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Agarwal D, Bailie CR, Rana S, Balan L, Grills NJ, Mathias K. Scaling a group intervention to promote caregiver mental health in Uttarakhand, India: A mixed-methods implementation study. Glob Ment Health (Camb) 2023; 10:e85. [PMID: 38161744 PMCID: PMC10755371 DOI: 10.1017/gmh.2023.79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/24/2023] [Accepted: 11/16/2023] [Indexed: 01/03/2024] Open
Abstract
Caregivers are integral to health and social care systems in South Asian countries yet are themselves at higher risk of mental illness. Interventions to support caregiver mental health developed in high-income contexts may be contextually inappropriate in the Global South. In this mixed-methods study, we evaluated the implementation and scaling of a locally developed mental health group intervention for caregivers and others in Uttarakhand, India. We describe factors influencing implementation using the updated Consolidated Framework for Implementation Research, and selected implementation outcomes. Key influencing factors we found in common with other programs included: an intervention that was relevant and adaptable; family support and stigma operating in the outer setting; training and support for lay health worker providers, shared goals, and relationships with the community and the process of engaging with organisational leaders and service users within the inner setting. We identified further factors including the group delivery format, competing responsibilities for caregivers and opportunities associated with the partnership delivery model as influencing outcomes. Implementation successfully reached target communities however attrition of 20% of participants highlights the potential for improving outcomes by harnessing enablers and addressing barriers. Findings will inform others implementing group mental health and caregiver interventions in South Asia.
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Affiliation(s)
- Disha Agarwal
- Project Burans, Herbertpur Christian Hospital, Atten Bagh, India
| | - Christopher R. Bailie
- Nossal Institute for Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Samson Rana
- Project Burans, Herbertpur Christian Hospital, Atten Bagh, India
| | - Laxman Balan
- Project Burans, Herbertpur Christian Hospital, Atten Bagh, India
| | - Nathan J. Grills
- Nossal Institute for Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Kaaren Mathias
- Project Burans, Herbertpur Christian Hospital, Atten Bagh, India
- Te Kaupeka Oranga, University of Canterbury, Christchurch, New Zealand
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Mac Eochagain C, Senac NMG, Cavanagh M, Roy M, Ciccone AS, Contreras B, Testa GD, Velasco R, Marinho J, Serrano AG, Schiaffino MK, Gomes F. Digital health in geriatric oncology: A Young International Society of Geriatric Oncology review. J Geriatr Oncol 2023; 14:101649. [PMID: 38682324 DOI: 10.1016/j.jgo.2023.101649] [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: 08/31/2023] [Revised: 09/27/2023] [Accepted: 10/11/2023] [Indexed: 05/01/2024]
Abstract
The integration of digital health technologies in geriatric oncology has the potential to enhance patient care and self-management. This review article discusses the applications of these technologies, including teleassessment, telemonitoring, and teleintervention, within geriatric oncology, and evaluates their potential to improve cancer care and patient outcomes. We also review challenges to the implementation of digital health technologies among populations of older patients with cancer. The article provides a perspective for clinicians, researchers, policymakers, and patients on the integration and utilisation of digital health technologies in current geriatric oncology practice.
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Affiliation(s)
- Colm Mac Eochagain
- Trinity St James Cancer Institute, Dublin, Ireland; Royal Marsden Hospital, London, UK.
| | - Nicolas Maria Gonzalez Senac
- Geriatrics Department, Hospital General Universitario Gregorio Marañon, Madrid, Spain; Instituto de Investigación Sanitaria Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Mercedes Cavanagh
- Medical Oncology Department, Hospital Universitario de Getafe, Madrid, Spain
| | - Mukul Roy
- Department of Radiation Oncology, Jaslok Hospital, Mumbai, India
| | - Andrea Sebastiano Ciccone
- Université Côte d'Azur, Sophia-Antipolis INSERM U1081, CNRS UMR 7284, Centre Hospitalier, Universitaire de Nice, Hôpital de Cimiez, Nice, France
| | | | - Giuseppe Dario Testa
- Department of Geriatric and Intensive Care Medicine, Careggi Hospital, University of Florence, Florence, Italy
| | - Rogelio Velasco
- Clinical Trial and Research Divison, Philippine Heart Center, Quezon City, Philippines; Lung Center of the Philippines, Quezon City, Philippines
| | - Joana Marinho
- Medical Oncology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal; Associação de Investigação de Cuidados de Suporte em Oncologia (AICSO), Vila Nova de Gaia, Portugal
| | - Adolfo Gonzalez Serrano
- Urology Department, Hospital Universitari Son Espases, Palma, Spain; Inserm, IMRB, Université Paris-Est-Créteil, Créteil, France
| | - Melody K Schiaffino
- School of Public Health, Division of Health Management and Policy, San Diego State University, San Diego, CA, United States of America; Center for Health Equity, Education and Research (CHEER), University of California San Diego, La Jolla, CA, United States of America; UC San Diego School of Medicine, CA, United States of America
| | - Fabio Gomes
- Medical Oncology Department, The Christie NHS Foundation Trust, Manchester, UK
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Noronha V, Rao AR, Ramaswamy A, Kumar A, Pillai A, Dhekale R, Krishnamurthy J, Kapoor A, Gattani S, Sehgal A, Kumar S, Castelino R, Mahajan S, Daptardar A, Sonkusare L, Deodhar J, Ansari N, Vagal M, Mahajan P, Timmanpyati S, Nookala M, Chitre A, Narasimhan PN, Banerjee J, Gota V, Banavali S, Badwe RA, Prabhash K. The current status of geriatric oncology in India. Ecancermedicalscience 2023; 17:1595. [PMID: 37799956 PMCID: PMC10550294 DOI: 10.3332/ecancer.2023.1595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Indexed: 10/07/2023] Open
Abstract
Geriatric oncology in India is relatively new. The number of older persons with cancer is increasing exponentially; at our institution, 34% of patients registered are 60 years and over. Apart from the Tata Memorial Hospital in Mumbai, there are currently no other Indian centers that have a dedicated geriatric oncology unit. Geriatric assessments (GAs) are done sporadically, and older patients with cancer are usually assessed and treated based on clinical judgement. Challenges to increasing the uptake of GA include a lack of training/time/interest or knowledge of the importance of the GA. Other challenges include a lack of trained personnel with expertise in geriatric oncology, and a paucity of research studies that seek to advance the outcomes in older Indian patients with cancer. We anticipate that over the next 10 years, along with the inevitable increase in the number of older persons with cancer in India, there will be a commensurate increase in the number of skilled personnel to care for them. Key goals for the future include increased research output, increased number of dedicated geriatric oncology units across the country, India-specific geriatric oncology guidelines, geriatric oncology training programs, and a focus on collaborative work across India and with global partners. In this narrative review, we provide a broad overview of the status of geriatric oncology in India, along with a description of the work done at our center. We hope to spark interest and provide inspiration to readers to consider developing geriatric oncology services in other settings.
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Affiliation(s)
- Vanita Noronha
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 400012, India
| | - Abhijith Rajaram Rao
- Department of Geriatric Medicine, All India Institute of Medical Science, New Delhi 110023, India
| | - Anant Ramaswamy
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 400012, India
| | - Anita Kumar
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 400012, India
| | - Anupa Pillai
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 400012, India
| | - Ratan Dhekale
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 400012, India
| | - Jyoti Krishnamurthy
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 400012, India
| | - Akhil Kapoor
- Department of Medical Oncology, Mahamana Pandit Madan Mohan Malviya Cancer Center & Homi Bhabha Cancer Hospital, Varanasi 221005, India
| | - Shreya Gattani
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 400012, India
| | - Arshiya Sehgal
- Department of Clinical Pharmacology, Advanced Centre for Treatment Research and Education in Cancer, Navi Mumbai 410210, India
| | - Sharath Kumar
- Department of Clinical Pharmacology, Advanced Centre for Treatment Research and Education in Cancer, Navi Mumbai 410210, India
| | - Renita Castelino
- Department of Clinical Pharmacology, Advanced Centre for Treatment Research and Education in Cancer, Navi Mumbai 410210, India
| | - Sarika Mahajan
- Department of Physiotherapy, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 400012, India
| | - Anuradha Daptardar
- Department of Physiotherapy, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 400012, India
| | - Lekhika Sonkusare
- Department of Psycho-oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 400012, India
| | - Jayita Deodhar
- Department of Psycho-oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 400012, India
| | - Nabila Ansari
- Department of Occupational Therapy, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 400012, India
| | - Manjusha Vagal
- Department of Occupational Therapy, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 400012, India
| | - Purabi Mahajan
- Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 400012, India
| | - Shivshankar Timmanpyati
- Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 400012, India
| | - Manjunath Nookala
- Department of Clinical Pharmacology, Advanced Centre for Treatment Research and Education in Cancer, Navi Mumbai 410210, India
| | - Ankita Chitre
- Department of Physiotherapy, Mahamana Pandit Madan Mohan Malviya Cancer Center & Homi Bhabha Cancer Hospital, Varanasi 400012, India
| | | | - Joyita Banerjee
- Venu Geriatric Care Centre, Venu Charitable Society, New Delhi 110017, India
| | - Vikram Gota
- Department of Clinical Pharmacology, Advanced Centre for Treatment Research and Education in Cancer, Navi Mumbai 410210, India
| | - Shripad Banavali
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 400012, India
| | - Rajendra A Badwe
- Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 400012, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 400012, India
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Bailie CR, Pillai PS, Goodwin Singh A, Leishman J, Grills NJ, Mathias K. Does the Nae Umeed group intervention improve mental health and social participation? A pre-post study in Uttarakhand, India. Glob Ment Health (Camb) 2023; 10:e47. [PMID: 37854393 PMCID: PMC10579688 DOI: 10.1017/gmh.2023.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 06/21/2023] [Accepted: 07/19/2023] [Indexed: 10/20/2023] Open
Abstract
There are few evidence-based interventions to support caregiver mental health developed for low- and middle-income countries. Nae Umeed is a community-based group intervention developed with collaboratively with local community health workers in Uttarakhand, India primarily to promote mental wellbeing for caregivers and others. This pre-post study aimed to evaluate whether Nae Umeed improved mental health and social participation for people with mental distress, including caregivers. The intervention consisted of 14 structured group sessions facilitated by community health workers. Among 115 adult participants, 20% were caregivers and 80% were people with disability and other vulnerable community members; 62% had no formal education and 92% were female. Substantial and statistically significant improvements occurred in validated psychometric measures for mental health (12-Item General Health Questionnaire, Patient Health Questionnaire-9) and social participation (Participation Scale). Improvements occurred regardless of caregiver status. This intervention addressed mental health and social participation for marginalised groups that are typically without access to formal mental health care and findings suggest Nae Umeed improved mental health and social participation; however, a controlled community trial would be required to prove causation. Community-based group interventions are a promising approach to improving the mental health of vulnerable groups in South Asia.
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Affiliation(s)
- Christopher R. Bailie
- Nossal Institute for Global Health, University of Melbourne, Parkville, VIC, Australia
| | - Pooja S. Pillai
- Burans, Herbertpur Christian Hospital, Emmanuel Hospital Association, Dehradun, India
| | - Atul Goodwin Singh
- Burans, Herbertpur Christian Hospital, Emmanuel Hospital Association, Dehradun, India
| | - Jed Leishman
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Nathan J. Grills
- Nossal Institute for Global Health, University of Melbourne, Parkville, VIC, Australia
| | - Kaaren Mathias
- Burans, Herbertpur Christian Hospital, Emmanuel Hospital Association, Dehradun, India
- Faculty of Health, University of Canterbury, Christchurch, New Zealand
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Li C, Tang N, Yang L, Zeng Q, Yu T, Pu X, Wang J, Zhang H. Effect of caregiver burden on anticipatory grief among caregivers of elderly cancer patients: Chain mediation role of family functioning and resilience. Front Psychol 2023; 13:1020517. [PMID: 36704702 PMCID: PMC9872027 DOI: 10.3389/fpsyg.2022.1020517] [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: 08/16/2022] [Accepted: 12/16/2022] [Indexed: 01/11/2023] Open
Abstract
This study aimed to explore the relationship between caregiver burden and anticipatory grief among caregivers of elderly cancer patients, and to examine the chain mediation effects of family functioning and resilience. A total of 624 valid questionnaires were collected. The Structural Equation Model was established to test the mediating effects of family functioning and resilience. Results showed that caregiver burden has a direct positive effect on anticipatory grief, both family functioning and resilience have negative effects on caregiver burden and anticipatory grief, and that resilience moderates the mediating effect of family functioning. Our findings suggest that reducing the caregiver burden among caregivers of elderly cancer patients, improving family functioning, and enhancing resilience have important effects in alleviating the anticipatory grief of caregivers. Our findings provide some references for further research. Medical staff should better understand the grief experience of caregivers and implement interventions to enable caregivers to better cope with anticipatory grief and psychological stress, so as to promote the quality of care for elderly cancer patients.
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Affiliation(s)
- Caiyue Li
- School of Nursing, Lanzhou University, Lanzhou, China
| | - Nan Tang
- School of Nursing, Lanzhou University, Lanzhou, China
| | - Lili Yang
- School of Nursing, Lanzhou University, Lanzhou, China
| | - Qing Zeng
- School of Nursing, Lanzhou University, Lanzhou, China
| | - Tana Yu
- School of Nursing, Lanzhou University, Lanzhou, China
| | - Xiaojin Pu
- Lanzhou University First Hospital, Lanzhou, China
| | - Juan Wang
- Lanzhou University Second Hospital, Lanzhou, China
| | - Hongchen Zhang
- School of Nursing, Lanzhou University, Lanzhou, China,*Correspondence: Hongchen Zhang,
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