Mediating effect of social support between caregiver burden and quality of life among family caregivers of cancer patients in palliative care units

Relationship between caregiver burden and family resilience among Chinese parents of children with autism spectrum disorder: The mediating role of social support and positive cognition

PURPOSE

This study was designed to assess the impact of caregiver burden on family resilience and explore the potential mediating role of social support and positive cognition in this association among Chinese families of children with autism spectrum disorder (ASD).

DESIGN AND METHODS

A total of 254 parents of children with ASD were recruited using convenience sampling from five ASD rehabilitation institutions in Wenzhou and Ningbo, Zhejiang Province from June to August 2021. The Zarit Burden Scale, Social Support Rate Scale, Illness Cognition Questionnaire-Parent Version, and Family Resilience Assessment Scale were employed to investigate the mediating mechanisms of social support and illness cognition between caregiver burden and family resilience. Structural equation models were conducted to evaluate the relationships among the variables.

RESULTS

This study revealed that caregiver burden negatively associated with family resilience, with social support partially mediating this relationship (accounting for 17.86 % of the total effect), and both factors being indirectly linked through social support and positive cognition (accounting for 3.76 % of the total effect).

CONCLUSIONS

The findings emphasize the need for interventions aimed at enhancing social support and positive cognition to alleviate the negative effects of caregiver burden on family resilience among parents of children with ASD.

Current status and influencing factors of social support for main caregivers of children with traumatic brain injury: a cross-sectional survey

BACKGROUND

Children with Traumatic Brain Injury (TBI) frequently undergo rapid fluctuations in their health status, imposing significant strain on their caregivers. This study aimed to evaluate the social support available to primary caregivers of pediatric TBI patients, to provide actionable insights to improve clinical support systems.

METHODS

Primary caregivers of pediatric TBI patients treated at our hospital from February 1, 2024, to August 31, 2024, were included in this study. The Social Support Rating Scale was utilized to assess the social support of these caregivers. Pearson correlation analysis and logistic regression were conducted to identify determinants significantly associated with the level of social support.

RESULTS

Two hundred forty-two primary caregivers of children with TBI were enrolled in this study. The mean social support score for these caregivers was 38.52 (± 9.29), suggesting a moderate level of social support. Correlations were identified between social support scores and several caregiver characteristics: age (r=-0.564), educational level (r = 0.602), place of residence (r = 0.542), and monthly per capita family income (r = 0.633). Logistic regression analysis revealed that age (OR = 2.184, 95%CI: 1.904-3.022), educational level (OR = 2.462, 95%CI: 1.755-4.086), residence (OR = 2.189, 95%CI: 1.805-2.753), and monthly per capita family income (OR = 3.428, 95%CI: 2.402-4.216) significantly influenced the level of social support.

CONCLUSION

Enhancing the social support for primary caregivers of children with TBI is imperative. Clinical healthcare providers are advised to develop and implement targeted interventions aimed at the modifiable factors identified, in order to bolster the social support levels of these caregivers.

Exploring the role of perceived social support, and spiritual well-being in predicting the family Caregiving burden among the parents of disabled children

BACKGROUND AND AIM

Caregiver burden encompasses the physical, emotional, financial, and social challenges faced by individuals caring for a sick or disabled person. Spiritual well-being and social support have been identified as protective factors against psychological and physical issues, potentially alleviating caregiver burden. This study aims to explore the relationship between spiritual well-being, perceived social support, and caregiver burden among parents of children with disabilities.

METHOD

A descriptive-analytical study was conducted with 260 family caregivers, selected through systematic random sampling. Data were collected using a demographic questionnaire, the Novak and Gaug Caregiving Burden Scale, the Paloutzian-Ellison Spiritual Well-being Scale, and the Zimet Social Support Questionnaire. Statistical analysis was performed using IBM SPSS version 22, with significance set at p < 0.05.

RESULTS

Among the caregivers, 148 (61.4%) reported a high level of caregiving burden, while 81% indicated moderate spiritual well-being and 14.5% reported high spiritual well-being. A significant negative correlation was found between spiritual well-being, social support, and caregiving burden (p < 0.05). Multiple linear regression analysis revealed that spiritual well-being (β = -0.41) and social support (β = -0.33) were the most significant predictors of caregiving burden. Additional significant predictors included social activities, underlying health conditions, age, caregiving duration, insurance coverage, and marital status (p < 0.05).

CONCLUSION

The high caregiving burden observed in this population, along with the inverse relationship between social support, spiritual well-being, and caregiving burden, underscores the need for strategies to enhance social support and spiritual well-being. These factors may serve as cost-effective, accessible interventions to alleviate caregiving burden.

Efficacy of Supportive Care Interventions for Improving Posttraumatic Stress Symptoms and Resilience in Family Caregivers of Cancer-Affected Children: A Meta-Analysis of Randomized Controlled Trials

BACKGROUND

The diagnosis of pediatric cancer is a major shock to family caregivers, and posttraumatic stress symptoms (PTSSs) emerge as the most prevalent adverse psychological outcomes. However, not all family caregivers have sufficient resilience to cope with these challenges; thus, supportive care interventions are necessary. These interventions, which include psychosocial support, education, and other forms of assistance, are designed to enhance the well-being of those affected by disease. In the past few years, more research has been delving into supportive care interventions for family caregivers of cancer-affected children, yet there is still a variance in the results.

OBJECTIVE

To investigate the impacts of supportive care interventions on PTSSs and resilience in family caregivers of cancer-affected children, also focusing on the impacts of prerecruitment time to diagnosis, duration, type of intervention, and recruitment area on the outcomes.

METHODS

Nine databases (Cochrane Library, Ovid MEDLINE, CINAHL Plus with Full Text, Embase, CNKI, Sinomed, WANFANG, VIP, and Web of Science) were searched from their inception to February 21, 2024. The revised Cochrane Risk of Bias tool and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method were used to evaluate the quality of evidence. To gauge the effectiveness of the interventions, we computed the standard mean difference (SMD) and the 95% confidence interval (CI) utilizing StataCorp (version 16.0). Sensitivity analysis and Egger's test were also conducted.

RESULTS

Supportive care interventions significantly improved the PTSSs (SMD = -0.86, 95% CI [-1.39, -0.33], p < 0.01, I2 = 94.95%) and resilience (SMD = 0.85, 95% CI [0.26, 1.44], p < 0.01, I2 = 88.3%) among family caregivers of cancer-affected children. Subgroup analyses revealed that early interventions for family caregivers after the diagnosis of children and the short-term interventions were associated with improvements in their PTSS and resilience. Moreover, cognitive behavioral interventions were the most common type of interventions and were effective in supporting family caregivers. Additionally, supportive care interventions did not improve PTSSs among family caregivers in middle-income countries.

LINKING EVIDENCE TO ACTION

Supportive care interventions have demonstrated efficacy in improving PTSSs and resilience among family caregivers of cancer-affected children. This research proved the imperative of providing prompt supportive care to family caregivers early after the pediatric cancer diagnosis. Additionally, it is also necessary to further study and explore the optimal way to combine different intervention components based on caregivers' need and to develop regionally adapted and culturally sensitive supportive care interventions to better improve health outcomes for family caregivers.

Factors which influence social connection among cancer caregivers: an exploratory, interview study

BACKGROUND/AIMS

Social connectedness is increasingly recognised as influencing health outcomes in cancer caregivers; however, there is little understanding of factors which foster feelings of social connectedness among caregivers when providing care. We sought to examine from the caregivers' perspective, factors which contribute to perceived social connection when providing care to someone with cancer.

METHODS

Semi-structured interviews were conducted with 20 caregivers of people with cancer. Participants were recruited through social media and were eligible if they were aged 18 + years and had provided care to someone with cancer in the preceding 3 years. Data were analysed thematically using NVivo.

RESULTS

Following thematic analysis of interview data, six overarching themes emerged detailing caregivers' experiences with social support, networks, and connectedness. Themes included: people in caregivers' social networks and communication frequency, supportive communication with people in social networks, challenges with talking with others and seeking support, receiving instrumental support from social networks, impact of the carer role on friendships and community activities, and factors which fostered perceived connectedness.

CONCLUSIONS

For caregivers of people with cancer, our qualitative findings suggest the importance of receiving emotional and instrumental support from social networks to cope with, and alleviate the stress and strain of providing care. Development and empirical testing of strategies and interventions that improve social support seeking and subsequently perceived connectedness among caregivers are recommended to improve health and wellbeing.

Family dynamics and support network of family caregivers of people with progressive cancer

OBJECTIVE

To analyze family dynamics, the support network of family caregivers of individuals with progressive cancer, and their needs for comprehensive care.

METHOD

Qualitative, descriptive study developed based on the Calgary Family Assessment Model framework. It was conducted from September 2022 to April 2023, through participant observation at a public health institution in São Paulo and interviews with six family caregivers. The analysis was performed using Genogram and Ecomap, following the Calgary Model, with the support of software for data organization.

RESULTS

The data were categorized into structural, developmental, and functional family assessments. They revealed the strengthening of family relationships with strong bonds, an increased level of burden on the caregiver as cancer progressed, neglect of self-care, and financial difficulties. Due to the burden, caregivers struggled to outline the composition of their support network, but the employed model enabled the identification of its elements, with faith being mentioned by all.

CONCLUSION

The diagnosis and progression of cancer led to changes in family structure, development, and functionality which need to be individually assessed to improve care planning. This involves mobilizing elements and services according to the reality of families.

The effect of targeted palliative care interventions on depression, quality of life and caregiver burden in informal caregivers of advanced cancer patients: A systematic review and meta-analysis of randomized controlled trials

OBJECTIVE

To investigate the efficacy of targeted palliative care interventions on depression, quality of life and caregiver burden in informal caregivers of advanced cancer patients, along with the consequences of various intervention types.

DESIGN

This study performed a comprehensive review and a meta-analysis of randomized controlled trials.

METHOD

An extensive search was carried out across eight databases, namely, PubMed, Embase, CLNAHL, PsyclNFO, Cochrane, VIP, CNKI, and WANFANG, spanning from the inception of the library to May 4, 2024. Two examiners independently screened the articles and extracted the data according to the eligibility criteria formulated in accordance with the PICOS principles. The meta-analysis was conducted utilizing the StataCorp (version 16.0), estimating the impacts of the interventions through the computation of the standardized mean difference (SMD) and the 95 % confidence interval (CI). Sensitivity analysis was carried out using a one-way-out method. Egger's test and the Duval and Tweedie trim-and-fill methods were used to explore the potential publication bias. The Cochrane risk-of-bias tool was used to evaluate the methodological quality of the included studies, and the overall quality of evidence was evaluated using the GRADE method.

RESULTS

This study pooled 16 RCTs (including 2046 informal caregivers) that were published from 2007 to 2023. The meta-analysis results indicated that the targeted palliative care interventions significantly improved depression (SMD = -0.74, 95 % CI: [-1.25, -0.23], P < 0.01) and quality of life (SMD = 0.63, 95 % CI: [0.08, 1.17], P = 0.03), though not in terms of caregiver burden (SMD = -0.33, 95 % CI: [-0.95, 0.29], P = 0.30) among informal caregivers of advanced cancer patients. Analysis of the subgroups revealed a correlation between short-term interventions, under three months, and the improvement of depression. Strategies focused solely on caregivers have proven effective in alleviating depression. Interventions utilizing offline methods have been shown to not only lower depression levels but also improve the quality of life for caregivers.

CONCLUSIONS

The targeted palliative care interventions effectively improved informal caregivers' depression and quality of life, yet they fail to markedly lessen the caregiver burden. To better support informal caregivers, interveners ought to adopt personalized strategies based on comprehensive consideration of the duration, format, and delivery methods of the interventions. Simultaneously, further exploration and effort from scholars are necessary to enhance the accessibility of palliative care services, and to effectively incorporate academic research findings into clinical practice.

REGISTRATION

CRD42023475620.

The Efficacy of Virtual Reality-Based Interventions on Pain, Anxiety, Depression, and Quality of Life Among Patients With Cancer: A Meta-analysis of Randomized Controlled Trials

BACKGROUND

Although cancer patients are living longer, the numerous physical and psychological outcomes of cancer can still be burdensome. Pain, anxiety, depression, and decreased quality of life are symptoms that are highly impacted by cancer. The availability of modalities to cope with these symptoms is critical. Virtual reality-based interventions have been used among patients with cancer, but their effects on pain, anxiety, depression, and quality of life remain unclear.

OBJECTIVE

To determine the efficacy of virtual reality-based interventions on pain, anxiety, depression, and quality of life among cancer patients and to assess the efficacy of different contents and duration.

METHODS

Nine databases were retrieved from inception to July 31, 2024. The methodological quality was evaluated via the Cochrane Risk of Bias 2.0 tool. Data synthesis was conducted with Stata version 16.0, and sensitivity analysis and subgroup analysis were also performed.

RESULTS

Virtual reality-based interventions can soothe pain and anxiety. Subgroup analysis revealed that interventions focused on playing games and watching videos were effective at reducing pain. In addition, enjoying landscapes, receiving treatment-related health education, and watching videos were effective at decreasing anxiety; moreover, short-term (≤6 weeks) interventions were effective at relieving pain.

CONCLUSIONS

Virtual reality-based interventions are effective at decreasing pain and anxiety. The contents and duration of the intervention had an impact on their effectiveness.

IMPLICATIONS FOR NURSING PRACTICE

Symptom management is a paramount aspect of clinical cancer care. In daily oncology nursing, we encourage nurses to utilize the benefits of virtual reality-based interventions to improve cancer patients' experience with medical treatment.

Family caregivers' administration of medications at the end-of-life in China: a qualitative study

BACKGROUND

Effective medication management is crucial for ensuring timely pain and symptom control at the end of life. Dying in pain is a major concern for patients, yet some find less effective pain control at home. Family caregivers (FCGs) play a vital role in managing pain and symptom control for dying patients. However, the experience of administering medications at home for terminal-stage patients has not been widely recognized or understood. Our study aimed to explore the experiences of FCGs in administering medications to adult dying patients.

METHODS

We conducted a directed content analysis of data from 73 semi-structured interviews with FCGs across 19 Chinese provinces from 2021 to 2023. FCGs were recruited through the Voluntary Cooperative Network Research. We asked, "Could you recall the end-of-life care process for the patients?" We aligned the themes with the five issues identified by Wilson et al. (2018): administration, organizational skills, empowerment, relationships, and support.

RESULTS

FCGs in China exhibit concerns about over-engagement and empowerment in medication administration, concealing medication information from the patient, and medication accessibility. FCGs faced significant challenges in accurately identifying and addressing pain and symptoms, determining appropriate dosages, accessing effective medications, and managing the emotional stress associated with potential medication errors. Financial burden, medication regulatory restrictions, geographical inequality, and travel restrictions during COVID impeded patients and FCGs from accessing medication. A culturally specific finding is the use of alternative medicine at the end of life.

CONCLUSION

Our findings build upon Wilson et al.'s framework and extend their insights on empowerment, highlighting the need for policies to support home-based palliative care professionals in training FCGs for effective medication administration.

Perceptions of Telehealth Services Among Rural Lung Cancer Patients in China: A Qualitative Study Using the Technology Acceptance Model

OBJECTIVES

To describe the perceptions of telehealth services among lung cancer patients in rural areas of China, as well as to explore the potential of telemedicine to improve long-term health recovery at home for rural lung cancer patients.

METHODS

A qualitative descriptive study design was used in this study and we conducted semi-structured interviews with 14 rural Chinese lung cancer patients between December 2022 and March 2023. Interview content was analyzed using Nvivo software and a framework analysis was performed using the Technology Acceptance Model to identify meaningful themes.

RESULTS

Participants identified perceptual and technical factors related to perceived ease of use, benefits and drawbacks related to perceived usefulness, and facilitators and barriers related to intention to use. However, regional and disease features including literacy barriers, medical insurance condition, symptom burden, and rural cultural health seeking behavior conduct must be taken into account.

CONCLUSIONS

Lung cancer patients in rural China believe that telehealth services could be an alternative solution for addressing health and care needs, but various aspects, such as user interface design, cost-effectiveness, and technological anxiety, need to be optimized.

IMPLICATIONS FOR NURSING PRACTICE

More highly specialized nursing team, friendly telecare lung function modules, and media technology training courses should be developed for rural lung cancer patients to enhance the quality of their home care, meet their information needs and better control their disease progression.

Effect of Tele-exercise Interventions on Quality of Life in Cancer Patients: A Meta-analysis

PURPOSE

To evaluate the impacts of tele-exercise intervention with cancer patients' quality of life, taking into account the influence of the duration of tele-exercise intervention, type of intervention, and gender of cancer patients on quality of life.

METHODS

The PubMed (MEDLINE), Embase, CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, and PsycINFO databases were searched from inception to August 21, 2023. The Cochrane Collaboration's risk of bias tool 2 was utilized to estimate the risk of bias, and the Grading of Recommendations, Assessment. For statistical analyses, R Studio was employed.

RESULTS

This meta-analysis contained eight trials. When compared to controls, tele-exercise interventions (SMD = 0.41, 95% CI: 0.12 to 0.70, p < .010; I2 = 54%, p = .030) have a positive influence on boosting the quality of life within cancer patients. Subgroup analyses demonstrated the greater effectiveness of tele-exercise in enhancing the quality of life of cancer patients when the duration was greater than or equal to 10 weeks. Furthermore, tele-exercise was found to have a stronger advantageous effect on quality of life among female cancer. In addition, among the types of interventions for tele-exercise, neither web-based nor telephone-based formats significantly enhanced quality of life among cancer patients.

CONCLUSION

Tele-exercise interventions are a cost-effective and feasible non-pharmacologic complementary way to promote cancer patients' quality of life. Additional large-sample, carefully designed randomized controlled trials are warranted to further validate the impact of tele-exercise concerning cancer patients' quality of life.

REGISTRATION NUMBER

CRD42023477147.

Comparative efficacy of telehealth interventions on promoting cancer screening: A network meta-analysis of randomized controlled trials

BACKGROUND

Cancer screening is a pivotal method for reducing mortality from disease, but the screening coverage is still lower than expected. Telehealth interventions demonstrated significant benefits in cancer care, yet there is currently no consensus on their impact on facilitating cancer screening or on the most effective remote technology.

DESIGN

A network meta-analysis was conducted to detect the impact of telehealth interventions on cancer screening and to identify the most effective teletechnologies.

METHODS

Six English databases were searched from inception until July 2023 to yield relevant randomized controlled trials (RCTs). Two individual authors completed the literature selection, data extraction, and methodological evaluations using the Cochrane Risk of Bias tool. Traditional pairwise analysis and network meta-analysis were performed to identify the overall effects and compare different teletechnologies.

RESULTS

Thirty-four eligible RCTs involving 131,644 participants were enrolled. Overall, telehealth interventions showed statistically significant effects on the improvement of cancer screening. Subgroup analyses revealed that telehealth interventions were most effective for breast and cervical cancer screening, and rural populations also experienced benefits, but there was no improvement in screening for older adults. The network meta-analysis indicated that mobile applications, video plus telephone, and text message plus telephone were associated with more obvious improvements in screening than other teletechnologies.

CONCLUSION

Our study identified that telehealth interventions were effective for the completion of cancer screening and clarified the exact impact of telehealth on different cancer types, ages, and rural populations. Mobile applications, video plus telephone, and text message plus telephone are the three forms of teletechnologies most likely to improve cancer screening. More well-designed RCTs involving direct comparisons of different teletechnologies are needed in the future.

CLINICAL RELEVANCE

Telehealth interventions should be encouraged to facilitate cancer screening, and the selection of the optimal teletechnology based on the characteristics of the population is also necessary.