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Reblin M, Ambrose N, Pastore N, Nowak S. Perceived helpfulness of caregiver support resources: Results from a state-wide poll. PEC INNOVATION 2024; 4:100295. [PMID: 38855072 PMCID: PMC11157270 DOI: 10.1016/j.pecinn.2024.100295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 05/20/2024] [Accepted: 05/24/2024] [Indexed: 06/11/2024]
Abstract
Objective Our goal was to identify specific types of services desired by caregivers and determine subgroups most interested in each service type. Methods Caregiving questions were added to a state-wide poll conducted in a majority-rural state. Those who identified as caregivers (n = 428) were asked to report on the helpfulness of 6 domains of services. Descriptive analysis and logistic regressions were conducted. Results Top resources caregivers identified as potentially helpful included hands-on services (33.9%), help coordinating care from multiple providers (21.5%), help with finances (18.9%), and help managing emotional stress (17.8%). Only 15% indicated no caregiver resources would be helpful. Younger caregivers endorsed several service domains as more helpful than older caregivers; caregivers reporting higher stress were more likely to endorse most domains as helpful. Conclusion Data reinforces the overwhelming need to offer caregiver services. Navigation and integrated and tailored service models may be beneficial to help caregivers identify and access appropriate services within healthcare systems. Innovation This study uses an innovative approach to identifying needs of caregivers, who are often invisible within the healthcare system. Our findings suggest a paradigm shift is needed to broaden the scope and depth of services offered to caregivers.
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Affiliation(s)
- Maija Reblin
- Vermont Conversation Lab, Department of Family Medicine, University of Vermont, Burlington, VT, USA
| | - Natalie Ambrose
- Vermont Conversation Lab, Department of Family Medicine, University of Vermont, Burlington, VT, USA
| | - Nina Pastore
- Vermont Conversation Lab, Department of Family Medicine, University of Vermont, Burlington, VT, USA
| | - Sarah Nowak
- Department of Pathology and Laboratory Medicine, University of Vermont, Burlington, VT, USA
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2
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Choi H, Reblin M, Litzelman K. Conceptualizing Family Caregivers' Use of Community Support Services: A Scoping Review. THE GERONTOLOGIST 2024; 64:gnad039. [PMID: 37022354 DOI: 10.1093/geront/gnad039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Only a fraction of the 53 million caregivers in the United States use available formal community services. This scoping review synthesized the literature on the barriers and facilitators of community support service utilization by adult caregivers of a family member or friend with an illness, disability, or other limitation. RESEARCH DESIGN AND METHODS We searched PubMed, CINAHL, PsycInfo, and Web of Science for quantitative and qualitative articles assessing barriers and facilitators of caregivers' access to and utilization of resources, following Preferred Reporting Items for Systematic Review and Meta-Analysis scoping review guidelines. Thematic analysis, drawing on an initial conceptualization, informed key insights around caregivers' resource navigation process. RESULTS The review provides support for individual factors affecting service use. Notably, some factors-such as time restrictions and increased caregiving demands-appear to function as barriers to accessing services even as they increase caregivers' need for support. Additionally, contextual barriers including cultural factors and support of friends/family can affect caregivers' access to resources. Finally, experience with health systems and structures and the intersection with other factors can affect service utilization. DISCUSSION AND IMPLICATIONS Suboptimal access to and utilization of community support services can be addressed at both the person and system level to mitigate potential inequities. Ensuring that caregivers are aware of, eligible for, and have the capacity and support to access the appropriate resources at the right time is essential for improving caregiver outcomes, reducing burnout, and supporting continued care.
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Affiliation(s)
- Hyojin Choi
- Department of Human Development and Family Studies, School of Human Ecology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Maija Reblin
- Department of Family Medicine, Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Kristin Litzelman
- Department of Human Development and Family Studies, School of Human Ecology, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Center for Demography of Health and Aging, University of Wisconsin-Madison, Madison, Wisconsin, USA
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3
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Winter N, McKenzie K, Spence D, Lane K, Ugalde A. The experience of bereaved cancer carers in rural and regional areas: The impact of the COVID-19 pandemic and the potential of peer support. PLoS One 2023; 18:e0293724. [PMID: 37934771 PMCID: PMC10629652 DOI: 10.1371/journal.pone.0293724] [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: 11/09/2022] [Accepted: 10/18/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND Caring for someone with cancer during end of life care can be a challenging and complex experience. Those living in rural and regional areas are less likely to have local healthcare services and may be physically isolated. Even where support services such as respite do exist, they may be less likely to be accessed due to the time burden in travelling to services. This was compounded by the COVID-19 pandemic. AIM To understand the potential benefits of peer support for bereaved carers of people with cancer from rural and regional locations during the COVID-19 period. METHODS Phone interviews were conducted with bereaved cancer carers living in rural and regional areas in Victoria. Semi-structured interviews were used, and participants were asked about their experience as a carer, bereavement and the potential for peer support. Interviews were audio recorded and transcribed verbatim; transcripts were coded and a thematic analysis was conducted. FINDINGS 12 interviews were conducted. Carers were mostly female (85%) and were on average 58 years of age (range 42-71). Interviews lasted an average of 58 minutes (range 53-91 minutes). Three themes were derived from the data; 1) Supportive care needs while caring and the impact of COVID-19; 2) Isolation during bereavement compounded by the COVID-19 pandemic; and 3) Peer support requires flexibility to meet diverse needs. CONCLUSION Peer support has potential to assist bereaved carers of people with cancer. A co-design approach may be beneficial for developing a flexible model for supporting and linking carers together.
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Affiliation(s)
- Natalie Winter
- School of Nursing & Midwifery and Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Kerry McKenzie
- Strategy and Support Division, Cancer Council Victoria, Melbourne, Australia
| | - Danielle Spence
- Strategy and Support Division, Cancer Council Victoria, Melbourne, Australia
| | - Katherine Lane
- Strategy and Support Division, Cancer Council Victoria, Melbourne, Australia
| | - Anna Ugalde
- School of Nursing & Midwifery and Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
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4
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Decosimo K, Drake C, Coffman CJ, Sperber NR, Tucker M, Hughes JM, Zullig LL, Chadduck T, Christensen L, Kaufman B, Allen KD, Hastings SN, Van Houtven CH. Implementation intensification to disseminate a skills-based caregiver training program: protocol for a type III effectiveness-implementation hybrid trial. Implement Sci Commun 2023; 4:97. [PMID: 37587517 PMCID: PMC10428549 DOI: 10.1186/s43058-023-00475-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 07/24/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND Family caregiver training decreases caregiver psychological burden and improves caregiver depressive symptoms and health-related quality of life. Caregivers FIRST is an evidence-based group skills training curriculum for family caregivers and was announced for national dissemination in partnership with the Veterans Health Administration (VHA) National Caregiver Support Program (CSP). Previous evaluations of Caregivers FIRST implementation highlighted that varying support was needed to successfully implement the program, ranging from minimal technical assistance to intensive assistance and support. However, we do not know the optimal level of support needed to inform cost-effective national scaling of the program. We describe a protocol for randomizing 24 non-adopting VA medical centers 1:1 to a tailored, high-touch implementation support or a standard, low-touch implementation support to test the primary hypothesis that high-touch support increases Caregivers FIRST penetration, fidelity, and adoption. Additionally, we describe the methods for evaluating the effect of Caregivers FIRST participation on Veteran outcomes using a quasi-experimental design and the methods for a business case analysis to examine cost of delivery differences among sites assigned to a low or high-touch implementation support. METHODS We use a type III hybrid implementation-effectiveness study design enrolling VA medical centers that do not meet Caregivers FIRST adoption benchmarks following the announcement of the program as mandated within the CSP. Eligible medical centers will be randomized to receive a standard low-touch implementation support based on Replicating Effective Programs (REP) only or to an enhanced REP (high-touch) implementation support consisting of facilitation and tailored technical assistance. Implementation outcomes include penetration (primary), fidelity, and adoption at 12 months. Mixed methods will explore sites' perceptions and experiences of the high-touch intensification strategy. Additional analyses will include a patient-level effectiveness outcome (Veteran days at home and not in an institution) and a business case analysis using staffing and labor cost data. DISCUSSION This pragmatic trial will lead to the development and refinement of implementation tools to support VA in spreading and sustaining Caregivers FIRST in the most efficient means possible. TRIAL REGISTRATION This study was registered on April 8, 2022, at ClinicalTrials.gov (identifier NCT05319535).
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Affiliation(s)
- Kasey Decosimo
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, NC, 27705, USA.
| | - Connor Drake
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, NC, 27705, USA
- Department of Population Health Sciences, Duke University, Durham, NC, USA
| | - Cynthia J Coffman
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, NC, 27705, USA
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA
| | - Nina R Sperber
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, NC, 27705, USA
- Department of Population Health Sciences, Duke University, Durham, NC, USA
| | - Matthew Tucker
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, NC, 27705, USA
| | - Jaime M Hughes
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, NC, 27705, USA
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Section On Gerontology and Geriatric Medicine, Division of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Leah L Zullig
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, NC, 27705, USA
- Department of Population Health Sciences, Duke University, Durham, NC, USA
| | - Trisha Chadduck
- Veteran's Health Administration Central Office, Washington, DC, USA
| | - Leah Christensen
- Veteran's Health Administration Central Office, Washington, DC, USA
| | - Brystana Kaufman
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, NC, 27705, USA
- Department of Population Health Sciences, Duke University, Durham, NC, USA
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, USA
| | - Kelli D Allen
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, NC, 27705, USA
- Department of Medicine & Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - S Nicole Hastings
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, NC, 27705, USA
- Department of Population Health Sciences, Duke University, Durham, NC, USA
- Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC, USA
- Geriatric Research, Education, and Clinical Center, Durham VA Health Care System, Durham, NC, USA
- Division of Geriatrics, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Courtney H Van Houtven
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, NC, 27705, USA
- Department of Population Health Sciences, Duke University, Durham, NC, USA
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, USA
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Ramirez M, De Anda S, Jin H, Herrera JR, Wu S. Health Information-Seeking Behavior of Latino Caregivers of People Living with Dementia: A Mixed-Methods Study. J Appl Gerontol 2023; 42:1738-1748. [PMID: 36932723 PMCID: PMC10440225 DOI: 10.1177/07334648231163430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023] Open
Abstract
This mixed-methods study examined the health information-seeking behavior of Latino caregivers of people living with dementia. A structured survey and semi-structured interviews were conducted with 21 Latino caregivers in Los Angeles, California. For triangulation, semi-structured interviews were also conducted with six healthcare and social service providers. The interview transcripts were coded and analyzed via thematic analysis, while the survey data were summarized using descriptive statistics. The results show that caregivers sought information on what changes to expect as dementia progresses. Some desired detailed (limited) information to be better prepared (to worry less). The most common action to address their information needs was searching the Internet. However, those who did this tended to be concerned about the quality of information. Overall, this study sheds light on how much detail Latino caregivers desire in the information they need and the actions they take to obtain this information.
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Affiliation(s)
- Magaly Ramirez
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA
| | - Sofia De Anda
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA
| | - Haomiao Jin
- Center for Economic and Social Research, University of Southern California, Los Angeles, CA, USA
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Joseph R Herrera
- Rancho/USC Geriatric Neurobehavior and Alzheimer's Center, Downey, CA, USA
| | - Shinyi Wu
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
- Daniel J. Epstein Department of Industrial and Systems Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, USA
- Edward R. Roybal Institute on Aging, University of Southern California, Los Angeles, CA, USA
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6
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Van Houtven CH, Drake C, Malo TL, Decosimo K, Tucker M, Sullivan C, D'Adolf J, Hughes JM, Christensen L, Grubber JM, Coffman CJ, Sperber NR, Wang V, Allen KD, Hastings SN, Shea CM, Zullig LL. Ready, set, go! The role of organizational readiness to predict adoption of a family caregiver training program using the Rogers' diffusion of innovation theory. Implement Sci Commun 2023; 4:69. [PMID: 37337208 DOI: 10.1186/s43058-023-00447-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 05/30/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND Caregivers FIRST is an evidence-based program addressing gaps in caregivers' skills. In 2020, the Veterans Health Administration Caregiver Support Program (CSP) nationally endorsed Caregivers FIRST, offering credit in leadership performance plans to encourage all VA medical centers (VAMCs) to implement locally. This study examines the association of organizational readiness with VAMC adoption of Caregivers FIRST. METHODS In a cohort observational study, we surveyed CSP managers about their facilities' readiness to implement using the Organizational Readiness for Implementing Change (ORIC) instrument and compared change commitment and change efficacy domains among VAMCs "adopters" defined as delivering Caregivers FIRST within 1 year of the national announcement to those that did not ("non-adopters"). Within "adopters," we categorized time to adoption based on Rogers' diffusion of innovation theory including "innovators," "early adopters," "early majority," "late adopters," and "laggards." Organizational readiness and site characteristics (facility complexity, staffing levels, volume of applications for caregiver assistance services) were compared between "adopters," "non-adopters," and between time to adoption subcategories. Separate logistic regression models were used to assess whether ORIC and site characteristics were associated with early adoption among "adopters." RESULTS Fifty-one of 63 (81%) VAMCs with CSP manager survey respondents adopted Caregivers FIRST during the first year. ORIC change commitment and efficacy were similar for "adopters" and "non-adopters." However, sites that adopted earlier (innovators and early adopters) had higher ORIC change commitment and efficacy scores than the rest of the "adopters." Logistic regression results indicated that higher ORIC change commitment (odds ratio [OR] = 2.57; 95% confidence interval [CI], 1.11-5.95) and ORIC change efficacy (OR = 2.60; 95% CI, 1.12-6.03) scores were associated with increased odds that a VAMC was an early adopter (categorized as an "innovator," "early adopter", or "early majority"). Site-level characteristics were not associated with Caregivers FIRST early adoption. CONCLUSIONS To our knowledge, this study is the first to prospectively assess organizational readiness and the timing of subsequent program adoption. Early adoption was associated with higher ORIC change commitment and change efficacy and not site-level characteristics. These findings yield insights into the role of organizational readiness to accelerate program adoption. TRIAL REGISTRATION ClinicalTrials.gov, NCT03474380. Registered on March 22, 2018.
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Affiliation(s)
- Courtney H Van Houtven
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System (152), 508 Fulton Street, Durham, NC, 27705, USA
- Department of Population Health Sciences, Duke University, Durham, NC, USA
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, USA
| | - Connor Drake
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System (152), 508 Fulton Street, Durham, NC, 27705, USA
- Department of Population Health Sciences, Duke University, Durham, NC, USA
| | - Teri L Malo
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System (152), 508 Fulton Street, Durham, NC, 27705, USA
| | - Kasey Decosimo
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System (152), 508 Fulton Street, Durham, NC, 27705, USA.
| | - Matthew Tucker
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System (152), 508 Fulton Street, Durham, NC, 27705, USA
| | - Caitlin Sullivan
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System (152), 508 Fulton Street, Durham, NC, 27705, USA
| | - Josh D'Adolf
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System (152), 508 Fulton Street, Durham, NC, 27705, USA
| | - Jaime M Hughes
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System (152), 508 Fulton Street, Durham, NC, 27705, USA
- Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Section on Gerontology and Geriatric Medicine, Division of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Leah Christensen
- Veteran's Health Administration Central Office, Washington, DC, USA
| | - Janet M Grubber
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System (152), 508 Fulton Street, Durham, NC, 27705, USA
- Cooperative Studies Program Coordinating Center, Veterans Affairs Boston Healthcare System, Boston, MA, USA
| | - Cynthia J Coffman
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System (152), 508 Fulton Street, Durham, NC, 27705, USA
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA
| | - Nina R Sperber
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System (152), 508 Fulton Street, Durham, NC, 27705, USA
- Department of Population Health Sciences, Duke University, Durham, NC, USA
| | - Virginia Wang
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System (152), 508 Fulton Street, Durham, NC, 27705, USA
- Department of Population Health Sciences, Duke University, Durham, NC, USA
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, USA
| | - Kelli D Allen
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System (152), 508 Fulton Street, Durham, NC, 27705, USA
- Department of Medicine & Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - S Nicole Hastings
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System (152), 508 Fulton Street, Durham, NC, 27705, USA
- Department of Population Health Sciences, Duke University, Durham, NC, USA
- Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC, USA
- Geriatric Research, Education, and Clinical Center, Durham VA Health Care System, Durham, NC, USA
- Division of Geriatrics, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Christopher M Shea
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Leah L Zullig
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System (152), 508 Fulton Street, Durham, NC, 27705, USA
- Department of Population Health Sciences, Duke University, Durham, NC, USA
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Park T, Pillemer K, Loeckenhoff C, Suitor JJ, Riffin C. What Motivates Physicians to Address Caregiver Needs? The Role of Experiential Similarity. J Appl Gerontol 2023; 42:1003-1012. [PMID: 36661199 PMCID: PMC10081953 DOI: 10.1177/07334648231151937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Despite the significant stress of family caregiving, caregivers' needs and risks are often overlooked in healthcare settings. This study examined the factors associated with primary care physicians' perceived responsibility to identify and address caregiver needs and risks. Using a national random sample of U.S. primary care physicians (N = 106), multivariable logistic regression analyses were conducted to examine associations of physicians' perceived responsibility to assess caregivers' needs with experiential similarity (personal experience with caregiving), structural similarity (being older and female), and secondary exposure variables (time seeing older adults in the outpatient setting). Most (76.5%) physicians felt responsible for identifying caregivers' needs and risks. In multivariable models, physicians who had personal experience with caregiving were four times more likely than those without it to feel responsible for identifying caregivers' needs and risks and assessing caregivers' mental health concerns. Thus, physicians may benefit from educational interventions that immerse them in caregivers' lived experiences.
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Affiliation(s)
- Taeyoung Park
- Department of Medicine, Weill Cornell Medicine, New York, NY, 10065 USA
| | - Karl Pillemer
- Department of Psychology, Cornell University, Ithaca, NY, 14850 USA
| | | | - J. Jill Suitor
- Department of Sociology, Purdue University, West Lafayette, IN, 47907 USA
| | - Catherine Riffin
- Department of Medicine, Weill Cornell Medicine, New York, NY, 10065 USA
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8
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Tangchitnusorn K, Prachuabmoh V. Motivation and Quality of Work Life of In-Home Paid Caregivers of Older Adults. J Appl Gerontol 2023; 42:737-746. [PMID: 36513623 DOI: 10.1177/07334648221145167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Hiring in-home paid caregivers (IPCs) to tend to older adults at home has been one of the popular long-term care strategies in several urban aging societies. Relevant studies in the Global South that provide empirical findings have been lacking. This study contributes to the literature on home care by conducting a qualitative analysis of work motivation and the quality of work life of female IPCs in Thailand. We found that work motivation involved the desire for personal economic improvement and the search for an emotional anchor. Analysis of quality of work life pointed to three major themes: great contribution but low recognition and support; interdependence as an ultimate career goal; and effective training as a key to opportunity and success. We proposed a theoretical extension to the existing care theories and suggested necessary policy interventions to sustain the supply of IPCs.
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Affiliation(s)
| | - Vipan Prachuabmoh
- College of Population Studies, 197948Chulalongkorn University, Bangkok, Thailand
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9
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Sperber NR, Boucher N, Hughes JM, Bruening R, Zullig LL, Decosimo K, Tucker M, Christensen LA, Allen KD, Hastings SN, Van Houtven CH. Mandated Caregiver Training in the Veterans Health Administration: Caregiver Inquiry Informs National Dissemination. THE GERONTOLOGIST 2023; 63:534-544. [PMID: 36327120 PMCID: PMC10461180 DOI: 10.1093/geront/gnac162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND AND OBJECTIVES A minority of family caregivers receive training, with implications for their own and their recipient's outcomes. Federal policy has supported the implementation and expansion of caregiver training and support. The Department of Veterans Affairs (VA) has developed a national Caregiver Support Program and collaborated with VA health services researchers to explore caregivers' acceptance of an evidence-based training program in preparation for system-wide dissemination. RESEARCH DESIGN AND METHODS This approach entailed a convergent mixed-methods design, which involved separate analyses of quantitative and qualitative data. Survey questions based on the Kirkpatrick model for training evaluation measured caregivers' reaction and learning, and interview questions elicited caregivers' reports about the value of the program for them. RESULTS Most caregivers reported satisfaction with the training when responding to survey questions, although qualitative interviews revealed caveats suggesting need to hone the best timing and specific group of caregivers for maximal benefit. DISCUSSION AND IMPLICATIONS Our findings indicate that understanding program-user fit may be particularly critical when implementing training for caregivers as they come to the program at different points along their caregiving journey, needing differing types and intensities of support. While a general program may appeal to policymakers aiming to scale caregiver training within a large, heterogeneous system, there may be shortcomings in terms of end-user acceptance and subsequent downstream outcomes such as reach and ultimately program effectiveness. Good, iterative communication flow between program developers and policymakers facilitates this understanding and, in turn, decisions about scaling.
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Affiliation(s)
- Nina R Sperber
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA
- Department of Population Health Sciences, Duke University, Durham, North Carolina, USA
| | - Nathan Boucher
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA
- Sanford School of Public Policy, Duke University, Durham, North Carolina, USA
| | - Jaime M Hughes
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA
- Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Rebecca Bruening
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA
| | - Leah L Zullig
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA
- Department of Population Health Sciences, Duke University, Durham, North Carolina, USA
| | - Kasey Decosimo
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA
| | - Matthew Tucker
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA
| | - Leah A Christensen
- Veteran's Health Administration Central Office, Washington, District of Columbia, USA
| | - Kelli D Allen
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Susan N Hastings
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA
- Division of Geriatrics, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Courtney H Van Houtven
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA
- Department of Population Health Sciences, Duke University, Durham, North Carolina, USA
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10
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Shepherd-Banigan ME, Ford CB, Smith VA, Belanger E, Wetle TT, Plassman BL, Burke JR, DePasquale N, O’Brien EC, Sorenson C, Van Houtven CH. Amyloid-β PET Scan Results Disclosure and Care-Partner Emotional Well-Being Over Time. J Alzheimers Dis 2022; 90:775-782. [DOI: 10.3233/jad-220611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Diagnostic tests, such as amyloid-β positron emission tomography (PET) scans, can increase appropriate therapeutic management for the underlying causes of cognitive decline. To evaluate the full utility of this diagnostic tool, information is needed on whether results from amyloid-β PET scans influence care-partner outcomes. Objective: This study examines the extent to which previous disclosure of elevated amyloid (suggestive of Alzheimer’s disease (AD) etiology) versus not-elevated amyloid (not suggestive of AD etiology) is associated with changes in care-partner wellbeing. Methods: The study used data derived from a national longitudinal survey of Medicare beneficiaries (n = 921) with mild cognitive impairment (MCI) or dementia and their care-partners. Care-partner wellbeing outcomes included depressive symptoms (PHQ-8), subjective burden (4-item Zarit burden score), and a 3-item measure of loneliness. Change was measured between 4 (Time 1) and 18 (Time 2) months after receiving the scan results. Adjusted linear regression models regressed change (Time 2-Time 1) in each outcome on scan result. Results: Care-partners were primarily white, non-Hispanic, college-educated, and married to the care recipient. Elevated amyloid was not associated with statistically significant Time 1 differences in outcomes or with statistically significant changes in depressive symptoms 0.22 (–0.18, 0.61), subjective burden 0.36 (–0.01, 0.73), or loneliness 0.15 (–0.01, 0.32) for care-partners from one time point to another. Conclusion: Given advances in AD biomarker testing, future research in more diverse samples is needed to understand the influence of scan results on care-partner wellbeing across populations.
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Affiliation(s)
- Megan E. Shepherd-Banigan
- Duke University, Department of Population Health Sciences, Durham, NC, USA
- Duke-Margolis Centerfor Health Policy, Durham, NC, USA
- Durham VA Health Care System, Durham, NC, USA
| | - Cassie B. Ford
- Duke University, Department of Population Health Sciences, Durham, NC, USA
| | - Valerie A. Smith
- Duke University, Department of Population Health Sciences, Durham, NC, USA
- Durham VA Health Care System, Durham, NC, USA
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Emmanuelle Belanger
- Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, RI, USA
- Center for Gerontology and Healthcare Research, School of Public Health, Brown University, Providence, RI, USA
| | - Terrie T. Wetle
- Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, RI, USA
- Center for Gerontology and Healthcare Research, School of Public Health, Brown University, Providence, RI, USA
| | - Brenda L. Plassman
- Department of Neurology and Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University, Durham, NC, USA
| | - James R. Burke
- Department of Neurology and Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University, Durham, NC, USA
| | - Nicole DePasquale
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Emily C. O’Brien
- Duke University, Department of Population Health Sciences, Durham, NC, USA
| | - Corinna Sorenson
- Duke University, Department of Population Health Sciences, Durham, NC, USA
- Duke-Margolis Centerfor Health Policy, Durham, NC, USA
- Duke University, Sanford School of Public Policy, Durham, NC, USA
| | - Courtney H. Van Houtven
- Duke University, Department of Population Health Sciences, Durham, NC, USA
- Duke-Margolis Centerfor Health Policy, Durham, NC, USA
- Durham VA Health Care System, Durham, NC, USA
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11
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Miller KEM, Van Houtven CH, Smith VA, Lindquist JH, Gray K, Richardson C, Shepherd-Banigan M. Family Caregivers of Veterans Experience Clinically Significant Levels of Distress Prepandemic and During Pandemic: Implications for Caregiver Support Services. Med Care 2022; 60:530-537. [PMID: 35471419 PMCID: PMC9187587 DOI: 10.1097/mlr.0000000000001726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Of the 26.4 million family caregivers in the United States, nearly 40% report high levels of emotional strain and subjective burden. However, for the 5 million caregivers of Veterans, little is known about the experiences of caregivers of Veterans during the coronavirus disease 2019 (COVID-19) pandemic. OBJECTIVE The aim was to examine pandemic-related changes of caregiver well-being outcomes. RESEARCH DESIGN, SUBJECTS, AND MEASURES Using a pre/post design and longitudinal data of individual caregivers captured pre-COVID-19 and during COVID-19, we use multilevel generalized linear mixed models to examine pandemic-related changes to caregiver well-being (n=903). The primary outcome measures include Zarit Subjective Burden, Center for Epidemiologic Studies Short Depression Scale, perceived financial strain, life chaos, and loneliness. RESULTS During the pandemic, we observe slight improvements for caregivers across well-being measures except for perceived financial strain. Before the pandemic, we observed that caregivers screened positive for clinically significant caregiver burden and probable depression. While we do not observe worsening indicators of caregiver well-being during the COVID-19 pandemic, the average predicted values of indicators of caregiver well-being remain clinically significant for caregiving subjective burden and depression. CONCLUSIONS These findings illuminate pandemic-related impacts of caregivers receiving support through the Veterans Affairs (VA) pre-COVID and during the COVID-19 pandemic while caring for a population of frail, older care-recipients with a high burden of mental illness and other chronic conditions. Considering the long-term impacts of the pandemic to increase morbidity and the expected increased demand for caregivers in an aging population, these consistently high levels of distress despite receiving support highlight the need for interventions and policy reform to systematically support caregivers more broadly.
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Affiliation(s)
- Katherine E M Miller
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Courtney H Van Houtven
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC
- Department of Population Health Sciences, Duke University Medical Center
- Duke-Margolis Center for Health Policy
| | - Valerie A Smith
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC
- Department of Population Health Sciences, Duke University Medical Center
- Division of General Internal Medicine, Department of Medicine, Duke University, Durham, NC
| | - Jennifer H Lindquist
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC
| | - Kaileigh Gray
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC
| | | | - Megan Shepherd-Banigan
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC
- Department of Population Health Sciences, Duke University Medical Center
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12
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Riffin C, Griffin JM, Brody L, Wolff JL, Pillemer KA, Adelman RD, Bangerter LR, Starks SM, Falzarano F, Villanigro-Santiago M, Veney L, Czaja SJ. Engaging and Supporting Care Partners of Persons With Dementia in Health-Care Delivery: Results From a National Consensus Conference. THE PUBLIC POLICY AND AGING REPORT 2022; 32:58-65. [PMID: 35607366 PMCID: PMC9118070 DOI: 10.1093/ppar/prac004] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Indexed: 11/15/2022]
Affiliation(s)
- Catherine Riffin
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Joan M Griffin
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Lilla Brody
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Jennifer L Wolff
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Karl A Pillemer
- Department of Psychology, Cornell University, Ithaca, New York, USA
| | - Ronald D Adelman
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Lauren R Bangerter
- Research and Development, UnitedHealth Group, Minnetonka, Minnesota, USA
| | - Steven M Starks
- Department of Clinical Sciences, University of Houston College of Medicine, Houston, Texas, USA
| | | | | | | | - Sara J Czaja
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
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13
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Leykum LK, Finley EP, Penney LS, Parish Johnson J, Pugh JA, Noel PH. Engaging Veterans, caregivers, and system stakeholders to improve VA home and community-based services. Health Serv Res 2022; 57 Suppl 1:66-76. [PMID: 35243641 DOI: 10.1111/1475-6773.13926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 11/11/2021] [Accepted: 11/14/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To understand Veterans', caregivers', and stakeholders' perceptions of home-based and caregiver support services and their suggestions for improvement to better align services with needs. DATA SOURCES We identified Veterans and caregivers at four EDCoE sites using the VA high-need, high-risk list, representing Veterans who qualify for home-based primary care. We randomly selected Veterans and their caregivers, stratifying by age. We also identified leaders and clinicians involved in clinical service delivery. STUDY DESIGN Between February and November 2019, we conducted in-person and telephone interviews and focus groups using semi-structured questions tailored to each group, analyzing them through a rapid qualitative analysis approach and providing real-time feedback to operational partners. DATA COLLECTION Thirty-four Veterans, 24 caregivers, and 39 leaders and clinicians participated. PRINCIPAL FINDINGS Respondents identified key categories of experience that could be monitored and improved, including navigating an increasingly complex system, coordinating and communicating across services, and unmet household and financial needs. Veterans and caregivers described quality in terms of reliability, timeliness, standardization, and accountability. Summaries were created to contextualize results and to highlight gaps and opportunities for new measures and policy development. CONCLUSIONS Collaborating with Veterans, caregivers, and stakeholders enables us to understand their daily experiences and to develop meaningful approaches to evaluating services that incorporate their perspectives. Providing regular, actionable feedback to operational partners informs policy and operational initiatives, such as the scope of services and infrastructure for system navigation.
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Affiliation(s)
- Luci K Leykum
- Department of Veterans Affairs, Elizabeth Dole Center of Excellence for Veterans and Caregiver Research, USA.,Medicine and Research Services, South Texas Veterans Health Care System, San Antonio, Texas, USA.,Dell Medical School, University of Texas at Austin, Austin, Texas, USA
| | - Erin P Finley
- Department of Veterans Affairs, Elizabeth Dole Center of Excellence for Veterans and Caregiver Research, USA.,Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.,Research Services, VA Greater Los Angeles Health Care System, Los Angeles, California, USA
| | - Lauren S Penney
- Department of Veterans Affairs, Elizabeth Dole Center of Excellence for Veterans and Caregiver Research, USA.,Medicine and Research Services, South Texas Veterans Health Care System, San Antonio, Texas, USA.,Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Julie Parish Johnson
- Department of Veterans Affairs, Elizabeth Dole Center of Excellence for Veterans and Caregiver Research, USA.,Medicine and Research Services, South Texas Veterans Health Care System, San Antonio, Texas, USA.,Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Jacqueline A Pugh
- Department of Veterans Affairs, Elizabeth Dole Center of Excellence for Veterans and Caregiver Research, USA.,Medicine and Research Services, South Texas Veterans Health Care System, San Antonio, Texas, USA.,Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Polly H Noel
- Department of Veterans Affairs, Elizabeth Dole Center of Excellence for Veterans and Caregiver Research, USA.,Medicine and Research Services, South Texas Veterans Health Care System, San Antonio, Texas, USA.,Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
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14
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Boucher NA, Shapiro A, Van Houtven CH, Steinhauser KE, Allen KD, Johnson KS. Needs of care partners of older Veterans with serious illness. J Am Geriatr Soc 2022; 70:1785-1791. [DOI: 10.1111/jgs.17714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 01/25/2022] [Accepted: 01/29/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Nathan A. Boucher
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) Durham VA Health System HSR&D Durham North Carolina USA
- Sanford School of Public Policy Duke University Durham North Carolina USA
- Department of Population Health Sciences School of Medicine, Duke University Durham North Carolina USA
- Division of Geriatrics, Department of Medicine School of Medicine, Duke University Durham North Carolina USA
- Duke‐Margolis Center for Health Policy Durham North Carolina USA
| | - Abigail Shapiro
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) Durham VA Health System HSR&D Durham North Carolina USA
| | - Courtney H. Van Houtven
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) Durham VA Health System HSR&D Durham North Carolina USA
- Department of Population Health Sciences School of Medicine, Duke University Durham North Carolina USA
- Duke‐Margolis Center for Health Policy Durham North Carolina USA
- Duke Center for the Study of Aging and Human Development Durham North Carolina USA
| | - Karen E. Steinhauser
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) Durham VA Health System HSR&D Durham North Carolina USA
- Department of Population Health Sciences School of Medicine, Duke University Durham North Carolina USA
- Duke Center for the Study of Aging and Human Development Durham North Carolina USA
| | - Kelli D. Allen
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) Durham VA Health System HSR&D Durham North Carolina USA
- Department of Medicine & Thurston Arthritis Research Center University of North Carolina Chapel Hill North Carolina USA
| | - Kimberly S. Johnson
- Division of Geriatrics, Department of Medicine School of Medicine, Duke University Durham North Carolina USA
- Duke Center for the Study of Aging and Human Development Durham North Carolina USA
- Geriatric Research Education and Clinical Center Durham VA Health System HSR&D Durham North Carolina USA
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15
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Matthews M, Reid J, McKeaveney C, Noble H. Knowledge Requirements and Unmet Needs of Informal Caregivers of Patients with End-Stage Kidney Disease (ESKD) Receiving Haemodialysis: A Narrative Review. Healthcare (Basel) 2021; 10:healthcare10010057. [PMID: 35052221 PMCID: PMC8775298 DOI: 10.3390/healthcare10010057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/20/2021] [Accepted: 12/26/2021] [Indexed: 11/30/2022] Open
Abstract
Background: Patients with end-stage kidney disease receiving haemodialysis rely heavily on informal caregivers to support them living at home. Informal caregiving may exact a toll on caregivers’ physical, emotional, and social well-being, impacting negatively on their overall quality of life. The aim of this narrative review is to report knowledge requirements and needs of informal caregivers of patients with end stage kidney disease (ESKD) receiving haemodialysis. Methods: The review followed the Preferred Reporting Items for Reporting Systematic Reviews and Meta-analyses (PRISMA). Five electronic databases were searched: Web of Science, PsycINFO, Embase, Medline, and CINAHL to identify the experiences and unmet needs of informal caregivers of patients with end stage kidney disease (ESKD) receiving haemodialysis. Results: Eighteen papers were included in the review and incorporated a range of methodological approaches. There are several gaps in the current literature around knowledge and informational needs and skills required by informal caregivers, such as signs and symptoms of potential complications, dietary requirements, and medication management. Although most research studies in this review illustrate the difficulties and challenges faced by informal caregivers, there is a paucity of information as to which support mechanisms would benefit caregivers. Conclusion: Informal caregivers provide invaluable assistance in supporting people with ESKD undergoing haemodialysis. These informal caregivers however experience multiple unmet needs which has a detrimental effect on their health and negatively influences the extent to which they can adequately care for patients. The development of supportive interventions is essential to ensure that informal caregivers have the requisite knowledge and skills to allow them to carry out their vital role.
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16
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Ma JE, Grubber J, Coffman CJ, Wang V, Hastings SN, Allen KD, Shepherd-Banigan M, Decosimo K, Dadolf J, Sullivan C, Sperber NR, Van Houtven CH. Identifying family and unpaid caregivers in the electronic health record: A descriptive analysis (Preprint). JMIR Form Res 2021; 6:e35623. [PMID: 35849430 PMCID: PMC9345058 DOI: 10.2196/35623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 03/08/2022] [Accepted: 04/22/2022] [Indexed: 11/30/2022] Open
Abstract
Background Most efforts to identify caregivers for research use passive approaches such as self-nomination. We describe an approach in which electronic health records (EHRs) can help identify, recruit, and increase diverse representations of family and other unpaid caregivers. Objective Few health systems have implemented systematic processes for identifying caregivers. This study aimed to develop and evaluate an EHR-driven process for identifying veterans likely to have unpaid caregivers in a caregiver survey study. We additionally examined whether there were EHR-derived veteran characteristics associated with veterans having unpaid caregivers. Methods We selected EHR home- and community-based referrals suggestive of veterans’ need for supportive care from friends or family. We identified veterans with these referrals across the 8 US Department of Veteran Affairs medical centers enrolled in our study. Phone calls to a subset of these veterans confirmed whether they had a caregiver, specifically an unpaid caregiver. We calculated the screening contact rate for unpaid caregivers of veterans using attempted phone screening and for those who completed phone screening. The veteran characteristics from the EHR were compared across referral and screening groups using descriptive statistics, and logistic regression was used to compare the likelihood of having an unpaid caregiver among veterans who completed phone screening. Results During the study period, our EHR-driven process identified 12,212 veterans with home- and community-based referrals; 2134 (17.47%) veteran households were called for phone screening. Among the 2134 veterans called, 1367 (64.06%) answered the call, and 813 (38.1%) veterans had a caregiver based on self-report of the veteran, their caregiver, or another person in the household. The unpaid caregiver identification rate was 38.1% and 59.5% among those with an attempted phone screening and completed phone screening, respectively. Veterans had increased odds of having an unpaid caregiver if they were married (adjusted odds ratio [OR] 2.69, 95% CI 1.68-4.34), had respite care (adjusted OR 2.17, 95% CI 1.41-3.41), or had adult day health care (adjusted OR 3.69, 95% CI 1.60-10.00). Veterans with a dementia diagnosis (adjusted OR 1.37, 95% CI 1.00-1.89) or veteran-directed care referral (adjusted OR 1.95, 95% CI 0.97-4.20) were also suggestive of an association with having an unpaid caregiver. Conclusions The EHR-driven process to identify veterans likely to have unpaid caregivers is systematic and resource intensive. Approximately 60% (813/1367) of veterans who were successfully screened had unpaid caregivers. In the absence of discrete fields in the EHR, our EHR-driven process can be used to identify unpaid caregivers; however, incorporating caregiver identification fields into the EHR would support a more efficient and systematic identification of caregivers. Trial Registration ClincalTrials.gov NCT03474380; https://clinicaltrials.gov/ct2/show/NCT03474380
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Affiliation(s)
- Jessica E Ma
- Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs Health Care System, Durham, NC, United States
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Janet Grubber
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, United States
| | - Cynthia J Coffman
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, United States
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, United States
| | - Virginia Wang
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, United States
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, United States
- Department of Population Health Sciences, Duke University, Durham, NC, United States
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, United States
| | - S Nicole Hastings
- Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs Health Care System, Durham, NC, United States
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, United States
- Department of Population Health Sciences, Duke University, Durham, NC, United States
- Center for the Study of Aging, Duke University School of Medicine, Durham, NC, United States
- Division of Geriatrics, Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Kelli D Allen
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, United States
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Megan Shepherd-Banigan
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, United States
- Department of Population Health Sciences, Duke University, Durham, NC, United States
| | - Kasey Decosimo
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, United States
| | - Joshua Dadolf
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, United States
| | - Caitlin Sullivan
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, United States
| | - Nina R Sperber
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, United States
- Department of Population Health Sciences, Duke University, Durham, NC, United States
| | - Courtney H Van Houtven
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, United States
- Department of Population Health Sciences, Duke University, Durham, NC, United States
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, United States
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17
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Johnson SS, Sowa M, McCann R, Cohen SA, Nash CC, Greaney ML, Alexander RA, Kasten J, Martin MP, McEntee ML, Suri Y, Roman C, Bane S, Opthof E. Knowing Well, Being Well: well-being born of understanding: The Science of Teamwork. Am J Health Promot 2021; 35:1028-1047. [PMID: 34351249 DOI: 10.1177/08901171211030142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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18
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Martin MP, McEntee ML, Suri Y. Caregiver Quality of Life: How to Measure It and Why. Am J Health Promot 2021; 35:1042-1045. [PMID: 34351244 DOI: 10.1177/08901171211030142f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | | | - Yash Suri
- Arizona State University, Phoenix, AZ, USA
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19
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Law S, Ormel I, Babinski S, Kuluski K, Quesnel-Vallée A. "Caregiving is like on the job training but nobody has the manual": Canadian caregivers' perceptions of their roles within the healthcare system. BMC Geriatr 2021; 21:404. [PMID: 34193054 PMCID: PMC8243301 DOI: 10.1186/s12877-021-02354-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 06/17/2021] [Indexed: 11/25/2022] Open
Abstract
Background Stepping into the role of an unpaid caregiver to offer help is often considered a natural expectation of family members or friends. In Canada, such contributions are substantial in terms of healthcare provision but this comes at a considerable cost to the caregivers in both health and economic terms. Methods In this study, we conducted a secondary analysis of a collection of qualitative interviews with 39 caregivers of people with chronic physical illness to assess how they described their particular roles in caring for a loved one. We used a model of caregiving roles, originally proposed by Twigg in 1989, as a guide for our analysis, which specified three predominant roles for caregivers – as a resource, as a co-worker, and as a co-client. Results The caregivers in this collection spoke about their roles in ways that aligned well with these roles, but they also described tasks and activities that fit best with a fourth role of ‘care-coordinator’, which required that they assume an oversight role in coordinating care across institutions, care providers and often advocate for care in line with their expectations. For each of these types of roles, we have highlighted the limitations and challenges they described in their interviews. Conclusions We argue that a deeper understanding of the different roles that caregivers assume, as well as their challenges, can contribute to the design and implementation of policies and services that would support their contributions and choices as integral members of the care team. We provide some examples of system-level policies and programs from different jurisdictions developed in recognition of the need to sustain caregivers in their role and respond to such limitations.
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Affiliation(s)
- Susan Law
- Trillium Health Partners - Institute for Better Health, 100 Queensway West, 6th Floor CA Building, Mississauga, ON, L5B 1B8, Canada. .,University of Toronto - Institute for Health Policy, Management and Evaluation, 155 College Street, 4th Floor, Toronto, ON, M5T 3M6, Canada.
| | - Ilja Ormel
- St. Mary's Research Centre, 3830 avenue Lacombe, Montreal, QC, H3T 1M5, Canada.,Department of Family Medicine, McGill University, 5858 Cote-des-Neiges Road, Montreal, QC, H3S 1Z1, Canada
| | - Stephanie Babinski
- Ryerson University, Faculty of Community Services, 350 Victoria Street, Toronto, ON, M5B 2K3, Canada.,ELLICSR Health, Wellness & Cancer Survivorship Centre, Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 585 University Ave, Toronto, ON, M5G 2N2, Canada
| | - Kerry Kuluski
- Trillium Health Partners - Institute for Better Health, 100 Queensway West, 6th Floor CA Building, Mississauga, ON, L5B 1B8, Canada.,University of Toronto - Institute for Health Policy, Management and Evaluation, 155 College Street, 4th Floor, Toronto, ON, M5T 3M6, Canada
| | - Amélie Quesnel-Vallée
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Pine Avenue West, Montreal, QC, H3A 1A2, Canada
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20
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Informal Care in the Context of Long-term Health Care for the Elderly in Slovenia: a Qualitative Study. Zdr Varst 2021; 60:167-175. [PMID: 34249163 PMCID: PMC8256769 DOI: 10.2478/sjph-2021-0024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 06/01/2021] [Indexed: 11/20/2022] Open
Abstract
Background Slovenia is an aging society. Social security expenditures for the elderly are rising steadily, and the majority of Slovenians are firmly convinced that the state must provide elder care. This situation means that informal caregivers face many challenges and problems in their altruistic mission. Objectives To explore the experiences and feelings of informal caregivers and to provide an understanding of how informal caregivers support the elderly and what challenges and difficulties they face in Slovenian society. Methods The study is based on qualitative semi-structured interviews with 10 caregivers. In addition to descriptive statistics, we conducted a qualitative study using the qualitative content analysis method. Results We identified four themes among health caregivers’ experiences with challenges and problems in providing long-term health care for the elderly. Caregivers pointed out that they are mostly left to themselves and their altruistic mission of giving informal long-term care to their elderly relatives and friends. Systemic regulation of the national public health care system is the source of many problems. Conclusion Other social systems determine and limit the position of informal caregivers in Slovenia. This qualitative study should be understood as useful stepping-stone to future research and real improvement in this area.
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21
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Fleming V, Litzelman K. Caregiver resource utilization: Intellectual and development disability and dementia. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2021; 34:1468-1476. [PMID: 34124823 DOI: 10.1111/jar.12889] [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] [Received: 11/10/2020] [Revised: 03/03/2021] [Accepted: 04/09/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Adults with intellectual and developmental disabilities and their families have high need for support services. This study assessed resource utilization among caregivers of intellectual and developmental disabilities and other conditions. METHODS We assessed 366 caregivers of adults with intellectual and developmental disabilities, dementia or other conditions Regressions assessed group differences in number of agency contacts and frequency of service use. A secondary analysis assessed reasons for underutilization of services. RESULTS Caregivers of individuals with dementia contacted twice as many agencies as other caregivers and were more likely to report using suggested services. Agency contact and service utilization were similar among caregivers of adults with intellectual and developmental disabilities compared to other caregivers. Caregivers of adults with intellectual and developmental indicated that suggested services were unavailable to them. CONCLUSION The findings of this study shed light on challenges with access to and utilization of support services.
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Affiliation(s)
- Victoria Fleming
- Department of Human Development & Family Studies, University of Wisconsin-Madison, Madison, WI, USA
| | - Kristin Litzelman
- Department of Human Development & Family Studies, University of Wisconsin-Madison, Madison, WI, USA
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Masoud SS, Meyer KN, Martin Sweet L, Prado PJ, White CL. "We Don't Feel so Alone": A Qualitative Study of Virtual Memory Cafés to Support Social Connectedness Among Individuals Living With Dementia and Care Partners During COVID-19. Front Public Health 2021; 9:660144. [PMID: 34055724 PMCID: PMC8155306 DOI: 10.3389/fpubh.2021.660144] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 04/08/2021] [Indexed: 01/10/2023] Open
Abstract
Introduction: Loneliness and low social support can be detrimental to the health of individuals living with Alzheimer's and related dementias (ADRD) and family care partners. Restrictions on gatherings to prevent the spread of COVID-19 create an even greater risk for social isolation. Memory Cafés are a highly replicated program that provide individuals living with ADRD and care partners an opportunity to socialize in an inclusive and supportive environment without fear of judgment, pressure, or stigma. Following restrictions on in-person gatherings, virtual Memory Cafés offer regular social engagement opportunities in an online format. While the Memory Café model has been replicated globally, their effects on loneliness and perceived social support are generally unknown. Even less is known about their impact when operating in a virtual environment. Methods: Semi-structured interviews in Spanish and English were conducted with individuals living with dementia and family care partners who regularly attend Memory Cafés hosted by partners in a Texas Memory Café Network. Interviews took place online using video conferencing software, were transcribed, then analyzed for common themes using a combined inductive and deductive approach. Results: A total of 17 interviews were conducted with persons living with dementia (n = 5) and family care partners (n = 12) who attend Memory Cafés to learn about their perceived experiences of social connectedness since COVID-19. Care partners included spouses (n = 8) and adult children (n = 4). Interviews included attendees of different Memory Café models, including in-person only (n = 2), virtual only (n = 9), and those who attend both models (n = 6). Five key themes were identified: (1) Reprieve; (2) What is still possible; (3) Connectedness; (4) Inclusivity; and (5) Value added, with ten sub-themes supporting these main themes. Discussion: Findings substantiate evidence that Memory Cafés offer important benefits for families living with dementia, providing vital new insight into the potential for virtual Memory Cafés to offer similar benefits. Findings have implications beyond the context of COVID-19, where virtual models may support the social connectedness of those living in geographically marginalized and underserved areas. Virtual models may not address the needs of all families experiencing dementia due to lack of access to technology and limitations for virtual engagement with those experiencing later stage dementia.
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Affiliation(s)
- Sara S. Masoud
- Caring for the Caregiver, School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Kylie N. Meyer
- Caring for the Caregiver, School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Lauryn Martin Sweet
- Caring for the Caregiver, School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
- School of Health Professions, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Patricia J. Prado
- Caring for the Caregiver, School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
- School of Health Professions, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Carole L. White
- Caring for the Caregiver, School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
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Boucher NA, Zullig LL, Shepherd-Banigan M, Decosimo KP, Dadolf J, Choate A, Mahanna EP, Sperber NR, Wang V, Allen KA, Hastings SN, Van Houtven CH. Replicating an effective VA program to train and support family caregivers: a hybrid type III effectiveness-implementation design. BMC Health Serv Res 2021; 21:430. [PMID: 33952263 PMCID: PMC8099701 DOI: 10.1186/s12913-021-06448-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 04/27/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Caring for a growing aging population using existing long-term care resources while simultaneously supporting and educating family caregivers, is a public health challenge. We describe the application of the Replicating Effective Programs (REP) framework, developed by the Centers for Disease Control Prevention and used in public health program implementation, to scale up an evidence-based family caregiver training intervention in the Veterans Affairs (VA) healthcare system. METHODS From 2018 to 2020, clinicians at eight VA medical centers received REP-guided implementation including facilitation, technical assistance, and implementation tools to deliver the training program. The project team used the REP framework to develop activities across four distinct phases - (1) pre-conditions, (2) pre-implementation, (3) implementation, and (4) maintenance and evolution - and systematically tracked implementation facilitators, barriers, and adaptations. RESULTS Within the REP framework, results describe how each medical center adapted implementation approaches to fit local needs. We highlight examples of how sites balanced adaptations and intervention fidelity. CONCLUSIONS The REP framework shows promise for national expansion of the caregiver training intervention, including to non-VA systems of care, because it allows sites to adapt while maintaining intervention fidelity. TRIAL REGISTRATION NCT03474380 . Date registered: March 22, 2018.
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Affiliation(s)
- N A Boucher
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, 508 Fulton Street (Mailcode 152), Durham, NC, 27705, USA.
- Department of Population Health Sciences, School of Medicine, Duke University, 215 Morris Street, Durham, NC, 27701, USA.
- Sanford School of Public Policy, Duke University, Durham, NC, 27710, USA.
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, 27710, USA.
- Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC, 27710, USA.
| | - L L Zullig
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, 508 Fulton Street (Mailcode 152), Durham, NC, 27705, USA
- Department of Population Health Sciences, School of Medicine, Duke University, 215 Morris Street, Durham, NC, 27701, USA
| | - M Shepherd-Banigan
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, 508 Fulton Street (Mailcode 152), Durham, NC, 27705, USA
- Department of Population Health Sciences, School of Medicine, Duke University, 215 Morris Street, Durham, NC, 27701, USA
| | - K P Decosimo
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, 508 Fulton Street (Mailcode 152), Durham, NC, 27705, USA
| | - J Dadolf
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, 508 Fulton Street (Mailcode 152), Durham, NC, 27705, USA
| | - A Choate
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, 508 Fulton Street (Mailcode 152), Durham, NC, 27705, USA
| | - E P Mahanna
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, 508 Fulton Street (Mailcode 152), Durham, NC, 27705, USA
| | - N R Sperber
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, 508 Fulton Street (Mailcode 152), Durham, NC, 27705, USA
- Department of Population Health Sciences, School of Medicine, Duke University, 215 Morris Street, Durham, NC, 27701, USA
| | - V Wang
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, 508 Fulton Street (Mailcode 152), Durham, NC, 27705, USA
- Department of Population Health Sciences, School of Medicine, Duke University, 215 Morris Street, Durham, NC, 27701, USA
- Department of Medicine, Duke University Medical Center, 300 Morris Street, Durham, NC, 27701, USA
| | - K A Allen
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, 508 Fulton Street (Mailcode 152), Durham, NC, 27705, USA
- Department of Medicine & Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - S N Hastings
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, 508 Fulton Street (Mailcode 152), Durham, NC, 27705, USA
- Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC, 27710, USA
- Department of Medicine, Duke University Medical Center, 300 Morris Street, Durham, NC, 27701, USA
- Geriatrics Research, Education, and Clinical Center, Durham VA Health Care System, Durham, NC, 27705, USA
| | - C H Van Houtven
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, 508 Fulton Street (Mailcode 152), Durham, NC, 27705, USA
- Department of Population Health Sciences, School of Medicine, Duke University, 215 Morris Street, Durham, NC, 27701, USA
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, 27710, USA
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Family Physician's and Primary Care Team's Perspectives on Supporting Family Caregivers in Primary Care Networks. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18063293. [PMID: 33806725 PMCID: PMC8005195 DOI: 10.3390/ijerph18063293] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 03/14/2021] [Accepted: 03/18/2021] [Indexed: 12/24/2022]
Abstract
Background. Research, practice, and policy have focused on educating family caregivers to sustain care but failed to equip healthcare providers to effectively support family caregivers. Family physicians are well-positioned to care for family caregivers. Methods. We adopted an interpretive description design to explore family physicians and primary care team members’ perceptions of their current and recommended practices for supporting family caregivers. We conducted focus groups with family physicians and their primary care team members. Results. Ten physicians and 42 team members participated. We identified three major themes. “Family physicians and primary care teams can be a valuable source of support for family caregivers” highlighted these primary care team members’ broad recognition of the need to support family caregiver’s health. “What stands in the way” spoke to the barriers in current practices that precluded supporting family caregivers. Primary care teams recommended, “A structured approach may be a way forward.” Conclusion. A plethora of research and policy documents recommend proactive, consistent support for family caregivers, yet comprehensive caregiver support policy remains elusive. The continuity of care makes primary care an ideal setting to support family caregivers. Now policy-makers must develop consistent protocols to assess, and care for family caregivers in primary care.
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Ferré-Grau C, Raigal-Aran L, Lorca-Cabrera J, Lluch-Canut T, Ferré-Bergadà M, Lleixá-Fortuño M, Puig-Llobet M, Miguel-Ruiz MD, Albacar-Riobóo N. A Mobile App-Based Intervention Program for Nonprofessional Caregivers to Promote Positive Mental Health: Randomized Controlled Trial. JMIR Mhealth Uhealth 2021; 9:e21708. [PMID: 33480852 PMCID: PMC7864775 DOI: 10.2196/21708] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/24/2020] [Accepted: 12/22/2020] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND While nonprofessional caregivers often experience a sense of fulfillment when they provide care, there is also a significant risk of emotional and physical burnout. Consequently, this can negatively affect both the caregiver and the person being cared for. Intervention programs can help empower nonprofessional caregivers of people with chronic diseases and develop solutions to decrease the physical and psychological consequences resulting from caregiving. However, most clinically tested intervention programs for nonprofessional caregivers require face-to-face training, and many caregivers encounter obstacles that hinder their participation in such programs. Consequently, it is necessary to design internet-based intervention programs for nonprofessional caregivers that address their needs and test the efficacy of the programs. OBJECTIVE The aim of this study was to evaluate the effectiveness of a smartphone app-based intervention program to increase positive mental health for nonprofessional caregivers. METHODS This study was a randomized controlled trial of 3 months' duration. A total of 152 caregivers over 18 years of age with a minimum of 4 months' experience as nonprofessional caregivers were recruited from primary health care institutions. Nonprofessional caregivers were randomized into two groups. In the intervention group, each caregiver installed a smartphone app and used it for 28 days. This app offered them daily activities that were based on 10 recommendations to promote positive mental health. The level of positive mental health, measured using the Positive Mental Health Questionnaire (PMHQ), and caregiver burden, measured using the 7-item short-form version of the Zarit Caregiver Burden Interview (ZBI-7), were the primary outcomes. Users' satisfaction was also measured. RESULTS In all, 113 caregivers completed the study. After the first month of the intervention, only one factor of the PMHQ, F1-Personal satisfaction, showed a significant difference between the groups, but it was not clinically relevant (0.96; P=.03). However, the intervention group obtained a higher mean change for the overall PMHQ score (mean change between groups: 1.40; P=.24). The results after the third month of the intervention showed an increment of PMHQ scores. The mean difference of change in the PMHQ score showed a significant difference between the groups (11.43; P<.001; d=0.82). Significant changes were reported in 5 of the 6 factors, especially F5-Problem solving and self-actualization (5.69; P<.001; d=0.71), F2-Prosocial attitude (2.47; P<.001; d=1.18), and F3-Self-control (0.76; P=.03; d=0.50). The results of the ZBI-7 showed a decrease in caregiver burden in the intervention group, although the results were inconclusive. Approximately 93.9% (46/49) of the app users indicated that they would recommend the app to other caregivers and 56.3% (27/49) agreed that an extension of the program's duration would be beneficial. CONCLUSIONS The app-based intervention program analyzed in this study was effective in promoting positive mental health and decreasing the burden of caregivers and achieved a high range of user satisfaction. This study provides evidence that mobile phone app-based intervention programs may be useful tools for increasing nonprofessional caregivers' well-being. The assessment of the effectiveness of intervention programs through clinical trials should be a focus to promote internet-based programs in health policies. TRIAL REGISTRATION ISRCTN Registry ISRCTN14818443; http://www.isrctn.com/ISRCTN14818443. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/s12889-019-7264-5.
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Affiliation(s)
- Carme Ferré-Grau
- Department of Nursing, Universitat Rovira i Virgili, Tarragona, Spain
| | - Laia Raigal-Aran
- Department of Nursing, Universitat Rovira i Virgili, Tarragona, Spain
| | | | - Teresa Lluch-Canut
- Department of Public Health, Mental Health and Maternal-Child Nursing, School of Nursing, University of Barcelona, Barcelona, Spain
| | - Maria Ferré-Bergadà
- Department of Computer Engineering and Mathematics, Universitat Rovira i Virgili, Tarragona, Spain
| | - Mar Lleixá-Fortuño
- Territorial Health Services of Terres de l'Ebre, Catalan Health Institute, Tortosa, Spain
| | - Montserrat Puig-Llobet
- Department of Public Health, Mental Health and Maternal-Child Nursing, School of Nursing, University of Barcelona, Barcelona, Spain
| | - Maria Dolores Miguel-Ruiz
- Department of Mental Health, Campus Docent Sant Joan de Déu--Fundació Privada, University of Barcelona, Barcelona, Spain
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Kontrimiene A, Sauseriene J, Blazeviciene A, Raila G, Jaruseviciene L. Qualitative research of informal caregivers' personal experiences caring for older adults with dementia in Lithuania. Int J Ment Health Syst 2021; 15:12. [PMID: 33472676 PMCID: PMC7816390 DOI: 10.1186/s13033-020-00428-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 12/14/2020] [Indexed: 11/28/2022] Open
Abstract
Background In many communities around the world, informal caregivers of older adults with dementia represent an essential, yet often underappreciated, source of long-term care. The present study aimed to determine the personal experiences of such caregivers, which could be instrumental for developing means of improving the quality of care for both care receivers and their informal caregivers. Methods Five semi-structured focus-group discussions were held. The participants (n = 31) were all informal caregivers of older adults with dementia. The focus-group discussions were audio-recorded and transcribed verbatim. An inductive approach was used, and thematic data analysis was applied. Results Four thematic categories were identified: learning caregiving through personal experience; implications of caregiving on social wellbeing; caregivers’ contradictory emotions regarding care delivery; and addressing challenges regarding care provision. Conclusions This study revealed, among the informal caregivers, a variety of experiences, contradicting feelings, and problem-solving strategies relating to the care of older adults with mental disorders. Becoming an effective caregiver involves professional and psychological development. Developing caregiving skills, supportive environment and positive attitude can help facilitate providing care. Caregiving largely impacts the emotional, physical, and social wellbeing of the person; thus, comprehensive approaches are needed to prevent burnout and associated social disadvantages.
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Affiliation(s)
- Ausrine Kontrimiene
- Department of Family Medicine, Lithuanian University of Health Sciences (LUHS), Mickeviciaus 9, 44307, Kaunas, Lithuania.
| | - Jolanta Sauseriene
- Department of Family Medicine, Lithuanian University of Health Sciences (LUHS), Mickeviciaus 9, 44307, Kaunas, Lithuania
| | - Aurelija Blazeviciene
- Department of Nursing and Care, Lithuanian University of Health Sciences (LUHS), Eivenių str. 4, 50161, Kaunas, Lithuania
| | - Gediminas Raila
- Department of Family Medicine, Lithuanian University of Health Sciences (LUHS), Mickeviciaus 9, 44307, Kaunas, Lithuania
| | - Lina Jaruseviciene
- Department of Family Medicine, Lithuanian University of Health Sciences (LUHS), Mickeviciaus 9, 44307, Kaunas, Lithuania
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Litzelman K, Harnish A. Caregiver Eligibility for Support Services: Correlates and Consequences for Resource Utilization. J Appl Gerontol 2020; 41:515-525. [PMID: 33155498 DOI: 10.1177/0733464820971134] [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: 01/01/2023] Open
Abstract
Policymakers and community organizations have implemented numerous programs and services to support the more than 40 million family caregivers in the United States. However, the existence of such services is not sufficient to ensure equitable and optimal access and utilization. Using data from the Caregiving in the US study (2015; n = 1,185), we estimated that nearly one in five family caregivers do not meet broad eligibility criteria for support services. This resource gap was particularly likely to affect high-priority populations such as those caring for someone with a mental health problem. Furthermore, ineligible caregivers had lower service utilization and increased financial strain. The findings highlight a pattern of vulnerability among caregivers who do not meet broad eligibility criteria for financial support resources. Careful policy consideration is needed to determine how support services should be allocated to maximize caregiver and care recipient outcomes at the population level.
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Wyse JJ, Ono SS, Kabat M, True G. Supporting family caregivers of Veterans: Participant perceptions of a federally-mandated caregiver support program. HEALTHCARE (AMSTERDAM, NETHERLANDS) 2020; 8:100441. [PMID: 32919580 PMCID: PMC8054832 DOI: 10.1016/j.hjdsi.2020.100441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 03/23/2020] [Accepted: 05/26/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To understand patients' and caregivers' experiences with and perceptions of a federally-mandated program within the Department of Veterans Affairs (VA) that provides educational and monetary support to family caregivers of post-9/11 Veterans. METHODS Twenty-six Veterans and their family caregivers were recruited to participate in individual and dyadic interviews. Interviews lasted between 60 and 90 min and took place between August 2016 and July 2018 in Oregon and Louisiana. Interviews were recorded, transcribed and coded by multiple team members. Recurrent themes and categories were identified through close examination of coded text and comparison within and across transcripts. RESULTS Three main themes emerged in the data: 1) appreciation of the caregiver program for validating and compensating family caregiver work; 2) perception that some caregiving activities are less visible, and thus go unrecognized and uncompensated; 3) concern about loss of benefits. CONCLUSIONS Implications and policy recommendations for programs to support family caregivers, both within the VA and in the context of the broader national movement to support family caregivers, are discussed.
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Affiliation(s)
- Jessica J Wyse
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, USA; Oregon Health & Science University-Portland State University School of Public Health, USA.
| | - Sarah S Ono
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, USA; Department of Family Medicine, Oregon Health & Science University, USA
| | - Margaret Kabat
- Atlas Research, Former National Director, Caregiver Support Program, US Department of Veterans Affairs, USA
| | - Gala True
- South Central Mental Illness Research, Education, and Clinical Center, Southeast Louisiana Veterans Health Care System, USA; Section of Population and Community Medicine, LSU School of Medicine, USA
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Shepherd‐Banigan M, Sherman SR, Lindquist JH, Miller KEM, Tucker M, Smith VA, Van Houtven CH. Family Caregivers of Veterans Experience High Levels of Burden, Distress, and Financial Strain. J Am Geriatr Soc 2020; 68:2675-2683. [DOI: 10.1111/jgs.16767] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 07/07/2020] [Accepted: 07/12/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Megan Shepherd‐Banigan
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) Durham Veterans Affairs Health Care System Durham North Carolina USA
- Department of Population Health Sciences Duke University Medical Center Durham North Carolina USA
| | - Sophia R. Sherman
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) Durham Veterans Affairs Health Care System Durham North Carolina USA
| | - Jennifer H. Lindquist
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) Durham Veterans Affairs Health Care System Durham North Carolina USA
| | - Katherine E. M. Miller
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) Durham Veterans Affairs Health Care System Durham North Carolina USA
- Department of Health Policy and Management University of North Carolina at Chapel Hill Chapel Hill North Carolina USA
| | - Matthew Tucker
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) Durham Veterans Affairs Health Care System Durham North Carolina USA
| | - Valerie A. Smith
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) Durham Veterans Affairs Health Care System Durham North Carolina USA
- Department of Population Health Sciences Duke University Medical Center Durham North Carolina USA
- Department of General Internal Medicine Duke University Durham North Carolina USA
| | - Courtney Harold Van Houtven
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) Durham Veterans Affairs Health Care System Durham North Carolina USA
- Department of Population Health Sciences Duke University Medical Center Durham North Carolina USA
- Duke‐Margolis Center for Health Policy Durham North Carolina USA
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Peters M, Rand S, Fitzpatrick R. Enhancing primary care support for informal carers: A scoping study with professional stakeholders. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:642-650. [PMID: 31770820 PMCID: PMC7027470 DOI: 10.1111/hsc.12898] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 10/21/2019] [Accepted: 11/07/2019] [Indexed: 06/10/2023]
Abstract
Informal carers (i.e. people who provide unpaid care to family and/or friends) are crucial in supporting people with long-term conditions. Caring negatively impacts on carers' health and experiences of health services. Internationally and nationally, policies, legislation, professional guidance and research advocate for health and care services to do more to support carers. This study explored the views of health and social care providers, commissioners and policy makers about the role and scope for strengthening health service support for carers. Twenty-four semi-structured interviews, with 25 participants were conducted, audio-recorded, transcribed verbatim and analysed by thematic analysis. Three main themes emerged: (a) identifying carers, (b) carer support, and (c) assessing and addressing carer needs. Primary care, and other services, were seen as not doing enough for carers but having an important role in identifying and supporting carers. Two issues with carer identification were described, first people not self-identifying as carers and second most services not being proactive in identifying carers. Participants thought that carer needs should be supported by primary care in collaboration with other health services, social care and the voluntary sector. Concerns were raised about primary care, which is under enormous strain, being asked to take on yet another task. There was a clear message that it was only useful to involve primary care in identifying carers and their needs, if benefit could be achieved through direct benefits such as better provision of support to the carer or indirect benefit such as better recognition of the carer role. This study highlights that more could be done to address carers' needs through primary care in close collaboration with other health and care services. The findings indicate the need for pilots and experiments to develop the evidence base. Given the crucial importance of carers, such studies should be a high priority.
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Affiliation(s)
- Michele Peters
- Health Services Research UnitNuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - Stacey Rand
- Personal Social Services Research UnitSchool of Social Policy, Sociology and Social ResearchUniversity of KentCanterburyUK
| | - Ray Fitzpatrick
- Health Services Research UnitNuffield Department of Population HealthUniversity of OxfordOxfordUK
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