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Fong ZV, Teinor J, Engineer L, Yeo TP, Rinaldi D, Greer JB, Lavu H, Qadan M, Johnston FM, Ferrone CR, Chang DC, Yeo CJ, Wolfgang CL, Warshaw AL, Lillemoe KD, Fernandez-del Castillo C, Weiss MJ, Wu AW, Wolff JL. Caregiver-reported quality of communication in pancreatic and periampullary cancer. Cancer 2024; 130:2051-2059. [PMID: 38146683 PMCID: PMC11102340 DOI: 10.1002/cncr.35154] [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: 06/05/2023] [Revised: 10/05/2023] [Accepted: 10/25/2023] [Indexed: 12/27/2023]
Abstract
BACKGROUND Communication between caregivers and clinical team members is critical for transitional care, but its quality and potential impact on outcomes are not well understood. This study reports on caregiver-reported quality of communication with clinical team members in the postpancreatectomy period and examines associations of these reports with patient and caregiver outcomes. METHODS Caregivers of patients with pancreatic and periampullary malignancies who had undergone pancreatectomy were surveyed. Instrument measures assessed care experiences using the Caregiver Perceptions About Communication with Clinical Team Members (CAPACITY) instrument. The instrument has two main subscales: communication, assessing the extent to which providers helped caregivers comprehend details of clinical visits, and capacity, defined as the extent to which providers assessed whether caregivers were able to care for patients. RESULTS Of 265 caregivers who were approached, 240 (90.6%) enrolled in the study. The mean communication and capacity subscale scores were 2.7 ± 0.6 and 1.5 ± 0.6, respectively (range, 0-4 [higher = better]). Communication subscale scores were lower among caregivers of patients who experienced (vs. those who did not experience) a 30-day readmission (2.6 ± 0.5 vs. 2.8 ± 0.6, respectively; p = .047). Capacity subscale scores were inversely associated with restriction in patient daily activities (a 0.04 decrement in the capacity score for every 1 point in daily activity restriction; p = .008). CONCLUSIONS After pancreatectomy, patients with pancreatic and periampullary cancer whose caregivers reported worse communication with care providers were more likely to experience readmission. Caregivers of patients with greater daily activity restrictions were less likely to report being asked about the caregiver's skill and capacity by clinicians. PLAIN LANGUAGE SUMMARY This prospective study used a validated survey instrument and reports on the quality of communication between health care providers and caregivers as reported by caregivers of patients with pancreatic and periampullary cancer after pancreatectomy. In an analysis of 240 caregivers enrolled in the study, lower communication scores (the extent to which providers helped caregivers understand clinical details) were associated with higher odds of 30-day patient readmission to the hospital. In addition, lower capacity scores (the extent to which providers assessed caregivers' ability to care for patients) were associated with greater impairment in caregivers. The strikingly low communication quality and capacity assessment scores suggest substantial room for improvement, with the potential to improve both caregiver and patient outcomes.
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Affiliation(s)
| | - Jonathan Teinor
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
| | - Lilly Engineer
- Johns Hopkins University School of Medicine, Baltimore, MD
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | - Dee Rinaldi
- Thomas Jefferson University, Philadelphia, PA
| | | | - Harish Lavu
- Thomas Jefferson University, Philadelphia, PA
| | | | | | | | | | | | | | | | | | | | | | - Albert W Wu
- Johns Hopkins University School of Medicine, Baltimore, MD
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Jennifer L Wolff
- Johns Hopkins University School of Medicine, Baltimore, MD
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Raj M, Stephenson AL, DePuccio MJ, Sullivan EE, Tarver W, Fleuren B, Thomas SC, Scheck McAlearney A. Conceptual Framework for Integrating Family Caregivers Into the Health Care Team: A Scoping Review. Med Care Res Rev 2023; 80:131-144. [PMID: 36000495 DOI: 10.1177/10775587221118435] [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: 11/16/2022]
Abstract
More than 80% of family care partners of older adults are responsible for coordinating care between and among providers; yet, their inclusion in the health care delivery process lacks recognition, coordination, and standardization. Despite efforts to include care partners (e.g., through informal or formal proxy access to their care recipient's patient portal), policies and procedures around care partner inclusion are complex and inconsistently implemented. We conducted a scoping review of peer-reviewed articles published from 2015 to 2021 and reviewed a final sample of 45 U.S.-based studies. Few articles specifically examine the inclusion of care partners in health care teams; those that do, do not define or measure care partner inclusion in a standardized way. Efforts to consider care partners as "partners" rather than "visitors" require further consideration of how to build health care teams inclusive of care partners. Incentives for health care organizations and providers to practice inclusive team-building may be required.
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Affiliation(s)
| | | | | | | | | | | | - Samuel C Thomas
- Stanford School of Medicine and Intermountain Healthcare, USA
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3
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Continuity of care (COC) and amyloid-β PET scan: the CARE-IDEAS study. Alzheimers Res Ther 2023; 15:6. [PMID: 36611213 PMCID: PMC9824903 DOI: 10.1186/s13195-022-01126-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 11/18/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND High continuity of care (COC) is associated with better clinical outcomes among older adults. The impact of amyloid-β PET scan on COC among adults with mild cognitive impairment (MCI) or dementia of uncertain etiology is unknown. METHODS We linked data from the CARE-IDEAS study, which assessed the impact of amyloid-β PET scans on outcomes in Medicare beneficiaries with MCI or dementia of uncertain etiology and their care partners, to Medicare claims (2015-2018). We calculated a participant-level COC index using the Bice-Boxerman formula and claims from all ambulatory evaluation and management visits during the year prior to and following the amyloid-β PET scan. We compared baseline characteristics by scan result (elevated or non-elevated) using standardized differences. To evaluate changes in COC, we used multiple regression models adjusting for sociodemographics, cognitive function, general health status, and the Charlson Comorbidity Index. RESULTS Among the 1171 cohort members included in our analytic population, the mean age (SD) was 75.2 (5.4) years, 61.5% were male and 93.9% were non-Hispanic white. Over two-thirds (68.1%) had an elevated amyloid-β PET scan. Mean COC for all patients was 0.154 (SD = 0.102; range = 0-0.73) prior to the scan and 0.158 (SD = 0.105; range = 0-1.0) in the year following the scan. Following the scan, the mean COC index score increased (95% CI) by 0.005 (-0.008, 0.019) points more for elevated relative to not elevated scan recipients, but this change was not statistically significant. There was no association between scan result (elevated vs. not elevated) or any other patient covariates and changes in COC score after the scan. CONCLUSION COC did not meaningfully change following receipt of amyloid-β PET scan in a population of Medicare beneficiaries with MCI or dementia of uncertain etiology. Future work examining how care continuity varies across marginalized populations with cognitive impairment is needed.
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Wittenberg E, Goldsmith JV, Savage MW, Sullivan SS. Exploring Differences in Caregiver Communication in Serious Illness. J Palliat Med 2023. [PMID: 36603111 DOI: 10.1089/jpm.2022.0406] [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: 01/07/2023] Open
Abstract
Background: Demographic factors, such as disease context and family relationships, are communication mediators and moderators; however, little is known about how understanding these factors can improve caregiver communication with providers. Recognition of communication differences among caregivers may aid the development of approaches to improve serious illness communication. Objective: To explore whether caregiver communication differs by disease context (cancer vs. dementia) and caregiver communication type (Manager, Carrier, Partner, and Lone). Caregiver communication type is based on communication patterns between the care recipient and caregiver. Design and Measurements: Caregivers of persons with cancer and/or dementia were surveyed from a U.S. national research registry website. Measures of caregiver communication included information needs, communication confidence, perception of provider understanding of the caregiver, perceived frequency of caregiver assessment, and caregiver stress. Analysis of variance (ANOVA) determined significant differences between caregiver communication (p < 0.05) based on disease context and caregiver communication type. Results: Cancer caregivers reported higher unrecognized-demanded information states (i.e., not recognizing information was needed), more communication confidence, and more frequent caregiver assessment compared to dementia caregivers. Among caregiver communication types, Manager caregiver types were more confident communicating than other caregiver types and perceived greater understanding by providers than the Lone caregiver type. Manager caregivers reported significantly less stress than other caregiver communication types. Conclusions: Understanding disease context and caregiver communication type may help improve caregiver communication with health care providers.
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Affiliation(s)
- Elaine Wittenberg
- Department of Communication Studies, California State University, Los Angeles, Los Angeles, California, USA
| | - Joy V Goldsmith
- Department of Communication and Film, University of Memphis, Memphis, Tennessee, USA
| | - Matthew W Savage
- School of Communication, San Diego State University, San Diego, California, USA
| | - Suzanne S Sullivan
- School of Nursing, University at Buffalo, State University of New York, Buffalo, New York, USA
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MILLER KATHERINEEM, STEARNS SALLYC, VAN HOUTVEN COURTNEYH, GILLESKIE DONNA, HOLMES GEORGEM, KENT ERINE. The Landscape of State Policies Supporting Family Caregivers as Aligned With the National Academy of Medicine Recommendations. Milbank Q 2022; 100:854-878. [PMID: 35579187 PMCID: PMC9576229 DOI: 10.1111/1468-0009.12567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Policy Points In the absence of federal policy, states adopted policies to support family caregivers, but availability and level of support varies. We describe, compare, and rank state policies to support family caregivers as aligned with National Academy of Medicine recommendations. Although the landscape of state policies supporting caregivers has improved over time, few states provide financial supports as recommended, and benefit restrictions hinder accessibility for all types of family caregivers. Implementing policies supporting family caregivers will become more critical over time, as the reliance on family caregivers as essential providers of long-term care is only expected to grow as the population ages. CONTEXT In the United States in 2020, approximately 26 million individuals provided unpaid care to a family member or friend. On average, 60% of caregivers were employed, and they provided 20.4 hours of care per week on top of employment. Although a handful of patchwork laws exist to aid family caregivers, systematic supports, including comprehensive training, respite, and financial support, remain limited. In the absence of federal supports, states have adopted policies to provide assistance, but they vary in availability and level of support provided. Our objectives were to describe, compare, and rank state policies to support family caregivers over time. METHODS We used publicly available data from the AARP Long-Term Services and Supports State Scorecard, the National Academy for State Health Policy, and Tax Credits for Workers and Families for all 50 states and the District of Columbia (2015-2019). FINDINGS We found that states had increased supports to family caregivers over this five-year period, although significant variability in adoption and implementation of policies persists. Approximately 20% of states had enacted policies that exceed the federal Family and Medical Leave Act requirements, and 18% offered paid family leave. However, most states had not improved spousal impoverishment protections for Medicaid beneficiaries. For example, from 2016 to 2019, 24% of states provided fewer or no protections, while 71% of states did not improve spousal impoverishment protections over time. Access to training for caregivers varied based on eligibility criteria (e.g., select populations and/or only co-residing caregivers). CONCLUSIONS Overall, state approaches to support family caregivers vary by eligibility and scope of services. Substantial gaps in support of caregivers, particularly economic supports, persist. Although the landscape of state policies supporting caregivers has improved over time, few states provide financial supports as recommended by the National Academy of Medicine, and benefit restrictions hinder accessibility for all family caregivers.
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Affiliation(s)
- KATHERINE E. M. MILLER
- Durham Center of Innovation to Accelerate Discovery and Practice TransformationDurham VA Health Care System
- Gillings School of Global Public HealthUniversity of North Carolina at Chapel Hill
- Author affiliation at time work was conducted
| | - SALLY C. STEARNS
- Gillings School of Global Public HealthUniversity of North Carolina at Chapel Hill
- University of North Carolina at Chapel Hill
| | - COURTNEY H. VAN HOUTVEN
- Durham Center of Innovation to Accelerate Discovery and Practice TransformationDurham VA Health Care System
- Population Health SciencesDuke University School of Medicine
- Duke Margolis Center for Health PolicyDuke University
| | | | - GEORGE M. HOLMES
- Gillings School of Global Public HealthUniversity of North Carolina at Chapel Hill
- Cecil G. Sheps Center for Health Services ResearchUniversity of North Carolina at Chapel Hill
| | - ERIN E. KENT
- Gillings School of Global Public HealthUniversity of North Carolina at Chapel Hill
- Cecil G. Sheps Center for Health Services ResearchUniversity of North Carolina at Chapel Hill
- Lineberger Comprehensive Cancer CenterUniversity of North Carolina at Chapel Hill
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Griffin JM, Riffin C, Bangerter LR, Schaepe K, Havyer RD. Provider Perspectives on Integrating Family Caregivers into Patient Care Encounters. Health Serv Res 2021; 57:892-904. [PMID: 34957543 PMCID: PMC9264458 DOI: 10.1111/1475-6773.13932] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 11/05/2021] [Accepted: 12/14/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To examine and compare healthcare provider perceptions for integrating family caregivers into patient encounters and other processes of care by medical specialty. DATA SOURCES/SETTING Data were from nineteen interviews conducted in 2018, ten with primary care or palliative care providers and nine with proceduralists or interventionists in practices located in Minnesota, Florida, and Arizona. STUDY DESIGN This was a qualitative study using data collected from one-on-one, semi-structured interviews with physicians. DATA COLLECTION Using purposeful 'maximum variation' sampling to capture differences between primary and palliative care providers and proceduralists/interventionists, data were collected, reviewed, coded, and then analyzed using inductive content analysis with a constant comparison approach. PRIMARY FINDINGS Primary care providers described a lack of organizational and institutional resources to support caregivers. Accordingly, they were compelled to curb caregiver engagement in order to meet patients' clinical care needs within the time and workflow demands in encounters. Proceduralists and interventionists described the need to assess caregivers for suitability to provide care during intense periods of treatment. They reported having access to more formal organizational resources for supporting caregivers. Overall, providers described a paradox, where caregivers are seen as contributing value to patient encounters until they need training, education, or support to provide care, at which point they become burdensome and require more time and resources than are typically available. CONCLUSIONS Results highlight how organizational constraints inhibit caregiver engagement in patient encounters and influence provider attitudes about engaging caregivers and assessing their unmet needs. Findings also provide insights into challenges across practice types for implementing state and federal laws that promote caregiver engagement. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Joan M Griffin
- Mayo Clinic, 200 First Avenue SW, Rochester, Minnesota, United States
| | - Catherine Riffin
- Weill Cornell Medicine, 420 East 70th Street, 3rd Floor (LH-317), New York, New York, United States
| | | | - Karen Schaepe
- Mayo Clinic, 200 First Avenue SW, Rochester, Minnesota, United States
| | - Rachel D Havyer
- Mayo Clinic, 200 First Avenue SW, Rochester, Minnesota, United States
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Shepherd-Banigan M, Ford CB, DePasquale N, Smith VA, Belanger E, Lippmann SJ, O'Brien EC, Van Houtven CH. Making the Informal Formal: Discussing and Completing Advance Care Plans in Care Dyads with Cognitive Impairment. J Palliat Care 2021; 37:289-297. [PMID: 34898305 DOI: 10.1177/08258597211063047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Discussing advance care planning (ACP) with care partners may be a steppingstone to the completion of advance directives (ADs) for persons with cognitive impairment (PwCIs). OBJECTIVES To examine whether PwCI-reported occurrence of and PwCI-care partner agreement about ACP discussions are associated with completion of ADs. DESIGN AND SUBJECTS We conducted a secondary, cross-sectional analysis of data from 1672 PwCI-care partner dyads in the BLINDED study. PwCIs were Medicare beneficiaries in the US, aged >65 years, and diagnosed with mild cognitive impairment or dementia. Care partners were identified by PwCIs as being most involved in their health care. MEASUREMENTS PwCIs' completion of ADs was determined by 1 or more affirmative responses to dichotomous indicators for formalizing a living will, medical directive, or durable power of attorney for health care. Discussion occurrence was based on PwCI reports and agreement between PwCI and care partner reports of prior conversations about PwCIs' ACP preferences between PwCIs and care partners. RESULTS In logistic regression models adjusted for PwCI and care partner characteristics, PwCIs who had (vs. had not) discussed ACP were 10% more likely to complete ADs. PwCIs from dyads agreeing (vs. disagreeing) a discussion occurred were 7% more likely to complete ADs. PwCIs from care dyads in agreement (vs. disagreement) about non-discussion were 11% less likely to formalize ADs. CONCLUSIONS Discussing ACP with care partners plays a direct, positive role in completing ADs among PwCIs. Health care providers who approach ACP as a dyadic, communicative decision-making process from the outset may facilitate PwCIs' uptake of ADs.
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Affiliation(s)
- Megan Shepherd-Banigan
- Durham VA Health Care System, NC, USA.,Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.,Duke-Margolis Center for Health Policy, Durham, NC, USA
| | - Cassie B Ford
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Nicole DePasquale
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Valerie A Smith
- Durham VA Health Care System, NC, USA.,Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.,Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Emmanuelle Belanger
- Department of Health Services, Policy and Practice, Brown University, Providence, RI, USA.,Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA
| | - Steven J Lippmann
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Emily C O'Brien
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Courtney H Van Houtven
- Durham VA Health Care System, NC, USA.,Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.,Duke-Margolis Center for Health Policy, Durham, NC, USA
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8
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Shepherd-Banigan ME, Boucher NA, McKenna K, Delgado RE, Whitaker C, Christensen L, Sperber NR. Family Caregiver and Provider Perspectives on Inclusive Care: Aligning Needs and Expectations. Med Care 2021; 59:961-969. [PMID: 34348392 DOI: 10.1097/mlr.0000000000001622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Home-based and community-based health care for individuals with complex medical conditions is often provided by family caregivers. Yet caregivers often are not meaningfully included in interactions with clinical health care teams. Inclusive care means inviting the caregiver to participate in shared decision-making and treatment planning. For aging or medically vulnerable adults, caregiver inclusion is an important facet of patient-centered care. METHODS We apply a mixed-methods approach using a survey (n=50) and semistructured interview data (n=13) from a national sample of caregivers of veterans and semistructured interview data from (n=24) providers from 3 Veterans Affairs regional networks. We elicited data from caregivers about their experiences with inclusive care and how providers communicate with them and assess their capacity. We juxtaposed these data with provider perspectives to see where there was alignment. FINDINGS We determined that caregivers play important roles in trust-building, communications management, implementation of care plans at home or in the community, and improving the care of care recipients-while maintaining a balance between competing tensions. CONCLUSIONS Our findings suggest that expanding inclusive care could improve care quality and health outcomes of individuals with complex health care needs. Further, our findings bolster recent policy efforts at the federal and state levels to increase recognition of caregivers as key members of the health care team.
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Affiliation(s)
- Megan E Shepherd-Banigan
- Duke University Department of Population Health Sciences
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System
- Duke-Margolis Center for Health Policy
| | - Nathan A Boucher
- Duke University Department of Population Health Sciences
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System
- Duke-Margolis Center for Health Policy
- Sanford School of Public Policy, Duke University
- Duke University School of Medicine, Center for the Study of Aging and Human Development, Durham, NC
| | - Kevin McKenna
- Duke University Department of Population Health Sciences
| | - Roxana E Delgado
- General and Hospital Medicine Division, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | | | - Leah Christensen
- National Caregiver Support Program, Department of Veterans Affairs, Washington, DC
| | - Nina R Sperber
- Duke University Department of Population Health Sciences
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System
- Duke-Margolis Center for Health Policy
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Kim E, Baskys A, Law AV, Roosan MR, Li Y, Roosan D. Scoping review: the empowerment of Alzheimer's Disease caregivers with mHealth applications. NPJ Digit Med 2021; 4:131. [PMID: 34493819 PMCID: PMC8423781 DOI: 10.1038/s41746-021-00506-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 08/03/2021] [Indexed: 11/09/2022] Open
Abstract
Alzheimer's Disease (AD) is one of the most prevalent neurodegenerative chronic diseases. As it progresses, patients become increasingly dependent, and their caregivers are burdened with the increasing demand for managing their care. Mobile health (mHealth) technology, such as smartphone applications, can support the need of these caregivers. This paper examines the published academic literature of mHealth applications that support the caregivers of AD patients. Following the PRISMA for scoping reviews, we searched published literature in five electronic databases between January 2014 and January 2021. Twelve articles were included in the final review. Six themes emerged based on the functionalities provided by the reviewed applications for caregivers. They are tracking, task management, monitoring, caregiver mental support, education, and caregiver communication platform. The review revealed that mHealth applications for AD patients' caregivers are inadequate. There is an opportunity for industry, government, and academia to fill the unmet need of these caregiver.
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Affiliation(s)
- Eunhee Kim
- Western University of Health Sciences, College of Pharmacy, Department of Pharmacy Practice and Administration, Pomona, CA, USA
| | - Andrius Baskys
- Western University of Health Sciences, College of Graduate Biomedical Sciences, Pomona, CA, USA
| | - Anandi V Law
- Western University of Health Sciences, College of Pharmacy, Department of Pharmacy Practice and Administration, Pomona, CA, USA
| | - Moom R Roosan
- Chapman University, School of Pharmacy, Department of Pharmacy Practice, Pomona, CA, USA
| | - Yan Li
- Claremont Graduate University, School of Information Systems & Technology, Pomona, CA, USA
| | - Don Roosan
- Western University of Health Sciences, College of Pharmacy, Department of Pharmacy Practice and Administration, Pomona, CA, USA.
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10
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Riffin C, Wolff JL, Pillemer KA. Assessing and Addressing Family Caregivers' Needs and Risks in Primary Care. J Am Geriatr Soc 2020; 69:432-440. [PMID: 33217776 DOI: 10.1111/jgs.16945] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 09/18/2020] [Accepted: 09/20/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To characterize current practices, barriers, and facilitators to assessing and addressing family caregivers' needs and risks in primary care. DESIGN Cross-sectional, national mail-based survey. SETTING American Medical Association Masterfile database. PARTICIPANTS U.S. primary care physicians (N = 106), including general internists (n = 44) and geriatricians (n = 62). MEASUREMENTS Approaches to assessing and addressing family caregivers' needs and risks; barriers and facilitators to conducting caregiver assessments. RESULTS Few respondents reported conducting a formal caregiver assessment using a standardized instrument in the past year (10.5%). Informal, unstructured discussions about caregivers' needs and risks were common and encompassed a range of issues, most frequently caregivers' management of patients' safety (41.0%), ability to provide assistance (40.0%), and need for support (40.0%). To address caregiver needs, most respondents endorsed referring patients to services (e.g., adult day care, home care) (69.8%), assessing the appropriateness of the patient's living situation (67.9%), and referring caregivers to community agencies (63.2%). Lack of time was the most frequently cited barrier to assessing caregivers' needs (81.1%). The most commonly endorsed facilitators were access to better referral options (67.0%) and easier referral mechanisms (65.1%). Practice patterns, barriers, and facilitators to caregiver assessment did not differ by physician type. CONCLUSIONS Primary care physicians use informal, unstructured discussions rather than standardized instruments to assess caregivers' needs and risks. There is heterogeneity in the topics discussed and types of referrals made. Findings indicate the lack of translation of caregiver assessment tools from research to practice.
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Affiliation(s)
- Catherine Riffin
- Division of Geriatrics & Palliative 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 Human Development, Cornell University, Ithaca, New York, USA
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Holland DE, Vanderboom CE, Mandrekar J, Borah BJ, Dose AM, Ingram CJ, Griffin JM. A technology-enhanced model of care for transitional palliative care versus attention control for adult family caregivers in rural or medically underserved areas: study protocol for a randomized controlled trial. Trials 2020; 21:895. [PMID: 33115524 PMCID: PMC7594268 DOI: 10.1186/s13063-020-04806-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 10/16/2020] [Indexed: 11/30/2022] Open
Abstract
Background Transitioning care from hospital to home is associated with risks of adverse events and poor continuity of care. These transitions are even more challenging when new approaches to care, such as palliative care, are introduced before discharge. Family caregivers (FCGs) are expected to navigate these transitions while also managing care. In addition to extensive caregiving responsibilities, FCGs often have their own health needs that can inhibit their ability to provide care. Those living in rural areas have even fewer resources to meet their self-care and caregiving needs. The purpose of this study is to test the efficacy and cost-effectiveness of an intervention to improve FCGs’ health and well-being. The intervention uses video visits to teach, guide, and counsel FCGs in rural areas during hospital-to-home transitions. The intervention is based on evidence of transitional and palliative care principles, which are individualized to improve continuity of care, provide caregiver support, enhance knowledge and skills, and attend to caregivers’ health needs. It aims to test whether usual care practices are similar to this technology-enhanced intervention in (1) caregiving skills (e.g., caregiving preparedness, communication with clinicians, and satisfaction with care), (2) FCG health outcomes (e.g., quality of life, burden, coping skills, depression), and (3) cost. We describe the rationale for targeting rural caregivers, the methods for the study and intervention, and the analysis plan to test the intervention’s effect. Methods The study uses a randomized controlled trial design, with FCGs assigned to the control condition or the caregiver intervention by computer-generated lists. The intervention period continues for 8 weeks after care recipients are discharged from the hospital. Data are collected at baseline, 2 weeks, 8 weeks, and 6 months. Time and monetary costs from a societal perspective are captured monthly. Discussion This study addresses 2 independent yet interrelated health care foci—transitional care and palliative care—by testing an intervention to extend palliative care practice and improve transition management for caregivers of seriously ill patients in rural areas. The comprehensive cost assessment will quantify the commitment and financial burden of FCGs. Trial registration ClinicalTrials.gov NCT03339271. Registered on 13 November 2017. Protocol version: 11. Supplementary information Supplementary information accompanies this paper at 10.1186/s13063-020-04806-0.
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Affiliation(s)
- Diane E Holland
- Department of Health Sciences Research, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Catherine E Vanderboom
- Department of Health Sciences Research, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Jay Mandrekar
- Department of Health Sciences Research, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Bijan J Borah
- Department of Health Sciences Research, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.,The Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Ann Marie Dose
- Department of Health Sciences Research, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Cory J Ingram
- Center for Palliative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Joan M Griffin
- Department of Health Sciences Research, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA. .,The Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, 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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Wolff JL, Freedman VA, Mulcahy JF, Kasper JD. Family Caregivers' Experiences With Health Care Workers in the Care of Older Adults With Activity Limitations. JAMA Netw Open 2020; 3:e1919866. [PMID: 31977063 PMCID: PMC6991279 DOI: 10.1001/jamanetworkopen.2019.19866] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
IMPORTANCE Family and unpaid caregivers often play an active role in managing the care of older adults with activity limitations. OBJECTIVE To examine caregivers' experiences with older adults' health care workers. DESIGN, SETTING, AND PARTICIPANTS This survey study constitutes a secondary analysis of a sample of 1916 family and unpaid caregivers to 1203 community-living older adults with activity limitations who participated in the 2017 National Health and Aging Trends Study. Data analysis was performed January to August 2019. EXPOSURES Caregiver sociodemographic characteristics, caregiving intensity, and frequency speaking with or emailing older adults' health care workers. MAIN OUTCOMES AND MEASURES Caregiver-reported experiences when interacting with older adults' health care workers in the prior year, including being listened to, being asked about understanding of treatments, and being asked about help needed in managing older adults' care. RESULTS Caregivers (mean [SE] age, 59.4 [0.5] years; 63.7% women) assisting community-living older adults with activity limitations reported that they never (56.3%), sometimes or rarely (33.0%), or often (10.7%) spoke with or emailed older adults' health care workers in the prior year. Most caregivers who interacted with older adults' health care workers reported being always (70.6%) or usually (18.2%) listened to and always (54.4%) or usually (17.7%) being asked about their understanding of older adults' treatments. Fewer caregivers reported being always (21.3%) or usually (6.9%) asked whether they needed help managing older adults' care, and nearly one-half (45.0%) were never asked. Caregivers who interacted with older adults' health care workers often (vs sometimes or rarely) were more likely to report being always or usually listened to (94.8% vs 86.9%; P = .004), being asked about understanding treatments (80.1% vs 69.5%; P = .02), and being asked about needing help (40.8% vs 24.1%; P < .001). No other exposures were consistently associated with caregiver experiences. Measures of caregiving intensity, including caring for an older adult with dementia, were not associated with being listened to or asked about understanding, but were associated with being asked about needed help. Although caregivers of persons with dementia were more likely than caregivers of persons without dementia to report always being asked about needed help (26.9% vs 19.0%), a high percentage in both groups were never asked (41.2% vs 46.5%) (P = .007). CONCLUSIONS AND RELEVANCE These findings reinforce the need for strategies to better support family and unpaid caregivers, who are the main source of assistance to older adults with physical and/or cognitive limitations.
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Affiliation(s)
- Jennifer L. Wolff
- Roger C. Lipitz Center for Integrated Health Care, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - John F. Mulcahy
- Roger C. Lipitz Center for Integrated Health Care, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Judith D. Kasper
- Roger C. Lipitz Center for Integrated Health Care, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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James HJ, Van Houtven CH, Lippmann S, Burke JR, Shepherd-Banigan M, Belanger E, Wetle TF, Plassman BL. How Accurately Do Patients and Their Care Partners Report Results of Amyloid-β PET Scans for Alzheimer's Disease Assessment? J Alzheimers Dis 2020; 74:625-636. [PMID: 32065790 PMCID: PMC7183243 DOI: 10.3233/jad-190922] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Amyloid-β PET scans will likely become an integral part of the diagnostic evaluation for Alzheimer's disease if Medicare approves reimbursement for the scans. However, little is known about patients' and their care partners' interpretation of scan results. OBJECTIVE This study seeks to understand how accurately patients with mild cognitive impairment (MCI) or dementia and their care partners report results of amyloid-β PET scans and factors related to correct reporting. METHODS A mixed-methods approach was used to analyze survey data from 1,845 patient-care partner dyads and responses to open-ended questions about interpretation of scan results from a sub-sample of 200 dyads. RESULTS Eighty-three percent of patients and 85% of care partners correctly reported amyloid-β PET scan results. Patients' higher cognitive function was associated with a small but significant decrease in the predicted probability of not only patients accurately reporting scan results (ME: -0.004, 95% CI: -0.007, -0.000), but also care partners accurately reporting scan results (ME: -0.006, 95% CI: -0.007, -0.001), as well as decreased concordance between patient and care partner reports (ME: -0.004, 95% CI: -0.007, -0.001). Content analysis of open-ended responses found that participants who reported the scan results incorrectly exhibited more confusion about diagnostic terminology than those who correctly reported the scan results. CONCLUSION Overall, patients with MCI or dementia showed high rates of accurate reporting of amyloid-β PET scan results. However, responses to questions about the meaning of the scan results highlight the need for improved provider communication, including providing written explanations and better prognostic information.
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Affiliation(s)
- Hailey J. James
- Department of Health Policy and Management, University of North Carolina, Chapel Hill, NC, USA
- Department of Population Health Sciences, Duke University, Durham, NC, USA
| | - Courtney Harold Van Houtven
- Department of Population Health Sciences, Duke University, Durham, NC, USA
- Health Services Research and Development in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Steven Lippmann
- Department of Population Health Sciences, Duke University, Durham, NC, USA
| | - James R. Burke
- Department of Neurology, School of Medicine, Duke University, Durham, NC, USA
| | - Megan Shepherd-Banigan
- Department of Population Health Sciences, Duke University, Durham, NC, USA
- Health Services Research and Development in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Emmanuelle Belanger
- Center for Gerontology and Healthcare Research, School of Public Health, Brown University, Providence, RI, USA
- Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, RI, USA
| | - Terrie Fox Wetle
- Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, RI, USA
| | - Brenda L. Plassman
- Department of Neurology, School of Medicine, Duke University, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University, Durham, NC, USA
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Bruening R, Sperber N, Miller K, Andrews S, Steinhauser K, Wieland GD, Lindquist J, Shepherd-Banigan M, Ramos K, Henius J, Kabat M, Van Houtven C. Connecting Caregivers to Support: Lessons Learned From the VA Caregiver Support Program. J Appl Gerontol 2019; 39:368-376. [PMID: 30658547 DOI: 10.1177/0733464818825050] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Development and evaluation of supportive caregiver interventions has become a national priority. This study's aim was to evaluate how caregivers participating in the Department of Veterans Affairs (VA) Caregiver Support Program (CSP) use and value supportive services. Qualitative semi-structured interviews (N = 50 caregivers) were the core of a mixed-methods design, and surveys (N = 160) were supplemental. Caregivers who had used CSP services valued emotional, functional, and health care navigational support, calling support groups and the program coordinator their "lifeline." However, many described a lack of connection with the program-not knowing about or successfully engaging in program services-and needed more information about available resources. Caregivers in rural areas or caring for individuals with specific diseases reported needing tailored services to meet their unique needs. Policy makers and practitioners should proactively promote supportive services for caregivers. Future research should explore strategies for reducing barriers to accessing tailored support to meet the needs of a diverse caregiver population.
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Affiliation(s)
| | - Nina Sperber
- Durham VA Medical Center, NC, USA.,Duke University School of Medicine, Durham, NC, USA
| | | | - Sara Andrews
- RTI International, Research Triangle Park, NC, USA
| | - Karen Steinhauser
- Durham VA Medical Center, NC, USA.,Duke University School of Medicine, Durham, NC, USA
| | - G Darryl Wieland
- Durham VA Medical Center, NC, USA.,Duke University, Durham, NC, USA
| | | | | | - Katherine Ramos
- Durham VA Medical Center, NC, USA.,Duke University, Durham, NC, USA
| | - Jennifer Henius
- United States Department of Veterans Affairs Caregiver Support Program Office, Washington, DC, USA
| | - Margaret Kabat
- United States Department of Veterans Affairs Caregiver Support Program Office, Washington, DC, USA
| | - Courtney Van Houtven
- Durham VA Medical Center, NC, USA.,Duke University School of Medicine, Durham, NC, USA
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