Layers of Loss: A Scoping Review and Taxonomy of HD Caregivers' Spiritual Suffering, Grief/Loss and Coping Strategies

The meaning of apathy in Huntington's disease: A qualitative study of caregiver perspectives

Although one of the most prevalent and impactful features of Huntington's disease (HD), little is known about the impact of apathy on HD caregivers, although there is evidence it affects perceptions of distress and burden. Given the importance of the caregivers, we aimed to explore the lived experience of people supporting someone with HD and associated apathy. Semi-structured interviews were conducted with 11 caregivers and analysed using reflective thematic analysis, informed by a phenomenological framework. Five overarching themes were produced: (1) What even is apathy? (2) It makes my life harder: the practical impact of apathy, (3) They haven't forgotten me, but they have forgotten that they ever loved me, (4) I'm grieving for someone who hasn't died yet, and (5) I need a safe space to say what I really feel without fear of judgement. Inter-woven between these themes were complex narratives about the unspoken nature of HD, the invisibility of caregivers who felt trapped and unheard, and the one-sided nature of loving someone with the disease. Findings are discussed in relation to theoretical frameworks of anticipatory grief and ambiguous loss, and situated within the wider literature on caregiving for people with a neurodegenerative condition.

Huntington's disease caregivers: A qualitative exploration of caregivers experience

Caring for a family member with Huntington's disease can be complex and challenging. This study set out to investigate the research question: what are the experiences of Huntington's disease caregivers. In this qualitative study, 11 adult caregivers (6 female and 5 male, aged 49-77 years), of a family member with Huntington's disease participated in semi-structured interviews, using either video-link or telephone. Data analysis was informed by interpretative phenomenological analysis. The analysis identified three themes related to the caregiver experience: The impact on the caregiver; The impact of the genetic risk; Accessing health care & support services. Complexities of caregiving are compounded by the lack of services available to Huntington's disease patients, as well as the lack of knowledge and expertise related to the disease. This study highlights the need for enhanced knowledge of the disease in community services, along with access to psychological and multidisciplinary support.

Navigating competing needs: a qualitative study on parenthood with a partner with Huntington's disease

Objective

Huntington's disease (HD) is a rare neurodegenerative condition characterised by progressive symptoms affecting motricity, cognition, neuropsychiatric function and behaviour. HD develops during a period of life in which many live in partnership and have children. HD impacts all family members through its cognitive and psychological symptoms, mid-life onset, long disease trajectory and genetic risk. The aim of the study was to explore how parents without HD experience and manage parenthood when their partner is affected by HD.

Methods

Qualitative interviews with 14 caregivers were analysed using reflexive thematic analysis.

Results

Three main themes with corresponding subthemes were identified, followed by an underlying theme: Genetic risk: An underlying layer of complexity. The first theme, Balancing competing demands, describes the challenges involved when attempting to attend to conflicting needs within the family. Theme 2, Needing a shoulder to lean on, covers participants' feelings of loneliness and their need to be seen by others, whereas Theme 3, Restoring and building strength, encompasses coping strategies used by caregivers to protect themselves and their children from potential negative experiences. The underlying theme describes how the genetic aspect of the disease permeates the participants' experiences across all other themes.

Conclusion

Support providers may be unaware of the extensive repercussions HD can have on a family. Acknowledging the central role of partners without HD and their risk of psychological distress is crucial. Exhausted partners may struggle to support their children, which may lead to childhoods overshadowed by HD. For family members to prioritise their own needs, tailored support must be set in place for parents with HD.

Approaching Suffering in Young University Students, New Challenge for a Compassionate University: A Qualitative Study of Undergraduate Nursing Students

BACKGROUND/OBJECTIVES

Student distress is diverse and manifests itself in a variety of ways. Driven by the constant pressure to meet academic and personal expectations, many students experience a deep sense of insufficiency and hopelessness. Anxiety and depression are widespread and are often accompanied by self-critical thoughts and feelings of worthlessness. Seeking temporary relief that often exacerbates their long-term struggles, some students resort to self-harm as a way to manage their emotional pain.

METHODS

This study employs an exploratory qualitative design with a phenomenological approach to deeply examine students' experiences of suffering. Using semi-structured interviews, the study captures detailed narratives from 17 purposely selected students, providing a rich understanding of their lived experiences. Adhering to COREQ guidelines (Consolidated Criteria for Reporting Qualitative Studies).

RESULTS

The analysis identified four main themes: the concept of suffering, its causes, students' responses, and coping strategies. Eleven sub-themes were identified, highlighting the significant challenges students face, including low self-esteem, anxiety, depression, and self-harm. These problems are increased by academic stress and social pressure derived from the intensive use of social networks. The constant social comparison and the search for external validation on social networks generate feelings of inadequacy and emotional exhaustion. Students often lack effective strategies to manage these pressures. In addition, bullying and the absence of meaningful relationships in the academic environment increase their suffering.

CONCLUSIONS

This study provides a novel contribution by focusing on the lived experiences of nursing students and emphasizing the importance of the compassionate university model as a framework for addressing student suffering. It highlights the urgent need to implement strategies for support and compassion in educational institutions centred on emotional management, presence, listening, and specific mindfulness and stress management programmes. Additionally, fostering healthier and more mindful use of social media is crucial to help students manage their expectations, reduce their suffering, and cultivate self-compassion.

"In God We Trust": An Exploratory Study of the Associations Between Religiosity and the Caregiving Experiences of Parents of Children with Rare Diseases in Poland

Most children with a rare disease are cared for by their family members but parenting such a child is extremely demanding due to the complexity and severity of symptoms, with serious physical, emotional, social, and financial consequences for caregivers. Although religion may serve as a positive coping strategy, little is known about its role in helping caregivers manage the stress related to the burden of caregiving in Poland. Therefore, we surveyed 925 Polish family caregivers of children with rare diseases to understand the association between caregivers' religiosity and their caring experiences. The findings suggest that parents' religiosity is associated with a more positive caregiving experience, perceived quality of life, and experienced caregiving burden. While religious caregivers reported experiencing less distressing emotions and stressed the encouraging impact of their child's disease on their life more often, non-religious caregivers experienced role captivity and role overload more frequently. Since religion may serve as a source of strength and a protecting factor against mental health problems and the burden of caregiving, healthcare professionals should be aware of the importance of religious and spiritual care, and caregivers' religiosity should be considered an integral part of a holistic approach.

Exploring Psychedelics for Alleviating Existential and Spiritual Suffering in People With Serious Illnesses: Links to the Theory of Self-Transcendence

The fields of palliative and holistic Nursing are dedicated to providing comprehensive care for the person, emphasizing special attention to the existential and spiritual aspects of care. Psychedelic-assisted therapy has emerged as a promising approach for symptom management in individuals with serious illnesses, particularly those of existential and spiritual origin. People who undergo challenging experiences, as is the case with serious illnesses, often undergo an identity crisis and question the purpose of their lives. Psychedelic therapy, when conducted properly by trained professionals, can facilitate self-exploration and self-transcendence, opening doors to states of expanded consciousness and fostering a profound connection with oneself. This experience can help patients develop a greater sense of self-awareness and a deeper understanding of their existential and spiritual issues, enabling them to find meaning and inner peace. The Theory of Self-Transcendence theory provides a Nursing framework for understanding how psychedelic-assisted therapy can facilitate, through self-transcendence, the journey of spiritual and existential healing, offering the possibility of achieving wellbecoming from a state of vulnerability.

Helping the helpers: Understanding information and support needs of caregivers in underserved communities

Informal caregivers caring for patients at the end of life in rural geographic areas may have inadequate support due to insufficient community-based palliative care services. We conducted a parallel mixed-methods study to understand informal caregivers' unmet supportive, educational, and informational needs living in rural areas with limited community-based palliative care services. Forty-four caregivers of loved ones that died at home between December 2017 and September 2020 completed the Carer Support Needs Assessment Tool (CSNAT) and 14 caregivers were interviewed. Using a parallel mixed analysis, results showed that caregiver distress was associated with unmet information needs about how to accurately assess and manage pain levels and identify signs and symptoms of end-of-life. Caregivers needed more support related to available, knowledgeable, and well-trained home health care providers, accessible equipment, 24-hour respite care, accessible grief counseling, and a central triage contact number for community support.

Palliative care to support the needs of adults with neurological disease

Neurological diseases cause physical, psychosocial, and spiritual or existential suffering from the time of their diagnosis. Palliative care focuses on improving quality of life for people with serious illness and their families by addressing this multidimensional suffering. Evidence from clinical trials supports the ability of palliative care to improve patient and caregiver outcomes by the use of outpatient or home-based palliative care interventions for people with motor neuron disease, multiple sclerosis, or Parkinson's disease; inpatient palliative care consultations for people with advanced dementia; telephone-based case management for people with dementia in the community; and nurse-led discussions with decision aids for people with advanced dementia in long-term care. Unfortunately, most people with neurological diseases do not get the support that they need for their palliative care under current standards of healthcare. Improving this situation requires the deployment of routine screening to identify individual palliative care needs, the integration of palliative care approaches into routine neurological care, and collaboration between neurologists and palliative care specialists. Research, education, and advocacy are also needed to raise standards of care.