1
|
Linton KF, Aharon-Ezer J, Ramirez M, Hodge M, Hernandez R, Supple K, Rumbo B, Kao R. Family Caregiver Support Interventions' Effectiveness Before and During the COVID-19 Pandemic. Soc Work Public Health 2023; 38:359-372. [PMID: 37740894 DOI: 10.1080/19371918.2023.2259896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/25/2023]
Abstract
The authors aimed to assess the impact of a family caregiver support intervention on caregiver burden and hospital readmission before and during the COVID-19 pandemic. By adopting a quasi-experimental design with no randomization, caregivers (n = 65) received a 90-day home visitation caregiver support intervention before the COVID-19 pandemic and caregivers (n = 41) received a 90-day phone-only visitation caregiver support intervention during the COVID-19 pandemic. Caregiver burden was collected in a survey, and hospital readmission of the care recipient was collected by hospital data. The results of a repeated-measures ANOVA demonstrated that participants of a family caregiver support intervention during the COVID-19 pandemic improved their caregiver burden statistically significantly more than those who received the intervention before the pandemic. There were no significant differences in hospital readmissions before or during the COVID-19 pandemic. The study demonstrates the efficacy of family caregiver support interventions over the phone during a pandemic.
Collapse
Affiliation(s)
- Kristen Faye Linton
- Ambulatory Medicine, Community Memorial Health System, Ventura, CA, USA
- Health Science Program, California State University Channel Islands, Camarillo, CA, USA
| | | | - Mayra Ramirez
- Social Work, St. John's Medical Center, Oxnard and Camarillo, CA, USA
| | - Maureen Hodge
- Ambulatory Medicine, Community Memorial Health System, Ventura, CA, USA
| | - Rosie Hernandez
- Social Work, St. John's Medical Center, Oxnard and Camarillo, CA, USA
| | - Kristine Supple
- Ambulatory Medicine, Community Memorial Health System, Ventura, CA, USA
| | - Benito Rumbo
- Health Science Program, California State University Channel Islands, Camarillo, CA, USA
| | - Rasmey Kao
- Health Science Program, California State University Channel Islands, Camarillo, CA, USA
| |
Collapse
|
2
|
Sánchez-Cárdenas MA, Iriarte-Aristizábal MF, León-Delgado MX, Rodríguez-Campos LF, Correa-Morales JE, Cañón-Piñeros A, Parra SL. Rural Palliative Care Telemedicine for Advanced Cancer Patients: A Systematic Review. Am J Hosp Palliat Care 2023; 40:936-944. [PMID: 36331174 DOI: 10.1177/10499091221130329] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
Context: Telemedicine offers the opportunity to provide remote palliative care for patients to control symptoms and improve quality of life, even for patients with advanced diseases. Objectives: Establish a telemedicine model of rural palliative care for advanced cancer patients with difficulties in accessing standard care. Methods: This review comports with the minimum standards described in the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) and uses the palliative care literature review iterative method (PALETTE) proposed by Zwakman et al in 2018. Results: Three hundred, ninety-two articles were identified in PubMed and EMBASE databases and alternative search engines such as Google Scholar and OpenGrey. A telemedicine delivery model was developed for patients with limited access to standard care, which consists of identifying the candidate population, establishing the most convenient telemedicine modality, agreeing with patients and caregivers on palliative care needs, and evaluating the interventions effectiveness. Conclusion: Telemedicine is a revolutionary tool to provide palliative care to advanced cancer patients whose clinical condition or location prevent them from accessing conventional care.
Collapse
Affiliation(s)
| | | | | | | | - Juan Esteban Correa-Morales
- School of Medicine, Universidad de La Sabana, Chía, Colombia
- Department of Pain Medicine and Palliative Care, National Cancer Institute, Bogotá, Colombia
| | | | | |
Collapse
|
3
|
Liddicoat Yamarik R, Chiu LA, Flannery M, Van Allen K, Adeyemi O, Cuthel AM, Brody AA, Goldfeld KS, Schrag D, Grudzen CR. Engagement, Advance Care Planning, and Hospice Use in a Telephonic Nurse-Led Palliative Care Program for Persons Living with Advanced Cancer. Cancers (Basel) 2023; 15:cancers15082310. [PMID: 37190238 DOI: 10.3390/cancers15082310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/31/2023] [Accepted: 04/13/2023] [Indexed: 05/17/2023] Open
Abstract
Persons living with advanced cancer have intensive symptoms and psychosocial needs that often result in visits to the Emergency Department (ED). We report on program engagement, advance care planning (ACP), and hospice use for a 6-month longitudinal nurse-led, telephonic palliative care intervention for patients with advanced cancer as part of a larger randomized trial. Patients 50 years and older with metastatic solid tumors were recruited from 18 EDs and randomized to receive nursing calls focused on ACP, symptom management, and care coordination or specialty outpatient palliative care (ClinicialTrials.gov: NCT03325985). One hundred and five (50%) graduated from the 6-month program, 54 (26%) died or enrolled in hospice, 40 (19%) were lost to follow-up, and 19 (9%) withdrew prior to program completion. In a Cox proportional hazard regression, withdrawn subjects were more likely to be white and have a low symptom burden compared to those who did not withdraw. Two hundred eighteen persons living with advanced cancer were enrolled in the nursing arm, and 182 of those (83%) completed some ACP. Of the subjects who died, 43/54 (80%) enrolled in hospice. Our program demonstrated high rates of engagement, ACP, and hospice enrollment. Enrolling subjects with a high symptom burden may result in even greater program engagement.
Collapse
Affiliation(s)
| | - Laraine Ann Chiu
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Mara Flannery
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Kaitlyn Van Allen
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Oluwaseun Adeyemi
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Allison M Cuthel
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Abraham A Brody
- Rory Meyers College of Nursing, New York University, New York, NY 10010, USA
- Division of Geriatric Medicine and Palliative Care, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Keith S Goldfeld
- Department of Population Health, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Deborah Schrag
- Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | | |
Collapse
|
4
|
Koekkoek JAF, van der Meer PB, Pace A, Hertler C, Harrison R, Leeper HE, Forst DA, Jalali R, Oliver K, Philip J, Taphoorn MJB, Dirven L, Walbert T. Palliative care and end-of-life care in adults with malignant brain tumors. Neuro Oncol 2023; 25:447-456. [PMID: 36271873 PMCID: PMC10013651 DOI: 10.1093/neuonc/noac216] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND This systematic review provides updated insights, from the published literature in the past 5 years, based on the 2017 European Association of Neuro-Oncology (EANO) guidelines for palliative care in adults with malignant brain tumors. It provides an overview of palliative care options, including during the end-of-life phase for patients with malignant brain tumors. METHODS A systematic literature search was conducted from 2016 to 2021 focusing on four main topics: (1) symptom management, (2) caregiver needs, (3) early palliative care, and (4) care in the end-of-life phase. An international panel of palliative care experts in neuro-oncology synthesized the literature and reported the most relevant updates. A total of 140 articles were included. RESULTS New insights include that: Hippocampal avoidance and stereotactic radiosurgery results in a lower risk of neurocognitive decline in patients with brain metastases; levetiracetam is more efficacious in reducing seizures than valproic acid as first-line monotherapy antiseizure drug (ASD) in glioma patients; lacosamide and perampanel seem well-tolerated and efficacious add-on ASDs; and a comprehensive framework of palliative and supportive care for high-grade glioma patients and their caregivers was proposed. No pharmacological agents have been shown in randomized controlled trials to significantly improve fatigue or neurocognition. CONCLUSIONS Since the 2017 EANO palliative care guidelines, new insights have been reported regarding symptom management and end-of-life care, however, most recommendations remain unchanged. Early palliative care interventions are essential to define goals of care and minimize symptom burden in a timely fashion. Interventional studies that address pain, fatigue, and psychiatric symptoms as well as (the timing of) early palliative care are urgently needed.
Collapse
Affiliation(s)
- Johan A F Koekkoek
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Pim B van der Meer
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Andrea Pace
- Neuro-Oncology Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Caroline Hertler
- Competence Center Palliative Care, Department of Radiation Oncology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Rebecca Harrison
- Division of Medical Oncology, BC Cancer, The University of British Colombia, Vancouver, Canada
| | - Heather E Leeper
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland,USA
| | - Deborah A Forst
- Division of Neuro-Oncology, Department of Neurology, Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Rakesh Jalali
- Department of Radiation Oncology, Apollo Proton Cancer Center, Chennai, India
| | - Kathy Oliver
- International Brain Tumour Alliance, Tadworth, UK
| | - Jennifer Philip
- Department of Medicine, St. Vincent’s Hospital Melbourne, University of Melbourne, Victoria, Australia
| | - Martin J B Taphoorn
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Linda Dirven
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Tobias Walbert
- Department of Neurology and Neurosurgery, Henry Ford Health System and Department of Neurology Wayne State University, Detroit, Michigan, USA
| |
Collapse
|
5
|
Zapata CB, Dionne-Odom JN, Harris HA, Kalanithi L, Lin J, Bischoff K, Fazzalaro K, Pantilat SZ. Honoring What We Say We Do: Developing Real-World Tools for Routine Family Caregiver Assessment and Support in Outpatient Palliative Care. J Palliat Med 2023; 26:376-384. [PMID: 36608316 DOI: 10.1089/jpm.2022.0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background: Family caregivers are essential to the care of patients with serious illness and supporting caregivers alongside patients is a core tenet of palliative care. While there is increasing recognition of the need to support family caregivers, there are limited resources to assess and support their needs in a systematic way in outpatient palliative care practice. Objectives: The aim of this study is to develop an approach to conducting assessments of routine needs and support of family caregivers in outpatient palliative care practice using a quality improvement framework. Setting: Seven, interdisciplinary, outpatient palliative care teams in California collaborated in this study. Measurements: Family caregivers were surveyed about levels of distress and support using a 10-point scale and asked about specific areas of need for support. Usefulness of a supportive caregiver resource was also measured on a 10-point scale, in addition to qualitative assessment of clinician satisfaction and feasibility of routine caregiver assessment and support. Results: Seven hundred thirty-six caregiver needs assessments were conducted and 44 supportive tool kits were distributed. A majority of family caregivers reported moderate or severe distress related to caregiving (score ≥4 on a 10-point scale). The most common sources of distress included emotional distress, worry caregiving was negatively impacting their own health, and planning for the future. Most caregivers reported feeling moderately or very well supported, most commonly by family, friends, and faith/spirituality. Caregivers rated the supportive tool kit an 8.4 on a 10-point usefulness scale and 92% would recommend it to others. Conclusions: We successfully developed and piloted practical clinical tools for routine family caregiver screening and support.
Collapse
Affiliation(s)
- Carly B Zapata
- Division of Palliative Medicine, University of California, San Francisco, San Francisco, California, USA
| | | | - Heather A Harris
- Division of Hospital Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, California, USA
| | | | - Jessica Lin
- Stanford University Medical Partners, Oakland, California, USA
| | - Kara Bischoff
- Division of Palliative Medicine, University of California, San Francisco, San Francisco, California, USA
| | | | - Steven Z Pantilat
- Division of Palliative Medicine, University of California, San Francisco, San Francisco, California, USA
| |
Collapse
|
6
|
Jung M, Jeong Y, Park BJ. Adaptation of families of adult patients with brain tumor: Partial least squares structural equation modeling. PLoS One 2023; 18:e0285677. [PMID: 37167209 PMCID: PMC10174583 DOI: 10.1371/journal.pone.0285677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 04/23/2023] [Indexed: 05/13/2023] Open
Abstract
Brain tumor patients experience physical, psychological, social, and cognitive changes. These changes are challenging for both the patients and their families. These patients and their families need to adapt together on the cancer treatment path. This study aimed to identify the factors affecting adaptation in families of adult patients with brain tumors. A quantitative, cross-sectional study of 165 families of adult patients with primary brain tumors was conducted using a self-administered questionnaire. Partial least squares structural equation modeling was used to test a hypothetical model. The results showed that family stress, family functioning, and family resources influenced on family adaptation in families of adult patients with primary brain tumors. Among these factors, family resources were identified to be the strongest factor associated with family adaptation. The results of this study may be utilized as a theoretical basis in nursing to improve the family adaptation of patients with brain tumors. Regarding nursing practices, the results suggest that nurses should provide family-centered nursing interventions and promote family resources to help brain tumor patients and their families to adapt.
Collapse
Affiliation(s)
- Mijung Jung
- Department of Nursing, Kwangju Women's University, Gwangju, Korea
| | - Younhee Jeong
- College of Nursing Science, Kyung Hee University, Seoul, Korea
- East-West Nursing Research Institute, Kyung Hee University, Seoul, Korea
| | - Bong Jin Park
- College of Medicine, Kyung Hee University, Seoul, Korea
- Department of Neurosurgery, Kyung Hee Medical Center, Seoul, Korea
| |
Collapse
|
7
|
Coyne E, Winter N, Carlini J, Robertson J, Dieperink K. Developing video resources to reduce the burden of caring for persons with brain cancer. Eur J Oncol Nurs 2022; 60:102187. [DOI: 10.1016/j.ejon.2022.102187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 07/21/2022] [Accepted: 07/27/2022] [Indexed: 11/04/2022]
|
8
|
Bechthold AC, Azuero A, Pisu M, Pierce JY, Williams GR, Taylor RA, Wells R, Curry K, Reed RD, Harrell ER, Gazaway S, Mollman S, Engler S, Puga F, Bakitas MA, Dionne-Odom JN. The Project ENABLE Cornerstone randomized controlled trial: study protocol for a lay navigator-led, early palliative care coaching intervention for African American and rural-dwelling advanced cancer family caregivers. Trials 2022; 23:452. [PMID: 35655285 PMCID: PMC9161197 DOI: 10.1186/s13063-022-06305-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 04/13/2022] [Indexed: 11/10/2022] Open
Abstract
Background Family caregivers play a vital, yet stressful role in managing the healthcare needs and optimizing the quality of life of patients with advanced cancer, from the time they are newly diagnosed until end of life. While early telehealth palliative care has been found to effectively support family caregivers, little work has focused on historically under-resourced populations, particularly African American and rural-dwelling individuals. To address this need, we developed and are currently testing Project ENABLE (Educate, Nurture, Advise, Before Life Ends) Cornerstone, a lay navigator-led, early palliative care coaching intervention for family caregivers of African American and rural-dwelling patients with newly diagnosed advanced cancer. Methods This is a 2-site, single-blind, hybrid type I implementation-effectiveness trial of the Cornerstone intervention versus usual care. Cornerstone is a multicomponent intervention based on Pearlin’s Stress-Health Process Model where African American and/or rural-dwelling family caregivers of patients with newly diagnosed advanced cancer (target sample size = 294 dyads) are paired with a lay navigator coach and receive a series of six, brief 20–60-min telehealth sessions focused on stress management and coping, caregiving skills, getting help, self-care, and preparing for the future/advance care planning. Subsequent to core sessions, caregivers receive monthly follow-up indefinitely until the patient’s death. Caregiver and patient outcomes are collected at baseline and every 12 weeks until the patient’s death (primary outcome: caregiver distress at 24 weeks; secondary outcomes: caregiver: quality of life and burden; patient: distress, quality of life, and healthcare utilization). Implementation costs and the intervention cost effectiveness are also being evaluated. Discussion Should this intervention demonstrate efficacy, it would yield an implementation-ready model of early palliative care support for under-resourced family caregivers. A key design principle that has centrally informed the Cornerstone intervention is that every caregiving situation is unique and each caregiver faces distinct challenges that cannot be addressed using a one-size-fits all approach. Hence, Cornerstone employs culturally savvy lay navigator coaches who are trained to establish a strong, therapeutic alliance with participants and tailor their coaching to a diverse range of individual circumstances. Trial registration ClinicalTrials.gov NCT04318886. Registered on 20 March, 2020. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06305-w.
Collapse
Affiliation(s)
- Avery C Bechthold
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Andres Azuero
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Maria Pisu
- Division of Preventive Medicine, UAB School of Medicine, Birmingham, AL, USA
| | | | - Grant R Williams
- Division of Hematology and Oncology, Department of Medicine, UAB, Birmingham, AL, USA
| | - Richard A Taylor
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Rachel Wells
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Kayleigh Curry
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Rhiannon D Reed
- Division of Transplantation, Department of Surgery, UAB, Birmingham, AL, USA
| | - Erin R Harrell
- Department of Psychology, University of Alabama, Tuscaloosa, AL, USA
| | - Shena Gazaway
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Sarah Mollman
- College of Nursing, South Dakota State University, Rapid City, SD, USA
| | - Sally Engler
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Frank Puga
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Marie A Bakitas
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, USA.,Division of Geriatrics, Gerontology, and Palliative Care, UAB Department of Medicine, Birmingham, AL, USA
| | - J Nicholas Dionne-Odom
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, USA. .,Division of Geriatrics, Gerontology, and Palliative Care, UAB Department of Medicine, Birmingham, AL, USA.
| |
Collapse
|
9
|
Loughan AR, Willis KD, Braun SE, Rodin G, Lanoye A, Davies AE, Svikis D, Mazzeo S, Malkin M, Thacker L. Managing cancer and living meaningfully (CALM) in adults with malignant glioma: a proof-of-concept phase IIa trial. J Neurooncol 2022; 157:447-456. [PMID: 35437687 PMCID: PMC9909556 DOI: 10.1007/s11060-022-03988-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 03/14/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Managing Cancer and Living Meaningfully (CALM) is an evidence-based, brief, semi-structured psychotherapy designed to help patients with advanced cancer cope with the practical and profound challenges of their illness. However, no study to date has investigated its feasibility, acceptability, and preliminary effectiveness in adults with malignant glioma, despite the well-documented incidence of psychological distress in this vulnerable and underserved population. METHODS Fourteen patients with glioma and elevated symptoms of depression and/or death anxiety enrolled in the trial: 83% glioblastoma, 75% female, Mage = 56 years (SD = 15.1; range = 27-81). Feasibility was assessed based on established metrics. Acceptability was measured by post-session surveys and post-intervention interviews. Preliminary intervention effects were explored using paired t-tests, comparing psychological distress at baseline and post-intervention. RESULTS Of the 14 enrolled patients, 12 were evaluable. Nine completed the study (75% retention rate). Three patients withdrew due to substantial disease progression which affected their ability to participate. Participants reported high perceived benefit, and all recommended the program to others. Baseline to post-intervention assessments indicated reductions in death anxiety, generalized anxiety, and depression, and increases in spirituality. Quality of life and fear of cancer recurrence remained stable throughout the study period. CONCLUSIONS CALM appears feasible for use with adults with malignant glioma. Enrollment and retention rates were high and comparable to psychotherapy trials for patients with advanced cancer. High perceived benefit and reductions in symptoms of death anxiety, generalized anxiety, and depression were reported by participants. These findings are extremely encouraging and support further study of CALM in neuro-oncology. TRIAL REGISTRATION NUMBER NCT04646213 registered on 11/27/2020.
Collapse
Affiliation(s)
- Ashlee R Loughan
- Department of Neurology, School of Medicine, Virginia Commonwealth University, 1201 East Marshall St, Richmond, VA, 23298-0037, USA.
- Massey Cancer Center, Richmond, VA, USA.
- Division of Neuro-Oncology, Department of Neurology, Virginia Commonwealth University, School of Medicine, VCU Massey Cancer Center, 1201 East Marshall St, Richmond, VA, 23298-0037, USA.
| | - Kelcie D Willis
- Massey Cancer Center, Richmond, VA, USA
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Sarah Ellen Braun
- Department of Neurology, School of Medicine, Virginia Commonwealth University, 1201 East Marshall St, Richmond, VA, 23298-0037, USA
- Massey Cancer Center, Richmond, VA, USA
| | - Gary Rodin
- Princess Margaret Cancer Center, Toronto, Canada
| | - Autumn Lanoye
- Massey Cancer Center, Richmond, VA, USA
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Alexandria E Davies
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Dace Svikis
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Suzanne Mazzeo
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Mark Malkin
- Department of Neurology, School of Medicine, Virginia Commonwealth University, 1201 East Marshall St, Richmond, VA, 23298-0037, USA
- Massey Cancer Center, Richmond, VA, USA
| | - Leroy Thacker
- Massey Cancer Center, Richmond, VA, USA
- Department of Biostatistics, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| |
Collapse
|
10
|
Liu B, Kent EE, Dionne-Odom JN, Alpert N, Ornstein KA. A national profile of health-focused caregiving activities prior to a new cancer diagnosis. J Geriatr Oncol 2022; 13:454-461. [PMID: 34801426 PMCID: PMC9058151 DOI: 10.1016/j.jgo.2021.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/22/2021] [Accepted: 11/09/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND Little is known about how unpaid family caregivers may already be engaged in caregiving activities prior to their care recipient's cancer diagnosis. We examined pre-cancer diagnosis caregiving patterns and their association with caregiving strain. METHODS We conducted a population-based analysis of 2011-2017 National Health and Aging Trends Study (NHATS) linked with the National Study of Caregiving (NSOC) and Medicare claims data. Latent class analysis was used to examine patterns of 16 health-focused caregiving tasks (e.g., tracking medications, making appointments) of family caregivers assisting adults ≥65 years prior to an incident cancer diagnosis. High caregiving strain was defined as a total score ≥ 85th percentile of 6 caregiving strain items (e.g., financial difficulty, no time for self). Association between caregiving patterns and strain were examined using multivariable logistic regression, adjusting for care recipient and caregiver characteristics. RESULTS An estimated 4.2 million caregivers cared for older adults prior to care recipients' new cancer diagnoses during 2011-2017. They engaged in a median of four health-focused caregiving activities. Nearly 1-in-5 (18.7%) pre-cancer caregivers had high caregiving strain. Caregivers were classified into 3 health-focused caregiving activity classes: Low-level (41.2%), Moderate-coordination (29.3%), and High-intensity (29.4%). Higher caregiving activity was associated with higher caregiving strain (adjusted odds ratio (aOR) = 3.85, 95% CI: 2.34-6.33). Caregivers in the High-intensity class had the highest caregiving strain (39.9%), and included more spouses (28.1% vs <18%). CONCLUSION One-third of U.S. caregivers who help older adults prior to their cancer diagnoses are already highly strained and engaged in high-level health-focused caregiving tasks. Oncology clinicians should assess the capacity and strain of family caregivers who may already be supporting patients with new cancer diagnoses and refer caregivers to additional supportive care services.
Collapse
Affiliation(s)
- Bian Liu
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America.
| | - Erin E Kent
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States of America; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, NC, United States of America
| | - J Nicholas Dionne-Odom
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, United States of America; Center for Palliative and Supportive Care, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Naomi Alpert
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Katherine A Ornstein
- Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| |
Collapse
|
11
|
Abstract
Specialists in palliative care view the family meeting as a means to engage patients and their families in a serious illness discussion that may clarify the values of patients and caregivers, provide information, determine care preferences, and identify sources of illness-related distress and burden. The family meeting is considered the best practice for achieving patient- and family-centered care in palliative care. Although studies of the family meeting are limited, those extant suggest that these interventions may reduce caregiver distress, mitigate the perception of unmet needs, prepare family members for caregiving, and improve bereavement outcomes. The experience of palliative care specialists further suggests that the family meeting may reinforce the therapeutic alliance with families, promote consensus, and reduce the need for ad hoc meetings. Physician satisfaction may be enhanced when the treatment plan includes the opportunity to show empathy and see the family’s perspective—core elements of the clinical approach to the family meeting. In the oncology setting, the potential to achieve these positive outcomes supports the integration of the family meeting into practice. Clinical skills for the planning and running of family meetings should be promoted with consideration of a standardized protocol for routine family meetings at critical points during the illness and its treatment using an interdisciplinary team. Further research is needed to refine understanding of the indications for the family meeting and determine the optimal timing, structure, and staffing models. Outcome studies employing validated measures are needed to better characterize the impact of family meetings on patient and family distress and on treatment outcomes. Although better evidence is needed to guide the future integration of the family meeting into oncology practice, current best practices can be recommended based on available data and the extensive observations of palliative care specialists.
Collapse
|
12
|
Dionne-Odom JN, Azuero A, Taylor RA, Dosse C, Bechthold AC, Currie E, Reed RD, Harrell ER, Engler S, Ejem DB, Ivankova NV, Martin MY, Rocque GB, Williams GR, Bakitas MA. A lay navigator-led, early palliative care intervention for African American and rural family caregivers of individuals with advanced cancer (Project Cornerstone): Results of a pilot randomized trial. Cancer 2022; 128:1321-1330. [PMID: 34874061 PMCID: PMC8882155 DOI: 10.1002/cncr.34044] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/25/2021] [Accepted: 11/13/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND The objective of this study was to assess the feasibility, acceptability, and potential efficacy of ENABLE (Educate, Nurture, Advise, Before Life Ends) Cornerstone-a lay navigator-led, early palliative care telehealth intervention for African American/Black and/or rural-dwelling family caregivers of individuals with advanced cancer (ClinicalTrials.gov identifier NCT03464188). METHODS This was a pilot randomized trial (November 2019 to March 2021). Family caregivers of patients with newly diagnosed, stage III/IV, solid-tumor cancers were randomized to receive either an intervention or usual care. Intervention caregivers were paired with a specially trained lay navigator who delivered 6 weekly, 20-minute to 60-minute telehealth coaching sessions plus monthly follow-up for 24 weeks, reviewing skills in stress management, self-care, getting help, staying organized, and future planning. Feasibility was assessed according to the completion of sessions and questionnaires (predefined as a completion rate ≥80%). Acceptability was determined through intervention participants' ratings of their likelihood of recommending the intervention. Measures of caregiver distress and quality of life were collected at 8 and 24 weeks. RESULTS Sixty-three family caregivers were randomized (usual care, n = 32; intervention, n = 31). Caregivers completed 65% of intervention sessions and 87% of questionnaires. Average ratings for recommending the program were 9.4, from 1 (not at all likely) to 10 (extremely likely). Over 24 weeks, the mean ± SE Hospital Anxiety and Depression Scale score improved by 0.30 ± 1.44 points in the intervention group and worsened by 1.99 ± 1.39 points in the usual care group (difference, -2.29; Cohen d, -0.32). The mean between-group difference scores in caregiver quality of life was -1.56 (usual care - intervention; d, -0.07). Similar outcome results were observed for patient participants. CONCLUSIONS The authors piloted ENABLE Cornerstone, an intervention for African American and rural-dwelling advanced cancer family caregivers. The acceptability of the intervention and data collection rates were high, and the preliminary efficacy for caregiver distress was promising. LAY SUMMARY To date, very few programs have been developed to support under-resourced cancer family caregivers. To address this need, the authors successfully pilot tested an early palliative care program, called Educate, Nurture, Advise, Before Life Ends (ENABLE) Cornerstone, for African American and rural family caregivers of individuals with advanced cancer. Cornerstone is led by specially trained lay people and involves a series of weekly phone sessions focused on coaching caregivers to manage stress and provide effective support to patients with cancer. The authors are now testing Cornerstone in a larger trial. If the program demonstrates benefit, it may yield a model of caregiver support that could be widely implemented.
Collapse
Affiliation(s)
- J Nicholas Dionne-Odom
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama.,Division of Geriatrics, Gerontology, and Palliative Care, UAB Department of Medicine, Birmingham, Alabama.,UAB Center for Palliative and Supportive Care, Birmingham, Alabama
| | - Andres Azuero
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama
| | - Richard A Taylor
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama
| | - Chinara Dosse
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama
| | - Avery C Bechthold
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama
| | - Erin Currie
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama
| | - Rhiannon D Reed
- Comprehensive Transplant Institute, UAB, Birmingham, Alabama
| | - Erin R Harrell
- Department of Psychology, University of Alabama, Tuscaloosa, Alabama
| | - Sally Engler
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama
| | - Deborah B Ejem
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama
| | | | - Michelle Y Martin
- Department of Preventive Medicine, Center for Innovation in Health Equity Research, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Gabrielle B Rocque
- Division of Geriatrics, Gerontology, and Palliative Care, UAB Department of Medicine, Birmingham, Alabama.,UAB Center for Palliative and Supportive Care, Birmingham, Alabama.,Division of Hematology and Oncology, Department of Medicine, UAB, Birmingham, Alabama
| | - Grant R Williams
- Division of Hematology and Oncology, Department of Medicine, UAB, Birmingham, Alabama
| | - Marie A Bakitas
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama.,Division of Geriatrics, Gerontology, and Palliative Care, UAB Department of Medicine, Birmingham, Alabama.,UAB Center for Palliative and Supportive Care, Birmingham, Alabama
| |
Collapse
|
13
|
Wu A, Colón GR, Lim M. Quality of Life and Role of Palliative and Supportive Care for Patients With Brain Metastases and Caregivers: A Review. Front Neurol 2022; 13:806344. [PMID: 35250815 PMCID: PMC8893046 DOI: 10.3389/fneur.2022.806344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 01/07/2022] [Indexed: 12/25/2022] Open
Abstract
Brain metastases (BM) are the most commonly diagnosed secondary brain lesions in adults, influencing these patients' symptoms and treatment courses. With improvements in oncologic treatments, patients with BM are now living longer with their advanced cancers, and issues pertaining to quality of life become more pressing. The American Society of Clinical Oncology has recommended early implementation of palliative care for cancer patients, though incorporation and implementation of palliative and other supportive services in the setting of true multidisciplinary care requires additional attention and research for patients with intracranial metastases. We review the physical, cognitive, and psychosocial challenges patients with BM and their caregivers face during their cancer course as well as the current published research on quality of life metrics relating to this patient population and the diverse roles specialty palliative care, rehabilitation services, and other healthcare providers play in a comprehensive multidisciplinary care model.
Collapse
Affiliation(s)
- Adela Wu
- Department of Neurosurgery, Stanford Healthcare, Stanford, CA, United States
- *Correspondence: Adela Wu
| | - Gabriela Ruiz Colón
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Michael Lim
- Department of Neurosurgery, Stanford Healthcare, Stanford, CA, United States
| |
Collapse
|
14
|
Jones D, Pinkham MB, Wallen MP, Hart NH, Joseph R, Strodl E, Ownsworth T, Beesley V, Crichton M, Chan RJ. Benefits of supportive strategies for carers of people with high-grade glioma: a systematic review : Strategies for addressing the needs of high-grade glioma carers. Support Care Cancer 2022; 30:10359-78. [PMID: 36282336 DOI: 10.1007/s00520-022-07419-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 10/13/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE To systematically review and examine current evidence for the carer-reported benefits of supportive care strategies for carers of adults with high-grade glioma (HGG). METHODS Four databases (CINAHL, EMBASE, PubMed, PsycINFO) were searched for articles published between January 2005 and April 2022 that assessed strategies for addressing the supportive care needs of carers of adults with HGG (WHO grade 3-4). Study selection and critical appraisal were conducted independently by three authors (DJ/MC, 2021; DJ/RJ 2022). Data extraction was conducted by one author (DJ) and checked by a second author (RJ). Results were synthesised narratively. RESULTS Twenty-one studies involving 1377 caregivers were included, targeting the carer directly (n = 10), the patient-carer dyad (n = 3), or focused on people with HGG + / - their carers (n = 8). A paucity of high-quality evidence exists for effective and comprehensive support directly addressing outcomes for carers of adults with HGG. Strategies that demonstrated some benefits included those that built carer knowledge or provided emotional support, delivered by health professionals or through peer support. Supportive and early palliative care programmes have potential to reduce unmet carer needs while providing ongoing carer support. CONCLUSION Strategies incorporating an educational component, emotional support, and a regular needs assessment with corresponding tailored support are most valued by carers. Future practice development research should adopt a value-based approach and exceed evaluation of efficacy outcomes to incorporate evaluation of the experience of patients, carers, and staff, as well as costs.
Collapse
|
15
|
Bakitas M, Cheville AL, Mulvey TM, Peppercorn J, Watts K, Dionne-Odom JN. Telehealth Strategies to Support Patients and Families Across the Cancer Trajectory. Am Soc Clin Oncol Educ Book 2021; 41:413-422. [PMID: 34010046 DOI: 10.1200/edbk_320979] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Effective delivery of cancer care via telehealth requires a planned care system that accounts for myriad patient, provider, and practice/cancer center resources before, during, and after the care episode. Telehealth is broadly defined as a method to have virtual, bidirectional communication between patients and providers. Telehealth can include methods such as audio-only, video-consultation, and tele-monitoring, which can occur in a synchronous, asynchronous, or blended format. The purpose of this review is to present common foundational principles for providing clinical cancer care via telehealth, followed by an overview of three distinct examples of comprehensive telehealth programs that have been developed to meet the needs of patients and families across the cancer trajectory, including survivorship, rehabilitation, and palliative care phases. The programs described are exemplars that were developed and implemented prior to the coronavirus pandemic, so they reflect many years of planning and evidence. Lessons learned include the need for ongoing patient support, clinician training, and cancer health system/practice programmatic considerations such as billing, scheduling, reimbursement, software, and hardware/platform security. Although the COVID-19 pandemic produced an explosive shift in regulations and implementation, sustainability of these changes may not be long-term. Nevertheless, a permanent shift in cancer care to include telehealth is likely here to stay.
Collapse
Affiliation(s)
- Marie Bakitas
- School of Nursing, Center for Palliative and Supportive Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | | | | | | | | | - J Nicholas Dionne-Odom
- School of Nursing, Center for Palliative and Supportive Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| |
Collapse
|