significant improvement in self-efficacy in pain-related communication. In qualitative interviews, caregivers emphasized the utility of PICT's components, including pain assessment tools, and offered considerations for future enhancements, such as technology-based adaptations and integration within care delivery systems. Discussion and Implications This pilot trial demonstrates that PICT is feasible to implement, acceptable to caregivers, and has the potential to improve confidence in recognizing and communicating about pain. Results support conducting a fully powered efficacy trial, an important step toward future integration into real-world care delivery. Clinical Trial Registration Number NCT03853291.
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Affiliation(s)
- Catherine Riffin
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Lilla Brody
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Priya Mukhi
- College of Human Ecology, Cornell University, Ithaca, New York, USA
| | - Keela Herr
- College of Nursing, University of Iowa, Iowa City, Iowa, USA
| | - Karl Pillemer
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
- College of Human Ecology, Cornell University, Ithaca, New York, USA
| | - Madeline Rogers
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | | | - M Cary Reid
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
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Armitage AE, Fonkem E. Supportive care of neurodegenerative patients. Front Oncol 2023; 13:1029938. [PMID: 36865803 PMCID: PMC9974138 DOI: 10.3389/fonc.2023.1029938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 01/06/2023] [Indexed: 02/16/2023] Open
Abstract
Neurodegenerative illnesses are notorious for paucity of treatments and relentless clinical progression. Illness may follow a relatively acute presentation, as is seen with primary brain tumors such as glioblastoma or have a more insidious onset with a slower yet unyielding course, such as that seen in Parkinson's disease. Though disparate in presentation, these neurodegenerative illnesses are universally terminal, and both the patients and their families benefit from the intervention of supportive care in conjunction with primary disease management. Supportive palliative care has been shown to improve quality of life, enhance patient outcomes, and often extend patient life-but such care needs to be tailored. This clinical commentary examines the role of supportive palliative care in the management of neurologic patients, comparing and contrasting glioblastoma patients with idiopathic Parkinson's disease patients. Both patient populations are high utilizers of healthcare resources, require active management of multiple symptoms, and have high caregiver burden which underscores the need for supportive services in conjunction with disease management provided by the primary care team. Review of prognostication, patient and family communication, trust and relationship building, and complementary medicinal approaches are explored for these two diseases which broadly represent two differing poles of incurable neurological illness.
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Affiliation(s)
- A. E. Armitage
- Department of Supportive Palliative Care, Baylor Scott and White Health, Temple, TX, United States,*Correspondence: A. E. Armitage, ; E. Fonkem,
| | - E. Fonkem
- Department of Neurosurgery, Baylor Scott and White Health, Temple, TX, United States,*Correspondence: A. E. Armitage, ; E. Fonkem,
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Abstract
The informal caregiver experience has surged as a research topic in health care, including in nursing. However, the "informal" language is controversial, lacking conceptual clarity. Without a common understanding of who an "informal caregiver" may be, nurses may fail to consistently identify informal caregivers requiring support. Therefore, a concept analysis of "informal caregiver" was conducted on the basis of a sample of 20% of relevant nursing literature. The analysis of the attributes, antecedents, consequences, and contexts associated with "informal caregiver" offers a foundational guide for the ongoing development of nurses' understanding of the informal caregiver role.
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Wan SW, Chong CS, Toh EL, Lim SH, Loi CT, Lew YFH, Chua MCH, Jee XP, Liu G, Zhu L, Pikkarainen M, He HG. A Theory-Based, Multidisciplinary Approach to Cocreate a Patient-Centric Digital Solution to Enhance Perioperative Health Outcomes Among Colorectal Cancer Patients and Their Family Caregivers: Development and Evaluation Study. J Med Internet Res 2021; 23:e31917. [PMID: 34878991 PMCID: PMC8693179 DOI: 10.2196/31917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 09/10/2021] [Accepted: 10/21/2021] [Indexed: 11/25/2022] Open
Abstract
Background Elective colorectal cancer (CRC) surgeries offer enhanced surgical outcomes but demand high self-efficacy in prehabilitation and competency in self-care and disease management postsurgery. Conventional strategies to meet perioperative needs have not been pragmatic, and there remains a pressing need for novel technologies that could improve health outcomes. Objective The aim of this paper was to describe the development of a smartphone-based interactive CRC self-management enhancement psychosocial program (iCanManage) in order to improve health outcomes among patients who undergo elective CRC surgeries and their family caregivers. Methods A multidisciplinary international team comprising physicians, specialist nurses, a psychologist, software engineers, academic researchers, cancer survivors, patient ambassadors, and ostomy care medical equipment suppliers was formed to facilitate the development of this patient-centric digital solution. The process occurred in several stages: (1) review of current practice through clinic visits and on-site observations; (2) review of literature and findings from preliminary studies; (3) content development grounded in an underpinning theory; (4) integration of support services; and (5) optimizing user experience through improving interface aesthetics and customization. In our study, 5 participants with CRC performed preliminary assessments on the quality of the developed solution using the 20-item user version of the Mobile App Rating Scale (uMARS), which had good psychometric properties. Results Based on the collected uMARS data, the smartphone app was rated highly for functionality, aesthetics, information quality, and perceived impact, and moderately for engagement and subjective quality. Several limiting factors such as poor agility in the adoption of digital technology and low eHealth literacy were identified despite efforts to promote engagement and ensure ease of use of the mobile app. To overcome such barriers, additional app-training sessions, an instruction manual, and regular telephone calls will be incorporated into the iCanManage program during the trial period. Conclusions This form of multidisciplinary collaboration is advantageous as it can potentially streamline existing care paths and allow the delivery of more holistic care to the CRC population during the perioperative period. Should the program be found to be effective and sustainable, hospitals adopting this digital solution may achieve better resource allocation and reduce overall health care costs in the long run. Trial Registration ClinicalTrials.gov NCT04159363; https://clinicaltrials.gov/ct2/show/NCT04159363
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Affiliation(s)
- Su Wei Wan
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore, Singapore.,National University Health System, Singapore, Singapore
| | - Choon Seng Chong
- National University Health System, Singapore, Singapore.,Division of Colorectal Surgery and Surgical Oncology, Department of Surgery, National University Cancer Institute, National University Hospital, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ee-Lin Toh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Colorectal Surgery, Singapore General Hospital, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Siew Hoon Lim
- Division of Nursing, Singapore General Hospital, Singapore, Singapore
| | - Carol Tt Loi
- Centre of Psychosocial Support, Singapore Red Cross Academy, Singapore, Singapore
| | - Yuen Foong Henry Lew
- Department of Psychology, School of Humanities and Behavioural Science, Singapore University of Social Sciences, Singapore, Singapore
| | - Matthew Chin Heng Chua
- Medical and Cybernetics Systems, Institute of Systems Science, National University of Singapore, Singapore, Singapore
| | - Xin Pei Jee
- National University Health System, Singapore, Singapore.,Division of Colorectal Surgery, Department of Nursing, National University Hospital, Singapore, Singapore
| | - Guangyu Liu
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore, Singapore
| | - Lixia Zhu
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore, Singapore
| | - Minna Pikkarainen
- Faculty of Health Sciences and Faculty of Technology, Art and Design, Oslomet - Oslo Metropolitan University, Oslo, Norway.,Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden.,Faculty of Medicine and Oulu Business School, University of Oulu, Oulu, Finland
| | - Hong-Gu He
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore, Singapore.,National University Health System, Singapore, Singapore
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8
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Carbery M, Schwartz S, Werner N, Fields B. Education and skills training for care partners of hospitalised older adults: A scoping review. HEALTH EDUCATION JOURNAL 2021; 80:921-933. [PMID: 37131526 PMCID: PMC10150946 DOI: 10.1177/00178969211034192] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Background The care partners of hospitalised older adults often feel dissatisfied with the education and skills training provided to them, resulting in unpreparedness and poor health outcomes. Objective This review aimed to characterise and identify gaps in the education and skills training used with the care partners of older adults in the hospital. Methods We conducted a scoping review on the education and skills training practices used with the care partners of hospitalised older adults in the USA via sources identified in the PubMed, PsychINFO and CINAHL databases. Results Twelve studies were included in this review. Results illustrate that nurses utilise multiple modes of delivery and frequently provide education and skills training tailored to the needs of care partners at the latter end of hospital care. The provision of education and skills training varies greatly, however, including who provides education, in what way information is conveyed, and how care partner outcomes are measured. Conclusion This is the first scoping review to describe and synthesise the education and skills training practices used with care partners of hospitalised older adults. Findings highlight the need for education and skills training to be interprofessional, tailored to individual care partners' needs and begin at, or even before, the hospital admission of older adult patients.
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Affiliation(s)
- Madeline Carbery
- Department of Kinesiology, University of Wisconsin–Madison, Madison, WI, USA
| | - Samantha Schwartz
- Department of Kinesiology, University of Wisconsin–Madison, Madison, WI, USA
| | - Nicole Werner
- Department of Industrial and Systems Engineering, University of Wisconsin–Madison, WI, Madison, USA
| | - Beth Fields
- Department of Kinesiology, University of Wisconsin–Madison, Madison, WI, USA
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Yakerson A. Informal family caregiver experiences with publicly funded home care in Ontario. Home Health Care Serv Q 2021; 41:65-75. [PMID: 34842061 DOI: 10.1080/01621424.2021.2006849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Publicly funded home care in Ontario, Canada, is a critical component of the health care system. Over the last few decades the sector has undergone numerous reforms impacting the funding and provision of services. In light of this, the purpose of this study was to examine the lived experiences of informal family caregivers who seek in-home publicly funded care for their relatives. In doing so, the goal was to understand the circumstances and challenges faced by these individuals in accessing care and obtaining respite from their duties. This knowledge is fundamental to the health care system which seeks to prevent institutionalization as well as to minimize health care costs associated with the physical and psychological outcomes of informal caregiving.
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Affiliation(s)
- Alla Yakerson
- The Graduate Program in Health, York University, Toronto, Ontario, Canada
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10
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Levesque BPsych Hons PhD J, Bamgboje-Ayodele B Tech MSc PhD A, Paradiso BPsych Hons J, Descallar BSc MBiostats J, Girgis BSc PhD A. Cancer-related challenges, unmet needs and emotional distress in male caregivers of women with breast cancer: the influence of self-efficacy. J Psychosoc Oncol 2021; 40:519-526. [PMID: 34392802 DOI: 10.1080/07347332.2021.1955317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To explore the challenges, unmet needs, and emotional distress of male caregivers of women with breast cancer (BC); and determine how self-efficacy relates to these variables. Methods: Adult (≥18 yr) males currently caring for or who had previously cared for a woman with BC completed questionnaires assessing their emotional distress, challenges, unmet needs, and self-efficacy. Bivariate correlations determined the relationships between the variables used in the regression and mediation models. Mediation analysis examined whether cancer-related challenges and unmet needs predict emotional distress and whether self-efficacy mediates the relationships between challenges, unmet needs and distress, while accounting for education, employment, and time from diagnosis. Results: Self-efficacy was significantly negatively related to emotional distress, challenges experienced, and unmet needs. The mediation model accounted for a significant 18% of emotional distress variability. Self-efficacy did not mediate the relationship between challenges and emotional distress or between unmet needs and emotional distress. Conclusions: Male caregivers may benefit from interventions to enhance self-efficacy. Self-efficacy is a modifiable variable, ideally suited for inclusion in supportive interventions.
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Affiliation(s)
- Janelle Levesque BPsych Hons PhD
- Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Sydney, Australia.,School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | | | - Jessica Paradiso BPsych Hons
- School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Joseph Descallar BSc MBiostats
- Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - Afaf Girgis BSc PhD
- Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
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11
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Mollica MA, Kent EE. Caregiver Education and Training: Learning Preferences of Informal Caregivers of Adult Care Recipients. Clin J Oncol Nurs 2021; 25:483-487. [PMID: 34269341 DOI: 10.1188/21.cjon.483-487] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Oncology nurses play a key role in supporting caregivers through education and training in both inpatient and outpatient settings. This article describes the learning preferences of informal caregivers of adult care recipients. Caregiver respondents preferred multiple training methods, with most endorsing in-person instruction, online video instruction, and reading materials.
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Affiliation(s)
| | - Erin E Kent
- Lineberger Comprehensive Cancer Center at the University of North Carolina at Chapel Hill
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12
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Chowdhury MK, Shopna K, Lynch-Godrei A, Jain M, Farheen N, Begum N, Ahmad N, Doherty M. Providing Home-Based Support for Children with Chronic Conditions in an Urban Slum: Experiences from a Community-Based Palliative Care Program in Bangladesh. Glob Pediatr Health 2021; 8:2333794X21999155. [PMID: 33816710 PMCID: PMC7995301 DOI: 10.1177/2333794x21999155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 02/05/2021] [Indexed: 11/15/2022] Open
Abstract
We describe the palliative care needs of children with chronic conditions and their caregivers in an urban slum in Bangladesh. In this cross-sectional study, we interviewed 25 caregivers whose children receive support from a community-based program lead by community health workers, that provides medication, medical supplies, food, caregiver training, and psychological support free of charge. The chronic conditions of children in the program included cerebral palsy (80%), congenital heart disease (8%), neurodegenerative conditions (4%), cancer (4%), and intellectual disabilities (4%). Common symptoms included cough or breathing problems (64%), fever (56%), and pain (56%). Most caregivers (96%) reported they were unable to do any paid work due to their child's needs and in all families, the child's condition had a significant impact on their financial situation. Community-based palliative care programs can be developed to support children with chronic conditions who may not access care from acute care facilities.
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Affiliation(s)
| | | | | | - Mehr Jain
- University of Ottawa, Ottawa, ON, Canada
| | - Nadia Farheen
- Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | | | | | - Megan Doherty
- University of Ottawa, Ottawa, ON, Canada
- Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada
- Megan Doherty, Children’s Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, ON K1H8L1, Canada.
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13
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Thomas Hebdon MC, Coombs LA, Reed P, Crane TE, Badger TA. Self-efficacy in caregivers of adults diagnosed with cancer: An integrative review. Eur J Oncol Nurs 2021; 52:101933. [PMID: 33799022 DOI: 10.1016/j.ejon.2021.101933] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 03/03/2021] [Accepted: 03/04/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE Cancer caregivers experience health challenges related to their caregiving role, and self-efficacy can contribute to health outcomes through behavioral, environmental, and personal factors. The purpose of this integrative review was to examine self-efficacy in caregivers of adults diagnosed with cancer, including its association with health factors. METHOD A systematic search of PubMed, CINAHL, and PsychInfo yielded 560 articles. Following duplicate removal, 232 articles were screened for inclusion criteria with 71 articles remaining for final review. RESULTS Studies were generally quantitative (n = 67), with predominantly female (n = 55), White (n = 36) caregivers, between the ages of 45-60 (n = 48). Self-efficacy was significantly associated with quality of life, caregiver function, social support, hope, depression, anxiety, and burden as a predictor, mediator, and outcome. Physical health and social determinants of health (social support and financial well-being) were addressed among fewer studies than mental and emotional health outcomes. CONCLUSIONS Addressing self-efficacy in diverse populations and within physical, mental, and social health contexts will enhance understanding of how self-efficacy impacts caregivers of adults diagnosed with cancer. Nurses and other health care professionals can then effectively address supportive needs of caregivers in the personal, behavioral, and environmental domains.
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Affiliation(s)
| | - Lorinda A Coombs
- University of North Carolina Chapel Hill, School of Nursing, Lineberger Comprehensive Cancer Center, USA.
| | - Pamela Reed
- University of Arizona College of Nursing, 1305 N. Martin Ave., Tucson, AZ, 85721, USA.
| | - Tracy E Crane
- University of North Carolina Chapel Hill, School of Nursing, Lineberger Comprehensive Cancer Center, USA.
| | - Terry A Badger
- University of North Carolina Chapel Hill, School of Nursing, Lineberger Comprehensive Cancer Center, USA.
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14
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Mohamed NE, Shah QN, Kata HE, Sfakianos J, Given B. Dealing With the Unthinkable: Bladder and Colorectal Cancer Patients' and Informal Caregivers' Unmet Needs and Challenges in Life After Ostomies. Semin Oncol Nurs 2021; 37:151111. [PMID: 33423864 DOI: 10.1016/j.soncn.2020.151111] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES We examined patient and informal caregiver unmet needs to identify areas for targeted supportive care interventions and programs to enhance both patient and informal caregiver experience. DATA SOURCES A total of 30 patients who underwent ostomy surgeries for bladder or colorectal cancers and 13 informal caregivers participated in the study. Patients were enrolled at the Icahn School of Medicine at Mount Sinai between 2017 and 2018. Qualitative data were collected by individual interviews, audiotaped, and transcribed verbatim. Transcribed data were iteratively analyzed using Atlas.ti to explore patient and caregiver unmet needs. RESULTS Patients and informal caregivers reported having insufficient psychological preparation for ostomy surgeries, and very limited hands-on training on stoma care and utility of stomal appliances. Unmet psychological needs related to depression, anxiety, and distress caused by changes in body image and sexual, urinary, and bowel function were reported. Patients and caregivers also reported significant patient medical needs in the acute postoperative period including pain, fatigue, sleep disturbance, inflammation, and complications resulting in hospital readmissions. Colorectal cancer patients specifically experienced significant challenges with changes in diet and nutrition that contributed to ostomy care burden. Both patients and caregivers recommended seeking psychological and social support to enhance both patient and caregiver emotional adjustment to life after ostomies. CONCLUSION Meeting patient and informal caregiver unmet informational and supportive care needs is imperative to improve their quality of life and adjustment. IMPLICATIONS FOR NURSING PRACTICE An effective supportive care plan should be designed and utilized in clinical care to improve ostomy patients' and caregivers' outcomes.
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Affiliation(s)
- Nihal E Mohamed
- Department of Urology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Qainat N Shah
- Department of Urology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Medical Education, Albany Medical College, 43 New Scotland Ave, Albany, New York
| | - Holden E Kata
- Department of Urology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - John Sfakianos
- Department of Urology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Barbara Given
- College of Nursing, Michigan State University, 1355 Bogue St, East Lansing, Michigan
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15
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Knobloch LK, Nichols LO, Martindale-Adams J. Applying Relational Turbulence Theory to Adult Caregiving Relationships. THE GERONTOLOGIST 2020; 60:598-606. [PMID: 31228192 DOI: 10.1093/geront/gnz090] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Indexed: 01/06/2023] Open
Abstract
Although the quality of the relationship between caregivers and care recipients predicts the well-being of both people, gaps exist in understanding the interpersonal dynamics of adult caregiving. We introduce relational turbulence theory as a conceptual framework for understanding how caregivers and care recipients relate to each other. We searched for research on relational turbulence theory as well as research on the relationships of adult care partners. Then, we integrated the two bodies of work. Our review suggests initial support for the theory's three central tenets: (a) transitions, including the transition to caregiving, are key periods within relationships; (b) relational uncertainty and interdependence are relationship parameters that complicate relating during transitions; and (c) relational turbulence predicts outcomes. Recommendations for practice include (a) helping care partners focus on relationship continuity, (b) gearing clinical services toward both people, (c) educating them about relational uncertainty and interdependence, and (d) teaching them communication strategies for diminishing relational turbulence. Making care partners aware of interpersonal challenges may bolster relationship satisfaction.
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Affiliation(s)
| | - Linda O Nichols
- Veterans Affairs Medical Center Memphis and Departments of Preventive Medicine and Internal Medicine, University of Tennessee Health Science Center, Memphis
| | - Jennifer Martindale-Adams
- Department of Preventive Medicine, University of Tennessee Health Science Center and Veterans Affairs Medical Center Memphis, Memphis
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16
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Keeton VF, Trask J, Whitney R, Bell JF. Overburdened and Underprepared: Medical/Nursing Task Performance Among Informal Caregivers in the United States. J Gerontol Nurs 2020; 46:25-35. [DOI: 10.3928/00989134-20200811-05] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 04/28/2020] [Indexed: 11/20/2022]
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17
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Supportive care needs and service use during palliative care in family caregivers of patients with advanced cancer: a prospective longitudinal study. Support Care Cancer 2020; 29:1303-1315. [PMID: 32632761 PMCID: PMC7843549 DOI: 10.1007/s00520-020-05565-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 06/05/2020] [Indexed: 11/15/2022]
Abstract
Purpose This study aimed to investigate the supportive care needs of family caregivers (FCs) of advanced cancer patients and their support service use at the beginning of specialist inpatient palliative care (SIPC), near the patient’s death, and during bereavement. Methods FCs reported their needs using the Family Inventory of Needs (FIN), along with their utilization of psychosocial and bereavement support services at the beginning (N = 232) and 6–9 months after SIPC (N = 160). Results At the beginning of SIPC, mean of 16.9 of 20 needs were reported to be highly important, and 12.2 were reported to be met. At the time of the patient’s death, 16.8 needs were highly important, and 13.8 were met. At both time points, the highest ranked need was related to information about changes in the patient’s condition (100% vs. 99%), and the most frequently unmet need was related to feeling hope (73% vs. 71%). Multivariate linear regression analysis revealed a low education level to be consistently related to a greater number of highly important needs. Higher satisfaction with care and better social support was related to a greater number of met needs. Twenty-five percent of FCs had accessed at least one psychosocial support service prior to SIPC, and 30% had done so during bereavement. Among non-users of support services, > 75% indicated sufficient informal support as a barrier to service use. Conclusions The findings offer a useful guide for adequately addressing FCs’ needs in an effort to optimize FC support. However, only a subgroup of the FCs used support services. Better information and provision of tailored services might improve FCs’ situations in the future.
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Penagos Castro RV, Vargas Escobar LM. Efectividad de una intervención de enfermería para modificar la autoeficacia y la sobrecarga del cuidador del paciente hemato- oncológico. REVISTA CUIDARTE 2020. [DOI: 10.15649/cuidarte.867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introducción: El paciente hemato-oncológico va a requerir de un cuidador que lo ayude en el control de síntomas físicos, terapéuticas prescritas, apoyo emocional, entre otros. El cuidador debe prepararse, fortalecer su confianza y motivación a través de la autoeficacia de su rol ya que, si se siente eficaz para cuidar, podrá desarrollar su rol adecuadamente, disminuyendo las posibilidades de presentar sobrecarga. Materiales y Métodos: Estudio cuantitativo, cuasi experimental, con dos grupos, pre y pos prueba. El objetivo fue establecer la efectividad de una intervención de enfermería al compararla con la intervención estándar, en la modificación de la autoeficacia y la sobrecarga del rol de cuidador del paciente hemato-oncológico. Para la medición se usó la Escala General de Autoeficacia y la Escala de Zarit. Resultados: La intervención es efectiva para modificar la autoeficacia del cuidador, lo cual se evidencia en la comparación entre el grupo control y experimental posterior a la intervención pasando de 25,8 a 29,8 (p=0.00) en la escala de autoeficacia, así como al interior del grupo experimental pasando de 25,5 a 26,3 (p=0.00). No se observaron diferencias significativas respecto a la sobrecarga del rol de cuidador del paciente hemato-oncológico posterior a la intervención. Discusión: Se aporta una intervención efectiva desde la teoría de enfermería de Resnick para la práctica. Se requieren nuevos estudios que comprueben la efectividad de la intervención en otros contextos. Conclusiones: Las intervenciones educativas de enfermería con enfoque motivacional, son relevantes en la práctica y la investigación, para modificar la autoeficacia del cuidador del paciente hemato-oncológico.
Como citar este artículo: Penagos Castro Rodmar Vanessa, Vargas-Escobar Lina María. Efectividad de una intervención de enfermería para modificar la autoeficacia y la sobrecarga del cuidador del paciente hemato- oncológico. Revista Cuidarte. 2020; 11(2): e867. http://dx.doi.org/10.15649/cuidarte.867
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Doherty M, Power L, Petrova M, Gunn S, Powell R, Coghlan R, Grant L, Sutton B, Khan F. Illness-related suffering and need for palliative care in Rohingya refugees and caregivers in Bangladesh: A cross-sectional study. PLoS Med 2020; 17:e1003011. [PMID: 32126076 PMCID: PMC7053708 DOI: 10.1371/journal.pmed.1003011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 01/24/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Despite recognition that palliative care is an essential component of any humanitarian response, serious illness-related suffering continues to be pervasive in these settings. There is very limited evidence about the need for palliative care and symptom relief to guide the implementation of programs to alleviate the burden of serious illness-related suffering in these settings. A basic package of essential medications and supplies can provide pain relief and palliative care; however, the practical availability of these items has not been assessed. This study aimed to describe the illness-related suffering and need for palliative care in Rohingya refugees and caregivers in Bangladesh. METHODS AND FINDINGS Between November 20 and 24, 2017, we conducted a cross-sectional study of individuals with serious health problems (n = 156, 53% male) and caregivers (n = 155, 69% female) living in Rohingya refugee camps in Bangladesh, using convenience sampling to recruit participants at the community level (i.e., going house to house to identify eligible individuals). The serious health problems, recent healthcare experiences, need for medications and medical supplies, and basic needs of participants were explored through interviews with trained Rohingya community members, using an interview guide that had been piloted with Rohingya individuals to ensure it reflected the specificities of their refugee experience and culture. The most common diagnoses were significant physical disabilities (n = 100, 64.1%), treatment-resistant tuberculosis (TB) (n = 32, 20.5%), cancer (n = 15, 9.6%), and HIV infection (n = 3, 1.9%). Many individuals with serious health problems were experiencing significant pain (62%, n = 96), and pain treatments were largely ineffective (70%, n = 58). The average age was 44.8 years (range 2-100 years) for those with serious health problems and 34.9 years (range 8-75 years) for caregivers. Caregivers reported providing an average of 13.8 hours of care per day. Sleep difficulties (87.1%, n = 108), lack of appetite (58.1%, n = 72), and lack of pleasure in life (53.2%, n = 66) were the most commonly reported problems related to the caregiving role. The main limitations of this study were the use of convenience sampling and closed-ended interview questioning. CONCLUSIONS In this study we found that many individuals with serious health problems experienced significant physical, emotional, and social suffering due to a lack of access to pain and symptom relief and other essential components of palliative care. Humanitarian responses should develop and incorporate palliative care and symptom relief strategies that address the needs of all people with serious illness-related suffering and their caregivers.
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Affiliation(s)
- Megan Doherty
- Department of Pediatrics, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- World Child Cancer, London, United Kingdom
- * E-mail:
| | - Liam Power
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Mila Petrova
- Cambridge Palliative and End of Life Care Group, Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Scott Gunn
- Faculty of Medicine, Queens University, Kingston, Ontario, Canada
| | | | - Rachel Coghlan
- Centre for Humanitarian Leadership, Faculty of Arts and Education, Deakin University, Burwood, Victoria, Australia
| | - Liz Grant
- Usher Institute of Population Health Sciences and Informatics, Global Health Academy, Centre for Population Health Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Brett Sutton
- Health Protection and Emergency Management, Department of Health and Human Services, Melbourne, Victoria, Australia
| | - Farzana Khan
- Fasiuddin Khan Research Foundation, Dhaka, Bangladesh
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20
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Havyer RD, van Ryn M, Wilson PM, Bangerter LR, Griffin JM. Concordance of Patient and Caregiver Reports on the Quality of Colorectal Cancer Care. J Oncol Pract 2019; 15:e979-e988. [PMID: 31430216 PMCID: PMC6851791 DOI: 10.1200/jop.19.00136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2019] [Indexed: 11/20/2022] Open
Abstract
PURPOSE We aimed to better understand how similarly patients with colorectal cancer and caregivers view care quality and to assess factors that may influence concordance. MATERIALS AND METHODS We conducted a secondary analysis of paired patient and caregiver quality ratings of colorectal cancer care in three specific domains: surgery, chemotherapy overall, and chemotherapy nursing. Agreement was assessed with difference scores, concordance with Gwet second-order agreement statistics (AC2), and variation in agreement with stratified analyses. We examined whether the care experiences of patients and caregivers were associated with top-box (most-positive) ratings and examined variations in concordance on the basis of the presence of a top-box score. RESULTS Four hundred seventeen patient-caregiver dyads completed the surveys. Quality-of-care ratings were positively skewed, with most dyads indicating top-box ratings. Patient and caregiver care experiences were highly associated with top-box ratings. Overall patient-caregiver concordance was very high for all three care domains (surgery: AC2, 0.87 [95% CI, 0.83 to 0.90]; chemotherapy overall: AC2, 0.84 [95% CI, 0.79 to 0.88]; chemotherapy nursing: AC2, 0.91 [95% CI, 0.87 to 0.94]). Stratified analyses of patient and caregiver characteristics did not identify any patterns that consistently affected concordance. The concordance statistic significantly decreased for all three outcomes (P < .001), however, when the patient or caregiver assessed quality as anything other than top box. CONCLUSION Caregiver and patient reports on care quality were highly concordant for top-box care and did not vary with patient or caregiver factors. Additional exploration is needed to identify reasons for increased variability when the quality scores were less than a top-box response.
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21
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Overcash J, Fugett S, Tan A, Ginther J, Williams N. Strain Among Caregivers of Older Adults Diagnosed With Breast Cancer. Oncol Nurs Forum 2019; 46:E185-E201. [PMID: 31626615 DOI: 10.1188/19.onf.e185-e201] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To illustrate the predictors of strain among caregivers of older adults diagnosed with breast cancer. SAMPLE & SETTING This study involved 39 women diagnosed with breast cancer who were aged 69 years or older, receiving any type of treatment, and seeking an initial assessment in a geriatric oncology program at a large cancer center in the midwestern United States and their caregivers. METHODS & VARIABLES This cross-sectional study evaluated relationships among the variables of caregiver strain, age, employment status, patient characteristics, and patient scores on the comprehensive geriatric assessment. Bivariate statistics and logistic regression models were used. RESULTS Increasing age of the caregiver was associated with less caregiver strain. Caregivers employed part-time experienced greater strain than those employed full-time. IMPLICATIONS FOR NURSING Nurses must assess for strain in caregivers of individuals diagnosed with cancer, particularly if they are younger and employed part-time. Caregivers of depressed patients should be assessed for strain and offered support.
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Affiliation(s)
| | - Susan Fugett
- Ohio State University Comprehensive Cancer Center and the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute
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22
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Given CW. Family Caregiving for Cancer Patients: the State of the Literature and a Direction for Research to Link the Informal and Formal Care Systems to Improve Quality and Outcomes. Semin Oncol Nurs 2019; 35:389-394. [PMID: 31229345 DOI: 10.1016/j.soncn.2019.06.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Based on recent shifts in reimbursement for cancer treatment from fee-for-service to bundled and value-based payment, this concluding article summarizes data from these papers and the large body of literature on caregiving to suggest how caregiving research might be redirected to link the formal with the informal systems to achieve higher-quality and lower-cost care. Caregiver dyads, the tasks of care, and strategies for training are presented. DATA SOURCES Articles in this issue of Seminars in Oncology Nursing, the larger body of caregiving literature, and the Oncology Care Model driving bundled payments and value-based care. CONCLUSION Research on informal caregiving for cancer patients should begin to reframe the rich body of evidence available toward a focus on caregivers reactions to the tasks of care, the training necessary for caregivers to perform them, and how each contributes to quality care at lower costs and appropriate outcomes given patients' stage of disease and goals of treatment. IMPLICATIONS FOR NURSING PRACTICE Oncology systems must take a more active role in including patients and their families as partners to manage treatments and side effects to achieve the best possible patient outcomes. They must be able to evaluate the patient and the caregiver to determine what tasks they will be able to perform, and then make sure they have the training and resources to carry out those tasks. Training could be done by social media and through communication using patient portals that could be expanded through the electronic medical records to include caregiver portals, enabling caregiver questions and reports of patients' conditions.
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Affiliation(s)
- Charles W Given
- College of Nursing, Michigan State University, East Lansing, MI.
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Irwin MM, Dudley W, Northouse L, Berry DL, Mallory GA. Oncology Nurses' Knowledge, Confidence, and Practice in Addressing Caregiver Strain and Burden. Oncol Nurs Forum 2019; 45:187-196. [PMID: 29466346 DOI: 10.1188/18.onf.187-196] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To describe nurses' practices, confidence, and knowledge of evidence-based interventions for cancer caregiver strain and burden and to identify factors that contribute to these aspects.
. SAMPLE & SETTING 2,055 Oncology Nursing Society members completed an emailed survey.
. METHODS & VARIABLES Pooled analysis of survey results. Variables included the baseline nursing assessment, intervention, confidence, knowledge, strategies used, and barriers encountered.
. RESULTS Nurses tend to overestimate the strength of evidence for interventions not shown to be effective and have moderate confidence in assessing and intervening with caregivers. Having been an informal caregiver and having received care from an informal caregiver were associated with higher reported practice and confidence. Major strategies used were referral to social workers and others. Barriers reported were financial, caregiver emotional responses, and distance.
. IMPLICATIONS FOR NURSING An opportunity exists to increase nurses' knowledge and confidence in assessment and intervention with caregivers. Greater use of technology may help nurses overcome some barriers to working with caregivers. Findings can be used to plan continuing education, develop clinical processes, and identify resources nurses need to address strain and burden among informal caregivers.
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Oechsle K. Current Advances in Palliative & Hospice Care: Problems and Needs of Relatives and Family Caregivers During Palliative and Hospice Care-An Overview of Current Literature. Med Sci (Basel) 2019; 7:medsci7030043. [PMID: 30871105 PMCID: PMC6473856 DOI: 10.3390/medsci7030043] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 03/01/2019] [Accepted: 03/05/2019] [Indexed: 12/18/2022] Open
Abstract
Palliative and hospice care aims to improve quality of life of patients’ relatives, but still little is known about their specific problems and needs. We present a comprehensive literature update. Narrative review to present an expert overview of peer-reviewed, English-written original research publications and reviews on psychosocial and existential problems, supportive needs as well as interventions for relatives during the patients’ disease trajectory published between January 2017 and November 2018. A total of 64 publications were included. Relatives report high rates of psychological and existential distress, burden and psychological morbidity during the total disease trajectory of the patient. In addition, relatives report an alarmingly high number of unmet needs with information being the central issue. Relatives’ problems and needs are part of complex systems influenced by various socio-demographic factors and patient–relatives-interactions and dependency between different psychological phenomena. First support interventions for relatives during disease trajectory have proven feasible and secondary data from randomized studies suggest beneficial effects of providing early palliative care also for relatives. Relatives should be addressed to a still larger extent in the daily practice of palliative and hospice care, thus further research to reveal more detailed systematic information is needed to improve relatives’ psychological burden and quality of life.
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Affiliation(s)
- Karin Oechsle
- Palliative Care Unit, Department of Oncology, Hematology and BMT, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany.
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Shaffer KM, Chow PI, Cohn WF, Ingersoll KS, Ritterband LM. Informal Caregivers' Use of Internet-Based Health Resources: An Analysis of the Health Information National Trends Survey. JMIR Aging 2018; 1:e11051. [PMID: 31518244 PMCID: PMC6715019 DOI: 10.2196/11051] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 10/29/2018] [Accepted: 10/30/2018] [Indexed: 01/05/2023] Open
Abstract
Background Informal caregivers express strong interest in technology innovations to help them in their caregiving role; however, divides across sociodemographic characteristics in internet and technology access may preclude the most vulnerable caregivers from accessing such resources. Objective This study aims to examine caregivers’ internet use, both generally and for seeking health-related information, and whether usage differs as a function of caregivers’ characteristics. Methods Data were analyzed from the Health Information National Trends Survey 5 Cycle 1. Participants were included in analyses if they self-identified as providing uncompensated care to a close individual. Caregivers reported internet use factors, age, education, rurality, general health, distress, and objective caregiving burden. We used chi-square tests of independence with jackknife variance estimation to compare whether internet use factors differed by caregivers’ characteristics. Results A total of 77.5% (303/391) caregivers surveyed reported ever using the internet. Of internet users, 88.1% (267/303) accessed from a home computer and 83.2% (252/303) from a mobile device. Most caregivers accessed health information for themselves (286/391, 73.1%) or others (264/391, 67.5%); fewer communicated with a doctor over the Web (148/391, 37.9%) or had a wellness app (171/391, 43.7%). Caregivers reporting younger age, more education, and good health were more likely to endorse any of these activities. Furthermore, two-thirds of caregivers (258/391, 66.0%) endorsed trust in health information from the internet. Conclusions Computers and mobile devices are practical platforms for disseminating caregiving-related information and supportive services to informal caregivers; these modalities may, however, have a more limited reach to caregivers who are older, have less education, and are in poorer health.
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Affiliation(s)
- Kelly M Shaffer
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, United States.,Center for Behavioral Health & Technology, Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, VA, United States
| | - Philip I Chow
- Center for Behavioral Health & Technology, Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, VA, United States
| | - Wendy F Cohn
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, United States
| | - Karen S Ingersoll
- Center for Behavioral Health & Technology, Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, VA, United States
| | - Lee M Ritterband
- Center for Behavioral Health & Technology, Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, VA, United States
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Lee YH, Liao YC, Shun SC, Lin KC, Liao WY, Chang PH, Jhang SY, Yu CJ, Yang PC, Hsieh PY, Lai YH. Trajectories of caregiver burden and related factors in family caregivers of patients with lung cancer. Psychooncology 2018; 27:1493-1500. [PMID: 29476636 DOI: 10.1002/pon.4678] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 02/05/2018] [Accepted: 02/08/2018] [Indexed: 11/12/2022]
Abstract
OBJECTIVE This study aimed to (1) identify the changes of 5 domains of family caregiver (FC) burden, overall burden, and its subtrajectories when caring for newly diagnosed advanced lung cancer patients during the first 6 months following cancer diagnosis; and (2) identify the FC-related and patient-related factors most associated with the overall FC burden and each of its subtrajectories. METHODS A total of 150 newly diagnosed advanced lung cancer patient-FC dyads were recruited from a Taiwanese medical center. The overall FC burden was evaluated 4 times: before treatment, and 1, 3, and 6 months after treatment. The potential subtrajectory of the caregiver burden was investigated by latent class growth analysis. The FC-related and patient-related factors having the greatest effect on the overall FC burden and its subtrajectories over time were identified by generalized estimating equations. RESULTS The highest level of burden domain was "Impact on daily schedule" over time. Generally, most of the FC reported a moderate level of overall burden over the investigation period. Three subtrajectories of the overall FC burden over time (% caregivers) were identified: high burden (34.7%), moderate burden (56.0%), and low burden (9.3%), respectively. The self-efficacy of FC was the strongest factor related to the changes of the FC's burden and burden in each subtrajectory. CONCLUSION The results support the existing and different types of subtrajectories of the FC's burden. Health care professionals should provide care based on those differences. Further research to test interventions which integrate those important factors related to FC's burden, particularly FC's self-efficacy, is strongly suggested.
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Affiliation(s)
- Yun-Hsiang Lee
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yu-Chien Liao
- Department of Nursing, Yuanpei University, Hsinchu City, Taiwan
| | - Shiow-Ching Shun
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Kuan-Chia Lin
- Institute of Hospital and Health Care Administration, Community Medicine Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Wei-Yu Liao
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Pi-Hua Chang
- Department of Nursing, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Sin-Yuan Jhang
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Chong-Jen Yu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Pan-Chyr Yang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Pei-Yin Hsieh
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Yeur-Hur Lai
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
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Levesque JV, Gerges M, Girgis A. The development of an online intervention (Care Assist) to support male caregivers of women with breast cancer: a protocol for a mixed methods study. BMJ Open 2018; 8:e019530. [PMID: 29455166 PMCID: PMC5855323 DOI: 10.1136/bmjopen-2017-019530] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION It is projected that 17 730 women will be diagnosed with breast cancer in Australia in 2017, with 3114 of these predicted to be fatal. Caregiving for a person with cancer can significantly impact caregivers' physical and mental health. Many caregivers feel ill-prepared for this role, especially when care involves complex medical needs accompanied by the psychological challenges experienced following a cancer diagnosis. METHODS AND ANALYSIS This study employs a convergent, parallel, mixed methods design combining an online survey with an optional interview. Eligible, consenting participants will be invited to participate in a survey to examine (1) participants' unmet needs, (2) challenges experienced throughout the cancer journey, (3) perceived self-efficacy to determine participants' level of confidence in undertaking caregiver tasks, (4) views regarding suitable content to include in a caregiver training intervention, (5) preferred method of intervention delivery (ie, website, smartphone application and/or interactive video), and (6) preferences for the timing of delivery of the intervention content (ie, ability to choose a module, access to the entire content or have a set order in which they receive the information). Caregivers will be eligible to participate if they (1) are male, (2) have previously cared for or are currently caring for a woman with breast cancer, (3) are aged over 18 years, and (4) do not currently suffer from a cognitive impairment or mental health condition (ie, depression, anxiety). Data analysis will include examination of differences in psychological outcomes and needs based on demographic variables, and mediation analysis to explore whether self-efficacy mediates the relationship between challenges, unmet needs and distress. Qualitative data will be analysed using thematic analysis. ETHICS AND DISSEMINATION The study was reviewed and approved by two human research ethics committees within Australia. We anticipate two to three publications may be developed from the study.
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Affiliation(s)
- Janelle V Levesque
- Psycho-Oncology Research Group, Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
- South Western Sydney Clinical School, The University of New South Wales, Liverpool, New South Wales, Australia
- School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Martha Gerges
- Psycho-Oncology Research Group, Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
- South Western Sydney Clinical School, The University of New South Wales, Liverpool, New South Wales, Australia
| | - Afaf Girgis
- Psycho-Oncology Research Group, Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
- South Western Sydney Clinical School, The University of New South Wales, Liverpool, New South Wales, Australia
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Mollica MA, Litzelman K, Rowland JH, Kent EE. The role of medical/nursing skills training in caregiver confidence and burden: A CanCORS study. Cancer 2017; 123:4481-4487. [PMID: 28727147 PMCID: PMC5673528 DOI: 10.1002/cncr.30875] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 05/30/2017] [Accepted: 05/30/2017] [Indexed: 11/05/2022]
Abstract
BACKGROUND Informal cancer caregivers provide essential support to cancer patients, including performing direct medical/nursing tasks, assisting with activities of daily living, and offering social support. This study examined associations between the receipt of medical/nursing skills training and the caregiver burden as well as the mediation of caregiving confidence on this relationship in a sample of caregivers of lung and colorectal cancer patients. METHODS Caregivers who had been identified by cancer patients in the Cancer Care Outcomes Research and Surveillance consortium completed a questionnaire assessing the care provided, the type of medical/nursing skills training received, the burden (measured with the modified short-form Zarit Burden Interview), and the confidence in caring for their patient's physical needs. Regression models that had been adjusted for sociodemographic, caregiver, and care recipient characteristics assessed the relationship between training received and burden, and a mediation analysis assessed the role of confidence in this relationship. RESULTS Six hundred forty-one caregivers performed some type of medical/nursing task, with 59% (n = 377) reporting that they did not receive training for all the care provided. Caregivers reported moderate levels of burden (mean summary score, 32.07; standard deviation, 12.66; possible range, 14-70), and a lack of receipt of training was associated with greater levels of burden (b = 2.60; standard error, 0.98; P = .01). Confidence partially mediated the relation between training and burden (Sobel's t = 1.90; P = 0.03). CONCLUSIONS As the number of cancer patients and caregivers increases, understanding how best to reduce the caregiver burden is necessary. Skills training is a potential area for interventions, but research on how best to provide training for caregivers (ie, the content, mode of delivery, and timing) is needed. Cancer 2017;123:4481-7. © 2017 American Cancer Society.
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Affiliation(s)
- Michelle A Mollica
- Outcomes Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Kristin Litzelman
- School of Human Ecology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Julia H Rowland
- Office of Cancer Survivorship, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Erin E Kent
- Outcomes Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
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Altschuler A, Liljestrand P, Grant M, Hornbrook MC, Krouse RS, McMullen CK. Caregiving and mutuality among long-term colorectal cancer survivors with ostomies: qualitative study. Support Care Cancer 2017; 26:529-537. [PMID: 28844086 DOI: 10.1007/s00520-017-3862-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 08/16/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE The cancer caregiving literature focuses on the early phases of survivorship, but caregiving can continue for decades when cancer creates disability. Survivors with an ostomy following colorectal cancer (CRC) have caregiving needs that may last decades. Mutuality has been identified as a relationship component that can affect caregiving. This paper discusses how mutuality may affect long-term ostomy caregiving. METHODS We conducted semi-structured, in-depth interviews with 31 long-term CRC survivors with ostomies and their primary informal caregivers. Interviewees were members of an integrated health care delivery system in the USA. We used inductive theme analysis techniques to analyze the interviews. RESULTS Most survivors were 71 years of age or older (67%), female (55%), and with some college education (54%). Two thirds lived with and received care from spouses. Caregiving ranged from minimal support to intimate assistance with daily ostomy care. While some survivors received caregiving far beyond what was needed, others did not receive adequate caregiving for their health care needs. Low mutuality created challenges for ostomy caregiving. CONCLUSIONS Mutuality impacts the quality of caregiving, and this quality may change over time, depending on various factors. Emotional feedback and amplification is the proposed mechanism by which mutuality may shift over time. Survivorship care should include assessment and support of mutuality as a resource to enhance health outcomes and quality of life for survivors with long-term caregiving needs and their caregivers. Appropriate questionnaires can be identified or developed to assess mutuality over the survivorship trajectory.
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Affiliation(s)
- Andrea Altschuler
- Kaiser Permanente Division of Research, 2000 Broadway, Oakland, CA, 94612, USA.
| | - Petra Liljestrand
- Kaiser Permanente Division of Research, 2000 Broadway, Oakland, CA, 94612, USA
| | - Marcia Grant
- City of Hope, 1500 E Duarte Rd, Duarte, CA, 91010, USA
| | - Mark C Hornbrook
- Kaiser Permanente Center for Health Research, 3800 N. Interstate Avenue, Portland, OR, 97227, USA
| | - Robert S Krouse
- Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, 3641 Locust Walk #210, Philadelphia, PA, 19104, USA
- Cpl. Michael J. Crescenz Veterans Affairs Medical Center, 3900 Woodland Ave., Philadelphia, PA, 19104, USA
| | - Carmit K McMullen
- Kaiser Permanente Center for Health Research, 3800 N. Interstate Avenue, Portland, OR, 97227, USA
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Look KA, Stone JA. Medication management activities performed by informal caregivers of older adults. Res Social Adm Pharm 2017; 14:418-426. [PMID: 28528023 DOI: 10.1016/j.sapharm.2017.05.005] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 05/13/2017] [Accepted: 05/15/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Medication management is commonly performed by informal caregivers, yet they are often unprepared and ill-equipped to manage complex medication regimens for their older adult care recipients. In order to develop interventions that will enhance the caregiver's ability to safely and confidently manage medications, it is critical to first understand caregiver challenges and unmet needs related to medication management. OBJECTIVES To explore how informal caregivers manage medications for their older adult care recipients by identifying the activities involved in medication management and the tools or strategies used to facilitate these activities. METHODS Four focus groups with caregivers of older adults were conducted with 5-9 caregivers per group. Participants were asked to describe the medication management activities performed and the tools or strategies used to facilitate these activities. Focus groups were recorded, transcribed verbatim, and analyzed for themes using an inductive approach. RESULTS Caregivers were commonly involved in 2 types of activities: direct activities requiring physical handling of medications such as obtaining medications, preparing pill boxes, and assisting with medication administration; and indirect activities that were more complex and required more of a cognitive effort by the caregiver, such as organizing and tracking medications, gathering information, and making treatment decisions. They utilized a variety of tools and strategies to support these medication management activities; however, these approaches often needed to be modified or personalized to meet the specific needs of their caregiving situation. CONCLUSIONS Informal caregivers play a vital role in ensuring safe and appropriate medication use by older adults. Medication management is complex and involves many activities that are supported through the use of a variety of tools and strategies that have been adapted and individualized to each specific caregiving scenario. Caregivers should be an important component of interventions that aim to improve medication use among older adults.
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Affiliation(s)
- Kevin A Look
- Social and Administrative Sciences Division, University of Wisconsin-Madison, School of Pharmacy, 777 Highland Ave., Madison, WI, 53705-2222, USA.
| | - Jamie A Stone
- Social and Administrative Sciences Division, University of Wisconsin-Madison, School of Pharmacy, 777 Highland Ave., Madison, WI, 53705-2222, USA
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