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Waldrop DP, McGinley JM. Beyond Advance Directives: Addressing Communication Gaps and Caregiving Challenges at Life's End. J Pain Symptom Manage 2022; 63:415-422. [PMID: 34662723 DOI: 10.1016/j.jpainsymman.2021.09.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 09/24/2021] [Accepted: 09/30/2021] [Indexed: 11/23/2022]
Abstract
CONTEXT The premise of advance directives and care planning is to help people articulate and document their wishes so surrogate decision-makers and providers can honor them. However, beyond the completion of such a document, underlying challenges are often unaddressed OBJECTIVES: The overall purpose of the study was to investigate how communication, including but not limited to the completion of advance directives, and caregiving influenced family caregivers' experiences. Communication gaps and caregiving challenges that were unaddressed by advance directives are presented. METHODS Non-dominant simultaneous mixed-methods (QUAL-QUAN) were used to explore how end-of-life events influenced family caregivers. In-depth interviews were conducted with 108 caregivers about 4 months following the death of a family member who was in hospice care. RESULTS A majority (n = 90; 84.9%) had specific wishes about end-of-life treatment. Patients had a completed: Health Care Proxy-101 (93.3%); Living Will-43 (39.8%); Do Not Resuscitate orders (DNR)-82 (75.9%) and Medical Orders for Life Sustaining Treatment-40 (37%). A majority (n = 83; 76.9%) of caregivers said that they had "enough" or "just the right amount" of information to prepare for the patients' death. Five themes illustrated caregivers' experiences: Family Conflict; Patient/Family-Provider Conflict; Uncertainty, Caregiving Realities; Awareness-Avoidance of Dying. CONCLUSION A majority of had an advance directive, yet caregivers expressed feeling unprepared for decision-making, caregiving and discussing it with the dying person. The advance directive and care planning process fell short of providing needed communication, knowledge and preparation; it can be an opportunity for teaching, learning, preparing and supporting families at life's end.
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Affiliation(s)
- Deborah P Waldrop
- University at Buffalo School of Social Work (D.P.W.), Buffalo, New York, USA.
| | - Jacqueline M McGinley
- Binghamton University (J.M.M.), College of Community & Public Affairs, Department of Social Work, Binghamton, New York, USA
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Rodríguez AA, Martínez Ó, Amayra I, López-Paz JF, Al-Rashaida M, Lázaro E, Caballero P, Pérez M, Berrocoso S, García M, Luna PM, Pérez-Núñez P, Passi N. Diseases Costs and Impact of the Caring Role on Informal Carers of Children with Neuromuscular Disease. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18062991. [PMID: 33803993 PMCID: PMC7999397 DOI: 10.3390/ijerph18062991] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/09/2021] [Accepted: 03/10/2021] [Indexed: 01/06/2023]
Abstract
This study aims to evaluate the costs of informal care for children with neuromuscular disease and evaluate how physical and psychological health is associated with socio-demographic variables. A cross sectional design was used with a convenience sample of 110 carers that participated in this study. Participants were recruited from Spanish hospitals and rare diseases organizations. Economic costs and sociodemographic aspects were assessed using the economic costs questionnaire and the sociodemographic questionnaire. Physical and psychological health was evaluated using the CarerQol-7D, PHQ-15, Barthel Index, Zarit Overload Scale and Satisfaction with Life Scale. Carers of children with neuromuscular disease spent a large percentage of their annual income in physical therapy, psychological care and speech therapy. Informal costs differed according to the degree of dependency of the child. These were higher in those caregivers whose child under their care presented low functional independence. The loss of work productivity was related to marital status, use of professional services and the child’s dependency. Finally, carers who were female, single or separated and without a job showed worse physical and psychological health. The results highlighted that carers have to face a number of high costs because of the non-existence of social protection and due to the child’s diagnosis.
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Ornstein KA, Aldridge M, Gillezeau C, Kristensen MS, Gazibara T, Groenvold M, Thygesen LC. New antidepressant utilization pre- and post-bereavement: a population-based study of partners and adult children. Soc Psychiatry Psychiatr Epidemiol 2020; 55:1261-1271. [PMID: 32185418 PMCID: PMC7494560 DOI: 10.1007/s00127-020-01857-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 03/03/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE Bereavement is associated with increased morbidity and mortality, but few studies have examined the specific timing of depression onset. This study examines the risk of developing new-onset depression in adult children and partners by month, 1 year before and after death. METHODS Using population-based registers in Denmark, we assembled a cohort of 236,000 individuals who died a natural death (2010-2016). Partners and adult children of the deceased were identified and demographic and prescription data were collected. GEE logistic regression was used to model whether the bereaved received a new antidepressant prescription around the death of their loved one across 24 time intervals (12 months before and after death). RESULTS Male and female partners had an increase in receipt of new antidepressant prescriptions in the 11 months after the death of their partner, with a peak increase 2 or 3 months after death. Partners also increased new antidepressant prescription use 2 months before death. Characteristics of the decedents including cause of death were not associated with new antidepressant prescription in the surviving partner. Adult children did not have increased odds of being prescribed new antidepressants at any time. CONCLUSION Both male and female partners have increase in new antidepressant utilization before and after the death of their partner. Our work points to the importance of supporting partners not only after the death of their partner, but also in the period before death when families may be actively engaged in caregiving for the seriously ill.
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Affiliation(s)
- Katherine A Ornstein
- Department of Geriatric and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, USA.
| | - Melissa Aldridge
- Department of Geriatric and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Christina Gillezeau
- Department of Geriatric and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Marie S Kristensen
- National Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Tatjana Gazibara
- National Institute of Public Health, University of Southern Denmark, Odense, Denmark
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Beograd, Serbia
| | | | - Lau C Thygesen
- National Institute of Public Health, University of Southern Denmark, Odense, Denmark
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Wilson DM, Errasti-Ibarrondo B, Rodríguez-Prat A. A Research Literature Review to Determine How Bereavement Programs Are Evaluated. OMEGA-JOURNAL OF DEATH AND DYING 2019; 83:831-858. [PMID: 31430222 DOI: 10.1177/0030222819869492] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A review of all 44 research reports published between 2000 and 2018 on bereavement program evaluation was undertaken to identify evaluation methods and assess their apparent efficacy. Bereavement program evaluations varied considerably, with multiple data collection methods per study common (61.4%) over single methods (38.6%). Among these evaluation methods, a self-devised questionnaire was most often used (59.1%), followed by qualitative interviewing (36.4%), and the use of 1 or more of 35 data collection instruments such as grief inventories or depression scales (40.9%). Evaluative data were usually only collected once (77.3%), typically around program completion. Formal bereavement program evaluation appears to be ad hoc and sporadic, and potentially unlikely to provide the type and quality of information needed to retain, improve, expand, or abandon programs. Evaluation method developments including evaluation standards are needed to ensure recipients and others benefit as expected from bereavement programs.
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Affiliation(s)
- Donna M Wilson
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
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Hajradinovic Y, Tishelman C, Lindqvist O, Goliath I. Family members´ experiences of the end-of-life care environments in acute care settings - a photo-elicitation study. Int J Qual Stud Health Well-being 2019; 13:1511767. [PMID: 30176152 PMCID: PMC6127834 DOI: 10.1080/17482631.2018.1511767] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
PURPOSE This article explores experiences of the acute-care environment as a setting for end-of-life (EoL) care from the perspective of family members of a dying person. METHOD We used participant-produced photographs in conjunction with follow-up interviews with nine family members to persons at the EoL, cared for in two acute-care settings. RESULTS The interpretive description analysis process resulted in three constructed themes-Aesthetic and un-aesthetic impressions, Space for privacy and social relationships, and Need for guidance in crucial times. Aspects of importance in the physical setting related to aesthetics, particularly in regard to sensory experience, and to a need for enough privacy to facilitate the maintenance of social relationships. Interactions between the world of family members and that of professionals were described as intrinsically related to guidance about both the material and immaterial environment at crucial times. CONCLUSION The care environment, already recognized to have an impact in relation to patients, is concluded to also affect the participating family members in this study in a variety of ways.
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Affiliation(s)
- Yvonne Hajradinovic
- a Palliative Education & Research Centre, Region Östergötland , Vrinnevi hospital , Norrköping , Sweden.,b Sophiahemmet University , Department of Nursing Science , Stockholm , Sweden
| | - Carol Tishelman
- c Division of Innovative Care Research, Department of Learning, Informatics, Management and Ethics , Karolinska Institutet , Stockholm , Sweden.,d The Center for Rural Medicine , Storuman , Västerbottens county council (VLL).,e Stockholm Health Care Services (SLSO) , Stockholms country council (SLL) , Stockholm , Sweden
| | - Olav Lindqvist
- c Division of Innovative Care Research, Department of Learning, Informatics, Management and Ethics , Karolinska Institutet , Stockholm , Sweden.,f Department of Nursing , Umeå University , Umeå , Sweden
| | - Ida Goliath
- c Division of Innovative Care Research, Department of Learning, Informatics, Management and Ethics , Karolinska Institutet , Stockholm , Sweden.,g Ersta hospital , Hospice , Stockholm , Sweden
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Wilson DM, Cohen J, MacLeod R, Houttekier D. Bereavement grief: A population-based foundational evidence study. DEATH STUDIES 2018; 42:463-469. [PMID: 28985143 DOI: 10.1080/07481187.2017.1382609] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Information is needed on the incidence and prevalence of bereavement grief, and factors associated with severe or prolonged grief. Among 1,208 representative Canadian adults, 96% had experienced bereavement grief and 78% were actively grieving at interview. Grief levels were higher among women, Protestants, and Catholics, when the death was under 2 years previously, when a spouse, parent, or child had died, and when the perceived death quality was lower. This study reveals the importance of good deaths; they are essential for dying people and also those who mourn their deaths.
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Affiliation(s)
- Donna M Wilson
- a Faculty of Nursing , University of Alberta , Edmonton , Alberta , Canada
| | - Joachim Cohen
- b End-of-Life Care Research Group , Vrije Universiteit Brussel, and Ghent University , Brussels , Belgium
| | - Rod MacLeod
- c HammondCare and University of Sydney , Sydney , Australia
| | - Dirk Houttekier
- b End-of-Life Care Research Group , Vrije Universiteit Brussel, and Ghent University , Brussels , Belgium
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Jansson MRN, von Heymann-Horan A, Rasmussen BK, Albieri V, Frederiksen K, Suppli N, Dalton SO, Johansen C, Bidstrup PE. Risk for use of antidepressants, anxiolytics, and hypnotics in partners of glioma patients-A nationwide study covering 19 years of prescriptions. Psychooncology 2018; 27:1930-1936. [PMID: 29683227 DOI: 10.1002/pon.4744] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 03/28/2018] [Accepted: 04/12/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Suffering from malignant brain tumor is a stressful condition, for patients and their partners. In a retrospective cohort study using nationwide registries, we examined partners' risk for first use of antidepressants, anxiolytics, or hypnotics. METHODS We followed all 4373 partners of adults with glioma, diagnosed in 1998 to 2013 in Denmark and a cohort of 43 808 partners of glioma-free persons matched 1:10. In Cox proportional hazard models, we estimated hazard ratios (HRs) for a first prescription of psychotropic medications (antidepressants, anxiolytics, or hypnotics) according to the partner's glioma status. Among partners of glioma patients, we further estimated HRs for a first prescription of psychotropic medication according to disease characteristics, sociodemographic factors, and bereavement. RESULTS Two years after diagnosis, 29% of female and 21% of male partners of glioma patients had had a first prescription of psychotropic medication compared with 10% in female and 8% in male partners of glioma-free persons. Partners of glioma patients had a significantly increased, 4-fold higher risk for a first prescription of psychotropic medications in the first year after diagnosis than partners of glioma-free persons (HR 4.10, 95% CI, 3.80:4.43). Among partners of glioma patients, the risk was significantly reduced in bereaved compared with non-bereaved partners. CONCLUSIONS We have documented, for the first time, that the psychological impact of a diagnosis of glioma is such a severe stress exposure that it increases the risk for having medication prescribed to treat symptoms of anxiety, sleep problems, and depression.
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Affiliation(s)
| | | | - Birthe K Rasmussen
- Department of Neurology, Nordsjaellands Hospital, University of Copenhagen, Denmark.,Danish Neuro-Oncology, Denmark
| | - Vanna Albieri
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | | | - Nis Suppli
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | | | - Christoffer Johansen
- Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Oncology, University Hospital Rigshospitalet, Copenhagen, Denmark
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Lundberg T, Forinder U, Olsson M, Fürst CJ, Årestedt K, Alvariza A. Bereavement stressors and psychosocial well-being of young adults following the loss of a parent - A cross-sectional survey. Eur J Oncol Nurs 2018; 35:33-38. [PMID: 30057081 DOI: 10.1016/j.ejon.2018.05.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 05/07/2018] [Accepted: 05/11/2018] [Indexed: 10/16/2022]
Abstract
PURPOSE The knowledge about young adults who have lost a parent to cancer is limited, and to reach a broader understanding about this group, this study used the Dual Process Model of Coping with Bereavement (Stroebe and Schut, 1999) as a theoretical framework. The purpose of this study was to describe loss- and restoration-oriented bereavement stressors and psychosocial wellbeing of young adults following the loss of a parent to cancer. METHOD This survey used baseline data from a longitudinal study. Young adults, aged 16-28 years, who lost a parent to cancer more than two months earlier and agreed to participate in support groups held at three palliative care services in Sweden, responded to a comprehensive theory-based study-specific questionnaire. RESULTS Altogether, 77 young adults (64 women and 13 men) answered the questionnaire an average of five-to-eight months after the loss. Twenty percent (n = 15) had not been aware of their parent's impending death at all or only knew a few hours before the death, and 65% (n = 50) did not expect the death when it occurred. The young adults reported low self-esteem (n = 58, 76%), mild to severe anxiety (n = 55, 74%), mild to severe depression (n = 23, 31%) and low life satisfaction. CONCLUSION Young adults reported overall poor psychosocial wellbeing following bereavement. The unexpectedness and unawareness of the parent's imminent death, i.e., loss-oriented bereavement stressors, might influence psychosocial wellbeing. Despite these reports, restoration-oriented stressors, such as support from family and friends, helped them to cope with the loss.
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Affiliation(s)
- Tina Lundberg
- Department of Neurobiology, Care Sciences and Society/Division of Social Work, Karolinska Institutet, 141 83, Huddinge, Sweden; Department of Health Care Sciences/Palliative Research Centre, Ersta Sköndal Bräcke University College, Box 11189, 100 61, Stockholm, Sweden; Function Area in Social Work and Health, Karolinska University Hospital, 171 76, Stockholm, Sweden.
| | - Ulla Forinder
- Department of Neurobiology, Care Sciences and Society/Division of Social Work, Karolinska Institutet, 141 83, Huddinge, Sweden; Function Area in Social Work and Health, Karolinska University Hospital, 171 76, Stockholm, Sweden; Department of Social Work and Psychology, Gävle University, 801 76, Gävle, Sweden
| | - Mariann Olsson
- Department of Neurobiology, Care Sciences and Society/Division of Social Work, Karolinska Institutet, 141 83, Huddinge, Sweden; Function Area in Social Work and Health, Karolinska University Hospital, 171 76, Stockholm, Sweden; Stockholms Sjukhem Foundation, Box 12230, 102 26, Stockholm, Sweden
| | - Carl Johan Fürst
- The Institute for Palliative Care at Lund University and Region Skåne, Department of Clinical Sciences, Oncology, Lund University, Box 117, 221 00, Lund, Sweden
| | - Kristofer Årestedt
- Faculty of Health and Life Science, Linnaeus University, 391 82 Kalmar, Sweden; Department of Medical and Health Sciences, Linköping University, 581 83, Linköping, Sweden; Kalmar County Council, Box 601, 391 26, Kalmar, Sweden
| | - Anette Alvariza
- Department of Health Care Sciences/Palliative Research Centre, Ersta Sköndal Bräcke University College, Box 11189, 100 61, Stockholm, Sweden; Capio Palliative Care Unit, Dalen Hospital, Åstorpsringen 6, Enskededalen, 121 87, Stockholm, Sweden
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Broady TR, Saich F, Hinton T. Caring for a family member or friend with dementia at the end of life: A scoping review and implications for palliative care practice. Palliat Med 2018; 32:643-656. [PMID: 29343195 DOI: 10.1177/0269216317748844] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Although people with dementia receive substantial care from informal sources, there is limited research available that investigates how these carers experience end-of-life care. AIM This review aimed to identify what is currently known about carers' experiences of providing end-of-life care to a family member or friend with dementia and draw implications for palliative care policy and service provision. DESIGN A scoping literature review was conducted, first using a targeted key word search, followed by assessments of eligibility based on title and then abstract content. DATA SOURCES Records were sourced through PsycINFO, PubMed and CINAHL databases. Peer-reviewed papers published between 2000 and 2016, reporting on data collected directly from carers, were included for review. RESULTS Carers' experience centred on relationships (with care recipients, family and friends and health care professionals) and the specific context of caring for someone with dementia. These broad categories of carers' experiences had clear influences on them personally, particularly in relation to their sense of self and their wellbeing. CONCLUSION Palliative care services would benefit from ensuring holistic approaches to supporting people with dementia, their carers and wider family networks. Tailoring services to the specific context of dementia would enable effective, personalised support throughout extended periods leading up to care recipient death as well as through the challenges faced beyond bereavement.
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Affiliation(s)
| | | | - Tom Hinton
- Carers NSW, North Sydney, NSW, Australia
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Spatuzzi R, Giulietti MV, Ricciuti M, Merico F, Meloni C, Fabbietti P, Ottaviani M, Violani C, Cormio C, Vespa A. Quality of life and burden in family caregivers of patients with advanced cancer in active treatment settings and hospice care: A comparative study. DEATH STUDIES 2017; 41:276-283. [PMID: 27982741 DOI: 10.1080/07481187.2016.1273277] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The aim of this study was to evaluate caregiver burden and quality of life (QoL) in active treatment settings and hospice care for 76 family caregivers of advanced cancer patients, using the Medical Outcomes Study Short Form and the Caregiver Burden Inventory. Compared to the active group, the hospice group reported significantly lower QoL scores in mental component summary score and higher scores in general health subscale and in physical component summary score. Future research needs to further investigate the complexities of caregivers' needs, especially in the emotional and mental domains, and offer effective, clinically proven interventions.
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Affiliation(s)
| | - Maria Velia Giulietti
- b Department of Neurology , INRCA-IRCCS National Institute of Science and Health on Aging , Ancona , Italy
| | | | - Fabiana Merico
- c Palliative Care Center , "Casa di Betania" Hospice , Tricase , Lecce , Italy
| | - Cristina Meloni
- b Department of Neurology , INRCA-IRCCS National Institute of Science and Health on Aging , Ancona , Italy
| | - Paolo Fabbietti
- d Biostatistical Center , INRCA-IRCCS National Institute of Science and Health on Aging , Ancona , Italy
| | - Marica Ottaviani
- b Department of Neurology , INRCA-IRCCS National Institute of Science and Health on Aging , Ancona , Italy
| | | | - Claudia Cormio
- f Experimental Unit of Psycho-oncology , National Research Centre "Giovanni Paolo II," , Bari , Italy
| | - Anna Vespa
- b Department of Neurology , INRCA-IRCCS National Institute of Science and Health on Aging , Ancona , Italy
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