Living with mesothelioma: A systematic review of patient and caregiver psychosocial support needs

Impact of Surgery on Quality of Life in Families of Children With a Cleft Lip and/or Palate: A Systematic Review

ObjectiveTo synthesize research exploring the impact of surgery on quality of life (QoL) in families of children with a cleft lip and/or palate (CL/P).DesignMedline, PsycINFO, CINAHL, and ProQuest databases were systematically searched (from database inception to July 2024) to identify studies exploring QoL in families following surgery for a child with CL/P. Studies were quality appraised using Quality Assessment for Diverse Studies criteria, and a narrative synthesis was undertaken.Main Outcome Measure: Quality of life was explored but specific measures varied across studies.Interventions: Type of surgery being investigated varied across the reviewed studies. This systematic review focussed on both functional and aesthetic surgeries throughout childhood.ResultsOf 157 identified studies, 9 were eligible for inclusion (1 mixed-methods, 1 observational, 1 qualitative, 2 cross-sectional, 4 quasi-experimental). Analysis indicated that QoL was positively impacted by surgery through reduced financial burden, increased sense of mastery/coping, and reduced social impact. However, for some families, new demands (eg, medical/dental appliances, food restrictions), intolerance of uncertainty, and adjustment to changes to their child's appearance were identified following surgery.ConclusionsThere is limited qualitative and quantitative research exploring the impact of a child's cleft surgery on family QoL. The quality of studies included in the review was variable. Supporting families accessing cleft services, especially where QoL and mental health are negatively impacted, is important. Due to the variability within and between the studies, and lack of detail relating to rationale and processes taken, the conclusions from this review are tentative. Further research is needed that addresses methodological and conceptual limitations.

Psychosocial Needs of People Living With Pleural Mesothelioma and Family Carers: A Mixed Methods Study

BACKGROUND

Mesothelioma is a cancer of growing global incidence, especially in developing countries, with unique complex psychosocial impacts on patients and their carers.

AIMS

To provide a comprehensive understanding of the psychosocial needs of people living with pleural mesothelioma and family carers.

METHODS

A mixed methods design with 61 semi-structured interviews and psychometrically validated questionnaires to assess pleural mesothelioma patients' (n = 36) quality of life and frailty and carers' (n = 25) caregiving experiences, quality of life, and pre-loss prolonged grief symptoms.

RESULTS

People with mesothelioma (29 men, 7 women, aged 46-89 years) indicated moderate quality of life; 18 (50%) met criteria for frailty. Current carers (21 women, 4 men; aged 41-79 years) generally reported positive caregiving experiences and high quality of life; 5 (20%) scored in the range indicative of risk for prolonged grief disorder. Four themes were generated: a desire for tailored information with bespoke detail, assistance to coordinate tasks of treatment, improved social and peer support, and effective psychological services. Needs varied, with main concerns being about breaking the news to spouses/children, the impact of the disease and death on family, loss of personal future, managing psychological symptoms, and avoiding burden.

CONCLUSIONS

These specific and unmet psychosocial needs provide a strong basis for individualised care pathways to address these needs via the integration of psychology into the multidisciplinary care team and the development and evaluation of mental health and wellbeing interventions for mesothelioma patients and carers. Doing so will reduce psychosocial distress and improve residual vitality.

Psychological Interventions for Mesothelioma Patients and Their Caregivers: A Systematic Literature Review

Malignant Mesothelioma (MM) has a striking impact on the somatopsychic balance of patients and their families, including physical, psychological, and interpersonal problems. The aim of this systematic literature review was to investigate what psychological interventions are offered to patients with MM and their caregivers worldwide.

METHODS

The review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The literature search led to the identification of 12 articles. Results were categorized into five categories. 1. Individual psychological support, 2. Group psychological support, 3. Cognitive-behavioral group psychotherapy, 4. Brief psychoanalytic groups, 5. Multifamily group.

RESULTS

The interventions differed in terms of form, duration and resources used. Most of them were group-based and psychoanalytically oriented, although individual and cognitive-behavioral interventions were also described. Despite the differences, the interventions appeared to be fundamental in facilitating the processing of mental pain and anger related to the diagnosis.

CONCLUSION

Our study has shown that there are still few psychological interventions available for MM patients and their caregivers. The somatopsychic consequences of MM in patients and caregivers should encourage institutions and healthcare professionals to develop assessment and intervention models that address the different dimensions of their suffering and promote their residual vitality.

Confirmatory validation of a brief patient-reported outcome measure assessing psychological distress in caregivers of malignant mesothelioma patients: the Mesothelioma Psychological Distress Tool-Caregivers

Objective

The diagnosis of malignant mesothelioma (MM) can be devastating for both patients and caregivers, who may experience intense suffering from a physical, psychological, and interpersonal perspective. Despite the extensive literature on caregiver distress, there is a lack of validated measures to provide evidence of psychological distress of caregivers of MM patients. Therefore, in a previous study we developed the Mesothelioma Psychological Distress Tool-Caregivers (MPDT-C) to evaluate the specific profile of psychological distress in this population. This paper describes the item selection, factor analysis, and psychometric evaluation of the revised MPDT-C.

Methods

The analyses of this work first aimed to confirm the previous factorial structure. In the case of nonfit, it aimed to find an alternative structure and causes of nonfit in the model. Examination of the fit of the factorial model was conducted using a Bayesian approach.

Results

The final version of the MPDT-C is a 7-item self-report questionnaire consisting of one factor (Burden for the caregiver).

Conclusion

Having a short self-report questionnaire to assess the psychological distress experienced by caregivers of MM patients has several advantages. First, it is suited to epidemiological studies where multiple variables and measures are involved. Second, it is easy to administer and does not take much time to complete. Therefore, the MPDT-C can also be administered in clinical contexts, perhaps when MM patients attend follow-up medical evaluation. Lastly, short measures are less affected by cognitive fatigue, which is very common in a long battery of tests and could affect response reliability.

Living with mesothelioma: a systematic review of mental health and well-being impacts and interventions for patients and their informal carers

OBJECTIVES

Mesothelioma is an aggressive cancer predominantly affecting the lung and abdominal linings. It can have a unique impact on mental health and well-being (MHWB) due to its incurability, poor prognosis and asbestos-exposure causation. This review's aims were to identify/synthesise international evidence on mesothelioma's MHWB impacts; explore MHWB interventions used by patients and carers; and identify evidence of their effectiveness.

DESIGN

Systematic review.

DATA SOURCES

Databases, searched March 2022 and March 2024, were MEDLINE; CINAHL; PsycINFO; Cochrane Library; ASSIA.

ELIGIBILITY CRITERIA

We included study designs focusing on psychological impacts of living with mesothelioma and MHWB interventions used by patients and informal carers, published in English since January 2002.

DATA EXTRACTION AND SYNTHESIS

A team of reviewers screened included studies using standardised methods. Quality was assessed using validated tools: Mixed-Methods Appraisal tool for primary research and Joanna Briggs Institute Critical Appraisal Checklist for Systematic Reviews.

RESULTS

Forty-eight studies met the inclusion criteria: 20 qualitative, 16 quantitative, nine reviews, two mixed-methods, one combined systematic review/qualitative study. UK studies predominated. Many MHWB impacts were reported, including traumatic stress, depression, anxiety and guilt. These were influenced by mesothelioma's causation, communication issues and carer-patient relational interactions. Participants used wide-ranging MHWB interventions, including religious/spiritual practice; talking to mental-health professionals; meaning-making. Some strategies were presented as unhelpful, for example, denial. Participants reported lack of access to support.

CONCLUSIONS

Most qualitative studies were rated high quality. The quality of the quantitative studies and reviews varied. The sparse literature regarding MHWB in mesothelioma means more research is needed into impacts on patients and carers, including trauma. To enable access to evidence-based support, research is recommended concerning MHWB interventions' effectiveness in mesothelioma.

PROSPERO REGISTRATION NUMBER

CRD42022302187.

The mental health and well-being implications of a mesothelioma diagnosis: A mixed methods study

PURPOSE

Mesothelioma is an incurable, asbestos-related cancer with a poor prognosis. There is scant evidence about the mental health and well-being impacts on patients and carers living with the illness. This study aimed to investigate mesothelioma's impact on mental health and well-being and the scale of mental health conditions in patients and informal carers.

METHODS

A mixed-methods design was used: a cross-sectional survey of mesothelioma patients and informal carers plus semi-structured interviews with patients and carers. The survey used validated scales collecting data on mental health aspects of mesothelioma: the EQ5D to assess health-related quality-of-life; the Hospital Anxiety and Depression scale; the PCL-5 to assess Posttraumatic Stress; and the Posttraumatic Growth Inventory. The datasets were integrated during analysis.

RESULTS

96 useable survey responses were received. A clinical level of depression was reported by 29 participants (30.21%), of anxiety by 48 (50%), of posttraumatic distress disorder by 32 (33.33%), and of posttraumatic growth by 34 (35.42%). Carers had worse scores than patients. Three main themes were developed from interviews with 10 patients and 11 carers: 'Prognosis', 'Support from services', and 'Social connections and communication'.

CONCLUSIONS

Healthcare professionals delivering a mesothelioma diagnosis require regular training in communication skills plus updating in current treatment options, so they provide an appropriate mix of realism and hope. Better signposting to mental health support is needed for patients and carers. Our introduction of posttraumatic growth into the mesothelioma literature is novel. We recommend specialist nurses are trained to recognise, understand, and foster posttraumatic growth.

Caregivers of patients with malignant pleural mesothelioma: who provides care, what care do they provide and what burden do they experience?

PURPOSE

There are limited data on the impact of caregiving for patients with malignant pleural mesothelioma (MPM) on the caregiver. We aimed to identify the demographic characteristics of these caregivers, the caregiving activities they perform and how caregiving burden impacts their work productivity and overall activity.

METHODS

This cross-sectional study collected data from caregivers of patients with MPM across France, Italy, Spain and the United Kingdom January-June 2019. Caregiver demographics, daily caregiving tasks and the impact of caregiving on physical health was collected via questionnaire. The Zarit Burden Interview (ZBI) was used to assess caregiver burden and the Work Productivity and Activity Impairment questionnaire (WPAI) assessed impairment at work and during daily activities. Analyses were descriptive.

RESULTS

Overall, 291 caregivers provided data. Caregivers were mostly female (83%), living with the patient (82%) and their partner/spouse (71%). Caregivers provided over five hours of daily emotional/physical support to patients. ZBI scores indicated 74% of caregivers were at risk of developing depression. Employed caregivers had missed 12% of work in the past seven days, with considerable presenteeism (25%) and overall work impairment (33%) observed. Overall, the mean activity impairment was 40%.

CONCLUSION

Caregivers provide essential care for those with MPM. We show caregiving for patients with MPM involves a range of burdensome tasks that impact caregivers' emotional health and work reflected in ZBI and WPAI scores. Innovations in the management of MPM must account for how caregivers may be impacted and can be supported to carry out this important role.

Depression and Complicated Grief, and Associated Factors, of Bereaved Family Members of Patients Who Died of Malignant Pleural Mesothelioma in Japan

OBJECTIVES

we investigated the prevalence and associated factors of depression and complicated grief (CG) among bereaved family members of malignant pleural mesothelioma (MPM) patients in Japan.

METHODS

Bereaved family members of MPM patients (n = 72) were surveyed. The Japanese version of the Patient Health Questionnaire-9 (PHQ-9) and the Japanese version of the Brief Grief Questionnaire (BGQ) were used to assess depression and complicated grief (CG), respectively. Socio-economic factors, anger toward asbestos, care satisfaction, achievement of good death, and quality of end-of-life care were assessed in relation to depression and CG.

RESULTS

In the family members of MPM patients, the frequencies of depression and CG were 19.4% and 15.3%, respectively. The bereaved family members who were not compensated by the asbestos-related health-damage relief system (p = 0.018) and who felt the financial impacts of the patient's MPM on the family (p = 0.006) had a higher likelihood of depression. The bereaved family members who were not satisfied with the care given when the patient became critical (p = 0.034), who were not compensated by the asbestos-related health-damage relief system (p = 0.020), who felt the financial impact of the patient's MPM on the family (p = 0.016), and whose deceased relative underwent surgery (p = 0.030) had a higher likelihood of CG.

CONCLUSIONS

For bereaved family members of MPM patients, routine screening for depression and CG and the provision of grief care are suggested. In addition, for family members of MPM patients, financial support, including the promotion of the asbestos-related health-damage relief system, and improved care for patients who undergo surgery and when patients become critical, are recommended.