Family caregiver ambassador support for caregivers of patients with newly diagnosed hematological cancer: a feasibility study

Implementation and Evaluation of Peer Ambassador Support to Patients Newly Diagnosed With Hematological Cancer and Their Caregivers

Aims and Objectives: To provide a comprehensive report on the development and implementation of peer ambassador support to patients newly diagnosed with hematological malignant disease and their caregivers within a clinical setting. Methods: The continued development and implementation of the peer ambassador support program took place between October 2022 and January 2024 at the Department of Hematology, Copenhagen University Hospital, Rigshospitalet. Grol and Wensing's 5-step model of implementation guided the process. Results: This paper demonstrates the successful adaptation and implementation of the peer ambassador program and provides valuable insights into the enabling factors and obstacles encountered. In total, 48 peer ambassadors were recruited, and 27 patients and seven caregivers received support. Over 90% of patients and caregivers reported high satisfaction with the support, and the majority (70%) noted that the support improved their understanding and provided new insights into their disease and treatment journey. Conclusion: The development and implementation of the intervention are complex and demanding long-term processes that require applying theoretical knowledge, understanding patient and caregiver's experiences, and collaboration with the interdisciplinary team in clinical practice. Implications: This paper provides knowledge for implementing future peer ambassador support initiatives. It has potential transferability and value in a broader context for patients with life-threatening illnesses and their caregivers. Impact: It contributes to research and transparency in the development and implementation of evidence-based nursing interventions. It confirms that implementation of a peer support intervention is complex and requires theoretical knowledge, application of that knowledge, and interdisciplinary collaboration in clinical practice. Finally, it provides evidence-based knowledge applicable to the implementation of future peer support initiatives. Patient Contribution: Patients and their caregivers have been actively involved throughout the development and implementation of the peer ambassador support program. Trial Registration: ClinicalTrials.gov identifier: NCT03493906 and NCT04039100.

Problem-Solving Skills Training for Parents of Children Undergoing Hematopoietic Stem Cell Transplantation: A Mixed Methods Feasibility Study

BACKGROUND

Caregivers of children undergoing hematopoietic stem cell transplantation (HSCT) are at risk for psychological distress. Bright IDEAS® (BI) is an effective and acceptable modification of problem-solving therapy for caregivers of children with new cancer diagnoses, but it has not been tested on caregivers of children undergoing HSCT. This randomized controlled pilot examined the feasibility, acceptability, and preliminary efficacy of BI among caregivers of children undergoing HSCT.

METHODS

English- and Spanish-speaking caregivers of children aged 2-21 years were recruited within 10 days of their child's autologous or allogeneic HSCT. Participants were randomized 1:1 to receive six-to-eight individualized BI sessions or usual care. Participants completed self-report measures of psychological distress at enrollment (pre-intervention) and on days 60, 90, and 180 post HSCT. Qualitative interviews were conducted among a subset (N = 7) of intervention completers to assess caregiver perceptions of BI.

RESULTS

A total of 107 caregivers were screened for participation; 64 were eligible. Thirty-eight were enrolled (59.4%) and randomized. In the BI group, 14/20 participants (70%) completed six or more sessions. The completion rate for distress measures was at least 78% for both study groups across timepoints. Despite higher baseline scores, caregivers in the BI group reported lower anxiety and depression scores at follow-up timepoints compared to the control group, based on observed trends. Qualitative interviews reflected acceptability of BI.

CONCLUSIONS

The results support the feasibility and acceptability of BI for caregivers of children undergoing HSCT. A larger efficacy trial of BI in the pediatric HSCT setting is warranted.

Exploring motivations of peer supporters for caregivers of patients with hematological malignancies-a qualitative study

PURPOSE

Social support interventions, particularly peer support from former family caregivers, offer unique assistance to caregivers of newly diagnosed patients. Since voluntary peer support is driven by personal choice, understanding the motivations for participating and how motivation evolves over time is essential. This study explores the motivations for becoming a peer support provider for family caregivers of patients with hematological malignancies and how motivation changes over time.

METHODS

This qualitative study encompasses 18 semi-structured interviews with family caregivers providing peer support (N = 11) at two time points: (1) just after certification as peer supporters but prior to starting the peer support program and (2) at the 6-week mark of their 12-week peer support program. Interpretive phenomenological analysis was used to analyze the data.

RESULTS

Motivation for participating in a voluntary peer-to-peer support program as a peer support provider center on four main themes: "Driven by past experiences", "Moral obligation is intrinsic to identity", "Meaningful use of personal experiences", and "Guiding new caregivers". Motivation was influenced during the support program, particularly by the presence or absence of feedback from family caregivers and by participation in network meetings with other peer support providers.

CONCLUSIONS

This study emphasizes the importance of networking meetings for family caregiver peer support providers, as they facilitate exchange of knowledge and insights and discussion of challenges and rewards and provide an ongoing support and motivation. It also highlights the untapped potential of volunteering to provide unique social support benefiting both the family caregiver recipient of support and the support provider.

Palliative Care in Hematology: A Systematic Review of the Components, Effectiveness, and Implementation

CONTEXT

While the evidence supporting the benefits of integration of palliative care into cancer care for patients and informal caregivers is growing, it poses challenges for hematological cancer patients due to rapidly changing disease trajectories, uncertain prognosis, and diverse care needs.

OBJECTIVES

This systematic review aims to provide an overview of the intervention components, the targeted outcomes, the effectiveness in improving patient and informal caregiver outcomes, and the implementation into clinical practice.

METHODS

We systematically searched PubMed (MEDLINE), EMBASE, CENTRAL, PsycINFO, and CINAHL in March 2023. The studies included described interventions in palliative care, with multiple components, targeting patients with hematological cancer and/or their informal caregivers, and producing primary data on effectiveness or implementation. Quality was assessed using the QualSyst tool.

RESULTS

We identified 19 reports on 16 different palliative care interventions, including four quasi-randomized controlled trials. These interventions were provided by secondary and tertiary palliative care providers in a hospital setting. Tertiary interventions significantly improved the most common patient outcomes, including pain, quality of life, symptom burden, depression, and anxiety. Meanwhile, secondary interventions were feasible and well-accepted by healthcare professionals and patients. Despite limited inclusion of informal caregivers, the results indicated significant improvements in quality of life and depression.

CONCLUSION

While palliative care interventions are found to improve patient outcomes, future research is needed on the effectiveness of secondary palliative care interventions, integrating primary palliative care, and more reliable and frequent implementation measurements. More focus on informal caregivers and resource allocation based on patient needs is warranted.

Caring through uncertainty: a qualitative exploration of older colorectal cancer caregivers' experiences during palliative chemotherapy

PURPOSE

Despite the increasing research on cancer patient caregivers, there is still a lack of detailed understanding about the experiences of spouses caring for elderly colorectal cancer patients. This study aimed to fill this gap by examining the caregiving experiences of spouses during palliative chemotherapy for elderly Chinese colorectal cancer patients.

METHODS

Using a qualitative descriptive design, we recruited spousal caregivers of elderly colorectal cancer patients undergoing palliative chemotherapy. Semistructured interviews were conducted, and thematic analysis was employed to analyse the data.

RESULTS

Sixteen caregivers aged 60 to 82 years participated in the interviews. The analysis revealed three main themes: ambivalence, multiple role adaptation to conflicts, and the coexistence of hope and pressure. These themes shed light on the behaviors of older caregivers and the challenges they face, including physical and psychosocial issues associated with aging.

CONCLUSION

This study highlights the significant stress and challenges experienced by older caregivers, characterized by intertwined emotions such as anxiety about their spouses' health deterioration, exhaustion from long-term care responsibilities, and anticipation of treatment outcomes.

Fear of cancer recurrence and associated factors in family caregivers of patients with hematologic malignancy receiving chemotherapy: A latent profile analysis

Objective

This study identified the potential subgroups of fear of cancer recurrence (FCR) in family caregivers (FCs) of patients with hematologic malignancies receiving chemotherapy, as well as exploring factors associated with subgroups.

Methods

This was a cross-sectional study involving 206 pairs of participating patients with hematologic malignancies receiving chemotherapy and their FCs. Using Mplus 8.3 to perform the latent profile analysis of FCs' FCR, the FCs' burden, quality of life, psychological resilience, and anxiety as well as their demographic characteristics were compared between the subgroups, with a logistic regression analysis being applied to examine the factors associated with the FCR subgroups.

Results

A total of 206 FCs were classified into two subgroups: "a low level of FCR" (Class 1, 65.4%) and "a high level of FCR" (Class 2, 34.6%). Quality of life, anxiety, and frequency of chemotherapy were significantly associated with the two subgroups.

Conclusions

FCs of patients with hematologic malignancy receiving chemotherapy had two FCR subgroups, "a low level of FCR" and "a high level of FCR", in association with quality of life, anxiety, and frequency of chemotherapy. These findings provide the theoretical foundations for screening the FCR factor of FCs and conducting interventions for them.

Family caregiver quality of life and symptom burden in patients with hematological cancer: A Danish nationwide cross-sectional study

OBJECTIVE

To investigate the quality of life (QoL) and the impact of caregiving in family caregivers of hematological cancer patients and its association with patient symptom burden.

METHODS

A cross-sectional study including Danish patients (n = 375) and caregivers (n = 140). Caregivers completed scales for anxiety and depression using the Hospital Anxiety and Depression Scale, sleep quality using the Pittsburgh Sleep Quality Index, health related QoL using the 12-item Short-Form Health Survey, and caregiver roles using the Caregiver Roles and Responsibilities Scale. Patients reported symptoms using the MD Anderson Symptom Inventory. Analysis of covariance was used to examine associations between patient symptom burden and caregivers' QoL outcomes.

RESULTS

The results show that caregivers experience sleep difficulties, moderate anxiety, and reduced QoL. Patient symptom burden was significantly associated with caregiver anxiety (p = 0.009), and mental well-being (p = 0.002), while patient treatment status was a significant factor associated with caregiver anxiety (p = 0.016), depression (p = 0.009), emotional well-being (p = 0.002), and sleep (p = 0.01).

CONCLUSION

Caregivers of patients with hematological cancers undergoing active treatment face a high symptom burden, which significantly impacts their QoL, including sleep, psychological well-being, and emotional health. Patients reported a high symptom burden, and patient symptom burden was significantly associated with caregiver QoL. Adequate patient and caregiver support is needed to promote their well-being and mitigate adverse health effects in caregivers, and this should be acknowledged in the context of caring for patients with hematological cancer.

"I don't have a choice but to keep getting up and doing the things that protect her": The informal caregiver's adaptation to the cancer diagnosis

PURPOSE

Patients with hematologic malignancies (HM) typically rely on informal caregivers for support. Caregivers experience distress, poorer health, and lower quality of life. This study aimed to understand caregivers' experiences adapting to, and making meaning of, their family members' cancer diagnosis and treatment.

APPROACH

Qualitative, constructivist approach.

PARTICIPANTS

Caregivers (N = 28) of patients with HM within three months of diagnosis.

METHODS

A descriptive content analysis was used to analyze semi-structured interview responses and generate themes.

FINDINGS

Six themes emerged: power and control (powerlessness, empowerment, relinquishing control/accepting help), protection (gatekeeping, protective buffering), integrating the diagnosis, tolerating uncertainty, preparedness for the caregiver role, and maintaining positivity.

CONCLUSIONS

Findings highlight challenges and resilience-promoting processes for caregivers adapting to HM diagnosis and treatment.

IMPLICATIONS FOR PSYCHOSOCIAL PROVIDERS

Psychological and supportive care interventions can promote acceptance of the diagnosis, preparation for caregiving, navigation of power and control, and targeted coping strategies.

Experiences and preferences for psychosocial support: a qualitative study exploring the views of patients with chronic haematological cancers

OBJECTIVES

Patients with chronic haematological cancers are often treated on a relapsing-remitting pathway, which may extend for many years. Such diagnoses are associated with uncertainties that often cause anxiety and distress, meaning patients (and families) are susceptible to potentially prolonged emotional difficulties, across the cancer journey. Experiences and preferences regarding psychosocial needs and support over time are relatively unexplored, which this study aimed to address.

SETTING AND DESIGN

Set within the UK's Haematological Malignancy Research Network (an ongoing population-based cohort that generates evidence to underpin improved clinical practice) a qualitative, exploratory study was conducted, using semistructured interviews. Reflexive thematic analysis was used to assess the interview data via an exploratory, inductive approach, underpinned by the research questions.

PARTICIPANTS

Thirty-five patients were included with chronic lymphocytic leukaemia, follicular lymphoma, marginal zone lymphoma or myeloma; 10 of whom were interviewed alongside a relative.

RESULTS

Five themes were identified from the data: (1) accessing support, (2) individual coping behaviour affecting support preferences, (3) divergent and fluctuating thoughts on patient support forums, (4) the role, influence and needs of family and friends and (5) other sources of support and outstanding needs. Findings suggest that patients' individual attitudes towards support varied over time. This also influenced whether support was perceived to be available, and if it was then used.

CONCLUSION

This study highlighted the variation in preferences towards psychosocial support among patients with chronic haematological cancers. As patients can live for many years with significant emotional difficulties, they may benefit from frequent monitoring of their psychosocial well-being, as well as signposting to holistic support, if this is needed.

RESILIENCE OF FAMILY CAREGIVERS OF CHILDREN AND ADOLESCENTS WITH CANCER AND ASSOCIATED FACTORS: MIXED METHOD STUDY

ABSTRACT Objective to analyze the relationship between resilience and associated factors (stress, minor psychiatric disorders and quality of life) of family caregivers with children and adolescents undergoing cancer treatment. Method mixed methods research, with sequential explanatory strategy, carried out with family caregivers of children and adolescents undergoing cancer treatment in a public hospital in the Rio Grande do Sul State, Brazil. Data collection took place from February to September 2018. The quantitative study was cross-sectional in nature, and the qualitative research was descriptive-exploratory. Participants included 62 family caregivers in the quantitative stage and 16 responded to semi-structured interviews. An instrument containing sociodemographic, economic, labor, health and resilience scales (CD-RISC-10-Br), minor psychiatric disorders (MPDs) (SRQ-20), quality of life (QOL) (WHOQO-Bref) and stress and semi-structured interview were applied. Descriptive and inferential statistics were used for quantitative data and content analysis for qualitative data. Results family caregivers had a moderate level of resilience (48.4%); high level of perceived stress (41%); suspicion for MPDs (45%). They presented satisfaction in the physical Qol domains (67.7%); psychological (62.9%); personal relationships (61.3%), and dissatisfaction in the environment domain (75.8%). The interviews reported for health changes that could trigger MPD, stress and changes in quality of life. Conclusion high level of stress; suspicion for MPD and low QoL, with the environment, were evidenced as associated factors for a lower level of resilience of family caregivers. The need to develop actions that strengthen resilience was percieved, as caregivers were essential for the effectiveness of the care plan for children and adolescents undergoing cancer treatment.

RESILIÊNCIA DE CUIDADORES FAMILIARES DE CRIANÇAS E ADOLESCENTES COM CÂNCER E FATORES ASSOCIADOS: ESTUDO DE MÉTODOS MISTOS

RESUMO Objetivo analisar a relação entre resiliência e fatores associados (estresse, distúrbios psíquicos menores e qualidade de vida) de cuidadores familiares de crianças e adolescentes em tratamento oncológico. Método pesquisa de métodos mistos, com estratégia explanatória sequencial, realizado com cuidadores familiares de crianças e adolescentes em tratamento oncológico em um hospital público do interior do Rio Grande do Sul, Brasil. A coleta de dados ocorreu de fevereiro a setembro de 2018. O estudo quantitativo foi de natureza transversal e a pesquisa qualitativa teve caráter descritivo-exploratório. Participaram 62 cuidadores familiares na etapa quantitativa e 16 responderam as entrevistas semiestruturadas. Aplicaram-se instrumento contendo questões sociodemográficas, econômicas, laborais, de saúde e escalas de resiliência (CD-RISC-10-Br), distúrbios psíquicos menores (DPMs) (SRQ-20), qualidade de vida (QV) (WHOQO-Bref) e estresse e entrevista semiestruturada. Utilizou-se estatística descritiva e inferencial para os dados quantitativos e análise de conteúdo para os qualitativos. Resultados os cuidadores familiares possuíam nível moderado de resiliência (48,4%); alto nível de estresse percebido (41%); suspeição para distúrbios psíquicos menores (45%). Apresentaram satisfação nos domínios de qualidade de vida físico (67,7%); psicológico (62,9%); relações pessoais (61,3%), e insatisfação no domínio meio ambiente (75,8%). As entrevistas reportaram para alterações de saúde que poderiam desencadear distúrbios psíquicos menores, estresse e alterações na qualidade de vida. Conclusão alto nível de estresse; suspeição para distúrbios psíquicos menores e baixa qualidade de vida, com o meio ambiente, evidenciaram-se como fatores associados para um menor nível de resiliência dos cuidadores familiares. Percebeu-se a necessidade de desenvolver ações que fortalecessem a resiliência, pois os cuidadores foram essenciais para a efetividade do plano de cuidado de crianças e adolescentes em tratamento oncológico.