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Gustafson DH, Landucci G, Vjorn OJ, Gicquelais RE, Goldberg SB, Johnston DC, Curtin JJ, Bailey GL, Shah DV, Pe-Romashko K, Gustafson DH. Effects of Bundling Medication for Opioid Use Disorder With an mHealth Intervention Targeting Addiction: A Randomized Clinical Trial. Am J Psychiatry 2024; 181:115-124. [PMID: 37789744 PMCID: PMC10843669 DOI: 10.1176/appi.ajp.20230055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
OBJECTIVE Medication for opioid use disorder (MOUD) improves treatment retention and reduces illicit opioid use. A-CHESS is an evidence-based smartphone intervention shown to improve addiction-related behaviors. The authors tested the efficacy of MOUD alone versus MOUD plus A-CHESS to determine whether the combination further improved outcomes. METHODS In an unblinded parallel-group randomized controlled trial, 414 participants recruited from outpatient programs were assigned in a 1:1 ratio to receive either MOUD alone or MOUD+A-CHESS for 16 months and were followed for an additional 8 months. All participants were on methadone, buprenorphine, or injectable naltrexone. The primary outcome was abstinence from illicit opioid use; secondary outcomes were treatment retention, health services use, other substance use, and quality of life; moderators were MOUD type, gender, withdrawal symptom severity, pain severity, and loneliness. Data sources were surveys comprising multiple validated scales, as well as urine screens, every 4 months. RESULTS There was no difference in abstinence between participants in the MOUD+A-CHESS and MOUD-alone arms across time (odds ratio=1.10, 95% CI=0.90-1.33). However, abstinence was moderated by withdrawal symptom severity (odds ratio=0.95, 95% CI=0.91-1.00) and MOUD type (odds ratio=0.57, 95% CI=0.34-0.97). Among participants without withdrawal symptoms, abstinence rates were higher over time for those in the MOUD+A-CHESS arm than for those in the MOUD-alone arm (odds ratio=1.30, 95% CI=1.01-1.67). Among participants taking methadone, those in the MOUD+A-CHESS arm were more likely to be abstinent over time (b=0.28, SE=0.09) than those in the MOUD-alone arm (b=0.06, SE=0.08), although the two groups did not differ significantly from each other (∆b=0.22, SE=0.11). MOUD+A-CHESS was also associated with greater meeting attendance (odds ratio=1.25, 95% CI=1.05-1.49) and decreased emergency department and urgent care use (odds ratio=0.88, 95% CI=0.78-0.99). CONCLUSIONS Overall, MOUD+A-CHESS did not improve abstinence relative to MOUD alone. However, MOUD+A-CHESS may provide benefits for subsets of patients and may impact treatment utilization.
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Affiliation(s)
- David H. Gustafson
- Center for Health Enhancement Systems Studies, University of Wisconsin–Madison
- Department of Industrial and Systems Engineering, University of Wisconsin–Madison
| | - Gina Landucci
- Center for Health Enhancement Systems Studies, University of Wisconsin–Madison
| | - Olivia J. Vjorn
- Center for Health Enhancement Systems Studies, University of Wisconsin–Madison
| | | | - Simon B. Goldberg
- Department of Counseling Psychology, University of Wisconsin–Madison
- Center for Healthy Minds, University of Wisconsin–Madison
| | - Darcie C. Johnston
- Center for Health Enhancement Systems Studies, University of Wisconsin–Madison
| | - John J. Curtin
- Department of Psychology, University of Wisconsin–Madison
| | - Genie L. Bailey
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, R.I
- Stanley Street Treatment and Resources (SSTAR), Fall River, Mass
| | - Dhavan V. Shah
- School of Journalism and Mass Communication, University of Wisconsin–Madison
| | - Klaren Pe-Romashko
- Center for Health Enhancement Systems Studies, University of Wisconsin–Madison
| | - David H. Gustafson
- Center for Health Enhancement Systems Studies, University of Wisconsin–Madison
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2
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Chow R, Mathews JJ, Cheng EY, Lo S, Wong J, Alam S, Hannon B, Rodin G, Nissim R, Hales S, Kavalieratos D, Quinn KL, Tomlinson G, Zimmermann C. Interventions to improve outcomes for caregivers of patients with advanced cancer: a meta-analysis. J Natl Cancer Inst 2023; 115:896-908. [PMID: 37279594 PMCID: PMC10407714 DOI: 10.1093/jnci/djad075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 04/04/2023] [Accepted: 05/01/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Family caregivers of patients with advanced cancer often have poor quality of life (QOL) and mental health. We examined the effectiveness of interventions offering support for caregivers of patients with advanced cancer on caregiver QOL and mental health outcomes. METHODS We searched Ovid MEDLINE, EMBASE, Cochrane CENTRAL, and Cumulative Index to Nursing and Allied Health Literature databases from inception through June 2021. Eligible studies reported on randomized controlled trials for adult caregivers of adult patients with advanced cancer. Meta-analysis was conducted for primary outcomes of QOL, physical well-being, mental well-being, anxiety, and depression, from baseline to follow-up of 1-3 months; secondary endpoints were these outcomes at 4-6 months and additional caregiver burden, self-efficacy, family functioning, and bereavement outcomes. Random effects models were used to generate summary standardized mean differences (SMD). RESULTS Of 12 193 references identified, 56 articles reporting on 49 trials involving 8554 caregivers were eligible for analysis; 16 (33%) targeted caregivers, 19 (39%) patient-caregiver dyads, and 14 (29%) patients and their families. At 1- to 3-month follow-up, interventions had a statistically significant effect on overall QOL (SMD = 0.24, 95% confidence interval [CI] = 0.10 to 0.39); I2 = 52.0%), mental well-being (SMD = 0.14, 95% CI = 0.02 to 0.25; I2 = 0.0%), anxiety (SMD = 0.27, 95% CI = 0.06 to 0.49; I2 = 74.0%), and depression (SMD = 0.34, 95% CI = 0.16 to 0.52; I2 = 64.4) compared with standard care. In narrative synthesis, interventions demonstrated improvements in caregiver self-efficacy and grief. CONCLUSIONS Interventions targeting caregivers, dyads, or patients and families led to improvements in caregiver QOL and mental health. These data support the routine provision of interventions to improve well-being in caregivers of patients with advanced cancer.
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Affiliation(s)
- Ronald Chow
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jean J Mathews
- Division of Palliative Medicine, Department of Medicine and Department of Oncology, Queen’s University, Kingston, ON, Canada
| | - Emily YiQin Cheng
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Samantha Lo
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Joanne Wong
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Sorayya Alam
- Palliative Medicine, Sobell House, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Breffni Hannon
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Medicine, University Health Network, Toronto, ON, Canada
| | - Gary Rodin
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Centre for Mental Health, University Health Network, Toronto, ON, Canada
| | - Rinat Nissim
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Centre for Mental Health, University Health Network, Toronto, ON, Canada
| | - Sarah Hales
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Centre for Mental Health, University Health Network, Toronto, ON, Canada
| | - Dio Kavalieratos
- Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University, Atlanta, GA, USA
| | - Kieran L Quinn
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Division of General Internal Medicine and Palliative Care, Department of Medicine, Sinai Health System, Temmy Latner Centre for Palliative Care, Toronto, ON, Canada
| | - George Tomlinson
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Medicine, University Health Network, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Camilla Zimmermann
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Medicine, University Health Network, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Auger C, Guay C, Pysklywec A, Bier N, Demers L, Miller WC, Gélinas-Bronsard D, Ahmed S. What's behind the Dashboard? Intervention Mapping of a Mobility Outcomes Monitoring System for Rehabilitation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13303. [PMID: 36293885 PMCID: PMC9602496 DOI: 10.3390/ijerph192013303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 10/03/2022] [Accepted: 10/11/2022] [Indexed: 06/16/2023]
Abstract
Training and follow-up for older adults who received new assistive technology can improve device use adoption and function, but there is a lack of systematic and coordinated services. To address this gap, the Internet-based MOvIT+™ was designed to provide remote monitoring and support for assistive technology users and their caregivers. This paper presents the intervention mapping approach that was used. In step 1, we established a project governance structure and a logic model emerged from interviews with stakeholders and a systematic review of literature. In step 2, a modified TRIAGE consensus process led to the prioritization of thirty-six intervention components. In step 3, we created use cases for all intervention end users. In step 4, the intervention interface was created through iterative lab testing, and we gathered training resources. In step 5, a two-stage implementation plan was devised with the recruited rehabilitation sites. In step 6, we proposed an evaluation protocol. This detailed account of the development of MOvIT+™ demonstrates how the combined use of an intervention mapping approach and participatory processes with end users can help linking evidence-based, user-centered, and pragmatic reasoning. It makes visible the complexities behind the development of Internet-based interventions, while guiding future program developers.
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Affiliation(s)
- Claudine Auger
- Faculty of Medicine, School of Rehabilitation, Université de Montréal, Montréal, QC H3C 3J7, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montréal, QC H3S 1M9, Canada
| | - Cassioppée Guay
- Faculty of Medicine, School of Rehabilitation, Université de Montréal, Montréal, QC H3C 3J7, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montréal, QC H3S 1M9, Canada
| | - Alex Pysklywec
- Faculty of Medicine, School of Rehabilitation, Université de Montréal, Montréal, QC H3C 3J7, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montréal, QC H3S 1M9, Canada
| | - Nathalie Bier
- Faculty of Medicine, School of Rehabilitation, Université de Montréal, Montréal, QC H3C 3J7, Canada
- Centre de Recherche de l’Institut Universitaire de Gériatrie de Montréal, Montreal, QC H3W 1W5, Canada
| | - Louise Demers
- Faculty of Medicine, School of Rehabilitation, Université de Montréal, Montréal, QC H3C 3J7, Canada
- Centre de Recherche de l’Institut Universitaire de Gériatrie de Montréal, Montreal, QC H3W 1W5, Canada
| | - William C. Miller
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Dominique Gélinas-Bronsard
- Faculty of Medicine, School of Rehabilitation, Université de Montréal, Montréal, QC H3C 3J7, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montréal, QC H3S 1M9, Canada
| | - Sara Ahmed
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montréal, QC H3S 1M9, Canada
- School of Physical and Occupational Therapy, McGill University, Montréal, QC H3A 0G4, Canada
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Sak-Dankosky N, Sherwood P, Vehviläinen-Julkunen K, Kvist T. Interventions improving well-being of adult cancer patients' caregivers: A systematic review. J Adv Nurs 2022; 78:2747-2764. [PMID: 35696332 DOI: 10.1111/jan.15320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 03/23/2022] [Accepted: 05/01/2022] [Indexed: 11/30/2022]
Abstract
AIM The aim of this study was to determine what kind of psychosocial interventions aimed at improving the well-being of adult cancer patient caregivers were developed, and to describe the methodological characteristics and clinical effectiveness of the interventions which could be included in the nursing care plans. DESIGN Systematic review DATA SOURCES: A systematic search of three databases (PubMed, CINAHL, and PsycINFO) was conducted to identify peer-reviewed papers published between years 2004-2019. REVIEW METHODS The review was guided by the Joanna Briggs Institute manual for systematic reviews. Data were extracted and appraised by three reviewers using standardized checklists. Narrative synthesis was used to analyse the data. RESULTS A total of 37 studies underwent analysis. Most of the studies described psychoeducational interventions, designed for patient-caregiver dyads, delivered face-to-face. There was a great variety in caregiver outcomes and measurement tools used. Even though most studies used a randomized controlled design and standardized intervention protocols, many reported problems with recruitment and attrition. Most studies reported that the intervention improved caregiver outcomes, yet the majority of them failed to report effect sizes. CONCLUSION There are currently a plethora of successful interventions available for cancer patient caregivers which can be included to the nursing care plan. Psychoeducational online interventions which include a social support component may have the best potential in supporting caregivers. It is important to address specific caregiver needs at different cancer stages rather than general needs of caregivers in future interventions. IMPACT This review suggests that despite a large number of different interventions which can be included in the nursing care plan to improve the support offered to caregivers, some issues should be addressed while designing an intervention study. The emphasis should be placed on reporting effect sizes, focusing on specific caregiver needs and improving recruitment, retention strategies and sustainability of caregiver interventions.
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Affiliation(s)
| | - Paula Sherwood
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Katri Vehviläinen-Julkunen
- Department of Nursing Science, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - Tarja Kvist
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
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5
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Gustafson DH, Mares ML, Johnston DC, Landucci G, Pe-Romashko K, Vjorn OJ, Hu Y, Gustafson DH, Maus A, Mahoney JE, Mutlu B. Using Smart Displays to Implement an eHealth System for Older Adults With Multiple Chronic Conditions: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2022; 11:e37522. [PMID: 35511229 PMCID: PMC9121223 DOI: 10.2196/37522] [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: 02/23/2022] [Revised: 03/22/2022] [Accepted: 03/24/2022] [Indexed: 11/29/2022] Open
Abstract
Background Voice-controlled smart speakers and displays have a unique but unproven potential for delivering eHealth interventions. Many laptop- and smartphone-based interventions have been shown to improve multiple outcomes, but voice-controlled platforms have not been tested in large-scale rigorous trials. Older adults with multiple chronic health conditions, who need tools to help with their daily management, may be especially good candidates for interventions on voice-controlled devices because these patients often have physical limitations, such as tremors or vision problems, that make the use of laptops and smartphones challenging. Objective The aim of this study is to assess whether participants using an evidence-based intervention (ElderTree) on a smart display will experience decreased pain interference and improved quality of life and related measures in comparison with participants using ElderTree on a laptop and control participants who are given no device or access to ElderTree. Methods A total of 291 adults aged ≥60 years with chronic pain and ≥3 additional chronic conditions will be recruited from primary care clinics and community organizations and randomized 1:1:1 to ElderTree access on a smart display along with their usual care, ElderTree access on a touch screen laptop along with usual care, or usual care alone. All patients will be followed for 8 months. The primary outcomes are differences between groups in measures of pain interference and psychosocial quality of life. The secondary outcomes are between-group differences in system use at 8 months, physical quality of life, pain intensity, hospital readmissions, communication with medical providers, health distress, well-being, loneliness, and irritability. We will also examine mediators and moderators of the effects of ElderTree on both platforms. At baseline, 4 months, and 8 months, patients will complete written surveys comprising validated scales selected for good psychometric properties with similar populations. ElderTree use data will be collected continuously in system logs. We will use linear mixed-effects models to evaluate outcomes over time, with treatment condition and time acting as between-participant factors. Separate analyses will be conducted for each outcome. Results Recruitment began in August 2021 and will run through April 2023. The intervention period will end in December 2023. The findings will be disseminated via peer-reviewed publications. Conclusions To our knowledge, this is the first study with a large sample and long time frame to examine whether a voice-controlled smart device can perform as well as or better than a laptop in implementing a health intervention for older patients with multiple chronic health conditions. As patients with multiple conditions are such a large cohort, the implications for cost as well as patient well-being are significant. Making the best use of current and developing technologies is a critical part of this effort. Trial Registration ClinicalTrials.gov NCT04798196; https://clinicaltrials.gov/ct2/show/NCT04798196 International Registered Report Identifier (IRRID) PRR1-10.2196/37522
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Affiliation(s)
- David H Gustafson
- Center for Health Enhancement Systems Studies, University of Wisconsin-Madison, Madison, WI, United States.,Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, United States
| | - Marie-Louise Mares
- Department of Communication Arts, University of Wisconsin-Madison, Madison, WI, United States
| | - Darcie C Johnston
- Center for Health Enhancement Systems Studies, University of Wisconsin-Madison, Madison, WI, United States
| | - Gina Landucci
- Center for Health Enhancement Systems Studies, University of Wisconsin-Madison, Madison, WI, United States
| | - Klaren Pe-Romashko
- Center for Health Enhancement Systems Studies, University of Wisconsin-Madison, Madison, WI, United States
| | - Olivia J Vjorn
- Center for Health Enhancement Systems Studies, University of Wisconsin-Madison, Madison, WI, United States
| | - Yaxin Hu
- Department of Computer Sciences, University of Wisconsin-Madison, Madison, WI, United States
| | - David H Gustafson
- Center for Health Enhancement Systems Studies, University of Wisconsin-Madison, Madison, WI, United States
| | - Adam Maus
- Center for Health Enhancement Systems Studies, University of Wisconsin-Madison, Madison, WI, United States
| | - Jane E Mahoney
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI, United States
| | - Bilge Mutlu
- Department of Computer Sciences, University of Wisconsin-Madison, Madison, WI, United States
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6
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Park LS, Chih MY, Stephenson C, Schumacher N, Brown R, Gustafson D, Barrett B, Quanbeck A. Testing an mHealth System for Individuals With Mild to Moderate Alcohol Use Disorders: Protocol for a Type 1 Hybrid Effectiveness-Implementation Trial. JMIR Res Protoc 2022; 11:e31109. [PMID: 35179502 PMCID: PMC8900897 DOI: 10.2196/31109] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 12/02/2021] [Accepted: 12/20/2021] [Indexed: 12/11/2022] Open
Abstract
Background The extent of human interaction needed to achieve effective and cost-effective use of mobile health (mHealth) apps for individuals with mild to moderate alcohol use disorder (AUD) remains largely unexamined. This study seeks to understand how varying levels of human interaction affect the ways in which an mHealth intervention for the prevention and treatment of AUDs works or does not work, for whom, and under what circumstances. Objective The primary aim is to detect the effectiveness of an mHealth intervention by assessing differences in self-reported risky drinking patterns and quality of life between participants in three study groups (self-monitored, peer-supported, and clinically integrated). The cost-effectiveness of each approach will also be assessed. Methods This hybrid type 1 study is an unblinded patient-level randomized clinical trial testing the effects of using an evidence-based mHealth system on participants’ drinking patterns and quality of life. There are two groups of participants for this study: individuals receiving the intervention and health care professionals practicing in the broader health care environment. The intervention is a smartphone app that encourages users to reduce their alcohol consumption within the context of integrative medicine using techniques to build healthy habits. The primary outcomes for quantitative analysis will be participant data on their risky drinking days and quality of life as well as app use from weekly and quarterly surveys. Cost measures include intervention and implementation costs. The cost per participant will be determined for each study arm, with intervention and implementation costs separated within each group. There will also be a qualitative assessment of health care professionals’ engagement with the app as well as their thoughts on participant experience with the app. Results This protocol was approved by the Health Sciences Minimal Risk Institutional Review Board on November 18, 2019, with subsequent annual reviews. Recruitment began on March 6, 2020, but was suspended on March 13, 2020, due to the COVID-19 pandemic restrictions. Limited recruitment resumed on July 6, 2020. Trial status as of November 17, 2021, is as follows: 357 participants were enrolled in the study for a planned enrollment of 546 participants. Conclusions The new knowledge gained from this study could have wide and lasting benefits related to the integration of mHealth systems for individuals with mild to moderate AUDs. The results of this study will guide policy makers and providers toward cost-effective ways to incorporate technology in health care and community settings. Trial Registration ClinicalTrials.gov NCT04011644; https://clinicaltrials.gov/ct2/show/NCT04011644 International Registered Report Identifier (IRRID) DERR1-10.2196/31109
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Affiliation(s)
- Linda S Park
- Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Ming-Yuan Chih
- Department of Health and Clinical Sciences, College of Health Sciences, University of Kentucky, Lexington, KY, United States
| | - Christine Stephenson
- Center for Health Disparities Research, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Nicholas Schumacher
- Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Randall Brown
- Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - David Gustafson
- Department of Industrial and Systems Engineering, College of Engineering, University of Wisconsin-Madison, Madison, WI, United States
| | - Bruce Barrett
- Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Andrew Quanbeck
- Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
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Hossain SN, Jaglal SB, Shepherd J, Perrier L, Tomasone JR, Sweet SN, Luong D, Allin S, Nelson MLA, Guilcher SJT, Munce SEP. Web-Based Peer Support Interventions for Adults Living With Chronic Conditions: Scoping Review. JMIR Rehabil Assist Technol 2021; 8:e14321. [PMID: 34032572 PMCID: PMC8188320 DOI: 10.2196/14321] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 10/27/2020] [Accepted: 04/17/2021] [Indexed: 12/15/2022] Open
Abstract
Background Globally, 1 in 3 adults live with multiple chronic conditions. Thus, effective interventions are needed to prevent and manage these chronic conditions and to reduce the associated health care costs. Teaching effective self-management practices to people with chronic diseases is one strategy to address the burden of chronic conditions. With the increasing availability of and access to the internet, the implementation of web-based peer support programs has become increasingly common. Objective The purpose of this scoping review is to synthesize existing literature and key characteristics of web-based peer support programs for persons with chronic conditions. Methods This scoping review follows the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) extension for scoping reviews guidelines. Studies were identified by searching MEDLINE, CINAHL, Embase, PsycINFO, and the Physiotherapy Evidence Database. Chronic diseases identified by the Public Health Agency of Canada were included. Our review was limited to peer support interventions delivered on the web. Peers providing support had to have the chronic condition that they were providing support for. The information abstracted included the year of publication, country of study, purpose of the study, participant population, key characteristics of the intervention, outcome measures, and results. Results After duplicates were removed, 12,641 articles were screened. Data abstraction was completed for 41 articles. There was a lack of participant diversity in the included studies, specifically with respect to the conditions studied. There was a lack of studies with older participants aged ≥70 years. There was inconsistency in how the interventions were described in terms of the duration and frequency of the interventions. Informational, emotional, and appraisal support were implemented in the studied interventions. Few studies used a randomized controlled trial design. A total of 4 of the 6 randomized controlled trials reported positive and significant results, including decreased emotional distress and increased health service navigation, self-efficacy, social participation, and constructive attitudes and approaches. Among the qualitative studies included in this review, there were several positive experiences related to participating in a web-based peer support intervention, including increased compassion and improved attitudes toward the individual’s chronic condition, access to information, and empowerment. Conclusions There is limited recent, high-level evidence on web-based peer support interventions. Where evidence exists, significant improvements in social participation, self-efficacy, and health-directed activity were demonstrated. Some studies incorporated a theoretical framework, and all forms of peer support—emotional, informational, and appraisal support—were identified in the studies included in this review. We recommend further research on web-based peer support in more diverse patient groups (eg, for older adults and chronic conditions outside of cancer, cardiovascular disease, and HIV or AIDS). Key gaps in the area of web-based peer support will serve to inform the development and implementation of future programs.
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Affiliation(s)
- Saima N Hossain
- Toronto Rehabilitation Insititute, University Health Network, Toronto, ON, Canada
| | - Susan B Jaglal
- Toronto Rehabilitation Insititute, University Health Network, Toronto, ON, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,Department of Physical Therapy, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - John Shepherd
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Laure Perrier
- University of Toronto Libraries, University of Toronto, Toronto, ON, Canada
| | - Jennifer R Tomasone
- School of Kinesiology and Health Studies, Queen's University, Kingston, ON, Canada
| | - Shane N Sweet
- School of Kinesiology and Health Studies, Queen's University, Kingston, ON, Canada
| | - Dorothy Luong
- Toronto Rehabilitation Insititute, University Health Network, Toronto, ON, Canada
| | - Sonya Allin
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Michelle L A Nelson
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada.,Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Toronto, ON, Canada
| | - Sara J T Guilcher
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Sarah E P Munce
- Toronto Rehabilitation Institute - Rumsey Centre, University Health Network, Toronto, ON, Canada
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8
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Gustafson DH, Mares ML, Johnston DC, Mahoney JE, Brown RT, Landucci G, Pe-Romashko K, Cody OJ, Gustafson DH, Shah DV. A Web-Based eHealth Intervention to Improve the Quality of Life of Older Adults With Multiple Chronic Conditions: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2021; 10:e25175. [PMID: 33605887 PMCID: PMC7935655 DOI: 10.2196/25175] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 12/28/2020] [Accepted: 01/15/2021] [Indexed: 12/02/2022] Open
Abstract
Background Multiple chronic conditions (MCCs) are common among older adults and expensive to manage. Two-thirds of Medicare beneficiaries have multiple conditions (eg, diabetes and osteoarthritis) and account for more than 90% of Medicare spending. Patients with MCCs also experience lower quality of life and worse medical and psychiatric outcomes than patients without MCCs. In primary care settings, where MCCs are generally treated, care often focuses on laboratory results and medication management, and not quality of life, due in part to time constraints. eHealth systems, which have been shown to improve multiple outcomes, may be able to fill the gap, supplementing primary care and improving these patients’ lives. Objective This study aims to assess the effects of ElderTree (ET), an eHealth intervention for older adults with MCCs, on quality of life and related measures. Methods In this unblinded study, 346 adults aged 65 years and older with at least 3 of 5 targeted high-risk chronic conditions (hypertension, hyperlipidemia, diabetes, osteoarthritis, and BMI ≥30 kg/m2) were recruited from primary care clinics and randomized in a ratio of 1:1 to one of 2 conditions: usual care (UC) plus laptop computer, internet service, and ET or a control consisting of UC plus laptop and internet but no ET. Patients with ET have access for 12 months and will be followed up for an additional 6 months, for a total of 18 months. The primary outcomes of this study are the differences between the 2 groups with regard to measures of quality of life, psychological well-being, and loneliness. The secondary outcomes are between-group differences in laboratory scores, falls, symptom distress, medication adherence, and crisis and long-term health care use. We will also examine the mediators and moderators of the effects of ET. At baseline and months 6, 12, and 18, patients complete written surveys comprising validated scales selected for good psychometric properties with similar populations; laboratory data are collected from eHealth records; health care use and chronic conditions are collected from health records and patient surveys; and ET use data are collected continuously in system logs. We will use general linear models and linear mixed models to evaluate primary and secondary outcomes over time, with treatment condition as a between-subjects factor. Separate analyses will be conducted for outcomes that are noncontinuous or not correlated with other outcomes. Results Recruitment was conducted from January 2018 to December 2019, and 346 participants were recruited. The intervention period will end in June 2021. Conclusions With self-management and motivational strategies, health tracking, educational tools, and peer community and support, ET may help improve outcomes for patients coping with ongoing, complex MCCs. In addition, it may relieve some stress on the primary care system, with potential cost implications. Trial Registration ClinicalTrials.gov NCT03387735; https://www.clinicaltrials.gov/ct2/show/NCT03387735. International Registered Report Identifier (IRRID) DERR1-10.2196/25175
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Affiliation(s)
- David H Gustafson
- Center for Health Enhancement Systems Studies, University of Wisconsin-Madison, Madison, WI, United States.,Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, United States
| | - Marie-Louise Mares
- Department of Communication Arts, University of Wisconsin-Madison, Madison, WI, United States
| | - Darcie C Johnston
- Center for Health Enhancement Systems Studies, University of Wisconsin-Madison, Madison, WI, United States
| | - Jane E Mahoney
- Department of Medicine, University of Wisconsin-Madison, Madison, WI, United States
| | - Randall T Brown
- Department of Family Medicine, University of Wisconsin School of Medicine & Public Health, Madison, WI, United States
| | - Gina Landucci
- Center for Health Enhancement Systems Studies, University of Wisconsin-Madison, Madison, WI, United States
| | - Klaren Pe-Romashko
- Center for Health Enhancement Systems Studies, University of Wisconsin-Madison, Madison, WI, United States
| | - Olivia J Cody
- Center for Health Enhancement Systems Studies, University of Wisconsin-Madison, Madison, WI, United States
| | - David H Gustafson
- Center for Health Enhancement Systems Studies, University of Wisconsin-Madison, Madison, WI, United States
| | - Dhavan V Shah
- School of Journalism and Mass Communication, University of Wisconsin-Madison, Madison, WI, United States
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Boyko RM, Sodhi S, Herman DJ. Evaluation of an Online Home Caregiver Support Program for Non-Professional Caregivers of Patients With Palliative Care Needs. Am J Hosp Palliat Care 2020; 38:1099-1105. [PMID: 33078620 DOI: 10.1177/1049909120968257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Caring for loved ones with palliative needs can be very stressful for carers'. To address this growing issue, an online Home Caregiver Support Program course was created to provide information to non-professional home caregivers about end-of-life care. OBJECTIVES To measure non-professional caregivers' perceived level of competence in addressing physical, psychological, social, and spiritual needs before and after completing online training modules. METHODS Learners rated their competence before and after completing online modules addressing 4 key dimensions relevant to palliative caregivers. Self-ratings of competence were assessed through surveys, completed before and after the online modules. Scores from before and after each module were compared to determine if the online course had increased participant competence. The Wilcoxon signed rank test was used to analyze participant responses to the pre- and post-survey questions. RESULTS A total of 176 participants who completed one or more of the online modules between July 2017-December 2018, 70 (40%) of the participants completed at least one pre- and post-module survey and did not declare themselves as a professional caregiver. Participating in the online Home Caregiver Support Program increased participants' ratings of perceived competence in all domains (p < .01). This significance was maintained when professional caregivers were added to our analysis. CONCLUSION After the completing the modules, participants' self-ratings of perceived competence increased suggesting that participants completing the online program had improved knowledge in addressing the physical, psychological, social, and spiritual challenges faced by non-professional caregivers.
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Affiliation(s)
- Robert M Boyko
- 12366Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sukhmani Sodhi
- 12366Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Dakoda J Herman
- 12366Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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10
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Empowering caregivers in the radiotherapy process: the results of a randomized controlled trial. Support Care Cancer 2020; 29:2395-2404. [PMID: 32918607 DOI: 10.1007/s00520-020-05743-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 09/04/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The present study aims to evaluate the effectiveness of a mobile-assisted empowerment program developed specifically for caregivers of cancer patients undergoing radiotherapy. METHODS In this study, seventy-four individuals who gave care for cancer patients that received radiotherapy between September 2019 and May 2020 were randomized to receive a mobile-assisted empowerment program or standard care. The mobile-assisted empowerment program comprised of education and information related to the radiotherapy process, videos, activities, and question-and-answer modules to support caregivers during the radiotherapy process. Outcome measures were collected at baseline (day 1 of radiotherapy) and on day 21 and included caregiver demographics, distress, quality of life, and coping style using validated questionnaires. RESULTS Compared with baseline, individuals' mean scores of distress were lower in the empowerment group than the control group (p < 0.001). General quality of life and sub-dimension mean scores were higher in the empowerment group than the control group (p ≤ 0.05). There was no difference in the coping style average scores (p ≥ 0.05) between the two groups. CONCLUSIONS This study supports the findings that a mobile-supported empowerment program reduced the level of caregiver distress and increased quality of life during their loved one's treatment with radiotherapy.
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11
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Namkoong K, Stanley SJ, Kim J. Man shall not live by bread alone: the role of perceived emotional support in low-income adults' health outcomes. J Public Health (Oxf) 2020; 42:247-253. [PMID: 30855683 DOI: 10.1093/pubmed/fdz021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 12/18/2018] [Accepted: 02/15/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Adults with low income have limited access to valuable health resources thus presenting a major obstacle to improving their health. Although there are diverse health enhancement programs for low-income populations, relatively few focus on emotional support despite the positive impact of perceived emotional support on health. This study examines the interaction of perceived emotional support and income on the overall health status and psychological well-being of adults with low income. METHODS Secondary data were collected from the Health Information National Trends Survey (Cycle 4). A total of 3677 respondents completed the survey, including 889 adults with low income, as determined by their eligibility for the Supplemental Nutrition Assistance Program (SNAP). Ordinary-least square hierarchical regression analysis was conducted to test main and interaction effects. RESULTS Perceived emotional support moderated the relationship between SNAP eligibility and health outcomes. Lacking an emotional support network has greater detrimental effects on the overall health and psychological well-being of people with low income compared to similar persons with higher income. CONCLUSION These findings suggest the need for health programs that enhance access to emotional support for adults with low income.
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Affiliation(s)
- Kang Namkoong
- Department of Communication, University of Maryland, College Park, MD 20742-7635, USA
| | - Samantha J Stanley
- Department of Communication, University of Maryland, College Park, MD 20742-7635, USA
| | - Jiyoun Kim
- Department of Communication, University of Maryland, College Park, MD 20742-7635, USA
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12
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Luo X, Gao L, Li J, Lin Y, Zhao J, Li Q. A critical literature review of dyadic web-based interventions to support cancer patients and their caregivers, and directions for future research. Psychooncology 2019; 29:38-48. [PMID: 31702839 DOI: 10.1002/pon.5278] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 10/23/2019] [Accepted: 10/27/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVE With the rapid development of the Internet, e-health interventions are becoming popular and are showing positive impacts. Cancer affects not only patients but also their caregivers, leading to a recognition that cancer patient-caregiver dyads cope with cancer as a unit rather than as individuals. The objectives of this paper are to explore web-based interventions for cancer patient-caregiver dyads coping with cancer from the aspects of intervention content, delivery format, outcome measurements, and outcomes and to provide recommendations on developing patient-caregiver dyadic web-based interventions for future research. METHODS Literature focused on cancer patient-caregiver dyadic web-based interventions, published in English or Chinese from the launch of five databases (CINAHL, PsycINFO, EMBase, Medline, Science Citation Index Expanded) to April 2019, was systematically searched. Manual searching through the references of full-text articles was also conducted. RESULTS Of a total of 812 articles, 17 articles met the inclusion criteria. The content of these web-based dyadic interventions mainly included information support, communication and support, skills-building, and psycho-education. These web-based interventions reported a small to large positive impact on patients with cancer and their caregivers in terms of physical health (d = 0.17-0.75), psychological health (d = 0.04-0.80), overall quality of life (d = 0.20-0.68), and dyadic relationship (d = 0.30-0.95). CONCLUSIONS Web-based dyadic interventions can be designed for tailored content, which benefits both patients and their caregivers. Future research on cancer patient-caregiver web-based interventions should be conducted in diverse cultures.
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Affiliation(s)
- Xingjuan Luo
- Wuxi Medical School, Jiangnan University, Wuxi, China
| | - Lihong Gao
- Department of Nursing, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Jieyu Li
- Wuxi Medical School, Jiangnan University, Wuxi, China
| | - Yi Lin
- Wuxi Medical School, Jiangnan University, Wuxi, China
| | - Jie Zhao
- Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Qiuping Li
- Wuxi Medical School, Jiangnan University, Wuxi, China
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Kedia SK, Collins A, Dillon PJ, Akkus C, Ward KD, Jackson BM. Psychosocial interventions for informal caregivers of lung cancer patients: A systematic review. Psychooncology 2019; 29:251-262. [DOI: 10.1002/pon.5271] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 10/19/2019] [Accepted: 10/20/2019] [Indexed: 01/08/2023]
Affiliation(s)
- Satish K. Kedia
- Division of Social and Behavioral Sciences, School of Public Health University of Memphis Memphis Tennessee
| | - Andy Collins
- Division of Social and Behavioral Sciences, School of Public Health University of Memphis Memphis Tennessee
| | - Patrick J. Dillon
- School of Communication Studies Kent State University at Stark North Canton Ohio
| | - Cem Akkus
- Division of Social and Behavioral Sciences, School of Public Health University of Memphis Memphis Tennessee
| | - Kenneth D. Ward
- Division of Social and Behavioral Sciences, School of Public Health University of Memphis Memphis Tennessee
| | - Bianca M. Jackson
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis Tennessee
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Kannaley K, Mehta S, Yelton B, Friedman DB. Thematic analysis of blog narratives written by people with Alzheimer's disease and other dementias and care partners. DEMENTIA 2019; 18:3071-3090. [PMID: 29642716 PMCID: PMC6027602 DOI: 10.1177/1471301218768162] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Limited research takes a socio-biographical approach to study the experiences and perspectives of individuals affected by Alzheimer’s disease and related dementias. The purpose of this study was to thematically analyze blog narratives written by people with Alzheimer’s disease and related dementia and care partners in order to increase understanding of their experiences. Nineteen blogs written by people with Alzheimer’s disease and related dementia and 44 blogs written by care partners were analyzed. The first two authors utilized line-by-line open coding to analyze five posts from each group for the development of a codebook. Using NVivo software, the first author proceeded to code the remaining blogs for emergent themes and subcategories. Emergent themes included (1) effects of Alzheimer’s disease and related dementia on the person with Alzheimer’s disease and related dementia and/or the care partner; (2) seeing the positives; (3) feeling out of control; (4) advocacy and empowerment; (5) coping mechanisms and compensatory strategies; and (6) candid descriptions of experiences with Alzheimer’s disease and related dementia. These themes also encompassed numerous subcategories that are discussed in this paper. Results from this study provide insights into the experiences of individuals affected by Alzheimer’s disease and related dementia. Writers discussed several topics that are consistent with research on illness narratives of individuals with chronic diseases, including loss of identity, strategies for coping, and poignant descriptions of life with the disease. This study provides information in the form of overlapping themes from first-person perspectives of numerous individuals affected by Alzheimer’s disease and related dementia. This type of data is crucial to understand the experiences of people who live with ADRD.
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Kajiwara K, Kako J, Miyashita M. Response to: “Caring for the person with cancer and the role of digital technology in supporting carers”. Support Care Cancer 2019; 28:961. [DOI: 10.1007/s00520-019-04994-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 07/11/2019] [Indexed: 11/29/2022]
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Zhu Y, Stephens KK. Online Support Group Participation and Social Support: Incorporating Identification and Interpersonal Bonds. SMALL GROUP RESEARCH 2019. [DOI: 10.1177/1046496419861743] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
An increasing number of people with chronic diseases exchange social support using online support groups (OSGs). However, there is little understanding of group communication mechanisms that underpin the relationship between OSG participation and social support. Drawing on Prentice, Miller, and Lightdale’s common-identity and common-bond framework, we propose and test a theoretical model that explains group communication mechanisms through which members’ participation influences their perceived social support. In the process, we identified and empirically validated a three-factor solution for an OSG participation scale. Based on 356 users across 12 popular OSGs, we find that two group communication mechanisms—identification with the community and interpersonal bonds with other members—mediate the relationship between OSG participation and perceived social support. Specifically, identification has a stronger mediating effect than interpersonal bonds in the relationship between OSG participation and perceived social support. We also discuss theoretical and practical implications.
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Calton BA, Rabow MW, Branagan L, Dionne-Odom JN, Parker Oliver D, Bakitas MA, Fratkin MD, Lustbader D, Jones CA, Ritchie CS. Top Ten Tips Palliative Care Clinicians Should Know About Telepalliative Care. J Palliat Med 2019; 22:981-985. [PMID: 31237467 DOI: 10.1089/jpm.2019.0278] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The field of telehealth is rapidly growing and evolving across medical specialties and health care settings. While additional data are needed, telepalliative care (the application of telehealth technologies to palliative care) may help address important challenges inherent to our specialty, such as geography and clinician staffing; the burden of traveling to brick-and-mortar clinics for patients who are symptomatic and/or functionally limited; and the timely assessment and management of symptoms. Telepalliative care can take many forms, including, but not limited to, video visits between clinicians and patients, smartphone applications to promote caregiver well-being, and remote patient symptom-monitoring programs. This article, created by experts in telehealth and palliative care, provides a review of the current evidence for telepalliative care and potential applications and practical tips for using the technology.
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Affiliation(s)
- Brook Anne Calton
- 1Division of Palliative Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Michael W Rabow
- 1Division of Palliative Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Linda Branagan
- 2Telehealth Resource Center, University of California, San Francisco, San Francisco, California
| | | | - Debra Parker Oliver
- 4Department of Family and Community Medicine, School of Medicine, University of Missouri, Columbia, Missouri
| | - Marie A Bakitas
- 3University of Alabama at Birmingham, School of Nursing, Birmingham, Alabama.,5University of Alabama at Birmingham, Division of Gerontology, Geriatrics, and Palliative Care, Birmingham, Alabama
| | | | - Dana Lustbader
- 7Department of Palliative Care, ProHEALTH Care, Lake Success, New York
| | - Christopher A Jones
- 8Department of Medicine and Palliative and Advanced Illness Research Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Christine S Ritchie
- 9Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California
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Innovative Tools to Support Family Caregivers of Persons with Cancer: The Role of Information Technology. Semin Oncol Nurs 2019; 35:384-388. [PMID: 31229338 DOI: 10.1016/j.soncn.2019.06.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To describe the current evidence of studies examining the use of information technology for family caregivers of persons with cancer. We highlight emerging technologies and trends and discuss ethical and practical implications. DATA SOURCES Review scientific studies and systematic reviews of technology use to support caregivers of persons with cancer. CONCLUSION The evidence base is growing; however, more studies are needed to test the effectiveness of technology. IMPLICATIONS FOR NURSING PRACTICE Several tools have potential to provide support to family caregivers but the selection of such tools needs to address access, privacy, interoperability, and usability considerations.
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Treanor CJ, Santin O, Prue G, Coleman H, Cardwell CR, O'Halloran P, Donnelly M. Psychosocial interventions for informal caregivers of people living with cancer. Cochrane Database Syst Rev 2019; 6:CD009912. [PMID: 31204791 PMCID: PMC6573123 DOI: 10.1002/14651858.cd009912.pub2] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Increasingly, cancer is recognised as a chronic condition with a growing population of informal caregivers providing care for cancer patients. Informal caregiving can negatively affect the health and well-being of caregivers. We need a synthesised account of best evidence to aid decision-making about effective ways to support caregivers for individuals 'living with cancer'. OBJECTIVES To assess the effectiveness of psychosocial interventions designed to improve the quality of life (QoL), physical health and well-being of informal caregivers of people living with cancer compared with usual care. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, PsycINFO, ProQuest, Open SIGLE, Web of Science from inception up to January 2018, trial registries and citation lists of included studies. SELECTION CRITERIA We included randomised and quasi-randomised controlled trials comparing psychosocial interventions delivered to adult informal caregivers of adults affected by cancer on a group or individual basis with usual care. Psychosocial interventions included non-pharmacological interventions that involved an interpersonal relationship between caregivers and healthcare professionals. We included interventions delivered also to caregiver-patient dyads. Interventions delivered to caregivers of individuals receiving palliative or inpatient care were excluded. Our primary outcome was caregiver QoL. Secondary outcomes included patient QoL, caregiver and patient depression, anxiety, psychological distress, physical health status and intervention satisfaction and adverse effects. DATA COLLECTION AND ANALYSIS Pairs of review authors independently screened studies for eligibility, extracted data and conducted 'Risk of bias' assessments. We synthesised findings using meta-analysis, where possible, and reported remaining results in a narrative synthesis. MAIN RESULTS Nineteen trials (n = 3, 725) were included in the review. All trials were reported in English and were undertaken in high-income countries. Trials targeted caregivers of patients affected by a number of cancers spanning newly diagnosed patients, patients awaiting treatment, patients who were being treated currently and individuals post-treatment. Most trials delivered interventions to caregiver-patient dyads (predominantly spousal dyads) and there was variation in intervention delivery to groups or individual participants. There was much heterogeneity across interventions though the majority were defined as psycho-educational. All trials were rated as being at 'high risk of bias'.Compared to usual care, psychosocial interventions may improve slightly caregiver QoL immediately post intervention (standardised mean difference (SMD) 0.29, 95% confidence interval (CI) 0.04 to 0.53; studies = 2, 265 participants) and may have little to no effect on caregiver QoL at 12 months (SMD 0.14, 95% CI - 0.11 to 0.40; studies = 2, 239 participants) post-intervention (both low-quality evidence).Psychosocial interventions probably have little to no effect on caregiver depression immediately to one-month post-intervention (SMD 0.01, 95% CI -0.14 to 0.15; studies = 9, 702 participants) (moderate-quality evidence). Psychosocial interventions may have little to no effect on caregiver anxiety immediately post-intervention (SMD -0.12, 95 % CI -0.33 to 0.10; studies = 5, 329 participants), depression three-to-six months (SMD 0.03, 95% CI -0.33 to 0.38; studies = 5. 379 participants) post-intervention and patient QoL six to 12 months (SMD -0.05, 95% CI -0.37 to 0.26; studies = 3, 294 participants) post-intervention (all low-quality evidence). There was uncertainty whether psychosocial interventions improve patient QoL immediately (SMD -0.03, 95 %CI -0.50 to 0.44; studies = 2, 292 participants) or caregiver anxiety three-to-six months (SMD-0.25, 95% CI -0.64 to 0.13; studies = 4, 272 participants) post-intervention (both very low-quality evidence). Two studies which could not be pooled in a meta-analysis for caregiver physical health status found little to no effect immediately post-intervention and a small intervention effect 12 months post-intervention. Caregiver or patient satisfaction or cost-effectiveness of interventions were not assessed in any studies. Interventions demonstrated good feasibility and acceptability.Psychosocial interventions probably have little to no effect on patient physical health status immediately post-intervention (SMD 0.17, 95 % CI -0.07 to 0.41; studies = 4, 461 participants) and patient depression three to six months post-intervention (SMD-0.11, 95% CI -0.33 to 0.12; studies = 6, 534 participants) (both moderate-quality evidence).Psychosocial interventions may have little to no effect on caregiver psychological distress immediately to one-month (SMD -0.08, 95% CI -0.42 to 0.26; studies = 3, 134 participants), and seven to 12 months (SMD 0.08, 95% CI -0.42 to 0.58; studies = 2, 62 participants) post-intervention; patient depression immediately (SMD -0.12, 95% CI -0.31 to 0.07; studies = 9, 852 participants); anxiety immediately (SMD -0.13, 95% CI -0.41 to 0.15;studies = 4, 422 participants), and three to six months (SMD -0.22, 95% CI -0.45 to 0.02; studies = 4, 370 participants); psychological distress immediately (SMD -0.02, 95% CI -0.47 to 0.44; studies = 2, 74 participants) and seven to 12 months (SMD -0.27, 95% CI -0.78 to 0.24; studies = 2, 61 participants); and physical health status six to 12 months (SMD 0.06, 95% CI -0.18 to 0.30; studies = 2, 275 participants) post-intervention (all low-quality evidence).Three trials reported adverse effects associated with the interventions, compared with usual care, including higher distress, sexual function-related distress and lower relationship satisfaction levels for caregivers, higher distress levels for patients, and that some content was perceived as insensitive to some participants.Trials not able to be pooled in a meta-analysis did not tend to report effect size and it was difficult to discern intervention effectiveness. Variable intervention effects were reported for patient and caregiver outcomes. AUTHORS' CONCLUSIONS Heterogeneity across studies makes it difficult to draw firm conclusions regarding the effectiveness of psychosocial interventions for this population. There is an immediate need for rigorous trials with process evaluations and clearer, detailed intervention descriptions. Cost-effectiveness studies should be conducted alongside future trials.
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Affiliation(s)
- Charlene J Treanor
- Queen's University BelfastCentre for Public HealthInstitute of Clinical Sciences Block B, Royal Victoria Hospital SiteGrosvenor RoadBelfastNorthern IrelandUKBT12 6BJ
| | - Olinda Santin
- Queen's University BelfastSchool of Nursing and Midwifery97 Lisburn RoadBelfastUKBT9 7BL
| | - Gillian Prue
- Queen's University BelfastSchool of Nursing and Midwifery97 Lisburn RoadBelfastUKBT9 7BL
| | - Helen Coleman
- Queen's University BelfastCentre for Public HealthInstitute of Clinical Sciences Block B, Royal Victoria Hospital SiteGrosvenor RoadBelfastNorthern IrelandUKBT12 6BJ
| | - Chris R Cardwell
- Queen's University BelfastCentre for Public HealthInstitute of Clinical Sciences Block B, Royal Victoria Hospital SiteGrosvenor RoadBelfastNorthern IrelandUKBT12 6BJ
| | - Peter O'Halloran
- Queen's University BelfastSchool of Nursing and Midwifery97 Lisburn RoadBelfastUKBT9 7BL
| | - Michael Donnelly
- Queen's University BelfastCentre for Public HealthInstitute of Clinical Sciences Block B, Royal Victoria Hospital SiteGrosvenor RoadBelfastNorthern IrelandUKBT12 6BJ
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20
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Ugalde A, Gaskin CJ, Rankin NM, Schofield P, Boltong A, Aranda S, Chambers S, Krishnasamy M, Livingston PM. A systematic review of cancer caregiver interventions: Appraising the potential for implementation of evidence into practice. Psychooncology 2019; 28:687-701. [PMID: 30716183 PMCID: PMC6594143 DOI: 10.1002/pon.5018] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 12/30/2018] [Accepted: 01/25/2019] [Indexed: 01/15/2023]
Abstract
Objective nformal caregivers provide substantial support for people living with cancer. Previous systematic reviews report on the efficacy of cancer caregiver interventions but not their potential to be implemented. The aim of this systematic review was to explore the potential for cancer caregiver interventions to be implemented into practice. Methods We searched three electronic databases to identify cancer caregiver interventions on 5 January 2018. We operationalised six implementation outcomes (acceptability, adoption, appropriateness, feasibility, fidelity, and costs) into a tool to guide data extraction. Results The search yielded 33 papers (27 papers from electronic databases and six papers from other sources) reporting on 26 studies that met review criteria. Fewer than half the studies (46%) contained evidence about the acceptability of interventions from caregivers' perspectives; only two studies (8%) included interventions developed with input from caregivers. Two studies (8%) addressed potential adoption of interventions, and no studies discussed intentions, agreement, or action to implement interventions into practice. All studies reported on intervention appropriateness by providing a rationale for the interventions. For feasibility, on average less than one‐third of caregivers who were eligible to be involved consented to participate. On fidelity, whether interventions were conducted as intended was reported in 62% of studies. Cost data were reported in terms of intervention delivery, requiring a median time commitment of staff of 180 minutes to be delivered. Conclusions Caregiver intervention studies lack components of study design and reporting that could bridge the gap between research and practice. There is enormous potential for improvements in cancer caregiver intervention study design to plan for future implementation.
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Affiliation(s)
- Anna Ugalde
- School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia
| | - Cadeyrn J Gaskin
- Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Nicole M Rankin
- Cancer Research Division, Cancer Council NSW, Sydney, New South Wales, Australia
| | - Penelope Schofield
- Department of Psychology, Swinburne University, Melbourne, Victoria, Australia.,Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| | - Anna Boltong
- Strategy and Support Division, Cancer Council Victoria, Melbourne, Victoria, Australia.,Victorian Comprehensive Cancer Centre, Parkville, Victoria, Australia
| | - Sanchia Aranda
- Cancer Council Australia, Sydney, New South Wales, Australia
| | - Suzanne Chambers
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia.,Cancer Council QLD, Brisbane, Queensland, Australia
| | - Meinir Krishnasamy
- Victorian Comprehensive Cancer Centre, Parkville, Victoria, Australia.,Centre for Cancer Research, University of Melbourne, Parkville, Victoria, Australia
| | - Patricia M Livingston
- School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia.,Faculty of Health, Deakin University, Geelong, Victoria, Australia
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Gélinas-Bronsard D, Mortenson WB, Ahmed S, Guay C, Auger C. Co-construction of an Internet-based intervention for older assistive technology users and their family caregivers: stakeholders’ perceptions. Disabil Rehabil Assist Technol 2018; 14:602-611. [DOI: 10.1080/17483107.2018.1499138] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Dominique Gélinas-Bronsard
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
- Center for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, QC, Canada
| | - W. Ben Mortenson
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- GF Strong Rehabilitation Center, Vancouver, BC, Canada
- International Collaboration on Repair Discoveries, Vancouver, BC, Canada
| | - Sara Ahmed
- Center for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, QC, Canada
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University Health Centre, Clinical Epidemiology, McGill University, Montreal, QC, Canada
| | - Cassioppée Guay
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
- Center for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, QC, Canada
| | - Claudine Auger
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
- Center for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, QC, Canada
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22
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Sherifali D, Ali MU, Ploeg J, Markle-Reid M, Valaitis R, Bartholomew A, Fitzpatrick-Lewis D, McAiney C. Impact of Internet-Based Interventions on Caregiver Mental Health: Systematic Review and Meta-Analysis. J Med Internet Res 2018; 20:e10668. [PMID: 29970358 PMCID: PMC6053616 DOI: 10.2196/10668] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 05/24/2018] [Accepted: 05/24/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The health of informal caregivers of adults with chronic conditions is increasingly vital since caregivers comprise a large proportion of supportive care to family members living in the community. Due to efficiency and reach, internet-based interventions for informal caregivers have the potential to mitigate the negative mental health outcomes associated with caregiving. OBJECTIVE The objective of this systematic review and meta-analysis was to examine the impact of internet-based interventions on caregiver mental health outcomes and the impact of different types of internet-based intervention programs. METHODS MEDLINE, EMBASE, CINAHL, PsycINFO, Cochrane, and AgeLine databases were searched for randomized controlled trials or controlled clinical trials published from January 1995 to April 2017 that compared internet-based intervention programs with no or minimal internet-based interventions for caregivers of adults with at least 1 chronic condition. The inclusion criteria were studies that included (1) adult informal caregivers (aged 18 years or older) of adults living in the community with a chronic condition; (2) an internet-based intervention program to deliver education, support, or monitoring to informal caregivers; and (3) outcomes of mental health. Title and abstract and full-text screening were completed in duplicate. Data were extracted by a single reviewer and verified by a second reviewer, and risk of bias assessments were completed accordingly. Where possible, data for mental health outcomes were meta-analyzed. RESULTS The search yielded 7923 unique citations of which 290 studies were screened at full-text. Of those, 13 studies met the inclusion criteria; 11 were randomized controlled trials, 1 study was a controlled clinical trial, and 1 study comprised both study designs. Beneficial effects of any internet-based intervention program resulted in a mean decrease of 0.48 points (95% CI -0.75 to -0.22) for stress and distress and a mean decrease of 0.40 points (95% CI -0.58 to -0.22) for anxiety among caregivers. For studies that examined internet-based information and education plus professional psychosocial support, the meta-analysis results showed small to medium beneficial effect sizes of the intervention for the mental health outcomes of depression (-0.34; 95% CI -0.63 to -0.05) and anxiety (-0.36; 95% CI -0.66 to -0.07). Some suggestion of a beneficial effect on overall health for the use of information and education plus combined peer and professional support was also shown (1.25; 95% CI 0.24 to 2.25). Overall, many studies were of poor quality and were rated at high risk of bias. CONCLUSIONS The review found evidence for the benefit of internet-based intervention programs on mental health for caregivers of adults living with a chronic condition, particularly for the outcomes of caregiver depression, stress and distress, and anxiety. The types of interventions that predominated as efficacious included information and education with or without professional psychological support, and, to a lesser extent, with combined peer and psychological support. Further high-quality research is needed to inform the effectiveness of interactive, dynamic, and multicomponent internet-based interventions. TRIAL REGISTRATION PROSPERO CRD42017075436; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=75436 (Archived by WebCite at http://www.webcitation.org/709M3tDvn).
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Affiliation(s)
- Diana Sherifali
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.,McMaster Evidence Review and Synthesis Team, School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.,Diabetes Care and Research Program, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Muhammad Usman Ali
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Jenny Ploeg
- Aging, Community and Health Research Unit, School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.,Department of Health, Aging and Society, Faculty of Social Sciences, McMaster University, Hamilton, ON, Canada.,McMaster Institute for Research on Aging, McMaster University, Hamilton, ON, Canada
| | - Maureen Markle-Reid
- Aging, Community and Health Research Unit, School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.,McMaster Institute for Research on Aging, McMaster University, Hamilton, ON, Canada.,Person-Centred Interventions for Older Adults with Multimorbidity and their Caregivers, Hamilton, ON, Canada
| | - Ruta Valaitis
- Aging, Community and Health Research Unit, School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.,McMaster Institute for Research on Aging, McMaster University, Hamilton, ON, Canada.,World Health Organization Collaborating Centre for Primary Care and Health Human Resources, School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.,Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Amy Bartholomew
- Aging, Community and Health Research Unit, School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Donna Fitzpatrick-Lewis
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Carrie McAiney
- Program for Interprofessional Practice, Education and Research, Department of Psychiatry and Behavioural Neurosciences, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
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Duggleby W, Ghosh S, Struthers-Montford K, Nekolaichuk C, Cumming C, Thomas R, Tonkin K, Swindle J. Feasibility Study of an Online Intervention to Support Male Spouses of Women With Breast Cancer. Oncol Nurs Forum 2018; 44:765-775. [PMID: 29052658 DOI: 10.1188/17.onf.765-775] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To evaluate the feasibility of a web-based psychosocial supportive intervention entitled Male Transition Toolkit (MaTT).
. DESIGN Randomized, controlled trial, mixed methods, concurrent feasibility design.
. SETTING Edmonton, a large metropolitan city in western Canada.
. SAMPLE 40 dyads (women with breast cancer and their spouse).
. METHODS Male spouse participants in the treatment group accessed MaTT for four weeks. Data on hope, quality of life, general self-efficacy, and caregiver guilt were collected at baseline and days 14, 28, and 56. Quality-of-life data were collected from the women with breast cancer at each time period. Qualitative data were collected from the usual care group in an open-ended interview and from the treatment group in an evaluation survey on days 14 and 28.
. MAIN RESEARCH VARIABLES Feasibility, as measured by the MaTT questionnaire.
. FINDINGS Evaluation survey scores indicated that MaTT was feasible, acceptable, and easy to use. Male spouse quality-of-life scores were not significantly different between groups. As guilt scores decreased, male spouses' quality of life increased.
. CONCLUSIONS The findings provided useful information to strengthen MaTT and improve study design. Additional research is needed to determine its efficacy in improving male spouses' quality of life.
. IMPLICATIONS FOR NURSING MaTT is a feasible intervention. Future research should evaluate MaTT with larger samples as well as determine the amount of time participants used MaTT.
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Marzorati C, Renzi C, Russell-Edu SW, Pravettoni G. Telemedicine Use Among Caregivers of Cancer Patients: Systematic Review. J Med Internet Res 2018; 20:e223. [PMID: 29914858 PMCID: PMC6028768 DOI: 10.2196/jmir.9812] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 04/27/2018] [Accepted: 05/15/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The number of published studies and systematic reviews examining different telehealth interventions targeting patients and their effects on patients' well-being and quality of life have grown in recent decades. However, the use of telemedicine tools aimed at the family members and caregivers of adult cancer patients is less defined. OBJECTIVE We aimed to conduct a systematic review to provide a more complete picture regarding telemedicine tools for informal caregivers (usually family members or close friends) implemented in all phases of cancer care. More specifically, the review aimed to better describe the study samples' characteristics, to analyze measured outcomes and the specific questionnaires used to assess them, and to describe in depth the implemented interventions and their formats. Finally, we examined the role of telehealth, and usability and feasibility trends in supporting patients' caregivers. METHODS We systematically searched the literature in the following databases: Web of Science, Cochrane Library, PubMed, Scopus, CINAHL, MEDLINE, EMBASE, Google Scholar, and PsycINFO. Inclusion criteria were being written in English, published in peer-reviewed journals, describing a telehealth-implemented intervention, and focusing on caregivers of adult cancer patients at any stage of the disease. We selected studies published up to November 2017. We critically appraised included articles using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and graded the quality of evidence by outcome using the Centre for Evidence-Based Medicine framework. RESULTS We included 24 studies in the final selection. In 21 of the 24 studies, the patient-caregiver dyad was analyzed, and the study population dealt with different types of cancer at different stages. Included studies considered the caregiver's condition from both an individual and a relational point of view. Along with psychosocial variables, some studies monitored engagement and user satisfaction regarding Web-based platforms or telehealth interventions. All studies reported significant improvements in some of the investigated areas, but they often showed small effect sizes. Two types of telehealth intervention formats were used: Web-based platforms and telephone calls. Some of the included studies referred to the same project, but on study samples with different cancer diagnoses or with new versions of previously developed interventions. CONCLUSIONS Reported outcomes seem to suggest that we are in an exploratory phase. More detailed and targeted research hypotheses are still needed. Clarifying caregivers' needs related to telehealth tools and better defining outcome measures may yield more significant results.
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Affiliation(s)
- Chiara Marzorati
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Chiara Renzi
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, Milan, Italy
| | | | - Gabriella Pravettoni
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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25
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Heynsbergh N, Heckel L, Botti M, Livingston PM. Feasibility, useability and acceptability of technology-based interventions for informal cancer carers: a systematic review. BMC Cancer 2018; 18:244. [PMID: 29499663 PMCID: PMC5834845 DOI: 10.1186/s12885-018-4160-9] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Accepted: 02/21/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Carers looking after someone with cancer often experience negative impacts on their own health. M-health interventions have been designed to provide information and support to patients and their carers. However, the effectiveness of technology-based interventions for carers is less well understood. The objectives were to assess the feasibility, useability and acceptability of technology-based interventions among carers of people living with cancer. METHODS A systematic search of the CINAHL, MEDLINE and PSYCINFO databases was performed using terms related to web-based interventions and smartphone applications, carers and cancer. Studies were included if a randomised controlled trial or pilot study was conducted, focused on adult carers looking after another adult with cancer and were published between January 2007-June 2017. Articles were excluded if they reported qualitative results only or were evaluating existing websites and applications. Feasibility was measured by attrition, recruitment rates and frequency of intervention use; useability was measured by the ease of intervention use and the role of features to minimise errors in use. Acceptability was measured by carers' perception of the appropriateness of the content and their ability to incorporate the intervention into their daily routines. RESULTS Of the 729 articles, six articles met the inclusion criteria. Attrition ranged from 14% - 77%, recruitment rates from 20% - 66% and intervention useability varied across studies. Half of the studies implemented measures to improve useability. Overall, carers rated the content of the interventions as appropriate and reported improved knowledge and communication. Acceptability was further demonstrated as carers preferred the flexibility available with web-based interventions. CONCLUSIONS Technology-based interventions are suitable for use among carers of people with cancer. Further research is required to fully assess the impact of technology as an information and support mechanism for carers.
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Affiliation(s)
- Natalie Heynsbergh
- Geelong, Faculty of Health, School of Nursing and Midwifery, Deakin University, Geelong, Victoria, 3220, Australia.
| | - Leila Heckel
- Geelong, Faculty of Health, School of Nursing and Midwifery, Deakin University, Geelong, Victoria, 3220, Australia
| | - Mari Botti
- Geelong, Faculty of Health, School of Nursing and Midwifery and Epworth HealthCare, Deakin University, Geelong, Victoria, 3220, Australia
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Sin J, Henderson C, Spain D, Cornelius V, Chen T, Gillard S. eHealth interventions for family carers of people with long term illness: A promising approach? Clin Psychol Rev 2018; 60:109-125. [PMID: 29429856 DOI: 10.1016/j.cpr.2018.01.008] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 11/29/2017] [Accepted: 01/31/2018] [Indexed: 12/22/2022]
Abstract
Family carers of people who have long term illness often experience physical and mental health morbidities, and burden. While there is good evidence to suggest that carers benefit from psychosocial interventions, these have primarily been delivered via face-to-face individual or group-formats. eHealth interventions offer a novel, accessible and self-paced approach to care delivery. Whether these are effective for carers' wellbeing has been little explored. This paper reports the first comprehensive systematic review in this area. A total of 78 studies, describing 62 discrete interventions, were identified. Interventions commonly aimed to promote carers' knowledge, self-efficacy, caregiving appraisal, and reduce global health morbidities. Interventions were offered to carers of people with a wide range of long term illness; dementia has been the most researched area, as reported in 40% of studies. Clinical and methodological heterogeneity in interventions precluded meta-analyses, and so data were analysed narratively. The most popular approach has comprised psychoeducational interventions delivered via an enriched online environment with supplementary modes of communication, such as network support with professionals and peers. Overall, carers appreciate the flexibility and self-paced nature of eHealth interventions, with high rates of satisfaction and acceptability. More studies using robust designs are needed to extend the evidence base.
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Affiliation(s)
- Jacqueline Sin
- Population Health Research Institute, St George's, University of London, Cranmer Terrace, London SW17 0RE, England, UK; School of Psychology & Clinical Language Sciences, University of Reading, Earley Gate, Reading RG6 6AL, England, UK.
| | - Claire Henderson
- Health Service & Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, England, UK.
| | - Debbie Spain
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, England, UK.
| | - Victoria Cornelius
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, Stadium House, 68 Wood Lane, London W12 7RH, England, UK.
| | - Tao Chen
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, England, UK.
| | - Steve Gillard
- Population Health Research Institute, St George's, University of London, Cranmer Terrace, London SW17 0RE, England, UK.
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27
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Namkoong K, Shah DV, Gustafson DH. Offline Social Relationships and Online Cancer Communication: Effects of Social and Family Support on Online Social Network Building. HEALTH COMMUNICATION 2017; 32:1422-1429. [PMID: 27824257 PMCID: PMC6095462 DOI: 10.1080/10410236.2016.1230808] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This study investigates how social support and family relationship perceptions influence breast cancer patients' online communication networks in a computer-mediated social support (CMSS) group. To examine social interactions in the CMSS group, we identified two types of online social networks: open and targeted communication networks. The open communication network reflects group communication behaviors (i.e., one-to-many or "broadcast" communication) in which the intended audience is not specified; in contrast, the targeted communication network reflects interpersonal discourses (i.e., one-to-one or directed communication) in which the audience for the message is specified. The communication networks were constructed by tracking CMSS group usage data of 237 breast cancer patients who participated in one of two National Cancer Institute-funded randomized clinical trials. Eligible subjects were within 2 months of a diagnosis of primary breast cancer or recurrence at the time of recruitment. Findings reveal that breast cancer patients who perceived less availability of offline social support had a larger social network size in the open communication network. In contrast, those who perceived less family cohesion had a larger targeted communication network in the CMSS group, meaning they were inclined to use the CMSS group for developing interpersonal relationships.
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Affiliation(s)
- Kang Namkoong
- Department of Community and Leadership Development, University of Kentucky, Address: 504 Garrigus Building, Lexington, KY 40546-0215, United States, Phone: 859-257-4657, Fax: 859-257-1164,
| | - Dhavan V. Shah
- School of Journalism and Mass Communication, University of Wisconsin - Madison, Address: 5162 Vilas Communication Hall, 812 University Avenue, Madison, WI 53706, Phone: 608-262-0388, Fax: 608-262-1361,
| | - David H. Gustafson
- Center for Health Enhancement Systems Studies, University of Wisconsin - Madison Address: 4109 Mechanical Engineering Building, 1513 University Avenue, Madison, WI 53706 Phone: 608-263-4882, Fax: 608-890-1438,
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28
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Solli H, Bjørk IT, Hvalvik S, Hellesø R. Like an extended family: Relationships that emerge when older caregivers use written messages to communicate in an ICT-based healthcare service. Inform Health Soc Care 2017; 43:207-217. [PMID: 29035665 DOI: 10.1080/17538157.2017.1364245] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To explore the relationships that emerge amongst caregivers of persons with dementia and stroke when caregivers use written messages as their communication tool in a closed information and communication technology (ICT)-based support group. METHODS An explorative design with a qualitative approach was used that applied systematic text condensation (STC) to analyse 173 written messages extracted from a web forum. RESULTS Empathetic, empowering and familiar relationships emerged amongst peers of older caregivers when the caregivers used written messages as their communication tool. The empathetic relationship was characterised by sincerity and openness when the caregivers shared emotions related to caregiving. The empowering relationship reflected a fellowship based on solidarity influenced by a sense of optimism and a willingness to share knowledge to support one another in overcoming challenges. In the familiar relationship, the caregivers were thoughtful and good-humoured with one another and displayed an attitude of consideration towards one another, as in an extended family. PRACTICE IMPLICATION The use of computer-mediated communication in health care service will change the context of establishing and maintaining interpersonal relationships. Therefore, greater knowledge regarding how the peers of caregivers interact with one another is vital so nurses may better support and educate ICT-based support groups.
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Affiliation(s)
- Hilde Solli
- a Department of Health Science , University College of Southeast Norway , Porsgrunn , Norway
| | - Ida Torunn Bjørk
- b Department of Nursing Science , University of Oslo , Blindern , Oslo , Norway
| | - Sigrun Hvalvik
- a Department of Health Science , University College of Southeast Norway , Porsgrunn , Norway
| | - Ragnhild Hellesø
- c Department of Nursing Science , Faculty of Medicine , Oslo , Norway
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29
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Guay C, Auger C, Demers L, Mortenson WB, Miller WC, Gélinas-Bronsard D, Ahmed S. Components and Outcomes of Internet-Based Interventions for Caregivers of Older Adults: Systematic Review. J Med Internet Res 2017; 19:e313. [PMID: 28928109 PMCID: PMC5627044 DOI: 10.2196/jmir.7896] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 07/11/2017] [Accepted: 07/11/2017] [Indexed: 12/02/2022] Open
Abstract
Background When trying to access interventions to improve their well-being and quality of life, family caregivers face many challenges. Internet-based interventions provide new and accessible opportunities to remotely support them and can contribute to reducing their burden. However, little is known about the link existing between the components, the use of behavior change techniques, and the outcomes of these Internet-based interventions. Objective This study aimed to provide an update on the best available evidence about the efficacy of Internet-based interventions for caregivers of older adults. Specifically, the components and the use of behavior change techniques and how they impact on the efficacy of the intervention were sought. Methods A systematic review searched primary source studies published between 2000 and 2015. Included studies were scored with a high level of evidence by independent raters using the GRADE criteria and reported caregiver-specific outcomes about interventions delivered through the Internet for caregivers of people aged 50 years and older. A narrative synthesis identified intervention components (eg, content, multimedia use, interactive online activities, and provision of support), behavior change techniques, and caregiver outcomes (eg, effects on stressors, mediators, and psychological health). The risk of bias within the included studies was assessed. Results A total of 2338 articles were screened and 12 studies describing 10 Internet-based interventions were identified. Seven of these interventions led to statistically significant improvements in caregiver outcomes (eg, reducing depression or anxiety, n=4). These efficacious interventions used interactive components, such as online exercises and homework (n=4) or questionnaires on health status (n=2) and five of them incorporated remote human support, either by professionals or peers. The most frequently used behavior change techniques included in efficacious interventions were provision of social support (n=6) and combinations of instructions to guide behavior change and barrier identification (n=5). The design and aim of the included studies did not permit determining exactly which component and/or behavior change technique was more efficacious in producing positive outcomes in caregivers. The risk for selection bias was low for all the studies, and low to high for performance, detection, and attrition biases. Conclusions In sum, Internet-based interventions that incorporate professional and social support, and provide instructions to change behavior and problem solve in an interactive manner appear to lead to positive outcomes in caregivers. Studies isolating the specific effect of components are needed to improve our understanding of the underlying mechanism of action.
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Affiliation(s)
- Cassioppée Guay
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, QC, Canada
| | - Claudine Auger
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, QC, Canada
| | - Louise Demers
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada.,Centre de recherche de l'Institut universitaire de gériatrie de Montréal, Montreal, QC, Canada
| | - W Ben Mortenson
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,GF Strong Rehabilitation Center, Vancouver, BC, Canada.,International Collaboration on Repair Discoveries, Vancouver, BC, Canada
| | - William C Miller
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,GF Strong Rehabilitation Center, Vancouver, BC, Canada
| | - Dominique Gélinas-Bronsard
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, QC, Canada
| | - Sara Ahmed
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, QC, Canada.,School of Physical and Occupational Therapy, Faculty of Medicine, McGill University Health Centre, Clinical Epidemiology, McGill University, Montreal, QC, Canada
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30
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Ploeg J, Markle-Reid M, Valaitis R, McAiney C, Duggleby W, Bartholomew A, Sherifali D. Web-Based Interventions to Improve Mental Health, General Caregiving Outcomes, and General Health for Informal Caregivers of Adults With Chronic Conditions Living in the Community: Rapid Evidence Review. J Med Internet Res 2017; 19:e263. [PMID: 28754652 PMCID: PMC5554353 DOI: 10.2196/jmir.7564] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 05/11/2017] [Accepted: 06/07/2017] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Most adults with chronic conditions live at home and rely on informal caregivers to provide support. Caregiving can result in negative impacts such as poor mental and physical health. eHealth interventions may offer effective and accessible ways to provide education and support to informal caregivers. However, we know little about the impact of Web-based interventions for informal caregivers of community-dwelling adults with chronic conditions. OBJECTIVE The purpose of this rapid evidence review was to assess the impact of Web-based interventions on mental health, general caregiving outcomes, and general health for informal caregivers of persons with chronic conditions living in the community. METHODS A rapid evidence review of the current literature was employed to address the study purpose. EMBASE, MEDLINE, PsychInfo, CINAHL, Cochrane, and Ageline were searched covering all studies published from January 1995 to July 2016. Papers were included if they (1) included a Web-based modality to deliver an intervention; (2) included informal, unpaid adult caregivers of community-living adults with a chronic condition; (3) were either a randomized controlled trial (RCT) or controlled clinical trial (CCT); and (4) reported on any caregiver outcome as a result of use or exposure to the intervention. RESULTS A total of 20 papers (17 studies) were included in this review. Study findings were mixed with both statistically significant and nonsignificant findings on various caregiver outcomes. Of the 17 included studies, 10 had at least one significant outcome. The most commonly assessed outcome was mental health, which included depressive symptoms, stress or distress, and anxiety. Twelve papers examined the impact of interventions on the outcome of depressive symptoms; 4 found a significant decrease in depressive symptoms. Eight studies examined the outcome of stress or distress; 4 of these found a significant reduction in stress or distress as a result of the intervention. Three studies examined the outcome of anxiety; 2 of these found significant reductions in anxiety. Other significant results of the interventions were seen in the outcomes of caregiver gain (ie, positive aspects of caregiving), knowledge, bonding, reduction of anger-hostility, and negative mood. Based on this review, it is not possible to determine which interventions were most effective since studies differed in their design, sample, and intervention. Study results suggest that Web-based interventions may result in reduced depressive symptoms, anxiety, and stress or distress among informal caregivers of adults with chronic conditions in the community. CONCLUSIONS This is the first review assessing the impact of Web-based technologies on mental health, general caregiving outcomes, and general health for caregivers of adults with chronic conditions living in the community. Further rigorous research is needed that includes adequately powered studies examining the critical components of the intervention and the dosage needed to have an effect.
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Affiliation(s)
- Jenny Ploeg
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.,Aging, Community and Health Research Unit, McMaster University, Hamilton, ON, Canada.,Department of Health, Aging and Society, McMaster University, Hamilton, ON, Canada
| | - Maureen Markle-Reid
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.,Aging, Community and Health Research Unit, McMaster University, Hamilton, ON, Canada
| | - Ruta Valaitis
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.,Aging, Community and Health Research Unit, McMaster University, Hamilton, ON, Canada.,WHO Collaborating Centre for Primary Care and Health Human Resources, McMaster University, Hamilton, ON, Canada.,Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Carrie McAiney
- Department of Psychiatry & Behavioural Neurosciences, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.,Program for Interprofessional Practice, Education and Research (PIPER), McMaster University, Hamilton, ON, Canada
| | - Wendy Duggleby
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada.,Innovations in Seniors' Care Research Unit, Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Amy Bartholomew
- Aging, Community and Health Research Unit, McMaster University, Hamilton, ON, Canada
| | - Diana Sherifali
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.,McMaster Evidence Review and Synthesis Centre, McMaster University, Hamilton, ON, Canada
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Abstract
This article contains a review of literature published from 2010 to 2016 on family caregiving in oncology. An analysis of 810 citations resulted in 50 randomized trials. These trials describe the need to prepare family caregivers for the complex role they play in cancer care. Several studies have demonstrated improved quality of life for family caregivers and improved emotional support from interventions. Several studies addressed communication and relational intimacy, which are key concerns. An additional focus of these trials was in the area of caregiving tasks and ways to diminish the burden of caregiving and preparedness for this role. Further research is needed in this area given the shift to outpatient care and as family caregivers become the primary providers of care. Future research should include expanding tested models of family caregiver support in clinical practice and in diverse populations. CA Cancer J Clin 2017. © 2017 American Cancer Society. CA Cancer J Clin 2017;67:318-325. © 2017 American Cancer Society.
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Affiliation(s)
- Betty Ferrell
- Director, Division of Nursing Research and Education, City of Hope National Medical Center, Duarte, CA
| | - Elaine Wittenberg
- Associate Professor, Division of Nursing Research and Education, City of Hope National Medical Center, Duarte, CA
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Wasilewski MB, Stinson JN, Cameron JI. Web-based health interventions for family caregivers of elderly individuals: A Scoping Review. Int J Med Inform 2017; 103:109-138. [PMID: 28550996 DOI: 10.1016/j.ijmedinf.2017.04.009] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 03/14/2017] [Accepted: 04/09/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND For the growing proportion of elders globally, aging-related illnesses are primary causes of morbidity causing reliance on family members for support in the community. Family caregivers experience poorer physical and mental health than their non-caregiving counterparts. Web-based interventions can provide accessible support to family caregivers to offset declines in their health and well-being. Existing reviews focused on web-based interventions for caregivers have been limited to single illness populations and have mostly focused on the efficacy of the interventions. We therefore have limited insight into how web-based interventions for family caregiver have been developed, implemented and evaluated across aging-related illness. OBJECTIVES To describe: a) theoretical underpinnings of the literature; b) development, content and delivery of web-based interventions; c) caregiver usage of web-based interventions; d) caregiver experience with web-based interventions and e) impact of web-based interventions on caregivers' health outcomes. METHODS We followed Arksey and O'Malley's methodological framework for conducting scoping reviews which entails setting research questions, selecting relevant studies, charting the data and synthesizing the results in a report. RESULTS Fifty-three publications representing 32 unique web-based interventions were included. Over half of the interventions were targeted at dementia caregivers, with the rest targeting caregivers to the stroke, cancer, diabetes and general frailty populations. Studies used theory across the intervention trajectory. Interventions aimed to improve a range of health outcomes for caregivers through static and interactive delivery methods Caregivers were satisfied with the usability and accessibility of the websites but usage was generally low and declined over time. Depression and caregiver burden were the most common outcomes evaluated. The interventions ranged in their impact on health and social outcomes but reductions in perception of caregiver burden were consistently observed. CONCLUSIONS Caregivers value interactive interventions that are tailored to their unique needs and the illness context. However, usage of the interventions was sporadic and declined over time, indicating that future interventions should address stage-specific needs across the caregiving trajectory. A systematic review has the potential to be conducted given the consistency in caregiver burden and depression as outcomes.
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Affiliation(s)
| | | | - Jill I Cameron
- Rehabilitation Sciences Institute, University of Toronto, Canada; Department of Occupational Science & Occupational Therapy, University of Toronto, Canada.
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33
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A Qualitative Analysis of "Naturalistic" Conversations in a Peer-Led Online Support Community for Lung Cancer. Cancer Nurs 2016; 38:E21-31. [PMID: 25254411 DOI: 10.1097/ncc.0000000000000207] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Online support communities are popular in use by patients with cancer and their families for emotional, informational, and social support. Nonetheless, most research has focused on diagnoses other than lung cancer, indicating a need for studies to include more diverse participants and cancer conditions. OBJECTIVE Our aim was to describe the content of messages in a United States-based online support community for lung cancer. METHODS A descriptive exploratory qualitative approach was used to analyze a sample of 688 pages with threaded messages across 2 time periods in 2008 and 2009. We analyzed 68 main posts and 586 replies in 344 pages for period 1 (262 users), and 55 main posts and 697 replies in 344 pages for period 2 (307 users). RESULTS Most users were female and equally divided as patients or support persons. Content analysis generated 9 themes: disease information, diagnostic test information, treatment information, symptoms, marked deterioration, advocacy, experiencing healthcare providers and the system, positive survivorship, and making sense of emotions. CONCLUSION Findings highlighted how the online support community is a valued, accessible avenue for information exchange and nonjudgmental emotional support for individuals dealing with lung cancer. IMPLICATIONS FOR PRACTICE Findings of daily living needs as articulated in this online community serve as a valuable guide for nurses to: better understand support needs, participate in developing and evaluating effective Internet and educational supports, and be better informed as advocates for more resources for Internet support mechanisms for people dealing with stigmatized conditions such as lung cancer.
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Barbabella F, Poli A, Andréasson F, Salzmann B, Papa R, Hanson E, Efthymiou A, Döhner H, Lancioni C, Civerchia P, Lamura G. A Web-Based Psychosocial Intervention for Family Caregivers of Older People: Results from a Mixed-Methods Study in Three European Countries. JMIR Res Protoc 2016; 5:e196. [PMID: 27713113 PMCID: PMC5073207 DOI: 10.2196/resprot.5847] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 08/11/2016] [Accepted: 08/24/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Informal caregiving is the main source of care for older people in Europe. An enormous amount of responsibility and care activity is on the shoulders of family caregivers, who might experience problems in their psychological well-being and in reconciling caregiving and their personal sphere. In order to alleviate such burden, there is increasing interest and growing research in Europe on Web-based support addressing family caregivers and their needs. However, the level of development and penetration of innovative Web-based services for caregivers is still quite low and the access to traditional face-to-face services can be problematic for logistic, availability, and quality reasons. OBJECTIVE As part of the European project INNOVAGE, a pilot study was conducted for developing and testing a Web-based psychosocial intervention aimed at empowering family caregivers of older people in Italy, Sweden, and Germany. The program offered information resources and interactive services to enable both professional and peer support. METHODS A mixed-methods, sequential explanatory design was adopted. Caregivers' psychological well-being, perceived negative and positive aspects of caregiving, and social support received were assessed before and after the 3-month intervention. Poststudy, a subsample of users participated in focus groups to assist in the interpretation of the quantitative results. RESULTS A total of 94 out of 118 family caregivers (79.7%) from the three countries used the Web platform at least once. The information resources were used to different extents in each country, with Italian users having the lowest median number of visits (5, interquartile range [IQR] 2-8), whereas German users had the highest number (17, IQR 7-66) (P<.001). The interactive services most frequently accessed (more than 12 times) in all countries were the social network (29/73, 40%) and private messages (27/73, 37%). The pretest-posttest analysis revealed some changes, particularly the slight worsening of perceived positive values of caregiving (Carers of Older People in Europe [COPE] positive value subscale: P=.02) and social support received (COPE quality-of-support subscale: P=.02; Multidimensional Scale of Perceived Social Support subscale: P=.04), in all cases with small effect size (r range -.15 to -.18). Focus groups were conducted with 20 family caregivers and the content analysis of discussions identified five main themes: online social support, role awareness, caregiving activities, psychological well-being, and technical concerns. The analysis suggested the intervention was useful and appropriate, also stimulating a better self-efficacy and reappraisal of the caregivers' role. CONCLUSIONS The intervention seemed to contribute to the improvement of family caregivers' awareness, efficacy, and empowerment, which in turn may lead to a better self-recognition of their own needs and improved efforts for developing and accessing coping resources. A major implication of the study was the finalization and implementation of the InformCare Web platform in 27 European countries, now publicly accessible (www.eurocarers.org/informcare).
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Affiliation(s)
- Francesco Barbabella
- Centre for Socio-Economic Research on Ageing, National Institute of Health and Science on Ageing (INRCA), Ancona, Italy.
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Kaltenbaugh DJ, Klem ML, Hu L, Turi E, Haines AJ, Hagerty Lingler J. Using Web-based interventions to support caregivers of patients with cancer: a systematic review. Oncol Nurs Forum 2015; 42:156-64. [PMID: 25806882 DOI: 10.1188/15.onf.156-164] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To explore the literature to examine the physical, social, psychological, financial, usability, and feasibility outcomes of Web-based interventions on caregivers of people with cancer and to identify potential trends in this body of evidence. DATA SOURCES PubMed, CINAHL®, PsycINFO®, and Inspec. DATA SYNTHESIS Six articles met inclusion criteria. Across studies, most caregivers were middle-aged female spouses with some college attendance who felt "somewhat comfortable" using the Internet. Caregiver interventions used single- and multicomponent services and reduced negative mood. CONCLUSIONS Web-based caregiver interventions can be beneficial in offering information and support and may positively influence the social and psychological outcomes in this population. IMPLICATIONS FOR NURSING Many studies described caregiver Internet usage and interventional perceptions and needs, but few have examined the impact of web-based interventions on caregivers. More research is needed to produce high-quality evidence in this population.
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Affiliation(s)
| | - Mary Lou Klem
- Health Sciences Library System, University of Pittsburgh, Pittsburgh, PA
| | - Lu Hu
- University of Pittsburgh, Pittsburgh, PA
| | | | - Alice J Haines
- Department of Acute/Tertiary Care, University of Pittsburgh, Pittsburgh, PA
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36
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Slev VN, Mistiaen P, Pasman HRW, Verdonck-de Leeuw IM, van Uden-Kraan CF, Francke AL. Effects of eHealth for patients and informal caregivers confronted with cancer: A meta-review. Int J Med Inform 2015; 87:54-67. [PMID: 26806712 DOI: 10.1016/j.ijmedinf.2015.12.013] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 12/16/2015] [Accepted: 12/19/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND eHealth can be defined as information provision about illness or health care and/or support for patients and/or informal caregivers, using the computer or related technologies. eHealth interventions are increasingly being used in cancer care, e.g. to support patients and informal caregivers in managing symptoms and problems in daily life. OBJECTIVES To synthesize evidence from systematic reviews on the effects of eHealth for cancer patients or their informal caregivers. MATERIALS AND METHODS A systematic meta-review, in the sense of a systematic review of reviews, was conducted. Searches were performed in PubMed, Embase, CINAHL, PsycINFO, and the Cochrane Library. All steps in the review process were either performed by two reviewers independently or checked by a second reviewer. Disagreements were resolved by consensus. RESULTS Ten systematic reviews were included. All reviews focused on the effects of eHealth for patients and none on effects for informal caregivers. Except for one review of high methodological quality, all reviews were of moderate methodological quality. Evidence was found for effects on perceived support, knowledge levels, and information competence of cancer patients. Indications of evidence were found for health status and healthcare participation. Findings were inconsistent for outcomes related to decision-making, psychological wellbeing, depression and anxiety, and quality of life. No evidence was found for effects on physical and functional wellbeing. CONCLUSION There is evidence for positive effects of eHealth on perceived support, knowledge, and information competence of cancer patients. For effects on other outcomes in cancer patients, findings are mainly inconsistent or lacking. This meta-review did not find relevant reviews focusing on or including the effects of eHealth on informal caregivers, which seems a rather unexplored area.
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Affiliation(s)
- Vina N Slev
- VU University Medical Center, Department of Public and Occupational Health, The EMGO Institute for Health and Care Research, Amsterdam, Netherlands; Expertise Center for Palliative Care, Amsterdam, Netherlands.
| | - Patriek Mistiaen
- NIVEL, Netherlands Institute for Health Services Research Utrecht, Netherlands
| | - H Roeline W Pasman
- VU University Medical Center, Department of Public and Occupational Health, The EMGO Institute for Health and Care Research, Amsterdam, Netherlands; Expertise Center for Palliative Care, Amsterdam, Netherlands
| | - Irma M Verdonck-de Leeuw
- VU University Medical Center, Department of Otolaryngology-Head & Neck Surgery, The EMGO Institute for Health and Care Research, Cancer Center Amsterdam (CCA), Amsterdam, Netherlands; Vrije Universiteit Amsterdam, Department of Clinical Psychology, The EMGO Institute for Health and Care Research, Cancer Center Amsterdam (CCA), Amsterdam, Netherlands
| | - Cornelia F van Uden-Kraan
- Vrije Universiteit Amsterdam, Department of Clinical Psychology, The EMGO Institute for Health and Care Research, Cancer Center Amsterdam (CCA), Amsterdam, Netherlands
| | - Anneke L Francke
- VU University Medical Center, Department of Public and Occupational Health, The EMGO Institute for Health and Care Research, Amsterdam, Netherlands; Expertise Center for Palliative Care, Amsterdam, Netherlands; NIVEL, Netherlands Institute for Health Services Research Utrecht, Netherlands
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37
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Huh J. Clinical Questions in Online Health Communities: The Case of "See your doctor" Threads. CSCW : PROCEEDINGS OF THE CONFERENCE ON COMPUTER-SUPPORTED COOPERATIVE WORK. CONFERENCE ON COMPUTER-SUPPORTED COOPERATIVE WORK 2015; 2015:1488-1499. [PMID: 26146665 DOI: 10.1145/2675133.2675259] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Online health communities are known to provide psychosocial support. However, concerns for misinformation being shared around clinical information persist. An existing practice addressing this concern includes monitoring and, as needed, discouraging asking clinical questions in the community. In this paper, I examine such practice where moderators redirected patients to see their health care providers instead of consulting the community. I observed that, contrary to common beliefs, community members provided constructive tips and persuaded the patients to see doctors rather than attempting to make a diagnosis or give medical advice. Moderators' posts on redirecting patients to see their providers were highly associated with no more follow up replies, potentially hindering active community dynamic. The findings showed what is previously thought of as a solution-quality control through moderation-might not be best and that the community, in coordination with moderators, can provide critical help in addressing clinical questions and building constructive information sharing community environment.
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Affiliation(s)
- Jina Huh
- Department of Media and Information, Michigan State University,
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38
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Mohd Roffeei SH, Abdullah N, Basar SKR. Seeking social support on Facebook for children with Autism Spectrum Disorders (ASDs). Int J Med Inform 2015; 84:375-85. [PMID: 25701266 DOI: 10.1016/j.ijmedinf.2015.01.015] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 12/02/2014] [Accepted: 01/22/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE This study examined the types of social support messages exchanged between parents and/or caregivers of children with Autism Spectrum Disorders (ASDs) who communicate via Facebook (FB); it studies two autism support groups: Autism Malaysia (AM) and Autism Children Club (ACA). METHOD A total of 3637 messages including both postings (381) and comments (3256) were gathered from August to November 2013. The study employed a deductive content-analysis approach. The qualitative data were analyzed for social support themes adapted from the Social Support Behavior Code (SSBC). Before collecting the data, email was sent to the FB groups' moderators to gain formal consent from the members. RESULT The finding indicated that the highest percentage of messages offered dealt with Informational support (30.7%) followed by Emotional support (27.8%). Network and Esteem support messages were responsible for 20.97% and 20.2%, respectively. Tangible Assistance was the least frequent category (0.4%). A majority of these messages discussed and addressed challenges and difficulties associated with caring and raising ASD children, as well as issues such as children's social lives and self-care routines. CONCLUSION Understandings of how FB is used to seek social support could impact supporting and maintaining effective communication among parents and/or caregivers of children with ASDs. This information could also improve approaches used by health professionals in developing, improving and evaluating social support systems for parents/caregivers.
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Affiliation(s)
- Siti Hajar Mohd Roffeei
- Department of Library & Information Science, Faculty of Computer Science & Information Technology, University of Malaya, 50603 Kuala Lumpur, Malaysia.
| | - Noorhidawati Abdullah
- Department of Library & Information Science, Faculty of Computer Science & Information Technology, University of Malaya, 50603 Kuala Lumpur, Malaysia.
| | - Siti Khairatul Razifah Basar
- Department of Library & Information Science, Faculty of Computer Science & Information Technology, University of Malaya, 50603 Kuala Lumpur, Malaysia.
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39
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Fergus K, Ahmad S, McLeod DL, Stephen J, Gardner S, Pereira A, Warner E, Carter W. Couplelinks - an online intervention for young women with breast cancer and their male partners: study protocol for a randomized controlled trial. Trials 2015; 16:33. [PMID: 25630357 PMCID: PMC4336511 DOI: 10.1186/s13063-014-0534-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Accepted: 12/19/2014] [Indexed: 11/24/2022] Open
Abstract
Background Young breast cancer survivors (aged 50 years and under) and their partners are at an elevated risk for relationship distress and poor psychological adjustment relative to older age couples. Limited availability of time and resources and the distance to travel are major barriers to engaging in evidence-based psychosocial support programs. This paper describes the study protocol of a novel, manualized online intervention called Couplelinks that was developed to improve relationship adjustment and psychological wellbeing of young couples affected by breast cancer. Couplelinks is a custom-designed website offering a professionally facilitated, couple-centered intervention that entails informational, experiential, and interactive components. Methods/Design A total of 80 heterosexual couples from across Canada in which the female partner has been diagnosed with a primary breast cancer will be recruited and randomized to a treatment or waitlist control group. Six dyadic learning modules form the core of the program and will be undertaken on a weekly basis. The manualized online intervention involves psycho-education and experiential exercises to enhance communication, coping ability, mutual empathy, and perspective-taking in relation to cancer. An online facilitator who is a trained mental health professional will guide and support couples throughout the process. Data collection will occur at baseline, at post-treatment or eight weeks into the waiting period, and at the three-month follow-up assessment. Primary outcome measures include the Revised Dyadic Adjustment Survey (RDAS) and Dyadic Coping Inventory (DCI) scores, and secondary outcome measures include the Hospital Anxiety and Depression Survey (HADS) score. Discussion Couplelinks is one of the first internet-based psychological interventions to improve the psychosocial adjustment of couples coping with a life-threatening illness such as cancer. If successful, the design of this program as described in this paper makes a valuable contribution to the literature on the delivery of couple-focused psychosocial interventions, both within and outside of oncology. Trial registration This trial was registered with ClinicalTrials.gov (identifier: NCT01089764) on 17 March 2010.
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Affiliation(s)
- Karen Fergus
- Department of Psychology, Faculty of Health, York University, 4700 Keele Street, Toronto, Ontario, M3J 1P3, Canada. .,Patient and Family Support Program, Odette Cancer Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada.
| | - Saunia Ahmad
- Department of Psychology, Faculty of Health, York University, 4700 Keele Street, Toronto, Ontario, M3J 1P3, Canada. .,Patient and Family Support Program, Odette Cancer Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada.
| | - Deborah L McLeod
- Cancer Program, Queen Elizabeth II Health Sciences Centre, Victoria 11-006, 1276 South Park Street, Halifax, Nova Scotia, B3H 2Y9, Canada.
| | - Joanne Stephen
- Department of Oncology, Faculty of Medicine, Cumming School of Medicine, Health Sciences Centre, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta, T2N 4N1, Canada.
| | - Sandra Gardner
- Ontario HIV Treatment Network, 1300 Yonge Street, Toronto, Ontario, M4T 1X3, Canada. .,Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario, M5T 3M7, Canada.
| | - Amanda Pereira
- Department of Psychology, Faculty of Health, York University, 4700 Keele Street, Toronto, Ontario, M3J 1P3, Canada.
| | - Ellen Warner
- Division of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada.
| | - Wendy Carter
- Dr. Wendy Carter, 7 Admiral Road, Coach House, Toronto, Ontario, M5R 2L4, Canada.
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40
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Namkoong K, McLaughlin B, Yoo W, Hull SJ, Shah DV, Kim SC, Moon TJ, Johnson CN, Hawkins RP, McTavish FM, Gustafson DH. The effects of expression: how providing emotional support online improves cancer patients' coping strategies. J Natl Cancer Inst Monogr 2014; 2013:169-74. [PMID: 24395987 DOI: 10.1093/jncimonographs/lgt033] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Emotional support has traditionally been conceived as something a breast cancer patient receives. However, this framework may obscure a more complex process, facilitated by the emerging social media environment, which includes the effects of composing and sending messages to others. Accordingly, this study explores the effects of expression and reception of emotional support messages in online groups and the importance of bonding as a mediator influencing the coping strategies of breast cancer patients. METHODS Data were collected as part of two National Cancer Institute-funded randomized clinical trials. Eligible subjects were within 2 months of diagnosis of primary breast cancer or recurrence. Expression and reception of emotionally supportive messages were tracked and coded for 237 breast cancer patients. Analysis resulted from merging 1) computer-aided content analysis of discussion posts, 2) action log analysis of system use, and 3) longitudinal survey data. RESULTS As expected, perceived bonding was positively related to all four coping strategies (active coping: β = 0.251, P = .000; positive reframing: β = 0.288, P = .000; planning: β = 0.213, P = .006; humor: β = 0.159, P = .009). More importantly, expression (γ = 0.138, P = .027), but not reception (γ = -0.018, P = .741), of emotional support increases perceived bonding, which in turn mediates the effects on patients' positive coping strategies. CONCLUSIONS There is increasing importance for scholars to distinguish the effects of expression from reception to understand the processes involved in producing psychosocial benefits. This study shows that emotional support is more than something cancer patients receive; it is part of an active, complex process that can be facilitated by social media.
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Affiliation(s)
- Kang Namkoong
- Department of Community and Leadership Development, University of Kentucky, 504 Garrigus Building, Lexington, KY 40546-0215.
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Hu C, Kung S, Rummans TA, Clark MM, Lapid MI. Reducing caregiver stress with internet-based interventions: a systematic review of open-label and randomized controlled trials. J Am Med Inform Assoc 2014; 22:e194-209. [PMID: 25125686 DOI: 10.1136/amiajnl-2014-002817] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 07/25/2014] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The high level of stress associated with caring for others with medical conditions has been recognized for some time. Reducing caregiver stress can improve caregiver quality of life as well as improve the care they provide to loved ones. This systematic review assesses the effectiveness of internet-based interventions to decrease caregiver stress. MATERIALS AND METHODS A comprehensive literature search of Ovid MEDLINE (1946-2013), Embase (1988-2013), PsycINFO (1987-2013), and CINAHL was conducted using terms related to caregiver and internet-based interventions. Internet-based interventions involving informal caregivers in an open-label or randomized controlled trial setting were included. A pair of raters independently reviewed all published abstracts. Data regarding participants, interventions, and outcomes were extracted and, for randomized trials, methodology quality was also reviewed. RESULTS Eight open-label trials met the review criteria: three showed positive benefit in reducing caregiver stress, four were partially positive (some outcomes positive, others negative), and one was a negative study. Sixteen randomized trials met the review criteria: six showed positive benefit, five were partially positive, and five were negative. There were no clear patterns as to the variables (such as study duration and complexity of intervention) associated with better outcomes, although earlier studies typically had more negative outcomes. DISCUSSION Internet-based interventions were mostly effective in reducing aspects of caregiver stress and improving their well-being. Further studies to assess outcomes for caregivers and their recipients' health, different technology delivery methods, and the cost of such interventions are needed.
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Affiliation(s)
- Chunling Hu
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Simon Kung
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Teresa A Rummans
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Matthew M Clark
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Maria I Lapid
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
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Tang WP, Chan CW, So WK, Leung DY. Web-based interventions for caregivers of cancer patients: A review of literatures. Asia Pac J Oncol Nurs 2014; 1:9-15. [PMID: 27981077 PMCID: PMC5123453 DOI: 10.4103/2347-5625.135811] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Diagnosed with cancer is a traumatic event; it does not only affect the diagnosed patients, but also their caregivers. It brings along negative impacts on biopsychosocial health to the caregivers. Supportive interventions are essential for the caregivers to go through the cancer trajectory. In the past, interventions were being delivered in either face-to-face format or delivering written documents. Although Internet becomes a popular platform for delivering interventions given its substantial growth in usage, the effectiveness of this mode of intervention delivery is unclear. The aim of this review is to review existing literatures regarding efficacy of web-based interventions in psychological outcomes of cancer caregivers. A Literature search was performed in December 2012 from seven databases, including, Ovid MEDLINE, EMBASE, PsycINFO, CINHAL, ERIC, British Nursing Index and EBM Reviews. The following keywords were used in the search but were not limited to "paediatric", "parent", "caregiver", "cancer", "web-based", and "psycho education". Totally 4668 citations were identified, after excluding the duplicated and irrelevant citations; finally six studies were included in this review. A review of the literatures identified that the web-based interventions including either online support group only or a combination of informational website and online support group significantly improved coping skills, in a way reduced anxiety, stress, depression, burden, as well as negative mood and perceived bonding in cancer caregivers. It is concluded that a web-based format as a potential platform for delivering intervention to the caregivers of cancer patients for its unique advantage of easy accessibility, and no geographic or time barriers.
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Affiliation(s)
- Winnie Py Tang
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - Carmen Wh Chan
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - Winnie Kw So
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - Doris Yp Leung
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
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43
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Diefenbeck CA, Klemm PR, Hayes ER. Emergence of Yalom's therapeutic factors in a peer-led, asynchronous, online support group for family caregivers. Issues Ment Health Nurs 2014; 35:21-32. [PMID: 24350748 DOI: 10.3109/01612840.2013.836260] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Support groups fill a critical void in the health care system, harnessing the power of shared experiences to provide support to group members. Likewise, family caregivers fill a void in the health care system, providing billions in unpaid care to the chronically ill. Caregiver support groups offer an opportunity for alleviating the psychological burden of caregiving. The power of any group, including a support group, to foster psychological well-being lies in its ability to cultivate Yalom's therapeutic factors. Gaps in the literature remain regarding the ability of non-prototypical groups to promote therapeutic mechanisms of change. The purpose of this study was to determine if and when Yalom's therapeutic group factors emerged in a peer-led support group delivered in an asynchronous, online format. Qualitative content analysis utilizing deductive category application was employed. Participants' responses were coded and frequency counts were conducted. Results revealed that 9 of 11 therapeutic factors emerged over the course of the group, with Group Cohesiveness, Catharsis, Imparting of Information, and Universality occurring most often. Several factors, including Interpersonal Learning, Corrective Recapitulation of the Primary Family Group, Imitative Behavior, and Development of Socializing Techniques were absent or virtually absent, likely due to the peer-led format of the group. Progression of therapeutic factors over the course of the group is presented. Findings demonstrate the presence of a variety of Yalom's therapeutic factors in an asynchronous, peer-led online support group.
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Berk L, Berk M, Dodd S, Kelly C, Cvetkovski S, Jorm AF. Evaluation of the acceptability and usefulness of an information website for caregivers of people with bipolar disorder. BMC Med 2013; 11:162. [PMID: 23844755 PMCID: PMC3717000 DOI: 10.1186/1741-7015-11-162] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 06/13/2013] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Bipolar disorder is associated with extreme mood symptoms, disability and suicide risk. Close family or friends often have a primary role in supporting an adult with bipolar disorder. However, not all support is helpful and there is little publicly accessible evidence-based information to guide caregivers. Caregiver burden increases the risk of caregiver depression and health problems. To help fill the information gap, expert clinicians, caregivers and consumers contributed to the development of guidelines for caregivers of adults with bipolar disorder using the Delphi consensus method. This paper reports on an evaluation of the acceptability and usefulness of the online version of the guidelines, http://www.bipolarcaregivers.org. METHODS Visitors to the website responded to an initial online survey about the usefulness of the information (N=536). A more detailed follow-up feedback survey was emailed to web users who were adult caregivers of adults with bipolar disorder a month later (N=121). The feedback was analyzed quantitatively and qualitatively to establish user appraisals of the online information, whether and how caregivers applied the information and ways it could be improved. RESULTS The majority of users (86.4% to 97.4%) found the various sections of the website useful. At follow-up, nearly 93% of caregivers reported that the information was relevant to them and 96% thought it would help others. Most respondents said that the information was supportive and encouraged adaptive control appraisals. However, a few respondents who were experiencing complex family problems, or who cared for a person with severe chronic bipolar disorder did not appraise it as positively. Nevertheless, over two-thirds of the caregivers reported using the information. Optional interactive features were recommended to maximize benefits. CONCLUSIONS Overall, http://www.bipolarcaregivers.org was appraised positively and used. It appears useful to close family and friends seeking basic information and reassurance, and may be an inexpensive way to disseminate guidelines for caregivers. Those who care for people with more severe and chronic bipolar disorder, or who have complex family problems might benefit from more specialized interventions, suggesting the importance of a stepped-care approach to supporting caregivers. The potential of evidence-based, collaboratively developed information websites to enhance caregiver and consumer outcomes merits further investigation.
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Affiliation(s)
- Lesley Berk
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, Victoria, Australia.
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Oprescu F, Campo S, Lowe J, Andsager J, Morcuende JA. Online information exchanges for parents of children with a rare health condition: key findings from an online support community. J Med Internet Res 2013; 15:e16. [PMID: 23470259 PMCID: PMC3636206 DOI: 10.2196/jmir.2423] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Revised: 12/17/2012] [Accepted: 12/20/2012] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The Internet provides new opportunities for parents of children with difficult illnesses and disabilities to find information and support. The Internet is particularly important for caregivers of children with special needs due to numerous health-related decisions they face. For at-risk populations, online support communities can become key settings and channels for health promotion and communication. OBJECTIVE This study is an initial exploration of the information-seeking and information-provision processes present in an online support community, which is an area of opportunity and interest for Internet-based medical research and practice. The aim of this study was to explore and describe information-related processes of uncertainty management in relationship to clubfoot. Specifically, the study explored interpersonal communication (information seeking and provision) in an online support community serving the needs of parents of children with clubfoot. METHODS The study population consisted of messages posted to an online community by caregivers (parents) of children with clubfoot. The theoretical framework informing the study was the Uncertainty Management Theory (UMT). The study used content analysis to explore and categorize the content of 775 messages. RESULTS Women authored 664 of 775 messages (86%) and men authored 47 messages (6%). Caregivers managed uncertainty through information seeking and provision behaviors that were dynamic and multilayered. The ratio of information-seeking messages to information-provision responses was 1 to 4. All five types of information-seeking behaviors proposed by Brashers' schema were identified, most of them being correlated. Information seeking using direct questions was found to be positively correlated to self-disclosure (r=.538), offering of a candidate answer (r=.318), and passive information seeking (r=.253). Self-disclosure was found to be positively correlated to provision of a candidate answer (r=.324), second-guessing (r=.149), and passive information seeking (r=.366). Provision of a candidate answer was found to be positively correlated with second-guessing (r=.193) and passive information seeking (r=.223). Second-guessing was found to be positively correlated to passive information seeking (r=.311). All correlations reported above were statistically significant (P<0.01). Of the 775 messages analyzed, 255 (33%) identified a medical professional or institution by name. Detailed medical information was provided in 101 (13%) messages, with the main source of information identified being personal experience rather than medical sources. CONCLUSION Online communities can be an effective channel for caregivers, especially women, to seek and offer information required for managing clubfoot-related uncertainty. To enhance communication with parents, health care institutions may need to invest additional resources in user-friendly online information sources and online interactions with caregivers of children with special illnesses such as clubfoot. Furthermore, explorations of information-seeking and information-provision behaviors in online communities can provide valuable data for interdisciplinary health research and practice.
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Affiliation(s)
- Florin Oprescu
- University of the Sunshine Coast, Faculty of Science, Health, Education and Engineering, School of Health and Sport Sciences, Maroochydore, Australia.
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Oprescu F, Campo S, Lowe J, Andsager J, Morcuende JA. Managing uncertainty in the context of clubfoot care: exploring the value of uncertainty management theory and the sense of virtual community. THE IOWA ORTHOPAEDIC JOURNAL 2013; 33:142-148. [PMID: 24027474 PMCID: PMC3748870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Serious health conditions, such as clubfoot, could be a major source of uncertainty and stress for parents of children affected. How parents deal with uncertainty and stress as related to their child's health condition is of interest for medical professionals and health communicators alike. While physicians remain a preferred source of health information, during medical encounters or via phone and email communication, many individuals seek out health information on the Internet, including in online support communities. This study explored the connections between Uncertainty Management Theory (UMT) constructs and the potential contribution of the sense of virtual community (SOVC) to the UMT framework. The results of this research suggest that the UMT needs to be adapted for use in online contexts. One way is to include theoretical constructs, such as the sense of virtual community, specifically developed to measure online interactions. A modified and updated Uncertainty Management Theory could be useful in exploring, analyzing and understanding online behaviors related to health conditions such as clubfoot and thus contribute substantially to what we know about caregivers in their role as uncertainty managers.
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Affiliation(s)
- Florin Oprescu
- University of the Sunshine Coast, Sippy Downs, QLD, Australia
| | | | - John Lowe
- University of the Sunshine Coast, Sippy Downs, QLD, Australia
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